Barriers and facilitators to mental healthcare for women veterans: a scoping review

BACKGROUND

Traditionally, veteran research and support have centred on the requirements of a predominantly male population. However, as female participation in the Armed Forces increases and their roles diversify, consideration of women's unique mental health needs is imperative. Women veterans are at greater risk of post-service mental health challenges than their male counterparts, and female mental health outcomes have deteriorated in recent years.

AIMS

To determine the provenance of these outcomes, a scoping review considering both barriers and facilitators to female veteran participation in mental health services was conducted.

METHODS

A review was carried out following the 2020 Joanna Briggs Institute Scoping Review framework. Twenty-four papers were identified, with all but one originating from the US.

RESULTS

This research indicated that whilst women experience barriers common to male veterans (e.g. help-seeking stigma), they also experience unique gender-specific barriers to accessing mental healthcare services (e.g. lack of gender-sensitive treatment options, feeling uncomfortable) and such barriers result in under-utilization of services.

CONCLUSIONS

Literature indicates that consideration and mitigation of these barriers might improve access and health outcomes for women veterans. Further research is required outside the US to understand the barriers to mental healthcare experienced by women veterans internationally.

The impact of caring for family members with mental illnesses on the caregiver: a scoping review

A large number of multidisciplinary, qualitative and quantitative research suggests that providing care for family members with mental health illnesses can have both positive and negative effects on the carers' wellbeing. However, to date a comprehensive overview and synthesis of literature that compares and contrasts positive and negative effects of family-caregiving on the carer is missing. To address this gap, this scoping review examines the effects of family-caregiving on carers' wellbeing. A Boolean search generated a total of 92 relevant articles that were included in the analysis. The results suggest that, to understand the effects of family-caregiving on the carer's mental and physical wellbeing, it is necessary to take a combination of situational and sociodemographic characteristics into consideration. Elderly, female, spousal-carers and primary-carers may be a group that is at risk of suffering from a lack of positive mental and physical wellbeing as a result of caring. However, the negative effects of caregiving can be balanced by extraversion, social support and religious or spiritual beliefs. Therefore, future interventions that aim to promote family caregivers' wellbeing may need to take personality, particular circumstances as well as cultural and personal beliefs into consideration.

Gender differences in barriers to mental healthcare for UK military veterans: a preliminary investigation

INTRODUCTION

Limited UK research focuses on female military veterans' gender-related experiences and issues when accessing civilian mental healthcare support. This study sought to illuminate a preliminary understanding of any gender differences in barriers that may discourage them accessing mental healthcare support.

METHODS

A total of 100 participants completed an open online survey of UK triservice veterans who identified as having experienced postmilitary mental health problems. They completed a 30-item Barriers to Access to Care Evaluation scale and were asked to elaborate using free-text questions. Resulting quantitative data were analysed for gender-related differences, while the qualitative text was thematically explored.

RESULTS

While stigma, previous poor experience of mental healthcare and a lack of trust in civilian providers were found to act as barriers to postmilitary support for both men and women, significantly more women reported that their gender had also impacted on their intention to seek help. Women also commented on the impact of gender-related discrimination during service on their help-seeking experiences.

CONCLUSIONS

While efforts are being made by the UK Ministry of Defence to reduce barriers to mental healthcare for those still serving in the Armed Forces, it has been more difficult to provide a similar level of support to the veteran population. With little veteran research focusing on the specific experiences of women, this study suggests that female veterans encounter specific access barriers and issues related to their gender. Further research is therefore needed to ensure these findings are addressed.

The effect of acute simulated moderate altitude on power, performance and pacing strategies in well-trained cyclists

