Effectiveness of the self-regulation educational program in increasing knowledge about COVID-19 in Peruvian soldiers.

OBJECTIVE: To determine the effectiveness of the educational program based on self-regulation of learning in the level of knowledge about COVID-19 in the soldiers. METHODS: Pre-experimental study with a pre-test and post-test design with a single group, carried out in 2020. 179 soldiers from Puno, Peru participated. Two expository-participatory sessions and a demonstrative workshop were developed. A valid (Aiken's V = 0.69) and reliable (McDonald's Omega = 0.81) questionnaire was used. The Friedman's test was used to compare the results pre and post-test. RESULTS: The level of knowledge about COVID-19 and in two of its dimensions changed from poor (pre-test) to regular (post-test). However, in the preventive measures dimension, it changed from poor (pre-test) to excellent (post-test). CONCLUSION: The proposed educational intervention was effective in increasing knowledge about COVID-19 in the soldiers, mainly in terms of preventive measures.

Opportunities to Strengthen the National Disaster Medical System: The Military-Civilian NDMS Interoperability Study.

The definitive care component of the National Disaster Medical System (NDMS) may not be able to effectively manage tens of thousands of casualties resulting from a catastrophic disaster incident or overseas conflict. To address this potential national security threat, Congress authorized the US Secretary of Defense to conduct the NDMS Pilot Program to improve the interoperability, special capabilities, and patient capacity of the NDMS. The pilot's first phase was the Military-Civilian NDMS Interoperability Study, designed to identify broad themes to direct further NDMS research. Researchers conducted a series of facilitated discussions with 49 key NDMS federal and civilian (private sector) stakeholders to identify and assess weaknesses and opportunities for improving the NDMS. After qualitative analysis, 6 critical themes emerged: (1) coordination, collaboration, and communication between federal and private sector NDMS partners; (2) funding and incentives for improved surge capacity and preparedness for NDMS partners; (3) staffing capacity and competencies for government and private NDMS partners; (4) surge capacity, especially at private sector healthcare facilities; (5) training, education, and exercises and knowledge sharing between federal and private sector NDMS partners; and (6) metrics, benchmarks, and modeling for NDMS partners to track their NDMS-related capabilities and performance. These findings provide a roadmap for federal-level changes and additional operations research to strengthen the NDMS definitive care system, particularly in the areas of policy and legislation, operational coordination, and funding.

Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study.

BACKGROUND: During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel. METHODS: We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments. RESULTS: We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43). CONCLUSION: We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.

Haematological changes in sailors who had COVID-19.

BACKGROUND: Follow-up of patients who had coronavirus disease 2019 (COVID-19) proves that clinical symptoms persist for months after recovery. A complex of such persistent manifestations is defined as the post-COVID-19 syndrome. One of the criteria for post-COVID-19 syndrome may be typical changes in white blood cell count and white blood cell (WBC) differential. The aim of the work is to study the frequency of haematological changes in sailors who had the acute coronavirus infection. MATERIALS AND METHODS: The retrospective study covered 30 candidate sailors aged 21 to 60 years with a history of COVID-19 and persistent changes in the WBC count and WBC differential and who did not have haematological abnormalities during the previous medical examinations. RESULTS: Analysis of WBC and WBC count at the long-term period after COVID-19 confirmed persistent changes in the form of neutrophilia, lymphopenia, changes in the neutrophils and lymphocytes ratio. The revealed changes in the WBC count were typical and fit into several patterns: A. Absolute leukocytosis, absolute and relative neutrophilia, relative lymphopenia; B. Relative and absolute lymphopenia, relative neutrophilia; C. Relative and absolute lymphocytosis, relative neutropenia; D. Relative lymphopenia, without other changes in WBC differential. CONCLUSIONS: The most typical laboratory change in WBC count in patients with the past COVID-19 is relative or absolute leukopenia. Persistent changes in WBC count are not always outside of the reference range for absolute values and should be assessed by a complex of typical changes. The presence of typical changes in WBC count in a patient with the past COVID-19 requires a profound examination for the post-COVID-19 syndrome.

Drive-Through Mass Vaccination Center Operations in a Rural, Medically Underserved Area Using Military Civilian Partnership During the COVID-19 Pandemic.

