Bmj Military Health最新文献

{"title":"Researchers' perceptions of US Defense Health Agency Institutional Review Board performance.","authors":"Elizabeth A D Dayag, Kathryn Bell, George C Balazs","doi":"10.1136/military-2026-003347","DOIUrl":"https://doi.org/10.1136/military-2026-003347","url":null,"abstract":"<p><strong>Introduction: </strong>The US Defense Health Agency (DHA) maintains five Institutional Review Boards (IRBs) within the Office of Human Research Protection Human Research Protection Program (HRPP) to oversee the research portfolio. DHA researchers completed the IRB Researcher Assessment Tool (IRB-RAT) to share their perceptions of IRB performance and identify areas where future process improvement efforts can be focused.</p><p><strong>Methods: </strong>This study was a cross-sectional programme evaluation and IRB determination was received. Participants were asked to complete the IRB-RAT. The primary outcome was the performance gap score, calculated for each item as Actual minus Ideal. Linear mixed-effects models were used to analyse responses and to evaluate institutional variability.</p><p><strong>Results: </strong>An electronic invitation to complete the IRB-RAT was sent to 5960 registered DHA Electronic IRB system (EIRB) users between May and October 2025. Of those, 473 responded. Analysis identified the most important Ideal characteristics as (Q1) <i>timeliness</i>, (Q4) <i>providing complete explanations for changes</i> and (Q25) <i>not using its power to suppress research</i>. The largest performance gap scores were (Q1) <i>timeliness,</i> (Q24) <i>being an ally rather than a hurdle</i> and (Q15) <i>accountability for errors or delays</i>. Items identified for process improvement were (Q1) <i>timeliness</i>, (Q4) <i>providing complete explanations for changes,</i> (Q24) <i>being an ally rather than a hurdle</i> and (Q22) <i>understanding and acting within their scope of function</i>. There were significant differences across the five IRBs. Performance was not uniform across the DHA.</p><p><strong>Conclusions: </strong>The IRB-RAT effectively captured respondents' perceptions of DHA IRB performance. Timeliness was a universal concern and improvements within IRB scope of function and providing explanations for changes should help minimise delays. Additional work is needed to understand why DHA researchers view the IRB as a hurdle, not an ally. The DHA IRBs must harmonise best practices across the five IRBs and develop future process improvement projects to address researchers' concerns.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585756","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":"Implications of obesity in the US military: unfit to serve?","authors":"Christine M Florez, Kembra Albracht-Schulte, Danielle E Levitt, Jacob A Mota, Grant M Tinsley","doi":"10.1136/military-2025-003145","DOIUrl":"10.1136/military-2025-003145","url":null,"abstract":"<p><p>Obesity remains a significant public health concern with substantial implications for military readiness. Rising rates of overweight and obesity among service members challenge recruitment, retention and deployability. Although the military continues to screen and manage obesity, current body composition tools and policies often fail to capture true health risk or operational capability. This narrative review evaluates the prevalence and impact of obesity in the US military, critiques existing assessment methods and discusses recent policy updates across service branches. Particular attention is given to limitations of traditional metrics such as body mass index and circumference-based measures, as well as the potential of modern approaches to improve accuracy and effectiveness. Despite policy revisions, obesity remains the leading medical disqualifier for service and a major contributor to lost workdays, injuries and medical costs. Aligning body composition standards with scientific evidence and operational demands is essential for supporting readiness across modern defence forces.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"309-314"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834934","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":"Initial opioid prescribing practices among providers treating an opioid-naïve US military sample.","authors":"Jenneth Carpenter, R S Adams, A Linton, K B Highland, M Bauer, G Zolotusky, N Moresco, M J Larson","doi":"10.1136/military-2024-002937","DOIUrl":"10.1136/military-2024-002937","url":null,"abstract":"<p><strong>Introduction: </strong>General opioid prescribing has decreased in response to practice guidelines and policy changes, but information on recent practices in initial opioid prescribing is needed to support interventions to reduce the risk of long-term opioid prescription use.</p><p><strong>Methods: </strong>This cross-sectional study examined Military Health System data between 1 October 2015 and 30 September 2021 to explore initial opioid prescriptions and prescribing practices among providers serving 1.66 million US service members. We compared the characteristics of a subgroup (n=372 960) receiving an initial opioid within 7-24 months after study entry with those of the sample as a whole. We described characteristics of initial opioid prescriptions, including healthcare encounters associated with those prescriptions, prescriber characteristics and opioid prescribing practices.