{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:48:09Z","timestamp":1776448089877,"version":"3.51.2"},"reference-count":37,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Netherlands Ministry of Defense"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Military personnel training and operating on the Arctic battlefield face unique medical challenges because of extreme conditions and demanding training regiments. This study aims to characterize the morbidity patterns among military personnel participating in a Joint Arctic Training exercises conducted by the Netherlands Marine Core.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted using Epidemiological Surveillance in NATO-2 (EpiNATO-2) data from Joint Arctic Training exercises spanning from January 2014 to April 2024. Medical registrations were categorized according to EpiNATO-2 body system classifications. The frequency and distribution of illnesses and injuries were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the study period of 10 years acquiring of data was complex. We were able to retrieve and analyze data from 5 years of training. During these years medical personnel provided treatment to 2,464 patients. Musculoskeletal diseases (35.51% n\u2009=\u2009875) and dermatological conditions (22.85% n\u2009=\u2009563) were the most prevalent categories, accounting for 58.36% of all medical consultations. Within musculoskeletal diseases, unspecified conditions (14.85% n\u2009=\u2009366) and knee injuries (5.40% n\u2009=\u2009133) were most common. Dermatology unspecified (9.54% n\u2009=\u2009253), other dermatological injuries (8.94% n\u2009=\u2009220) combined with burns (2.11% n\u2009=\u200952) being the most prevalent in the dermatology categories. Despite the harsh environment, cold injuries\/frostbite (2.68% n\u2009=\u200966) and hypothermia (0.12% n\u2009=\u20093) were relatively infrequent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Musculoskeletal and dermatological conditions represent significant medical concerns during arctic military training. Targeted preventive strategies, optimized training regimens, improved data collection linked to climatological and operational circumstances, and (arctic) medical training focused on musculoskeletal injuries are recommended to mitigate these risks and enhance the health and readiness of military personnel operating in Arctic environments. Future research should focus on identifying specific risk factors and evaluating the effectiveness of targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag164","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:35:33Z","timestamp":1775561733000},"source":"Crossref","is-referenced-by-count":0,"title":["Medical Treatment in the Arctic: A Retrospective 10-Year Analysis"],"prefix":"10.1093","author":[{"given":"Casper Matthias","family":"Fransen","sequence":"first","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin Leslie","family":"Turner","sequence":"additional","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerardus","family":"Rietjens","sequence":"additional","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e9","family":"Joosten","sequence":"additional","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]},{"name":"Defense Healthcare Organisation, Ministry of Defense , Herculeslaan 1 , Utrecht, 3548 AB,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mich\u00e8le Elise Visser","family":"\u2018t Hooft","sequence":"additional","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]},{"name":"Defense Healthcare Organisation, Ministry of Defense , Herculeslaan 1 , Utrecht, 3548 AB,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William Graeme","family":"Spinhoven","sequence":"additional","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thijs Theodorus Cornelis Franciscus","family":"van Dongen","sequence":"additional","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]},{"name":"Defense Healthcare Organisation, Ministry of Defense , Herculeslaan 1 , Utrecht, 3548 AB,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rigo","family":"Hoencamp","sequence":"additional","affiliation":[{"name":"Ministry of Defense , Kalvermarkt 32 , Den Haag, 2511 CB,","place":["The Netherlands"]},{"name":"Defense Healthcare Organisation, Ministry of Defense , Herculeslaan 1 , Utrecht, 3548 AB,","place":["The Netherlands"]},{"name":"Department of Surgery, Alrijne Hospital , Leiderdorp, Simon Smitweg 1 , 2353 GA,","place":["The Netherlands"]},{"name":"Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam , Dr. Molewaterplein 40 , Rotterdam, 3015 GD,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"2026041713013054300_usag164-B1","year":"2025"},{"key":"2026041713013054300_usag164-B2","author":"Montgomery","year":"2025"},{"key":"2026041713013054300_usag164-B3","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.wem.2012.01.002","article-title":"Belaya Smert: the White death","volume":"23","author":"Rodway","year":"2012","journal-title":"Wilderness