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An association between body mass index (BMI; weight (kg)/height (m)2) and low back pain (LBP) has long been debated, but inconsistent measurements of BMI and varying definitions of LBP have produced conflicting findings. We explored this association using measured BMI and physician documentation of recurrent LBP among healthy young adults. Data were extracted from the Israel Defense Forces electronic medical record system. All Israeli citizens with compulsory military service during January 2008–March 2019 were included (n  = 705,840). Exclusion criteria were spine deformities, disc pathologies, spinal surgeries, arthropathies, connective tissue diseases, pain syndromes, low bone density disorders, cancers, and psychiatric illnesses. LBP was defined as electronic medical record system documentation of 1) 2 medical visits at least 6 weeks apart with a diagnosis of LBP or "LBP with radiation" or 2) 1 medical visit resulting in referral to an orthopedic surgeon. Logistic regression models were used to explore the association between BMI category and LBP; 619,969 (87.8%) individuals (mean age = 18.9 (standard deviation, 0.97) years; 56.9% male) were included. LBP prevalence was 9.2% (n  = 56,918) and higher among males (9.7%) than females (8.5%). Overweight (odds ratio = 1.123, 95% confidence interval: 1.096, 1.151) and obesity (odds ratio = 1.137, 95% confidence interval: 1.096, 1.179) were associated with LBP. The association remained significant after accounting for various sociodemographic factors. Maintaining a healthy BMI may aid in the prevention of LBP in young adults. [ABSTRACT FROM AUTHOR]

While commonly thought to be effective for management of limb and junctional hemorrhage, the manual pressure points technique was excluded from leading prehospital guidelines over a decade ago following the publication of a single human-volunteers study presenting unfavorable results. This work aimed to re-assess the efficacy and feasibility of the femoral and supraclavicular pressure points technique for temporary hemorrhage control distal to the pressure point. A prospective, non-randomized, human volunteer, controlled environment study. In the study 35 healthy male combat medics (age 21.1 ± 1.3 years) received brief training after which they were requested to apply pressure in the femoral and supraclavicular points in attempts to stop regional blood flow, measured distally by Doppler ultrasound. Success rates in achieving flow cessation in under 2 minutes, time required for achievement of flow cessation, and cumulative flow cessation duration within a 3-minute follow-up after initial success were measured. For the supraclavicular point, success rates were 97.1% with a mean time to success of 12.5 (±20.9) seconds, lasting for 76.2% (±23.7) of the follow-up time. For the femoral point, success rates were 100% with a mean time to success of 5.5 (±4.3) seconds, lasting for 98.7% (±3.8) of the follow-up time. Manual pressure on the femoral and supraclavicular points is an applicable and efficient method for temporary hemorrhage control distal to the pressure point. As such, with additional study, this method may be considered for re-introduction to prehospital care guidelines and training programs. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the emergency care provided by the Israeli Military Airborne Combat Evacuation Unit (MACEU) during helicopter winching operations. Methods: A retrospective cohort study was performed of all patients rescued by winching by the MACEU between December 2011 and October 2018. Data were extracted from the electronic medical records of the unit registry. The data collected included helicopter type, scene times, demographics, mechanism of injury, interventions, medications, and survival. Results: During the study period, 208 civilians with a mean age of 36.8 ± 19.2 years were evacuated from inaccessible areas, 192 were from difficult terrain, 10 from sea vessels, and 5 from floods. All patients were winched up with a crewmember. No patient or crewmember was injured during winching. Overall, 156/208 (75%) had a traumatic injury, and 52/208 (25%) had a medical emergency. Sikorsky UH-60 "BlackHawk" helicopters and Sikorsky CH-53 "Sea Stallion" helicopters were used in 179 and 28 operations, respectively. Eighteen different procedures were performed by the medical personnel of the unit on scene and en route. The most performed procedures were peripheral vascular access establishment (60.6%), fluids administration (57.7%), oxygen supplementation (42.8%), analgesia (39.9%) and spine immobilization (37.5%). On scene, none of the patients was treated with a physician-only intervention. Thirty/208 (14.5%) patients were winched-up in darkness conditions. Eleven/208 (5.3%) apneic breathing patients were winched up ventilated by a crewmember. All the six patients who had oxygen saturation ≥89% after entrance into the cabin, survived. Conclusions: The reported MACEU experience provides useful information on the clinical characteristics, medical interventions, and outcomes of patients rescued using a winching operation. Study findings emphasize the importance of airway management and ventilation during winching. [ABSTRACT FROM AUTHOR]

