Institute of Naval Medicine

Hampshire, United Kingdom

Institute of Naval Medicine

Hampshire, United Kingdom
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Roscoe D.,Defence Medical Rehabilitation Center Headley Court | Roscoe D.,University of Surrey | Roscoe D.,Institute of Naval Medicine | Roberts A.J.,Defence Medical Rehabilitation Center Headley Court | And 2 more authors.
American Journal of Sports Medicine | Year: 2015

Background: Patients with chronic exertional compartment syndrome (CECS) have pain during exercise that subsides with rest. Diagnosis is usually confirmed by intramuscular compartment pressure (IMCP) measurement. Controversy exists regarding the accuracy of existing diagnostic criteria. Purpose: (1) To compare dynamic IMCP measurement and anthropometric factors between patients with CECS and asymptomatic controls and (2) to establish the diagnostic utility of dynamic IMCP measurement. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 40 men aged 21 to 40 years were included in the study: 20 with symptoms of CECS of the anterior compartment and 20 asymptomatic controls. Diagnoses other than CECS were excluded with rigorous inclusion criteria and magnetic resonance imaging. The IMCP was measured continuously before, during, and after participants exercised on a treadmill, wearing identical footwear and carrying a 15-kg load. Results: Pain experienced by study subjects increased incrementally as the study progressed (P<.001). Pain levels experienced by the case group during each phase of the exercise were significantly different (P = .021). Subjects had higher IMCP immediately upon standing at rest compared with controls (23.8 mm Hg [controls] vs 35.5 mm Hg [subjects]; P = .006). This relationship persisted throughout the exercise protocol, with the greatest difference corresponding to the period of maximal tolerable pain (68.7 mm Hg [controls] vs 114 mm Hg [subjects]; P<.001). Sensitivity and specificity were consistently higher than the existing criteria with improved diagnostic value (sensitivity = 63%, specificity = 95%; likelihood ratio = 12.5 [95% CI, 3.2-49]). Conclusion: Anterior compartment IMCP is elevated immediately upon standing at rest in subjects with CECS. In patients with symptoms consistent with CECS, diagnostic utility of IMCP measurement is improved when measured continuously during exercise. A cutoff of 105 mm Hg in phase 2 provides better diagnostic accuracy than do the Pedowitz criteria of 30 mm Hg and 20 mm Hg at 1 and 5 minutes after exercise, respectively. © 2014 The Author(s).


Harris R.C.,Junipa Ltd | Hoffman J.R.,University of Central Florida | Allsopp A.,Institute of Naval Medicine | Routledge N.B.H.,Junipa Ltd
Nutrition Research | Year: 2012

Differences in plasma l-glutamine (L-Gln) concentrations from ingestion of different formulations of L-Gln were examined in 8 men (26.8 ± 4.2 years old, 181.1 ± 10.9 cm, 85.8 ± 15.4 kg). Subjects reported to the laboratory on 4 separate occasions and randomly consumed 1 of 4drinks containing 60 mg/kg of L-Gln; 89 mg/kg of Sustamine (l-alanylglutamine [AlaGln]; Kyowa Hakko Europe GmbH, Düsseldorf, Germany), which contained an equivalent L-Gln dose as consumed in L-Gln); 200 mg/kg of an enzymatically hydrolyzed wheat protein (HWP) with an L-Gln content of 31 mg/kg; or a control that consisted only of water. It was hypothesized that the AlaGln trial would increase plasma glutamine concentrations greater than the other experimental trials. Ingestion of L-Gln, AlaGln, and HWP resulted in significant increases in the plasma L-Gln concentration, peaking at 0.5, 0.5, and 0.75 hours, respectively. The corresponding mean peak increases were 179 ± 61, 284 ± 84, and 134 ± 36 μmol/L, respectively. Concentrations returned to baseline in all subjects by 2 hours after L-Gln and HWP and by 4 hours after AlaGln. Mean areas under the plasma concentration curve, calculated between 0 and 4 hours, were 127 ± 61, 284 ± 154, and 151 ± 63 μmol{bullet operator}h{bullet operator}L -1 for L-Gln, AlaGln, and HWP, respectively. When allowance was made for the lower L-Gln dose administered as HWP, the peak plasma concentration and area under the plasma concentration curve were approximately the same as for AlaGln. The results suggest a greater transfer from the gut to plasma of L-Gln when supplied as AlaGln and possibly also as HWP compared with when the same dose was provided as the free amino acid. © 2012 Elsevier Inc.


