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- Mental well-being interventions in the military: The ten key principles
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Authors:
Lawrence, E. G; Jones, N, Greenberg, N, Fear, N. T, Wessely, S, Michael, G, Taylor-Beirne, S, Simms, A.
Pages: 179 - 180
Abstract: Organisations including the United Kingdom Armed Forces should seek to implement mental health interventions to increase the psychological well-being of their workforce. This editorial briefly presents ten key principles that military forces should consider before implementing such interventions. These include job-focused training; evaluating interventions; the use of internal versus external training providers; the role of leaders; unit cohesion, single versus multiple session psychological interventions; not overgeneralising the applicability of interventions; the need for repeated skills practice; raising awareness and the fallibility of screening.
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001740
Issue No: Vol. 168, No. 3 (2022)
- Sources of occupational stress among the military musicians of the Royal
Air Force-
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Authors:
Davison; D.
Pages: 181 - 185
Abstract: IntroductionOccupational stress has been studied in the military and among professional musicians but not yet among military musicians. We may speculate that military musicians are subject to military occupational stresses as well as those of the professional musician, but we do not know what the stresses of the role actually are. This study is the first to identify sources of occupational stress and measure the prevalence of music performance anxiety (MPA) among a group of military musicians.MethodsVolunteer musicians were recruited from the UK Royal Air Force (RAF) Music Services and invited to take part in an anonymous online survey that captured demographic information, incorporated the Kenny Music Performance Anxiety Inventory (K-MPAI) and asked an open, free-text question: ‘Thinking about your occupation as an RAF Musician, what causes you to feel stressed'’. Quantitative data were analysed using SPSS. Qualitative data were coded, collated and analysed for themes.Results57 musicians (38% of those eligible) completed the survey. A prevalence of 46% for significant MPA was found. Females scored significantly higher than males. Other stressors were time constraints, the negative judgement of others, musical and military challenges, tensions between musical and military values, issues relating to promotion and existential concerns.ConclusionsMilitary musicians share MPA, career development stressors and conflicts between career and social life as sources of occupational stress with their civilian colleagues. Military stressors include being posted/deployed or compulsory fitness testing. The hierarchical structure of the military brings additional stress when rank and promotion may not be talent based.
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001432
Issue No: Vol. 168, No. 3 (2022)
- Alcohol screening and brief intervention among military service members
and veterans: rural-urban disparities-
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Authors:
McDaniel, J. T; Albright, D. L, Laha-Walsh, K, Henson, H, McIntosh, S.
Pages: 186 - 191
Abstract: BackgroundAccess to screening, brief intervention and referral to treatment programmes for alcohol use have been shown to be effective; however, little is known about access to these services among service members and veterans. We examined the association of service member or veteran rural-dwelling area and the following outcomes: recent general health check-up, alcohol screening and alcohol brief intervention.MethodsData on 5080 military service members and veterans were obtained from the 2017 Behavioural Risk Factor Surveillance System of the USA. We estimated rural–urban disparities in the receipt of a recent voluntary general health check-up, as well as the receipt of alcohol screening and brief intervention, using a mixed logit model.ResultsOf the 5080 participants in the study, a total of 4666 (90.49%, 95% CI 89.39% to 91.48%) reported a general health check-up in the last 2 years. Results showed 7.48% of the sample (95% CI 6.64% to 8.41%) exhibited heavy alcohol consumption patterns. Of the 414 participants who did not undergo a general health check-up, 13.80% (95% CI 9.63% to 19.41%) exhibited a pattern of heavy alcohol consumption. Rural individuals were less likely to report a recent health check-up (adjusted OR=0.82, 95% CI 0.79 to 0.87). Rurality was also independently associated with decreased likelihood of receiving an alcohol screening and brief intervention.ConclusionGreater access to telehealth or other geographically flexible screening and brief intervention programmes is needed in rural areas for service members and veterans.
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001479
Issue No: Vol. 168, No. 3 (2022)
- Beyond HOSPEX: what is the additional training value of military hospital
exercises (HOSPEX)'-
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Authors:
Gimzewska, M; Hunter, K, Al Azzawi, S, Boreham, A.
