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- 1 Opening a can of worms: gastrointestinal parasite infections in at-risk
UK armed forces populations-
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Authors:
Nevin, W; Melhuish, J, Wakefield, R, Jones, J, Cunningham, L, Bhanot, K, Nicol, E, Dermont, M, Guest, S, Vargha, G, Cable, J, Gough, A, Scanlon, E, Smith, M, Beeching, N, Lamb, L, OShea, M, Fletcher, T.
Pages: e3 - e3
Abstract: BackgroundGastrointestinal parasite (GIP) infections are of major military importance. They have been frequently diagnosed post-deployment and can have debilitating sequelae.1–4 Some, such as Strongyloides, are often asymptomatic before presenting as severe disease, which has been fatal in veterans.5 6Whilst the UK Armed Forces recruit many personnel from endemic countries, few are offered testing. Furthermore, despite extensive Defence activity in endemic areas, data on post deployment prevalence is scarce.MethodsA total of 437 participants were recruited from three groups: 250 personnel from Fiji, 119 recently returned from jungle training in Brunei (tested at 2- and 12-weeks post-return), and 68 with historical deployments to Brunei. Participants were tested for GIP using serum for Strongyloides serology, full blood counts, and faeces for microscopy, culture, and qPCR.ResultsHigh GIP infection rates, particularly Strongyloides, were observed across all groups. Amongst Fijian migrants, 35.1% (87/248) had positive Strongyloides serology and 18.9% (14/74) had GIP in faeces. In personnel recently returned from Brunei, 56.0% (65/116) had a positive faecal test for GIP, with 47.4% (55/116) positive for Strongyloides. Serological testing in this group was insensitive (16%), and sequencing revealed infection with Strongyloides fuelleborni and callosciureus. In Group 3, 17.6% (12/68) had a positive Strongyloides result, with the longest infection lasting over 5 years.ConclusionsThe novel findings of this project have uncovered a high GIP burden in Armed Forces personnel. The prevalence of Strongyloides found in this first ever study of Fijian migrants has significant public health implications and has prompted steps to offer testing to all Fijian personnel. This study is also the first globally on imported S. fuelleborni infection, revealing previously unknown limitations of serology, and is the first to identify human infection with S. callosciureus. The stark findings demonstrate the uniquely military risk these parasites present and have immediately impacted clinical practice and policy.References
Bailey M, Thomas R, Green A, Bailey J, Beeching N. Helminth infections in British troops following an operation in Sierra Leone. Transactions of the Royal Society of Tropical Medicine and Hygiene 2006;100(9):842–6.
Genta RM, Weesner R, Douce RW, Huitger-O’Connor T, Walzer PD. Strongyloidiasis in US veterans of the Vietnam and other wars. JAMA 1987;258(1):49–52.
Gill GV, Bell DR. Strongyloides stercoralis infection in former Far East prisoners of war. Br Med J. 1979;2(6190):572–4.
Lee VJ, Ong A, Lee NG, Lee WT, Fong KL, Lim PL. Hookworm infections in Singaporean soldiers after jungle training in Brunei Darussalam. Trans R Soc Trop Med Hyg. 2007;101(12):1214–8.
Gill G, Beeching N, Khoo S, Bailey J, Partridge S, Blundell J, et al. A British second world war veteran with disseminated strongyloidiasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 2004;98(6):382–6.
Hakim SZ, Genta RM. Fatal disseminated strongyloidiasis in a Vietnam War veteran. Arch Pathol Lab Med. 1986;110(9):809–12.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/bmjmilitary-2025-colt.1
Issue No: Vol. 171, No. 3 (2025)
- 2 Is there an association between occupational task exposure and the
development of hip pain in UK military personnel'-
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Authors:
Coppack, R; Cassidy, R, Bilzon, J, Houston, A, Papadopoulou, T, Bennett, A.
Pages: e3 - e3
Abstract: BackgroundOccupation is a key determinant for the risk of developing musculoskeletal injuries (MSKI). The aim of this study was to investigate the lifelong, cumulative effects of occupational physical loading as a risk factor for hip pain in UK military personnel.MethodsThis was a population-based case-control study. Cases (N=104) with physician diagnosed intra-articular hip pain were age-matched (1:1) with healthy controls (N=104). Participants were serving (male) UK military personnel (age range 19-50 yrs). Participants completed the Military Physical Loading Questionnaire (MPLQ) enquiring about lifetime exposure to 18 occupational & 18 operational physical tasks. Based on MPLQ responses participants were categorized into high, medium or low exposure groups for each task. Logistic regression analysis adjusting for baseline predictor variables was used to estimate the odds ratios (OR) & occupational risk for incident hip pain.ResultsA univariate logistic regression showed high cumulative exposure to the occupational tasks ‘road driving for at least 4-hours’ (OR 3.4, 95% CI, 1.70 – 6.72) & ‘driving over rough terrain’ (OR 2.3, 95% CI, 1.15 – 4.54) were significantly associated with hip pain. Two further driving tasks, ‘driving over rough, uneven terrain’ (OR 3.6, 95% CI, 1.55 – 8.26) & ‘mounted vehicle movements’ (OR 3.3, 95% CI, 1.43 – 7.75) presented the highest risk on deployed operations. Results of the multivariate logistic regression adjusted for predictor variables showed the strongest independent risk factor associated with hip pain was the occupational task ‘road driving for 4-hours’ (OR 4.5, 95% CI, 0.54 – 3.50).ConclusionsOccupational factors during military service are associated with a risk of developing hip pain. Prolonged exposure to driving & vehicle mounted tasks may present the highest risk. Since the future pattern of combat movement for UK troops is more likely to be mounted than dismounted, programmes should be developed aimed at preventing MSK disorders caused by prolonged vehicle movements.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/bmjmilitary-2025-colt.2
Issue No: Vol. 171, No. 3 (2025)
- 3 Longitudinal incidence, progression and predictors of radiographic knee
osteoarthritis and pain in a trauma-injured cohort - ADVANCE follow-up
findings-
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Authors:
OSullivan, M. O; Watson, F, Bull, A, Kluzek, S, Baldes, A, Bennett, A.
