Does universal insurance influence disparities in high-quality hospital use for inpatient pediatric congenital heart defect care within the first year of diagnosis?

BACKGROUND: Healthcare disparities are an issue in the management of Congenital Heart Defects (CHD) in children. Although universal insurance may mitigate racial or socioeconomic status (SES) disparities in CHD care, prior studies have not examined these effects in the use of High-Quality Hospitals (HQH) for inpatient pediatric CHD care in the Military Healthcare System (MHS). To assess for racial and SES disparities in inpatient pediatric CHD care that may persist despite universal insurance coverage, we performed a cross-sectional study of the HQH use for children treated for CHD in the TRICARE system, a universal healthcare system for the U.S. Department of Defense. In the present work we evaluated for the presence of disparities, like those seen in the civilian U.S. healthcare system, among military ranks (SES surrogate) and races and ethnicities in HQH use for pediatric inpatient admissions for CHD care within a universal healthcare system (MHS). METHODS: We conducted a cross-sectional study using claims data from the U.S. MHS Data Repository from 2016 to 2020. We identified 11,748 beneficiaries aged 0 to 17 years who had an inpatient admission for CHD care from 2016 to 2020. The outcome variable was a dichotomous indicator for HQH utilization. In the sample, 42 hospitals were designated as HQH. Of the population, 82.9% did not use an HQH at any point for CHD care and 17.1% used an HQH at some point for CHD care. The primary predictor variables were race and sponsor rank. Military rank has been used as an indicator of SES status. Patient demographic information at the time of index admission post initial CHD diagnosis (age, gender, sponsor marital status, insurance type, sponsor service branch, proximity to HQH based on patient zip code centroid, and provider region) and clinical information (complexity of CHD, common comorbid conditions, genetic syndromes, and prematurity) were used as covariates in multivariable logistic regression analysis. RESULTS: After controlling for demographic and clinical factors including age, gender, sponsor marital status, insurance type, sponsor service branch, proximity to HQH based on patient zip code centroid, provider region, complexity of CHD, common comorbid conditions, genetic syndromes, and prematurity, we did not find disparities in HQH use for inpatient pediatric CHD care based upon military rank. After controlling for demographic and clinical factors, lower SES (Other rank) was less likely to use an HQH for inpatient pediatric CHD care; OR of 0.47 (95% CI of 0.31 to 0.73). CONCLUSIONS: We found that for inpatient pediatric CHD care in the universally insured TRICARE system, historically reported racial disparities in care were mitigated, suggesting that this population benefitted from expanded access to care. Despite universal coverage, SES disparities persisted in the civilian care setting, suggesting that universal insurance alone cannot sufficiently address differences in SES disparities in CHD care. Future studies are needed to address the pervasiveness of SES disparities and potential interventions to mitigate these disparities such as a more comprehensive patient travel program.

Are equitable physical performance tests perceived to be fair? Understanding officer cadets' perceptions of fitness standards.

In the last few decades, the armed forces in Western countries such as Canada and the United States have accepted women into virtually all military occupations. Despite this, a growing body of research confirms that female service members face prejudiced treatment while conducting their work in these organizations that continue to be predominately masculine and male-dominated. In particular, women attending the Canadian Military Colleges (CMCs) experience gender-related conflicts arising from the dissimilar fitness test standards between male and female cadets. There have been, however, few studies that scrutinize the psychological mechanisms of these tensions. The aim of this study was to unpack the existing biased perceptions against women pertaining to physical fitness through ambivalent sexism, social dominance orientation, and right-wing authoritarianism. Officer and naval cadets (n = 167, 33.5% women) at the Royal Military College of Canada (RMC) completed survey measures. Indirect effect analyses showed that cadets who viewed the fitness standards to be unfair expressed more hostile rather than benevolent sexist outlooks against women, and these negative feelings were connected to greater levels of social dominance and right-wing authoritarianism. These results indicate that sexist beliefs, competitive worldviews, and authoritarianism are underlying attitudes that should be addressed by militaries striving to fully integrate women into their forces.

