Changes in haemoglobin and ferritin levels during basic combat training: relevance for attrition and injury frequency.

INTRODUCTION: The primary aim of the present study was to assess interindividual and intraindividual variations in haemoglobin and ferritin concentrations in Swedish recruits over 5 months of basic combat training (BCT). The secondary aim was to find predictors for missing training (a precursor for attrition) and overuse injuries during BCT. METHODS: In a cohort design, a total of 58 female and 104 male recruits provided complete data. We assessed the ferritin concentrations and haemoglobin concentrations at baseline and after 5 months of BCT and physical work capacity at baseline. RESULTS: During BCT, haemoglobin concentrations increased significantly in both females and males. Ferritin concentrations decreased significantly in both sexes and the prevalence of iron deficiency (ID) (ie, ferritin levels <30 µg/L) increased significantly in females. The physical work capacity at baseline was related to the risk of missing training in fully adjusted models. In gender-adjusted analyses, baseline ferritin was related to the risk of overuse injury, but neither baseline nor change in iron status was related to injuries or risk of missing training when controlling for confounders. Body mass increased significantly in both genders, but we found no correlation between individual change in body mass and change in haemoglobin or ferritin nor was change in body mass related to the risk of overuse injury or missing training. CONCLUSION: In the present study, the prevalence of ID increased over the course of 5 months, while haemoglobin concentrations increased. As baseline physical work capacity was related to missing training, there are reasons to support preparatory physical training before BCT. These findings may inform future preventive interventions aimed at preventing detrimental effects of ID.

Does climate change transform military medicine and defense medical support?

Background: Climate change has effects on multiple aspects of human life, such as access to food and water, expansion of endemic diseases as well as an increase of natural disasters and related diseases. The objective of this review is to summarize the current knowledge on climate change effects on military occupational health, military healthcare in a deployed setting, and defense medical logistics. Methods: Online databases and registers were searched on August 22nd, 2022 and 348 papers retrieved, published between 2000 and 2022, from which we selected 8 publications that described climate effects on military health. Papers were clustered according to a modified theoretical framework for climate change effects on health, and relevant items from each paper were summarized. Results: During the last decades a growing body of climate change related publications was identified, which report that climate change has a significant impact on human physiology, mental health, water- and vector borne infectious diseases, as well as air pollution. However, regarding the specific climate effects on military health the level of evidence is low. The effects on defense medical logistics include vulnerabilities in the cold supply chain, in medical devices functioning, in need for air conditioning, and in fresh water supply. Conclusions: Climate change may transform both the theoretical framework and practical implementations in military medicine and military healthcare systems. There are significant knowledge gaps on climate change effects on the health of military personnel in operations of both combat and non-combat nature, alerting the need for prevention and mitigation of climate-related health issues. Further research within the fields of disaster and military medicine is needed to explore this novel field. As climate effects on humans and the medical supply chain may degrade military capability, significant investments in military medical research and development are needed.

Exposures to lead during urban combat training.

Lead exposure is still a major concern for occupations that regularly train or work with firearms, such as law enforcement and military personnel. Due to the increasing number of women of fertile age in such professions, there is a strong incentive to monitor lead exposures during firearms training. Personal air sampling was performed during two sessions of a nine-day urban combat training (UCT) course for cadets in the Swedish Armed Forces, one session employing leaded ammunition (leaded scenario) and one session employing unleaded ammunition (unleaded scenario). Blood lead levels (BLLs) were measured before and after the course for 42 cadets and five instructors. During the leaded scenario, the instructors' airborne exposure (geometric mean, GM, 72.0 µg/m3) was higher than that of cadets (GM 42.9 µg/m3). During the unleaded scenario, airborne concentrations were similar for instructors and cadets and considerably lower than during the leaded scenario (GM 2.9 µg/m3). Despite comparably low external lead exposures during the course, we saw a statistically significant increase in systemic exposure for cadets (BLL GM increased from 1.09 to 1.71 µg/dL, p < 0.001). For the five instructors, notable differences were seen depending on task. The largest increase was seen for the two instructors performing close supervision during the leaded scenario (BLL GM increased from 2.41 µg/dL to 4.83 µg/dL). For the remaining three instructors the BLLs were unchanged (BLL GMs were 1.25 µg/dL before the course and 1.26 µg/dL after). None of the participants exceeded the applicable biological exposure limits, but extrapolating our findings shows that instructors in the leaded scenario may reach levels around 10 µg/dL after a year of repeated exposures. We conclude that comparably low airborne concentrations can contribute to the body burden of lead and that additional measures to reduce exposure are warranted, particularly for instructors.

