Bmj Military Health最新文献

{"title":"Resilience measures for the attacked Role 2 facility: lessons and strategies for future planning.","authors":"David N Naumann, T S G Short, B M Lomas, A M Rennie, K Clayton, I L Freshwater, C Tunstall, J Burns, C Bundy, B Gurung, D J Bond, A Wichaisri, A T Flanagan, R Chauhan","doi":"10.1136/military-2024-002882","DOIUrl":"https://doi.org/10.1136/military-2024-002882","url":null,"abstract":"","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014374","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":"Infantry training outcomes: are they improved with an initial reduction in load carriage mass and additional sprint intensity exercise?","authors":"Herbert Groeller, P Larsen, J R Drain, N Gibson, M Kitcher, L Alfiero, B J Dascombe, J A Sampson","doi":"10.1136/military-2024-002765","DOIUrl":"https://doi.org/10.1136/military-2024-002765","url":null,"abstract":"<p><strong>Introduction: </strong>Infantry is a physically demanding trade that is associated with elevated rates of musculoskeletal injury. A 17-week longitudinal intervention assessed the effect of a progressive increase in load carriage mass and sprint-intensity intervals on physical performance, physical complaints, medical encounters, physical activity and sleep in infantry trainees.</p><p><strong>Methods: </strong>91 infantry trainees from 2 separate platoons, randomly assigned as control (CON) or experimental (EXP), provided written voluntary consent. Both completed a 17-week training syllabus that included physical training and military education lessons. Compared with CON, EXP completed a modified regimen that included; a 25%-30% reduction in load carriage mass (weeks 1-4), sprint (weeks 1-7) and 3 min running intervals. Endurance, strength, power and functional performance were assessed (weeks 1, 6-8), physical activity and sleep were recorded using actigraphy (each day of training, weeks 1-17), with daily physical complaints tabulated (weeks 1-7) and frequency of medical encounters retrospectively extracted from defence health records (weeks 1-17).</p><p><strong>Results: </strong>On-time completion of training was attained in 93% and 79% of CON and EXP, respectively. Total load carriage mass (weeks 1-4) was 27% lower in EXP (10.1 kg/hour) than CON (13.9 kg/hour). Push-up repetitions in CON (5 reps) improved compared with EXP, with functional performance improving markedly in both groups (71 m, 23%). All other fitness assessments were similar between groups. No difference in sleep quality and quantity was observed between groups, with 77% and 16% of trainees sleeping <7 hours (suboptimal) and <6 hours (sleep restricted) per night, respectively. Physical complaints in CON were higher (62), despite no difference observed in medical encounters.</p><p><strong>Conclusions: </strong>The reduction in load carriage mass and inclusion of sprint interval training did not modify the adaptative or maladaptive responses to infantry training. Most trainees experienced chronic suboptimal sleep quantity and quality with over 15% classified as sleep restricted.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014369","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":"Demographic characteristics, gambling engagement, mental health, and associations with harmful gambling risk among UK Armed Forces serving personnel.","authors":"Matthew Jones, H Champion, G Dighton, J Larcombe, M Fossey, S Dymond","doi":"10.1136/military-2024-002726","DOIUrl":"10.1136/military-2024-002726","url":null,"abstract":"<p><strong>Introduction: </strong>Harmful gambling negatively impacts individuals, families and communities. Growing international evidence indicates that the Armed Forces (AF) community may be at a comparatively higher risk of experiencing harm from gambling than the general population. The current study sought to identify general predictors of harmful gambling and gambling engagement among UK AF serving personnel (AFSP).</p><p><strong>Methods: </strong>We conducted a cross-sectional, exploratory survey to identify associations between demographic factors, mental health, gambling engagement and gambling type in a sample (N=608) of AFSP.</p><p><strong>Results: </strong>Most of the sample reported past-year gambling, with 23% having experienced harm. Male gender, younger age and lower educational attainment all predicted harmful gambling, as did mental health variables of prior generalised anxiety and post-traumatic stress symptomatology. Strategy-based gambling and online sports betting were also predictive of experiencing harm from gambling.</p><p><strong>Conclusions: </strong>The risk of harm from gambling is associated with demographic, mental health and gambling engagement variables among AFSP. Better understanding of these predictors is important for the development of individualised treatment approaches for harmful gambling.