Tài liệu A Women’s Health Intervention for Gynecological Problems in the Deployed Environment ppt

A Women’s Health Intervention
for Gynecological Problems in
the Deployed Environment
the

Deployed

Environment
Presenter:
LTC Nancy Steele PhD WHNP
Presenter:

LTC

Nancy

Steele
,
PhD
,
WHNP
European Regional Medical Command
PI
LTC L i T PhD CNM
PI
:
LTC

L
or
i

T
rego,
PhD
,
CNM

AIs: COL Denise Hopkins-Chadwick, PhD, RN,
Dr. Lori Loan, PhD, RNC,
Dr. Maureen Shannon PhD, CNM, FNP
Funded Grant: Sigma Theta Tau International Council for Advancement Nursing Science
Vi d i hi i h f h h d d fl ffi i l li i i i f h D
f
hA
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 1
Vi
ews expresse
d

i
n t
hi
s presentat
i
on are t
h
ose o
f
t

h
e aut
h
ors, an
d

d
o not re
fl
ect o
ffi
c
i
a
l
po
li
c
i
es or pos
i
t
i
ons o
f
t
h
e
D
ept o

f
t
h
e
A
rm
y
,
Dept of Defense or U.S. Government
Women in the Military
OBJECTIVES
• Describe back
g
round, relevance, &
p
ur
p
ose
gpp
for genitourinary (GU) health research in
de
p
lo
y
ed female soldiers
py
• Provide research questions and specific aims
of current research study
of

current

research

study
• Discuss recent findings for ongoing study
Di i li ti f th t d
•
Di
scuss
i
mp
li
ca
ti
ons o
f

th
e s
t
u
dy
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 2
Women in the Military
BACKGROUND
• OIF/OEF deployed female
Soldiers have nearly twice
Soldiers

have

nearly

twice

as many GU health
p
roblems as those at home
p
duty stations
•
Many female Soldiers are
Many

female

Soldiers

are

not prepared for GU health
& h
yg
iene challen
g
es
yg g
during deployment

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 3
Women in the Military
Deployed Environment Challenges
• Terrain: desert, barren
regions, dirty
regions,

dirty
• Climate: hot, dry, dusty
•
Compromised feminine
Compromised

feminine

hygiene practices
•
Difficult travel
Difficult

travel

• Lack of facilities (latrines)
to
p
erform h
yg
iene
pyg

activities
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 4
Women in the Military
Deployed Environment Challenges cont…
 Duties limit breaks (i.e., patrols, security)
ii i“khif ”(i
 Ur
i
nat
i
ng may requ
i
re
“
ma
k
e s
hif
t measures
”

(i
.e.,
bottles, cans, plastic bags, layered pads, etc)
Ul t
tti t il l t i d/ d

U
nc

l
ean por
t
-a-
p
o
tti
es,
t
ra
il
ers,
l
a
t
r
i
nes, or san
d/
mu
d

terrain

Safety issues (combat operations)

Safety

issues

(combat

operations)
 Shared environment (female/male)
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 5
Women in the Military
Female GU problems in Deployed
Environment
Environment
1. Urination: increased rate of UTIs & symptoms (pain,
urgency, frequency)
urgency,

frequency)
• Holding urine
• Poor feminine hygiene
• Use of “make shift measures” to urinate
• Dehydration (not drinking fluids to prevent urination)
2. Vaginal symptoms: Itching, burning, pain, & discharge
3. Menstrual complaints: Pain, heavy bleeding, missed or
irregular periods, PMS
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 6
Women in the Military
Relevance of Problem
• Since Operation Desert Storm, women’s health experts
have recommended tar
g
eted

p
revention of
GU

p
roblems
gp GUp
in deployed female Soldiers, yet the problem persists
• Militar
y

p
re-de
p
lo
y
ment
p
olicies do not endorse a
yp
py p
program to help female Soldiers recognize the impact of
the deployed environment on feminine health and
hygiene
• Preventive measures to avoid vaginal infections, urinary
if i (UTI) d l
tract
i
n
f

ect
i
ons,
(UTI
s
)
an
d
menstrua
l
symptoms are not
routinely taught to women as part of the Soldier
Readiness Process
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 7
Readiness