Pages: 192 - 195
Abstract: BackgroundThe use of simulation in clinical environments is a frequently used adjunct to training individuals and teams. The military uses clinical simulation to train large numbers of personnel, standardise patient pathways and sustain specific skills to ensure medical personnel are prepared to deploy in their clinical roles.MethodsAs part of a North Atlantic Treaty Organization (NATO) exercise, 256 Field Hospital (Reserves) deployed a team of clinicians to simulate a role 2 basic field hospital. This hospital exercise (HOSPEX) involved training, and a 4-day real-time exercise with casualty simulation. A retrospective survey of all clinical personnel was conducted to analyse the utility of the exercise on their understanding of their job role, the workings of the field hospital and their confidence in deploying on operations.Results39 personnel were surveyed, with questions graded on a modified Likert scale. 41% had previous operational experience in their current job role. A significantly higher proportion of respondents graded their understanding of their job role, and the field hospital overall, as good or excellent having completed the exercise (p
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001438
Issue No: Vol. 168, No. 3 (2022)
- Viability of Bos taurus scapulae as a flat bone proxy for ballistic
testing-
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Authors:
Taylor, S. C; Kieser, D. C, Hammer, N, Ondruschka, B, Kranioti, E, Pullen, A, Hooper, G.
Pages: 196 - 199
Abstract: BackgroundHandguns and rifles are often involved in violent deaths such as homicide and suicide. Consequently, forensic investigations are important to clarify the nature of ballistic trauma.MethodsThis study investigated the differences in entrance and exit wound morphology with Bos taurus (bovine) scapulae that have two cortical layers surrounding a central cancellous bone section which are comparable with human flat bones, with a series of experiments using six different calibres (0.22 Long Rifle, 9x19 mm North Atlantic Treaty Organization, 0.40 Smith & Wesson, 0.45 Automatic Colt Pistol, 5.56x45 mm and 7.62x51 mm). B. taurus (bovine) scapulae were used for closed range 30 cm simulated executions.ResultsThe ballistic experiments presented similarities in entrance wound morphology and exit wound bevelling with that of recognised forensic cases. As muzzle velocity increased, bevelling increased. Circumferential delamination is clearly visible with full metal jacket rounds, yielding similar bone damage morphology as human crania.ConclusionBovine scapulae seem appropriate for ballistic simulations of flat bone injuries on the macroscopic level, if the correct portion of the scapulae is deployed. More research is needed to further substantiate these interpretations.
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2019-001369
Issue No: Vol. 168, No. 3 (2022)
- Control of three gastrointestinal illness outbreaks in a British Role 1
facility in Afghanistan: a primary care perspective-
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Authors:
Makin, S; Hudson, L, Robinson, R, Riley, M. R, Murphy, D.
Pages: 200 - 205
Abstract: IntroductionIn 2019, Camp Qargha (QAA), a British-led multinational military camp in Kabul, had three of the largest outbreaks of gastrointestinal illness (GI) experienced by the British Military since 2003. This paper discusses the incidence, the response of the British-led Role 1 (R1) medical treatment facility, identifies potential causative and exacerbating factors, and explains the control measures initiated.MethodGI in QAA results in local and UK military-wide data collection including in the form of local GI questionnaires, FMed85 forms and EpiNATO returns. The data from these was used to identify trends during and after outbreaks and produce environmental health (EH) and local outbreak reports.ResultsOverall, among the outbreaks 56% of stool samples tested positive for norovirus. In each outbreak incidence peaked within the first 3 days, and hardened multiperson rooms were worst affected. 206 patient presentations occurred during the three outbreaks, 706 working days were lost in isolation, with QAA shut down while in quarantine for 27 days.DiscussionSignificant strain was placed on QAA and the R1. Causative factors may include close interaction with the local national (LN) population, a high population density and accommodation being limited by specific national infrastructure protocols in an operational environment.ConclusionEarly recognition of GI, positive standard operating procedures and good hygiene habits are essential to prevent the spread of GI such as norovirus. An early awareness of LN population illness patterns will allow the R1 and command to be better prepared for outbreaks in the future.
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001458
Issue No: Vol. 168, No. 3 (2022)
- United States university-based officer training and its influence on
physical assessment test performance-
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Authors:
Tom, J. C; Schilling, B. K, Poston, B, Turner, C. L, Radzak, K. N.
