Bmj Military Health最新文献

{"title":"Population-based assessment of human security indicators to determine progress on the Ukrainian National Action Plan.","authors":"Kimberly T Johnson-Boua, Jana Asher, Vivitha Mani, Kateryna Lund, Olena Nesterova, Olga Gvozdetska, Lynn Lieberman Lawry","doi":"10.1136/military-2026-003365","DOIUrl":"https://doi.org/10.1136/military-2026-003365","url":null,"abstract":"<p><strong>Introduction: </strong>Since the full-scale Russian invasion of Ukraine in February 2022, the Ukrainian Women, Peace and Security National Action Plan (NAP) has become extremely important in creating conditions for the participation of both women and men in conflict resolution, peacebuilding, recovery, in addressing security challenges and systemic responses to conflict-related violence including sexual violence, in alignment with United Nations Security Council Resolution (UNSCR) 1325. NAPs are more effective when they have broad population acceptance. This paper introduces a structured method for evaluating progress towards the NAP via measurement of public opinion and creates baseline measures for that progress.</p><p><strong>Methods: </strong>We conducted a population-based, cross-sectional household quantitative study in 20 of 24 oblasts in Ukraine during a 2-month period from 01 May to 29 June 2025 to assess public opinion related to the progress of Ukraine's NAP across four pillars consistent with UNSCR 1325 to include participation, protection, prevention, and rehabilitation and recovery, which relate to indicators in the Ukrainian NAP.</p><p><strong>Results: </strong>Of the 4385 households surveyed, respondents from 4228 households completed the study (96%). The majority of the NAP indicators assessed were either met or somewhat met. Only one of the indicators scored low enough to be considered 'not met'. However, there were significant differences in agreement levels between sex and between civilians and former military.</p><p><strong>Conclusions: </strong>Despite the ongoing conflict, Ukraine continues to make significant progress towards its NAP goals, which are vital for long-term recovery, reintegration and resilience. Moving forward, shifting mindsets, particularly among males, to support female leadership and peacebuilding roles will be essential to securing lasting peace.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Military medicine in transparent large-scale combat operations: rethinking medical timelines as operational planning variables.","authors":"Karl Chevalley, Peter Mattsson, Göran Sandström","doi":"10.1136/military-2026-003406","DOIUrl":"https://doi.org/10.1136/military-2026-003406","url":null,"abstract":"<p><p>Large-scale combat operations (LSCO) are increasingly shaped by persistent surveillance, precision strike capability, electronic warfare, contested mobility and repeated attacks on healthcare personnel and facilities. These conditions challenge a core assumption of military medical planning: that casualties can be moved rapidly and predictably through a linear evacuation chain. This article asks how commanders and medical planners should treat medical timelines when evacuation, protection, logistics and information are themselves contested. Drawing on a directed qualitative content analysis of doctrinal, empirical, institutional and clinical sources, it identifies three linked mechanisms: evacuation becomes a contested operational activity rather than a predictable transport function; clinical responsibility shifts forward across an extended continuum of care and survivability depends on interdependence among mobility, protection, logistics, command-and-control, information and clinical capability. The implication is not that rapid evacuation has become obsolete, but that fixed evacuation timelines are brittle planning assumptions in transparent LSCO-a battlespace in which persistent, multi-domain surveillance makes concealment, massing and uncontested evacuation difficult. Military medicine should therefore be planned as a coupled operational capability that shapes course of action development, command risk assessment, wargaming and force generation. The policy challenge is to design medical systems that preserve combat power when movement, visibility, capacity and information are contested.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":".Degradation of active drugs in medicinal vials exposed to temperature extremes encountered during military operations: the Military Medication Temperature Effect Study.","authors":"Shreyans Shah, Charlene Wu, Fekade Sime, Steven Wallis, Meng-Wong Taing, Michael Charles Reade","doi":"10.1136/military-2026-003387","DOIUrl":"https://doi.org/10.1136/military-2026-003387","url":null,"abstract":"<p><strong>Introduction: </strong>Maintaining the activity of pharmaceuticals and preventing the accumulation of harmful degradation products during storage are essential for efficacy and safety, particularly for non-titrated medications such as antibiotics. Although manufacturers' storage instructions usually specify a target controlled temperature, military operations often occur in extreme environments with substantial temperature variability. No manufacturer provides data to guide decisions under such circumstances. This study assessed the stability of 10 medications commonly used in the Australian Defence Force (ADF) prehospital setting when subjected to operationally relevant temperatures.</p><p><strong>Methods: </strong>10 medications (pseudoephedrine, cefazolin, tranexamic acid, ceftriaxone, hydrocortisone, benzylpenicillin, promethazine, ketorolac, amiodarone and metoclopramide) were stored for 14 or 28 days under five conditions: -20°C, 30°C, 50°C, 30°C-50°C diurnal cycling and ambient control (24°C±1°C). Stability was assessed by recording pH, visual appearance, subvisible particle count distribution and intact content using validated physicochemical and chromatographic methods. Changes exceeding the coefficient of variation (CV) of ambient control replicates were flagged as signs of potential instability.