Psychological and spiritual factors affecting well-being among military personnel engaged in remote combat.

INTRODUCTION: Remotely piloted aircraft (RPA) require multiple crewmembers to successfully operate the aircraft. RPAs shape modern warfare and pose challenges for the spiritual-emotional health of RPA personnel. This study explored whether (a) RPA crewmembers could be separated into groups based on their experiences, (b) the groups differed in psychological health outcomes, and (c) they differed in aspects of spiritual well-being. METHOD: Participants included 354 United States Air Force personnel involved in RPA duty. Participants provided demographic information and completed the Work Role Strain Scale as a predictor. Outcome measures included job satisfaction, the Maslach Burnout Inventory, Outcome Questionnaire-45.2, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and medical complaints and psychosocial services indices. The Spiritual Well-Being Scale and Unit Cohesion Scale were assessed as moderating factors. RESULTS: Cluster analysis identified two groups of crewmembers. Psychologically healthy participants included 73.4% of crewmembers (n = 260); the remaining 26.6% (n = 94) were distressed. The distressed group included more imagery analysts, weapon-strike pilots, and females, and fewer sensor operators and males compared with the healthy group. Symptoms among the distressed group included more psychological difficulties and PTSD symptoms, more medical complaints, and greater use of psychosocial services. The distressed group reported greater work-role conflict, role ambiguity, work overload, relationship stress, emotional exhaustion, and cynicism as well as lower job satisfaction, unit cohesion, professional efficacy, and existential well-being. DISCUSSION: The strongest predictors of distress were lack of meaning and feeling overextended at work. Emotional exhaustion and low existential well-being identified distressed crewmembers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional reactions of distributed common ground system imagery analysts exposed to remote combat operations.

OBJECTIVE: Imagery analysts of the United States Air Force distributed common ground system (DCGS) provide real-time intelligence informing battlefield decision-making processes worldwide. The number of DCGS combat operations personnel has grown along with the demand for their products, but little is known about the emotional impacts of remote warfighting. The current study is a mixed methods analysis of emotional reactions to remote fatality-inducing combat events and of potential demographic, occupational, and mission-specific correlates of negative emotional reactions to these combat operations in DCGS personnel. METHOD: One-hundred ninety-six active duty analysts with direct exposure to weapon strike operations volunteered to participate in semistructured interviews. RESULTS: Participants were largely enlisted (93.9%), male (75%), and between 18 and 30 years of age (73.0%). Eighty-nine percent reported at least one positive emotion and 71% reported both positive and negative emotions in response to weapon strike events. An underlying current of positive emotions (e.g., pride, camaraderie, patriotism) combined with mission-specific negative emotions (e.g., sadness related to witnessing pain, suffering, and/or loss of life; anxiety and stress related to uncertainty and unforeseeable events) were commonly reported. Twenty-one percent endorsed negative emotions that disrupted their daily functioning, and witnessing a civilian casualty increased risk by 217%. CONCLUSION: DCGS analysts reported emotional responses similar to other remote warfighters but with proportional distributions that reflect their unique wartime roles and responsibilities. The heightened sense of responsibility associated with their wartime roles may elevate risk for negative emotional outcomes when adverse events, such as the death of a civilian, occur. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Uterine fibroids - Causes, impact, treatment, and lens to the African perspective.

Leiomyomas, or uterine fibroids as they are commonly known, are mostly seen in women of reproductive age. However, they can go undetected in most women, and approximately 25% of women show clinical symptoms. Although fibroids are a global burden impacting 80% of premenopausal women, they are more prevalent among Black women than among women of other races. Based on clinical diagnosis, the estimated cumulative incidence of fibroids in women ≤50 years old is significantly higher for black (>80%) versus white women (∼70%). The cause of leiomyomas is not clearly known, but studies have shown evidence of factors that drive the development or exacerbation of the disease. Evidence has linked risk factors such as lifestyle, age, environment, family history of uterine fibroids, and vitamin D deficiencies to an increased risk of uterine fibroids, which impact women of African descent at higher rates. Treatments may be invasive, such as hysterectomy and myomectomy, or non-invasive, such as hormonal or non-hormonal therapies. These treatments are costly and tend to burden women who have the disease. Sub-Saharan Africa is known to have the largest population of black women, yet the majority of uterine fibroid studies do not include populations from the continent. Furthermore, the prevalence of the disease on the continent is not well determined. To effectively treat the disease, its drivers need to be understood, especially with regard to racial preferences. This paper aims to review the existing literature and build a case for conducting future research on African women.