Pages: e3 - e3
Abstract: BackgroundChronic musculoskeletal injuries (MSKI) are the joint-most common cause of medical downgrade and discharge. Osteoarthritis (OA) contributes to one-third of US Military medical discharges, likely replicated in the UK military population. Understanding epidemiological trends and predictive tools enables OA prevention (primary, secondary or tertiary), minimising risk for Service Personnel. This study aims to understand rates of progression and incidence, and identify potential predictors, of knee radiographic OA (rOA) and pain (KP) in a military combat-injured cohort.MethodsADVANCE is a longitudinal cohort study of Afghanistan-deployed UK servicemen (combat-injured, n=579; age, rank, role, service, frequency-matched comparison, n=565). Ninety-two-percent attended Follow-up (n=1052, n=526 per group). Participants completed knee radiographs, venous sampling for OA biomarkers, and Knee Injury and Osteoarthritis Outcome Score, 8- and 11-years post-injury/deployment. Correlation analysis was performed to identify potential predictors (demographic, injury-related, patient-reported, radiological, functional and molecular).ResultsRadiographic OA incidence and progression rates increased over 3-years (by 12% and 16%, respectively), but this was not different between trauma-exposed and unexposed individuals (p=0.745 and p=0.443, respectively). However, those with a traumatic-amputation had 2.06x increased rOA incidence risk (p=0.002). Trauma-exposed participants were 1.44x more likely to KP incidence (p=0.024), with those sustaining a knee-specific injury 2.52x more likely to report KP progression (p=0.032). There were inconsistent results from potential predictor variables, with minimal overlap between those with and without a traumatic-amputation. Increased age correlated with increased rOA incidence and progression (both p=0.01), decreased time from injury to rOA progression (p=0.006) and KOOS to KP incidence (p
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/bmjmilitary-2025-colt.3
Issue No: Vol. 171, No. 3 (2025)
- 4 Big hits and little molecules: characterising the proteomic response to
increasing anatomical injury severity-
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Authors:
Ross, J; Brohi, K.
Pages: e3 - e3
Abstract: BackgroundInjured patients show higher rates of mortality and multiple organ dysfunction syndrome (MODS) as the severity of their injury increases. This study aimed to investigate the relationship between anatomical injury severity and the immediate underlying biological response to injury, developing our understanding this response and providing insight into the physiological processes potentially driving poor clinical outcomes in trauma patients.MethodProspectively collected data and samples from a cohort of 413 trauma patients recruited to the ACIT-II study (REC approval: 07/Q0603/29) were used. ISS was used to categorise patients into groups of increasing anatomical injury severity (ISS 0-3 = Control, ISS 4-8 = Mild, ISS 9-15 = Moderate, ISS 16-24 = Severe, ISS 25-35 = Critical, ISS ≥36 = Super Critical). Proteomics analysis for 4979 proteins was performed on blood samples taken at presentation to the ED. Median change from Control was calculated for each protein in each injury severity group. Those showing significant change were utilised for pathway analysis, identifying enriched biological processes associated with higher injury severity groups.ResultsThe number of proteins showing change from Control increases cumulatively as injury severity increases, with 3865 proteins showing significant change in the Super Critical group. 496 of these are unique to this group. A total of 2118 proteins show significant change in only the Critical and/or Super Critical groups. Pathway analysis on both the Super Critical group (ISS ≥36) and combined Critical-Super Critical (ISS ≥25) group identifies a large number of processes, with the JAK-STAT signalling pathway most significantly enriched in both analyses.ConclusionThe biological response to trauma is massive and complex, however proteomic pathway analysis of patients with the highest levels of injury can highlight areas for further investigation, supporting future work on the potential identification of modifiable targets within these pathways and the optimisation of personalised care for trauma patients.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/bmjmilitary-2025-colt.4
Issue No: Vol. 171, No. 3 (2025)
- 5 Abdominal aortic junctional tourniquets - clinically important increases
in pressure in aortic zone 1 and zone 3 in a cadaveric study directly
relevent to combat medics treating non-compressible torso haemorrhage-
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Authors:
Smith, T; Pallister, I, Parker, P.