Unethical behaviour in the military: The role of supervisor ethicality, ethical climate, and right-wing authoritarianism.

Using an anonymous self-report survey of 350 Canadian Armed Forces (CAF) personnel, this study investigated the effect of perceptions of the ethicality of one's immediate supervisor (supervisor ethics), right-wing authoritarianism (RWA), and ethical climate on self-reported unethical behavior in the form of discrimination and obeying an unlawful command (past behavior, behavioral intentions). As well, we investigated how supervisor ethics and RWA interact when predicting unethical behavior, and whether ethical climate mediated the relation between supervisor ethics and self-reported unethical behavior. Unethical behavior depended on perceptions of the ethicality of one's supervisor and RWA. RWA predicted discrimination toward a gay man (behavioral intentions), and supervisor ethics predicted discrimination against outgroups of people, and obedience of an unlawful command (past behavior). As well, the effects of ethical supervision on discrimination (past behavior, behavioral intentions) depended on participants' level of RWA . Finally, ethical climate mediated the relation between supervisor ethics and obeying an unlawful command, such that higher perceptions of supervisor ethics led to a higher ethical climate, which led to less obedience of an unlawful command in the past. This suggests that leaders can affect the ethical climate of on organization, which in turn affects ethical behavior of followers.

[Professor Veniamin Vasilievich Volkov (to the 100th anniversary of his birth)]. / Professor Veniamin Vasil'evich Volkov (k 100-letiyu so dnya rozhdeniya).

The article presents the main stages of the career of Professor V.V. Volkov - the Hero of Socialist Labor, USSR State Prize Laureate, Honored Scientist of the RSFSR, Honorary Doctor of the Military Medical Academy, and describes his scientific and practical contribution to the development of modern ophthalmology. The authors reviewed his life journey, clinical, scientific and educational activities.

Humanitarian crisis amid the military coup in Niger republic; what went wrong?

Introduction: A humanitarian crisis means any event or series of events that are harmful to the health or security of the general population. The Niger Republic is currently facing a serious crisis amid the military coup of July 26, 2023. We fear that if nothing is done about it quickly, there could be a civil war in Niger and other neighboring countries. Aim: This present article aims to provide comprehensive knowledge about the ongoing humanitarian crisis in Niger, highlighting the factors that caused it and providing possible solutions for them. Methodology: A literature search was conducted on the recent humanitarian crisis caused by the military coup in Niger Republic using databases such as PubMed, ResearchGate, Google Scholar, World Health Organization, United Nations, online newspapers, and reports from 2013 to 2023. Result: We found that the humanitarian crisis amid the military coup in Niger Republic has further amplified the vulnerability of millions of Nigeriens to more problems in the Niger Republic. The number of Nigeriens in need of humanitarian assistance has reportedly increased by 65%, from 2.3 million in 2019 to 3.8 million in 2021. More than two million children in Niger have been impacted by the crisis in the country and need humanitarian assistance. Furthermore, other causes of the humanitarian crisis in the Niger Republic include sociodemographic factors, climate change, and other natural disasters. Conclusion: The humanitarian crisis in Niger, caused by different factors such as socioeconomic stagnation, environmental causes, food insecurity, terrorist activities, and internal displacement, is an alarming situation that requires an urgent solution and a response from the international community. There is a need to analyze all the underlying causes of humanitarian crises and find long-lasting solutions for them.

Attitudes towards women in the military and their relation to both quantity and quality contact with female leaders.