Environ Med"},{"key":"2026041713013054300_usag164-B4","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1177\/014107688307601119","article-title":"A short but distant war\u2014the falklands campaign","volume":"76","author":"Marsh","year":"1983","journal-title":"J R Soc Med"},{"key":"2026041713013054300_usag164-B5","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s13031-024-00632-2","article-title":"A qualitative assessment of disease and non-battle injuries in Ukraine since the russian invasion","volume":"19","author":"Lawry","year":"2025","journal-title":"Confl Health"},{"key":"2026041713013054300_usag164-B6","doi-asserted-by":"publisher","first-page":"37","DOI":"10.55460\/GVPX-UBR3","article-title":"Combat casualty care in arctic or extreme cold environments: considerations for the army health system","volume":"25","author":"Reynhout","year":"2025","journal-title":"J Spec Oper Med"},{"key":"2026041713013054300_usag164-B7","year":"2025"},{"key":"2026041713013054300_usag164-B8","year":"2017"},{"key":"2026041713013054300_usag164-B9","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1093\/milmed\/165.12.905","article-title":"Injuries and risk factors in an 18-day marine winter Mountain training exercise","volume":"165","author":"Reynolds","year":"2000","journal-title":"Mil Med"},{"key":"2026041713013054300_usag164-B10","doi-asserted-by":"publisher","first-page":"e1461\u201371","DOI":"10.1093\/milmed\/usaa027","article-title":"Musculoskeletal injuries and United States army readiness part I: overview of injuries and their strategic impact","volume":"185","author":"Molloy","year":"2020","journal-title":"Mil Med"},{"key":"2026041713013054300_usag164-B11","doi-asserted-by":"publisher","first-page":"e2608\u201315","DOI":"10.1093\/milmed\/usad438","article-title":"Force health surveillance in NATO does not meet the needs of its users: a structured evaluation of EpiNATO-2","volume":"189","author":"Rowh","year":"2024","journal-title":"Mil Med"},{"key":"2026041713013054300_usag164-B12","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/1941738118813051","article-title":"Alpine skiing injuries","volume":"11","author":"Davey","year":"2019","journal-title":"Sports Health"},{"key":"2026041713013054300_usag164-B13","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1093\/milmed\/144.10.680","article-title":"Morbidity associated with cold weather training","volume":"144","author":"McCarroll","year":"1979","journal-title":"Mil Med"},{"key":"2026041713013054300_usag164-B14","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1249\/MSS.0000000000001349","article-title":"Meta-analysis of cigarette smoking and musculoskeletal injuries in military training","volume":"49","author":"Bedno","year":"2017","journal-title":"Med Sci Sports Exerc"},{"key":"2026041713013054300_usag164-B15","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1007\/s40279-014-0192-8","article-title":"Alcohol: impact on sports performance and recovery in male athletes","volume":"44","author":"Barnes","year":"2014","journal-title":"Sports Med"},{"key":"2026041713013054300_usag164-B16","first-page":"25","article-title":"Energy deficiency in soldiers: The risk of the athlete triad and relative energy deficiency in sport syndromes in the military","volume":"7","author":"O\u2019Leary","year":"2020","journal-title":"Front Nutr"},{"key":"2026041713013054300_usag164-B17","doi-asserted-by":"publisher","first-page":"627","DOI":"10.3390\/physiologia3040046","article-title":"Time-Course of recovery for biomarkers and physical performance after strenuous military training: a systematic review","volume":"3","author":"Granlund","year":"2023","journal-title":"Physiologia"},{"key":"2026041713013054300_usag164-B18","doi-asserted-by":"publisher","first-page":"2267425","DOI":"10.1080\/07853890.2023.2267425","article-title":"A review of skin disease in military soldiers: challenges and potential solutions","volume":"55","author":"Singal","year":"2023","journal-title":"Ann Med"},{"key":"2026041713013054300_usag164-B19","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1093\/milmed\/usz110","article-title":"The burden of skin disease on deployed servicemembers","volume":"184","author":"Gregory","year":"2019","journal-title":"Mil Med"},{"key":"2026041713013054300_usag164-B20","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/jns.12363","article-title":"Backpack palsy and other brachial plexus neuropathies in the military population","volume":"25","author":"Dorhout Mees","year":"2020","journal-title":"J Peripher Nerv Syst"},{"key":"2026041713013054300_usag164-B21","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3402\/ijch.v66i2.18237","article-title":"Cold air-provoked respiratory symptoms: the mechanisms and management","volume":"66","author":"Koskela","year":"2007","journal-title":"Int J Circumpolar Health"},{"key":"2026041713013054300_usag164-B22","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s41256-021-00232-0","article-title":"The military as a