Pages: e3 - e3
Abstract: Background‘Non-compressible’ torso haemorrhage (NCTH) is the leading cause of preventable battlefield death. UK Joint Theatre Trauma Registry (JTTR) analysis 2002–12 showed 85.5% NCTH mortality. Gas insufflation and hyper-pressure intra-peritoneal fluid animal studies demonstrated significant reductions in blood loss in splanchnic injuries. We hypothesised that the non-invasive Abdominal Aortic Junctional Tourniquet-Stabilised (AAJT-S) would be a forward medic intervention to tamponade bleeding from coeliac trunk vessels in zone 1 by generating clinically significant proximal epigastric compartment pressure.MethodsFour cadaveric donors each had two balloon manometers placed intra-peritoneally: one epigastric and one retropubic. Baseline pressures of 8 cmH2O were set (equating mean intra-abdominal pressure (IAP.)) AAJT-S was applied. Pressures were contemporaneously recorded. AAJT-S was removed, and 500 ml of water was added through the epigastric aperture to simulate blood. The manometer was replaced and reset to 8 cmH2O. AAJT-S was re-applied, IAP steady pressures were again recorded.ResultsProximal compartment pressures reached a mean of 54.6 cmH2O (40.2 mmHg); distal compartment pressures a mean of 46 cmH2O (34 mmHg.) With 500 ml intraperitoneal fluid, proximal compartment achieved a mean of 52.25 cmH2O (38.4 mmHg); distal compartment achieved a mean of 35 cmH2O (25.7 mmHg.) BMI had a statistically significant inverse effect, in our range (16.7–22.9.) This proved clinically insignificant, with sufficient pressure still achieved in all tests.ConclusionAAJT-S at 250 mmHg achieves proximal epigastric compartment pressures of 40mmHg, with or without 500 ml simulated free blood in the abdomen. This represents a highly significant and titratable reduction in blood flow in coeliac trunk branches. BMI does not have a clinically significant effect. AAJT-S application also produces Zone 3 aortic and inferior vena cava occlusion. AAJT-S may be a point of injury intervention for forward medics that contributes to non-surgical haemorrhage control and likely clot stabilisation for Zone 1 vascular and solid organ injuries.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/bmjmilitary-2025-colt.5
Issue No: Vol. 171, No. 3 (2025)
- 6 A novel injury risk function for aircrew helmets
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Authors:
Mackay; A.
Pages: e3 - e3
Abstract: BackgroundInternationally, military aircrew helmet standards require helmets to demonstrate impact performance based on peak translational acceleration (PTA), which is associated with skull fractures but poorly predicts traumatic brain injury (TBI). Analyses of fast-jet ejections and rotary-wing crashes reveal that while skull fractures are rare, aircrew frequently sustain mild to moderate TBIs, with loss of consciousness being most prevalent. Even a brief incapacitation can have catastrophic consequences, especially due to the risk of post-crash fires, operating over water, or in non-permissive environments. This research introduces a novel tissue-level Injury Risk Function (IRF) that enables helmet assessment based on the risk of loss of consciousness.MethodsKinematic data were calculated from 82 reconstructed NFL head impacts, 20 involving a clear loss of consciousness. This data was used to load a Finite Element Method (FEM) model of the human brain, where brain deformation was quantified using the 90th percentile maximum principal strain (MPS90), calculated for the whole brain, brainstem, and specific brainstem nuclei. Multiple IRFs were constructed using logistic regression, survival analysis, and machine learning techniques such as support vector machines and random forest. The performance of these IRFs was evaluated in accordance with ISO 18506:2014.ResultsWhole brain strain and strain rate in three key brainstem nuclei were sensitive predictors of loss of consciousness, with a receiver operating characteristic (ROC) curve area under the curve (AUC) between 0.75 and 0.83. A survival analysis curve based on whole brain strain was constructed assuming a Weibull distribution.DiscussionA novel IRF has been developed for use in future military aircrew helmet impact standards. This IRF allows the development of a new injury criterion to assess helmet performance in protecting against significant brain injury, including loss of consciousness. Introducing this criterion would reduce the risk to life in aircraft crashes or ejections.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/bmjmilitary-2025-colt.6
Issue No: Vol. 171, No. 3 (2025)
- Colt Foundation Defence Research & Clinical Innovation Meeting 2024, The
Medical Society of London-
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Authors:
Melhuish, J; Barker-Davies, R, Breeze, J.
Pages: e3 - e3
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/bmjmilitary-2025-colt.editorial
Issue No: Vol. 171, No. 3 (2025)
- Dispatches from the Editor in Chief: my final issue of BMJ Military Health
-
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Authors:
Breeze; J.
Pages: 189 - 190
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2025-002994
Issue No: Vol. 171, No. 3 (2025)
- Defining expeditionary dentistry in US doctrine for the era of great power
competition and conflict-
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Authors:
Cook, R. K; Riesberg, J, Mendoza, A, Tempel, T. R.
