Military medicine
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Musculoskeletal injury patterns are under-investigated in the Royal Australian Infantry Corps. Subsequently, more evidence is needed to support injury prevention processes in this population. One difficulty in collecting injury information to monitor injury patterns within combat populations accurately is known injury concealment behaviors in such populations. This study aims to examine musculoskeletal injury epidemiology within Australian infantry battalions using a tailored approach to mitigate reporting avoidance. ⋯ Musculoskeletal injuries are common in the Australian infantry and significantly burden the workforce. Physical training and field exercises are most associated with injury and represent opportunities for injury risk-mitigation strategies to support the overall deployability of personnel and the combat effectiveness of their battalions. Future research should more formally explore the injury risk factors related to these activities using more robust study designs to collect injury and exposure information more accurately and reliably. One study strength includes using military-specific international injury surveillance guidelines to inform the survey design, to collect the recommended injury information for effective surveillance, and to enable future research comparison. A second study strength was tailoring the survey to promote participatory engagement, providing a high completion rate. A challenge in conducting this research was coordinating participant recruitment and data collection during domestic operations. Such challenges reflect the reality of conducting research in the military.
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Military personnel exposed to blasts receive repeated subconcussive head impacts. Although these events typically do not cause immediate symptoms and do not lead to medical evaluation, the cumulative effects of subconcussive impacts can be significant and can include postconcussive symptoms, changes in brain structure and function, long-term cognitive dysfunction, depression, and chronic traumatic encephalopathy. Retinal measures such as thickness of retinal neural layers, density of retinal microvasculature, and strength of retinal neuronal firing are associated with cognitive function and brain structure and function in healthy populations and in neurodegenerative disease cohorts, and changes over time in retinal indices predict cognitive decline and brain atrophy in longitudinal studies in a range of medical populations. ⋯ Despite this, preclinical and human evidence suggests that they could be among the most effective methods for tracking central nervous system damage in people exposed to repeated blasts. Retinal biomarkers could also contribute to brief test batteries to determine who is most at risk for long-term negative effects of future exposures. In addition, the sensitivity of retinal indices to blast exposure and mild traumatic brain injury suggests that they should be incorporated into research on strategies to minimize or prevent blast-related short- and long-term central nervous system changes in blast-exposed military personnel.
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The prevalence of treatment-resistant depression within global and military populations highlights the need for novel treatment approaches beyond monoamine neurotransmitter modulators. Buprenorphine (BUP), a semi-synthetic partial opioid agonist, is approved for the treatment of opioid use disorder and has shown promise in treating both depression and chronic pain. ⋯ An unexpected finding was the discontinuation of prescribed hydromorphone for pain, suggesting the potential unique benefit of BUP in treating chronic pain and treatment resistant depression comorbidities. These findings implicate the diverse beneficial potential of BUP in psychiatric treatments for military populations.
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Pneumothorax (PTX) incidence in patients arriving to a trauma center can be as high as 20%. The severity of PTX can range from insignificant to life-threatening. Five percent of combat casualties sustaining thoracic trauma have tension PTX (tPTX) at the time of death. Rapid diagnosis and decompression, traditionally with a needle decompression in the prehospital setting, is essential. However, high iatrogenic injury rates reveal a need for a device with the potential to decrease injury rate without compromising decompression success. The Donaldson Decompression Needle (DDN) is a 10-gauge × 3.25 inch needle with a locking mechanism designed to prevent over-insertion. During insertion, a spring-loaded blunt tip retracts, releasing the lock. After penetration of the parietal pleura, the blunt tip projects forward, which in turn locks the device in place on the chest. The device also contains an integrated 1-way valve (OWV) to prevent causing iatrogenic PTX, if placed into a healthy lung cavity. ⋯ Despite the similar length and gauge of the DDN compared to the standard of care (SOC), the success rate of thoracic decompression was lower for the DDN when compared to the SOC (46% vs. 87%, P = .077) although statistical noninferiority was not established. Additionally, intradevice comparisons indicated decompression with the OWV on significantly prolonged decompression time when compared to when it was removed. It could be appropriate to consider removing the OWV after placement to decrease the decompression time, followed by reattachment for transport. Further research into the ability of the DDN to decrease iatrogenic injury will follow validation of decompression capabilities.
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A comparison of body composition assessments using military circumferences to bioelectrical impedance analysis (BIA) and the reference standard dual-energy X-ray absorptiometry (DEXA) can gauge effectiveness of assessments. High-frequency (500 KHz) direct segmental multifrequency bioelectrical impedance analysis (DSM-BIA) accurately calculates total water mass and body fat% (BF%), but it is unknown whether higher frequencies (1,000 KHz) increase measurement accuracy. The purpose was to compare DSM-BIA 500, DSM-BIA 1000, the DoD Circumference Method (CM), and the reference-standard DEXA. ⋯ This study found that CM BF% was moderately correlated with DSM-BIA 500 kHz, DSM-BIA 1,000 kHz BIA, and DEXA. Both DSM-BIA 500 and DSM-BIA 1,000 kHz strongly correlated well with DEXA implying that there was no further increase in correlation with increased frequency. Additionally, there was proportional bias in BF% in the female group between CM and DEXA and in the total group between CM and DSM BIA 1000.