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Sarah E Gollust, Brooke A Cunningham, Barbara G Bokhour, Howard S Gordon, Charlene Pope, Somnath S Saha, Dina M Jones, Tam Do, Diana J Burgess
Progress to address health care equity requires health care providers' commitment, but their engagement may depend on their perceptions of the factors contributing to inequity. To understand providers' perceptions of causes of racial health care disparities, a short survey was delivered to health care providers who work at 3 Veterans Health Administration sites, followed by qualitative interviews (N = 53). Survey data indicated that providers attributed the causes of disparities to social and economic conditions more than to patients' or providers' behaviors...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
Veronica Fassio, Sherrie L Aspinall, Xinhua Zhao, Donald R Miller, Jasvinder A Singh, Chester B Good, Francesca E Cunningham
OBJECTIVES: To describe the prevalence and incidence of opioid and nonsteroidal anti-inflammatory drug (NSAID) use before and since the start of the Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) and to assess rates of adverse events (AEs). STUDY DESIGN: Historical cohort study. METHODS: The OSI began in August 2012 and was fully implemented by the end of fiscal year (FY) 2013. The study timeframe was categorized into baseline (FY 2011-2012), transition (FY 2013), and postimplementation (FY 2014-2015) phases...
March 1, 2018: American Journal of Managed Care
Erin S Rogers, Steven S Fu, Paul Krebs, Siamak Noorbaloochi, Sean M Nugent, Amy Gravely, Scott E Sherman
INTRODUCTION: Veterans with a mental health diagnosis have high rates of tobacco use but encounter low rates of treatment from providers. This study tested whether a proactive tobacco treatment approach increases treatment engagement and abstinence rates in Department of Veterans Affairs mental health patients. STUDY DESIGN: RCT. SETTING/PARTICIPANTS: The study was performed from 2013 to 2017 and analyses were conducted in 2017. Investigators used the electronic medical record at four Veterans Administration facilities to identify patients documented as current smokers and who had a mental health clinic visit in the past 12 months...
March 15, 2018: American Journal of Preventive Medicine
Amrita Aranake-Chrisinger, Jenny Zhao Cheng, Maxwell R Muench, Rose Tang, Angela Mickle, Hannah Maybrier, Nan Lin, Troy Wildes, Eric Lenze, Michael Simon Avidan
INTRODUCTION: Postoperative delirium (POD) is a common complication in elderly patients, characterised by a fluctuating course of altered consciousness, disordered thinking and inattention. Preliminary research has linked POD with persistent cognitive impairment and decreased quality of life. However, these findings maybe confounded by patient comorbidities, postoperative complications and frailty. Our objective is to determine whether POD is an independent risk factor for persistent impairments in attention and executive function after elective surgery...
March 17, 2018: BMJ Open
C Laurel Franklin, Amanda M Raines, Jessica L Chambliss, Jessica L Walton, Kelly P Maieritsch
BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association [APA], 2013) includes Other- and Unspecified- Trauma and Stressor-Related Disorders to capture subthreshold Posttraumatic Stress Disorder (PTSD) symptoms. However, the DSM-5 does not specify the number or type of symptoms needed to assign them. The purpose of the current study was to extend our understanding of subthreshold PTSD by comparing four commonly used definitions adapted to the DSM-5 PTSD criteria in an outpatient treatment-seeking sample...
March 7, 2018: Journal of Affective Disorders
Matthew L Maciejewski, Megan Shepherd-Banigan, Susan D Raffa, Hollis J Weidenbacher
CONTEXT: Since 2006, the Veterans Health Administration has delivered a population-based behavioral weight management program (MOVE!) to Veterans, which numerous studies have examined. The purpose of this study was to systematically review these studies to understand MOVE! participation rates and the association between MOVE! participation and weight change. EVIDENCE ACQUISITION: A December 2016 PubMed search identified 320 English-language abstracts published between January 1, 2005 and December 31, 2016, of which 42 underwent full-text review...