</p><p><strong>Results: </strong>Nine of the 10 medications retained ≥90% of original content across all conditions and met criteria for stability according to visual appearance, pH and subvisible particle formation. However, after 14 days at 50°C, cefazolin content fell below this threshold (87.7%), and the CV in pH failed the acceptance criterion. Minor fluctuations above control CV were also noted for tranexamic acid, promethazine and pseudoephedrine, but no significant degradation trends emerged.</p><p><strong>Conclusions: </strong>Most of the medications tested retained acceptable physicochemical characteristics over 28 days under conditions simulating field exposure. These findings provide preliminary support that some medications may remain suitable for use when manufacturer-recommended temperatures cannot be maintained, and resupply is unlikely. However, the single sample (n=1) study design limits confidence in the findings. Further replicated studies are required before these results should inform medicines management policy.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indirect ballistic spinal cord injury following thoracic gunshot wound.","authors":"Rayan Fawaz, Philémon Robert, Renaud Dulou, Christophe Joubert","doi":"10.1136/military-2026-003413","DOIUrl":"https://doi.org/10.1136/military-2026-003413","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to train small military medical teams.","authors":"David McConnell, Peter Harper","doi":"10.1136/military-2026-003343","DOIUrl":"https://doi.org/10.1136/military-2026-003343","url":null,"abstract":"<p><p>Small military medical teams are increasingly required to deliver advanced clinical capability in remote and austere environments. They are structurally fragile because expertise is concentrated in a small number of individuals who cannot be replaced or rotated. Redundancy is minimal and the organisational depth that absorbs interpersonal dysfunction in larger systems is absent. When dysfunction occurs, the consequences may propagate directly into patient care and operational capability. Dysfunction in these teams is not primarily a product of technical deficit. It arises from a combination of maladaptive behavioural responses to psychological stress caused by environmental and team factors. Resource constraint, compromised standards, eligibility restrictions, moral strain and sustained underload are all predictable sources. Because they are predictable, they are trainable. Human factors approaches, effective in complicated and reproducible clinical environments, are insufficient for the complex, non-linear dynamics of austere deployment where errors arise through the interaction of individuals under strain rather than through system failures. Establishment of an effective team can often be seen as part of a clinical process rather than a stand-alone objective. This paper argues that structured, team-centric pre-deployment preparation, in which behavioural alignment and psychological safety are established before clinical simulation training begins, should be a core readiness requirement. Adaptive behaviours must be established before the team is tested clinically, in training or on operations, otherwise maladaptive behaviours will propagate and become difficult to displace. Preparing small medical teams as cohesive performance units is a patient safety intervention that protects deployed medical capability.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific differences in functional outcomes from anterior knee pain in military personnel.","authors":"Lilach Gavish, Elad Spitzer, Ilan Friedman, Joseph Lowe, S David Gertz, Arik Eisenkraft, Noam Olshinka, Michael Malkin, Yair Barzilay","doi":"10.1136/military-2026-003339","DOIUrl":"https://doi.org/10.1136/military-2026-003339","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of anterior knee pain (AKP) in female military personnel is twice that of their male counterparts. However, whether AKP affects functional outcomes differently in females remains unclear. The objective of this study was to identify differences in AKP-associated functional outcomes between male and female combatants.</p><p><strong>Methods: </strong>This was a cross-sectional secondary analysis by biological sex (male/female) of active combat soldiers of the Israel Defense Forces and Israel Border Police personnel with AKP due to overuse, using screening data originally collected for a registered interventional study. Outcome measures included Kujala AKP scores by functional domain, anatomical mapping of pain location (by tenderness on palpation) and pain level measured using a Visual Analogue Scale (VAS).</p><p><strong>Results: </strong>The cohort comprised 27 females, 45 males and 112 knees. Females were younger (20.1 ± 1.3 vs 22.9 ± 6.3 years, p< 0.001), had lower body mass index (23.0 ± 3.2 vs 24.6 ± 3.2 kg/m², p=0.006) and reported less premilitary physical activity (67% vs 89%, p=0.021). In female combatants, tenderness on palpation was more frequent over the patellar ligament (PL) versus the patella (P) itself (PL vs P: females, 59% vs 32%, p=0.016; males, 51% vs 48%, p=0.74). Females reported significantly higher pain levels than males (VAS: 54±23 vs 45±23 mm on scale, p=0.046) and significantly lower overall functionality and symptoms (Kujala: 67±12 vs 73±11, p=0.030). The frequencies of affected performance from AKP were significantly greater in females for running and ascending/descending stairs (running: 30% vs 9%, p=0.022 and stairs: 82% vs 56%, p=0.025, respectively).</p><p><strong>Conclusions: </strong>Female combatants suffer more from AKP, report higher pain levels and have greater functional disability compared with their male counterparts. This study points to the important need for a sex-specific approach for evaluation of AKP-related functional disabilities in order to optimise treatment protocols and reduce the time to return to active service or performance in physically demanding settings.