Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities.

BACKGROUND: The Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. METHODS: Four ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities' infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations. RESULTS: Among 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28th week or later. Overall scores for providers' PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers' ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites. CONCLUSIONS: These findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early.

[Regulatory supervision and radiation survey in the area of location of former military technical bases].

Activities related to the rehabilitation of areas and facilities of the temporary storage of spent nuclear fuel and radioactive waste (SNF and RW) at Andreeva Bay and Gremikha on the Kola Peninsula and in the Primorsky Krai in the Russian Far East is an important component of the regulatory functions of the Federal Medical biological Agency (FMBA of Russia). Technical support to the FMBA of Russia in this activity is provided by A.L Burnazyan Federal Medical Biophysical Center Main research interests include evaluation of radiological threats to determine the priority directions of regulation, a detailed analysis of the radiation situation at areas, territories and in vicinity of temporary waste storage facilities, radiation control and environmental monitoring, the development of digital maps and geoinformation systems, project expertise in the field of rehabilitation of PVC including the management of SNF and RW Implementation of these natural, practical and theoretical works is completed by development a set of regulatory documents ensuring adherence to radiation safety for the stuff population and the environment, and the also documents governing the management of SNF and RW waste in the territories of PVC.

Perceptions of health and healthcare in ex-Army residents of Tameside: a pilot qualitative study.

BACKGROUND: Local authorities and other service providers need data on their local ex-military communities to be able to plan services. However, published research and data may not be applicable to the local population. Qualitative research offers a relatively low-cost way to get insights into the needs of local ex-military communities. METHODS: A pilot study using in-depth interviews with a small convenience sample of former ex-Army residents of Tameside. Framework analysis was used to identify and group themes arising from the data. This study was conducted using the Consolidated Criteria for Reporting Qualitative Research. RESULTS: While participants saw mental health as a particular challenge, they felt that it tends to get disproportionate attention relative to other needs. The study identified potential barriers to accessing health services that arise from an interaction between aspects of military and civilian healthcare culture and practices. Participants also said that military service could affect the health of both partners and children and that these effects might be more pronounced at key times, such as during adolescence. CONCLUSION: Participants' perceptions of the health of former members of the Armed forces reflect the published epidemiological literature. This suggests that qualitative data can be valid for understanding the health needs of local ex-military communities. Further research is needed to test the findings here with a broader group of ex-military personnel, to explore the barriers faced in accessing healthcare and to understand the health needs of the families of ex-service personnel.

Association of Suicide Risk With Transition to Civilian Life Among US Military Service Members.

Importance: Although interest is high in addressing suicide mortality after the transition from military to civilian life, little is known about the risk factors associated with this transition. To support the ongoing suicide surveillance work of the US Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention, examining these factors is important for targeting suicide prevention efforts. Objective: To examine the prevalence, patterns, and associated characteristics of suicide mortality among US service members after separation from military active status. Design, Setting, and Participants: This retrospective population-based cohort study obtained demographic and military service data from the VA/Department of Defense Identity Repository. Individuals who served on active duty in the US Army, Navy, Air Force, Marine Corps, or Coast Guard after September 11, 2001, and who separated from active status between January 1, 2010, and December 31, 2017, were included in the cohort. Data analyses were conducted from September 9, 2019, to April 1, 2020. Main Outcomes and Measures: Suicide mortality within 6 years after separation from military service. Results: A total of 1 868 970 service members (1 572 523 men [84.1%]; mean [SD] age at separation, 30.9 [9.9] years) separated from the military during the study period. Through the end of the study period (December 31, 2017), 3030 suicides (2860 men and 170 women) were identified as having occurred within 6 years of separation from the military. Statistically significant differences in suicide risk were found by demographic and military service characteristics. Suicide rates after separation were time dependent, generally peaking 6 to 12 months after separation and declining only modestly over the study period. Male service members had a statistically significantly higher hazard of suicide than their female counterparts (hazard ratio [HR], 3.13; 95% CI, 2.68-3.69). Younger individuals (aged 17-19 years; HR, 4.46 [95% CI, 3.71-5.36]) had suicide hazard rates that were approximately 4.5 times higher than those who transitioned at an older age (≥40 years). Service branch remained a risk factor for suicide even 6 years after separation; those who separated from the Marine Corps (HR, 1.55; 95% CI, 1.36-1.78) and the Army (HR, 1.48; 95% CI, 1.31-1.67) had a higher hazard than those who transitioned from the Air Force. The hazard for those who separated from the active component was higher than for those who separated from the reserve component (HR, 1.29; 95% CI, 1.18-1.42). Service members with a shorter length of service had a higher hazard (HR, 1.26; 95% CI, 1.11-1.42) than those with a longer service history. Conclusions and Relevance: Results of this study show that not all service members who recently transitioned from military life had the same risk of suicide. The data suggest that awareness of military service and demographic characteristics can help identify those most at risk for suicide to target prevention efforts.

Evaluating Behavioral Health Interventions for Military-Connected Youth: A Systematic Review.

INTRODUCTION: Military-connected youth are at increased risk for experiencing distinct psychosocial and behavioral health vulnerabilities. Although behavioral health interventions have been developed to treat vulnerabilities in military-connected youth, little is known about the methodological quality of studies evaluating these interventions. In this study, a systematic review of behavioral health interventions for military-connected youth was conducted to examine methodological quality and treatment outcomes. MATERIALS AND METHODS: Electronic databases were systematically searched for studies evaluating behavioral health interventions for military-connected youth which yielded 3,324 citations. Methodological quality was evaluated by 2 researchers with 3 measures that assessed scientific rigor, transparency, external and internal validity, and power for quantitative, qualitative, and mixed-method trials. Interrater reliability was strong (κ = 0.81). Sample characteristics and treatment outcomes were also assessed. RESULTS: Fourteen studies meeting full inclusion criteria evaluated 10 behavioral health interventions. Methodological quality scores for all studies were poor to fair, with limitations in reporting, external and internal validity, and power. Research designs were predominantly nonexperimental. Treatment effects for both psychosocial and behavioral health outcomes were consistently positive for all studies. In studies reporting effect sizes, treatment effects were small to moderate (d = 0.01-0.42, odds ratio = 0.04-0.47, b = -0.02-0.56). Demographic and military characteristics of samples were inconsistently reported. CONCLUSION: Behavioral health interventions for military-connected youth have noteworthy methodological limitations, indicating a need to employ more rigorous research strategies. Positive treatment outcomes, however, suggest promising interventions for improving psychosocial and behavioral health problems in military-connected youth. Future research directions and implications for clinical-community practice are also discussed.

Military Emergency Medical Service System Assessment: Application of the National Park Service Needs Assessment and Program Audit to Objectively Evaluate the Military EMS System of Okinawa, Japan.

INTRODUCTION: As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). METHODS: A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall "score" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. RESULTS: From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. CONCLUSION: This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems.

Preventive medicine oversight of splash pads on military installations.

Over the past several years, an increasing number of military installations have installed splash pads that provide fun, recreational water entertainment for Soldiers and their families. The addition of splash pads brings added responsibilities for medical treatment facility preventive medicine oversight and installation facilities maintenance to ensure a safe and healthy environment. Currently, there are no consistent standards or detailed guidance for military installations to follow when installing and maintaining splash pads. The central issues associated with splash pads on military installations are water quality and risk for waterborne illnesses, responsibility for safety and health oversight, and federal energy and water sustainability mandates. This article examines the importance of implementing a standard for design and oversight to ensure the health and safety of Soldiers and their families.