</p><p><strong>Results: </strong>The analytic sample was composed of 1 666 019 service members, 372 960 of whom filled an initial opioid prescription 7-24 months after study entry. The analytic sample was 83% assigned male; 58% white, non-Hispanic, 16% black, non-Hispanic and 15% Hispanic; and had a mean age of 27 (8.02). Initial opioid fills had a median days' supply of four (IQR 3.0-5.0) and milligram morphine equivalents (MME) of 30 (IQR 20-50). 10% of prescribers wrote the majority (64%) of initial opioid fills, representing 67% of total initial opioid MME. Dental encounters were associated with 38% of initial opioid fills, and 19% of fills were associated with musculoskeletal conditions. Dentists were associated with 32% of total initial opioid fills and 25% of total initial opioid MME.</p><p><strong>Conclusions: </strong>During recent years in the Military Health System, dental care was an important driver of initial opioid receipt among a relatively young population with full dental coverage. Similar populations may benefit from interventions that support dental providers in maintaining within-guideline prescribing practices.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"353-360"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term impact of combat-related traumatic injury on heart rate variability: findings from the ADVANCE study.","authors":"Rabeea Maqsood, S Schofield, A N Bennett, A Khattab, A Mj Bull, N T Fear, P Cullinan, C J Boos","doi":"10.1136/military-2024-002895","DOIUrl":"10.1136/military-2024-002895","url":null,"abstract":"<p><strong>Introduction: </strong>Combat-related traumatic injury (CRTI) has been associated with adverse cardiovascular outcomes in veterans. However, the long-term impact of contemporary CRTI on heart rate variability (HRV, a marker of autonomic function) has never been investigated in combat veterans and personnel. This analysis aimed to examine the association between CRTI and short-term HRV in a contemporary cohort of British servicemen.</p><p><strong>Methods: </strong>This analysis used the first follow-up data from the ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) prospective cohort study. Participants comprised 469 injured (those who sustained serious physical CRTI while on deployment in Afghanistan) and 506 uninjured servicemen [those who were uninjured and were frequency-matched to the injured based on age, sex (male), rank and deployment: Afghanistan 2003-2014 at recruitment]. Resting HRV was measured (5 min ECG) in the supine position. Root mean square of successive differences (RMSSD) and the sympathetic nervous system (SNS) index were reported as measures of parasympathetic and sympathetic activity, respectively. Multiple linear regression models reported the association between CRTI and HRV, adjusting for age, rank and ethnicity.</p><p><strong>Results: </strong>Participants' median age was 37.5 years. The time from CRTI/deployment was approximately 11 years. Median RMSSD was significantly lower in the injured versus uninjured [37.7 ms (IQR: 25.3 to 55.9) vs 41.9 ms (IQR: 27.7 to 62.2); p=0.01]. After confounder adjustment, CRTI was significantly associated with lower RMSSD [geometric mean ratio: 0.92 (95% CI 0.85 to 0.99)] and relatively higher SNS index [coefficient: 0.19 (95% CI 0.05 to 0.34)] in the injured versus uninjured. Blast injury and traumatic amputation were associated with significantly lower RMSSD and greater SNS activity.</p><p><strong>Conclusion: </strong>CRTI is associated with greater relative autonomic imbalance. These findings may help understand the recovery pathway following CRTI in wounded combat veterans and personnel.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"327-335"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643900","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":"Contraception in the Royal Navy: a service evaluation of the lived experience of serving women.","authors":"Isabel S Austin, C E Moore, F Crowsley-Allen, R Guest","doi":"10.1136/military-2025-003036","DOIUrl":"10.1136/military-2025-003036","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"379-380"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182459","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":"Academic Department of Military Surgery and Trauma (ADMST): preparedness for the next conflict through collaboration in research and innovation.","authors":"John Breeze, M E R Marsden, G Mcknight, D N Naumann, P Spreadborough, C Swain, R Staruch, J Whitaker, R Rickard, L Orr, N Tai","doi":"10.1136/military-2025-003024","DOIUrl":"10.1136/military-2025-003024","url":null,"abstract":"<p><p>The UK Strategic Defence Review 2025 provides a compelling examination of the threats faced by the UK. The UK as a whole, and the Ministry of Defence in particular, must become ready for large-scale conflict operations (LSCO) and learn the lessons from Ukraine. A successful academic military surgical department should regularly re-evaluate its mission, its surgical priorities and its outputs. This paper describes the principles by which the UK Defence Medical Services' Academic Department of Military Surgery and Trauma will work to address the likely clinical realities of LSCO. Three overarching themes to departmental work are described, underpinned by a commitment to collaboration via research partnerships-both within and external to Defence-to enable the delivery of best possible outcomes as the country's armed forces rapidly pivot to the future and adapt to new threats.