Shoulder pain is a very common complaint, and affects as many as 20% of all people at some point during their lives. Despite the availability of more advanced imaging modalities, X-ray remains the first imaging test to be performed in the investigation of any shoulder pain. However, with their increasing availability, ultrasound and magnetic resonance imaging have in recent years become first-line techniques for the diagnostic imaging of the shoulder. Moreover, ultrasound of the shoulder is increasingly performed in lieu of radiography. Nevertheless, many patients who visit a shoulder specialist for their pain are referred by a family physician or community orthopedist without an X-ray having ever been performed. Shoulder pain can be caused by many conditions, including rotator cuff tears, calcification within the tendons of the rotator cuff, stiff shoulder, subacromial impingement, space-occupying lesions, degenerative changes, and rheumatoid arthritis. This paper reviews various types of shoulder injury and the radiographic symptomatology of each, with the goal of encouraging the use of radiography by demonstrating the importance of this basic tool in the diagnostic process for these injuries. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak required prompt actions by health authorities around the world, in response to a novel threat. With enormous amounts of information originating in sources with uncertain degree of validation and accuracy, it is essential to provide executive level decision makers with the most actionable, pertinent and updated data analysis to enable them to adapt their strategy swiftly and competently.Objective: We report here the origination of a COVID-19 dedicated response in the Israel Defense Force (IDF) with the assembly of an operational Data Center for the Campaign against Coronavirus (ID3C).Methods: Spearheaded by directors with clinical, operational and data analytics orientation a multidisciplinary team utilized existing and newly developed platforms to collect and analyze large amounts of information for on an individual-level in the context of SARS-CoV2 contraction and infection.Results: Nearly 300,000 responses for daily questionnaires were recorded and were merged with other datasets to form unified data lake. By using basic as well as advanced analytic tools ranging from simple aggregation and display of trends to data-science application we provided commanders and clinicians with access to trusted, accurate and personalized information and tools that were designed to foster operational changes and mitigate the propagation of the pandemic. The developed tools aided in the in the identification of high-risk individuals for severe disease, resulted in a 30% decline of their attendance to their units. Moreover, the Corona lab exams queue was optimized by using a predictive model resulted in a high true positive rate of 20%, which is more than twice as high as the baseline rate (2.28 with 95% CI of 1.63-3.19).Conclusions: In times of ambiguity and uncertainty mixed with unprecedented flux of information, health organizations may find multidisciplinary teams working to provide intelligence from diverse and rich data, a key factor in providing executives relevant and actionable support for decision making.Clinicaltrial: [ABSTRACT FROM AUTHOR]

Study Objectives: Discerning the differential contribution of sleep behavior and sleep physiology to the subsequent development of posttraumatic-stress-disorder (PTSD) symptoms following military operational service among combat soldiers., Methods: Longitudinal design with three measurement time points: during basic training week (T1), during intensive stressed training week (T2), and following military operational service (T3). Participating soldiers were all from the same unit, ensuring equivalent training schedules and stress exposures. During measurement weeks soldiers completed the Depression Anxiety and Stress Scale (DASS) and the PTSD Checklist for DSM-5 (PCL-5). Sleep physiology (sleep heart-rate) and sleep behavior (duration, efficiency) were monitored continuously in natural settings during T1 and T2 weeks using wearable sensors., Results: Repeated measures ANOVA revealed a progressive increase in PCL-5 scores from T1 and T2 to T3, suggesting an escalation in PTSD symptom severity following operational service. Hierarchical linear regression analysis uncovered a significant relation between the change in DASS stress scores from T1 to T2 and subsequent PCL-5 scores at T3. Incorporating participants' sleep heart-rate markedly enhanced the predictive accuracy of the model, with increased sleep heart-rate from T1 to T2 emerging as a significant predictor of elevated PTSD symptoms at T3, above and beyond the contribution of DASS stress scores. Sleep behavior did not add to the accuracy of the model., Conclusion: Findings underscore the critical role of sleep physiology, specifically elevated sleep heart-rate following stressful military training, in indicating subsequent PTSD risk following operational service among combat soldiers. These findings may contribute to PTSD prediction and prevention efforts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The COVID-19 outbreak required prompt action by health authorities around the world in response to a novel threat. With enormous amounts of information originating in sources with uncertain degree of validation and accuracy, it is essential to provide executive-level decision-makers with the most actionable, pertinent, and updated data analysis to enable them to adapt their strategy swiftly and competently., Objective: We report here the origination of a COVID-19 dedicated response in the Israel Defense Forces with the assembly of an operational Data Center for the Campaign against Coronavirus., Methods: Spearheaded by directors with clinical, operational, and data analytics orientation, a multidisciplinary team utilized existing and newly developed platforms to collect and analyze large amounts of information on an individual level in the context of SARS-CoV-2 contraction and infection., Results: Nearly 300,000 responses to daily questionnaires were recorded and were merged with other data sets to form a unified data lake. By using basic as well as advanced analytic tools ranging from simple aggregation and display of trends to data science application, we provided commanders and clinicians with access to trusted, accurate, and personalized information and tools that were designed to foster operational changes and mitigate the propagation of the pandemic. The developed tools aided in the in the identification of high-risk individuals for severe disease and resulted in a 30% decline in their attendance to their units. Moreover, the queue for laboratory examination for COVID-19 was optimized using a predictive model and resulted in a high true-positive rate of 20%, which is more than twice as high as the baseline rate (2.28%, 95% CI 1.63%-3.19%)., Conclusions: In times of ambiguity and uncertainty, along with an unprecedented flux of information, health organizations may find multidisciplinary teams working to provide intelligence from diverse and rich data a key factor in providing executives relevant and actionable support for decision-making., (©Gil A Geva, Itay Ketko, Maya Nitecki, Shoham Simon, Barr Inbar, Itay Toledo, Michael Shapiro, Barak Vaturi, Yoni Votta, Daniel Filler, Roey Yosef, Sagi A Shpitzer, Nabil Hir, Michal Peri Markovich, Shachar Shapira, Noam Fink, Elon Glasberg, Ariel Furer. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.09.2021.)

