US Navy Sailors Modify Their Eating Behaviors to Pass Cyclic Physical Readiness Tests.

OBJECTIVE: Investigate the influence of physical readiness tests (PRTs) on eating behaviors among US Navy Sailors. DESIGN: Focused ethnography using interviews and military policies. SETTING: Three US Naval installations. PARTICIPANTS: Active-duty enlisted Sailors (n = 32). PHENOMENON OF INTEREST: Eating behaviors. ANALYSIS: Authors analyzed data iteratively with data collection using domain, taxonomy, and thematic analysis to identify culturally relevant codes, domains, and themes. RESULTS: Five themes corresponded with PRT timing and Sailors' perceived ability to meet standards: (1) maintain usual eating habits, (2) get ready and switch it up, (3) make weight-damage control, (4) return to baseline-PRT is over, and (5) eat whatever-PRT is canceled. In contrast to the PRT policy's goal for Sailors to maintain standards and a healthy lifestyle, many Sailors modified their usual eating behaviors to pass the test. CONCLUSION AND IMPLICATIONS: Changes in eating behaviors during PRT cycles highlight a culture of getting ready vs staying ready, suggesting many Sailors do not eat a nutrient-dense diet to maintain the minimum physical fitness and body composition standards. There is a need for nutrition education for healthy weight maintenance, weight gain prevention, and healthy weight loss among military personnel.

Polycystic ovary syndrome and chronic pain among females and individuals of childbearing age: A scoping review.

Objectives: The purpose of this scoping review is to explore research studies on the association between chronic pain and polycystic ovary syndrome to create local (U.S.-based) and global recommendations to improve access to and quality of affordable symptom management and treatment options for patients with polycystic ovary syndrome. Methods: The study sections used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews as a checklist reference. The review followed the York methodology by Arksey and O'Malley for the extraction, analysis, and presentation of results in scoping reviews. Results: Final analysis included two conference abstracts published in peer-reviewed journals and two peer-reviewed articles. The relationship between pain perception and health-related quality of life warrants further investigation in patients with polycystic ovary syndrome as the interconnected pathophysiology of symptoms renders exploring associations between the two factors difficult. A comprehensive understanding of the causes of polycystic ovary syndrome-associated symptoms, particularly those relating to pain perceptions can provide more insight into polycystic ovary syndrome pathophysiology and aid in the development of innovative therapeutic approaches for long-term polycystic ovary syndrome management and care. Conclusion: Future studies are necessary to examine associations between the disease and pathophysiological symptoms for a better quality of life for patients with polycystic ovary syndrome.

A scoping review of mechanisms of auricular acupuncture for treatment of pain.

OBJECTIVES: Auricular acupuncture (AA) is becoming increasingly common in primary care clinics, emergency departments and peri-operatively for pain relief. Over the last decade, since the last comprehensive reviews were published, the literature has expanded. In this scoping review, we seek to document the efficacy of AA in treating both acute and chronic pain, describe the mechanism of action of AA in treating pain, and discuss how AA has been integrated into Western medicine to date. METHODS: The authors performed a MEDLINE search inclusive of articles from 1966 to June 2023 including articles written in English identifying literature. We included human studies when more than 3 patients were included. Three hundred and fourteen unique articles were identified and 152 were selected by title screen. After abstract review, 117 were chosen for full-text review. Following full-text review, 33 articles were excluded and 21 added from references, totaling 105 articles included in our scoping review. RESULTS: AA reduces pain severity in patients with both acute and chronic pain. The best studies in the acute settings have occurred in the peri-operative setting where sham AA is employed, multiple sessions of AA are given, and medication dosing is carefully monitored. In these cases, AA reduced pain and post-operative medications. In patients with chronic pain, multiple sessions of AA resulted not only in pain relief but also in improvements in function and disability. Literature suggests that AA works through multiple mechanisms with the most compelling data coupled to the autonomic nervous system and neuroendocrine system. Curriculums designed to teach AA and aid in implementation have been published. CONCLUSION: AA is an accessible, effective means of pain relief. AA is relatively straightforward to learn, and protocols and curriculums exist to teach healthcare professionals this valuable skill. Overcoming implementation barriers, including patient education, are essential next steps.

