Introducing a new method to record injuries during military training: a prospective study among 296 young Norwegian conscripts.

INTRODUCTION: Most epidemiological studies in the field of military medicine have been based on data from medical records and registries. The aims of this study were to test a self-reporting injury surveillance system commonly used in sports medicine in a military setting, and to describe the injury pattern among Norwegian army conscripts during a period of military training. METHOD: A total of 296 conscripts in His Majesty the King's Guard were asked to report all injuries each week for 12 weeks, using a modification of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). We recorded all injuries irrespective of their need for medical attention or consequences for military participation. In addition, we retrieved data on injuries recorded by military physicians in the medical record from the Norwegian Armed Forces Health Register. RESULTS: The mean weekly response rate was 74%. A total of 357 injuries were recorded, of which 82% were only captured through the OSTRC-H2 and 3% only in the medical records. The average weekly prevalence of injury was 28% (95% CI: 25% to 31%), and 10% (95% CI: 8% to 12%) experienced injuries with a substantial negative impact on training and performance. The greatest injury burden was caused by lower limb injuries, with knee and foot injuries as the predominant injury locations. CONCLUSION: The OSTRC-H2 is suitable for use in a military setting and records substantially more injuries than the standard medical record. The prevalence of injuries among conscripts is high and comparable with many elite sports.

Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline.

CLINICAL QUESTION: What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. CURRENT PRACTICE: Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. RECOMMENDATION: The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying to become pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or young adults (such as those ≤30 years old). HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. THE EVIDENCE: The systematic review included 21 trials with 2192 participants. For adults with SCH, thyroid hormones consistently demonstrate no clinically relevant benefits for quality of life or thyroid related symptoms, including depressive symptoms, fatigue, and body mass index (moderate to high quality evidence). Thyroid hormones may have little or no effect on cardiovascular events or mortality (low quality evidence), but harms were measured in only one trial with few events at two years' follow-up. UNDERSTANDING THE RECOMMENDATION: The panel concluded that almost all adults with SCH would not benefit from treatment with thyroid hormones. Other factors in the strong recommendation include the burden of lifelong management and uncertainty on potential harms. Instead, clinicians should monitor the progression or resolution of the thyroid dysfunction in these adults. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of thyroid hormones in multilayered evidence summaries and decision aids available in MAGIC (https://app.magicapp.org/) to support shared decisions and adaptation of this guideline.

Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline

What are the benefits and harms of thyroid hormones for adults with subclinical hypothyroidism (SCH)? This guideline was triggered by a recent systematic review of randomised controlled trials, which could alter practice. Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing. The guideline panel issues a strong recommendation against thyroid hormones in adults with SCH (elevated TSH levels and normal free T4 (thyroxine) levels). It does not apply to women who are trying tobecome pregnant or patients with TSH >20 mIU/L. It may not apply to patients with severe symptoms or youngadults (such as those ≤30 years old).