Genitourinary infections in Australian servicewomen

BACKGROUND

Genitourinary infections, including those associated with the urinary tract (urinary tract infection [UTI]) and vulvovaginal region, are common in women, affecting approximately one-third of biological females. A growing female military workforce necessitates consideration of their genitourinary health risks and needs to support and enhance their occupational health, safety, and performance.

METHOD

The pelvic health of active-duty servicewomen in the Australian Defense Force (ADF) was explored using an online cross-sectional survey. For the purposes of this study, only data related to genitourinary infections were extracted. The data were descriptively analysed to provide estimates of period prevalence rates. Risk factors and prevention and management strategies utilized were identified and described.

RESULTS

Of the 491 servicewomen who provided survey responses, 41% (95% confidence interval [CI]: 37%-46%) reported experiencing at least one UTI and 32% (95% CI: 28%-36%) reported experiencing regular symptoms of vulvovaginal irritation during their last period of active-duty service. Service arm, length of service, and history of participation in field activities or deployment were not substantially associated with prevalence estimates. Medical assessment was the most common diagnostic strategy for UTI and antibiotics were the most common management strategy.

CONCLUSION

Genitourinary infections are common in female ADF personnel and may impact on occupational health and performance. Therefore, organization-wide prevention and management approaches may be an important strategy for reducing the impact on personnel, their units and mission objectives, by reducing working days lost, utilization of health services and minimizing risks in more austere military environments.

Physical Health and Well-being: Updates and the Way Ahead

INTRODUCTION

The Women in Combat Summit 2021 "Forging the Future: How Women Enhance the Fighting Force" took place during February 9-11, 2021, via a virtual conference platform. The third and final day of the Summit regarded the physical health and well-being of military women and included the topics of urogenital health, nutrition and iron-deficiency anemia, unintended pregnancy and contraception, and traumatic brain injury.

MATERIALS AND METHODS

After presentations on the topics earlier, interested conference attendees were invited to participate in focus groups to discuss and review policy recommendations for physical health and well-being in military women. Discussions centered around the topics discussed during the presentations, and suggestions for future Women in Combat Summits were noted. Specifics of the methods of the Summit are presented elsewhere in this supplement.

RESULTS

We formulated research and policy recommendations for urogenital health, nutrition and iron-deficiency anemia, contraception and unintended pregnancy, and traumatic brain injury.

CONCLUSIONS

In order to continue to develop the future health of military women, health care providers, researchers, and policymakers should consider the recommendations made in this supplement as they continue to build on the state of the science and forge the future.

Physical health of Post-9/11 U.S. Military veterans in the context of Healthy People 2020 targeted topic areas: Results from the Comparative Health Assessment Interview Research Study

Large-scale epidemiological studies suggest that veterans may have poorer physical health than nonveterans, but this has been largely unexamined in post-9/11 veterans despite research indicating their high levels of disability and healthcare utilization. Additionally, little investigation has been conducted on sex-based differences and interactions by veteran status. Notably, few studies have explored veteran physical health in relation to national health guidelines. Self-reported, weighted data were analyzed on post-9/11 U.S. veterans and nonveterans (n = 19,693; 6,992 women, 12,701 men; 15,160 veterans, 4,533 nonveterans). Prevalence was estimated for 24 physical health conditions classified by Healthy People 2020 targeted topic areas. Associations between physical health outcomes and veteran status were evaluated using bivariable and multivariable analyses. Back/neck pain was most reported by veterans (49.3 %), twice that of nonveterans (22.8 %)(p < 0.001). Adjusted odds ratios (AORs) for musculoskeletal and hearing disorders, traumatic brain injury, and chronic fatigue syndrome (CFS) were 3-6 times higher in veterans versus nonveterans (p < 0.001). Women versus men had the greatest adjusted odds for bladder infections (males:females, AOR = 0.08, 95 % CI:0.04-0.18)(p < 0.001), and greater odds than men for multiple sclerosis, CFS, cancer, irritable bowel syndrome/colitis, respiratory disease, some musculoskeletal disorders, and vision loss (p < 0.05). Cardiovascular-related conditions were most prominent for men (p < 0.001). Veteran status by sex interactions were found for obesity (p < 0.03; greater for male veterans) and migraine (p < 0.01; greater for females). Healthy People 2020 targeted topic areas exclude some important physical health conditions that are associated with being a veteran. National health guidelines for Americans should provide greater consideration of veterans in their design.