Hill N.,Imperial College London | Fallowfield J.,Institute of Naval Medicine | Price S.,University of Birmingham | Wilson D.,Royal Center for Defence Medicine
Philosophical Transactions of the Royal Society B: Biological Sciences | Year: 2011

Food and nutrition are fundamental to military capability. Historical examples demonstrate that a failure to supply adequate nutrition to armies inevitably leads to disaster; however, innovative measures to overcome difficulties in feeding reap benefits, and save lives. In barracks, UK Armed Forces are currently fed according to the relatively new Pay As You Dine policy, which has attracted criticism from some quarters. The recently introduced Multi-Climate Ration has been developed specifically to deal with issues arising from Iraq and the current conflict in Afghanistan. Severely wounded military personnel are likely to lose a significant amount of their muscle mass, in spite of the best medical care. Nutritional support is unable to prevent this, but can ameliorate the effects of the catabolic process. Measuring and quantifying nutritional status during critical illness is difficult. A consensus is beginning to emerge from studies investigating the effects of nutritional interventions on how, what and when to feed patients with critical illness. The Ministry of Defence is currently undertaking research to address specific concerns related to nutrition as well as seeking to promote healthy eating in military personnel. © 2011 The Royal Society.


House C.,Institute of Naval Medicine | Reece M.A.,Defence Medical Rehabilitation Center | De Sa D.R.,Institute of Naval Medicine
Military Medicine | Year: 2013

This study was undertaken to determine whether the incidence of lower limb overuse injuries (LLOIs) sustained during Royal Marine training could be reduced by issuing the recruits with shock-absorbing insoles (SAIs) to wear in their military boots. This was a retrospective longitudinal trial conducted in two phases. Injury data from 1, 416 recruits issued with standard Saran insoles and 1, 338 recruits issued with SAI were compared. The recruits in the two groups were of similar height, body mass, and aerobic fitness and followed the same training course. The incidence of LLOI sustained by the recruits was lower (p < 0.05) in the SAI Group (19.0%) compared to the Saran Insole Group (31.7%). The incidences of lower limb stress fractures, tibial periostitis, tenosynovitis of foot, achilles tendonopathy, other tendonopathy and anterior knee pain were lower (p < 0.05) in the SAI Group. Tibial stress fracture incidence was lower (p < 0.05) in the SAI Group but metatarsal and femoral stress fracture incidences were the same for the two insole groups. Thus, issuing SAIs to military recruits undertaking a sustained, arduous physical training program with a high incidence of LLOI would provide a beneficial reduction in the incidence of LLOI.


Brown D.C.,Institute of Naval Medicine
Journal of the Royal Naval Medical Service | Year: 2010

The symposium successfully brought together key military medical and personnel managers with civilian experts in hearing disorders and charities to help streamline our knowledge of the aetiology, investigation, prevention and management of NIHL. A requirement for seamless medical care for veterans with NIHL was recognised and collaborative work has commenced.


Bridger R.S.,Institute of Naval Medicine | Bennett A.I.,Institute of Naval Medicine
Occupational Medicine | Year: 2011

Background: Seafaring is known to be a demanding occupation but the implications of ageing in seafarers are poorly understood. Aims: To investigate task demands and work ability in merchant seamen at sea and to identify factors predicting work ability. Methods: This was a cross-sectional study carried out on a single vessel during a summer deployment. Instantaneous heart rate (HR) was recorded at 5-s intervals during representative 8-h shifts in 41 merchant seamen. Participants completed the work ability index and also rated their daily task demands using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Body mass index (BMI), waist circumference and demographic details were recorded. Results: Work demands were found to be moderate according to both HR data and TLX scores. The mean BMI was 27.5 kg/m2 (standard deviation 3.3) and the mean age was 47 years. The majority of participants rated their work ability as 'good' to 'excellent'. The best predictor of work ability was the interaction between BMI and age, whereas there was a statistically significant negative correlation between HR and age. Conclusions: Work ability in this group of seafarers was found to be high and the work was shown to be moderately demanding, on average. Although work ability declined with age and with BMI independently, the best predictor of work ability was the interaction between BMI and age, with increased BMI having a deleterious effect on work ability in older employees doing moderately demanding work. © Crown copyright 2011.


