| Objective:Military training injury（MTI）has become a major health problem affecting military organizations in various countries.This study aims to understand the characteristics and explore the influencing factors of MTI of new trainees,in order to provide basic data support and scientific guidance for the development of scientific new training programs and effective prevention of MTI.Methods:In this study,a multi-stage stratified whole-group random sampling method was used to randomly select 10 new training sites in 7 regions such as Northeast,North,Central,East,South,Northwest and Southwest China as survey sites,and to establish cohorts based on inclusion and exclusion criteria.The demographic characteristics,pre-training dietary habits and physical exercise of the new trainees were collected before training.The behavioral habits and self-status of the subjects during training,self-assessed training status,awareness of training injuries and prevention education,and the occurrence of MTI during training were collected by self-report questionnaires at follow-up.A total of 8502new trainees were finally included in the study.The 818 recruits with the first occurrence of MTI were selected as the case group,and were case-control matched 1:4 for the analysis between exposure factors and risk of MTI by using a nested case-control study method.Continuous variables were expressed as mean±standard deviation,categorical variables were expressed as rates or percentages,and t tests andX2tests were used to compare the demographic characteristics of the study subjects.Multi-factor conditional logistic regression were used to analyze the relationship between factors and MTI.Constructing subgroups in the conditional logistic regression model was used to evaluate the multiplicative interactions among the factors.Restricted cubic splines（RCS）model and generalized least squares method fitted conditional logistic regression were applied to describe the dose-response relationship between each continuous type variable and the risk of MTI.Data entry was performed by using Epidata 3.1,and statistical analysis was performed by using R（4.1.3）.Results:（1）Incidence of MTI:the cumulative incidence of self-reported MTI in the cohort population was 9.62%（818/8502）,with a total of 914 visits,all by men.The occurrence number of MTI was once（90.83%）and once or more（9.17%）.The occurrence categories of MTI were acute injury（52.95%）,strain injury（37.42%）and obsolete injury（9.63%）,respectively.The occurrence types of MTI were soft tissue damage（55.91%）,bone and joint damage（38.29%）,organ damage（4.92%）and special environmental damage（0.88%）.The degree of damage was mild（60.50%）,moderate（37.09%）,severe（2.19%）and serious（0.22%）,respectively.The injury sites were lower limb sites（49.23%）,upper limb sites（31.51%）,trunk sites（14.88%）,head and neck injuries（2.41%）and other sites（1.97%）.The injury-causing subjects for MTI were physical training（56.67%）,tactical training（29.65%）,formation training（4.92%）,bomb disposal training（2.63%）,firing training（2.41%）,stabbing training（2.08%）,emergency assembly（0.88%）and foot marching（0.77%）.The occurrence time of MTI were the 3rd（40.48%）,4th（26.48%）,2nd（19.15%）,1st（10.72%）and 5th（3.17%）months after the start of the new training,and the weather was sunny（76.70%）,cloudy（7.66%）,drizzly（5.47%）,cloudy（4.48%）,stormy（3.50%）and windy（2.19%）,respectively.The occurrence place of MTI were concrete（35.45%）,sand（23.30%）,mud（14.55%）,grass（14.33%）,plastic（9.52%）,mountain（1.97%）and forest（0.88%）.（2）Influencing factors analysis:after controlling for the influencing factors of BMI,geography,only child,history of passive smoking and other influencing factors,multi-factor conditional logistic regression analysis revealed that the risk of MTI in new trainees who were self-rated less prone to injury was significantly lower than that in new trainees who were self-rated prone to injury[Odds Ratio（OR）:0.353,95%CI:0.230-0.542];the risk of MTI in new trainees who were self-rated training with repeated injuries was significantly higher than that in new trainees who were self-rated training without repeated injuries[OR:1.420,95%CI:1.018-1.980];the risk of MTI in new trainees who had regular meals was significantly lower than that in new trainees who had not regular meals[OR:0.829,95%CI:0.701-0.979];the risk of MTI in new trainees who had partial and picky eating was significantly higher than that in new trainees who had not partial and picky eating[OR:1.307,95%CI:1.004-1.702];the risk of MTI in new trainees who did not eat breakfast and had breakfast intake frequency of 1 to 2 days/week were significantly higher than that in new trainees who had breakfast intake frequency of 7 days/week,respectively[OR:1.345,95%CI:1.084-1.669;OR:1.201,95%CI:1.093-1.327];and the risk of MTI in new trainees who had sleep disturbance was significantly higher than that in new trainees who had not sleep disturbance[OR:1.267,95%CI:1.072-1.499].（3）Interaction analysis:in the nested case-control population,a multiplicative interaction between self-rated less prone to injury and sleep disturbance（OR:1.554,95%CI:1.085-2.225）increased the risk of MTI（P<0.05）.（4）The dose-response relationship:after controlling for the influencing factors of age,BMI,ethnicity,geography,education,only child,smoking status and history of passive smoking,there was no dose-response relationship between age level and the risk of MTI in the cohort.There was a linear dose-response relationship between BMI level and the risk of MTI in the cohort(P linear=0.017),and there was a non-linear dose-response relationship between fatigue level and the risk of MTI(P model<0.001,P non-linear<0.001).Conclusion:（1）The incidence of MTI among new trainees in 2022 showed a decreasing trend compared to the previous reported incidence.（2）The occurrence of MTI were characterized by the number of occurrences of once,acute injuries and strain injuries.The occurrence type was mainly soft tissue injury and bone and joint injury,and the degree of injury was mainly mild and moderate injury.The occurrence site was mainly the extremities,mostly concentrated in the knee,ankle,lower leg and foot.The top three injury-causing subjects were physical training,tactical training,and team training.MTI occurred in all months of training,with peak incidence in the 3rd and 4th months after the start of new training.And MTI was more likely to occur in sunny,cloudy and rainy weather,as well as on concrete and sandy surfaces.（3）Self-rated less prone to injury and regularity of three meals were independent protective factors for the occurrence of MTI factor,while self-rated training with repeated injuries,partial and picky eating,skipping breakfast,breakfast intake frequency of 1 to 2 days/week and sleep disturbance were independent risk factors for MTI.It is suggested that new trainees should strengthen their awareness of self-protection and develop healthy habits,the forces should combine the characteristics of MTI among the new trainees,reasonably arrange the training plan and train scientifically to reduce the incidence of MTI,reduce non-combat attrition,and enhance force combat effectiveness. |
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