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OBJECTIVE: Alcohol use in the military is prevalent and has short- and long-term health, safety, and career consequences. Although several studies have examined service members’ alcohol consumption, few have focused on alcohol use among military spouses. This study assessed factors at individual, interpersonal, and organizational levels to determine associations with risky alcohol use among military spouses. METHOD: Data from baseline and first follow-up of the Millennium Cohort Family Study were used (N = 5,475; 4,923 female) to model spousal self-reported risky drinking (heavy and/or binge drinking) at follow-up. Predictors included demographic characteristics, spousal adverse childhood experiences and mental health, smoking status, marital status, family satisfaction, social support, military stress, and service member military characteristics. Logistic regression models assessed the adjusted associations between spouse and service member characteristics and spousal risky drinking at follow-up. RESULTS: Among spouses in this sample, 19% were risky drinkers at follow-up. Baseline alcohol use status was associated with risky drinking at follow-up. Most spouses (64.2%) did not change their drinking behavior between baseline and follow-up; those who did change were nearly evenly split between an increasing (17.0%) versus decreasing (18.7%) pattern. Risk factors included male gender, cigarette smoking, elevated symptoms of post-traumatic stress, marital separation, and service member deployment with combat. CONCLUSIONS: Although most military spouses were not engaging in risky drinking, one in five were, with about half of these having moved into the risky drinking category over time. Risky alcohol use among spouses has ramifications for themselves, the service member, and the family unit.

Transitioning from military to civilian life can be challenging for families, but most research focuses only on the service member. We applied a life course model to assess spouse well-being following this important transition.Prospective, longitudinal survey of service members and their spouses.We captured three spouse well-being domains: psychological health, physical health, and family relationships. We identified differences between families who separated from service and those still affiliated (Spouses of service members who had separated from the military (versus those who had not) reported poorer mental health and family relationship quality at baseline and follow-up. After controlling for baseline differences, spouses whose families transitioned experienced a greater increase in PTSD symptoms and a steeper decline in quality of marriage. Spouses of active-duty service members reported greater increases in work-family conflict. Among families who had transitioned, the most consistent predictor of positive outcomes was baseline well-being. Protective factors included having more psychological and social resources and less financial stress.Several protective and risk factors identified in the study may inform programming for families transitioning from active duty.

Nurses care for different kinds of patients. Working in a multicultural country with over 100 nationalities and multiple ethnicities, it is inevitable for nurses in Qatar to encounter and deal with challenging patients. Capturing the lived experiences of a selected group of participants, this qualitative study employed phenomenology as a research design and utilized an indepth semi-structured interview to uncover the unique experiences of nurses in Qatar in handling challenging patients to determine the coping strategies they employ to effectively handle these types of patients. Findings of the study afloat three major coping strategies of nurses as they handle patients who are non-compliant, aggressive, or have high acuity needs. These coping strategies are Self-Directed Coping Strategies, PatientGenerated Coping Strategies, and Health Care Management-Supported Coping Strategies. SelfDirected Coping Strategies are coping styles nurses specifically do for themselves to get through tough situations and can be categorized into restoration, reflection, and reformation. Patient-Generated Coping Strategies are achieved through examination, communication, and compassion, while Health Care Management-Supported Coping Strategies are coping techniques nurses execute through specific provision, collaboration, and action. The findings of this study offer a panorama highlighting the strategies that enable nurses to fully embrace their work and handle challenging patients towards high quality healthcare