During the coronavirus disease (COVID-19) pandemic, mass vaccination centers became an essential element of the public health response. This drive-through mass vaccination operation was conducted in a rural, medically underserved area of the United States, employing a civilian-military partnership. Operations were conducted without traditional electronic medical record systems or Internet at the point of vaccination. Nevertheless, the mass vaccination center (MVC) achieved throughput of 500 vaccinations per hour (7200 vaccinations in 2 days), which is comparable with the performance of other models in more ideal conditions. Here, the study describes the minimum necessary resources and operational practicalities in detail required to implement a successful mass vaccination event. This has significant implications for the generalizability of our model to other rural, underserved, and international settings.

Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine.

BACKGROUND: Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis. METHODS: A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis. RESULTS: The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities. CONCLUSIONS: Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.

Feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing for active-duty Soldiers.

To increase Soldiers' access to HPV vaccination, we evaluated the feasibility and sustainability of a nurse-led intervention to integrate HPV vaccination into medical processing procedures for Soldiers. We partnered with nursing staff to introduce HPV vaccine into existing vaccination services at a nurse-led clinic that serves Soldiers at Fort Bragg, North Carolina. In addition to stocking the vaccine, the intervention included training nursing staff (n = 11) strategies for recommending HPV vaccination for Soldiers ages 18-26. We conducted surveys of nursing staff to assess their perspectives on feasibility. Nursing staff tracked HPV vaccine uptake among Soldiers for 4 weeks post-training to assess adoption and again for 2 weeks at 4-month follow-up to assess sustainability. We assessed delivery cost as the cost of personnel time, vaccine doses, and other materials during the initial 4-week intervention period. Nursing staff agreed that recommending HPV vaccination fit in with medical processing procedures (mean = 4.6 of 5.0). Of the 516 Soldiers offered HPV vaccine in the 4 weeks following the training, 198 (38%) accepted and received the vaccine. Soldier ages 18-20 more often accepted HPV vaccination than older Soldier ages 21-26 (46% versus 32%, p < .01). Vaccine uptake was similar at follow-up, with 98 of 230 eligible Soldiers (43%) receiving HPV vaccine. The total delivery cost was $12,737, with an average cost per vaccine dose delivered of $64. Our findings suggest that training nursing staff to recommend and administer HPV vaccinations to Soldiers is feasible and warrants wider-scale testing as a strategy to protect soldiers from HPV-attributable cancers.

HPV vaccination is not required for US military service, and Soldiers' uptake is low. We trained nursing staff at a large military clinic to recommend HPV vaccine to Soldiers using a nursing education intervention to integrate HPV vaccination into routine care for active duty Soldiers. Our findings suggest that training nursing staff to recommend and administer HPV vaccines to Soldiers is feasible and low cost, and may warrant wider-scale testing as a strategy for increasing military readiness and protecting Soldiers from HPV-attributable cancers. Until guideline and policy changes are implemented and HPV vaccine is required for military service, use of education strategies is one path to increasing HPV vaccine coverage among Soldiers to ensure protection from HPV-related diseases.

Trends in the Incidence of Eating Disorders Among Active Component Service Members, 2017 to 2021.

From 2017 through 2021, a total of 2,454 active component U.S. military service members received incident diagnoses for 1 of the following eating disorders: anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), or "other/unspecified eating disorder" (OUED). The incidence rate of any eating disorder was 3.6 cases per 10,000 person-years (p-yrs). The case defining diagnoses OUED, BN, and BED accounted for nearly 89% of total incident cases. The incidence rate of any eating disorder among women was more than 8 times the rate among men. Overall rates were highest among service members under 30 years of age. Crude annual incidence rates of total eating disorders increased in 2021, following the COVID-19 pandemic. Increased prevalence of major life stressors and mental health conditions were reported on Periodic Health Assessment (PHA) forms completed in the 1-year period after an eating disorder diagnosis. These data suggest the need for increased attention to eating disorder prevention. Additionally, treatment programs could be warranted as continued effects of the COVID-19 pandemic are elucidated within the military population.

Telehealth in the Military Health System: Impact, Obstacles, and Opportunities.