Military service and related risk factors for amyotrophic lateral sclerosis.

BACKGROUND: The cause of amyotrophic lateral sclerosis (ALS) is unknown, but occupations have been explored as a potential proxy measure of risk. There is a substantial body of literature connecting military service to ALS. We aimed to summarize and assess the quality of this evidence. METHODS: Systematic review of the literature, including observational studies which explored one of the following exposures: general military service (army, air force, marines, or navy); or specific exposures associated with military service measured among military personnel. The outcome of interest was ALS incidence, which could include onset, diagnosis, or death from ALS. RESULTS: A total of 2642 articles were screened. Following exclusion, 19 articles remained for inclusion in the systematic review, including 1 meta-analysis and 18 original observational studies. Most studies were of moderate quality. In general, the relationship between military service was suggestive of an increased risk, particularly among Gulf War and WWII veterans. Exposure to pesticides (including Agent Orange) certain chemicals (exhaust, burning agents), heavy metals, and head trauma appeared to increase the risk of ALS among military personnel. CONCLUSIONS: There is a possible association between military service and the subsequent development of ALS; however, the evidence was limited. Studies were generally hindered by small sample sizes and inadequate follow-up time. Future studies should endeavor to objectively measure specific exposures, or combinations thereof, associated with military service, as this will be of vital importance in implementing preventative strategies into military organizations.

XRMA and ToF-SIMS Analysis of Normal and Hypomineralized Enamel.

Molar incisor hypomineralization (MIH) is a developmental disturbance of the enamel. This study presents analyses of hypomineralized and normal enamel in first molar teeth diagnosed with MIH, utilizing time-of-flight secondary ion mass spectrometry area analyses and X-ray microanalysis of area and spot profiles in uncoated samples between gold lines which provide electrical conductivity. Statistical analysis of mean values allows discrimination of normal from MIH enamel, which has higher Mg and lower Na and P. Inductive analysis using complete data sets for profiles from the enamel surface to the enamel-dentin junction found that Mg, Cl and position in the profile provide useful discrimination criteria. Element profiles provide a visual complement to the inductive analysis and several elements also provide insight into the development of both normal and MIH enamel. The higher Mg content and different Cl profiles of hypomineralized enamel compared with normal enamel are probably related to a relatively short period during the development of ameloblasts between birth and the 1st year of life.

Evaluation of X-ray microanalysis for characterization of dental enamel.

Elemental analysis of dental hard tissues is of importance. The aim of this study is to evaluate X-ray microanalysis (XRMA) of bovine enamel in a scanning electron microscope (SEM) with different coatings. The buccal surface of bovine incisors was polished flat, one-third was coated with carbon, one-third with gold, leaving one-third uncoated for XRMA in an SEM equipped with an energy-dispersive microanalysis system. The elements oxygen, sodium, magnesium, phosphorous, chlorine, potassium, and calcium were analyzed using their respective characteristic K X-ray series. Comparisons were made with analyses of glass produced by fusion of the bovine enamel, showing that oxygen analyses using the K X-ray series are reliable and preferable to calculating oxygen by stoichiometry for natural enamel. For the gold-coated and uncoated analyses, carbon was also measured using the K X-ray series. Small area Analyses in small areas (80 × 80 µm) in variable pressure-SEM mode with low vacuum (20 Pa), without any coating, midway between 40 µm wide gold lines 140 µm apart to avoid build-up of electrostatic charge is the preferred method, especially if carbon is included in the analysis. The analyses of bovine enamel are sufficiently reproducible to be regarded as quantitative for all elements except carbon.

Manganese in occupational arc welding fumes--aspects on physiochemical properties, with focus on solubility.

Physicochemical properties, such as particle sizes, composition, and solubility of welding fumes are decisive for the bioaccessibility of manganese and thereby for the manganese cytotoxic and neurotoxic effects arising from various welding fumes. Because of the diverse results within the research on welding fume solubility, this article aims to review and discuss recent literature on physicochemical properties of gas metal arc welding, shielded metal arc welding, and flux-cored arc welding fumes, with focus on solubility properties. This article also presents a short introduction to the literature on arc welding techniques, health effects from manganese, and occupational exposure to manganese among welders.