Introduction Military spouses play a critical role in supporting military service members, and thus, their experiences may have a significant impact on the well-being, readiness, and resilience of the U.S. Armed Forces. Research suggests that military spouses experience unique stressors as a result of military life, but few studies have assessed demographic factors associated with their experiences of military life and perceived support. Materials and Methods Using data from the Millennium Cohort Family Study, a nationwide survey of 9,872 married spouses of service members with 2 to 5 years of military service, this study examined differences in experiences of military life and perceived support across multiple understudied subgroups of military spouses. Key outcomes included military-related stressors (e.g., deployment-related experiences), perceived social support, and perceived military efforts to provide support. Results Military life stress and perceived support differed across military spouse, service member, and family characteristics. Results indicated that spouses who are older than age 35 or are married to enlisted service members in the Army, Navy, or Marines are more likely to experience heightened military stress or less perceived social support. Dual-military couples reported experiencing less stress associated with military life and perceiving more social support and support from the military, compared with spouses who have never served in the military. Conclusion These findings may help guide effective channeling of resources and outreach to potentially vulnerable military families.

The aim of the current study was to examine patterns of strengths among a large sample of military couples. Family resilience theory was utilized to operationalize strengths in couples, including individual beliefs represented by self-mastery, positive outlook, and spirituality; organizational patterns represented by social support; and family communication. We used data from the Millennium Cohort Family Study; the current study was composed of 9642 married military dyads representing all service branches and components. Using latent profile analysis, results supported five patterns of strengths in couples. Over half (58.4%) of the couples exhibited a pattern indicative of high strengths for both members of the couple, about a third (33.6%) of couples exhibited two patterns in which one member of the couple was higher on strengths than the other member, and a small proportion (5.1%) of couples exhibited a pattern of low strengths where both members of the couple were low on all indicators. The least common pattern (2.9%) was of moderately high beliefs and social support, yet very low family communication. Sociodemographic and military correlates that most consistently distinguished high strengths in couples from other patterns were higher spouse education level and service member officer rank. Service members and spouses with poorer mental health, marital quality, and overall military satisfaction were more likely to exhibit patterns indicative of low strengths. Overall, most military couples exhibited high strengths early in the military career cycle. Future longitudinal research is needed to examine how military experiences impact patterns of strengths and adjustment in couples over time.

Patient: Male, 49 Final Diagnosis: Pulmonary alveolar microlithiasis Symptoms: Coughing • shortness of breath Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Pulmonary alveolar microlithiasis is an autosomal recessive disease in which a mutation in the SLC34A2 gene that codes for a sodium phosphate type IIb transporter protein (expressed in human epithelial tissues and functions in the clearance of phosphate ions) leads to the formation of extensive pulmonary intra-alveolar microliths. The subsequent characteristic clinical features of dyspnea and hypoxia are a manifestation of these microliths. There have been fewer than 1000 cases of pulmonary alveolar microlithiasis reported worldwide, and there have been 19 reported lung-transplanted patients. Case Report: A 49-year-old Saudi male patient presented with longstanding history of easy fatigability and tiredness on exertion since he was 16 years old. Throughout his follow-up in different hospitals (1986–1989), tuberculosis and pulmonary fibrosis were suspected. The patient was lost to follow-up between 1989 and 2001. In 2002, he presented to the emergency room with coughing, shortness of breath on exertion, abdominal swelling, and pedal edema. An investigation with chest x-rays, CT scan, electrocardiogram, and an echocardiogram was conducted. After referral to a tertiary care center, the patient was diagnosed with pulmonary alveolar microlithiasis. He subsequently developed pulmonary hypertension and polycythemia and therefore received a bilateral lung transplant in 2016. Following the lung transplant, he developed a mild reperfusion injury and tonic-clonic seizures, requiring ICU admission. After a successful extubatation with stable vitals and good recovery, he was discharged home in stable condition with planned follow-up. Conclusions: We report a case of pulmonary alveolar microlithiasis successfully treated with a bilateral lung transplant. Although pulmonary alveolar microlithiasis is a rare entity, healthcare providers should consider it in the differential diagnoses of parenchymal lung diseases and differentiate it from tuberculosis and pulmonary fibrosis.

