OBJECTIVE: U.S. Army Basic Combat Training (BCT) improves tibial volumetric bone mineral density (BMD) and structure in most, but not all soldiers. Few studies have investigated whether changes in serum bone biomarkers during BCT are associated with changes in tibial BMD and bone structure following BCT.
OBJECTIVE: To characterize bone biomarker changes during BCT and to investigate the relationship between changes in bone biomarkers and changes in tibial BMD and bone structure.
METHODS: We enrolled 235 trainees entering BCT in this ten-week prospective observational study. Trainees provided fasted blood samples and questionnaires weekly throughout BCT. Procollagen type 1 N-terminal propeptide (PINP) and C-terminal telopeptide of type 1 collagen (CTX) were measured by enzyme-linked immunoabsorbent assays every two weeks during BCT. We evaluated body composition and mass via dual-energy X-ray absorptiometry and bone structure, microarchitecture, and mineral density at the distal tibia via high-resolution peripheral quantitative computed tomography at baseline and post-BCT.
RESULTS: Both male (n = 110) and female trainees (n = 125) were young (20.9 ± 3.7 and 20.7 ± 4.3 years, respectively), with normal to overweight BMIs (25.2 ± 4.1 and 24.2 ± 3.6 kg/m2, respectively). In female trainees, PINP increased during and post-BCT compared to baseline, with the greatest increase in PINP at week four (45.4 % ± 49.6, p < 0.0001), whereas there were no changes in CTX. PINP also increased in male trainees, but only at weeks two and four (21.9 % ± 24.5, p = 0.0027 and 35.9 % ± 35.8, p < 0.0001, respectively). Unlike female trainees, in males, CTX was lower than baseline at weeks four, eight, and post-BCT. The change in PINP from baseline to week four of BCT was positively associated with changes in tibial BMD, Tb.BMD, Tb.Th, Tb.BV/TV, Ct.Th, Ct.Ar, and Ct.Po from the baseline to post-BCT.
CONCLUSIONS: The bone formation marker PINP increases during U.S. Army BCT, especially during the first four weeks. Increases in PINP, but not CTX, were correlated with improved BMD and bone structure in the distal tibia.

Military personnel need physical fitness to effectively carry out operational military activities within their specific field of operation. This research investigates the effects of a 34-week training program on Angolan cadets\' body composition, muscle strength, and cardiorespiratory fitness. Seventy-four volunteer recruits, aged 18 to 26 years, were monitored during their eight-month military service, following an exercise program protocol comprising 12 weeks of strength training followed by 24 weeks of endurance training. Anthropometric variables, including body mass, body mass index, and fat mass, were assessed, along with cardiorespiratory fitness (VO2max), sprint performance, countermovement jump (CMJ), medicine ball throw, push-ups, and curl-ups. The physical training protocol encompassed running sessions, strength exercises, agility drills, and flexibility exercises. The initial assessment revealed gender differences in various parameters such as body mass, body fat percentage, VO2max, sprinting, countermovement jump (CMJ), medicine ball throw, and push-ups. Following the training program, changes were observed in all variables (effect size between 0.48 and 2.33, p < 0.01) for the participants. Significant interactions (sex × time) were found in body mass (F = 5.18, p = 0.03, ηp2 = 0.06), body fat percentage (F = 5.31, p < 0.01, ηp2 = 0.14), and medicine ball throw (F = 10.84, p < 0.01, ηp2 = 0.13). Specifically, males exhibited a greater reduction in body mass (females: 2.70%, males: 3.47%, p < 0.05) and a substantial improvement in ball throwing performance (females: 7.74%, males: 11.47%, p < 0.01), while females experienced a greater reduction in fat mass (females: 5.34%, males: 3.15%, p < 0.01). The physical training regimen effectively influenced body composition, particularly in enhancing strength performance among males. The integration of exercise programs with military service led to a notable reduction in fat tissue and an increase in lean tissue. Hence, the development of tailored training protocols is imperative to enhance the physical capacity and overall health of military recruits, considering sex-specific characteristics and physical attributes.

