Search Results (353)

Background/Objectives: Active-duty military personnel may use caffeinated and sweetened beverages to manage alertness and fatigue, but co-occurring beverage behaviours are rarely examined. We identified beverage-frequency co-consumption profiles in Spanish Army personnel and tested their cross-sectional associations with self-reported sleep and habitual physical fatigue. Methods: This cross-sectional study included 1155 active-duty Spanish Army personnel. Latent classes were estimated from ordinal frequencies of caffeinated beverages, sugar-sweetened beverages, and energy drinks; these indicators represented frequency categories rather than caffeine dose, sugar intake, or standardized serving size. Adjusted outcome models incorporated classification uncertainty and controlled for demographic, occupational, training, hydration, alcohol, smoking, and recruitment-cohort covariates. Results: A three-class solution identified lower-frequency (47.7%), intermediate-frequency (28.3%), and higher-frequency (24.0%) profiles. Compared with the lower-frequency profile, the higher-frequency profile was associated with 0.230 h less sleep per night (95% CI −0.416 to −0.045; q = 0.022), 2.129 percentage points lower sleep efficiency (95% CI −4.177 to −0.082; q = 0.041), and 0.395 points greater habitual physical fatigue (95% CI 0.077 to 0.714; q = 0.022). Sensitivity analyses were directionally consistent. Conclusions: Beverage-frequency responses clustered into three profiles. The higher-frequency profile was cross-sectionally associated with shorter self-reported sleep, lower sleep efficiency, and higher habitual physical fatigue. The sleep-duration contrast was approximately 13.8 min/night, but the clinical or perceptible relevance of the sleep-efficiency and fatigue differences cannot be established from these self-reported measures. Prospective studies with product-specific dose and timing data are required to establish temporality and practical relevance. Full article

Background and Objectives: Military parachuting combines landing impact, carried load, and restricted visual information. This study examined the concurrent associations of two primary task exposures—recent jump volume and participation in at least one night jump with equipment—with self-reported parachuting-related musculoskeletal problems; individual characteristics were treated as adjustment variables or exploratory factors. Methods: A cross-sectional study was conducted in 105 parachutists from the Sapper Battalion of the Spanish Parachute Brigade. Exposure and outcome were both recalled for the same preceding 12 months, and their temporal sequence was not recorded. Prevalence was estimated with Wilson 95% confidence intervals, and the two primary exposures were entered simultaneously in Firth bias-reduced logistic regression adjusted for age and body mass index. A modified Poisson model with robust standard errors estimated adjusted prevalence ratios as a sensitivity analysis. Results: Forty-eight participants (45.7%) reported at least one parachuting-related musculoskeletal problem during the preceding year, most frequently at the knee, low back, and upper back or neck. Problems were reported by 79.4% of participants who had performed night jumps with equipment and by 29.6% of those who had not. Night jumps with equipment were associated with the outcome (odds ratio 7.13, 95% confidence interval 2.71–20.66), whereas recent jump volume was not. The adjusted prevalence ratio for the combined exposure was 2.44 (95% confidence interval 1.63–3.64). Conclusions: Night jumps with equipment showed a concurrent association with self-reported musculoskeletal problems, but the design cannot establish whether the exposure preceded the problem or separate the contributions of darkness and equipment. The findings should be treated as hypothesis-generating for prospective, jump-level surveillance. Full article

Artificial Intelligence (AI) is increasingly embedded in contemporary military operations, yet its effective and ethical integration depends largely on how defense institutions educate and prepare personnel. While technological advancements receive significant attention, the pedagogical systems that enable responsible adoption remain underexamined. This study examines how AI can be systematically incorporated into professional military education and training for irregular warfare. Using qualitative doctrinal analysis and thematic synthesis of United States and NATO policy documents and scholarly literature, the research develops a five-layer instructional framework linking strategic alignment, doctrinal integration, operational learning, data-driven intelligence education, and human-AI governance. Findings indicate that successful AI adoption requires coordinated reforms in doctrine, instructional design, and ethical oversight rather than isolated technical training, supported by experiential learning and continuous professional development. By reframing AI integration as a pedagogical transformation rather than a purely technical upgrade, this research offers practical guidance for educators, policymakers, and training institutions seeking to enhance operational readiness while preserving transparency, accountability, and principled human judgment. The framework is intended to safeguard against the potential misuse of AI by embedding rigorous ethical governance, accountability, and appropriate human oversight throughout military education and training. Full article