Background Posttraumatic stress disorder (PTSD) is an undertreated psychological condition prevalent among service members and veterans. Members of the military community often raise mental health concerns in primary care settings. However, many primary care physicians (PCPs) lack training in PTSD within the military community and may be underprepared to discuss PTSD or trauma with patients. Objectives We assessed PCPs' knowledge of evidence-based PTSD screening and treatment practices, confidence in their abilities to provide clinical care around PTSD, and frequency of asking new patients about their military history. We also examined PCP characteristics related to these measures. Research design We surveyed a national sample of 7426 PCPs to assess their PTSD knowledge, confidence, and military history screening practices. Data were analyzed using weighted multivariable regressions. Results Forty-three percent of PCPs reported they very often or always screened for military history and, on average, PCPs answered 41% of the PTSD knowledge items correctly. PCPs who rated their PTSD knowledge higher were more confident and more frequently screened for military history, but did not have higher knowledge scores compared with PCPs with lower self-assessed knowledge. Several PCP characteristics, such as sex, years of practice, and practice setting, predicted PTSD measures. Conclusions PCPs have gaps in their knowledge and screening practices related to PTSD. The absence of a meaningful correlation of knowledge scores with PCP self-assessed knowledge or confidence suggests PCPs may not accurately rate their own knowledge. Targeted, evidence-based training on effective practices may promote PTSD clinical knowledge.

Human immunodeficiency virus-infected patients have depleted CD4 lymphocyte counts and are susceptible to a plethora of infections of bacterial, viral, and fungal etiology. In addition to a wide range of systemic manifestations, human immunodeficiency virus-infected patients also display several characteristic oral manifestations. Studies have shown a correlation between some of the oral manifestations and CD4 lymphocyte counts which in turn is an independent prognostic indicator. To tackle the human immunodeficiency virus numerous drugs have been discovered and implemented. To overcome any potential resistance, human immunodeficiency virus patients are prescribed highly active antiretroviral therapy, wherein a combination of antiretroviral regimens are used. Studies have shown that in addition to controlling the viral activity, the treatment regimen, has a significant effect on the oral manifestations of the human immunodeficiency virus-infected patients. The present paper highlights the effects of highly active antiretroviral therapy on periodontal diseases in human immunodeficiency virus-infected individuals.

IntroductionThe use and misuse of opioids by active service members has been examined in several studies, but little is known about their spouses’ opioid use. This study estimates the number of military spouses who received high-risk or long-term opioid prescriptions between 2010 and 2014, and addresses how the Military Health System can help prevent risky prescribing in order to improve military force readiness.Materials and MethodsThis study used data from the Millennium Cohort Family Study, a nationwide survey of 9,872 spouses of service members with 2 to 5 years of military service, augmented with information from the military’s Pharmacy Data Transaction Service about prescriptions for controlled drugs dispensed to these service members’ spouses. Our objectives were to estimate the prevalence of opioid prescribing indicative of long-term use (≥60 day supply or at least one extended-release opioid prescription in any 3-month period) and, separately, high-risk use (daily dosage of ≥90 morphine mg equivalent or total dosage of ≥8,190 morphine mg equivalent, or prescriptions from more than three pharmacies, or concurrent prescriptions). For each of these dependent variables, we conducted bivariate analyses and multiple logistic regression models using information about spouses’ physical health, sociodemographic characteristics, substance use behaviors, perceived social support, and stresses associated with military stress, among others. Informed consent, including consent to link survey responses to medical and personnel records, was obtained from all participants. The Naval Health Research Center’s Institutional Review Board and the Office of Management and Budget approved the study.ResultsSpouses were predominantly female (86%), had not served in the military themselves (79%), and were spouses of enlisted (91%) active duty (86%) service members. Almost half (47.6%) of spouses obtained at least one opioid prescription during the 2-year observation window, and 8.5% had received opioid prescriptions that posed risk to their health. About 7% met the criteria for receipt of high-risk opioid prescriptions, 3% obtained opioids from three or more pharmacies during a 3-month period, and 4% of spouses who received any opioids received both long-term and high-risk prescriptions. Adverse childhood experiences, physical pain, and lack of social support were associated with increased odds of obtaining high-risk opioid prescriptions.ConclusionsApproximately 48% of military spouses had used Military Health System insurance to fill at least one opioid prescription during the 2-year observation period. The Department of Defense has taken measures to minimize high-risk opioid prescribing, including passing prescribing guidelines in 2017, establishing the controlled drug management analysis reporting tool, establishing a pain management education and training program, and more. These efforts should continue to expand as reducing the numbers of service members and spouses at risk for adverse events may be effective in reducing opioid misuse and improve the overall health and safety of military spouses and thus, the readiness of the U.S. Armed Forces.