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"296-300"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884039","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":"Operationalising prehospital management of exertional heat illness in athletes and team sports.","authors":"Todd Leckie, F Stourton, D Fitzpatrick, R Hemingway, C Kipps, M J Stacey, F Wood, A Hartle, A Boalch, H Pynn, G Jones","doi":"10.1136/military-2025-003116","DOIUrl":"10.1136/military-2025-003116","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"372-373"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of axial spondyloarthritis among military draft-eligible populations in South Korea: national and regional trends over recent decades.","authors":"Hong Jin Kim, P W Yoon, J Y Yoon, D-H Lee, E Cho, S M Park, S Park, J-K Moon","doi":"10.1136/military-2024-002901","DOIUrl":"10.1136/military-2024-002901","url":null,"abstract":"<p><strong>Introduction: </strong>Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder characterised by inflammation of the axial manifestations. For the military draftees, there are no epidemiological data on axSpA in nationwide and population-based databases. This retrospective, nationwide and population-based study aimed to assess the national and regional trends in axSpA prevalence among draft-eligible military populations in South Korea between 2014 and 2023.</p><p><strong>Methods: </strong>The study included 3 063 805 males examined by the Regional Military Manpower Administration. The annual nationwide prevalence was presented as the prevalence per 10 000 and a 95% CIs. The severity of axSpA was assessed using radiographic scoring of the sacroiliac joint based on the New York criteria. Regional trends of axSpA were evaluated for Seoul, metropolitan areas and provinces, categorised according to transportation accessibility.</p><p><strong>Results: </strong>The nationwide prevalence of axSpA increased from 10.75 (95% CI 9.68 to 11.81) in 2014 to 21.18 (95% CI 19.37 to 23.00). The prevalence of radiographic axSpA (r-axSpA) followed a similar upward trend, whereas the prevalence of non-radiographic axSpA (nr-axSpA) remained stable. The prevalence of r-axSpA (52.73% in 2015 and 79.52% in 2019) was higher than that of nr-axSpA. Meanwhile, r-axSpA patients with grade 3 sacroiliitis showed the highest prevalence during the recent 3-year follow-up. The mean regional prevalence of nr-axSpA differed significantly among the three regions (p=0.013), whereas there were no differences in the prevalence of r-axSpA (p=0.084).</p><p><strong>Conclusions: </strong>This epidemiological study revealed an increasing trend in the nationwide prevalence of axSpA over the past decade, primarily driven by an increase in moderate-grade r-axSpA. Therefore, early recognition and awareness of axSpA in young males are essential for initiating appropriate treatment options to slow disease progression.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"320-326"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086884","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":"UKAF performance tool: a structured tool for management of common mental health disorders in defence primary healthcare.","authors":"Adrian M Hucks","doi":"10.1136/military-2025-002996","DOIUrl":"10.1136/military-2025-002996","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"381-382"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561592","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":"Clinical, tactical and strategic benefits of a UK Spray Dried Plasma production capability.","authors":"Matt Ellington, E Barnard, L Bower, S Huish, L Green, P Moor, T Woolley, R Cardigan","doi":"10.1136/military-2024-002875","DOIUrl":"10.1136/military-2024-002875","url":null,"abstract":"<p><p>UK experience from recent conflicts in Iraq and Afghanistan has resulted in improvements in clinical care of injured patients. Resuscitation and blood transfusion is an area that has seen some of the greatest changes. The ongoing war in Ukraine has highlighted the challenges of medical support to Large-Scale Combat Operations (LSCO), one of which is the ability to deliver blood-based resuscitation near to the point of wounding.Plasma is a key aspect of damage control resuscitation and balanced blood transfusion strategies. It is supported by a strong evidence base, which also demonstrates that early administration improves patient outcomes. Conventional plasma transfusion using thawed fresh frozen plasma (FFP) has logistical constraints that preclude its expedient use in the prehospital environment.Temperature-controlled storage, and transport, of sufficient FFP to support LSCO is unrealistic, and temporary campaigns to increase civilian plasma donations signal a combat intent and could compromise Operational Security.Dried plasma components are stable in storage at ambient temperature. They are easily and quickly reconstituted to produce a plasma component with clinically acceptable clotting and coagulation profiles. The UK has access to dried plasma from two European allies, but availability is very limited and use is off-licence. The ongoing UK dried plasma project will provide clinical, tactical and strategic benefits to UK and allied armed forces in future conflicts.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":"288-291"},"PeriodicalIF":1.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789115","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}