Background: Hypertension (HTN) is the leading reversible risk factor for cardiovascular morbidity and all-cause mortality. Screening is currently based on office blood pressure measurement (OBPM) - a method that is neither sensitive nor specific in detecting true HTN. Home blood pressure monitoring, which is often used to confirm and follow-up the diagnosis of HTN, is limited in its ability to detect certain blood pressure (BP) patterns that are harmful, and not covered by Israeli health insurers. Over the last two decades, the alternative and gold standard - 24 hours ambulatory blood pressure monitoring (ABPM) has become cheap and easy to use, but it is virtually nonexistent in primary care clinics., Methods: This research aims to assess the clinical and distributional benefits of operating an ABPM in the primary clinic, without utilising any additional external resources besides the ABPM monitor, which was borrowed for this purpose from the regional Israeli Defense Force's Medical Corps (IDFMC) health-care center. All service-members in a medium sized Israeli Air Force (IAF) airbase were screened for HTN using OBPM. Inclusion criteria were BP over 130/85 at least once during the past two years or a personal or family history of HTN. Exclusion criteria were any antihypertensive medication taken over the past 6 months, renal dysfunction or secondary HTN., Results: A total of 2167 patients were screened, of whom 64 (2.9%) met selection criteria. Of these, 56 (87.5%) responded to our invitation and performed full OBPM on three separate occasions. During an 8 weeks long lease 46 of 47 (96.4%) available slots were utilized - 2.19 times more efficient than the regional clinic average utilization rate. Of 18 patients who have been diagnosed with HTN in the past, 13 (72.2%) met the criteria on OBPM but only 6 (46.1%) of these were confirmed as having HTN on ABPM. The positive predictive value (PPV) of abnormally high BP on OBPM for the diagnosis of HTN on ABPM averaged 41.3%. The negative predictive value (NPV) of normal OBPM was 80% and 83.4%, for patients diagnosed in the past with HTN or having risk factors (obesity and family history), respectively., Conclusions: The therapeutic, prognostic and economic implications of the diagnosis of HTN necessitate the utilization of an accurate diagnostic tool. Recent advancements, making ABPM affordable and easy to use, combined with the immediate and dramatic clinical implications witnessed when ABPM was used in our clinic, necessitate a closer look at the need to make ABPM available at the primary clinic.

Clavicle fractures compose 2.5% to 5% of all fractures, and usually occur due to a direct blow to the shoulder. The incidence of these fractures persistently increases. Most of the fractures are in the middle third--a result of the unique structure of the clavicle and its ligamentous and muscular attachments. The fracture diagnosis includes focused physical examination, radiographic evaluation, and comprehensive evaluation of the patient, considering the fact that the fracture can be the result of significant energy absorption and can hide other injuries. Usually treatment is non-operative, and results in fracture union of 95%. Healing is achieved with a certain amount of deformity. The most common treatment is a sling or figure-of-8 dressing worn for several weeks. When absolute surgical indications (open fracture or neurovascular injury) or relative surgical indications (multiple injuries or floating shoulder) exist, several surgical procedures can be chosen. The fracture displacement as a predictive factor for union or function after healing is controversial. Complications associated with clavicle fractures are the result of either conservative or surgical treatment. The most common complication is an esthetic defect. Other complications are non-union, mal-union, limited range of motion and neurovascular injury.

Shoulder pain is a common complaint--almost 20% of the population will suffer shoulder pain during their life time. Despite the availability of newer imaging techniques for evaluation of the shoulder, the first imaging study should be radiography. Recently, ultrasonography of the shoulder has become one of the first studies performed. Sometimes, ultrasonography is conducted before radiography; moreover, many patients are being referred to a shoulder specialist without performing an X-ray. There is a plethora of pathologies that can cause shoulder pain--rotator cuff tears, impingement syndrome, calcified tendinitis, osteoarthritis, rheumatoid arthritis, neoplasms and more. This review aims to show the significance of plain radiography in the diagnosis of shoulder pathologies, in order to encourage the use of this modality. In this paper we shall review the different causes of shoulder pain and their radiographic characteristics.