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עמוד בית
Tue, 16.07.24

December 2022 - (Issue 56)

Articles & Reviews
Yoram Epstein
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Assessing a person's tolerance to heat as a decision-making tool about returning to active duty/practice, especially after recovery from exertional heat injury, is relevant for athletes, soldiers, and workers who perform physical activity while exposed to heat stress. Since the pioneering study in South Africa's gold mines almost a century ago, many protocols have been proposed. These tests can be referred to as "functional tests" because their primary purpose is to assess the thermoregulatory capacity of the individual in situations of heat stress and not to be used as a "clinical diagnostic test." Such a test should be user-friendly, quantitative or at least semi-quantitative, and adequately reflective of the thermoregulatory response under conditions of heat stress. Quite a few tests of this nature have been proposed, many of which have been discarded. The present article will review the development of the various tests that have been proposed. The most common test today is the heat tolerance test which was developed by the IDF in the 1970s and has been in use since then. Other armed forces have also adopted this test, with solid evidence of its reliability and validity. At the same time, it should be remembered that the decision regarding the return to activity of a person who has recovered from exertional heat injury presents a significant medical challenge. Thus, the heat tolerance test should be only one of the tools deployed when making decisions in this regard.
Shani Sultani, Mika Gross, Vladislav Babushkin, Amir Hadid, Mika Littor, Jeni Muginshtein-Simkovitch, Gilad Twig, Itay Ketko
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Military history indicates a persistent increase in the weight carried by soldiers despite technological advancements. Physiologically, carrying loads leads to elevated physical exertion, manifesting in increased heart rate, greater energy consumption, and cumulative muscle fatigue. All of the above contribute to discomfort and fatigue, potentially impairing a soldier's operational readiness and performance. From an anatomical perspective, extended walking with heavy loads poses risks of stress fractures and lower back injuries, along with various medical issues such as foot pain, numbness, respiratory limitations, and nerve damage. Tasks involving load carriage are integral to military service; therefore, it is necessary to understand its implications to integrate women into combat roles while maximizing their performance and preserving their health and readiness. The emphasis on female soldiers stems from distinctions in anatomy and physiology, as discussed in professional literature. This review emphasizes differences between women and men in tasks involving loadcarrying and their impact on women's service in combat roles. It is essential to note that the review centers on population-level differences and does not address or apply to individual capabilities.
Uri Levor, Ira Shulman, Sigal Faran, Hadar Cohen, Arnon Catz, Zehorit Shiach, Mali Shauder, Itay Ketko
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Nutrition plays a significant role in military training, enabling soldiers to perform their tasks effectively and enhancing their overall quality of service. Over the last decade, several nutritional improvements have been applied in the Israeli Defense Forces )IDF(. Food variety was increased, special field rations were introduced to cater to soldiers with specific nutritional needs, special field rations were added, and special food mobilization equipment was introduced. Moreover, field dietitians wrote more comprehensive guidelines that are currently being implemented. Despite nutrition's proven importance, field units struggle to implement optimal nutrition principles due to knowledge gaps and a lack of a comprehensive system. The 'Nutrition Junction' model, a multi-factor nutrition management method for combat units, was established in 2017 to address this. This model links nutritional guidelines and the combat soldier’s diet by creating a common language for the relevant commanders and providing them with applicable techniques, primarily for combat units and basic and advanced training phases. Integrating dietitians into command structures enables units to address soldiers’ nutritional needs better, enhancing their overall performance. This comprehensive approach ensures that soldiers receive the necessary nutritional support to optimize their health and military performance. Implemented in training bases across IDF commands, the model has shifted commanders' perceptions, emphasizing nutrition's role in mission preparation and service quality. They now recognize its role in preparing soldiers to fulfill their mission and its impact on service quality. This article describes the “Nutrition Junction” model and its practical implementation in units.
Segev Sharon, Itay Ketko, Daniel S. Moran, David Erez
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Background: Body heat dissipation effectiveness during rigorous physical exercise
depends on ambient temperature and relative humidity. Inability to cool the
body results in body-core temperature, leading to heat-related injuries. Global
temperatures are expected to rise in the foreseeable future, potentially increasing
the number of heat-related illnesses. Combat soldiers in the Israel Defense Forces
often perform rigorous activities in hot environments, making them particularly
vulnerable to heat-related injuries. A potential strategy for mitigating heat-related
injuries is re-scheduling physical training during the summer.

Proposal: We propose inverting the sleep-wake cycle during basic training of
combat soldiers to reduce the risk of heat-related injuries. While the health effects of
inverting sleep-wake cycles are well-documented in civilian cohorts, there is a lack of
research investigating the prolonged efficacy of sleep inversion in combat soldiers.
We also propose evaluating the effect of inverting the sleep cycle on non-heatrelated
injuries, hormonal profiles, mental well-being, and cognitive and physical
performance. Furthermore, we propose that this research be performed using mixedgender
units to account for gender-based response differences.
Aya Ekshtein, MPE, Liora Levian Moadim, MHA Opt., Yuval Kozlov, B Med Sc, Dana Berger, MA, Maya Avni, B.Eng, Oded Ben-Ari, MD
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Introduction: Photorefractive Keratectomy (PRK) and Laser-Assisted in Situ
Keratomileusis (LASIK) are widely applied procedures designed to correct refractive
errors in adults. While there is evidence of the safety and effectiveness of these
surgeries, long-term visual and refractive outcomes in combat pilots have not been
thoroughly studied. This study aims to investigate the long-term effects of PRK and
LASIK on Israeli Air Force aviators, thereby providing essential insights into how
these procedures impact their performance.

Methods: Medical records of aviators who underwent refractive surgery during their
service were extracted. Preoperative and annual postoperative data were analyzed.
Key metrics included visual acuity (VA) and spherical equivalent (SE).

Results: 87 records were analyzed. Mean age at the time of surgery was 31.8±9.8
years; 95.4% of participants were male. Pre-surgery myopia severity (SE) was
-2.060±1.158. LASIK and PRK procedures were performed in 62.1% and 33.3% of the
surgeries, respectively. Both PRK and LASIK demonstrated significant, sustained
improvements in VA for 11 years (p=0.035) and in SE for 12 years (p<0.001). Myopia
severity pre-surgery was identified as a crucial determinant of postoperative
outcomes for VA (p=0.029) and SE (p=0.008). Age, astigmatism, and procedure type
did not significantly affect long-term outcomes.

Conclusions: This study highlights the enduring efficacy of PRK and LASIK for
aviators. The outcome is highly affected by the severity of preoperative myopia,
emphasizing the need for individualized assessments prior to the procedure
and consistent follow-ups afterward. These findings reinforce the safety and
effectiveness of PRK and LASIK in high-demand jobs, providing essential guidance
for healthcare providers in making refractive surgery decisions.
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