Pages: 206 - 211
Abstract: IntroductionCadets participating in Reserve Officers’ Training Corp (ROTC) at US universities undergo both Army Physical Fitness Test (APFT) and Occupational Physical Assessment Test (OPAT) evaluations prior to commissioning. The current study examined the relationship between ROTC physical training (PT) attendance and performance in the APFT and OPAT, and characterised physical activity of cadets outside of PT.MethodsTwenty-six cadets’ (21 males; age=20.81±2.48 years; height=171.16±8.62 cm; body mass=75.49±13.17 kg; body mass index=25.68±3.37 kg/m2) PT attendance, and diagnostic (week 1) and record (week 13) OPAT and APFT scores were documented. Paired samples t-tests evaluated differences in APFT and OPAT scores between the diagnostic and record tests. Pearson correlations were utilised to determine if a relationship existed between PT attendance and test performance. Participating cadets also completed monthly self-reported physical activity questionnaire (September, October, November); findings were reported using descriptive statistics.ResultsCadets attended 87% of PT sessions between OPAT administrations and 85% between APFT administrations. Cadets significantly improved the following test components: standing long jump (p=0.034), seated power throw (p=0.029), shuttle run (p=0.005), sit-ups (p=0.003) and 2-mile run (p=0.045). A significant, positive correlation was found between PT attendance and APFT sit-ups improvements (r=0.473, p=0.015). Cadets’ frequently reported additional physical activity days per week (range: 2.8–3.1 aerobic, 3.2–3.8 strength/power, 2.9–3.2 core strength/endurance).ConclusionsRegular participation in a single semester of ROTC PT was found to significantly increase cadets’ scores in some, but not all, components of the APFT and OPAT. Self-reported physical activity results indicate that cadets regularly train outside of organised PT.
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001486
Issue No: Vol. 168, No. 3 (2022)
- Impact of trauma centre capacity and volume on the mortality risk of
incoming new admissions-
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Authors:
Chiu, W. C; Powers, D. B, Hirshon, J. M, Shackelford, S. A, Hu, P. F, Chen, S. Y, Chen, H. H, Mackenzie, C. F, Miller, C. H, DuBose, J. J, Carroll, C, Fang, R, Scalea, T. M.
Pages: 212 - 217
Abstract: IntroductionTrauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions.MethodsFor a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24 hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression.ResultsThere were 42 003 (mean=7000/year) admissions having complete data sets, with 36 354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15 min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p1 hour) with SI ≥0.9, recent admissions (TRU ≤1 hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p
Keywords: Editor''s choice
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001483
Issue No: Vol. 168, No. 3 (2022)
- Effects of military life on changes in body mass index of enlisted men: a
cross-sectional study-
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Authors:
Lee, B. N; Bae, S. W, Oh, S. Y, Yoon, J. H, Roh, J, Won, J. U.
Pages: 218 - 223
Abstract: BackgroundObesity is a serious health problem with an incidence that is increasing rapidly. Enlisted men are a distinctive group characterised by 24-hour community-living and are likely to experience changes in body weight as a result of regular diet and exercise during enlistment.MethodsThis study reviewed data from the Second Military Health Survey. Changes in body mass index (BMI) before and during military service were analysed using paired t-test. We calculated OR and 95% CI for factors affecting weight improvement during military service through logistic regression.ResultsThe mean BMI in the underweight group increased by 5.87 kg/m2 during service, while that in the normal weight group increased by 1.18 kg/m2. In contrast, the mean BMI in the overweight group decreased by 5.47 kg/m2 during service. The OR for an improved BMI in the subjective good health group compared with the subjective poor health group was statistically significant (OR=1.71, 95% CI 1.02 to 2.87). The OR for an improved BMI was significantly higher in the group with three or more times per week of strength training than in the group with one to two times per week of strength training, and was higher among the marines compared with the Army soldiers (OR=1.48, 95% CI 1.03 to 2.12 and OR=2.15, 95% CI 1.07 to 4.32, respectively).ConclusionsStrength training showed a statistically significant increase in BMI during military service. Furthermore, the BMI of men who were underweight before their service increased, while it decreased among those who were overweight.
Keywords: Open access
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2019-001401
Issue No: Vol. 168, No. 3 (2022)
- Accelerated resolution therapy and a thematic approach to military
experiences in US Special Operations Veterans-
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Authors:
Hernandez, D; Kip, K. E, Long, C. J, Redman, J. L.
Pages: 224 - 228
Abstract: Accelerated Resolution Therapy (ART) is an emerging therapeutic intervention that has demonstrated effectiveness in treating post-traumatic stress, anxiety and depression. The ART protocol aligns with first-line trauma-focused psychotherapies and clinical guides in the USA and UK. This review addresses previous ART research that includes members of US Special Operations Forces. Observations from that research has led to a thematic conceptualisation of trauma through ART interventions. These include three clusters of traumatic memories and several themes relevant to individual distress but not necessarily symptoms that meet diagnostic criteria for PTSD. ART represents a movement in treatment away from the symptoms, to the individuals’ story. Not only the story of an event, but how that experience becomes incorporated into one’s sense of identity. The themes identified (and treated with ART) appear to have broader application to the entirety of one’s military experience, not just PTSD. These themes may be helpful in directing treatment and may help to focus on significant aspects of service not traditionally associated with PTSD. Theoretically, some of these areas may have protective implications in suicide.