neglected pathogen transmitter, from the nineteenth century to COVID-19: a systematic review","volume":"6","author":"Chaufan","year":"2021","journal-title":"Glob Health Res Policy"},{"key":"2026041713013054300_usag164-B23","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1136\/military-2022-002171","article-title":"Frostbite: a systematic review on freezing cold injuries in a military environment","volume":"171","author":"van Dongen","year":"2025","journal-title":"BMJ Mil Health"},{"key":"2026041713013054300_usag164-B24","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.emc.2016.12.006","article-title":"Frostbite","volume":"35","author":"Handford","year":"2017","journal-title":"Emerg Med Clin North Am"},{"key":"2026041713013054300_usag164-B25","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1136\/military-2023-002380","article-title":"Frostbite: a treatment guideline for prehospital treatment in a military environment","volume":"171","author":"Turner","year":"2025","journal-title":"BMJ Mil Health"},{"key":"2026041713013054300_usag164-B26","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1080\/23328940.2024.2408059","article-title":"Cold weather operations: preventive strategies in a military context","volume":"12","author":"Klous","year":"2025","journal-title":"Temperature"},{"key":"2026041713013054300_usag164-B27","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1016\/j.jsams.2020.11.010","article-title":"Human performance research for military operations in extreme cold environments","volume":"24","author":"Sullivan-Kwantes","year":"2021","journal-title":"J Sci Med Sport"},{"key":"2026041713013054300_usag164-B28","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s13102-023-00711-6","article-title":"Effects of 36-hour recovery on marksmanship and hormone concentrations during strenuous winter military survival training","volume":"15","author":"Ojanen","year":"2023","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2026041713013054300_usag164-B29","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1093\/milmed\/usae075","article-title":"Stress response to winter warfare training: potential impact of location","volume":"189","author":"Visconti","year":"2024","journal-title":"Mil Med"},{"key":"2026041713013054300_usag164-B30","doi-asserted-by":"publisher","first-page":"e002747","DOI":"10.1136\/military-2024-002747","article-title":"MSKI reduction strategies: evidence-based interventions to reduce musculoskeletal injuries in military service members","volume":"171","author":"Tingelstad","year":"2025","journal-title":"BMJ Mil Health"},{"key":"2026041713013054300_usag164-B31","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/s0749-3797(99)00166-x","article-title":"Cigarette smoking and exercise-related injuries among young men and women","volume":"18","author":"Altarac","year":"2000","journal-title":"Am J Prev Med"},{"key":"2026041713013054300_usag164-B32","doi-asserted-by":"publisher","first-page":"1621","DOI":"10.1093\/ntr\/nty155","article-title":"The combined effect of cigarette smoking and fitness on injury risk in men and women","volume":"21","author":"Brooks","year":"2019","journal-title":"Nicotine Tob Res"},{"key":"2026041713013054300_usag164-B33","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1097\/00005768-200106000-00014","article-title":"Risk factors for training-related injuries among men and women in basic combat training","volume":"33","author":"Knapik","year":"2001","journal-title":"Med Sci Sports Exerc"},{"key":"2026041713013054300_usag164-B34","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s40798-016-0046-z","article-title":"Musculoskeletal lower limb injury risk in army populations","volume":"2","author":"Andersen","year":"2016","journal-title":"Sports Med Open"},{"key":"2026041713013054300_usag164-B35","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1097\/TA.0000000000001341","article-title":"Review of military and civilian trauma registries: Does consensus matter?","volume":"82","author":"Van Dongen","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2026041713013054300_usag164-B36","doi-asserted-by":"publisher","first-page":"2246666","DOI":"10.1080\/22423982.2023.2246666","article-title":"Human performance and medical treatment during cold weather operations - synthesis of a symposium","volume":"82","author":"Mekjavic","year":"2023","journal-title":"Int J Circumpolar Health"},{"key":"2026041713013054300_usag164-B37","author":"Rydelius","year":"2025"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag164\/68107818\/usag164.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag164\/68107818\/usag164.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:01:41Z","timestamp":1776445301000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag164\/8658428"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":37,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag164","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]},"article-number":"usag164"}}