Influence of "Decide + Be Ready" Contraceptive Decision Aid on Pre-deployment Health Decisions

INTRODUCTION

The number of active duty servicewomen and the career opportunities available to them continue to increase. Of the approximately 350,000 women in uniform, 97% are estimated to be of reproductive age, underscoring the importance of reproductive health care. This study aimed to explore the influence of the Decide + Be Ready (DABR) contraceptive decision aid on providing contraceptive knowledge, facilitating a servicewoman's contraceptive choice before and during deployment, and enabling understanding of individual preferences around contraception in a population of active duty women most at risk for unintended pregnancy.

MATERIALS AND METHODS

We conducted a qualitative study, recruiting active duty women between the ages of 17 and 24 with at least one prior deployment who were stationed at Naval Station Norfolk and presented for evaluation at a primary care clinic. Participants downloaded and reviewed the DABR application. A semi-structured interview was conducted and audio-recorded. Interviews were transcribed and underwent thematic analysis.

RESULTS

Twenty women participated in the study over 2 weeks. Analysis revealed three overarching themes: perceived utility of and attitudes toward DABR, knowledge of and comfort with contraceptive options, and challenges specific to active duty women. In total, eight subthemes were also identified and explored.

CONCLUSIONS

The DABR app provided study participants with new information about contraception. Participants reported improved knowledge of gynecologic and reproductive health options available during deployment. Other findings raise interest for future studies exploring incorporation of peer validation in counseling and decision-making tools, challenges with the deployed environment for obstetric/gynecologic health, and medical support on naval deployments.

Female warfighters' perceptions of urogenital health in operational settings

BACKGROUND

An increased incidence in hygiene-related urogenital infections (bacterial vaginitis, vulvovaginal candidiasis, and urinary tract) has been reported in female warfighters serving in austere environments with decreased availability of water and sanitation resources, and when personal safety outweighs concerns for hygiene. Knowledge and access to an innovative kit designed for the female warfighter to self-test, self-identify, and self-treat common urogenital symptoms is critical to force health.

PURPOSE

The purpose of this descriptive, cross-sectional, exploratory qualitative study was to explore female warfighters': 1) confidence in seeking sex-specific health care in field and deployment environments and 2) acceptance and willingness to self-test, self-identify, and self-treat urogenital symptoms and infections.

METHODOLOGICAL ORIENTATION

Qualitative data for this thematic analysis were collected during administration of the Military Women's Readiness Urogenital Health Questionnaire. Participants provided open-ended comments associated with three survey questions. Braun and Clarke's inductive thematic analysis method guided the narrative analysis.

SAMPLE

Our sample included a diverse group of US Army women (USAW; n = 152) from a large, military installation.

RESULTS

Narratives and themes demonstrate USAW's desire and need for the availability of a self-test and self-treatment kit. Access, time, mission, and prevention of self-harm by quicker resolve of symptoms are cited as key reasons in support of such a kit.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Nurse practitioners (NPs) are ideally positioned to provide sex-specific educational interventions and anticipatory guidance that supports physical health, to include urogenital conditions. As urogenital self-testing becomes available for female warfighters, NPs are the model healthcare provider for educating women on their use.

Nursing Care of Women Veterans of the Iraq and Afghanistan Wars

The Iraq and Afghanistan wars are unlike earlier wars, and the women veterans who have served in them are unlike veterans of earlier wars. Now these veterans are presenting with distinctive general, genitourinary, reproductive, and behavioral health issues. When seeking health care after deployment, they may be accessing multiple health care providers across numerous sites, including the Veterans Health Administration and civilian facilities. Enhanced levels of understanding, respect, and concern for the many combat-related health challenges experienced by these veterans will help civilian nurses and other clinicians provide optimum care. Provision of health care to women veterans should be multidisciplinary and effectively coordinated among various health care providers and facilities to ensure that their post-deployment health and wellness needs are met.

Deployed women's illness behaviors while managing genitourinary symptoms: An exploratory theoretical synthesis of two qualitative studies

BACKGROUND

The recent removal of United States military combat exclusion rules resulted in more women serving in forward deployed austere conditions. In the deployed setting, women were diagnosed with genitourinary (GU) conditions five times greater than men.

PURPOSE

Describe deployed military women's GU illness behaviors.

METHOD

Two qualitative descriptive studies interviewing military women and enlisted medics were synthesized using the Illness Behavior Model.

DISCUSSION

Similar and divergent views on the impact of the military culture of the illness behaviors were described by women and medics. Both agreed appropriate attention on managing GU symptoms must continue; however differing strategies were appraised. One agreed option was to offer a health care mentor.