Pages: 191 - 192
Keywords:
Open access
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2024-002705
Issue No: Vol. 171, No. 3 (2025)
- What is the medical requirement for a quick release system in a body
armour vest'-
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Authors:
Breeze, J; Bowley, D, Russell, J, EJ Pugh, H.
Pages: 193 - 197
Abstract: A quick release system is a method by which personal armour can be rapidly doffed by the disconnection of structural components using little force. There are slight variations in the design of quick release systems available in different personal armour systems worldwide, including the position of the activation device, how many points on the vest are released at one time and how many constituent parts the vest dismantles into. Limited evidence exists, however, to justify each of these differences. We believe the medical requirements for a quickrelease system include reducing mass and bulk for rapid escape in confined areas or when transporting casualties, optimising rapid medical assessment and fully enabling medical assessment and treatment. The aim of this paper is to provide multidisciplinary evidence to support the medical requirements for this component and thereby facilitate innovation and the optimisation of future body armour design.
Keywords:
Open access
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002661
Issue No: Vol. 171, No. 3 (2025)
- How might the rapid development of artificial intelligence affect the
delivery of UK Defence healthcare'-
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Authors:
Patel; N. C.
Pages: 198 - 201
Abstract: Artificial intelligence (AI) has developed greatly and is now at the centre of technological advancements. Current and recent military conflicts have highlighted the evolving complexity of warfare with rapid technological change at the heart of it. AI aims to understand and design systems that show signs of intelligence and are able to learn by deriving knowledge from data. There have been multiple AI-related developments in the medical field in areas such as diagnostics, triage, wearable technology and training with direct translations that may benefit UK Defence healthcare. With the increasing use of AI in society and medical practice, it is important to consider whether AI can be trustworthy and has any legal implications, and evaluate its use through an ethical lens. In conclusion, the rapid development of AI presents exciting opportunities for UK Defence to enhance its healthcare delivery. This paper was selected as the BMJ Military Health Essay Prize winner at the Royal Society of Medicine Colt Foundation Meeting 2023.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2024-002682
Issue No: Vol. 171, No. 3 (2025)
- Nine years of surgical activity in the deployed French military role 2
medical treatment facility in Mali-
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Authors:
Pfister, G; Aries, P, de Lesquen, H, Mathieu, L.
Pages: 202 - 206
Abstract: IntroductionIn January 2013, France launched a military operation in Mali, which ended in August 2022. This study aimed to analyse the global activity performed by a surgical team within the role 2 medical treatment facility (MTF) deployed in Gao during this period, in order to adapt medical battlefield support and combat casualty care teaching.MethodsA retrospective study was conducted using the French surgical database OpEX (French Military Health Service) from January 2013 to August 2022. All patients operated on were included.ResultsDuring this period, 1298 patients with a median age of 29 (range: 23–38) years were included. Among them, 229 (17.6%) underwent a combat-related trauma surgery (CRTS), 234 (18.0%) underwent a non-CRTS, 167 (12.9%) underwent a non-trauma-related surgery and 668 (51.5%) underwent a scheduled surgery in the context of medical supply to the population.Among the CRTS group, 195 (85.2%) patients underwent an orthopaedic procedure, 73 (31.8%) required a general surgery. Finally, 15 (6.6%) wounded required a specialised surgery.ConclusionsIn line with the activity described in the role 2 MTF deployed in other contemporary asymmetric conflicts, this activity is moderate, especially if only combat-related injuries are considered; medical support to the population occupied most of the surgical activity. For CRTS, most of the traumas are limb traumas. Other traumas are composed of various lesions, which are often life-threatening. This fact imposes the presence of an orthopaedic surgeon with the appropriate equipment, as well as a general surgeon with a wide range of skills, in asymmetric conflicts.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002553
Issue No: Vol. 171, No. 3 (2025)
- Prevalence of sexually transmitted infections in women of the Czech
Republic Armed Forces: a cross-sectional pilot study-
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Authors:
Karasek, L; Smetana, J, Svobodova, P, Smahelova, J, Tachezy, R, Kiss, I, Nejedla, D.
Pages: 207 - 212
Abstract: IntroductionSexually transmitted infections (STIs) are an everlasting health issue globally. The military environment is recognised as a high-risk setting. Human papillomavirus (HPV), Chlamydia trachomatis and Neisseria gonorrhoeae are the most frequent STIs worldwide. This prospective cross-sectional pilot study focuses on the prevalence of selected STIs in the female population of the Czech Republic’s Armed Forces.Methods C. trachomatis, N. gonorrhoeae and HPV detection and genotyping were performed between August 2020 and December 2022 in 141 women. Participants were divided into three groups according to their military status—recruits (n=72), active soldiers (n=25) and control civilian group (n=44). Cervical smear tests were performed, and data on STI risk factors were obtained through a questionnaire.ResultsA significant difference in the HPV prevalence between recruits (64.5 %) and both active soldiers (46.4 %) and civilians (47.3 %) was found when adjusted for age (p=0.007 and p=0.01, respectively). Lower age of coitarche (median 16; p=0.005) and smaller agglomeration origin (p=0.013) were reported for military recruits. No difference was proven in other researched risk factors. Associations between HPV detection and the higher number of sexual partners (p=0.013), early coitarche (p=0.016) and single marital status (p=0.002) across the groups were observed. Not a single case of N. gonorrhoeae was detected in any of the 141 participants. The prevalence of C. trachomatis did not differ significantly between the three evaluated groups—recruits, control civilian group, and active soldiers (5.6%, 2.3%, 0%, respectively; p=0.567).ConclusionsThis pilot study showed a significantly higher HPV prevalence in female military recruits compared with both active military and civilian women. Recruits reported earlier coitarche which is a strong STI risk factor. Further study is needed to expand on the findings of this pilot study and generate data to support adjustment of STI preventive measures within the Czech Republic Armed Forces.