Families experience multiple stressors as a result of military service. The purpose of this study was to examine facets of military life and family factors that may impact child psychosocial and mental health functioning. Using baseline data from the Millennium Cohort Family Study, this study examined family demographics and composition (age, number of children), military life stressors (injury, family, and deployment stressors), family communication and satisfaction as assessed by the Family Adaptability and Cohesion Evaluation Scale-IV, parental social functioning assessed via the Short Form Health Survey-36, and child mental health and behavioral functioning (parental reports of clinician-diagnosed mental health conditions such as depression) and an adapted version of the Strengths and Difficulties Questionnaire. Injury- and family-related military stressors were significant indicators of heightened risk for child mental health conditions, whereas greater levels of parental social functioning and family satisfaction were associated with lower risk of child mental health conditions. Differential associations were found in child functioning when military-related variables (e.g., service component), sociodemographic, and family composition factors (number and age of the children in the home) were examined. These findings underscore the importance of examining the "whole child" within the broader ecological and military family context to understand factors associated with children's mental and behavioral health. The results from the present study highlight the complex relationships that may be at play, which, in turn, have considerable implications for the development of policies to support children and families encountering multiple stressors related to a parent's military service.

Background Approximately half of US service members are married, equating to 1.1 million military spouses, yet the prevalence of psychiatric morbidity among military spouses remains understudied. We assessed the prevalence and correlates of eight mental health conditions in spouses of service members with 2-5 years of service. Method We employed baseline data from the Millennium Cohort Family Study, a 21-year longitudinal survey following 9,872 military-affiliated married couples representing all US service branches and active duty, Reserve, and National Guard components. Couples were surveyed between 2011 and 2013, a period of high military operational activity associated with Operation Iraqi Freedom and Operation Enduring Freedom. Primary outcomes included depression, anxiety, posttraumatic stress disorder (PTSD), panic, alcohol misuse, insomnia, somatization, and binge eating, all assessed with validated self-report questionnaires. Results A total of 35.90% of military spouses met criteria for at least one psychiatric condition. The most commonly endorsed conditions were moderate-to-severe somatization symptoms (17.63%) and moderate-to-severe insomnia (15.65%). PTSD, anxiety, depression, panic, alcohol misuse, and binge eating were endorsed by 9.20%, 6.65%, 6.05%, 7.07%, 8.16%, and 5.23% of spouses, respectively. Having a partner who deployed with combat resulted in higher prevalence of anxiety, insomnia, and somatization. Spouses had lower prevalence of PTSD, alcohol misuse, and insomnia but higher rates of panic and binge eating than service members. Both members of a couple rarely endorsed having the same psychiatric problem. Conclusions One third of junior military spouses screened positive for one or more psychiatric conditions, underscoring the need for high-quality prevention and treatment services.

