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.

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.

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.

Medical Intelligence Team Lessons Learned: Early Activation and Knowledge Product Development Mitigate COVID-19 Threats.

Leadership during the emergence of the novel coronavirus pandemic is complex and involves coordinated efforts between multiple levels of leadership from the medical, installation, local, state, and federal levels. Medical intelligence is critical to successful pandemic threat mitigation. We describe one of the first coronavirus (Coronavirus Disease-2019 (COVID-19)) impacted Department of Defense Medical Treatment Facility's strategic activation of a COVID-19 Medical Intelligence Team (MIT), the products developed, and lessons learned during the pandemic onset. The MIT bridged COVID-19 knowledge and policy gaps by developing and delivering daily intelligence briefings on four domains: epidemiology and infectious disease, healthcare capabilities and infrastructure, policy and regulations, and diagnostics and therapeutic interventions. Twenty-three products were developed and delivered to aid in leadership decision-making and local policy development in the absence of higher-level policy and guidance. Employing MITs in future pandemic response strategy may more effectively mitigate pandemic threats and improve force health protection.

Developing the Process and Tracking the Implementation and Evaluation of the National Institutes of Health Strategic Plan for Women's Health Research.

The National Institutes of Health (NIH) released Advancing Science for the Health of Women: The Trans-NIH Strategic Plan for Women's Health Research, 2019-2023 (Strategic Plan) in February 2019. The NIH Office of Research on Women's Health (ORWH) engaged staff members from across NIH to develop recommendations on the implementation and evaluation of the Strategic Plan. OBJECTIVE: This paper describes the process used to develop recommendations for tools and approaches that NIH Institutes, Centers, and Offices (ICOs) could apply when implementing and evaluating the Strategic Plan. METHODS: A Trans-NIH Strategic Plan Implementation and Evaluation Guidance Development Team conducted meetings and individual interviews with 69 NIH staff members knowledgeable about research on the health of women and sex and gender differences and met with 11 Advisory Committee on Research on Women's Health Strategic Plan Evaluation Working Group members. The purpose of these stakeholder meetings and interviews was to obtain recommendations for implementing the Strategic Plan and identify measures for evaluating implementation success. A thematic analysis was performed to synthesize and map the recommendations to the Strategic Plan goals and objectives. RESULTS: The process resulted in the Guide for Implementing and Evaluating the 2019-2023 Trans-NIH Strategic Plan for Women's Health Research Across NIH Institutes, Centers, and Offices (the Guide), which includes both a conceptual and logic model for implementation and evaluation. CONCLUSIONS: The Guide offers methods, tools, and suggestions that ICO planning and evaluation staff, as well as national and international entities, can choose from when determining how to implement the Strategic Plan through ICO activities, programs, and research initiatives and how to evaluate their efforts in the context of their unique mission.

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.

Effectiveness of Lifestyle Interventions in an Active Duty Air Force Population.

PURPOSE: To examine the effectiveness of 3 lifestyle intervention programs in an active duty military population. DESIGN: Experimental design with stratified random assignment to 1 of 3 intervention groups. Measures were taken at baseline, 3 months and 6 months. SETTING: A Military Treatment Facility in the western U.S. SUBJECTS/INTERVENTION: 122 active duty service members were enrolled and randomly assigned to 1 of 3 lifestyle intervention programs: the Diabetes Prevention Program-Group Lifestyle Balance (DPP-GLB), the Better Body Better Life (BBBL) program or the Fitness Improvement Program (FIP). MEASURES: weight, abdominal circumference, lipid and HbA1c levels, physical activity, and well-being as measured by the RAND SF-36 questionnaire. ANALYSIS: Statistical analyses were performed to assess changes over time. RESULTS: 83 participants completed the study (BBBL N = 23, FIP N = 30, DPP-GLB N = 30). The DPP-GLB participants had statistically significant decreases in weight (-3.1 pounds, p = .01) and abdominal circumference (-0.9 inches; p = .01) over time. HbA1c was also significantly lower in this group at 6 months compared to baseline (p = .036). There were no statistically significant changes in weight, abdominal circumference, or HbA1c in the FIP or BBBL groups. No significant changes were observed in lipids in any of the groups. CONCLUSION: Results from this study indicate that the DPP-GLB program may be effective in reducing weight, abdominal circumference, and HbA1c in an active duty U.S. military population.

Polycystic Ovary Syndrome in Active Duty Service Women: A Retrospective Analysis.

INTRODUCTION: Women make up 16.3% of the Department of Defense (DoD) active duty military population. January 2016, the Secretary of the Defense opened all military positions to women, including combat positions. Identifying conditions that may impact health and military readiness are essential to maintaining a fit and ready force. Polycystic ovary syndrome (PCOS) is a condition that has significant health and military readiness implications for active duty service women (ADSW). Some of the common manifestations of PCOS, overweight, obesity, and abnormal menstrual cycles, have a direct impact on the deployment readiness of ADSW, which effects military operations. The prevalence of PCOS in ADSW must be identified to ascertain true numbers in the DoD to appropriately support, treat, and manage this population; therefore, the purpose of this study was to explore the prevalence of PCOS diagnosis, in ADSW. MATERIALS AND METHODS: A retrospective analysis of electronic health record data from the Department of Defense Military Health Systems DataMart was conducted for calendar years January 2011 - December 2016, using ICD 9 and 10 codes. ADSW with symptoms and conditions that were present with PCOS but did not have the ICD 9 or 10 code for PCOS were also identified to explore the potential undiagnosed prevalence of PCOS. The diagnosed symptoms and conditions included for analysis were weight gain, obesity, dyslipidemia, glucose intolerance, hypertension, acne, acanthosis nigricans, infertility, and menstrual irregularity. RESULTS: There are 11,190 (0.2%) ADSW diagnosed with PCOS, and 9,112 (0.17%) diagnosed with symptoms that meet the profile and characteristics present in PCOS, but have no diagnosis. All branches of service and ranks were represented in these numbers. CONCLUSIONS: PCOS is present in ADSW. Obtaining an accurate prevalence rate of this condition helps reveal the extent of its presence, helps increase awareness, and identify that there is a population in need of targeted support and interventions to maintain a fit and ready force.