For deployed military personnel, a single exposure from a rabies-infected animal can become a death sentence. With a case fatality rate approaching 100%, rabies remains a serious, yet insufficiently acknowledged hazard for service members, for whom prevention in operational environments poses unique challenges. We conducted a systematic literature search to identify relevant studies on rabies risk in armed forces personnel. By analysing rabies-related fatalities in the military, this review highlights the operational challenges posed by animal bites during deployment, including underreporting and delayed access to care, which compromise timely post-exposure prophylaxis (PEP) administration. Special emphasis is placed on prevention strategies, including pre-exposure prophylaxis (PrEP) and animal control protocols tailored to military settings. Its aim is to provide a comprehensive, evidence-based resource for healthcare professionals involved in the protection of deployed forces against this ancient yet still deadly infectious disease. Full article

We performed a focused review to better understand the pathogenesis of Agent Orange (AO)-associated myelodysplastic syndrome (MDS). We first examined the mechanisms underlying conventional (de novo) MDS, a clonal hematopoietic neoplasm that typically develops in later life, and integrated these findings with our recent analysis of obesity-associated carcinogenesis. Accordingly, we propose that genomic instability in de novo MDS results from selective inhibition of the DNA polymerase proofreading exonuclease. In obesity-associated carcinogenesis, impaired AMP-activated protein kinase (AMPK) activity disrupts mitochondrial ATP production, increasing intracellular AMP concentrations. Elevated AMP selectively inhibits the proofreading exonuclease while preserving polymerase activity, allowing replication errors to escape correction and become fixed as somatic mutations. Molecular studies demonstrate that AO-associated MDS exhibits essentially the same mutational profile as de novo disease despite arising after 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure in young, otherwise healthy military personnel. Because TCDD is highly lipophilic, it accumulates in adipose tissue and is released slowly over decades, producing sustained mitochondrial dysfunction, reduced ATP synthesis, and chronic elevation of intracellular AMP. We propose that this metabolic disturbance converges on the same endpoint—selective inhibition of the proofreading exonuclease—thereby promoting mutagenesis and clonal evolution. Recent studies further strengthen the central role of proofreading by demonstrating that many mutations, including many found in MDS, previously attributed to spontaneous cytosine deamination, instead arise from DNA polymerase misincorporation of thymidine opposite cytosine, particularly at CpG dinucleotides, emphasizing the critical importance of fully active proofreading in preventing such misincorporations from accumulating as mutations in the genome of the cell. Full article

Background: Standardized institutional feeding systems determine nutritional adequacy entirely through how the provided diet is formulated, yet how completely that formulation is documented is rarely examined. Military operational rations are the most widely deployed example of such a system. Objectives: We aimed to map the global availability of publicly accessible ration composition data; to assess the compositional adequacy of rations with complete profiles; and to test whether dietary diversity predicts micronutrient adequacy where dietary choice is absent. Methods: A standardized seven-step search was applied across 69 countries grouped into ten geopolitical clusters. All analyses used planned ration composition from official and published sources, not the food actually consumed. Compositional adequacy was quantified as mean per-nutrient coverage of the Dietary Reference Intake, and a separate diversity score was correlated with this aggregate measure. Results: Complete micronutrient profiles were publicly accessible for only 8 of 69 countries (11.6%), with post-conflict states showing the highest data-absence rate (80.0%). Vitamin D was the only nutrient critically low across all eight complete-data rations, ranging from 2.9% to 30.0% of the Dietary Reference Intake—a compositional feature, not a measure of personnel status. The correlation between aggregate adequacy and dietary diversity was negligible (r = −0.042). Pakistan’s high aggregate score (90.29%) coexisted with vitamin D at 2.9%, showing how aggregate scores mask single-nutrient deficiencies. Conclusions: Per-nutrient compositional assessment is essential for evaluating standardized institutional feeding; low public data availability does not imply absent nutritional planning. Full article