Nutrition in Gynecological Diseases: Current Perspectives.

Diet and nutrition are fundamental in maintaining the general health of populations, including women's health. Health status can be affected by nutrient deficiency and vice versa. Gene-nutrient interactions are important contributors to health management and disease prevention. Nutrition can alter gene expression, as well as the susceptibility to diseases, including cancer, through several mechanisms. Gynecological diseases in general are diseases involving the female reproductive system and include benign and malignant tumors, infections, and endocrine diseases. Benign diseases such as uterine fibroids and endometriosis are common, with a negative impact on women's quality of life, while malignant tumors are among the most common cause of death in the recent years. In this comprehensive review article, a bibliographic search was performed for retrieving information about nutrients and how their deficiencies can be associated with gynecological diseases, namely polycystic ovary syndrome, infertility, uterine fibroids, endometriosis, dysmenorrhea, and infections, as well as cervical, endometrial, and ovarian cancers. Moreover, we discussed the potential beneficial impact of promising natural compounds and dietary supplements on alleviating these significant diseases.

Sources of Stress and Psychological Health Outcomes for Remotely Piloted Aircraft Operators: A Comparison Across Career Fields and Major Commands.

INTRODUCTION: U.S. Air Force remotely piloted aircraft (RPA) operators perform a variety of around-the-clock global intelligence, surveillance, and reconnaissance (ISR) missions that are considered critical to operational effectiveness. The growing need for ISR operations has led to significant increases in operational tempo and workload, resulting in elevated operational stress, burnout, and psychological distress. These negative outcomes are linked to conditions such as long hours, low manning, lack of sleep, and communication issues. Through regular assessments and the implementation of additional resources (i.e., embedded health care providers), Air Force leadership is working to alleviate the stressors and maintain psychological well-being. Thus, the purpose of this study is to compare the levels of stress, and prevalence of burnout and psychological distress across RPA career fields within two major commands. MATERIALS AND METHODS: Assessments were completed by 571 RPA operators from 2 major commands: Air Force Special Operations Command (n = 158) and Air Combat Command (n = 413). RPA career fields included pilots (n = 331), sensor operators (n = 137), and intelligence operators (n = 103). RESULTS: Results revealed that high stress levels from an array of sources continue to result in increased risk of burnout and psychological distress for RPA operators. Several significant differences in sources of high stress across career fields and major commands are identified and discussed. CONCLUSIONS: Overall, the results of this study highlight specific problem areas unique to certain subsets of the RPA community in need of targeted intervention and clarify several avenues for future research.

The Significance of Measuring Vitamin D Serum Levels in Women with Uterine Fibroids.

Uterine fibroids (UFs) are benign tumors originating from smooth muscle cells and are considered a common pathology that affects numerous women which is a notable socio-economic problem. Several UF risk factors have been identified including black race, obesity, and vitamin D deficiency. Vitamin D is steroid compound with pleiotropic effects on the human body. Vitamin D deficiency is a major public health concern worldwide. Several studies have shown that the majority of UF patients experienced hypovitaminosis D. In addition, sufficient vitamin D serum levels are associated with the reduced risk of UFs. In this review, we present available data highlighting the importance of measuring vitamin D serum levels in women with UFs and women at a high risk for UF development. We proposed a preliminary clinical instruction of 25-hydroxyvitamin D measurements and vitamin D supplementation for clinicians who are involved in the treatment of patients with UFs. Achieving sufficient serum levels of vitamin D might be of interest in patients with UFs. Screening, supplementation, treatment guidelines, and public health strategies for vitamin D deficiency in women with UFs as well as women at a high risk of UF development might be of potential importance as well.

The Evolving Role of Natural Compounds in the Medical Treatment of Uterine Fibroids.

Uterine fibroids (UFs) remain a significant health issue for many women, with a disproportionate impact on women of color, likely due to both genetic and environmental factors. The prevalence of UFs is estimated to be approximately 70% depending on population. UF-derived clinical symptoms include pelvic pain, excessive uterine bleeding, gastrointestinal and voiding problems, as well as impaired fertility. Nowadays numerous methods of UF treatment are available-from conservative treatment to invasive surgeries. Selecting an appropriate treatment option should be individualized and adjusted to the patient's expectations as much as possible. So far, the mainstay of treatment is surgery, but their negative impact of future fertility is clear. On the other hand, emerging new pharmaceutical options have significant adverse effects like liver function impairment, hot flashes, bone density loss, endometrial changes, and inability to attempt conception during treatment. Several natural compounds are found to help treat UFs and relieve their symptoms. In this review we summarize all the current available data about natural compounds that may be beneficial for patients with UFs, especially those who want to preserve their future fertility or have treatment while actively pursuing conception. Vitamin D, epigallocatechin gallate, berberine, curcumin, and others are being used as alternative UF treatments. Moreover, we propose the concept of using combined therapies of natural compounds on their own or combined with hormonal agents to manage UFs. There is a strong need for more human clinical trials involving these compounds before promoting widespread usage.