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477679","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":"Estimates of unintended pregnancy among US active-duty service women and the impact on Women Peace and Security objectives as measured by potential readiness days lost.","authors":"Miranda Lynn Janvrin, A Banaag, L L Lawry, R Scott, T Koehlmoos","doi":"10.1136/military-2023-002654","DOIUrl":"10.1136/military-2023-002654","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of unintended pregnancy (UIP) in the United States is high among active-duty service women (ADSW).</p><p><strong>Objective: </strong>To estimate the number of UIPs and the impact these pregnancies have on the ability to meet Women, Peace and Security objectives as measured by maximum potential readiness days lost (mRDL).</p><p><strong>Methods: </strong>Using data from the Military Health System Data Repository, ADSW aged 18 to 44 years, were identified from fiscal year (FY) 2019 data. Deliveries were identified using Medicare Severity Diagnosis-Related Group codes. The estimated number of UIPs was calculated by multiplying both the number of ADSW and the number of deliveries by age-adjusted rates of UIP. Post partum women do not have to meet height and weight standards or complete a physical fitness test for up to 365 days after a full-term delivery. Lost readiness days were calculated by multiplying the number of UIPs by 365 days. Data were stratified by age, race, rank and branch of service.</p><p><strong>Results: </strong>A total of 230 596 ADSW were identified in FY2019. Using the number of ADSW, an estimated 12 683 ADSW experienced an unintended pregnancy, resulting in an estimated 4 629 215 mRDL. Using the number of deliveries, an estimated 6785 deliveries were a result of UIPs, resulting in an estimated 2 476 364 mRDL. The highest estimates of UIPs were among ADSW aged 18 to 24 years, of White race, in a Junior Enlisted rank and in the Army.</p><p><strong>Conclusion: </strong>Estimates of UIPs among ADSW would result in considerable impact on their military career. Dealng with UIPs proactively, by encouraging comprehensive family planning and instituting additional reproductive health policies for service members by ensuring that service members can make informed decisions about their reproductive health while maintaining operational effectiveness, is important for meeting United States Department of Defense Women, Peace and Security objectives.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753140","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":"Whole body vibrations and lower back pain: a systematic review of the current literature.","authors":"Abigail Bainbridge, I Moutsos, A Johnson, L McMenemy, A Ramasamy, S D Masouros","doi":"10.1136/military-2024-002801","DOIUrl":"https://doi.org/10.1136/military-2024-002801","url":null,"abstract":"<p><strong>Introduction: </strong>Whole body vibration (WBV) is thought to be associated with low back pain (LBP). To mitigate against this the International Organisation for Standardisation (ISO) have created the ISO 2631 standard, recommending safe dose limits. The aim of this research is to conduct a systematic review of available literature addressing the question, is WBV associated with LBP?</p><p><strong>Methods: </strong>A literature search was performed from January 1970 until April 2022, including studies focusing on LBP and sciatica in association with WBV, looking specifically for ones reporting on military populations. Studies on populations less than 18 years old or case studies were excluded. We conducted two subgroup analyses on studies that used a validated method to assess LBP and measured an A(8) (daily exposure) or VDV value (highest vibration exposure) as per ISO 2631-1 standard.</p><p><strong>Results: </strong>37 studies were included, 11 showed an association between LBP and WBV. 97.9% of the population was male with an average age of 40.2, 47% used a version of the Standard Nordic Questionnaire (SNQ) to assess LBP and 51% used a triaxial accelerometer standard to measure vibration. Two studies reported on military populations.The subgroup analysis for A(8) identified six studies with a total population of 1413. A(8) ranged from 0.17 m/s² to 0.59 m/s² and LBP prevalence from 25% to 66%. The subgroup analysis for VDV identified three papers with a total population of 1239. VDV ranged from 6.84 m/s^0.75 to 14.7 m/s^0.75 and LBP prevalence from 25% to 60.9%.