Keywords:
Open access
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002611
Issue No: Vol. 171, No. 3 (2025)
- 'One Is Too Many preventing self-harm and suicide in military veterans: a
quantitative evaluation-
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Authors:
Finnegan, A; Salem, K, Ainsworth-Moore, L.
Pages: 213 - 220
Abstract: IntroductionIn 2021, the Armed Forces Covenant Fund Trust allocated over £2 million to programmes designed to have a clear and demonstrable impact on suicide prevention. Four grant holders delivered a combination of psychotherapeutic interventions, group activities, social prescribing, peer support mentoring, life skills coaching, educational courses and practical help with housing and employment. The evaluation was completed between August 2021 and July 2023.MethodsA survey was completed by 503 participants at entry and 423 at exit. It captured data regarding demographic and military-specific details, health status, situational stressors, predisposing symptoms, help-seeking behaviour, social engagement, housing, living arrangements and employment status. The questionnaire included a number of validated psychometric questionnaires.ResultsThis evaluation revealed reductions in situational stressors, symptoms and mental health illnesses. Seventy-six per cent of participants had completed an Operational Tour, and 77% were exposed to a traumatic event during service. It was the negative impact of unresolved traumatic effects that influenced service-users to require support. Forty-nine per cent delayed seeking help, and 36% self-referred to the One Is Too Many programme which demonstrates the importance of this option. There were improvements in the participants’ social networking, social activities, club membership and having people to rely on. Only 4% of participants were women which reinforces the requirement to explore initiatives to engage with female veterans.ConclusionsTimely therapeutic and social prescribing interventions in a safe environment lowered depression, anxiety and the associated situational stressors leading to self-harming and may have reduced suicide. It presented another option to veterans and their families regarding where they can obtain support, care and therapeutic interventions. The programme provided a strong foundation for delivery organisations to forge lasting collaborative partnerships that can be extended to working with other authorities and institutes. The results highlight pathways for prevention and intervention strategies to inform policymakers, healthcare professionals and third-sector organisations.
Keywords:
Open access
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002623
Issue No: Vol. 171, No. 3 (2025)
- Continuous rise in oxygen consumption during prolonged military loaded
march in the heat with and without fluid replacement: a pilot study-
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Authors:
Wheelock, C. E; Stooks, J, Schwob, J, Hostler, D.
Pages: 221 - 226
Abstract: IntroductionVO2 drift, the rise in oxygen consumption during continuous exercise, has not been adequately reported during prolonged military marches. The purpose of this study was to analyse VO2 and energy expenditure (EE) during a loaded march with and without rehydration efforts. Second, the study aimed to compare EE throughout the march with predicted values using a validated model.MethodsSeven healthy men (23±2 years; VO2max: 50.8±5.3 mL/kg/min) completed four 60 min loaded marches (20.4 kg at 50% VO2max) in a warm environment (30°C and 50% relative humidity). Three were preceded by hypohydration via a 4-hour cold water immersion (18°C). The control (CON) visit was a non-immersed euhydrated march. After water immersion, subjects were rehydrated with 0% (NO), 50% (HALF) or 100% (FULL) of total body mass lost. During exercise, VO2 and EE were collected and core temperature change was calculated. To determine if EE could be accurately predicted, values were compared with a calculated estimate using the US Army Load Carry Decision Aid (LCDA).ResultsAt the start of exercise, there was no difference between conditions in VO2 (ALL: 24.3±0.3 mL/kg/min; p=0.50) or EE (ALL: 8.6±1.0 W/kg; p=0.68). VO2 (p=0.02) and EE (p
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002573
Issue No: Vol. 171, No. 3 (2025)
- 'Whether its your weapon or not, its your home: US military spouse
perspectives on personal firearm storage-
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Authors:
Betz, M. E; Meza, K, Friedman, K, Moceri-Brooks, J, Johnson, M. L, Simonetti, J, Baker, J. C, Bryan, C. J, Anestis, M. D.