This review was written to analyze the current research on an increasingly popular pain relief treatment, auricular acupuncture. Auricular acupuncture has been an effective method of pain relief for patients with short-term pain. People who experienced pain after surgery and received auricular acupuncture experienced a decrease in pain and pain medications. Patients with chronic pain who underwent auricular acupuncture experienced pain relief and an increase in their functional abilities. Auricular acupuncture is thought to affect the body's autonomic nervous system and neuroendocrine system as it creates its source of pain relief for the body. Auricular acupuncture is increasingly popular in the education of healthcare workers and clinical practice. Research shows auricular acupuncture is an effective, easy, and less expensive method of pain relief, whose growth in pain management use may benefit from further education, especially for patients.

The Experience of Living With Polycystic Ovary Syndrome in the Military.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is the most prevalent reproductive endocrinopathy in women, ranging from 5% to 26% depending on diagnostic criteria applied. Common manifestations of PCOS include overweight and obesity, abnormal menstrual cycles, pelvic pain, increased facial and body hair, acne, and infertility. These abnormalities and associated complications have significant military operational and readiness implications. There is a large gap in research regarding active duty servicewomen (ADW) with PCOS. Therefore, the purpose of this study is to describe ADW's experience of living with PCOS and to describe the service-branch-specific differences among these women. MATERIALS AND METHODS: Moderator's guide, audiotapes, transcripts, and field notes. This was a qualitative descriptive study using focus groups and individual interviews. The David Grant Medical Center Institutional Review Board at Travis AFB, CA, USA, approved the study protocol. Women with PCOS were recruited from U.S. Air Force, Army, and Navy locations. Data were analyzed using constant comparative content analysis. RESULTS: Twenty-three servicewomen from 19 occupations across the Army, Navy, Air Force, and Marine Corps participated. Three overarching categories emerged: (1) challenges managing PCOS symptoms, (2) navigating the military health care system, and (3) navigating PCOS as a service member. CONCLUSIONS: Servicewomen may have significant career consequences related to PCOS sequelae, such as overweight, obesity, uncontrolled menstrual cycle, and pain. Managing the myriad of symptoms can distract women while deployed, in austere conditions, or at their home stations. As one of the most common cardiometabolic, reproductive endocrinologic conditions in women, PCOS has not received the attention, awareness, education, or research necessary to sufficiently support ADW with this condition. It is imperative that evidence-based strategies are developed to inform relevant and high-quality care for these warfighters. Future qualitative studies are needed to further describe specific stressors and needs of ADW with PCOS. Future intervention studies are also needed to evaluate effective management options for ADW with PCOS.

Effects of COVID-19 disease on PAI-1 antigen and haematological parameters during disease management: A prospective cross-sectional study in a regional Hospital in Ghana.