Athletes regularly compete at 2,000-3,000 m altitude where peak oxygen consumption (VO2peak) declines approximately 10-20%. Factors other than VO2peak including gross efficiency (GE), power output, and pacing are all important for cycling performance. It is therefore imperative to understand how all these factors and not just VO2peak are affected by acute hypobaric hypoxia to select athletes who can compete successfully at these altitudes. Ten well-trained, non-altitude-acclimatised male cyclists and triathletes completed cycling tests at four simulated altitudes (200, 1,200, 2,200, 3,200 m) in a randomised, counter-balanced order. The exercise protocol comprised 5 x 5-min submaximal efforts (50, 100, 150, 200 and 250 W) to determine submaximal VO2 and GE and, after 10-min rest, a 5-min maximal time-trial (5-minTT) to determine VO2peak and mean power output (5-minTT(power)). VO2peak declined 8.2 +/- 2.0, 13.9 +/- 2.9 and 22.5 +/- 3.8% at 1,200, 2,200 and 3,200 m compared with 200 m, respectively, P < 0.05. The corresponding decreases in 5-minTT(power) were 5.8 +/- 2.9, 10.3 +/- 4.3 and 19.8 +/- 3.5% (P < 0.05). GE during the 5-minTT was not different across the four altitudes. There was no change in submaximal VO2 at any of the simulated altitudes, however, submaximal efficiency decreased at 3,200 m compared with both 200 and 1,200 m. Despite substantially reduced power at simulated altitude, there was no difference in pacing at the four altitudes for athletes whose first trial was at 200 or 1,200 m; whereas athletes whose first trial was at 2,200 or 3,200 m tended to mis-pace that effort. In conclusion, during the 5-minTT there was a dose-response effect of hypoxia on both VO2peak and 5-minTT(power) but no effect on GE.

Wealth from Health: an incentive program for disease and population management: a 12-year project

The future of healthcare is linked with its ability to face the challenges of consumerism. Disease and population management will represent the dominant style of healthcare delivery in the future. This article describes the Wealth from Health programs which utilize current and future technologies to help the healthcare system become a leader in healthcare delivery and to assist many communities at an affordable cost.

The ability of the community pharmacist to learn the proper actuation techniques of inhaler devices

Today, greater responsibility is placed on community pharmacists for the education of patients than ever before. Thus community pharmacists were recruited for this study and asked to demonstrate the proper steps in the actuation sequences of 3 inhaler devices. Baseline measurements were followed by an instructional session on the proper actuation technique, and then a posttest was conducted 4 to 6 weeks later. The mean changes between baseline and postinstruction percentage scores for the metered-dose inhaler device, the Turbuhaler, and the Diskus were (mean +/- SD) 17.1% +/- 15.4%, 22.6% +/- 18.7%, and 38.4% +/- 19.6%, respectively. This study demonstrates that a single instructional session can dramatically improve a community pharmacist's ability to demonstrate the correct method of actuation.

Enhancing causal interpretations of quality improvement interventions

In an era of chronic resource scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change. A commonly used research design, the single group pre-test/post-test design, provides little insight into whether quality improvement interventions cause measured outcomes. A re-evaluation of a quality improvement programme designed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications. The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design. Moreover, the re-evaluation provided tangible evidence in support of the suggestion that more rigorous designs can and should be more widely employed to improve the causal interpretability of quality improvement efforts. Evaluation designs for quality improvement projects should be constructed to provide a reasonable opportunity, given available time and resources, for causal interpretation of the results. Evaluators of quality improvement initiatives may infrequently have access to randomised designs. Nonetheless, as shown here, other very rigorous research designs are available for improving causal interpretability. Unilateral methodological surrender need not be the only alternative to randomised experiments.

Enhancing causal interpretations of quality improvement interventions

In an era of chronic resource scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change. A commonly used research design, the single group pre-test/post-test design, provides little insight into whether quality improvement interventions cause measured outcomes. A re-evaluation of a quality improvement programme designed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications. The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design. Moreover, the re-evaluation provided tangible evidence in support of the suggestion that more rigorous designs can and should be more widely employed to improve the causal interpretability of quality improvement efforts. Evaluation designs for quality improvement projects should be constructed to provide a reasonable opportunity, given available time and resources, for causal interpretation of the results. Evaluators of quality improvement initiatives may infrequently have access to randomised designs. Nonetheless, as shown here, other very rigorous research designs are available for improving causal interpretability. Unilateral methodological surrender need not be the only alternative to randomised experiments.

Effect of cholesterol levels on villous histology in colonic adenomas

To date no studies have examined the relationship between cholesterol levels and the occurrence of specific colonic polyp histologies. Villous histology has a greater predilection for subsequent malignancies than other histologies. Consequently, we examined the effect of cholesterol levels on the occurrence of villous adenomas. Just under one in 10 (9.5%, 15/158) patients had polyps with villous histologies. Cholesterol levels were positively and nonlinearly associated with a greater likelihood of villous histology, suggesting that a threshold exists for the effect of cholesterol level on the likelihood of having polyps with villous histology [odds ratios (OR) for combined two variable quadratic effect: cholesterol OR, 1.18; 95% confidence interval (CI), 1.02-1.37 and cholesterol squared OR, 1.004; 95% CI, 1.00-1.02]. Our data suggest that, in patients with polyps, higher cholesterol levels increase the likelihood of having polyps with villous histology, but that the effect of cholesterol level reaches a threshold.

