Medical Downgrading Research Articles

Effect of sex and combat employment on musculoskeletal injuries and medical downgrading in trained military personnel: an observational cohort study

IntroductionFollowing the opening of all combat roles to women across the UK Armed Forces, there is a requirement to understand the risk of injury to these female personnel. Women injure...

Longitudinal study of medical downgrades in the Royal Air Force

IntroductionAs the focus of the Royal Air Force (RAF) shifts from sustained to contingency operations and the number of personnel is reduced, the burden of retained, medically downgraded personnel may...

20 Armoured Infantry Brigade downgrade study: epidemiology of principal conditions and plugging leaks in the rehabilitation pipeline

IntroductionIn April 2017, 22% of Army Full-time Trade Trained Strength was downgraded, reducing fully deployable strength to 60 546, against a target of 82 000. In June 2017, Commander 20...

An evaluation of the burden placed on the General Internal Medicine team at the Role 3 Hospital in Camp Bastion by UK Armed Forces personnel presenting with symptoms resulting from previously identified disease

IntroductionDuring previous deployments of the British Armed Forces, a significant proportion of aeromedical evacuations were accounted for with recurrent symptoms from a known disease that had often triggered occupational medical...

Mortality, survival and residual injury burden of Royal Navy and Royal Marine combat casualties sustained in 11-years of operations in Iraq and Afghanistan

We present eleven years of prospectively-gathered data defining the full spectrum of the United Kingdom's (UK) Naval Service (Royal Navy and Royal Marines) casualties, and characterise the injury patterns, recovery and residual functional burden from the conflicts of the last decade. The UK Military Trauma Registry was searched for all Naval Service personnel injured between March 2003 and April 2013. These records were then cross-referenced with the records of the Naval Service Medical Board of Survey (NSMBOS), which evaluates injured Naval Service personnel for medical discharge, continued service in a reduced capacity or Return to Full Duty (RTD). Population at risk data was calculated from service records. There were 277 casualties in the study period: 63 (23%) of these were fatalities. Of the 214 survivors, 63 or 29% (23% of total) were medically discharged; 24 or 11% (9% of total) were placed in a reduced fitness category with medical restrictions placed on their continued military service. A total of 127 individuals (46% of the total and 59% of survivors) RTD without any restriction. The greatest number of casualties was sustained in 2007. There was a 3% casualty risk per year of operational service for Naval Service personnel. The most common reason cited by Naval Service Medical Board of Survey (NSMBOS) for medical downgrading or discharge was injury to the lower limb, with upper limb trauma the next most frequent. This study characterises the spectrum of injuries sustained by the Naval Service during recent conflicts with a very high rate of follow-up. Extremity injuries pose the biggest challenge to reconstructive and rehabilitative services striving to maximise the functional outcomes of injured service personnel.

Contact lens-related microbial keratitis in deployed British military personnel

AimsTo quantify the effect of contact lens-related microbial keratitis (CLMK) in the British Defence personnel particularly those in active service in the Arabian Gulf and Afghanistan between June 2001 and...

Smoking, BMI and psychological strain and fitness in the Naval Service

Data from the Naval Service (NS) cohort study of psychological strain were extracted and analysed to investigate the relationship between self-reported health and lifestyle factors and medical fitness. Identification of factors associated with medical downgrading is of obvious value in shaping future health and safety policy and in understanding the relative contributions of physical and psychosocial factors to adverse occupational health outcomes. To identify variables associated with a lack of fitness to serve. Extraction and analysis of data from the Phase I of the study, with a binary outcome of fitness as the dependent variable, controlling for psychosocial and other confounders. Stepwise logistic regression analysis found statistically significant effects due to smoking, body mass index (BMI), General Health Questionnaire (GHQ)-12 and work-family conflict. The model accounted for 5.6% of the variance in medical grading, 3% of which was due to smoking. With psychosocial factors and GHQ-12 scores accounted for, personnel who were not fully fit for NS were found to be more likely to be smokers and to have a high BMI (> or =25).

Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces

Objective: To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces. Methods: A sample of 4500 military personnel was randomly selected to...