Bridger R.S.,Institute of Naval Medicine | Brasher K.,Institute of Naval Medicine | Bennett A.,Institute of Naval Medicine
Ergonomics | Year: 2013

Data on health and lifestyle from the Naval service cohort study of occupational stress form the background to a discussion of employee health and the sustainability of a healthy workforce in relation to secular changes - in particular, the increasing prevalence of obesity. One thousand two hundred and forty-one Naval personnel returned questionnaires in 2007 and 2011 and reported their body mass index (BMI), alcohol consumption and smoking, general health and health conditions such as back pain and high blood pressure on both occasions. Health risk due to high BMI and waist circumference in 2011 was predicted by low participation in exercise in 2007. Those performing physically demanding work in 2007 were more likely to be in the 'no risk' category in 2011. High BMI in 2007 was associated with the development of back pain, musculoskeletal conditions and high blood pressure in 2011. The findings are discussed in relation to two aspects of sustainability: the sustainability of current ergonomics practice in relation to health and safety; and the role of ergonomics in sustaining a healthy and productive workforce.Practitioner Summary: Evidence is presented for the benefits of exercise in sustaining employee health and for an association between a high BMI and a number of common health complaints that have traditionally been tackled through workplace ergonomics. This evidence can be used to support the development of workplace design concepts that promote physical activity. © 2013 Copyright Taylor and Francis Group, LLC.


Paddan G.S.,Institute of Naval Medicine
Annals of Occupational Hygiene | Year: 2014

Sound pressure levels were measured on a military ship during firing of a Heavy Machine Gun (HMG). Measurements were made at three locations on the ship's bridge (the wheelhouse) and one location on the starboard bridge wing. The highest peak sound pressure levels measured on the bridge wing and on the bridge were 160.7 dB(C) (2170 Pa) and 122.7 dB(C) (27.3 Pa), respectively. The highest sound exposure levels measured on the bridge wing and on the bridge corresponding to one round being fired were 127.8 dB(A) and 88.9 dB(A), respectively. The ship's structure provided about 40 dB attenuation in the transmitted noise. The operator of the weapon would be required to wear some form of hearing protection. Based on the measured peak noise levels, there would be no requirement for bridge crew to wear any hearing protection during firing of a HMG. However, crew exposure to noise on the bridge is likely to exceed the upper exposure action value corresponding to 85 dB(A) after about 11 750 rounds. © The Author 2015. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.


Day A.J.,Institute of Naval Medicine | Brasher K.,Institute of Naval Medicine | Bridger R.S.,Institute of Naval Medicine
Accident Analysis and Prevention | Year: 2012

Understanding why accidents occur in the work place has a long and convoluted history. This paper adds to this corpus of research by investigating the relationship between an individual's level of cognitive failure, psychological stress, and work place accident occurrence. Retrospective analysis of accident-case individuals vs. control-match individuals on the General Health Questionnaire (GHQ) and Cognitive Failures Questionnaire (CFQ) was undertaken from amalgamated data of two Royal Navy databases. Individuals in the accident-case sub-sample had higher GHQ and CFQ scores when compared to matched-controls. Mediated regression analysis revealed high GHQ score predicted accidents but was transmitted through high CFQ scores. Individuals who are stressed are more likely to have an accident in the workplace because of a propensity for cognitive failures. A specific recommendation to reduce accident risk in the work-place is discussed.© 2010 Elsevier Ltd.


Nunns M.,University of Exeter | House C.,Institute of Naval Medicine | Fallowfield J.,Institute of Naval Medicine | Allsopp A.,Institute of Naval Medicine | Dixon S.,University of Exeter
Journal of Biomechanics | Year: 2013

Barefoot running has increased in popularity over recent years, with suggested injury risk and performance benefits. However, despite many anecdotal descriptions of barefoot running styles, there is insufficient evidence regarding the specific characteristics of barefoot running. The present study provided reference data for four footstrike modalities adopted across a large cohort of habitually shod male runners while running barefoot: heel strikers (HS), midfoot strikers (MS), forefoot strikers (FS) and a newly defined group, toe runners (TR - contact made only with the forefoot), compared with the three modalities previously reported. Plantar pressure analysis was used for the classification of footstrike modality, with clearly distinguishable pressure patterns for different modalities. In the present study, the distribution of footstrike types was similar to that previously observed in shod populations. The absence of differences in ground contact time and stride length suggest that potential performance benefits of a non-HS style are more likely to be a function of the act of running barefoot, rather than of footstrike type. Kinematic data for the knee and ankle indicate that FS and TR require a stiffer leg than HS or MS, while ankle moment and plantar pressure data suggest that a TR style may put greater strain on the plantar-flexors, Achilles tendon and metatarsal heads. TR style should therefore only be adopted with caution by recreational runners. These findings indicate the importance of considering footstrike modality in research investigating barefoot running, and support the use of four footstrike modalities to categorise running styles. © 2013.

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