Knowledge, attitudes, and practices of geriatricians regarding patients with dementia who are potentially dangerous automobile drivers: a national survey

OBJECTIVES

To determine geriatrician knowledge regarding how to prevent a patient with dementia who is a potentially dangerous driver from driving and to determine their willingness to recommend license revocation against the wishes of both the patient and the patient's family. Included is a comparison of responses from geriatricians in California, where related legislation has existed for a decade, with responses from geriatricians from all other US states combined.

DESIGN

Survey sample.

SETTING

Geriatric practices.

PARTICIPANTS

Probability sample of 467 geriatricians.

MAIN OUTCOME MEASURES

Survey responses.

RESULTS

More than 28% of all geriatricians (95% CI, 24.3%-32.7%) do not know how to report patients with dementia who are potentially dangerous drivers. A 22% difference (95% CI, 13.9%-30.8%) exists between California geriatricians and those in all other US states. More than 75% (95%, CI, 71.5%-79.5%) of all geriatricians agreed that physicians are responsible for reporting patients. More than 86% (95% CI, 83.2%-89.6%) of all geriatricians would contact state authorities despite the objections of the patient, and 72.9% (95% CI, 68.7%-77.1%) would contact authorities despite the objections of the patient's family.

CONCLUSIONS

Although most geriatricians will act to protect the public from patients with dementia who are potentially dangerous drivers, many do not know how to report these drivers. Legislation can improve a physician's ability to report patients with dementia who are potentially dangerous drivers.

A case of the Wolff-Parkinson-White ECG abnormality in a trainee military pilot

Wolff-Parkinson-White (WPW) Syndrome is a disorder of cardiac conduction which may cause recurrent atrial and ventricular rhythm disturbances, and even sudden death. The diagnosis of this condition or, more frequently the associated electrocardiographic (ECG) abnormality, in a professional aircrew member has, until recently, been cause for disqualification of that individual from flying status. The recent use of electrophysiological studies (EPS) in patients with WPW, and the use of radiofrequency ablation (RFA) to the accessory pathway(s), offers aircrew a safe and effective treatment for their condition.

Neonatal seizures: aetiology and outcome

Neonatal seizures occurred in 23 infants, a rate of 2.33 per 1000, 1978-81. In two infants these were due to congenital central nervous system malformation and in two infants hypocalcaemia. Hypoxic encephalopathy was the cause of the seizures in 19 infants, two of whom also suffered perinatal trauma. Pacific Island infants were overly represented in this group. The gestational age was 41, SD 1.8 weeks, birth weight 3140, SD 720 g; nine infants were 41 weeks or older although nine had unsure data and nine were small for gestational age. Despite vigorous resuscitation at birth, careful metabolic monitoring in the neonatal period and treatment with anti-convulsant medication, at follow-up evaluation 12 (67%) of the infants with hypoxic encephalopathy died or had neurologic sequelae.

Perinatal mortality at a level 2 obstetric hospital: problems after 32 weeks gestation

The aim of this study was to find ways to reduce perinatal mortality. At St Helens Hospital there were 9876 births in the four year period 1978-81 and 93 perinatal deaths occurred, a perinatal mortality rate of 9.42 per 1000, stillbirths 6.58 and early neonatal deaths 2.84. Since 1971 the perinatal rate has been reduced by 29%. Perinatal anoxia was the major cause of death affecting 56 (5.67 per 1000). Only one infant each died of obstetric trauma, and respiratory distress syndrome, 0.1 per 1000. Infection affected four (0.4 per 1000) and lethal congenital abnormalities 24 (2.43 per 1000). Potentially medical avoidable factors were found to have occurred in 31% of the mothers and patient avoidable factors in 6% of mainly late or unbooked mothers. Unsure or incorrect dates in many mothers increased the difficulties in the recognition of infants with intrauterine growth retardation who are at high risk of hypoxia.

Compliance clinic: an opportunity for an expanded practice role for pharmacists

The development and operation of a pharmacy-based clinic providing specialized services to noncompliant patients is described. Physicians refer patients who are not complying with their medication regimens to the pharmacy. The pharmacist interviews the patient to determine the reasons for noncompliant behavior and to reinforce the need for taking medications as directed. Special packaging, such as unit-of-use, may be used to encourage compliance. Medication calendars also are employed. The program has yet to be evaluated fully, but it is concluded that the compliance clinic has permitted the growth of comprehensive pharmacy practice.