Prolonged mounted patrolling is a risk factor for developing knee pain in Danish military personnel deployed to the Helmand Province.

INTRODUCTION: Non-battle injuries have been the leading cause of medical evacuation in the recent wars in Afghanistan and Iraq. This study investigates the hypothesis, that the occurrence of knee problems could be associated with mounted patrolling in armoured vehicles independent of other risk factors. METHOD: Retrospective questionnaire-based cohort study of Danish soldiers deployed to Afghanistan during 1 February-31 July 2013. RESULTS: 307 soldiers included. Response rate 70%. 33% reported knee pain. MAIN FINDING: Significant association between knee pain and time spent weekly on mounted patrols (OR 1.23, CI 1.07 to 1.41, p=0.003). Controlled for confounders age, body mass index and duration of military employment (OR 1.22, CI 1.06 to 1.41, p=0.006). Adjusted for confounders and all other risk factors (OR 1.25, CI 1.07 to 1.48, p=0.007). The main finding in a subset of the 33% with knee pain: Significant association between more severe knee problems with Knee injury and Osteoarthritis Outcome Score below 400 and time spent weekly on mounted patrols (OR 1.49, CI 1.17 to 1.56, p=0.002). CONCLUSIONS: A major concern regarding knee problems among Danish deployed military personnel is identified. The risk of suffering from knee problems and the severity of symptoms increase with the amount of time spent inside a vehicle on mounted patrols.

Risk of post-traumatic stress disorder among Danish junior medical officers deployed to Afghanistan is not increased.

INTRODUCTION: Since August 2006, the Danish Armed Forces have deployed junior medical officers (JMOs) to the Helmand Province in Afghanistan. Research has shown an increased incidence of post-traumatic stress disorder (PTSD) in deployed military personnel throughout the history of modern warfare. No investigation of the mental health of Danish military medical personnel has been performed. We wanted to investigate the extent of potentially traumatizing events experienced by Danish JMOs and the prevalence of PTSD among them. MATERIAL AND METHODS: We included all JMOs deployed for one or more tours of duty in Afghanistan from January 2006 to August 2010. Potential participants received a questionnaire to their home address including the PTSD Checklist - Civilian Version (PCL-C). RESULTS: A total of 72 JMOs were included in the survey. The completion rate was 65%. We found that 98% of the respondents had experienced a potentially traumatizing event and that 47% had experienced feeling fear, horror or helplessness in the context of such an event. The prevalence of PTSD was 0%. CONCLUSION: Danish JMOs do not seem to have an increased risk of PTSD after deployment to Afghanistan. However, further research on the mental health of this personnel group is needed. FUNDING: This study was partly funded by The Danish Armed Forces Health Services. TRIAL REGISTRATION: This study was registered with the Danish Data Protection Agency.

Prevention of vitamin K deficiency bleeding in breastfed infants: lessons from the Dutch and Danish biliary atresia registries.

OBJECTIVE: Newborns routinely receive vitamin K to prevent vitamin K deficiency bleeding. The efficacy of oral vitamin K administration may be compromised in infants with unrecognized cholestasis. We aimed to compare the risk of vitamin K deficiency bleeding under different prophylactic regimens in infants with biliary atresia. PATIENTS AND METHODS: From Dutch and Danish national biliary atresia registries, we retrieved infants who were either breastfed and received 1 mg of oral vitamin K at birth followed by 25 microg of daily oral vitamin K prophylaxis (Netherlands, 1991-2003), 2 mg of oral vitamin K at birth followed by 1 mg of weekly oral prophylaxis (Denmark, 1994 to May 2000), or 2 mg of intramuscular prophylaxis at birth (Denmark, June 2000-2005) or were fed by formula. We determined the absolute and relative risk of severe vitamin K deficiency and vitamin K deficiency bleeding on diagnosis in breastfed infants on each prophylactic regimen and in formula-fed infants. RESULTS: Vitamin K deficiency bleeding was noted in 25 of 30 of breastfed infants on 25 microg of daily oral prophylaxis, in 1 of 13 on 1 mg of weekly oral prophylaxis, in 1 of 10 receiving 2 mg of intramuscular prophylaxis at birth, and in 1 of 98 formula-fed infants (P < .001). The relative risk of a bleeding in breastfed compared with formula-fed infants was 77.5 for 25 microg of daily oral prophylaxis, 7.2 for 1 mg of weekly oral prophylaxis, and 9.3 for 2 mg of intramuscular prophylaxis at birth. CONCLUSIONS: A daily dose of 25 microg of vitamin K fails to prevent bleedings in apparently healthy infants with unrecognized cholestasis because of biliary atresia. One milligram of weekly oral prophylaxis offers significantly higher protection to these infants and is of similar efficacy as 2 mg of intramuscular prophylaxis at birth. Our data underline the fact that event analysis in specific populations at risk can help to evaluate and improve nationwide prophylactic regimens.