Sources of Stress and Psychological Health Outcomes Among U.S. Air Force Total Force Distributed Common Ground System Operators.

U.S. Air Force Distributed Common Ground Station (DCGS) intelligence (Intel) operators sustain 24/7 battlefield situational awareness and facilitate precision-strike operations. DCGS operations are global, synergistic, Total Force (TF) endeavors by active duty, Air National Guard (ANG) and Reserve units, providing combatant commanders with critical real-time intelligence and shaping operational and tactical decisions. Continual surveillance of this community's psychological health is important to its military leaders. This study re-examines the most frequently reported occupational stressors, as well as the prevalence of occupational burnout (i.e., high-emotional exhaustion and cynicism, and low professional efficacy), and psychological distress within this population. Active duty (n = 1717), ANG (n = 139), and Reserve (n = 173) Intel operators participated in a comprehensive, online, occupational health assessment. Results reveal that occupational stressors contributing to elevated rates of distress, regardless of TF status (i.e., low manning, long work hours, excessive workload, and organizational communication concerns) are consistent with previous research. The prevalence of high-emotional exhaustion (AD: 29%/ANG: 25%/RES: 14%) and psychological distress (AD: 19%/ANG: 17%/RES: 5%) are above estimates for other military communities. These findings combined with demographic and occupational risk factors lay the foundation for improving psychological health within this Total Force community.

Combat and operational risk factors for post-traumatic stress disorder symptom criteria among United States air force remotely piloted aircraft "Drone" warfighters.

The prevalence and expression of post-traumatic stress disorder (PTSD) symptoms among United States Air Force remotely piloted aircraft (RPA; commonly referred to as "drones") warfighters exposed to battlefield trauma via remote, electronic warfare is relevant and critical to the effective delivery of mental health care for this population. RPA warfighters (n = 715) with real-time exposure to at least one traumatic event participated in an online survey. Measures included the PTSD Checklist for DSM-5 (PCL-5) and survey of exposure to traumatic events during the course of operational combat missions. A total of 6.15% met PTSD symptom criteria; those in the age ranges of 31-35 and 36-40 and those working 51 or more hours per week had greater odds of meeting symptom criteria. For combat-related events, the number of events in which RPA warfighters witnessed civilian bystanders being killed by enemy forces or felt shared responsibility for the injury or death of bystanders were also significant predictors, regardless of whether the risk was anticipated or unanticipated. The results of this study suggest that specific types of exposure and participation in missions with specific outcomes, albeit via electronic, remote means, are associated with an increased risk for meeting PTSD symptom criteria.

Prevalence of posttraumatic stress symptoms in United States Air Force intelligence, surveillance, and reconnaissance agency imagery analysts.

Imagery analysts are critical to the intelligence capabilities of the United States Air Force (USAF) and are known as the "eyes" of the USAF. The purpose of this study was to assess for posttraumatic disorder (PTSD) symptoms among this cohort. Of the 498 imagery analysts who participated, a total of 4.22% met provisional diagnostic criteria for PTSD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 2000) which was lower than established rates of PTSD (up to 18%) among military personnel returning from deployment. Implications of subclinical PTSD symptoms on occupational functioning and overall diagnostic picture are discussed.

Long-Term Outcomes in Patients With Diabetes Mellitus Related to Prolonging Clopidogrel More Than 12 Months After Coronary Stenting.