BACKGROUND: The U.S. Military Health System (MHS) pioneered the use of telehealth in deployed environments in the early 1990s. However, its use in non-deployed environments historically lagged behind that of the Veterans Health Administration (VHA) and comparable large civilian health systems, due to administrative, policy, and other obstacles that slowed or blocked its expansion in the MHS. A report was prepared in December 2016, which summarized past and then-present telehealth initiatives in the MHS; described the obstacles, opportunities, and policy environment; and provided three possible courses of action for expansion of telehealth in deployed and non-deployed settings. METHODS: Gray literature, peer-reviewed literature, presentations, and direct input were aggregated under the guidance of subject matter experts. RESULTS: Past and then-current efforts demonstrated significant telehealth capability in use and in development for the MHS, mainly in deployed or operational settings. Policy from 2011 to 2017 demonstrated an environment favorable for MHS expansion, while the review of comparable civilian and veterans' healthcare systems showed significant benefits including increased access and lower cost from use of telehealth in non-deployed settings. The 2017 National Defense Authorization Act charged the Secretary of Defense with promoting telehealth usage for the Department of Defense, including provisions for removing obstacles and reporting progress within 3 years. The MHS has the ability to reduce burdensome interstate licensing and privileging requirements, but still requires an increased level of cybersecurity, compared to civilian systems. DISCUSSION: The benefits of telehealth fit with the MHS Quadruple Aim of improving cost, quality, access, and readiness. Readiness is particularly served by the use of "physician extenders," which allows nurses, physician assistants, medics, and corpsmen to provide hands-on care under remote oversight and to practice at the top of their licenses. Based on this review, three courses of action were recommended: to focus largely on developing telehealth in deployed environments; to maintain focus in deployed environments and increase telehealth development in non-deployed environments to keep pace with the VHA and private sector; or to use lessons learned from military and civilian telehealth initiatives to leapfrog the private sector. CONCLUSION: This review serves as a snapshot in time of the steps leading to telehealth expansion before 2017, which helped to set the stage for later use of telehealth in behavioral health initiatives and as a response to coronavirus disease 2019. The lessons learned are ongoing and further research is expected to inform additional development of telehealth capability for the MHS.

Increased Prevalence of Overweight and Obesity and Incidence of Prediabetes and Type 2 Diabetes During the COVID-19 Pandemic, Active Component Service Members, U.S. Armed Forces, 2018 to 2021

This study evaluated trends in the prevalence of overweight, obesity, and diabetes among active component service members between 2018 and 2021, before and after the start of the COVID-19 pandemic. This study also investigated the incidence of prediabetes and type 2 diabetes mellitus (T2DM) diagnoses during the same period. Between 2018 and 2021, the prevalence of obesity among active component service members who completed a Periodic Health Assessment (PHA) increased from 16.1% to 18.8%. The incidence of prediabetes increased from 588.2 to 763.8 cases per 100,000 person-years (p-yrs), and the incidence of T2DM increased from 55.5 to 69.6 per 100,000 p-yrs. The largest relative increases in obesity prevalence were in the youngest (<30 years) age categories. Navy members and Hispanic service members experienced the largest absolute and relative increases in rates of new diabetes diagnoses. These findings indicate that during the COVID-19 pandemic active component service members experienced increased prevalence of obesity, prediabetes, and diabetes. Evaluation of lifestyle factors associated with these chronic diseases among service members may be useful to enhance deployment readiness and operational effectiveness.

Personal health monitoring in the armed forces - scouting the ethical dimension : A case study in the Netherlands Armed Forces during the Covid-19 pandemic.

