Respiration is a crucial determinant of autonomic balance and heart rate variability (HRV). The comparative effect of spontaneous versus paced breathing on HRV has been almost exclusively explored in healthy adults and never been investigated in an injured military cohort.
Exposure to welding fume increases the risk of pneumococcal infection; whether such susceptibility extends to other respiratory infections is unclear. We report findings from a survey and from medical consultation data for workers in a large shipyard in the Middle East.Between January 2013 and December 2013, we collected cross-sectional information from 529 male workers variously exposed to welding fume. Adjusted ORs for respiratory symptoms (cough, phlegm, wheezing, shortness of breath and 'chest illness') were estimated using multivariable logistic regression. Subsequently, we examined consultation records from 2000 to 2011 for 15 954 workers who had 103 840 consultations for respiratory infections; the associations between respiratory infections and levels of welding exposure were estimated using a count regression model with a negative binomial distribution.13% of surveyed workers reported respiratory symptoms with a higher prevalence in winter, particularly among welders. The adjusted OR in welders versus other manual labourers was 1.72 (95% CI 1.02 to 3.01) overall and 2.31 (1.05 to 5.10) in winter months; no effect was observed in summer. The risk of consultation for respiratory infections was higher in welders than in manual labourers, with an adjusted incidence rate ratio of 1.45 (1.59 to 1.83) overall, 1.47 (1.42 to 1.52) in winter and 1.33 (1.23 to 1.44) in summer (interaction, p<0.001).The observation that respiratory symptoms and consultations for respiratory infection in welders are more common in winter may indicate an enhanced vulnerability to a broad range of infections. If confirmed, this would have important implications for the occupational healthcare of a very large, global workforce.
Ageing populations have focused policymakers on maintaining fitness to work in older adults. There is good evidence linking respiratory limitation to work disability. Our cross-sectional survey of adults aged 51-60 (9Lungs at Work9) found significant associations between breathlessness, airflow obstruction and work performance in a general population; a follow-up survey conducted 18 months later examined changes in economic activity in this cohort. A postal questionnaire enquired about changes in employment status. Cases experiencing employment change were frequency matched to referents of the same gender who reported no change (2:1 ratio). Nearly all (94%) participants responded to the follow up questionnaire; all had been in full time work 18 months earlier. At follow up 10.9% were no longer working and a similar proportion were part time. 9.3% of participants reported changing their hours/activity at work for health reasons. Economic inactivity rose with increasing breathlessness and airflow obstruction. Odds of dyspnoea or airflow obstruction at baseline were significantly higher in cases than referents. These findings indicate significant burden of respiratory disability associated with job instability and ultimately workforce loss of older workers. Focusing health surveillance and targeting intervention on those at higher risk of employment problems could help maintain a more functional older workforce.
Introduction The Afghanistan war (2003–2014) was a unique period in military medicine. Many service personnel survived injuries of a severity that would have been fatal at any other time in history; the long-term health outcomes of such injuries are unknown. The A rme D Ser V ices Tr A uma and Rehabilitatio N Out C om E (ADVANCE) study aims to determine the long-term effects on both medical and psychosocial health of servicemen surviving this severe combat related trauma. Methods and analysis ADVANCE is a prospective cohort study. 1200 Afghanistan-deployed male UK military personnel and veterans will be recruited and will be studied at 0, 3, 6, 10, 15 and 20 years. Half are personnel who sustained combat trauma; a comparison group of the same size has been frequency matched based on deployment to Afghanistan, age, sex, service, rank and role. Participants undergo a series of physical health tests and questionnaires through which information is collected on cardiovascular disease (CVD), CVD risk factors, musculoskeletal disease, mental health, functional and social outcomes, quality of life, employment and mortality. Ethics and dissemination The ADVANCE Study has approval from the Ministry of Defence Research Ethics Committee (protocol no:357/PPE/12) agreed 15 January 2013. Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications. Trial registration number The ADVANCE Study is registered at ISRCTN ID: ISRCTN57285353 .
BackgroundThe long-term psychosocial outcomes of UK armed forces personnel who sustained serious combat injuries during deployment to Afghanistan are largely unknown. We aimed to assess rates of probable post-traumatic stress disorder (PTSD), depression, anxiety, and mental health-associated multimorbidity in a representative sample of serving and ex-serving UK military personnel with combat injuries, compared with rates in a matched sample of uninjured personnel.MethodsThis analysis used baseline data from the ADVANCE cohort study, in which injured individuals were recruited from a sample of UK armed forces personnel who were deployed to Afghanistan and had physical combat injuries, according to records provided by the UK Ministry of Defence. Participants from the uninjured group were frequency-matched by age, rank, regiment, deployment, and role on deployment. Participants were recruited through postal, email, and telephone invitations. Participants completed a comprehensive health assessment, including physical health assessment and self-reported mental health measures (PTSD Checklist, Patient Health Questionnaire-9, and Generalised Anxiety Disorder-7). The mental health outcomes were rates of PTSD, depression, anxiety, and mental health-associated multimorbidity in the injured and uninjured groups. The ADVANCE study is ongoing and is registered with the ISRCTN registry, ISRCTN57285353.Findings579 combat-injured participants (161 with amputation injuries and 418 with non-amputation injuries) and 565 uninjured participants were included in the analysis. Participants had a median age of 33 years (IQR 30–37 years) at the time of assessment. 90·3% identified as White and 9·7% were from all other ethnic groups. The rates of PTSD (16·9% [n=89] vs 10·5% [n=53]; adjusted odds ratio [AOR] 1·67 [95% CI 1·16–2·41], depression (23·6% [n=129] vs 16·8% [n=87]; AOR 1·46 [1·08–2·03]), anxiety (20·8% [n=111] vs 13·5% [n=71]; AOR 1·56 [1·13–2·24]) and mental health-associated multimorbidity (15·3% [n=81] vs 9·8% [n=49]; AOR 1·62 [1·12–2·49]) were greater in the injured group than the uninjured group. Minimal differences in odds of reporting any poor mental health outcome were noted between the amputation injury subgroup and the uninjured group (AOR range 0·77–0·97), whereas up to double the odds were noted for the non-amputation injury subgroup compared with the uninjured group (AOR range 1·74–2·02).InterpretationSerious physical combat injuries were associated with poor mental health outcomes. However, the type of injury sustained influenced this relationship. Regardless of injury, this cohort represents a group who present with greater rates of PTSD than the general population, as well as increased psychological burden from multimorbidity.FundingThe ADVANCE Charity.