BACKGROUND: Recent large clinical trials show lower rates of late cardiovascular events by extending clopidogrel >12 months after percutaneous coronary revascularization (PCI). However, concerns of increased bleeding have elicited support for limiting prolonged treatment to high-risk patients. OBJECTIVES: The aim of this analysis was to determine the effect of prolonging clopidogrel therapy >12 months versus ≤12 months after PCI on very late outcomes in patients with diabetes mellitus (DM). METHODS: Using the Veterans Health Administration, 28,849 patients undergoing PCI between 2002 and 2006 were categorized into 3 groups: 1) 16,332 without DM; 2) 9,905 with DM treated with oral medications or diet; and 3) 2,612 with DM treated with insulin. Clinical outcomes, stratified by stent type, ≤4 years after PCI were determined from the Veterans Health Administration and Medicare databases and risk was assessed by multivariable and propensity score analyses using a landmark analysis starting 1 year after the index PCI. The primary endpoint of the study was the risk of all-cause death or myocardial infarction (MI). RESULTS: In patients with DM treated with insulin who received drug-eluting stents (DES), prolonged clopidogrel treatment was associated with a decreased risk of death (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.42 to 0.82) and death or MI (HR: 0.67; 95% CI: 0.49 to 0.92). Similarly, in patients with noninsulin-treated DM receiving DES, prolonged clopidogrel treatment was associated with less death (HR: 0.61; 95% CI: 0.48 to 0.77) and death or MI (HR: 0.61; 95% CI: 0.5 to 0.75). Prolonged clopidogrel treatment was not associated with a lower risk in patients without DM or in any group receiving bare-metal stents. CONCLUSIONS: Extending the duration of clopidogrel treatment >12 months may decrease very late death or MI only in patients with DM receiving first-generation DES. Future studies should address this question in patients receiving second-generation DES.

Utilizing Geographic Information Systems and Spatial Video to Analyze Patterns of Secondhand Smoke Exposure on College Campuses.

OBJECTIVE: Innovatively apply geographic information system (GIS) software and spatial video cameras to examine hotspots of smoking and secondhand smoke (SHS) exposure on a college campus. PARTICIPANTS: Pedestrians on a large public university in the United States. METHODS: Spatial video cameras mounted on bicycles and GIS software captured and analyzed smoking on campus. Data were collected during times of heavy pedestrian traffic. Hotspot locations with high concentrations of observed smoking were identified. RESULTS: Using this innovative methodology, several hotspots were identified on campus where SHS exposure occurs frequently. These hotspots were in areas of high pedestrian traffic, thus indicating a potential for SHS exposure to many students. CONCLUSIONS: This paper demonstrates an innovative application of GIS and spatial video technology to understand outdoor smoking patterns on campus. These techniques can aid in program planning, decision-making, policy development, and enforcement.

Reassessment of psychological distress and post-traumatic stress disorder in United States Air Force Distributed Common Ground System operators.

The goal of this study was to assess for the main sources of occupational stress, as well as self-reported symptoms of distress and post-traumatic stress disorder among U.S. Air Force (USAF) Distributed Common Ground System (DCGS) intelligence exploitation and support personnel. DCGS intelligence operators (n=1091) and nonintelligence personnel (n = 447) assigned to a USAF Intelligence, Surveillance, and Reconnaissance Wing responded to the web-based survey. The overall survey response rate was 31%. Study results revealed the most problematic stressors among DCGS intelligence personnel included high workload, low manning, as well as organizational leadership and shift work issues. Results also revealed 14.35% of DCGS intelligence operators' self-reported high levels of psychological distress (twice the rate of DCGS nonintelligence support personnel). Furthermore, 2.0% to 2.5% self-reported high levels of post-traumatic stress disorder symptoms, with no significant difference between groups. The implications of these findings are discussed along with recommendations for USAF medical and mental health providers, as well as operational leadership.

Symptoms of psychological distress and post-traumatic stress disorder in United States Air Force "drone" operators.

The goal of this study is to repeat a survey administered in 2010 to assess for changes in mental health among United States Air Force aircrew operating Predator/Reaper remotely piloted aircraft, also commonly referred to as "drones." Participants were assessed for self-reported sources of occupational stress, levels of clinical distress using the Outcome Questionnaire-45.2, and symptoms of post-traumatic stress disorder (PTSD) using the PTSD Checklist-Military Version. A total of 1,094 aircrew responded to the web-based survey composed of the commercially available standardized instruments mentioned above. The survey also contained nonstandardized items asking participants to report the main sources of their occupational stress, as well as questions addressing demographics and work-related characteristics. The estimated response rate to the survey was 49%. Study results reveal the most problematic self-reported stressors are operational: low manning, extra duties/administrative tasks, rotating shift work, and long hours. The results also reveal 10.72% of operators self-reported experiencing high levels of distress and 1.57% reported high levels of PTSD symptomology. The results are lower than findings from the 2010 survey and from soldiers returning from Iraq and Afghanistan. Implications of the study and recommendations for United States Air Force line leadership and mental health providers are discussed.