Suicide Among Regular-Duty Military Personnel: A Retrospective Case-Control Study of Occupation-Specific Risk Factors for Workplace Suicide

The purpose of this study was to examine the epidemiology, phenomenology, and occupation-specific risk factors for suicide among regular-duty military personnel as a model for other professions at risk for workplace suicide. Suicide incidence and methods were determined in a retrospective military cohort comprising all deaths (N=732) of regular-duty military personnel in the Irish Defence Forces between 1970 and 2002. A retrospective, case-control study using pair-matched military comparison subjects was conducted to determine occupation-specific risk factors for suicide, particularly by firearm, among military personnel. Risk factors were subjected to chi-square analysis or independent t tests and entered into a binary logistic regression analysis model. The period-averaged suicide rate for the cohort was 15.3/100,000. Firearm suicides accounted for 53% of the cases. Suicides that took place on duty occurred predominantly when personnel were alone shortly after duty commencement in the morning. Bivariate and logistic regression analyses identified psychiatric illness and a past history of deliberate self-harm, morning duty (shortly after duty assumption and consequent access to firearms), and a recent medical downgrading as independent risk factors predicting firearm suicide among military personnel. Occupation influences suicide method. Access to and opportunity to use lethal means in the workplace are distinct but related occupation-specific suicide risk factors in the military and in other at-risk professions. In professions where access to lethal means is inevitable, moderating opportunity for suicide is crucially important. In regular-duty military personnel, a medical downgrading, combined with risk factors established in civilians such as younger age, male gender, psychiatric illness, and past self-harm, increases the risk of suicide. The findings may be used to guide military harm-reduction strategies and have applicability in strategies for other professions at risk for workplace suicide.

Reducing Medical Downgrading In A High Readiness Royal Marine Unit

ObjectiveThis 3 year retrospective observational study aims to determine the diagnoses causing medical downgrading in a high readiness Royal Marine Commando unit, and to direct future investment to reduce numbers...

Lateral release for patello femoral pain

AbstractA retrospective survey of 586 patients has been carried out. These underwent one of five different types of Lateral Release for patello-femoral pain.The success rate for each type of Lateral Release is noted and compared in respect of the duration of medical downgrading, morbidity and the Serviceman’s ability to return to a P2 Category.

Peptic Ulcer in the British Army: A Comparison of Outcome following Medical and Early or Late Surgical Treatment in the Pre-Cimetidine Era

It is difficult to define the best treatment for peptic ulcer because the effectiveness of treatment may be measured in many different ways, each affecting the Therapeutic objectives might include relief of symptoms, healing of ulcer, prevention of complications, prevention of relapses, and social or occu­ pational rehabilitation. Despite the multiplicity of objectives, most clinicians will have some concept of what constitutes an acceptable or an unacceptable of treatment for each patient. In the British Army, compared with civilian life, certain criteria require to be more heavily emphasised than others in considering outcome. Fitness to perform his duties emoiently and continuously is a sine qua non of a serviceman's employment. If a medical defect exists which actually or potentially restricts his employalbiHty he must be either invalided from the service or medically down­ graded; the latter may render him ineligible for consideration for promotion and thereby ruin his career. Because he is expensive to train a new recruit will be more readily invalided from the service than a mature, fully-tl'a'ined specialist, the loss of whom would be a more catastrophic event both for the service and for the individual. Although only a small proportion of servicemen with peptic ulcer are invalided, this disease remains the single most common cause of invaliding from the British Army (Statistical Report on the Health of the Army, 1975). This fact is well known to service olinicians but despite this there is no unanimity as to the best approach to management, nor to the difficult qu~tion of the degree of medical downgrading or restriction upon employability indicated for peptic ulcer patients in various circumstances. Any data which throw light upon this problem are useful. This paper presents a retrospective analysis of the outcome of medical versus surgical treatment for peptic ulcer in a cohort of serving personnel in the pre-Cimetidine era. Patients and methods All personnel serving in the British Army who were first diagnosed during the year 1965,as having a peptic ulcer were identified and their medical documents examined. Reports of all out-patient attendances, hospital admissions,