Contact experiences with women in senior leadership roles are important for creating acceptance of women in organizations dominated by men, such as the military, as leadership roles are considered demanding, requiring numerous agentic qualities that are often ascribed to men. The military lacks women in leadership levels within its organization. We wished to determine whether quality and quantity contact with women in leadership positions reduces intergroup anxiety, increases empathy and perspective-taking, and subsequently creates more favorable attitudes toward women in the military. This was examined in three studies, one with a military sample consisting of men (n = 95), another with a civilian sample of men (n = 367), and a third study with a civilian sample of women (n = 374). Our findings revealed that quality contact was related to attitudes toward women in the military for all three samples. Results from the indirect effects tests conducted for the civilian male and female samples revealed that for civilian men, intergroup anxiety demonstrated a significant indirect effect between quantity contact and attitudes toward women in the military, while both intergroup anxiety and perspective-taking demonstrated significant indirect effects between quality contact and attitudes toward women in the military. Furthermore, both quantity and quality contact demonstrated significant direct effects. On the other hand, results revealed that for civilian women the only significant relation was the direct effect between quality contact and attitudes toward women in the military. Intergroup anxiety, perspective-taking, and empathy did not demonstrate any indirect effects for the civilian women sample. Thus, given that interactions with women in leadership positions are related to views of women in the military, research should further explore the role of contact for women in non-traditional work roles.

The State of Health and Health Care for LGBTQ+ Veterans: Differences Among Sexual and Gender Minority Veterans, by Identity and State Policy Climate, 2015-2021.

The U.S. government has affirmed commitments to improving health and well-being for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) veterans, who may have distinct needs and challenges when accessing timely and appropriate health care. To date, there are limited data about potential health disparities among LGBTQ+ veterans that examine differences by both sexual identity and gender identity. Understanding the nature and magnitude of disparities among LGBTQ+ veterans is critical for targeted efforts to improve their health and well-being. The authors of this study use nationally representative data from 2015-2021 from the Behavioral Risk Factor Surveillance System to compare the age-adjusted prevalence of health-related outcomes across multiple domains (health care access and affordability, general health, substance use, and chronic conditions) for sexual and gender minority veterans with that of their heterosexual and cisgender veteran peers. LGBTQ+ veterans showed poorer health-related outcomes in multiple domains than their heterosexual and cisgender peers, including in terms of healthcare affordability, mental health, chronic cardiovascular conditions, and chronic respiratory conditions. The authors also examine associations between state LGBTQ+ policy climates and health-related outcomes among LGBTQ+ veterans. Among LGBTQ+ veterans, living in a state with a more favorable (versus negative) LGBTQ+ policy climate was associated with several health indicators (e.g., having health insurance, lower smoking rates). The authors then discuss implications for ongoing efforts to improve health and well-being for LGBTQ+ veterans, including sustained actions to ensure that all LGBTQ+ veterans are able to access necessary care and use the full scope of benefits for which they are eligible.

A Historical Review of Military Medical Strategies for Fighting Infectious Diseases: From Battlefields to Global Health.

The environmental conditions generated by war and characterized by poverty, undernutrition, stress, difficult access to safe water and food as well as lack of environmental and personal hygiene favor the spread of many infectious diseases. Epidemic typhus, plague, malaria, cholera, typhoid fever, hepatitis, tetanus, and smallpox have nearly constantly accompanied wars, frequently deeply conditioning the outcome of battles/wars more than weapons and military strategy. At the end of the nineteenth century, with the birth of bacteriology, military medical researchers in Germany, the United Kingdom, and France were active in discovering the etiological agents of some diseases and in developing preventive vaccines. Emil von Behring, Ronald Ross and Charles Laveran, who were or served as military physicians, won the first, the second, and the seventh Nobel Prize for Physiology or Medicine for discovering passive anti-diphtheria/tetanus immunotherapy and for identifying mosquito Anopheline as a malaria vector and plasmodium as its etiological agent, respectively. Meanwhile, Major Walter Reed in the United States of America discovered the mosquito vector of yellow fever, thus paving the way for its prevention by vector control. In this work, the military relevance of some vaccine-preventable and non-vaccine-preventable infectious diseases, as well as of biological weapons, and the military contributions to their control will be described. Currently, the civil-military medical collaboration is getting closer and becoming interdependent, from research and development for the prevention of infectious diseases to disasters and emergencies management, as recently demonstrated in Ebola and Zika outbreaks and the COVID-19 pandemic, even with the high biocontainment aeromedical evacuation, in a sort of global health diplomacy.

A Collaborative To Evaluate And Improve The Quality Of Surgical Care Delivered By The Military Health System.

