Leilani Siaki

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 rec...

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 iden...

The objective is to provide a brief overview of the history of gender and sexual diverse service members, health utilization rates, outcomes, and disparities, as well as perceived challenges accessing health care and gaps in the evidence base underpinning sex- and gender-appropriate care. The article also provides strategies going forward to address these issues and optimize health care delivery.

BACKGROUND Sleep, critical to military operational effectiveness, is among the top five outpatient conditions for which military women seek care, yet sleep research in active duty servicewomen is sparse. We conducted a scoping review to 1) describe literature focused on sleep disorders and promotion of sleep health among U.S. active duty servicewomen and 2) identify opportunities for future health policies and research that may improve sleep health and decrease incidence of disordered sleep in servicewomen. METHODS The PRISMA-ScR guidelines for scoping reviews informed this project. We searched Ovid; MEDLINE and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions; Embase; CINAHL; Cochrane Central; the Cochrane Database of Systematic Reviews; PsycInfo; and the Web of Science, and several sources of grey literature, from January 2000 through March 2019. We used a three-step screening and data extraction process: 1) title and abstract screening, 2) full-text article screening, and 3) data extraction from included articles. RESULTS Seventeen of 1464 articles met the inclusion criteria. Most articles were retrospective, descriptive, or observational research. No intervention studies were identified. Sleep diagnoses and dimensions included insomnia, obstructive sleep apnea, disordered sleep quality and duration, and narcolepsy. Sex/gender differences were documented in screening, diagnosis, risk factors, and conditions associated with disordered sleep, for example, pregnancy and postpartum status. Actionable leverage points involve military culture, training, education, treatment, and self-care behaviors related to sleep health. CONCLUSIONS Although we identified leverage points where policy changes have the potential to improve sleep health in active duty servicewomen, there is an urgent need for intervention research to address the gaps in knowledge about sleep health in this population.

INTRODUCTION Based on defining criteria, hypertension (HTN) affects 31% to 46% of the adult U.S. population and almost 20% of service members. Resistant HTN (rHTN) consumes significant resources, carries substantial morbidity and mortality risk and costs over $350 billion dollars annually. For multiple reasons, only 48.3% of people with HTN are controlled, e.g., undiagnosed secondary HTN, therapeutic or diagnostic inertia, and patient adherence. Our purpose was to determine the feasibility of a web-based clinical decision support tool (CDST) using a renin-aldosterone system (RAS) classification matrix and drug sequencing algorithm to assist providers with the diagnosis and management of uncontrolled HTN (rHTN). Outcomes were blood pressure (BP) rates of control, provider management time, and end-user satisfaction. METHODS This two-phase, prospective, non-randomized, single-arm, six-month pilot study was conducted in primary care clinics at a tertiary military medical center. Patient...

This document shows the search strategies for an article entitled, "Sleep Health in US Military Women: A Scoping Review of the Literature 2000 – 2018," to be published in the journal, Women's Health Issues. It includes strategies for Ovid Medline, Embase, Cinahl, Cochrane Library, Web of Science, and PsycInfo.

Each year millions of people are readmitted to hospitals across the nation; many of these readmissions are preventable. Successful care coordination and transition management strategies are critical steps needed to meet Partnership for Patients goals of reducing harm and improving the quality and safety of health care. Decreasing variance in healthcare delivery can improve quality, safety, and improve patient outcomes. Project Re-Engineered Discharge shows promise as an evidence-based, standardized approach to address preventable hospital readmissions.

Despite the Institute of Medicine's goal of 90% of all practice being evidence-based by 2020, educational and practice institutions are not on target to achieve this goal. Evidence-based practice is one of 5 core elements of the Army Nurse Corps' patient care delivery system and a key focus of the Hawaii State Center for Nursing. In order to increase evidence-based practice (EBP), a civilian-military partnership was formed to include healthcare organizations in the state, optimize resources, and share strategies for successful practice changes statewide. The partnership has been successful in meeting each of these goals using national EBP competencies and Bloom's taxonomy as a guide. The article presents a discussion regarding the history, processes, and outcomes of this partnership.

The purpose of this article was to present the process of translating questions about perceived risk for diabetes into Samoan and describe important cultural adaptations to the modified Brislin's translation model for cross-cultural research. With the assistance of a culture broker and several Samoan translators, 14 questions were translated into the Samoan language. Cultural adaptations included using a group approach, working with a matai, and following protocols such as fa'alavelave. Questions were back-translated and then pilot tested. Results from the pilot testing supported the use of these cultural modifications in the translation model.