BACKGROUND: Individuals with COVID-19 experience thrombotic events probably due to the associated hypofibrinolysis resulting from the upregulation of plasminogen activator inhibitor-1 (PAI-1) antigen. This study evaluated plasma PAI-1 antigen levels and haematological parameters before treatment and after recovery from severe COVID-19 in Ghana. MATERIALS AND METHODS: This cross-sectional study was conducted at Sunyani Regional Hospital, and recruited 51 patients who had RT-PCR-confirmed SARS-CoV-2. Participants' sociodemographic data and clinical characteristics were taken from the hospital records. Venous blood was taken before COVID-19 treatment commenced for FBC, PAI-1 and ferritin assays. FBC was assessed using an automated haematology analyzer, whilst plasma PAI-1 Ag and serum ferritin levels were assessed with sandwich ELISA. All the tests were repeated immediately after participants recovered from COVID-19. RESULTS: Of the 51 participants recruited into the study, 78.4% (40) had non-severe COVID-19 whiles 21.6% (11) experienced a severe form of the disease. Severe COVID-19 participants had significantly lower haemoglobin (g/dL): 8.1 (7.3-8.4) vs 11.8 (11.0-12.5), p<0.001; RBC x 1012/L: 2.9 (2.6-3.1) vs 3.4 (3.1-4.3), p = 0.001; HCT%: 24.8 ± 2.6 vs 35.3 ± 6.7, p<0.001 and platelet x 109/L: 86.4 (62.2-91.8) vs 165.5 (115.1-210.3), p<0.001, compared with the non-severe COVID-19 group. But WBC x 109/L: 11.6 (9.9-14.2) vs 5.4 (3.7-6.6), p<0.001 and ferritin (ng/mL): 473.1 (428.3-496.0) vs 336.2 (249.9-386.5), p<0.001, were relatively higher in the participants with severe COVID-19 than the non-severe COVID-19 counterparts. Also, the severely ill SARS-CoV-2-infected participants had relatively higher plasma PAI-1 Ag levels (ng/mL): 131.1 (128.7-131.9) vs 101.3 (92.0-116.8), p<0.001, than those with the non-severe form of the disease. Participants had lower haemoglobin (g/dL): 11.4 (8.8-12.3 vs 12.4 (11.5-13.6), p<0.001; RBC x 1012/L: 3.3 (2.9-4.0) vs 4.3 (3.4-4.6), p = 0.001; absolute granulocyte count x 109/L: 2.3 ± 1.0 vs 4.6 ± 1.8, p<0.001, and platelet x 109/L: 135.0 (107.0-193.0) vs 229.0 (166.0-270.0), p<0.001 values at admission before treatment commenced, compared to when they recovered from the disease. Additionally, the median PAI-1 Ag (ng/mL): 89.6 (74.9-100.8) vs 103.1 (93.2-128.7), p<0.001 and ferritin (ng/mL): 242.2 (197.1-302.1) vs 362.3 (273.1-399.9), p<0.001 levels were reduced after a successful recovery from COVID-19 compared to the values at admission. CONCLUSION: Plasma PAI-1 Ag level was higher among severe COVID-19 participants. The COVID-19-associated inflammation could affect red blood cell parameters and platelets. Successful recovery from COVID-19, with reduced inflammatory response as observed in the decline of serum ferritin levels restores the haematological parameters. Plasma levels of PAI-1 should be assessed during the management of severe COVID-19 in Ghana. This will enhance the early detection of probable thrombotic events and prompts Physicians to provide interventions to prevent thrombotic complications associated with COVID-19.

Exploring Influences of Eating Behaviors Among Emerging Adults in the Military.

OBJECTIVE: Identify factors influencing eating behaviors among emerging adults in the military. DESIGN: Focused ethnography using interviews, observations, and artifacts for data. SETTING: Three US Naval installations. PARTICIPANTS: Thirty-two active-duty Sailors aged 18-25 years. ANALYSIS: Qualitative data were organized in NVivo and analyzed sequentially to categorize culturally relevant domains and themes using a social ecological model (SEM). Descriptive statistics were used to describe questionnaire data in SPSS (version 27.0, IBM, 2020). RESULTS: Leaders encouraged healthy eating through policies and messages, but cultural contradictions and environmental barriers undermined Sailors' efforts to eat healthily. Stress and resource constraints (intrapersonal), peer pressure (social), unhealthy food environments and lack of access to food preparation (environmental), and eating on the go because of mission-first norms (cultural) promoted unhealthy eating behaviors. Nutrition and culinary literacy (intrapersonal); peer support and leadership engagement (social); access to healthy, convenient, and low-cost foods (environmental); and indoctrination to healthy eating during recruit training (cultural) positively influenced eating behaviors. CONCLUSION AND IMPLICATIONS: The eating behaviors of service members are influenced by many modifiable factors. Targeted education, leadership engagement, and policies that make nutritious foods easily accessible, appealing, and preferred are needed.

Role of Integrative Health on Neuropathic Pain.

