| 1. |
- Andersson, Håkan, et al.
(author)
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Well-Tolerated Chemoprophylaxis Uniformly Prevented Swedish Soldiers from Plasmodium falciparum Malaria in Liberia, 2004-2006
- 2008
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In: Military medicine. - 0026-4075 .- 1930-613X. ; 173:12, s. 1194-1198
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Journal article (peer-reviewed)abstract
- Background: Between 2004 and 2006, 1,170 Swedish soldiers were deployed to Liberia. They were prescribed mefloquine or atovaquone/proguanil as malaria chemoprophylaxis. Our study aims were to estimate the chemoprophylaxis effectiveness and adverse events. Methods: Cases of malaria were routinely reported during and after the mission. After return to Sweden, the soldiers filled in a questionnaire concerning type of accommodation, use of prophylaxis, and adverse events. Results: No cases of Plasmodium falciparum malaria were recorded during a total of 7,000 person-months. Adverse events (AE) were reported by 57% in the mefloquine group and 34% in the atovaquone/proguanil group. In the mefloquine group, the soldiers reported more neuropsychological AE. Conclusions: Both drugs were safe and 100% effective as lone-term prophylaxis for prevention of P. falciparum malaria. Atovaquone/proguanil was better tolerated with respect to self-reported AE.
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| 2. |
- Andersson, Sten-Ove, et al.
(author)
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Fixing the wounded or keeping lead in the air-tactical officers' views of emergency care on the battlefield.
- 2015
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In: Military medicine. - : Association of Military Surgeons Us. - 0026-4075 .- 1930-613X. ; 180:2, s. 224-229
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Journal article (peer-reviewed)abstract
- The aim of this study was to identify tactical officers' views of prehospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat-oriented including being able to do one's specialist task, being able to talk with local people, and being able to give first aid, and (2) combat-oriented including soldiers' skills and roles in the unit, being able to act in the unit, and being able to lead the care of injured. These findings are important for officers' preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.
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| 3. |
- Andersson, Sten-Ove, et al.
(author)
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Interaction, Action, and Reflection : How Medics Learn Medical Care in the Swedish Armed Forces
- 2013
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In: Military medicine. - : Association of Military Surgeons of the U S. - 0026-4075 .- 1930-613X. ; 178:8, s. 861-866
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Journal article (peer-reviewed)abstract
- The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how learning is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. interaction during the period of education is important for learning. action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. reflection, learning to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.
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| 4. |
- Bersani, F. Saverio, et al.
(author)
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Novel Pharmacological Targets for Combat PTSD-Metabolism, Inflammation, The Gut Microbiome, and Mitochondrial Dysfunction
- 2020
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In: Military medicine. - : Oxford University Press (OUP). - 1930-613X .- 0026-4075. ; 185:1, s. 311-318
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Current pharmacological treatments of post-traumatic stress disorder (PTSD) have limited efficacy. Although the diagnosis is based on psychopathological criteria, it is frequently accompanied by somatic comorbidities and perhaps "accelerated biological aging," suggesting widespread physical concomitants. Such physiological comorbidities may affect core PTSD symptoms but are rarely the focus of therapeutic trials. METHODS: To elucidate the potential involvement of metabolism, inflammation, and mitochondrial function in PTSD, we integrate findings and mechanistic models from the DOD-sponsored "Systems Biology of PTSD Study" with previous data on these topics. RESULTS: Data implicate inter-linked dysregulations in metabolism, inflammation, mitochondrial function, and perhaps the gut microbiome in PTSD. Several inadequately tested targets of pharmacological intervention are proposed, including insulin sensitizers, lipid regulators, anti-inflammatories, and mitochondrial biogenesis modulators. CONCLUSIONS: Systemic pathologies that are intricately involved in brain functioning and behavior may not only contribute to somatic comorbidities in PTSD, but may represent novel targets for treating core psychiatric symptoms.
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| 5. |
- Björkman, Frida, et al.
(author)
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Physical Exercise as Treatment for PTSD : A Systematic Review and Meta-Analysis.