In an effort to improve surgical quality and reduce clinical variability, the Military Health System (MHS) expanded its participation in the National Surgical Quality Improvement Program to all military hospitals beginning in 2015. This expansion and a partnership with the American College of Surgeons laid the foundation for a surgical quality collaborative in the MHS. We review the history of the program in the MHS and the activities that have contributed to developing the collaborative. We also report promising trends in surgical outcomes at hospitals that were already participating in the program in 2014, when a critical MHS review identified areas for improvement in surgical care. We conclude with a discussion of possible lessons for other health systems and challenges ahead for the MHS, now that full enrollment in the program has been completed.

Development of Longitudinal Data Analysis in Mental Health Research For Military Service Members.

INTRODUCTION: Since the 1991 Gulf War, mental health conditions of military Service members have received increasing public attention and are a major focus for the U.S. government. A substantial proportion of military health research has been devoted to examining the pattern of change over time in mental health symptoms and diagnostic status among Service members. Unfortunately, many researchers continue to use somewhat obsolete methods to analyze trends and transitions in mental health, despite advances in statistical methodology that permit attention to the unique features inherent in longitudinal data. MATERIALS AND METHODS: This article defines and describes data features and structures, and basic specifications of longitudinal data analysis to military health researchers. In particular, we highlight the respective impacts of missing data and intra-individual correlation on longitudinal data analysis. Based on the descriptions of the basic features in longitudinal data, we introduce several popular techniques to analyze a variety of longitudinal data types. RESULTS: We demonstrate that traditional analytic techniques do not properly account for missing data and intra-individual correlation inherent in longitudinal data. Failure to use correct, appropriate models and methods can result in major bias in analytic results and mental health predictions. CONCLUSIONS: Failure to use correct, appropriate models and methods in longitudinal data analysis can have unfortunate repercussions on a military health system that needs accurate findings to support valid policy decisions. By applying adequate models and methods, military health researchers will be able to better understand the complex interactions of biological, psychological, and social factors on mental health trends and transitions among military Service members.

Evaluation of the Strength Aptitude Test and Other Fitness Tests to Qualify Air Force Recruits for Physically Demanding Specialties.

The Air Force uses the Strength Aptitude Test (SAT) to determine whether recruits meet the fitness levels needed to perform the duties of various Air Force specialties with physical strength requirements. However, the SAT was developed in the early 1980s and has not been revalidated since then. In the interim, the duties associated with many Air Force Specialty Code classifications may have changed, and new ones have been added. These changes require a reevaluation of the SAT's utility and effectiveness for qualifying recruits into these specialties. This study evaluates the status and validity of the SAT in a series of studies and summarizes the studies RAND has completed independently and one study conducted in conjunction with HumRRO, which provided the additional data necessary to develop some courses of action for the Air Force to follow to ensure airmen can meet job-related physical requirements.

Air Force Chaplains' Perceived Effectiveness on Service Member's Resilience and Satisfaction.

This study examined how 3,777 active duty male United States Air Force service members' (SMs) rank and residence location moderated the associations between perceived chaplain effectiveness, SMs' resilience, family coping, marital satisfaction, and satisfaction with the Air Force (AF). A multiple-sample structural equation model was conducted with four subgroups of SMs who had received chaplain support: enlisted members living on base, enlisted members living off base, officers living on base, and officers living off base. Chaplain effectiveness was significantly related, both directly and indirectly, to SM's spirituality, resilience, family coping, marital satisfaction, and AF satisfaction. Resilience was significantly associated with increased AF satisfaction for all SMs, except for those living on base. However, living on base was found to strengthen the protective factor between family coping and relationship satisfaction. Rank was found to moderate the link between resilience and family coping. Family coping was significantly related to increased relationship satisfaction.