Objectives: To analyze the effect of whole-body cryotherapy on exercise tolerance in healthy, training men related to their profession based on the 6 min walk test (6MWT). Methods: The study group consisted of 30 individuals aged 24 to 59 years (mean age 39.2; median 38, SD 8.72). The subjects were soldiers from the Special Forces Unit (Military Unit GROM) and officers from the State Protection Service (SOP). All participants underwent a physical fitness assessment using the 6 min walk test: before the study, after two weeks of kinesiotherapy, and after 10 cryotherapy sessions combined with exercise on a stationary bicycle. Kinesiotherapy consisted of 20 min of cycling on a stationary bicycle (cycloergometer) under the supervision of trained personnel (with a load of 50–100 W) from Monday to Friday, from 11 a.m. to 12 noon. Whole-body cryostimulation treatments took place from Monday to Friday from 11 a.m. to 12 noon, entering the cryogenic chamber with a temperature of −130 °C for 2 min, then they went to the gym and rode a stationary bicycle (cycloergometer) for 20 min under the supervision of trained personnel (with a load of 50–100 W). Results: Both analyzed factors, i.e., 20 min of stationary cycle ergometer riding and whole-body cryostimulation treatments combined with kinesiotherapy, had a statistically significant effect on improving 6 min walk test results. The obtained results indicate that the impact of the exercise program was slightly greater than the impact of a series of 10 whole-body cryotherapy treatments followed by cycle ergometer riding. Conclusions: Both physical activity and cryostimulation had an impact on the physical performance of the subjects, but the obtained results indicate that the impact of exercise alone was slightly greater. Full article

The study explores the trauma experiences and gendered labor of Ukrainian women working as local fixers for international major media outlets covering the Russian war. Using semi-structured interviews (N = 15) with Ukrainian women fixers and drawing on feminist standpoint epistemology and embodied journalism, this research investigates how they perceive and perform their roles in a male-dominated professional environment. Women fixers’ work is shaped by lived, embodied experiences and an alternative knowledge of conflict. The fixers have an unofficial leadership role in international news teams, describing themselves as producers who shape editorial decisions, ensure safety, and influence coverage. From a feminist standpoint, their experiences show how lived experiences afford them authority in war reporting, even when it is not formally recognized. However, they face gender inequalities, primarily from male foreign correspondents who question their competency, as well as from Ukrainian military personnel who undermine their expertise and authority. Women fixers have also received unwanted sexual propositions from other freelancers in the media teams. Participants acknowledged that they have been traumatized by the war coverage, and they do not receive sufficient institutional support, but they invest in self-funded coping strategies. Full article

Background: Psychological adaptation in high-demand contexts such as the military depends on the interaction of multiple emotional and psychological resources. Previous research has mainly examined emotional intelligence, resilience, and self-esteem using latent variable approaches, limiting understanding of how these variables dynamically interact within a broader network of interacting psychological resources. Objective: The present study aimed to analyze the network of relationships among emotional intelligence dimensions, resilience, and self-esteem, identifying the most central variables, their degree of clustering, and the strength of their associations. Methods: A cross-sectional study was conducted with 739 Spanish military personnel (M = 33.29; SD = 7.48). A regularized partial correlation network was estimated using the EBICglasso method (γ = 0.5). Centrality indices (strength and expected influence), clustering coefficients, and node predictability were analyzed. Network accuracy and stability were assessed through bootstrap procedures. Results: The estimated network showed moderate connectivity, indicating meaningful interrelations among emotional intelligence dimensions, resilience, and self-esteem. General mood and adaptability emerged as the most central nodes within the network. Resilience showed strong positive associations with adaptability and general mood, whereas self-esteem occupied a more peripheral position. Clustering analyses revealed a cohesive organization among adaptive emotional resources. Conclusions: Emotional intelligence dimensions and related psychological resources can be conceptualized as a dynamically interacting system associated with emotional adaptation in military personnel. The identification of central components may contribute to the development of targeted interventions aimed at strengthening emotional regulation and psychological adaptation in high-demand environments. Full article

Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy among U.S. military service members (SMs), yet the impact of deployment and deployment-related factors on survival remains unclear. Modern military service involves potential exposure to environmental hazards and trauma that could plausibly influence lymphoma biology, treatment tolerance, or long-term outcomes. Methods: Tricare beneficiaries with NHL diagnosed between 2001 and 2022 were identified from the Defense Health Agency Cancer Registry. Deployment history, demographics, lymphoma subtype, and mortality data were obtained from linked Department of War and National Death Index sources. Survival was compared between previously deployed (9/11 DEP) and non-deployed (NON-9/11 DEP) SMs using multivariable Cox models. Among deployed SMs, associations between deployment characteristics and mortality were evaluated. Results: Among 745 SMs, 378 had deployed, and 367 had not. There were no significant differences in all-cause, lymphoma-specific, or non-lymphoma mortality between cohorts. Deployment location, duration, number of deployments, and occupational category did not affect survival. Histologic differences between cohorts, higher diffuse large B-cell lymphoma and follicular lymphoma in deployed SMs, and higher T-cell lymphomas and marginal zone lymphoma in non-deployed SMs, were more consistent with unmeasured confounding and differential deployability than with deployment-related risk. Conclusions: These findings do not suggest major survival differences attributable to deployment status. Given the lack of publicly available validated exposure assessment tools for military personnel, as current military operations expand, including recent deployments to the Middle East, proactive and systematic approaches to exposure assessment are urgently needed. Strengthening military cancer registries and embedding validated exposure tools will be essential to proactively anticipate, identify, and manage exposure-related hematologic concerns in future Veterans. Full article

Data on menstrual health, energy availability, and injury risk in women undertaking extreme ultra-endurance expeditions remain limited. We conducted a prospective cohort study of the first all-female UK military team competing in a 3000-mile transatlantic rowing race, aiming to characterize menstrual function, low energy availability (LEA) risk, eating disorder (ED) risk, and injury profiles. Four female British Army personnel completed the 46-day race. Menstrual symptoms, injuries, and illnesses were recorded daily, while reproductive, inflammatory, biochemical, and hematological markers were assessed before and after the race. LEA and ED risk were evaluated using the Low Energy Availability in Females Questionnaire and Brief Eating Disorder in Athletes Questionnaire, respectively. Analyses were primarily descriptive. Three athletes experienced amenorrhea during the expedition, including one with previously regular cycles. The fourth reported intermittent abnormal bleeding associated with injury and illness and screened positive for LEA risk before and after the race. Another athlete screened positive for ED risk at both time points. Most biomarkers remained stable post-race, whereas reproductive hormones showed consistent reductions in follicle-stimulating hormone and luteinizing hormone in all four participants, alongside increased oestradiol. These findings, based on a sample of four athletes, suggest that menstrual function may be sensitive to sustained physiological stress in extreme ultra-endurance settings, and support prospective monitoring in female ultra-endurance, military, and expeditionary populations. Full article

Dengue virus infection remains a significant public health challenge in endemic regions, with growing evidence of autochthonous transmission in Europe. Assessing serological exposure in high-risk populations such as military personnel deployed to endemic areas is essential to quantify exposure risk and support operational decision-making, particularly regarding pre-deployment counselling and risks associated with secondary infection. We conducted a cross-sectional study involving 1355 members of the Italian Armed Forces, measuring anti-dengue IgG antibodies by ELISA and collecting data on deployment history and exposure risk. Overall, IgG seropositivity was 8.12%, with significantly higher prevalence among individuals reporting travel or deployment to endemic regions (24.71%) compared with non-exposed personnel (4.27%). Seropositivity increased with age and correlated with a CDC-derived cumulative dengue risk score (Spearman’s ρ = 0.299, p < 0.0001). A multivariable logistic regression model including age and exposure risk achieved an AUC of 0.75, while machine-learning models provided complementary predictive assessment, with random forest reaching an AUC of 0.79. These findings indicate substantial anti-dengue IgG seropositivity compatible with previous dengue exposure among Italian military personnel, particularly those deployed to endemic settings. The study highlights the need for targeted surveillance and risk-based preventive strategies, and supports the use of exposure-based models to improve epidemiological assessment and inform vaccination strategies in mobile populations. Full article