</p><p><strong>Discussion: </strong>This paper suggests WBV and LBP are associated but there is a research gap for high-level evidence and comparable data. The use of the SNQ was a preferrable method to assess LBP in most included studies. Using this in combination with a protocolised standard for measuring vibration exposure is needed for further research.</p><p><strong>Prospero registration number: </strong>CRD42022298283.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972840","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":"What is the risk of transfusing group O RhD-positive red blood cells to female service personnel of childbearing potential?","authors":"Mark H Yazer, T Scorer, D McConnell, J Gluyas-Harris","doi":"10.1136/military-2024-002904","DOIUrl":"https://doi.org/10.1136/military-2024-002904","url":null,"abstract":"<p><p>The traditional approach to resuscitating injured women of childbearing potential (WCBP) with an unknown RhD type is to transfuse RhD-negative blood products. This is to prevent alloimmunisation to the RhD antigen and ultimately prevent haemolytic disease of the fetus and newborn (HDFN) in future pregnancies should she survive. RhD-negative blood products are scarce in both military and civilian blood stocks. It is likely that only RhD-positive blood products are available for a servicewoman injured in combat. This analysis will review the latest models of D-alloimmunisation following transfusion of RhD-positive blood products to injured WCBPs, the subsequent rates of adverse events from HDFN and describe some surveys of WCBPs' preferences for transfusion in emergency situations. These data and opinions all point to the same conclusion: RhD-negative blood products should be the first choice for the resuscitation of women at risk of HDFN, but their absence should never lead to withholding a lifesaving transfusion.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972839","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":"Whole System Approach to designing, implementing and measuring health and performance benefits of improving diet behaviour in a military setting.","authors":"Joanne L Fallowfield, J Carins","doi":"10.1136/military-2024-002861","DOIUrl":"https://doi.org/10.1136/military-2024-002861","url":null,"abstract":"<p><p>Many employers-including the military-are experiencing systemic workforce capacity and capability challenges. This coincides with a time of declining workforce health, especially among military service entrants, where many performance-limiting health conditions are preventable if healthier behaviours are practised. Effectively tackling complex, interconnected health problems demands a multilevel, multicomponent Whole System Approach (WSA). However, despite recognition of the issues impacting international militaries, current policies and practices supporting healthy, performing workforces have failed. To arrest ill-health trends in personnel, military employers must develop transformational ways to support good health. This paper presents a military workplace WSA model, operationalised through COM-B to specifically target diet behaviour, supporting individual good health, promoting human performance and realising organisational benefits. The challenges of a military occupational setting to individual nutrition practices across the career are discussed. Finally, Impact Value Chain analysis is proposed to monitor system delivery and measure the effectiveness of an integrated, organisation-wide WSA.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967142","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":"Soldier performance management: insights from boots on ground research and recommendations for practitioners.","authors":"Luana C Main, T D Maroni, T Ojanen, J R Drain, B Nindl","doi":"10.1136/military-2024-002742","DOIUrl":"https://doi.org/10.1136/military-2024-002742","url":null,"abstract":"<p><p>Theoretically, the serial measurement of biomarkers to monitor physiological responses to military training could be used to mitigate musculoskeletal injury risk and better understand the recovery status of personnel. To date, the cost and scalability of these initiatives have impeded their uptake by defence organisations. However, advances in technology are increasing the accessibility of a range of health and performance biomarkers. This paper presents a synthesises of findings from the literature and discussions with informed stakeholders to provide contextually relevant advice for future efforts to monitor military personnel, together with key considerations to ensure actionable outcomes from the data captured. The aim of this review is, therefore, twofold; first, to demonstrate how wearable devices and biomarkers have been used in defence research to assess the context-specific, occupational demands placed on personnel; and second, to discuss their potential to monitor military workloads, optimise training programming and understand soldier adaptation to multi-stressor environments.