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Musculoskeletal injuries (MSK-I) are a well-documented problem in military populations and a leading contributor to disability across military services. However, only a portion of Service members who sustain an MSK-I report it to medical providers. Although several studies have identified barriers to seeking medical care in military populations, less is known about what motivates Service members to seek care for MSK-I. To describe determinants of medical care-seeking behavior for MSK-I and/or musculoskeletal pain (MSK-P) in recently enlisted US Marines during military training. Qualitative study. School of Infantry-West (SOI-W), Marine Corps Base Camp Pendleton, California. A total of 1097 US Marines entering Infantry Training Battalion or Marine Combat Training at SOI-W. Participants completed written surveys at entry to (baseline) and graduation from SOI-W. Closed-ended question responses were used to calculate MSK-I/MSK-P and care-seeking frequencies. Open-ended responses describing determinants of care-seeking behavior were analyzed using inductive thematic analysis. Ten percent of participants self-reported sustaining MSK-I during basic training, whereas 14% self-reported sustaining an MSK-I in SOI-W training. A greater proportion reported seeking medical care for their MSK-I/MSK-P during basic training than during SOI-W training. The thematic analysis resulted in 3 main themes that describe drivers and barriers for seeking medical care: (1) self-perceived need for medical care, (2) prioritizing military training, and (3) training-specific influences. Understanding determinants of care-seeking behavior is valuable when designing intervention strategies to promote early MSK-I treatment. Our findings add to previous research to elucidate reasons underlying the decisions about care-seeking for MSK-I/MSK-P. Interventions, including educational strategies and direct approaches like embedding medical providers within units, to minimize barriers to seeking medical care in the military may reduce the burden of MSK-I/MSK-P on Service members throughout their military careers. [ABSTRACT FROM AUTHOR]

Study Question: Does increased daily energy intake lead to menstrual recovery in exercising women with oligomenorrhoea (Oligo) or amenorrhoea (Amen)?Summary Answer: A modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen.What Is Known Already: Optimal energy availability is critical for normal reproductive function, but the magnitude of increased energy intake necessary for menstrual recovery in exercising women, along with the associated metabolic changes, is not known.Study Design, Size, Duration: The REFUEL study (trial # NCT00392873) is the first randomised controlled trial to assess the effectiveness of 12 months of increased energy intake on menstrual function in 76 exercising women with menstrual disturbances. Participants were randomised (block method) to increase energy intake 20-40% above baseline energy needs (Oligo/Amen + Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36). The study was performed from 2006 to 2014.Participants/materials, Setting, Methods: Participants were Amen and Oligo exercising women (age = 21.0 ± 0.3 years, BMI = 20.8 ± 0.2 kg/m2, body fat = 24.7 ± 0.6%) recruited from two universities. Detailed assessment of menstrual function was performed using logs and measures of daily urinary ovarian steroids. Body composition and metabolic outcomes were assessed every 3 months.Main Results and the Role Of Chance: Using an intent-to-treat analysis, the Oligo/Amen + Cal group was more likely to experience menses during the intervention than the Oligo/Amen Control group (P = 0.002; hazard ratio [CI] = 1.91 [1.27, 2.89]). In the intent-to-treat analysis, the Oligo/Amen + Cal group demonstrated a greater increase in energy intake, body weight, percent body fat and total triiodothyronine (TT3) compared to the Oligo/Amen Control group (P < 0.05). In a subgroup analysis where n = 22 participants were excluded (ambiguous baseline menstrual cycle, insufficient time in intervention for menstrual recovery classification), 64% of the Oligo/Amen + Cal group exhibited improved menstrual function compared with 19% in the Oligo/Amen Control group (χ2, P = 0.001).Limitations, Reasons For Caution: While we had a greater than expected dropout rate for the 12-month intervention, it was comparable to other shorter interventions of 3-6 months in duration. Menstrual recovery defined herein does not account for quality of recovery.Wider Implications Of the Findings: Expanding upon findings in shorter, non-randomised studies, a modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. Improved metabolism, as demonstrated by a modest increase in body weight (4.9%), percent body fat (13%) and TT3 (16%), was associated with menstrual recovery.Study Funding/competing Interest(s): This research was supported by the U.S. Department of Defense: U.S. Army Medical Research and Material Command (Grant PR054531). Additional research assistance provided by the Penn State Clinical Research Center was supported by the National Center for Advancing Translation Sciences, National Institutes of Health, through Grant UL1 TR002014. M.P.O. was supported in part by the Loretta Anne Rogers Chair in Eating Disorders at University of Toronto and University Health Network. All authors report no conflict of interest.Trial Registration Number: NCT00392873.Trial Registration Date: October 2006.Date Of First Patient’s Enrolment: September 2006. [ABSTRACT FROM AUTHOR]