Unit cohesion is the extent to which military service members feel committed to and supported by their military unit or, conversely, feel overlooked, neglected, and/or alienated. Unit cohesion reflects an important aspect of military social support and can act as a protective factor against mental health challenges, particularly in challenging situations. Theoretical suppositions and emerging evidence suggest that different types of unit support, specifically, vertical unit cohesion and horizontal unit cohesion, uniquely matter for service member well-being. Vertical unit cohesion (support from leaders in the unit and other higher-ranking positions) may be of universal importance to service members with implications for career progression and personal wellbeing, while horizontal unit cohesion (support from fellow unit members and peers) may be of importance under certain circumstances. Informed by the psychometric theory of scale development and validation, the dimensionality of unit cohesion theory, and the need for brief, sound measurement tools, this study first examined the psychometric properties of the Army STARRS four-item Vertical Unit Cohesion Scale in a longitudinal analysis with a large, diverse sample of Soldiers from the Pre/Post Deployment Study component of the Army STARRS dataset (N = 10,116). Then, exploratory analyses were conducted to examine the properties of the Horizontal Unit Cohesion Scale and understand the relationship between vertical and horizontal unit cohesion. Strong evidence for the Vertical Unit Cohesion Scale\'s psychometric soundness was established regarding factor structure, measurement invariance overtime, and construct validity. Conversely, preliminary evidence suggests that the three-item measure of Horizontal Unit Cohesion should be used with caution. Implications for researchers and military leadership are provided.

OBJECTIVE: Paying attention to the psychological characteristics of soldiers is a matter of concern for planners and senior commanders. Therefore, this study was conducted to investigate the mediating role of personality traits in the relationship between psychological empowerment and mental health in soldiers stationed in the Kerman Province barracks.
METHODS: In this cross-sectional study, 604 soldiers serving in Kerman Province barracks in the year 2021 were examined. The soldiers were selected from a cluster sampling of two barracks. Data were collected using a demographic information checklist, the Sportzier Psychological Empowerment Questionnaire (PEQ), the General Health Questionnaire (GHQ), and the NEO Personality traits (NEO). Pearson\'s correlation coefficient and structural equation modeling were used for data analysis. The Judd and Kenny\'s framework was also employed to investigate the mediating role.
RESULTS: Of these individuals, 390 (46.6%) had completed their military training, while 433 (71.7%) were single. The correlation between PEQ and GHQ was inverse and non-significant (P = 0.348), between PEQ and NEO was direct and significant (P = 0.002), and between NEO and GHQ was inverse and significant (P < 0.001). In the structural equation model, the PEQ variable had a significant impact on NEO (P = 0.002), but it did not significantly affect the GHQ variable (P = 0.850). The NEO variable also had a significant impact on GHQ.
CONCLUSIONS: The NEO variable has a full mediation effect on the relationship between PEQ and GHQ. Therefore, the use of psychologists and clinical physicians for appropriate interventions to enhance mental health, such as education, counseling, and psychotherapy, appears to be necessary.

The Master Resilience Training (MRT) course is the U.S. Army\'s resilience program of record to develop soldiers as resilience trainers within their home units. The Walter Reed Army Institute of Research (WRAIR) recently conducted an MRT Quality Improvement Evaluation (QIE) to understand perceptions of the MRT course, determine the effectiveness of the course, and provide revision recommendations for the next iteration of the course. Soldiers who were completing the MRT course were invited to take surveys and participate in interviews. Results from quantitative and qualitative data suggest that most participants felt satisfied with the training and that it was relevant for soldiers. Most participants also agreed that the training would help them become better soldiers and leaders. Along with positive feedback about the course, participants also identified areas that could be improved. Soldier feedback along with program evaluators\' observation informed recommendations for improving the overall MRT course and its implementation. Program evaluators recommend MRT participants learn fewer and less complex skills, focus on coach education throughout the course, and highlight leader development by promoting motivation and enhancing effective communication. Program evaluators recommendations for ways to improve buy-in from leaders and graduated MRTs are also discussed.