This article presents a discussion of development of a mid-range theory of risk perception. Unhealthy behaviours contribute to the development of health inequalities worldwide. The link between perceived risk and successful health behaviour change is inconclusive, particularly in vulnerable populations. This may be attributed to inattention to culture. The synthesis strategy of theory building guided the process using three methods: (1) a systematic review of literature published between 2000-2011 targeting perceived risk in vulnerable populations; (2) qualitative and (3) quantitative data from a study of Samoan Pacific Islanders at high risk of cardiovascular disease and diabetes. Main concepts of this theory include risk attention, appraisal processes, cognition, and affect. Overarching these concepts is health-world view: cultural ways of knowing, beliefs, values, images, and ideas. This theory proposes the following: (1) risk attention varies based on knowledge of the health risk in the context of health-world views; (2) risk appraisals are influenced by affect, health-world views, cultural customs, and protocols that intersect with the health risk; (3) strength of cultural beliefs, values, and images (cultural identity) mediate risk attention and risk appraisal influencing the likelihood that persons will engage in health-promoting behaviours that may contradict cultural customs/protocols. Interventions guided by a culturally sensitive mid-range theory may improve behaviour-related health inequalities in vulnerable populations. The synthesis strategy is an intensive process for developing a culturally sensitive mid-range theory. Testing of the theory will ascertain its usefulness for reducing health inequalities in vulnerable groups.

Cardiovascular disease (CVD) and diabetes, which are leading causes of morbidity and mortality in the United States, have a high incidence among Pacific Islanders. Risk of these conditions increases in the presence of metabolic syndrome. Risk-reducing behaviors for CVD and diabetes are driven partly by perceived risk of health threats and their consequences. Perceived risk is influenced by sociocultural beliefs and is a component of some health behavior models, yet it is understudied in Pacific Islanders. This mixed-methods study explored the perceived risk of CVD and diabetes in at-risk Samoan Pacific Islanders. We used culturally sensitive strategies to recruit and enroll 43 adult Samoans from a community setting in Hawaii. Participants were obese with at least 1 other component of metabolic syndrome. Their objective risk was determined by the National Cholesterol Education Program Adult Treatment Program III risk categories. Participants provided demographic and health history information and answered 2 quantitative perceived risk questions. They also participated in 1 of 7 focus groups--the source of perceived risk qualitative data. Quantitative and qualitative data were analyzed using descriptive statistics and content analysis, respectively. The mixed-methods analysis targeted points of data convergence and complementarity for the 2 methods. More than 80% of participants who were at moderately high (10%-20%) objective risk for CVD and diabetes had high (>20%) perceived risk of these conditions. There was high concordance of perceived risk for CVD and diabetes (P < .05). Qualitative data revealed bidirectional codes that influenced and were influenced by perceived risk within the participants' cultural perspective: current and planned health behavior, physical health, and family history of CVD or diabetes. Using mixed methods facilitated better understanding of cultural perspectives of perceived risk of CVD and diabetes. These results provide a foundation for developing culturally appropriate interventions targeting CVD and diabetes risk reduction in Samoans.

Melanoma is a skin cancer that can be deadly. Members of families with a strong history of melanoma have a high risk of melanoma occurrence or recurrence. Enhanced survival in these family members could be influenced by their knowledge of melanoma risk and by simple behaviors to decrease their risk or detect melanoma in its early, most curable, stage. Yet, there is minimal exploration on communication of risk or risk-modifying behaviors in melanoma at-risk families. In this study we described perceived intra-family communication of melanoma risk. Using a qualitative descriptive approach, we examined in-depth interviews with 22 members of eight families having two or more cases of melanoma. We identified four major themes: (1) Awareness and understanding of risk, (2) Families facilitate and hinder communication, (3) Promoting melanoma prevention and detection in the family, and (4) An obligation to tell others. We discuss these findings in the context of extant knowledge of cancer risk communication in families at high risk for other cancers, impediments to cancer risk communication, remaining gaps in knowledge of this phenomenon, suggestions for hypothesis-driven research, and clinical implications that are applicable to these and other at-risk families.

To explore literature on Pacific Islanders' perceived risk of cardiovascular disease (CVD) and diabetes. A search of literature databases for English-language perceived risk research published from 2000 to 2008. Few studies targeting perceived risk of CVD (n = 6) and diabetes (n = 4) included minority participants. No studies targeted Pacific Islanders exclusively. Overall, Pacific Islanders and other minority groups inaccurately perceive their risk of these conditions. No studies explored cultural relevancy or measurement of perceived risk. Perceived risk, an integral part of health behavior change theories, is greatly understudied in Pacific Islanders. Perceived risk research for CVD and diabetes is sparse for any minority group. More research is needed to develop socioculturally appropriate interventions that promote accurate risk perceptions for both diseases and facilitate adoption of health behaviors. Ultimately, these behaviors will reduce the onset and devastating consequences of CVD and diabetes in Pacific Islanders and other minority populations.