CONCLUSION

The Illness Behavior Model provided an excellent framework for evaluation of military women's illness behaviors exposing areas for comparing and contrasting the perspectives provided. While significant changes have been made, additional strategies will continue to improve the women's deployed health care quality.

Recurrent Lower Urinary Tract Infections Have a Detrimental Effect on Patient Quality of Life: a Prospective, Observational Study

INTRODUCTION

This study investigated the effects of recurrent urinary tract infections (rUTI) and the impact of prophylaxis on rUTI and patients' quality of life (QoL).

METHODS

Altogether, 575 patients affected by rUTI were included in a 6-month observational study. QoL was assessed using the Hospital Anxiety and Depression (HAD) and the Leicester scales. Statistical analyses were performed using SAS® Version 8.2 software (SAS Institute Inc., Cary, NC, USA). The significance level was set at 5%. Spearman correlation was used to assess the degree of correlation between infectious episodes and HAD and Leicester scores. For each parameter, the comparison between Day 0 and Day 180 was performed using Wilcoxon signed-rank test for quantitative data.

RESULTS

In total, 61.9% of patients suffering from rUTI exhibited some degree of depression at baseline (Day 0). Alternative oral non-antimicrobial prophylactic treatment for rUTI [Escherichia coli lyophilized bacterial lysate (OM-89)] was administered to 94.4% of patients (1 capsule a day for 90 days), followed by a 3-month treatment-free period. At the end of the study (Day 180), the mean number of UTI decreased by 59.3% (P ≤ 0.0001), the total HAD score decreased by 32.1% (P ≤ 0.0001), and the mean Leicester score decreased by 44.0% (P ≤ 0.0001) from baseline. There was a correlation trend between the reduction in the numbers of UTI at the end of the study compared to the 6 months prior to study entry and the reduction in the anxiety, depression, total HAD scores, activity, feeling, and total Leicester scores registered from Day 0 to Day 180, suggesting a lessening of emotional problems, and social and functional handicaps with decreasing UTI incidence.

CONCLUSIONS

This study showed that rUTI had a negative impact on patients' QoL and that effective alternative prophylaxis significantly improved their QoL.

Current challenges in female veterans' health

Abstract Women in the U.S. military are technically barred from serving in combat specialties, positions, or units; however, since Operation Desert Storm, women have served in forward positions in greater numbers. This increased involvement in combat zones has resulted in exposures to trauma, injury, and a myriad of environmental hazards associated with modern war. Some of these hazards present new health risks specifically relevant to women who have been deployed to or recently returned from Iraq or Afghanistan or both. To address this evolving public health concern, the Society for Women's Health Research (SWHR) convened a 1-day interdisciplinary scientific conference, with speakers and attendees from civilian, military, and veteran settings. The purpose of the conference was to reveal the state-of-the-science on the health of the female veteran and to focus attention on recent advances in biomedical research related to female veterans' health. The following topics were discussed: mental health (posttraumatic stress disorder [PTSD] and depression), urogenital health, musculoskeletal health, and traumatic brain injury (TBI).

A Call to Action for Evidence-Based Military Women’s Health Care: Developing a Women’s Health Research Agenda That Addresses Sex and Gender in Health and Illness

Women in the Army, Navy, Air Force, and Marines are serving in complex occupational specialties that sustain national policy and ensure combat effectiveness of our forces. Their roles have evolved from supportive roles during early conflicts to active roles in combat support and counterinsurgency operations today. Although women have received military health care over the past three decades, sex- and gender-specific care has been limited to reproductive needs and has rarely addressed military-specific health risks and outcomes. The complexity of military jobs and increased deployments to combat operations has led to increased occupational and health risks for women. As differences have been noted between men and women’s deployment-related health outcomes, it is incumbent on the Military Health Care System (MHS) to create an evidence base that addresses sex and gender differences in the health of its service members. A working group of military women’s health advanced practice nurses (APN) and research experts proposes to address this gap in knowledge and practices through sex- and gender-specific research. A sex-and gender-based research agenda for military women’s health will be a valuable instrument to those who are dedicated to the health of this population, including members of the Army, Navy, and Air Force military nursing community. Using the knowledge that the research agenda generates, military health care providers can develop clinical practice guidelines, influence policy, and participate in program development to improve the health of servicewomen. Shaping a sex- and gender-specific military women’s health research agenda will create the foundation for future evidence-based care.