BACKGROUND: The field of personal health monitoring (PHM) develops rapidly in different contexts, including the armed forces. Understanding the ethical dimension of this type of monitoring is key to a morally responsible development, implementation and usage of PHM within the armed forces. Research on the ethics of PHM has primarily been carried out in civilian settings, while the ethical dimension of PHM in the armed forces remains understudied. Yet, PHM of military personnel by design takes place in a different setting than PHM of civilians, because of their tasks and the context in which they operate. This case study therefore focusses on obtaining insights into the experiences and related values of different stakeholders regarding an existing form of PHM, the Covid-19 Radar app, in the Netherlands Armed Forces. METHODS: We carried out an exploratory qualitative study, using semi-structured interviews with twelve stakeholders in the Netherlands Armed Forces. We focussed on participation in the use of PHM, reflections on the practical use and use of data, moral dilemmas and the need for ethics support, all in regard to PHM. The data was analysed using an inductive thematic approach. RESULTS: Three interlinking categories reflecting ethical dimensions of PHM emerged: (1) values, (2) moral dilemmas, and (3) external norms. The main values identified were: security (in relation to data), trust and hierarchy. Multiple related values were found. Some, but no broadly shared, moral dilemmas were identified and no strong need for ethics support was expressed. CONCLUSION: This study shed light on key values, provide insights in the experienced and presumed moral dilemmas and bring to mind ethics support considerations when looking at PHM in the armed forces. Some values bring a certain vulnerability to military users when personal and organisational interests are not aligned. Furthermore, some identified values may hinder a careful consideration of PHM because they potentially conceal parts of ethical dimensions of PHM. Ethics support can assist in uncovering and addressing these concealed parts. The findings highlight a moral responsibility for the armed forces to devote attention to the ethical dimensions of PHM.

Low serological rate of SARS-CoV-2 in cats from military bases in Israel.

Domestic cats are susceptible to SARS-CoV-2 infection and can transmit the virus to other felines. A high number of COVID-19 human cases within the military personnel and a high density of stray cats living close to soldiers raised the need to perform active animal surveillance. We validated a novel quantitative serological microarray for use in cats, that enables simultaneous detection of IgG and IgM responses; in addition, molecular genetic SARS-CoV-2 detection was performed. Three out of 131 cats analyzed, showed IgG antibodies against SARS-CoV-2 RBD and S2P (2.3 %). None of cats were positive for SARS-CoV-2 RNA by RT-PCR. SARS-CoV-2 infection rate in soldiers ranged from 4.7 % to 16 % (average rate=8.9 %). Further investigations on a larger cohort are necessary, in the light of the emerging new viral variants in other animal species and in humans.

Characteristics, Treatment, and Outcomes of Patients With Severe or Life-threatening COVID-19 at a Military Treatment Facility-A Descriptive Cohort Study.

INTRODUCTION: The treatment of severe and life-threatening COVID-19 is a rapidly evolving practice. The purpose of our study was to describe the characteristics and outcomes of patients with severe or life-threatening COVID-19 who present to a Military Treatment Facility (MTF) with an emphasis on addressing institutional adaptations to rapidly changing medical evidence. MATERIALS AND METHODS: A single-center retrospective study conducted on a prospectively maintained cohort. The MTF is a 52-bed hospital within an urban setting. Patients were included in the cohort if they had laboratory-confirmed severe or life-threatening COVID-19 with positive SARS-CoV-2 reverse transcription polymerase chain reaction. Severe disease was defined as dyspnea, respiratory frequency ≥30/min, blood oxygen saturation ≤93% on ambient air, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, or lung infiltrates involving >50% of lung fields within 24-48 hours. Life-threatening COVID-19 was defined as respiratory failure, septic shock, or multiple organ dysfunction. The cohort included patients admitted from June 1 through November 13. Data were collected retrospectively via chart review by a resident physician. RESULTS: In total, our MTF saw 14 cases of severe or life-threatening COVID-19 from June 1 to November 13. Patients had a median age of 70.5 years, with 7% being active duty personnel, 21% dependents, and 71% retired military members. The median time to dexamethasone, remdesivir, and convalescent plasma administration was 4.7, 6.3, and 11.2 hours, respectively. The 28-day in-hospital mortality was 0%. CONCLUSIONS: Patients who present to an MTF with severe or life-threatening COVID-19 are largely retirees, with only a small fraction comprising active duty personnel. The institution of order sets and early consultation can help facilitate prompt patient care for COVID-19.

Sophocles' Philoctetes and Moral Injury in the COVID-19 Pandemic.

Strong emotional responses of health-care professionals to the unusual stress of providing care during the COVID-19 pandemic may be consistent with the experience of moral injury. This term, originally used to explain the feelings of guilt, shame, and righteous anger resulting from trauma experienced by US soldiers who felt betrayed by their leaders in combat, has recently been applied to the experiences of health-care workers who know the right thing to do but lack the autonomy, latitude, or authority to do it. Ancient Greek tragedy, which often explores stories about moral challenges, can provide a fruitful context for communicating about this kind of traumatic experience. Sophocles' Philoctetes is particularly relevant for health care since it describes the psychological pain of a would-be caregiver who is ordered by a superior to deny care to someone suffering with chronic pain, providing a clear example of betrayal through failed leadership and lack of authority to do the right thing. A more detailed reading of Sophocles' Philoctetes demonstrates that it also describes the kind of moral distress that results from being forced to respond to an unsolvable ethical dilemma when there is no clear right thing to do or when doing the right thing requires violating personal moral values.