Process
.
Women in the Military
R
esearch
Q
uestion
Q
• Does providing women with information on feminine
hygiene and menstrual self-care practices lead to a
decrease in genitourinary complaints during
deployment?
• Specific Aims

 To increase knowledge level about feminine hygiene in the
deployed environment
deployed

environment
 To determine the effectiveness of an intervention to
decrease:
• Vaginal & urinary tract symptoms
• Menstrual complaints
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 8
Women in the Military
Study Sample
• Two groups of U.S. Army Active Duty female
soldiers who will deploy to Iraq
soldiers

who

will

deploy

to

Iraq
.
– Intervention Group: Schofield Barracks, HI
•
Intervention includes 60 min pre

-
deployment education
Intervention

includes

60

min

pre
-
deployment

education

class, feminine hygiene tool kit, & Female Urinary
Diverter (FUD)
–
Non-equivalent Control Group: Fort Hood, TX
• Control group receives routine Soldier Readiness Processing
(SRP) care
(SRP)

care
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 9
Women in the Military
Pre-deployment Intervention
• 30 min class on feminine self-

care, and prevention of UTI,
vaginitis & menstrual
vaginitis
,
&

menstrual

symptoms
• Feminine Hygiene Deployment
Toolkit: “Just in Case” baggie,
“Keep it Clean” baggie, and the
Freshette
Freshette

• 30 min hands-on with toolkit,
models, & various types of
menstrual cycle control
methods.
•
Q&A with NP
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 10
Q&A

with

NP
Women in the Military
FUD Description

• Easy to use anatomically designed female
contoured plastic funnel (6” retractable
tbdi tfl )
t
u
b
e
di
rec
t
s
fl
ow
)
• Permits urination through opening with no
removal of clothing or gear
removal

of

clothing

or

gear
• Privacy: No need for cover
• Avoids unsanitar
y
latrines, dirt
y

terrain, &
unsafe conditions
•
Reusable light (1 oz) compact (5”x 3”x
•
Reusable
,
light

(1

oz)
,
compact

(5”x

3”x

1”,) & reusable
•
Transport pouch fits into cargo pocket
Freshette FUD
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 11
Transport

pouch

fits

into

cargo

pocket
Women in the Military
Measurements:
1. Women’s Feminine Health Assessment Questionnaire
2. De
p
lo
y
ed Menstrual Health Practices
Q
uestionnaire
py Q
3. Brief Knowledge Survey
4. Militar
y
Women's’ Attitudes towards Menstrual
y
Suppression Scale
Data Collection Times:
Data

Collection

Times:
1. Time 1: Baseline data collected prior to intervention

2
Time 2:
>
Six months after movement into deployed
2
.
Time

2:

>
Six

months

after

movement

into

deployed

setting
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 12
Women in the Military
Current Findings: Intervention Group
Time 1: Pre-deployment: n=104
Time 2:

6
-
11 mo into deployment, (n
=
32)
(Ongoing!!)
Time

2:

6
11

mo

into

deployment,

(n 32)

(Ongoing!!)
• Top 2 contraceptives:
–
Birth Control
p
ills
(
29
%

traditional use
,
11
%
continuous use
)
p(% ,% )
– Mirena IUD (17%)
•
M
enstrual S
y
m
p
toms:
yp
– Irregular periods (39%)
– Painful cramps (66%), PMS (66%) & heavy bleeding/clots
(45%)
• Vaginal Symptoms:
i l di h (59%) d (28%) i hi (24%)
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 13
–
vag
i
na
l

di

sc
h
arge
(59%)
, o
d
or
(28%)
,
i
tc
hi
ng
(24%)
Women in the Military
Current Findings cont
Current

Findings

cont
…
•
Most common UTI symptoms:
Most

common

UTI

symptoms:

– Urgency (38%)
Frequency (38%)
–
Frequency

(38%)
– Pain/burning with urination (10%)
• UTI incidence was 3/31 (10%)
• F
U
D Fr
es
h
e
tt
e

use:
Ueseeuse:
– 8/13 used FUD
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 14
Women in the Military
Implications for Nursing
• Findings can be incorporated into routine pre-
de
p
lo

y
ment care for female Soldiers to
p
romote well
py p
being and health
• Preventive measures can be implemented to avoid
vaginitis, UTIs, and menstrual symptoms during
deployment
• This study has potential of significantly contributing
to improving female Soldiers’ readiness and filling a
gap in military health care identified by experts over a
gap

in

military

health

care

identified

by

experts

over

a

decade ago
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 15
Women in the Military
References
• Bond, E. F (2004). Women’s physical and mental sequellae of wartime service . Nursing Clinics of
North America, 39, 53-68.
• Christopher LA, Miller L. Women in war: operational issues of menstruation and unintended
pregnancy. Mil Med. 2007 Jan;172(1):9-16.
•
Cox K L (2007 August) Gender & Health in the Military: Facts and Myths Paper presented at
Cox
,
K
.
L
.
(2007
,
August)
.
Gender

&

Health

in

the

Military:

Facts

and

Myths
.
Paper

presented

at

the 10th Annual Force Health Protection Conference, Louisville, KY.
• Czerwinski, B. S., Wardell, D. W., Yoder, L. H., Connelly, L. M., Ternus, M., Pitts, K., et al. (2001).
Variations in feminine hygiene practices of military women in deployed and noncombat
environments
Mil Med 166
(2) 152
158
environments
.
Mil

Med
,

166
(2)
,
152
-
158
.
• DWHRP Research Publications List. Retrieved April 9, 2008, from
http/:www.mmorg.publications/DWHRP /PUB/LIST./DWHRP_PUB_LIST.pdf
.
• Edelman AB, Gallo MF, Jensen JT, Nichols MD, Schulz KF, Grimes DA. Continuous or extended
cycle versus cyclic use of combined oral contraceptives for contraception. Cochrane Database of
Systematic Reviews.
• Friedl, K. E. (2005). Biomedical research on health and performance of military women:
Accom
p
lishments of the Defense Women's Health Research Pro
g
ram
(
DWHRP
)
.
J
ournal o
f

pg()
f
Women’s Health, 14(9), 764-802.

• Hawley-Bowland, C. (1996). Epidemiologic overview of common gynecologic disorders and first-
trimester complications among active-duty women. Womens Health Issues, 6(6), 353-355.
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 16
Women in the Military
References

Hanna JH An analysis of gynecological problems presenting to an evacuation hospital during
Hanna

JH
.
An

analysis

of

gynecological

problems

presenting

to

an

evacuation

hospital

during

Operation Desert Storm. Mil Med. 1992 May;157(5):222-4.
 Hannoun AB, Nassar AH, Usta IM, Zreik TG, Abu Musa AA. Effect of war on the menstrual cycle.
Obstet Gynecol. 2007 Apr;109(4):929-32.
IOM (1996)
HlhC fS i Di hP i GlfW R di f

IOM
.
(1996)
.
H
ea
l
t
h

C
onsequences o
f

S
erv
i
ce
D
ur

i
ng t
h
e
P
ers
i
an
G
u
lf

W
ar:
R
ecommen
d
at
i
ons
f
or
Research and Information Systems. from http;//books.nap.edu/books/0309055369/html/index.html.
 Lowe, N. K., & Ryan-Wenger, N. A. (2003). Military women's risk factors for and symptoms of
genitourinary infections during deployment. Mil Med, 168(7), 569-574.
 Ritchie, E. C. (2001). Issues for military women in deployment: an overview. Mil Med, 166(12),
1033-1037.
 Ryan-Wenger, N. A., & Lowe, N. K. (2000). Military women's perspectives on health care during
deployment.
Womens Health Issues, 10

(6), 333
-
343
.
deployment.

Womens

Health

Issues,

10
(6),

333
343
.
 USACHPPM. A Guide to Female Soldier Readiness. Aberdeen Proving Grounds 2006.
 Trego, L. L. (2007). Military women's menstrual experiences and interest in menstrual suppression
during deployment. J Obstet Gynecol Neonatal Nurs, 36(4), 342-347.
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h
yg
iene.
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Am Acad Nurse Pract, 13
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4
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Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 17
yg
()
Women in the Military
Questions???
Questions???
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 18
Women in the Military