PURPOSE OF REVIEW: Patients diagnosed with neuropathic pain experience continuous or intermittent spontaneous pain throughout their lives. Pharmacological treatments often provide limited relief; therefore, a multidisciplinary approach should be utilized to manage neuropathic pain. This review examines the current literature on integrative health modalities (anti-inflammatory diets, functional movement, acupuncture, meditation, and transcutaneous therapy) for treating patients with neuropathic pain. RECENT FINDINGS: The use of an anti-inflammatory diet, functional movement, acupuncture, meditation, and transcutaneous therapy in treating neuropathic pain has been investigated in prior literature with positive outcomes. However, there remains a large void in evidence-based knowledge and clinical applicability for these interventions. Overall, integrative health offers a cost-efficient and harmless way of creating a multidisciplinary approach to managing neuropathic pain. There are many complementary approaches to treating neuropathic pain as part of an integrative medicine approach. Research is needed to explore other herbs and spices not yet reported in the peer-review literature. Additionally, follow-on research is needed to understand the clinical applicability of the proposed interventions as well as the dose and timing of the interventions to predict response and duration.

Promoting Military Women's Health Through Research Design.

Although active duty women (ADW) represent over 17% of the total U.S. Armed Forces, there are few evidence-based guidelines to promote the health of women who serve in contemporary military roles. The existing body of evidence does not support guideline development because much of the evidence is not generalizable to ADW. The authors of this commentary recently conducted seven scoping reviews of the literature relevant to ADW's health and healthcare. While completing the literature reviews, it was noted that a substantial proportion of military studies either do not include ADW as research participants or fail to examine findings according to sex and/or active duty status. The authors of this commentary outline a rigorous, step-by-step approach to research design in which ADW are accounted for at every stage of the process. Furthermore, this team of authors identifies opportunities for key stakeholders to provide oversight of the research process to ensure rigorous methodology that includes ADW. Implementing these strategies is critical to building the evidence on which to support the health and healthcare of ADW, who represent a substantial and growing component of the U.S. Military. Optimizing the health of this population is critical to maintaining the strength and readiness of our U.S. Armed Forces.

The Military Women's Health Delphi Study: A Research Agenda for the Next Decade.

INTRODUCTION: As the burgeoning roles of women afford them the opportunities to perform in all combat and combat support assignments, the impact of all environmental, occupational, physical, and psychosocial factors inherent in military training and operations on their health must be considered. A robust foundation of knowledge is necessary to ascertain, prevent, and treat the potential impacts on women's health. However, a systematic review of the literature from 2000-2015 revealed widespread gaps in scientific knowledge of the musculoskeletal, psychological, occupational, and reproductive health of military women. The purpose of this study is to determine priorities for military women's health (MWH) research that will serve to fill these gaps in knowledge. METHODS: An advisory group of 11 senior military and women's health experts conducted a structured gap analysis of the results of a scoping review of literature from 2000 to 2015 and Military Health System utilization data to identify 15 topics for prioritization in MWH research. A modified e-Delphi study was conducted and consensus was achieved after two rounds. Participants (N = 32) included subject matter experts (SME) representing various professions enrolled, 23 completed both rounds. In round 1, topics were rated on forced Likert scales for relevance and feasibility to medical readiness and comments were elicited from the SMEs. Relevance and feasibility scores and themes from the comments guided the development of the round 2 survey, in which SMEs categorized the topics in terms of urgency and forced-choice ranked the priority of each topic. The quantitative data were analyzed using multilevel regression methods. Linear mixed models were fit separately on the numeric outcomes for feasibility, relevance, and urgency with research topic as the primary predictor. To analyze the rankings of research topic priority, crude and adjusted linear regression models were fit on the numeric outcome rank. RESULTS: The adjusted top five topics for research priorities as indicated by ranking were: genitourinary health, sleep, physical assault, behavioral health, and menstrual cycle research. The advisory group reviewed the findings in the context of Department of Defense strategic priorities and provided guidance on the design and dissemination of the MWH research agenda. CONCLUSIONS: The MWH research agenda is a validated research agenda of high-priority research topics that will promote enduring efforts to ensure evidence-based practices and health policies for military women through research.

Perceptions of pain in aging females undergoing spinal cord stimulation.