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967118","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":"Give us a hand, mate! A holistic review of research on human-machine teaming.","authors":"Jitu Patel, M Boardman, B Files, F Gregory, S Lamb, S Sarkadi, M Tešić, N Yeung","doi":"10.1136/military-2024-002737","DOIUrl":"10.1136/military-2024-002737","url":null,"abstract":"<p><p>Defence has a significant interest in the use of artificial intelligence (AI)-based technologies to address some of the challenges it faces. At the core of future military advantage will be the effective integration of humans and AI into human-machine teams (HMT) that leverages the capabilities of people and technologies to outperform adversaries. Realising the full potential of these technologies will depend on understanding the relative strengths of humans and machines, and how we design effective integration to optimise performance and resilience across all use cases and environments.Since the first robot appeared on the assembly line, machines have effectively augmented human capability and performance; however, they fall short of being a team member-someone you can ask to give you a hand! Working in teams involves collaboration, adaptive and dynamic interactions between team members to achieve a common goal. Currently, human-machine partnership is typically one of humans and machines working alongside each other, with each conducting discrete functions within predicable process and environments. However, with recent advances in neuroscience and AI, we can now envisage the possibility of HMT, not just in physical applications, but also complex cognitive tasks.This paper provides a holistic review of the research conducted in the field of HMT from experts working in this area. It summarises completed and ongoing studies and research in the UK and USA by a broad group of researchers. This work was presented in the HMT thematic session at the Sixth International Congress on Soldiers' Physical Performance (ICSPP23 London).</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886427","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":"Implementing a new model of residential rehabilitation: findings and future recommendations.","authors":"Anne Vickerstaff, D Hayhurst, P Morrison, R McHugh","doi":"10.1136/military-2024-002667","DOIUrl":"10.1136/military-2024-002667","url":null,"abstract":"<p><strong>Introduction: </strong>Musculoskeletal injury is one of the leading causes of medical discharge in the UK Armed Forces. Residential rehabilitation (RR) courses are part of Defence rehabilitation, for service personnel (SP) who do not respond to treatment at primary care. Historically, it was delivered as a 3-week block model. As a quality improvement project, rolling admissions were introduced aiming to improve access to RR and deliver outcomes that met the requirements of primary care referrers.</p><p><strong>Method: </strong>Clinical outcomes were assessed for SP with either spinal or lower limb pathology using the Musculoskeletal Health Questionnaire (MSK-HQ) on course admission and discharge and the Medical Deployment Standard (MDS) on admission and 6 months post course. Wait times were also recorded. Outcomes were compared with the block admission using retrospective audit data. Referrer feedback was gathered using a questionnaire pre introduction and post introduction of rolling admissions.</p><p><strong>Results: </strong>Rolling admissions reduced course wait times from an average of 55 days to 19 days. Of SP who attended a rolling admission course with spinal pathology (n=23), 58% showed an increase in MDS, 65% showed an increase of the minimally important change in MSK-HQ. With lower limb pathology (n=35) 57% increased MDS, 49% increased MSK-HQ. For the block model, of those with spinal pathology (n=30) 43% increased MDS, 67% increased MSK-HQ, with lower limb pathology (n=30) 60% increased MDS, 33% increased MSK-HQ. Referrer feedback improved with rolling admissions with feedback most positive in relation to the model's responsiveness for admitting SP onto the course.</p><p><strong>Conclusion: </strong>Rolling admission provided similar clinical outcomes as the previous block model in a shorter time frame with lower wait times and better met the needs of referrers. Future study recommendations include longer term follow-up and looking at alternative ways to measure the success of RR within the care pathway.</p>","PeriodicalId":48485,"journal":{"name":"Bmj Military Health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848029","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}