Analysis of Non-Compulsory Influenza and COVID-19 Vaccination among Polish Soldiers.

The COVID-19 pandemic posed many challenges in epidemiology, health care, and vaccinology. Pharmaceutical and biotechnology companies had to develop effective vaccines as soon as possible in order to halt the spread of infection outbreaks and enable the start of the National Vaccination Program. Firstly, medical services and security services (the army, fire brigade, and police), i.e., those most involved in the fight against the effects of the COVID-19 pandemic, were included in the aforementioned program. The presented publication analyzes the amount and type of vaccination against COVID-19 and influenza among Polish soldiers. Influenza, like COVID-19, is a viral disease that can vary in its course (from mild to acute and life-threatening). Both coronaviruses and influenza viruses are characterized by high genetic variability, resulting in the need for repeated vaccination during each autumn and winter season. Acquired data comes from the Central Register of Vaccination of Professional Soldiers. The collected material was statistically processed. The average level of the phenomenon was presented as a time series using a chronological average. In the analyzed period (December 2020-December 2021), the lowest vaccinations against COVID-19 were performed in December 2020, which is due to the schedule of the National Vaccination Program in Poland. In contrast, the highest number of vaccinations were administered between April and June 2021, or approximately 70.5% of all vaccines administered. In the case of influenza, there is a clear increase in the number of vaccinations during the autumn and winter seasons, which coincides with peaks in disease during these periods. Between August 2020 and January 2021, there is a noticeable increase in the number of flu injections given, nearly 50% compared to the previous period, which may be related to the simultaneous persistence of the COVID-19 pandemic and greater attention to one's own health. Non-mandatory vaccination is an important point in the vaccination schedule for soldiers. Numerous public campaigns combating misinformation and raising awareness of the need for immunization will help convince even more people, not only among soldiers but also the civilian population, to vaccinate.

Getting ready to act: theorising a stepwise transition into crisis response at points of entry based on interviews with COVID-19 responders and a military preparedness framework.

INTRODUCTION: Points of entry (POE) have an important role in timely national response to infectious diseases threats. However, a guiding framework is lacking for the transition from generic preparedness into optimally specified response for an imminent infectious disease threat, a step called 'operational readiness'. OBJECTIVE: We aim to contribute to the conceptual closure of this preparedness-response gap for infectious disease control at POE by providing content to the operational readiness concept. DESIGN: We first explored the NATO Combat Readiness (NCR) concept for its applicability on infectious disease control at POE, as the military discipline faces the same need of being flexible in preparing for unknown threats. Concepts of the NCR that support the transition into response to a specific threat were integrated into the operational readiness concept. To explore the added value of the concept in practice, we conducted and analysed semistructured interviews of professionals at European POE (n=24) responsible for the early COVID-19 response. RESULTS: Based on the NCR, operational readiness builds on the fact that activating the response capabilities and capacities to a specific threat requires time. For professionals at POE, the transition from generic preparedness into the COVID-19 response led to challenges in specifying response plans, dealing with an overload of information, while experiencing shortages of public health staff. These challenges could be covered within operational readiness by defining the time and the specific staging needed to upgrade response capabilities and capacities. DISCUSSION: We conclude that a guiding framework for operational readiness seems appropriate in relation to the many activities and challenges POE have had to face during the COVID-19 response. Operational readiness is mainly defined by the time dimension required to deploy the response to a specific threat. However, integrating this conceptual framework into practice requires structural and sustainable investments in outbreak preparedness.

Epidemiological Predictors of Positive SARS-CoV-2 Polymerase Chain Reaction Test in Three Cohorts: Hospitalized Patients, Healthcare Workers, and Military Population, Serbia, 2020.