March 14, 2018: American Journal of Preventive Medicine
David G Ashbrook, Benjamin Hing, Lindsay T Michalovicz, Kimberly A Kelly, Julie V Miller, Wilfred C de Vega, Diane B Miller, Gordon Broderick, James P O'Callaghan, Patrick O McGowan
BACKGROUND: Gulf War illness (GWI) is an archetypal, medically unexplained, chronic condition characterised by persistent sickness behaviour and neuroimmune and neuroinflammatory components. An estimated 25-32% of the over 900,000 veterans of the 1991 Gulf War fulfil the requirements of a GWI diagnosis. It has been hypothesised that the high physical and psychological stress of combat may have increased vulnerability to irreversible acetylcholinesterase (AChE) inhibitors leading to a priming of the neuroimmune system...
March 17, 2018: Journal of Neuroinflammation
Zihnet Selimbašić, Maja Brkić, Nermina Kravić, Jasmin Hamidović, Mirna Selimbašić
Aim To analyse symptoms of posttraumatic stress disorder and coping strategies of war veterans in Tuzla Canton twenty years after the war in Bosnia and Herzegovina (BiH). Methods The study analysed a group of 120 war veterans from the Tuzla Canton who had experience of the war in BiH. For assessment of posttraumatic stress disorder Harvard Trauma Questionnaire was used, a version for Bosnia and Herzegovina and for assessment of coping styles Life Style Index was used. Results Concerning number of traumatic experiences of war veterans, it was found that they suffered 12 traumatic experiences...
February 1, 2018: Medicinski Glasnik
Jeffrey A Leibowitz, Brandi K Ormerod
A large proportion of Gulf War Veterans suffer from Gulf War Illness (GWI) - a devastating chronic disorder characterized by heterogeneous fatigue, pain and neuropsychological symptoms. In their recent Brain, Behavior and Immunity publication entitled "Curcumin Treatment Leads to Better Cognitive and Mood Function in a Model of Gulf War Illness with Enhanced Neurogenesis, and Alleviation of Inflammation and Mitochondrial Dysfunction in the Hippocampus", Kodali and colleagues (2018) report that the polyphenol curcumin improves cognition and mood in a rat model of GWI, potentially by increasing the expression of antioxidant genes and by reversing the effects of chronic combined acetylcholinesterase inhibitor exposure on neuroinflammation, mitochondrial respiration and hippocampal neurogenesis...
March 13, 2018: Brain, Behavior, and Immunity
Payal K Patel, M Todd Greene, Mary A M Rogers, David Ratz, Latoya Kuhn, Jennifer Davis, Sanjay Saint
BACKGROUND: Hospital-acquired urinary tract-related bloodstream infections are rare but often lethal. Recent epidemiology of this condition among the United States veteran population is poorly described. METHODS: We conducted a retrospective review of hospital-acquired urinary tract-related bloodstream infections of adult inpatients admitted to 4 Veterans Affairs hospitals over 15 years. Electronic medical records were used to obtain clinical, demographic, and microbiologic information...
March 13, 2018: American Journal of Infection Control
Alexander D Jobrack, Suman Goel, Alvin M Cotlar
Introduction: Granular cell tumors (GCTs) are of neuroectodermal origin and account for 0.5% of soft tissue tumors. They are most prevalent in African-Americans in the fourth to sixth decades, with a predilection for the head and neck regions. GCTs usually resemble more common lesions and hence are difficult to diagnose preoperatively. The tumor is readily identified on needle biopsy. Although usually benign with a malignancy rate of only 2-3%, the malignant form has a reported 3-yr mortality of 60%...