Aim: Effects of age and sex on chronic pain outcomes following spinal cord stimulation (SCS) have not yet been assessed. Methods: We retrospectively reviewed 1 year outcomes from a database of patients receiving thoracic SCS. Subjects were divided into four cohorts: pre-menopausal and post-menopausal females, and aged-matched males. Improvement using the numerical rating scale, Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), McGill Pain Questionnaire and Pain Catastrophizing Scale (PCS) was assessed. Results: Older females were notably different from males and females under 60 as they had greater improvements in ODI, BDI and PCS. Further, females ≥60 had greater improvement in PCS compared with males ≥60. Conclusion: Our findings suggest greater improvement with 1 year SCS treatment in post-menopausal females, compared with age-matched males.

Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic pain that does not respond to other therapies. It is well recognized that men and women differ in how they perceive pain and how they respond to pain treatments. However, whether women who are over 60 years old and thus presumed to be menopausal respond differently to SCS has not been evaluated. We looked at our database which collected outcomes related to pain, measured before patients had SCS and 1 year after SCS. We found that women over 60 responded better to SCS treatment. They experienced significantly greater improvements in the disability, depression and catastrophizing associated with their pain than did women under 60. Further SCS resulted in more improvements in catastrophizing in women over 60 than in men over 60. Taken together, our hope is that these data help physicians to determine the best patients for SCS and to counsel their patients appropriately. To the best of our knowledge, this study is the first to show the impact of sex-specific aging on response to spinal cord stimulation. While we used age as a surrogate for menopause, menopausal status should be documented in the future to confirm that it effects response.

Continuing the legacy of a military women's health research interest group.

The Military Women's Health Research Interest Group (MWHRIG) was established in 2010. The purpose of the MWHRIG is to support military clinicians and leaders in determining research priorities, and making evidence-based practice and policy decisions relevant to sex- and gender-appropriate healthcare. This article highlights the history of the MWHRIG, and current activities inclusive of research, mentorship, and collaboration. Future activities for the MWHRIG will focus on continued use of a theoretical framework for military women's health research, inclusivity of gender sexual diversity (GSD), and metrics for future success.

A Grounded Theory Approach to Navigating Infertility Care During U.S. Military Service.

INTRODUCTION: In this study, we aimed to understand how active duty service members and their partners navigate the infertility care process within the Military Health System (MHS) while managing a military career. MATERIALS AND METHODS: We obtained Institutional Review Board approval to employ a qualitative design using grounded theory methods. We recruited participants using purposive sampling, followed by theoretical sampling. We derived data from demographic questionnaires and semi-structured interviews. Consistent with grounded theory methods, we began analysis with line-by-line coding and moved to focused coding. We employed constant comparative analysis throughout the process to name, categorize, and conceptualize data and relationships. RESULTS: The participants included 28 patients, five partners, nine health care providers, and two military leaders. The infertility care process began with active duty service members and their partners recognizing the desire to have a child and discovering infertility, followed by deciding to seek infertility care. The experience was temporally bound within the context of the military environment. We identified the following themes, which described facilitators and barriers to accessing care: Duty station location, career stage, military versus the civilian cost of services, command climate, and policy. These facilitators and barriers varied widely across the Department of Defense (DoD), which resulted in fragmented and inconsistent care cycles, contributed to emotional and physical stress, and created tension between career progression and family formation. CONCLUSIONS: Understanding how military couples perceive and manage demands of infertility care may enhance access to care, decrease patient costs, improve outcomes, result in better support for military couples who experience infertility, and ultimately improve the health and military readiness of our armed forces. The results support the need for action by providers, policy makers, and military leaders to develop effective infertility treatment programs and policies in the DoD.

Shared Decision-Making During Labor and Birth Among Low-Risk, Active Duty Women in the U.S. Military.