Background Few studies have longitudinally examined predictors of posttraumatic stress disorder (PTSD) in a nationally representative sample of US veterans. We examined predictors of warzone-related PTSD over a 25-year span using data from the National Vietnam Veterans Longitudinal Study (NVVLS). Methods The NVVLS is a follow-up study of Vietnam theater veterans (N = 699) previously assessed in the National Vietnam Veterans Readjustment Study (NVVRS), a large national-probability study conducted in the late 1980s. We examined the ability of 22 premilitary, warzone, and postmilitary variables to predict current warzone-related PTSD symptom severity and PTSD symptom change in male theater veterans participating in the NVVLS. Data included a self-report Health Questionnaire survey and a computer-assisted telephone Health Interview Survey. Primary outcomes were self-reported PTSD symptoms assessed by the PTSD Checklist for DSM-5 (PCL 5) and Mississippi PTSD Scale (M-PTSD). Results Predictors of current PTSD symptoms most robust in hierarchical multivariable models were African-American race, lower education level, negative homecoming reception, lower current social support, and greater past-year stress. PTSD symptoms remained largely stable over time, and symptom exacerbation was predicted by African-American race, lower education level, younger age at entry into Vietnam, greater combat exposure, lower current social support, and greater past-year stressors. Conclusions Findings confirm the robustness of a select set of risk factors for warzone-related PTSD, establishing that these factors can predict PTSD symptom severity and symptom change up to 40 years postdeployment.

The objective of this study was to assess the effect of bilateral oophorectomy on bone mineral density in comparison with natural menopause. Bone mineral density (BMD) is measured with dual energy X-ray DXA of lumber spine and femoral neck in 133 women, aged ranged (45 -70 years). Two surgical groups consist of 100 women either after or before, surgical after menopause SAM women with mean age (66.55 ± 1.11 years), menopause duration mean (15.88 ± 1.19 years) and body mass index BMI mean (32.09 ± 1.37 Kg /m2). Women who underwent surgery before menopause SBM the mean age (57.18 ± 0.84 years), (13.31 ± 0.83 years) the mean of menopause duration and (32.26 ± 0.7 Kg /m2) the mean of body mass index BMI. The natural menopause NM include 33 women mean age (56.45 ± 0.93 years) with (6.24 ± 0.81 years) duration of menopause and (33.49 ± 1.08 Kg /m2) BMI. The mean of BMD and T-score in lumber spine L1-L4 in SAM group was (0.84 ± 0.03 gr/cm2 and -2.32 ± 0.25) respectively, in the SBM group (BMD = 0.82 ± 0.01 gr/cm2 and T-score -2.46 ± 0.12) comparing to natural menopause group NM (BMD = 1.16 ± 0.03 gr /cm2 and T-score 0.31 ± 0.23). The mean of BMD measured for femoral neck in SAM (0.72± 0.03 gr /cm2 and T-score = - 1.54 ± 0.2), in SBM (BMD = 0.81 ± 0.81 gr/cm2 and T-score = - 0.86 ± 0.12), in NM (BMD = 0.93 ± 0.03 gr/cm2 and T-score = 0.3 6 ± 0.03). Bilateral oophorectomy associated with decrease in BMD, in addition age and duration of menopause are important factors affected on BMD.

Families experience multiple stressors as a result of military service. The purpose of this study was to investigate the associations among service member deployment experiences, family and military factors, and children's mental health using baseline data from the Millennium Cohort Family Study, a study designed to evaluate the health and mental health effects of military service on families, including children.This study examined administrative data on deployment status (combat, noncombat, and no deployments), as well as service member- and spouse-reported data on deployment experiences and family functioning in relation to the mental health of children in the family who were aged 9 to 17 years.Most children were not reported to have mental health, emotional, or behavioral difficulties regardless of parental deployment status. For an important minority of children, however, parental deployments with combat, compared with those with no deployment, were associated with a parental report of attention-deficit disorder/attention-deficit hyperactivity disorder and depression as diagnosed by a clinical provider, after accounting for demographics, psychosocial context, and military factors. Children's odds of a parental report of depression were significantly higher in both the combat and the noncombat deployment groups than in the no deployment group.These findings extend our understanding of the association between parental deployments and children's mental health, with implications for services and training mental health providers serving military families.