Pages: 227 - 232
Abstract: IntroductionIn the USA, an estimated 45% of veterans personally own firearms. Firearm access increases the risk of suicide, so suicide prevention efforts in the US Department of Defense (DoD) focus on lethal means safety, including reducing firearm access. Spouse input may enhance effective messaging and intervention delivery of lethal means safety. This study used qualitative methods to explore the perspectives of military spouses or partners on personal firearm storage, including at-home decisions, on-base storage and existing messaging from the DoD.Materials and methodsQualitative data were obtained using 1:1 interviews and focus groups with spouses/partners of US military service members (active duty, Reserve, National Guard, recently separated from the military) and representatives from military support organisations. Sessions focused on personal firearm storage (at home or on military installations) and military messaging around secure firearm storage and firearm suicide prevention. Data were analysed using a team-based, mixed deductive–inductive approach.ResultsAcross 56 participants (August 2022–March 2023), the themes were variability in current home firearm storage and spousal participation in decision-making; uncertainty about firearm storage protocols on military installations; mixed awareness of secure firearm storage messaging from the military; and uncertainty about procedures or protocols for removing firearm access for an at-risk person.ConclusionUS military spouses are important messengers for firearm safety and suicide prevention, but they are currently underutilised. Tailored prevention campaigns should consider spousal dynamics and incorporate education about installation procedures.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002591
Issue No: Vol. 171, No. 3 (2025)
- Psychometric properties, predictive utility and diagnostic capacity of the
Persian version of the Scale of Resilience to Suicide Attempts in army
conscripts-
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Authors:
Rashtbari, A; Rahnejat, A, Taghva, A, Jamil, L, Sheykholeslami, A.
Pages: 233 - 238
Abstract: IntroductionSuicide among army conscripts represents a poorly understood and complex public health issue that has escalated in recent decades. The early identification of individuals at risk holds the potential to significantly contribute to the effective prevention of suicide attempts. To address this, the Scale of Resilience to Suicide Attempts-18 (SRSA-18) has been developed to assess protective factors related to suicide attempts. The present study aimed to develop a Persian version of SRSA-18 (P-SRSA) and examine its psychometric properties and predictive utility within a sample of the Iranian Army.MethodsThe initial study sample consisted of 400 male conscripts from the Iranian Army grand forces (M=19.86, SD=1.40). Subsequently, for the follow-up stage, 296 participants (M=19.83, SD=1.39) were recruited. The participants were assessed using various measures of resilience, social support, suicide and hopelessness at baseline and a 6-month follow-up.ResultsIn contrast to the original version, both exploratory and confirmatory factor analyses supported an 18-item two-factor model of the P-SRSA (root mean square error of approximation=0.076; 95% CI (0.069 to 0.086), comparative fit index=0.943, Tucker-Lewis index=0.936). P-SRSA strongly correlated with convergent/divergent measures and demonstrated satisfactory internal consistency (α=0.82). Furthermore, regression analysis revealed that the P-SRSA significantly predicted suicide reattempts at baseline and during a 6-month follow-up period.ConclusionThe study confirms that the P-SRSA, comprising a two-factor, 18-item solution, is a reliable measure of resilience, displaying robust discriminant and predictive validity. These findings provide substantial support for implementing P-SRSA in samples from the Iranian Army, highlighting its potential to identify suicidal conscripts effectively.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002602
Issue No: Vol. 171, No. 3 (2025)
- Posture analysis in predicting fall-related injuries during French Navy
Special Forces selection course using machine learning: a proof-of-concept
study-
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Authors:
Verdonk, C; Duffaud, A. M, Longin, A, Bertrand, M, Zagnoli, F, Trousselard, M, Canini, F.
Pages: 239 - 244
Abstract: IntroductionInjuries induced by falls represent the main cause of failure in the French Navy Special Forces selection course. In the present study, we made the assumption that probing the posture might contribute to predicting the risk of fall-related injury at the individual level.MethodsBefore the start of the selection course, the postural signals of 99 male soldiers were recorded using static posturography while they were instructed to maintain balance with their eyes closed. The event to be predicted was a fall-related injury during the selection course that resulted in the definitive termination of participation. Following a machine learning methodology, we designed an artificial neural network model to predict the risk of fall-related injury from the descriptors of postural signal.ResultsThe neural network model successfully predicted with 69.9% accuracy (95% CI 69.3–70.5) the occurrence of a fall-related injury event during the selection course from the selected descriptors of the posture. The area under the curve value was 0.731 (95% CI 0.725–0.738), the sensitivity was 56.8% (95% CI 55.2–58.4) and the specificity was 77.7% (95% CI 76.8–0.78.6).ConclusionIf confirmed with a larger sample, these findings suggest that probing the posture using static posturography and machine learning-based analysis might contribute to inform risk assessment of fall-related injury during military training, and could ultimately lead to the development of novel programmes for personalised injury prevention in military population.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002542
Issue No: Vol. 171, No. 3 (2025)
- Five-day evaluation of the acceptability and comfort of wearable
technology at four anatomical locations during military training-
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Authors:
Taylor, N; Carroll, A, Gifford, R. M.