INTRODUCTION: The cesarean birth rate of 24.7% in the Military Health System (MHS) is lower than the national rate of 31.7%. However, the MHS rate remains higher than the 15-19% threshold associated with optimal maternal and neonatal outcomes. For active duty servicewomen, increased morbidity associated with cesarean birth is likely to affect the ability to meet the demands of assigned missions. Several decision-points occur during pregnancy and after the onset of labor that can affect the likelihood of cesarean birth including choice of provider, choice of hospital, timing of admission, and type of fetal monitoring. Evidence suggests the overuse of labor interventions may be associated with cesarean birth. Shared decision-making (SDM) is a strategy that can be used to carefully consider the risks, benefits, and alternatives of each labor intervention and is shown to be associated with positive patient outcomes. Most existing evidence explores SDM as an interaction that occurs between women and their providers. Few studies have explored the role of stakeholders such as spouses, family members, friends, labor and delivery nurses, and doulas. Furthermore, little is known about the process of SDM during labor and childbirth in the hospital setting, particularly for active duty women in the U.S. military. The purpose of this study was to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. MATERIALS AND METHODS: A qualitatively driven mixed-methods approach was conducted to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. Servicewomen were recruited from September 2019 to April 2020. Semi-structured interviews were analyzed using a constructivist grounded theory approach. Participants also completed the SDM Questionnaire (SDM-Q-9). RESULTS: Interviews were conducted with 14 participants. The sample included servicewomen from the Air Force (n = 7), Army (n = 4), and Navy (n = 3). Two participants were enlisted and the remainder were officers. Ten births occurred at military treatment facilities (MTFs) and four births took place at civilian facilities. The mean score on the SDM Questionnaire was 86.7 (±11.6), indicating a high level of SDM. Various stakeholders (e.g., providers, labor and delivery nurses, doulas, spouses, family members, and friends) were involved in SDM at different points during labor and birth. The four stages of SDM included gathering information, identifying preferences, discussing options, and making decisions. Events that most often involved SDM were deciding when to travel to the hospital, deciding when to be admitted, and selecting a strategy for pain management. Military factors involved in SDM included sources of information, selecting and working with civilian providers, and delaying labor interventions to allow time for an active duty spouse to travel to the hospital. CONCLUSIONS: SDM during labor and birth in the hospital setting is a multi-stage process that involves a variety of stakeholders, including the woman, members of her social and support network, and healthcare professionals. Future research is needed to explore perspectives of other stakeholders involved in SDM.

Integrative Review of Racial Disparities in Perinatal Outcomes Among Beneficiaries of the Military Health System.

OBJECTIVE: To examine the extent to which racial disparities exist in the perinatal outcomes of beneficiaries of the Military Health System (MHS). DATA SOURCES: We searched the PubMed, CINAHL, and Embase databases. STUDY SELECTION: We selected articles published in English in peer-reviewed journals in which the authors examined race in relation to perinatal outcomes among beneficiaries of the MHS. Date of publication was unrestricted through March 2021. DATA EXTRACTION: Twenty-six articles met the inclusion criteria. We extracted data about study design, purpose, sample, setting, and results. We also assigned quality appraisal ratings to each article. DATA SYNTHESIS: In most of the included articles, researchers observed differences in perinatal outcomes between Black and White women. Compared to White women, Black women had greater rates of cesarean birth, preterm birth, low birth weight, and small for gestational age neonates. White women had greater rates of postpartum depression than Black women. CONCLUSION: Racial disparities in very low birth weight newborns and preterm birth may be smaller in the MHS than in the general population of the United States. The overall rates of preterm birth, cesarean birth, and neonatal mortality were lower for beneficiaries of the MHS than in the general population of the United States.

A Social Ecological Model for Military Women's Health.