Processo de luto de familiares de desaparecidos políticos na ditadura militar brasileira / Mourning process of family members of missing politicians in the Brazilian military dictatorship

A Ditadura Militar do Brasil foi instaurada em 1964 e se prolongou até 1985. É considerada um período de repressão, violação de direitos, torturas, mortes e desaparecimentos, deixando um rastro inacabado. O objetivo desta pesquisa foi analisar o processo de luto de familiares que têm seus parentes desaparecidos desde a Ditadura civil-militar. Este trabalho caracteriza-se como um estudo de campo transversal com abordagem qualitativa. Foram entrevistados sete participantes que tiveram seus familiares desaparecidos no período da ditadura civil-militar no Brasil. Os instrumentos de pesquisa foram um questionário sociodemográfico e um roteiro de entrevista semidirigida. Entre os resultados obtidos na pesquisa, pode-se observar que o processo do luto carece de um desfecho, visto que a falta da ritualização e a ausência do corpo inviabilizam sua elaboração. Também foi observado que o sofrimento dos familiares é realçado por práticas discursivas recorrentes que negam a existência e as truculências da ditadura civil-militar brasileira.

Brazilian military dictatorship was installed in 1964 and lasted until 1985. It was a period of repression, violation of rights, torture, death, and disappearances, its signals still present. The objective of this research was analyzing the bereavement process of people who lost their relatives in the military-civilian Dictatorship and still are unaware of their whereabouts. This work is characterized as a cross-sectional, qualitative field study. Seven participants whose relatives were made to disappear during the Brazilian military-civilian dictatorship were interviewed. The research instruments were a sociodemographic questionnaire and a semi-structured interview script. Among results obtained in the research, it was found that the bereavement process lacks closure, since the lack of ritualization and the absence of the body do not allow for its elaboration. Family suffering was highlighted by frequent discursive practices that deny the truculence of the Brazilian military-civilian dictatorship.

A malaria vaccine for travelers and military personnel: Requirements and top candidates.

Malaria remains an important health threat to non-immune travelers with the explosive growth of global travel. Populations at high risk of acquiring malaria infections include once semi-immune travelers who visit friends and relatives, military forces, business travelers and international tourists with destinations to sub-Saharan Africa, where malaria transmission intensity is high. Most malaria cases have been associated with poor compliance with existing preventive measures, including chemoprophylaxis. High risk groups would benefit immensely from an efficacious vaccine to protect them against malaria infection and together make up a sizable market for such a vaccine. The attributes of an ideal malaria vaccine for non-immune travelers and military personnel include a protective efficacy of 80% or greater, durability for at least 6 months, an acceptable safety profile and compatibility with existing preventive measures. It is very likely that a malaria vaccine designed to effectively prevent infection and clinical disease in the non-immune traveler and military personnel will also protect semi-immune residents of malaria-endemic areas and contribute to malaria elimination by reducing or blocking malaria transmission. The RTS,S vaccine (GlaxoSmithKline) and the PfSPZ Vaccine (Sanaria Inc) are the leading products that would make excellent vaccine candidates for these vulnerable populations.

Challenges and Needs Faced by Female Combat Veterans.

This article presents findings of a study conducted to identify stressors that may contribute to mental health issues of military female veterans. Female members in the U.S. Armed Forces currently occupy more non-traditional roles; therefore deployment to combat zones, commonly reserved for males, is being taken on by females. While at the present time females serving in the military are not allowed to serve in combat occupations, the reality is that many are being placed in combat roles or environments. Consequently, many are now confronted with stressors related to combat and multiple deployments. This study was based on a descriptive, non-probability, snowball design. In cases where participants displayed a reluctance to share some information in front of counterparts who may have been at a higher or lower rank level; subsequent semi-structured, one-to-one interviews were conducted. The latter approach proved more effective in gathering important information, such as issues of military sexual trauma (MST) and issues of intimacy upon re-entering the home environment. This study was conducted before January 2013, when Defense Secretary Leon Panetta announced the lift of the ban on women serving in combat. Therefore, future studies will need to be conducted to discern how these stressors will affect them in their new role as active combatants.