Army women's sexual health information needs

OBJECTIVE

To ascertain Army women's specific sexual health information needs prior to developing a theoretically based, self-administered intervention to promote safer sexual practices during deployment.

DESIGN

An exploratory design was employed to address the research questions.

PARTICIPANTS

Participants (N= 131) were Army women recruited from Army posts around the United States. The women ranged in age from 18 to 68 years (M= 30.8, SD= 10.5), were of varied ethnicity, and had an average time in service of 8.0 years (SD= 6.6).

MAIN OUTCOME MEASURES

Desire for knowledge about sexual health and safer sexual practices were measured with forced-choice responses based upon DiIorio's Safer Sex Questionnaire (DiIorio, Parsons, Lehr, Adame, & Carlone, 1992) and open-ended questions to assess past information received, quality of that information, and information desired.

RESULTS

Participants had moderate levels of sexual risk behaviors. Forced-choice responses yielded little desire for information regarding safer sexual practices. Women identified different sexual health and safer sexual information needs based upon whether they were at a normal duty station or during deployment.

CONCLUSIONS

Participants did not identify many information needs; however, their sexual behaviors indicate the need for interventions.

Associations between intravaginal practices and bacterial vaginosis in Kenyan female sex workers without symptoms of vaginal infections

BACKGROUND

Bacterial vaginosis (BV) is highly prevalent among African women and has been associated with adverse pregnancy outcomes, sexually transmitted diseases, and HIV-1.

GOAL

The goal of this study was to analyze the relationship among intravaginal practices, bathing, and BV.

STUDY DESIGN

The authors conducted a cross-sectional study of HIV-1-seronegative Kenyan female sex workers without symptoms of vaginal infections.

RESULTS

Of 237 women enrolled, 206 (87%) reported vaginal washing using either a finger or cloth. Increasing frequency of vaginal washing was associated with a higher likelihood of BV (chi(2) test for trend, P = 0.05). In multivariate analysis, vaginal lubrication with petroleum jelly (odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.4-5.6), lubrication with saliva (OR = 2.3, 95% CI = 1.1-4.8), and bathing less than the median for the cohort (14 times/week; OR = 4.6, 95% CI = 1.2-17.5) were associated with a significantly higher likelihood of BV.

CONCLUSIONS

Modification of intravaginal and general hygiene practices should be evaluated as potential strategies for reducing the risk of BV.

Health and Exposure Concerns of Veterans Deployed to Iraq and Afghanistan

OBJECTIVE

We report the clinical concerns of US veterans of Operations Iraqi Freedom and Enduring Freedom evaluated at the New Jersey War-Related Illness and Injury Study Center (NJ WRIISC) between June 2004 and January 2006.

METHODS

We conducted a retrospective chart review of veterans' health and exposure concerns.

RESULTS

Veterans (n=56) reported an average of 4 (standard deviation [SD] = 2.1; range, 0-9) physical health concerns, and 2.7 (SD=2.3; range, 0-10) exposure concerns. The majority of veterans (55%) had a mental health concern, most commonly, posttraumatic stress disorder. The most common exposure concerns were depleted uranium, multiple vaccinations, and poor air quality. Greater proportions of Reserve veterans reported genitourinary concerns and exposure to smoke from burning trash than active duty veterans.

CONCLUSIONS

Veterans of military operations in Southwest Asia have deployment-related health and exposure concerns that will need to be addressed by their ambulatory care physicians.

Health perspectives regarding adolescents in military service

PURPOSE OF REVIEW

Our purpose is to illuminate health perspectives of adolescents in military service, who comprise the main bulk of military personnel.

RECENT FINDINGS

Two views are emphasized: the soldier as a developing adolescent and the healthcare of adolescent soldiers. The capacity for abstract thinking and future planning, characteristic of late adolescence, opposes the military challenges of obedience, disengagement from the family, and potential threats for physical injury and mental stress, in addition to the requirement for responsibility beyond the individual's personal needs. On the other hand, at discharge from military service, the mature young adult faces questions of a 17-year-old adolescent. Health perspectives regarding adolescents in military service include physical and mental health screening before draft; recruiting adolescents with chronic illnesses; specific healthcare issues during service, including routine medical care, psychosocial problems of young people in service and approach to suicide and to risk behaviors; health aspects of adolescent women in military frameworks; and the dual commitment of physicians as military officers.

SUMMARY

Professionals who care for the well-being of young people in their late teens and early 20s in military service need to consider the service period as an additional developmental stage within late adolescence that requires attention as part of the comprehensive healthcare.