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.

Using the RE-AIM Model of Health Promotion to Implement a Military Women's Health Promotion Program for Austere Settings.

The health concerns for military women who serve in austere environments include feminine hygiene, risk of infection, and limited knowledge of gynecologic conditions, symptoms, and prevention. The purpose of this study is to evaluate the effectiveness of the Women's Health Promotion Program (WHPP) for Austere Environments that was implemented in the military community setting of a large operational military unit on a southeastern U.S. military base. The WHPP is a pilot-tested program designed to educate women to recognize and prepare for environments that require alteration of feminine hygiene behaviors, with the goal of maintaining genitourinary health. Evaluation of the WHPP was designed according to the RE-AIM framework, which measures the Reach, Efficacy/effectiveness, Adoption, Implementation, and Maintenance of a health promotion program. The WHPP was offered to 49 military units (none of which declined) and presented to 443 military women in those units. One year after the implementation of the WHPP, the rates of urinary tract infections, vaginal candidiasis infections, and menstrual disorders decreased among the units that participated in the WHPP. These findings lay the foundation for an Army-wide adoption of this WHPP that could enhance readiness in military women.

Wife Caregiver Experiences in the Patient with Prostate Cancer at Home.

This study explored the caregiving experiences of wives of patients with prostate cancer. Twenty wives revealed those older, educated, or married longer were less burdened by caregiving, but needed more information. Findings contribute new dimensions in caregiving for patients with prostate cancer and their wives.

Genitourinary Syndrome Of Menopause and Vaginal Estrogen Use.

The prevalence of women experiencing the genitourinary syndrome of menopause is expected to escalate due to the rising numbers of menopausal women. In no other time in history has it been more important for nurses to possess current knowledge regarding menopause management.

Creating and sustaining a military women's Health Research Interest Group.

In 2008, four doctorate military nurse scientists representing the triservices (Army, Navy, and Air Force) identified a common interest in the health and care of all women in the armed forces. For 7 years, the team's shared vision to improve servicewomen's health inspired them to commit to a rigorous schedule of planning, developing, and implementing an innovative program that has the capability of advancing scientific knowledge and influencing health policy and practice through research. The ultimate goal of the Military Women's Health Research Interest Group (MWHRIG) is to support military clinicians and leaders in making evidence-based practice and policy decisions. They developed a 4-pronged approach to cultivate the science of military women's healthcare: evaluate the existing evidence, develop a research agenda that addresses gaps in knowledge, facilitate the collaboration of multidisciplinary research, and build the bench of future researchers. The MWHRIG has been a resource to key leaders; its value has been validated by multiservice and multidisciplinary consultations. However, the journey to goal attainment has only been achieved by the enduring commitment of these MWHRIG leaders and their passion to ensure the health and wellbeing of the many women who serve in the United States military. This article describes their journey of dedication.

Military women's urinary patterns, practices, and complications in deployment settings.

Military women's urination patterns and practices can be affected when deployed to austere environments. Current measures utilized for urination difficulties predispose women to dehydration, urinary symptoms, and/or urinary tract infections. This article explores the current issues related to this topic.

Comparison of nurse burnout across Army hospital practice environments.

