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爆炸背景下:长期职业性反复接触低强度爆炸物对加拿大武装部队爆破教官和靶场工作人员的神经心理及神经认知影响

Blast in Context: The Neuropsychological and Neurocognitive Effects of Long-Term Occupational Exposure to Repeated Low-Level Explosives on Canadian Armed Forces' Breaching Instructors and Range Staff.

作者信息

Vartanian Oshin, Tenn Catherine, Rhind Shawn G, Nakashima Ann, Di Battista Alex P, Sergio Lauren E, Gorbet Diana J, Fraser Douglas D, Colantonio Angela, King Kristen, Lam Quan, Saunders Doug, Jetly Rakesh

机构信息

Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada.

Department of Psychology, University of Toronto, Toronto, ON, Canada.

出版信息

Front Neurol. 2020 Dec 3;11:588531. doi: 10.3389/fneur.2020.588531. eCollection 2020.

Abstract

Currently, there is strong interest within the military to better understand the effects of long-term occupational exposure to repeated low-level blast on health and performance. To gain traction on the chronic sequelae of blast, we focused on -a tactical technique for gaining entry into closed/blocked spaces by placing explosives and maintaining a calculated safe distance from the detonation. Using a cross-sectional design, we compared the neuropsychological and neurocognitive profiles of breaching instructors and range staff to sex- and age-matched Canadian Armed Forces (CAF) controls. Univariate tests demonstrated that breaching was associated with greater post-concussive symptoms () and lower levels of energy (). In addition, breaching instructors and range staff were slower on a test that requires moving and thinking simultaneously (i.e., cognitive-motor integration). Next, using a multivariate approach, we explored the impact of other possible sources of injury, including concussion and prior war-zone deployment on the same outcomes. Concussion history was associated with higher post-concussive scores and musculoskeletal problems, whereas deployment was associated with higher post-concussive scores, but lower energy and greater PTSD symptomatology (using PCL-5). Our results indicate that although breaching, concussion, and deployment were similarly correlated with greater post-concussive symptoms, concussion history appears to be uniquely associated with altered musculoskeletal function, whereas deployment history appears to be uniquely associated with lower energy and risk of PTSD. We argue that the broader injury context must, therefore, be considered when studying the impact of repetitive low-level explosives on health and performance in military members.

摘要

目前,军方对更好地了解长期职业性反复接触低强度爆炸对健康和工作表现的影响有着浓厚兴趣。为了深入研究爆炸的慢性后遗症,我们重点关注了一种战术技术,即通过放置炸药并与爆炸保持计算好的安全距离来进入封闭/堵塞空间。采用横断面设计,我们将爆破教员和靶场工作人员的神经心理学和神经认知特征与年龄和性别匹配的加拿大武装部队(CAF)对照组进行了比较。单变量测试表明,爆破与更严重的脑震荡后症状()和更低的能量水平()相关。此外,在一项需要同时移动和思考的测试(即认知运动整合)中,爆破教员和靶场工作人员的速度较慢。接下来,我们采用多变量方法,探讨了其他可能的损伤来源,包括脑震荡和先前的战区部署对相同结果的影响。脑震荡史与更高的脑震荡后评分和肌肉骨骼问题相关,而部署则与更高的脑震荡后评分相关,但能量水平更低,创伤后应激障碍症状更严重(使用PCL-5)。我们的结果表明,虽然爆破、脑震荡和部署与更严重的脑震荡后症状同样相关,但脑震荡史似乎与肌肉骨骼功能改变有着独特的关联,而部署史似乎与更低的能量水平和创伤后应激障碍风险有着独特的关联。因此,我们认为,在研究重复性低强度爆炸对军人健康和工作表现的影响时,必须考虑更广泛的损伤背景。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e061/7744759/93b5ba28428f/fneur-11-588531-g0001.jpg

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