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001729
Issue No: Vol. 168, No. 3 (2022)
- 'Assisted self-proning in a case of severe COVID-19 pneumonitis
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Authors:
Pitts, W; Cais, S, Simon, E, Hunt, D.
Pages: 229 - 230
Keywords: COVID-19
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001826
Issue No: Vol. 168, No. 3 (2022)
- Heat illness experience at BMH Shaibah, Basra, during Operation TELIC:
May-July 2003-
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Authors:
Coleman, J; Fair, S, Doughty, H, Stacey, M. J.
Pages: 231 - 236
Abstract: This is an observational study of heat-related illness in UK Service Personnel deployed into summer conditions in Northern Kuwait and Southern Iraq. Among 622 hospitalisations reported during a 9-week period at the historical British Military Hospital, Shaibah, 303 consecutive admissions are reviewed in detail. Several clinical syndromes attributable to thermal stress were observed. These ranged from self-limiting debility to life-threatening failures of homeostasis, with 5.0% developing a critical care requirement. Hyponatraemia was a commonly occurring electrolyte disturbance by which, relative to the local reference range, a majority of heat-attributed admissions were affected. Reductions in measured serum sodium could be profound (
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001922
Issue No: Vol. 168, No. 3 (2022)
- Face of a king: battlefield penetrating trauma to the midface in 1403 and
a surgeon who changed the course of history-
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Authors:
Naumann, D. N; Anderson, J. R.
Pages: 237 - 238
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001968
Issue No: Vol. 168, No. 3 (2022)
- Initial naval officer training: enhancing physical preparedness through an
improved joining instruction process-
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Authors:
Hughes, H. J. J; Stevens, J.
Pages: 239 - 240
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001707
Issue No: Vol. 168, No. 3 (2022)
- Military cold facts
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Authors:
Pinney; R.
Pages: 240 - 240
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001792
Issue No: Vol. 168, No. 3 (2022)
- Training in sexual and reproductive health
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Authors:
Willman, A. S; Boyd, J.
Pages: 241 - 241
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001800
Issue No: Vol. 168, No. 3 (2022)
- Mutually supporting: a near-peer mentoring system for military junior
doctors-
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Authors:
Bourke, S; Bertram, I, Horne, S.-J, Wong, A. K. H, Stewart, A, Wallett, L, Dufty, N. E.
Pages: 242 - 242
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2020-001762
Issue No: Vol. 168, No. 3 (2022)
- Chronic non-cancer pain training and practice-based small group learning
in defence primary healthcare-
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Authors:
Willman; A. S.
Pages: 243 - 243
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001805
Issue No: Vol. 168, No. 3 (2022)
- Evaluation of the citizenAID app as an aide-memoire for defence healthcare
engagement activity-
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Authors:
Grant, S. W. J; Cooper, W. T.
Pages: 244 - 245
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001831
Issue No: Vol. 168, No. 3 (2022)
- Seroprevalence of anti-SARS-CoV-2 IgG among adolescents at military
fitness-for-duty evaluation-
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Authors:
Giuliano, E; Gennaro, V, Milani, G. P, Bianchetti, M, Kocher, C, Buehrer, T, Mathis, B, Togni, G, Muggli, F.
Pages: 246 - 247
Keywords: COVID-19
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001828
Issue No: Vol. 168, No. 3 (2022)
- Royal Navy smoking policy
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Authors:
Richardson; K.
Pages: 247 - 247
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001866
Issue No: Vol. 168, No. 3 (2022)
- Adapting smoking cessation targets for military smokers
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Authors:
Bishop; A.
Pages: 248 - 248
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001867
Issue No: Vol. 168, No. 3 (2022)
- Use of short medical courses as a defence engagement tool
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Authors:
Elliott, L; Whitaker, J, Horne, S.
Pages: 249 - 249
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001869
Issue No: Vol. 168, No. 3 (2022)
- Converting a British-era hospital into a state-of-the-art COVID-19 care
centre-
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Authors:
Dawra, S; Patnaik, S, Tevatia, M. S, Hasnain, S, Patnaik, U, Srivastava, S, Rajnikanth, T, Satish, K.
Pages: 250 - 252
Keywords: COVID-19
PubDate: 2022-05-23T06:33:24-07:00
DOI: 10.1136/bmjmilitary-2021-001895
Issue No: Vol. 168, No. 3 (2022)
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