PURPOSE: The primary purpose of this study was to examine the nursing practice environment and burnout of nursing personnel assigned to a deployed combat support hospital (CSH). A secondary aim was to compare differences in the level of burnout between the deployed Army nursing personnel and Army nursing personnel assigned to an Army hospital in the United States that served as the U.S. military's primary referral center for American combat casualties evacuated from Iraq. DESIGN: A nonexperimental cross-sectional design was used for this study. METHODS: The Maslach Burnout Inventory and the Practice Environment Scale were administered to 105 personnel who deployed with a CSH to Iraq. Data from this study were linked to data obtained from 152 nursing personnel who participated in an earlier burnout study at a large Army hospital in the United States. The linked datasets yielded a final sample of 257 Army nursing personnel. Analysis of variance and linear regression analysis were used to analyze these data. FINDINGS: Emotional exhaustion was common across groups. For the deployed nursing personnel, emotional exhaustion was related to a perceived lack of support from management, foundations for quality of care, collegial relationships, and extended work schedules. The U.S.-based Army hospital group scored significantly higher emotional exhaustion, but it was related to the additional responsibilities associated with being an Army nurse, working extended schedules, and working with combat casualties for extended periods of time. The U.S.-based group perceived more personal accomplishment from the work they do. CONCLUSIONS: Burnout was common across Army hospital settings. Emotional exhaustion was most problematic in the U.S.-based Army hospital; however, there was less cynicism toward patients and a greater perception of personal accomplishment associated with work. CLINICAL RELEVANCE: This study supports the importance of a professional practice environment for Army nursing personnel both during deployment and in U.S.-based Army hospitals.

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.

Rewards and challenges of nursing wounded warriors at Landstuhl Regional Medical Center, Germany.

Since the beginning of the Overseas Contingency Operation, more than 45,000 ill and wounded service members have been evacuated from the battlefield to Landstuhl Regional Medical Center (LRMC) in western Europe. LRMC is a stopover for these service members, where they are further assessed, treated, and stabilized before they return to the United States. This process requires coordination between different military services, health care teams, and modes of transportation. These processes can be complicated given the severity of the wounded. Nurses at LRMC have learned how to streamline services, providing efficient, comprehensive care for wounded service members and their families.

Characteristics of medical-surgical patients at the 86th Combat Support Hospital during Operation Iraqi Freedom.

A descriptive study was performed of the U.S. and coalition forces patients admitted to the Intermediate Care Ward (ICW) of the 86th Combat Support Hospital (CSH) in Baghdad, Iraq (2007-2009). A prospective study was conducted of the patients admitted to the ward between April 12 and July 19, 2008. Three hundred and fifty three patients were included in the study. Characteristics of the patients admitted during a 3-month period of the deployment of the 86th CSH in Iraq, as well as the types of illnesses and injuries most commonly seen are reported. Implications for nurses preparing to deploy as well as implications for future research are discussed.

Exhaust temperature profiles for application of passive diesel particulate filters to solid waste collection vehicles in California.

To reduce public exposure to diesel particulate matter (DPM), the California Air Resources Board has begun adoption of a series of rules to reduce these emissions from in-use heavy-duty vehicles. Passive diesel particulate filter (DPF) after-treatment technologies are a cost-effective method to reduce DPM emissions and have been used on a variety of vehicles worldwide. Two passive DPFs were interim-verified in California and approved federally for use in most 1994--2002 engine families for vehicles meeting min engine exhaust temperature requirements for successful filter regeneration. Some vehicles, however, may not be suited to passive DPFs because of lower engine exhaust temperatures. The purpose of this study was to determine the applicability of two types of passive DPFs to solid waste collection vehicles, the group of vehicles for which California recently mandated in-use DPM reductions. We selected 60 collection vehicles to represent the four main types of collection vehicle duty cycles--rolloffs, and front-end, rear, and side loaders--and collected second-by-second engine exhaust temperature readings for one week from each vehicle. As a group, the collection vehicles exhibited low engine exhaust temperatures, making the application of passive DPFs to these vehicles difficult. Only 35% of tested vehicles met the temperature requirements for one passive DPF, whereas 60% met the temperature requirements for the other. Engine exhaust temperatures varied by vehicle type. Side and front-end loaders met the engine exhaust temperature requirements in the greatest number of cases with approximately 50-90% achieving the required regeneration temperatures. Only 8-25% of the rear loader and roll-off collection vehicles met the engine exhaust temperature requirements. Solid waste collection vehicles represent a diverse fleet with a variety of duty cycles. Low engine exhaust temperatures will need to be addressed for successful use of passive DPFs in this application.