- 2022
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In: Military medicine. - : Oxford University Press. - 0026-4075 .- 1930-613X. ; 187:9-10, s. 1103-e1113
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Research review (peer-reviewed)abstract
- INTRODUCTION: Post-traumatic stress disorder (PTSD) is a cluster of physical and psychiatric symptoms following military or civilian trauma. The effect of exercise on PTSD symptoms has previously been investigated in several studies. However, it has not been fully determined what type of exercise most impacts PTSD symptoms. The aim of the present study was to systematically review the effects of different types of exercise on PTSD symptom severity and symptoms of coexisting conditions in adults.MATERIALS AND METHODS: Electronic searches were conducted in the databases PubMed, APA PsycInfo, and SportDiscus, from database inception up until February 1, 2021. Inclusion criteria were randomized controlled trials published in English, participants having a PTSD diagnosis or clinically relevant symptoms, and participants randomly allocated to either a non-exercising control group or an exercise group. Data concerning the number of participants, age, exercise type and duration, PTSD symptom severity (primary outcome), and symptoms of coexisting conditions (secondary outcomes) were extracted. The subgroup analysis included high or low training dose, military trauma versus non-military trauma, the type of intervention (yoga versus other exercise), active or passive control condition, group training versus individual exercise, and study quality. The study quality and risk of bias were assessed using grading of recommendation assessment, development and evaluation (GRADE) guidelines. A meta-analysis was performed with a mixed-effects model and restricted maximum likelihood as model estimator, and effect size was calculated as the standardized difference in mean and 95% CI.RESULTS: Eleven studies were included in the present review. Results showed a main random effect of exercise intervention (0.46; 95% CI: 0.18 to 0.74) and a borderline significant interaction between more voluminous (>20 hours in total) and less voluminous (≤20 hours in total) exercise interventions (P = .07). No significant findings from the subgroup analysis were reported. The secondary outcome analysis showed a small but significant effect of exercise on depressive symptoms (0.20, 95% CI: 0.01 to 0.38), and a larger effect on sleep (0.51, 95% CI: 0.29 to 0.73). For substance use (alcohol and drugs combined) and quality of life, we found significant effects of 0.52 (95% CI: 0.06 to 0.98) and 0.51 (95% CI: 0.34 to 0.69), respectively. No significant effect was found for anxiety (0.18, 95% CI: -0.15 to 0.51), and no sign of publication bias was found.CONCLUSIONS: Exercise can be an effective addition to PTSD treatment, and greater amounts of exercise may provide more benefits. However, as there were no differences found between exercise type, possibly due to the inclusion of a low number of studies using different methodologies, further research should aim to investigate the optimal type, dose, and duration of activity that are most beneficial to persons with PTSD.
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| 6. |
- Godhe, Manne, et al.
(author)
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Physiological Factors of Importance for Load Carriage in Experienced and Inexperienced Men and Women.
- 2020
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In: Military medicine. - : Oxford University Press. - 0026-4075 .- 1930-613X. ; 185:7-8, s. E1168-E1174
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Journal article (peer-reviewed)abstract
- INTRODUCTION: The ability to carry heavy loads is an important and necessary task during numerous outdoor activities and especially in military operations. The aim of this study was to investigate factors associated with load-carrying ability in men and women with and without extensive load-carrying experience.MATERIALS AND METHODS: The energy expenditure during carrying no load, 20, 35, and 50 kg at 2 walking speeds, 3 and 5 km h-1, was studied in 36 healthy participants, 19 men (30 ± 6 years, 82.5 ± 7.0 kg) and 17 women (29 ± 6 years, 66.1 ± 8.9 kg), experienced (>5 years) in carrying heavy loads (n = 16, 8 women) or with minor or no such experience (n = 20, 9 women). A standard backpack filled with weights to according carry load was used during the walks. Anthropometric data, leg muscle strength, as well as trunk muscle endurance and muscle fiber distribution of the thigh, were also obtained. Extra Load Index (ELI)-the oxygen uptake (VO2) during total load over unloaded walking-was used as a proxy for load-carrying ability at 20, 35, and 50 kg (ELI20, ELI35, and ELI50, respectively). In addition to analyzing factors of importance for the ELI values, we also conducted mediator analyses using sex and long-term carrying experience as causal variables for ELI as the outcome value. The study was approved by the Regional Ethics Committee in Stockholm, Sweden.RESULTS: For the lowest load (20 kg), ELI20, was correlated with body mass but no other factors. Walking with 35 and 50 kg load at 5 km h-1 body mass, body height, leg muscle strength, and absolute VO2max were correlated, while relative VO2max, trunk muscle endurance, and leg muscle fiber distribution were not correlated to ELI35 and ELI50.ELI50 at 5 km h-1 differed between the sexes. This difference was only mediated by the difference in body mass. Neither muscle fiber distribution, leg muscle strength, trunk muscle endurance, and body height nor did absolute or relative VO2max explain the difference.Participants with long-term experience of heavy load carrying had significant lower ELI20 and ELI50 values than those with minor or no experience, but none of the above studied factors could explain this difference.CONCLUSION: The study showed that body mass, without sex differences, and experience of carrying heavy loads are the dominant factors for the ability to carry heavy loads. Even though the effect of experience alludes to the need for extensive carrying training, no causality can be proven. Load carry training intervention studies is suggested for future investigations.
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| 7. |
- Grafte, Lars, et al.
(author)
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A literature review of recovery and cortisol among military personnel
- 2023
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In: Military medicine. - : Oxford University Press. - 0026-4075 .- 1930-613X.