Many researchers have developed work simulated tasks that can successfully predict fitness for work. In the fire service there are few tests available to make such predictions. This study was designed to evaluate the validity of four simulated fire-fighting tasks developed by Manchester Fire Service. Twenty-seven subjects each performed, in random order, three repeats of four simulated and four real-life tasks: under-running a 9 m ladder, dead lift, placing a 13.5 m ladder on an appliance and hauling an extended line. Comparisons between real and simulated tasks were assessed by measuring total time and amount of muscle activity. Recommendations were made to reduce the weight and to revise the lifting and grip positions for the 13.5 m ladder and dead lift, respectively, whereas the simulated 9 m ladder and hauling an extended line simulated tasks were sufficiently similar to the real-life activities to not warrant any change.
Combat-related traumatic injury (CRTI) has been linked to an increased cardiovascular disease (CVD) risk in servicemen returning from military operations. While Heart Rate Variability (HRV) has been established as an objective and non-invasive marker of CVD risk, the long-term impact of unselected CRTI on HRV has not been explored to date. This study aimed to investigate the impact of CRTI, injury mechanism and injury severity on HRV. We hypothesised that HRV would be lower in injured servicemen than in uninjured servicemen.
Methods
This was a baseline analysis from the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study. The sample consisted of British servicemen with CRTI sustained during deployment to Afghanistan (2003–2014) and an uninjured comparison group who were frequency-matched to the injured group based on age, rank, deployment period and role-in-theatre. Root mean square of successive differences between normal heartbeats (RMSSD) was reported as a measure of HRV. RMSSD was measured over an ultra-short time period (HRVUST) of up to 16s continuous recording of the femoral arterial pulse waveform signal via the Vicorder device. Other measures included the New Injury Severity Scores (NISS) as a measure of injury severity and injury mechanism (blast and others).
Results
Overall 862 participants aged 33.9±5.4 years (range 23–59 years) were included, of who 428 (49.6%) were injured and 434 (50.3%) were uninjured. The median (interquartile range) NISS for those injured was 12 (6–27; range 1–66) with blast being the predominant injury mechanism (76.8%). The median (IQR) RMSSD was significantly lower in the injured versus the uninjured [39.47 ms (27.77–59.77) vs 46.22 ms (31.14–67.84), p<0.001]. Using multiple linear regression (adjusting for age, rank, ethnicity and time from injury), CRTI was associated with a 13% lower geometric mean ratio (GMR) RMSSD versus the uninjured group (GMR 0.87, 95%CI 0.80–0.94, p<0.001). A higher injury severity (NISS>25) (GMR 0.78, 95%CI 0.69–0.89, p<0.001) and blast mechanism of injury (GMR: 0.86, 95%CI 0.79–0.93, p<0.001) were also independently associated with lower RMSSD.
Conclusion
These results suggest an inverse association between CRTI, its worsening severity and blast mechanism of injury with HRV. These findings may help understand the cardiovascular profile of the population with traumatic injuries. Further research from longitudinal studies and examination of the potential mediating factors in this CRTI-HRV relationship are needed to better understand the cardiovascular profile of the military personnel.
Breathlessness and airflow limitation increase with age and are likely to result in work disability.
Methods
A general population survey of adults in their sixth decade was carried out to examine the relationship between breathlessness, work performance, work disability, sickness absence and towards the end of working life. In a cross-sectional postal questionnaire survey of adults aged 51–60 across Kent (n=21 220, 33% response). breathlessness was reported using a modified MRC dyspnoea score, with a number of validated measures used to assess work performance and disability. A subgroup of respondents was assessed with lung function (n=1774).
Results
Logistic regression showed that increased breathlessness was significantly associated with risk of poor work performance in both sexes. When analysis was adjusted for demographic, psychological and occupational factors, the relationship between breathlessness and work performance remained. Spirometry showed that men with poor work performance had a statistically significant lower mean FEV1 than those with good performance (mean (SD) 3.12L (0.75) vs 3.35L (0.62). Using spirometry data, we found that 8.9% of men and 4.3% of women had lung function that was consistent with a diagnosis of COPD; disease prevalence was markedly higher than that of reported disease (1.9% men and 0.6% women).
Conclusions
In a large study we found a strong relationship between breathlessness and impaired work performance in older adults, likely to be due in most part to respiratory disease, the majority of it undiagnosed, as confirmed with spirometry. From a wider perspective, it seems likely that the planned increases in pension age will lead to a more disabled UK working population.
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