Posttraumatic headaches are one of the most common and controversial secondary headache types. After a mild traumatic brain, an estimated 11% to 82% of people develop a postconcussion syndrome, which has been controversial for more than 160 years. Headache is estimated as present in 30% to 90% of patients after a mild head injury. Most headaches are tension-type-like or migraine-like. Headaches in civilians, soldiers, athletes, and postcraniotomy are reviewed. The treatments are the same as for the primary headaches. Persistent posttraumatic headaches can continue for many years.

The concept of moral injury, referring to the psychological impact of having one\'s moral expectations and beliefs violated, is gaining a firm place in research on military trauma. Yet, although moral injury has the recognized potential to extend the understanding of trauma beyond the individualizing and pathologizing focus of the clinical realm, most studies nevertheless focus on clinical assessment, diagnosis and treatment. This review aims to contribute to a better understanding of contextual dimensions of moral injury. To this end, it complements current theory on moral injury with a systematic review of literature relevant to contextual factors in moral injury. It draws together insights from psychology, philosophy, theology and social sciences into spiritual/existential, organizational, political and societal dimensions of moral injury. Thus an interdisciplinary theoretical foundation is created for context-sensitive research and interventions.

Developmental coordination disorder (DCD) is a disorder affecting motor coordination which negatively impacts academic and daily activities in various environments. The military is a highly structured environment with limited freedom, placing high demand on motor coordination, organizational ability, time management, and social skills. All these present challenges to young adults with DCD. Our study aimed to describe and assess the functioning of young adults with DCD in the Israel Defense Forces. Participants included three groups of young adults recruited via the Israel Army Health Survey upon discharge from active service: probable DCD (135), suspected borderline DCD (149), and control (145). Participants completed the Adolescents & Adults Coordination Questionnaire and the Army Questionnaire. The probable-DCD group reported significantly more difficulties in their military service than did the other groups: more unit reassignments, more accidents during field operations, and more complaints related to discipline and professional behavior. Significant differences emerged between both DCD groups and the control group in \"understanding of learning materials,\" \"forgetting belongings,\" and \"success in the army.\" The participants with probable DCD and suspected borderline DCD were able to integrate into the army, but the probable-DCD group performed significantly worse than the others and reported more difficulties participating in the army. These results highlight the importance of being aware of soldiers with probable DCD, in order to assign them duties that fit their abilities.

Research suggests that preceding physical activity benefits learning in the general population, however the impact of physical activity before testing has not been systematically explored. We examined how an acute, complex anaerobic activity impacted learning and retention of text. Soldiers read Special Operations or Pension texts and were tested on recall and comprehension at 1 and 48 hours after reading. Participants also performed a challenging physical course before learning, before testing, or outside of these two periods. Results were compared using a mixed Analysis of Covariance with a \"fitness-effort\" covariate factor. Testing complied with Human Research Ethics Committee guidelines. Participants performing physical activity before testing had lower mean first test scores than participants performing the activity outside of the learning or testing window. After 48 hours, there was no difference among groups. Equally, while participants who read the Special Operations materials performed better than those who read the Pension materials, there was no effect related to activity timing. Acute obstacle course activity impeded recall but not learning of a read text. Additional study is needed to determine whether metabolic or motoric demands of the physical activity caused the deficit.

BACKGROUND: Soldiers constitute a professional group carrying out their duties in variable, often challenging environmental conditions, including harmful and burdensome ones.
METHODS: This study was conducted on a nationwide sample of 1331 soldiers. The research tool was an anonymous questionnaire comprising 48 questions. Descriptive statistics were used to describe the characteristics of the studied group. The chi-square test was employed to examine the relationship between variables. A 95% confidence interval was adopted, with a significance level of p = 0.05.
RESULTS: One in four soldiers work with low and one in five with moderate exposure to harmful chemical factors. Almost 10% of respondents lack knowledge about the types of chemical factors present during their service. One in five soldiers work with low and one in eight with moderate exposure to ionizing radiation. Approximately 5% of survey participants lack knowledge about the types of physical factors. One in three soldiers are unaware of the carcinogenic and mutagenic effects of the aforementioned factors.
CONCLUSIONS: The systematic enhancement of knowledge and awareness among army members will help minimize the consequences of exposure to harmful conditions.