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Journal article (other academic/artistic)abstract
- IntroductionRecovery is an essential factor in having a natural resistance to stress. When the body is exposed to a physiological or psychological stressor, a stress reaction occurs, and cortisol is released. This can affect the body in the short and long term. Militaries often practice in realistic scenarios to build resistance to stress and have the conditions to cope with actual events. During the exercises, the military is exposed to both physiological and psychological stress for long periods. After exercises, the body needs to recover to rebuild. Recovery is, therefore, an essential factor for the body. However, there is a research gap for long-term extreme exposure to stress in relation to recovery. The purpose of this study was to review the documentation on the relationship between cortisol levels, stress, and recovery for military personnel.Materials and MethodsA general literature study with a descriptive approach was carried out. Cortisol measured from serum, blood plasma, and saliva was included. Only full-text, peer-reviewed papers found in databases from the last 25 years were used. Diagnoses, drug use, or other issues affecting cortisol secretion were excluded. Four databases were searched, and nine relevant quantitative articles were found. A quantitative content analysis was done, and a descriptive result was generated.Results In the literature study, it became apparent that cortisol levels both increase and decrease in professionals in the military when they are exposed to extreme field exercises with insufficient recovery, causing cortisol levels not to return to their basal levels. The analysis of the included articles gave answers to three questions about the role of recovery in a military context. One study was found where cortisol levels and the recovery period differed between women and men. After field training and a 72-hour recovery period, the men's cortisol levels were back to basal levels, while the women's cortisol levels remained elevated for over two weeks. The Conclusion The literature review shows the lack of data on the impact of recovery for military personnel. A study containing both women and men in a group setting was found. Results show significantly longer recovery for women, making it an important research gap. As secrecy is often used in the military context, not all information is published. This affects the quality of the studies and the possibility for high transferability and validity. A longitudinal approach with a larger sample size and additional females should be considered in future studies for comparable results. In addition, more measurement points and a systematization would be desirable with cortisols natural deviations taken into account.
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| 8. |
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| 9. |
- Hooke, Alexander W., et al.
(author)
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Mechanical Assessment of Tissue Properties During Tourniquet Application
- 2021
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In: Military medicine. - : OXFORD UNIV PRESS. - 0026-4075 .- 1930-613X. ; 186, s. 378-383
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Journal article (peer-reviewed)abstract
- Introduction: Successful tourniquet application increases survival rate of exsanguinating extremity hemorrhage victims. Tactile feedback during tourniquet application training should reflect human tissue properties in order to increase success in the field. This study aims to understand the mechanical properties of a human limb during tourniquet application. Method: Six cadaveric extremities-three uppers and three lowers-were tested from three body mass index groups: low (<19) healthy (19-24), and overweight (>24). Each specimen donned with a tourniquet and mounted to a servo-hydraulic testing machine, which enabled controlled tightening of the tourniquet while recording the tourniquet tension force and strap displacement. A thin-film pressure sensor placed between the specimen and the tourniquet recorded contact pressure. Each limb was tested with the tourniquet applied at two different sites resulting in testing at the upper arm, forearm, thigh, and shank. Results: The load displacement curves during radial compression were found to be nonlinear overall, with identifiable linear regions. Average contact pressure under the tourniquet strap at 200N and 300N of tension force was 126.3 (sigma= 41.2) mm Hg and 205.3 (sigma = 75.3) mm Hg, respectively. There were no significant differences in tissue stiffness or contact pressure at 300N of tension force between limb (upper vs. lower) or body mass index. At 200N of tension, the upper limb had significantly higher contact pressure than the lower limb (P= 0.040). Relative radial compression was significantly different between upper (16.74, sigma = 4.16%) and lower (10.15, sigma = 2.25%) extremities at 200N tension (P= 0.005). Conclusions: Simulation of tissue compression during tourniquet application may be achieved with a material exhibiting elastic properties to mimic the force-displacement behavior seen in cadaveric tissue or with different layers of material. Different trainers for underweight, healthy, and overweight limbs may not be needed. Separate tourniquet training fixtures should be created for the upper and lower extremities.
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| 10. |
- Johansson, C. A., et al.
(author)
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A comparison of experiences of training emergency care in military exercises and competences among conscript nurses with different levels of education
- 2007
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In: Military Medicine. - : Association of Military Surgeons. - 0026-4075 .- 1930-613X. ; 172:10, s. 1046-1052
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Journal article (peer-reviewed)abstract
- The military emergency care education of nurses is primarily concerned with the treatment of soldiers with combat-related injuries. Even though great progress has been made in military medicine, there is still the pedagogical question of what emergency care education for military nurses should contain and how it should be taught. The aim of this study was to describe and compare experiences of training emergency care in military exercises among conscript nurses with different levels of education. A descriptive study was performed to describe and compare experiences of training emergency care in military exercises among conscript nurses with different levels of education in nursing. There were statistical differences between nurses with general nursing education and nurses with a general nursing education and supplementary education. A reasonable implication of the differences is that the curriculum must be designed differently depending on the educational background of the students. Hence, there is an interaction between background characteristics, e.g., the level of previous education and differences pertaining to clinical experience of the participants, and the impact of the exercise itself.
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