</p><p><strong>Trial registration number: </strong>NCT02845869.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mission command: a military leadership doctrine to improve surgical practice.","authors":"Begum Pekbay, J P C Ten Hove, M H J Verhofstad","doi":"10.1136/military-2026-003267","DOIUrl":"https://doi.org/10.1136/military-2026-003267","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Telemedicine is a capability, not a platform': lessons learned in the Ranger Regiment and the urgent requirement for operational telemedicine.","authors":"Alexander Shimmings, Luke John Turner, Bart van Herwijnen, James Daniels, Jenna Mackie, Katherine Thompson, Niall Aye Maung","doi":"10.1136/military-2025-003094","DOIUrl":"https://doi.org/10.1136/military-2025-003094","url":null,"abstract":"<p><p>Ranger Regiment medics often work alone and at reach, supporting small teams with extended timelines to definitive care. Enhanced telemedical support was identified as an operational requirement to mitigate this, leading to the development of a system which can stream live clinical data and video to a remote supporting physician. With this reachback, medics can deliver care above their intrinsic capabilities, including advanced decision making, enhanced analgesia and procedural capability.Ranger Telemed was developed 'ground-up' with a training and systems-based approach, using existing hardware and personnel. It was honed through experimentation on exercise and operations and enabled by a supportive and engaged chain of command. It has potential to recruit live secondary care input into both medical evacuation and prolonged casualty care scenarios, bringing specialist care as close to the point of wounding as possible. Ranger can now deliver enhanced telemedicine on operations globally, improving survivability of our patients and pushing the boundaries of remote support in the pre-hospital space.Telemedicine can empower medics, improve clinical care and mitigate against provider moral injury, yet it is not taught conceptually nor exercised as a military capability. Telemedicine must be understood conceptually as a device and software-agnostic capability to create realistic and resilient operational reachback systems and maximise its future potential. The changing nature of the battlespace and communications through the patient journey requires agility not provided by reliance on a single platform, but by an organisation trained and equipped to deliver a capability across a range of scalable mediums, innovating to overcome battlefield constraints.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fit to Operate: a system-based framework for the rehabilitation and long-term management of musculoskeletal injury in military personnel.","authors":"Peter Ladlow, Russell J Coppack, Robert Barker-Davies, Oliver O'sullivan, Robyn P Cassidy, Rachel Rodgers, Alexander N Bennett","doi":"10.1136/military-2026-003428","DOIUrl":"https://doi.org/10.1136/military-2026-003428","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discontinuation of infertility services or treatments in servicewomen aged 18-44 years: insights from the women's reproductive health survey.","authors":"Nicholas H Quintanilla, Lindsey Borgia, Catherine T Witkop, Anwar Ahmed","doi":"10.1136/military-2026-003341","DOIUrl":"https://doi.org/10.1136/military-2026-003341","url":null,"abstract":"<p><strong>Introduction: </strong>Discontinuation of infertility care without achieving a still-desired pregnancy represents a potential failure to meet patient needs and indicates healthcare system inefficiencies. While specific reasons for premature treatment cessation are documented in various populations, no study has extensively examined its prevalence or drivers within the Military Health System (MHS). This study identifies predictors and reasons for early discontinuation among active-duty servicewomen (ADSW), whose unique sociodemographic circumstances influence how and where fertility care is accessed and sustained.</p><p><strong>Methods: </strong>This cross-sectional secondary analysis used data from 3281 ADSW who received infertility services or treatments within the MHS, with a weighted response rate of 17.8%. We evaluated military and demographic characteristics, alongside care-related variables such as clinical setting, payment source, out-of-pocket expenses, care received both within and outside the MHS and unmet need for fertility services since joining the military. The outcome of the study was discontinuation of infertility treatments before achieving a desired pregnancy. A weighted binary logistic regression model calculated adjusted ORs (aORs) with 95% CIs to identify predictors of discontinuation before achieving pregnancy.</p><p><strong>Results: </strong>The prevalence of early discontinuation among ADSW who received infertility services or treatments within the MHS was 28.2% (95% CI 26.2% to 30.2%). Factors that were related to early treatment cessation included: educational attainment of high school or less (aOR: 1.40, 95% CI 1.04 to 1.89), age 35-44 years (aOR: 1.33, 95% CI 1.07 to 1.65), receiving care both within and outside the MHS (aOR: 1.52, 95% CI 1.22 to 1.90), incurring out-of-pocket expenses (aOR: 1.31, 95% CI 1.04 to 1.65) and having an unmet need for fertility services since joining the military (aOR: 1.37, 95% CI 1.12 to 1.67).</p><p><strong>Conclusions: </strong>To minimise early treatment discontinuation, the MHS should expand reproductive services to more facilities, integrate standardised psychological support and conduct qualitative research to explore uncaptured reasons for ADSW to discontinue care.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}