Peacekeeping operations in sub-Saharan Africa continue to be impacted by malaria both in-country and among returning service members. The Royal Thai Army (RTA) deploys an engineering company to Juba and Rumbek, South Sudan to conduct peacekeeping operations as part of the UN Mission in South Sudan (UNMISS). Each deployment is approximately 12 months long. The unit is given doxycycline one week before travel before switching to the UN-provided mefloquine during deployment and for four weeks after returning. The RTA routinely conducts post-deployment screening for malaria by microscopy and PCR for units returning from UNMISS. High rates of prophylaxis failure were observed from both during-mission and post-deployment screening cases, with cumulative malaria attack rates of 11.4% (31 cases out of 271 personnel), 18.2% (49 cases out of 270 personnel), and 23.1% (63 cases out of 273 personnel) for 2023, 2024, and 2025, respectively, with 98% of cases being due to P. falciparum. Furthermore, post-deployment screening revealed high rates of sub-microscopic and sub-clinical parasitemia with 40% of all malaria cases being identified as asymptomatic during post-deployment screening, and 61% of those asymptomatic cases being detected by PCR only. While factors underlying the high prophylaxis failure rate, as well as the high rate of sub-microscopic and sub-clinical parasitemia are unclear, these findings highlight the limitations of relying on clinical symptoms or microscopy for detecting malaria in military units returning from endemic regions and underscore the importance of unit-wide post-deployment molecular screening. Full article

This study aimed to assess the risks associated with ultraviolet radiation (UVR) exposure among military outdoor workers at Lohatla Military Base, South Africa, and to inform targeted risk reduction strategies. A quantitative, cross-sectional design was employed, using a questionnaire survey with 161 participants (81% completion rate; 58.39% male; the largest age group was 19–25 years) and five days of objective environmental monitoring. Environmental data confirmed the presence of elevated solar ultraviolet radiation conditions, with peak irradiance levels recorded between 12:00 PM and 1:00 PM, while temperature highs frequently exceeded 35 °C (peaking at 39 °C). Statistical analysis using Spearman’s rank-order correlation revealed strong positive associations among sun protection behaviours, including wearing protective clothing, hat use, sunscreen use, and avoidance of peak sun exposure hours (ρ values up to 0.764, p < 0.001), indicating the clustered and interdependent nature of effective sun safety practices. Furthermore, engagement in protective behaviours was significantly associated with improved health outcomes, including a lower incidence of sunburn (ρ = 0.407, p < 0.001) and reduced hyperpigmentation (ρ = 0.438, p < 0.001). These findings indicate that combined protective strategies are associated with reduced self-reported dermatological outcomes. Despite the benefits of individual behaviours, military personnel remain exposed to high levels of environmental ultraviolet radiation, underscoring the need for institutional, evidence-based policy interventions to mitigate occupational exposure risks. The study concludes that military organisations should implement mandatory administrative controls (e.g., schedule adjustments), standardise high-ultraviolet-protection-factor protective gear, and enhance targeted health literacy training to mitigate long-term UV-related health risks and improve the operational effectiveness of their workers. Full article

Objectives: Traumatic fractures represent a considerable burden to military personnel across nations. Despite substantial research examining traumatic fracture incidence and risk factors, there is no comprehensive synthesis of evidence on traumatic bone fractures in military populations. This study aimed to identify and synthesise findings from studies reporting on the incidence of, and risk factors for, traumatic fractures in military personnel. Design: Systematic review. Methods: A structured search was performed in PubMed, EBSCO, CINAHL, and ProQuest using key terms related to fractures, occupational exposure, and risk. Eligible studies were screened, and key findings including risk factors, incidence rates, and effect sizes were systematically extracted and summarised. Results: Twenty-nine studies were included, with four studies reporting on recruits/trainees and 25 on qualified personnel. Recruit incidence ranged from 21.8 to 105.3 fractures per 1000 person-years, while the incidence in qualified personnel ranged from 1.9 to 57.6 fractures per 1000 person-years. Enlisted personnel, younger servicemembers (18–29 years), and personnel of the Army and Marine Corps branches were at increased risk. Traumatic fractures predominantly occurred in the lower extremities. Risk factors and mechanisms for traumatic fractures in military personnel included sports participation and physical training. Other common mechanisms included motor vehicle accidents and collisions, and (in combat settings) blasts from improvised explosive devices and gunshot wounds. Conclusions: Traumatic fractures are a substantial source of injury across military careers, not limited to initial training. Army and Marine Corps personnel face higher fracture risks, particularly in the lower limbs, with sports/physical training and combat-related risk factors associated with increased susceptibility. Full article