Dimensões da prática cotidiana e (des)humanização do policial militar / Daily Practice Dimensions and (de)humanization of military policeman / Dimensiones de la práctica cotidiana y (des)humanización de la policia militar

A relação da polícia militar com a sociedade tem se caracterizado por situações de frequente tensão. Nessas situações pode também ser encontrado um processo de desumanização do policial militar, o que não contribui para o estabelecimento de parcerias entre a polícia e a comunidade. A partir da observação de situações do cotidiano desses profissionais, este estudo objetivou identificar e analisar as condições concretas do cotidiano de trabalho que potencializam a (des)humanização. São descritas algumas condições e adversidades da atividade policial, reunindo-se a observação de cinco relatos de experiências pessoais, vividas por policiais militares do Paraná. Sob a ótica dos pressupostos da polícia comunitária, da educação e da psicologia social comunitária, pretende-se discutir o processo de naturalização nas relações entre sociedade e policiais militares e alguns impactos no dia a dia, condição resultante de diferentes interesses políticos e ideológicos. Ao se problematizar esses aspectos busca-se o encontro de possibilidades para relações mais justas e humanas entre a polícia e a comunidade.

The relationship of the military police with society has been characterized by reflecting a tension environment. In this conflict situation there is a process of dehumanization of the military police officer, which does not contribute to the establishment of partnerships between police and the community. From the observation of everyday situations these professionals, this study aims to identify and analyze the concrete conditions of the daily work that enhance the (un)humanization. Some conditions and adversities of police activity are described, gathering the observation of five reports of personal experiences lived by military police of Paraná. From the perspective of the assumptions of community policing, education and community social psychology, we intend to discuss the process of naturalization in relations between society and police-military and some impacts on the day-to-day, a condition resulting from different political and ideological interests. By problematizing these aspects, we seek to find opportunities for more just and humane relations between police and the community.

La relación de la policía militar con la sociedad se ha caracterizado por las tensiones reflejan un entorno. En esta situación de conflicto hay un proceso de deshumanización de la policía militar, que no contribuye a la creación de asociaciones entre la policía y la comunidad. De la observación de situaciones cotidianas de estos profesionales, este estudio tiene como objetivo identificar y analizar las condiciones concretas de la labor diaria que mejoran la (des) humanización. Describir algunas condiciones y la adversidad en la actividad policial, cumpliendo la observación de cinco informes de experiencias personales vividas por la policía militar de Paraná. Desde la perspectiva de los supuestos de la policía de comunidad, de la educación y la psicología socialcomunitaria, hay la propuesta de discutir el proceso de naturalización de las relaciones entre la policía militar y la sociedad y algunos impactos en el día a día, cuya interacción resulta de los intereses políticos e ideológicos que están en juego. Con esta problematización hay la búsqueda de posibilidades que puedan contribuir para la construcción de una vida y sociedad más justa.

O legado educacional do regime militar / The educational heritage of the military regime

Este texto se propõe a uma retomada da política educacional e das realizações da ditadura militar no Brasil, pondo em destaque aspectos que se fazem presentes, ainda hoje, na educação brasileira. Eis os pontos destacados: vinculação da educação pública aos interesses e necessidades do mercado, que se efetivou na reforma universitária e especialmente no intento de implantação universal e compulsória do ensino profissionalizante; favorecimento à privatização do ensino, que ocorreu principalmente mediante as autorizações e reconhecimentos do Conselho Federal de Educação; estrutura de ensino decorrente da implantação de mecanismos organizacionais que se encontram em plena vigência; um modelo bem sucedido de pós-graduação implantado a partir da estrutura organizacional americana e da experiência universitária européia.

This paper reviews the Brazilian military dictatorship's educational policies and accomplishments. It particularly stresses aspects that are still present in the current Brazilian education. Those include: the link between public education and market interests and needs, brought forth by the University reform, especially the compulsory and universal implementation of professionalizing teaching; the favoritism of private teaching, which mainly took place through authorizations and accreditations granted by the Conselho Federal de Educação (Federal Education Council); the teaching structure resulting from the implementation of organizational mechanisms that is still fully in force; a successful post-graduation model established following the American organizational structure and the European university experience.