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resulting coronavirus disease 2019 (COVID-19) has caused a fast-moving pandemic. Diagnostic testing, aimed to identify patients infected with SARS-CoV-2, plays a key role in controlling the COVID-19 pandemic in different populations. (2) Methods: This retrospective cohort study aimed to investigate predictors associated with positive polymerase chain reaction (PCR) SARS-CoV-2 test results in hospitalized patients, healthcare workers (HCWs), and military personnel (MP) during 2020, before the widespread availability of COVID-19 vaccines. Persons with a positive test result were compared with persons with a negative test result in three cohorts during the study period. (3) Results: A total of 6912 respondents were tested, and 1334 (19.3%) of them had positive PCR SARS-CoV-2 test results. Contact with a known COVID-19 case within 14 days (p < 0.001; OR: 1.48; 95% CI: 1.25-1.76), fever (p < 0.001; OR: 3.66; 95% CI: 3.04-4.41), cough (p < 0.001; OR: 1.91; 95% CI: 1.59-2.30), headache (p = 0.028; OR: 1.24; 95% CI: 1.02-1.50), and myalgia/arthralgia (p < 0.001; OR: 1.99; 95% CI: 1.65-2.42) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of MP. Furthermore, fever (p < 0.001; OR: 2.75; 95% CI: 1.83-4.13), cough (p < 0.001; OR: 2.04; 95% CI: 1.32-3.13), headache (p = 0.008; OR: 1.76; 95% CI: 1.15-2.68), and myalgia/arthralgia (p = 0.039; OR: 1.58; 95% CI: 1.02-2.45) were independently associated with positive PCR SARS-CoV-2 test results in the cohort of HCWs. Moreover, independent predictors of positive PCR SARS-CoV-2 test results in hospitalized patients were contact with a known COVID-19 case within 14 days (p < 0.001; OR: 2.56; 95% CI: 1.71-3.83), fever (p < 0.001; OR: 1.89; 95% CI: 1.38-2.59), pneumonia (p = 0.041; OR: 1.45; 95% CI: 1.01-2.09), and neurological diseases (p = 0.009; OR: 0.375; 95% CI: 0.18-0.78). (4) Conclusions: According to data gathered from cohorts of hospitalized patients, HCWs, and MP, before the widespread availability of COVID-19 vaccines in Serbia, we can conclude that predictors of positive PCR SARS-CoV-2 test results in MP and HCWs were similar. Accurate estimates of COVID-19 in different population groups are important for health authorities.

"Feel the need to prepare for Armageddon even though I do not believe it will happen": Women Veterans' Firearm Beliefs and Behaviors during the COVID-19 Pandemic, Associations with Military Sexual Assault and Posttraumatic Stress Disorder Symptoms.

AIMS: Firearm purchasing increased within the U.S. during the coronavirus disease 2019 pandemic. While rates of firearm ownership and suicide are elevated among women Veterans compared to women non-Veterans, no studies have examined if and how firearm beliefs and behaviors changed among women Veterans during the pandemic. We examined women Veterans' changes in firearm beliefs and engagement in firearm behaviors during the early pandemic era. METHOD: 3,000 post-9/11 era women Veterans were invited to participate in a survey. 501 respondents (May-December 2020) comprised the sample for this concurrent nested mixed-method analysis. Thematic analysis and log-binomial regression were used. RESULTS: 13.88% (n = 69) of women Veterans in our sample reported changes in their firearm beliefs; 22.15% (n = 109) reported engaging in firearm behaviors. The most prevalent reported behaviors were making household firearms more accessible (16.13%) and purchasing ammunition (11.97%). Smaller percentages reported carrying a firearm more frequently (6.71%), loading previously unloaded firearms (5.69%), or purchasing a firearm (4.24%). Thematic analysis suggested firearm behaviors were likely driven by a perceived increased need to protect oneself, family, and property due to: (1) uncertainties brought on by the pandemic; (2) pandemic-related threats necessitating self-defense, preparedness, and self-sufficiency; (3) political, social, and racial unrest and protests. PTSD symptom severity and military sexual assault history were associated with higher prevalence of changes in firearm beliefs and engagement in firearm behaviors during the pandemic. DISCUSSION: Consideration of women Veterans' prior experiences and pandemic-related factors may be necessary to contextualize firearm discussions and inform future research. Given associations of military sexual assault and PTSD symptoms with firearm beliefs and behaviors, it may be crucial to ensure that such discussion are trauma-informed.