Pages: 245 - 249
Abstract: IntroductionWearable sensor technologies enable Defence to optimise human performance, remotely identify physiological abnormalities and enhance medical support. Maximising the acceptability of devices will ensure they are worn alongside other equipment. This study assessed the acceptability and comfort of four devices at different anatomical locations during military training.MethodA cross-sectional pilot study during a live firing infantry exercise or adventurous training assessed four anatomical locations concurrently over 5 days: finger, wrist, upper arm and chest. Participants rated comfort, acceptability and preference using a standardised questionnaire after 12 hours and 5 days of wear.ResultsTwenty-one regular British Army personnel soldiers participated, aged 24.4 (4.3) years. The upper arm location received the highest rating by participants for comfort, followed in order by wrist, finger and chest (p=0.002, X2=40.0). The finger was most commonly identified as uncomfortable during specific activities (76%), followed by chest (48%), wrist (23%) and upper arm devices (14%). There was no significant difference in participant confidence in the devices to collect data or allow movement, but there was a trend towards greater confidence in upper arm and wrist locations to stay in position than the others (p=0.059, X2=28.0). After 5 days of wear, 43% of participants said they preferred the upper arm for comfort, followed by wrist (36%), finger (24%) and chest (10%). 73% and 71% would wear the wrist and upper arm devices on deployed operations, compared with 29% and 24% for chest and finger devices, respectively.ConclusionThe upper arm location offered greater acceptability and comfort than finger, wrist or chest locations. It is essential to consider such findings from occupationally relevant settings when selecting wearable technology. A larger service evaluation in diverse settings is recommended to guide the choice of the most acceptable wearable devices across different equipment, roles and environments.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002524
Issue No: Vol. 171, No. 3 (2025)
- Assessing injury risk in male and female Royal Navy recruits: does the
Functional Movement Screen provide understanding to inform effective
injury mitigation'-
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Authors:
Gibbs, J; Power, C. N. T, Böhning, D, Warner, M, Downie, S, Allsopp, A, Stokes, M, Fallowfield, J. L.
Pages: 250 - 255
Abstract: IntroductionMusculoskeletal injuries (MSKIs) are common during military and other occupational physical training programmes, and employers have a duty of care to mitigate this injury risk. MSKIs account for a high number of working days lost during initial military training, contribute to training attrition and impact training costs. Poorer movement quality may be associated with increased MSKI risk.MethodsThe present study evaluated the relationship between the Functional Movement Screen (FMS) Score, as a measure of movement quality, and injury risk in Royal Navy (RN) recruits. A cohort of 957 recruits was assessed using the FMS prior to the 10-week phase I training programme. Injury occurrence, time, type and severity were recorded prospectively during the training period.ResultsTotal FMS Score was associated with injury risk (p≤0.001), where recruits scoring ≥13 were 2.6 times more likely to sustain an injury during training. However, FMS Score accounted for only 10% of the variance in injury risk (R2=0.1). Sex was the only additional variable to significantly affect the regression model. Mean FMS Scores for men (14.6±2.3) and women (14.4±2.4) were similar, but injury occurrence in women was 1.7 times greater than in men. Examining the influence of individual FMS movement tests on injury prediction did not improve the model, where those movements that significantly contributed to injury prediction only accounted for a small amount of the variance (R2=0.01).ConclusionThere was a weak relationship between FMS and injury risk in RN recruits. Evidence is provided that FMS score alone would not be appropriate to use as an injury prediction tool in military recruits.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002416
Issue No: Vol. 171, No. 3 (2025)
- Impact of poor air quality while deployed on respiratory health: a
systematic review-
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Authors:
Williams, L. G; Ross, D.
Pages: 256 - 261
Abstract: IntroductionBritish military personnel deploy internationally to areas with high levels of ambient air pollution. Air pollution can cause acute respiratory symptoms which lead to concern about potential long-lasting health effects. There is a requirement for evidence-based policy on chronic respiratory disease associated with military deployments to areas with poor air quality (AQ). This literature review examines the published evidence relating to the development of chronic respiratory disease in military personnel after exposure to poor AQ while deployed.MethodsA literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Embase, MEDLINE and Global health databases were searched for English language studies published since 2014 examining the respiratory health of military personnel deployed to Southwest Asia since 2001. A quality appraisal of selected articles was conducted using the Critical Appraisals Skills Programme checklist and a descriptive review completed.ResultsEleven studies were found, eight of which had objective outcome measures. Two prospective cohort studies were included; the remainder of the data were retrospective.ConclusionHigh rates of respiratory symptoms are reported by personnel who deploy to areas of poor AQ, giving rise to high levels of concern. Spirometry testing has found mild deficits, mostly of an obstructive nature, in a third of those with ongoing symptoms post deployment. These have not been consistently linked with deployment length. An increased risk of asthma appears to be multi-factorial in aetiology and there is no evidence for an increased risk of chronic obstructive pulmonary disease or histological pathology post deployment. At present, there is no definitive evidence of chronic respiratory disease due to exposure to poor AQ while deployed. Further objective longitudinal studies are required to continue to investigate the association, diagnosis and management of those with ongoing symptoms.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002381
Issue No: Vol. 171, No. 3 (2025)
- Abdominal aortic junctional tourniquet (AAJT-S): a systematic review of
utility in military practice-
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Authors:
Webster, S; Ritson, J. E, Barnard, E. B. G.
