Military medicine
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For trauma triage, the US Army has developed a portable heart rate complexity (HRC) monitor, which estimates cardiac autonomic input and the activity of the hypothalamic-pituitary-adrenal (HPA) axis. We hypothesize that autonomic/HPA stress associated with predeployment training in U.S. Army Forward Surgical Teams will cause changes in HRC. ⋯ Various forms of HPA stress during Forward Surgical Team STXs can be objectively quantitated continuously in real time with a portable non-invasive monitor. Differences from resting baseline indicate stress anticipating an impending STX whereas differences between average and peak responses indicate the relative stress between STXs. Monitoring HRC could prove useful to field commanders to rapidly and objectively assess the readiness status of troops during STXs or repeated operational missions. In the future, health care systems and regulatory bodies will likely be held accountable for stress in their trainees and/or obliged to develop wellness options and standardize efforts to ameliorate burnout, so HRC metrics might have a role, as well.
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Casualty evacuation is a key point in medical support to military operations, sometimes being necessary to transfer them to National Territory for a definitive diagnosis and treatment. The aim of this work is to analyze the patients evacuated from Areas of Operations to the Orthopedic Surgery and Traumatology Unit of the Spanish Role 4 Medical Treatment Facility in the last 10 years. ⋯ Evacuations because of trauma cause more than half of the medical repatriations carried out on the National Territory, of which the majority are due to fractures affecting the limbs, especially the bones of the hand. Sport was the first preventable cause of injury among evacuated patients. Our results are similar to the experience obtained by other allied armed forces. It is a moral imperative and a fundamental necessity for the Spanish military medical services to promote and maintain the Spanish Role 4 Medical Treatment Facility as an indispensable element in medical support for international missions.
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The majority of the published literature on contemporary military medicine contradicts the concept of austere. Operational medicine is part of every armed conflict around the world, while armed forces of most countries internationally have limited medical resources especially in the front line. The aim of this review is to identify the particularities of a truly austere environment and present a short guide of preparation and action for military medical personnel internationally. ⋯ The military surgeon must be specially trained and prepared to use a wide range of skills in truly austere environments in contemporary conflicts.
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Prenatal maternal anxiety and depression have been implicated as possible risk factors for preterm birth (PTB) and other poor birth outcomes. Within the military, maternal conditions account for 15.3% of all hospital bed days, and it is the most common diagnostic code for active duty females after mental disorders. The majority of women (97.6%) serving on active duty are women of childbearing potential. Understanding the impact that prenatal maternal anxiety and depression can have on PTB and low birthweight (LBW) in a military population is critical to providing insight into biological pathways that alter fetal development and growth. The purpose of the study was to determine the impact of pregnancy-specific anxiety and depression on PTB and LBW within a military population. ⋯ Pregnancy-specific anxiety was found to significantly increase the risk of PTB and LBW in a military population. Understanding this relationship is essential in developing effective assessments and interventions. Results emphasize the importance of prenatal maternal mental health to fetal health and birth outcomes. Further research is needed to determine the specific physiological pathways that link prenatal anxiety and depression with poor birth outcomes.