BACKGROUND: U.S. military women's health (MWH) is influenced by unique life experiences while serving in combat and combat support roles in the armed forces. Daily accomplishment of the military mission exposes women to occupational, physical, and psychosocial factors that affect their health status. Here, we present the theoretical framework for a social ecological model (SEM) for MWH. METHODS: By synthesizing the common elements of various SEMs for health, we describe the layers in the military social ecological system that are typical of the milieu of servicewomen. With the individual's knowledge, beliefs, behaviors, and physiology at the center of the model, relevant components of the microsystem, mesosystem, exosystem, and macrosystem are identified. RESULTS: Support for the SEM-MWH can be found in all layers of the social ecological system. Distinguishing factors of the SEM-MWH include characteristics of the military environment, community, health care system, regulations and policies, and the military culture in which women live and work. Servicewomen's life experiences in the microsystem, mesosystem, exosystem, and macrosystem occur in a nested, interactive system that affects their health behaviors and their health status. CONCLUSIONS: The social ecological system of servicewomen is unique and must be fully explored and appreciated to ensure the health of women who serve. Investigation of the effects of policies throughout all layers of the SEM-MWH on the individual servicewoman is warranted.

Adjustment Disorders in U.S. Active Duty Military Women: A Scoping Review for the Years 2000 to 2018.

BACKGROUND: Adjustment disorder (AD) is the most common mental health diagnosis in the U.S. military and is more than twice as likely to be diagnosed in active duty servicewomen as compared with male servicemembers. The literature on ADs, particularly in female servicemembers, has not been reviewed yet. We conducted a scoping review of the literature to explore the degree of research activity and summarize current literature gaps. METHODS: We created a PRISMA-ScR checklist and prospectively registered it in Open Science Framework. The literature search included articles (including studies and reports) published between 2000 and 2018 in either the grey literature or the following databases: Ovid Medline, CINAHL, Embase, PsycINFO, Web of Science, and Ovid Cochrane. We used DistillerSR to conduct title and abstracts screening, full-text screening, and data charting. The social ecological model for military women's health framework was used to organize the results. RESULTS: After screening 1,304 records, 29 were included for data charting. Most frequently, studies were descriptive (cross-sectional) (25%), with no randomized controlled studies. The studies primarily focused on ADs' risk factors in servicewomen (76%), followed by military readiness (38%). Only 14% addressed recommendations for treatments based on expert opinion, although they did not directly test interventions, and 7% focused on health outcomes. CONCLUSIONS: ADs affect the health of U.S. military women and military readiness, yet little is known about their successful treatment or health outcomes. Additional research in those areas is warranted.

Sexually Transmitted Infections in U.S. Military Women: A Scoping Review 2000-2018.

PURPOSE: High rates of sexually transmitted infections (STIs) have been documented among U.S. military servicemembers. The purpose of this scoping review is to evaluate the literature to determine what is known about the risk factors, preventive measures, and health outcomes regarding STIs among active duty servicewomen. METHODS: A search of six bibliographic databases and the grey literature identified articles published from January 1, 2000, to December 31, 2018. A two-level review process was used to evaluate the inclusion of articles. RESULTS: Fifty-six articles were included. The majority of studies (n = 47) were descriptive (95%). The primary STIs of focus were chlamydia (66%) and gonorrhea (38%), with a lesser focus on herpes simplex virus 1 and 2 (17%) and syphilis (11%). There were no studies on chancroid or pubic lice. Chlamydia and gonorrhea were highly prevalent. Age, race, and gender were nonmodifiable risk factors, whereas behaviors, beliefs, socioeconomic level, marital status, and concomitant or repeat infections were modifiable risk factors. Educational programs and studies evaluating efficacious STI prevention methods were lacking. STI diagnoses occurred in servicewomen at their home stations as well as in deployed settings. CONCLUSION: STIs remain an ongoing public health challenge with insufficient research to guide military and health care leaders. Future research should focus on prospective designs that leverage identified risk factors and at-risk populations where the most impact can be made to promote reproductive health.

A Scoping Review of Cervical Cancer Risk Factors, Prevention, Diagnosis, and Treatment in U.S. Active Duty Military Women.