Pages: 262 - 268
Abstract: IntroductionHaemorrhage is the leading cause of potentially survivable death on the battlefield. Despite overall improvement in battlefield mortality, there has been no improvement in survival following non-compressible torso haemorrhage (NCTH). The abdominal aortic junctional tourniquet-stabilised (AAJT-S) is a potential solution that may address this gap in improving combat mortality. This systematic review examines the evidence base for the safety and utility of the AAJT-S for prehospital haemorrhage control in the combat setting.MethodsA systematic search of MEDLINE, Cumulated Index to Nursing and Allied Health Literature and Embase (inception to February 2022) was performed using exhaustive terms, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The search was limited to English-language publications in peer-reviewed journals; grey literature was not included. Human, animal and experimental studies were included. Papers were reviewed by all authors to determine inclusion. Each study was assessed for level of evidence and bias.Results14 studies met the inclusion criteria: 7 controlled swine studies (total n=166), 5 healthy human volunteer cases series (total n=251), 1 human case report and 1 mannikin study. The AAJT-S was demonstrated to be effective at cessation of blood flow when tolerated in healthy human and animal studies. It was easy to apply by minimally trained individuals. Complications were observed in animal studies, most frequently ischaemia-reperfusion injury, which was dependent on application duration. There were no randomised controlled trials, and the overall evidence base supporting the AAJT-S was low.ConclusionsThere are limited data of safety and effectiveness of the AAJT-S. However, there is a requirement for a far-forward solution to improve NCTH outcomes, the AAJT-S is an attractive option and high-quality evidence is unlikely to be reported in the near future. Therefore, if this is implemented into clinical practice without a solid evidence base it will need a robust governance and surveillance process, similar to resuscitative endovascular balloon occlusion of the aorta, with regular audit of use.
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PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002451
Issue No: Vol. 171, No. 3 (2025)
- Optimisation of mitochondrial function as a novel target for resuscitation
in haemorrhagic shock: a systematic review-
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Authors:
Cottey, L; Smith, J. E, Watts, S.
Pages: 269 - 274
Abstract: IntroductionTraumatic injury is one of the leading causes of death worldwide, and despite significant improvements in patient care, survival in the most severely injured patients remains unchanged. There is a crucial need for innovative approaches to improve trauma patient outcomes; this is particularly pertinent in remote or austere environments with prolonged evacuation times to definitive care. Studies suggest that maintenance of cellular homeostasis is a critical component of optimal trauma patient management, and as the cell powerhouse, it is likely that mitochondria play a pivotal role. As a result, therapies that optimise mitochondrial function could be an important future target for the treatment of critically ill trauma patients.MethodsA systematic review of the literature was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol to determine the potential role of mitochondria in traumatic injury and haemorrhagic shock (HS) and to identify current evidence for mitochondrial optimisation therapies in trauma. Articles were included if they assessed a mitochondrial targeted therapy in comparison to a control group, used a model of traumatic injury and HS and reported a method to assess mitochondrial function.ResultsThe search returned 918 articles with 37 relevant studies relating to mitochondrial optimisation identified. Included studies exploring a range of therapies with potential utility in traumatic injury and HS. Therapies were categorised into the key mitochondrial pathways impacted following traumatic injury and HS: ATP levels, cell death, oxidative stress and reactive oxygen species.ConclusionThis systematic review provides an overview of the key cellular functions of the mitochondria following traumatic injury and HS and identifies why mitochondrial optimisation could be a viable and valuable target in optimising outcome in severely injured patients in the future.
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002427
Issue No: Vol. 171, No. 3 (2025)
- Delivering high-quality military healthcare: 'no need for fancy
subspecialties-
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Authors:
Cohen, H. M. L; Horne, S.-J, Campbell, E, Bowley, D. M, Mountain, A.
Pages: 275 - 276
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002662
Issue No: Vol. 171, No. 3 (2025)
- History of childbirth as a potential risk factor for musculoskeletal
injury in military personnel-
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Authors:
Edwards, C. M; Adamo, K. B.
Pages: 277 - 277
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002620
Issue No: Vol. 171, No. 3 (2025)
- Evaluation of fractional exhaled nitric oxide measurement in defence
primary healthcare-
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Authors:
Willman, A. S; Howard-Harwood, B, Blackadder-Weinstein, J.
Pages: 278 - 279
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2024-002675
Issue No: Vol. 171, No. 3 (2025)
- Assessing the attitudes of military trainees towards the UK Foundation
Programme-
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Authors:
Warsi, A; Sabey, A, Holland, T, King, K.
Pages: 280 - 281
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002606
Issue No: Vol. 171, No. 3 (2025)
- UK Armed Forces female hygiene in the austere environment
-
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Authors:
Guest, R; Willman, A. S, Kinkaid, V, Holland, T, King, K.
Pages: 282 - 283
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002626
Issue No: Vol. 171, No. 3 (2025)
- Addressing the success-satisfaction paradox in UK defence GP training
-
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Authors:
Holland, T. J; King, K.
Pages: 285 - 286
PubDate: 2025-05-21T03:35:52-07:00
DOI: 10.1136/military-2023-002598
Issue No: Vol. 171, No. 3 (2025)
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