Military culture is historically rooted in masculine characteristics and ideals. Yet, as of 2016, all occupational specialties in the United States military are open to women and, as such, the number of women that make up the Services is projected to continue rising. The growing presence of women within the military ranks may be at odds with the traditionally masculine military culture, potentially resulting in gender-based stigmatization of female Service members. The current study qualitatively assessed perceived gender stigmatization among newly commissioned male ( n  = 654, 87%) and female ( n  = 101, 13%) US Marine Corps officers entering The Basic Course (BOC) at The Basic School (TBS), a six-month secondary training course. A thematic analysis of open-ended survey questions identified that males and females described aspects of gender stigma similarly, with emphases on females' tendency to be viewed as weaker and needing to "prove themselves," and a call for equal physical fitness standards for both genders. There were mixed opinions as to whether gender stigmatization should be acknowledged and addressed or dismissed and ignored. Some participants voiced that bringing gender stigma to the attention of Service members could artificially inflate the magnitude of the issue and increase gender stigmatization that is otherwise negligible or non-existent. The insights offered by the participants of this study can help shape the direction of policies and procedures aimed at increasing equality and opportunities for success for Marine officers of all genders. Ultimately, the goal is to optimize physical and mental health and readiness for all Service members.

Introduction: Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities., Methods: A scoping review assessed literature from inception to April 2022 that included studies on MSK-IMPP implementation and/or effectiveness in military populations. Barriers and facilitators to implementing these programmes were identified., Results: From 132 articles, most were primary research studies (90; 68.2%); the remainder were review papers (42; 31.8%). Among primary studies, 3 (3.3%) investigated only women, 62 (69%) only men and 25 (27.8%) both. Barriers included limited resources, lack of stakeholder engagement, competing military priorities and equipment-related factors. Facilitators included strong stakeholder engagement, targeted programme design, involvement/proximity of MSK-I experts, providing MSK-I mitigation education, low burden on resources and emphasising end-user acceptability. Research gaps included variability in reported MSK-I outcomes and no consensus on relevant surveillance metrics and definitions., Conclusion: Despite a robust body of literature, there is a dearth of information about programme implementation; specifically, barriers or facilitators to success. Additionally, variability in outcomes and lack of consensus on MSK-I definitions may affect the development, implementation evaluation and comparison of MSK-IMPPs. There is a need for international consensus on definitions and optimal data reporting elements when conducting injury risk mitigation research in the military., Competing Interests: Competing interests: NA reports grants from Centre for Sport, Exercise & Osteoarthritis Research Versus Arthritis, outside of the submitted work. SdlM reports grants from the Congressionally Directed Medical Research Programme and the Veterans Affairs/Department of Defense Health Affairs Joint Incentive Fund, outside of the submitted work. JJF reports grants from Congressionally Directed Medical Research Programme and the Office of Naval Research, outside of the submitted work. In addition, JJF has a patent pending for an Adaptive and Variable Stiffness Ankle Brace, US Provisional Patent Application No. 63254,474. AR reports grants from the Concussion in Sport Group, Alberta Bone and Joint Strategic Clinical Network, Tonal Strength Institute, outside of the submitted work. DIR reports grants from the Congressionally Directed Medical Research Programme and the National Institutes of Health, outside of the submitted work, and grant support for the submitted work from the Uniformed Services University, Department of Physical Medicine & Rehabilitation, Musculoskeletal Injury Rehabilitation Research for Operational Readiness programme (MIRROR HU00011920011)., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)