INTRODUCTION: Maintaining military readiness requires integration and delivery of appropriate sex-specific health care services for active duty servicewomen (ADSW). Cervical cancer screening (CCS) provides early detection, intervention, and treatment, allowing for reductions in human papillomavirus (HPV) infections and cervical cancer cases. This scoping review examines existing cervical cancer evidence related to ADSW and identifies research gaps, leverage points, and policy recommendations within the context of the social ecological model for military women's health. METHODS: We conducted a scoping literature search using both indexed databases and nonindexed sources. We managed retrieved records from 2000 to 2018 with Endnote reference and DistillerSR systematic review software. RESULTS: Of 1,006 records from indexed databases and 208 records from nonindexed resources retrieved, 40 publications met the inclusion criteria. Cervical cancer research addressing ADSW is limited. Servicewomen have high rates of known cancer risk factors and face challenges related to deployments and change of duty station that affect continuity of health care and timely follow-up for abnormal CCS. Multimodal interventions with stakeholder support can encourage CCS adherence and increase HPV vaccination rates. CONCLUSION: Maintaining military readiness among ADSW requires robust evidence-based prevention efforts to address risk factors that are reportedly higher among servicewomen, as well as challenges to continuity in health care delivery that may increase the likelihood of cervical cancer incidence. Recognizing the role of HPV vaccination as cancer prevention, collaborations and partnerships, research, best practices, and creative solutions to close ADSW's sex-specific health gaps will help to ensure a fit and ready force.

A Scoping Review of Unintended Pregnancy in Active Duty United States Military Women.

INTRODUCTION: The purpose of this scoping review was to apply the Social Ecological Model for Military Women's Health to literature on unintended pregnancy (UIP) to answer the question: In United States active duty military women (population) with the potential for UIP (context), what is known about risk factors, prevention, and pregnancy outcomes (concepts)? METHODS: We conducted this review based on a PRISMA-ScR protocol registered a priori in Open Science Framework. Following a literature search of six databases and the grey literature, we used DistillerSR to manage data screening and data charting. The Social Ecological Model for Military Women's Health served as the theoretical framework to chart findings regarding UIP at the individual, microsystem, mesosystem, exosystem, and macrosystem levels. RESULTS: A total of 74 research, review, and grey literature articles met the inclusion criteria. Risk factors included specific demographics, military service, and recent deployment. Prevention included contraceptive practices, access, and education that should take place early in servicewomen's careers and before deployment. Outcomes included early return from deployment, personal career challenges, and seeking alternative health services outside the military health system. CONCLUSIONS: Research and policy initiatives should focus on decreasing risk factors in the military working environment, with particular attention to the deployed environment. These initiatives should include input from military leaders, health care providers, servicewomen, and servicemen with the goal of decreasing the incidence of unintended pregnancies. Pregnancy intentionality among military women should be considered as a concept to shape intervention research to reduce unintended pregnancies.

Menstrual Practices in Operational Military Women.

INTRODUCTION: Women's sex-specific health care and hygiene needs are part of military readiness for female service members and important for their leaders to ensure unit readiness. Promoting readiness that includes women's health needs contributes to the overall strength of the military. Because women comprise over 15% of today's military force and growing in proportion, readiness for military women has obtained increased attention in research and health practice. Menstruation is a sex-specific experience that must be part of the consideration for individual military readiness. Little research has explored the in-garrison readiness of women, particularly for women in high operations tempo settings, when considering menstruation management. The specific aim of this study was to explore how active duty U.S. Air Force women manage their menstruation while living day-to-day in a military culture. METHODS: A qualitatively driven mixed-method design using ethnography was conducted. Data collection included multiple sources: observations, questionnaire data, interviews, and focus groups among a group of Air Force Security Forces women. RESULTS: Data from questionnaires (n = 16) and interviews or focus groups (n = 10) were analyzed. Themes included knowledge, cop culture, and support. Comprehensive findings demonstrated that women were knowledgeable about menstruation and menstrual suppression, but did not practice it. No women in the study were suppressing menstruation. Military culture had minimal impact on menstrual practices, whereas knowledge, attitudes, and beliefs gained from family and friends was more influential on how women in this study managed menstruation. CONCLUSIONS: This study was the first to use a qualitatively driven mixed-method design to explore military women's menstrual practices in an operational setting. This study can be used in collaboration with other evidence to promote health of military women through clinical education and support in command environments. Future research should consider other operational settings where women are expected to maintain a high level of readiness.