March 14, 2018: Military Medicine
Eric B Elbogen, H Ryan Wagner, Mira Brancu, Nathan A Kimbrel, Jennifer C Naylor, Cindy M Swinkels, John A Fairbank
Introduction: In response to a strong focus on suicide prevention for all veterans, the Department of Veterans Affairs (VA) recently revised policy to provide emergency mental healthcare for veterans who received Other Than Honorable (OTH) discharges from the military. This current study takes a preliminary step toward identifying demographic, historic, military, clinical, and social characteristics of veterans with OTH discharges. Materials and Methods: N = 1,172 Iraq/Afghanistan-era veterans were evaluated between 2005 and 2016 in the multi-site VA Mid-Atlantic Mental Illness, Research, Education and Clinical Center (MIRECC) Study of Post-Deployment Mental Health (PDMH Study)...
March 14, 2018: Military Medicine
Rachel A Hoopsick, D Lynn Homish, Paul T Bartone, Gregory G Homish
Background: Much research has focused on stress related to deployments; however, a substantial proportion of soldiers never deploy. In a study of 1.3 million veterans, suicide risk was higher among veterans who had never deployed. Thus, not being deployed may have an impact on soldiers' well-being; however, no measures exist to assess emotions regarding non-deployment. We aimed to develop and test an original measure of non-deployment emotions. Methods: We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174)...
March 14, 2018: Military Medicine
Brian Shiner, Christine Leonard Westgate, Vanessa Simiola, Richard Thompson, Paula P Schnurr, Joan M Cook
Objective: Available studies on implementation of evidence-based psychotherapy (EBP) for patients attending Department of Veterans Affairs (VA) residential post-traumatic stress disorder (PTSD) programs rely on therapist self-report of EBP delivery. Patient-level data on receipt of EBP are needed both to corroborate therapist self-report and to understand patient factors that predict receipt of EBPs for PTSD. Materials and Methods: We identified 159 therapists from 38 VA residential PTSD programs who responded to a survey about EBP implementation during the 2015 fiscal year (FY15)...
March 14, 2018: Military Medicine
Gregory Fant, Lisa Backus
Introduction: It is important to monitor the use of optometric services by Veterans and consider the implications for other optometric and vision rehabilitation services. We did not find public health reports documenting the recent utilization of Veterans Health Administration (VHA) optometric eye exam services. Methods: A cross-sectional study design was used in this secondary data analysis report. We were interested in reporting on the number of Veterans using the VHA system with at least one VHA optometric eye exam service in 2014, 2015, or 2016 within a VHA optometry clinic...
March 13, 2018: Military Medicine
E A Smith, W S C Poston, C K Haddock, S A Jahnke, R E Malone
National military and veteran service organizations (MVSOs) have the potential to be advocates for stronger military tobacco control. This study consisted of qualitative analysis of interviews with 5 MVSO leaders (or their designees) and 6 focus groups conducted with veterans, to explore the opinions of MVSO leaders and veterans about military tobacco use and tobacco control policy, and to assess their current knowledge, attitudes, and likelihood of engaging with civilian tobacco control. Themes discussed include the impact of tobacco use on the military mission and on veterans; the possibility of stronger military tobacco control policies; and the idea that such policies would affect the rights of military personnel...
2018: Military Behavioral Health
Luther Elliott, Andrew Golub, Alexander Bennett
This study examines the temporal relationship between prescription opioid (PO) and heroin use among veterans in New York City. Drawing on survey data from a convenience sample of 214 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND)-era opioid-using military veterans, analyses demonstrate substantial cohort-level variation. Most notably, heroin use prior to PO initiation and prior to military enlistment was reported more frequently among the cohorts born prior to 1970 and after 1984...
2018: Military Behavioral Health
Kenzie A Cameron, Elaine R Cohen, Joelle R Hertz, Diane B Wayne, Debi Mitra, Jeffrey H Barsuk
OBJECTIVES: The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. METHODS: Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas...
March 14, 2018: Journal of Patient Safety
Amy C Justice, Kirsha S Gordon, Melissa Skanderson, Eva Jennifer Edelman, Kathleen M Akgün, Cynthia L Gibert, Vincent Lo Re, David Rimland, Julie A Womack, Christina M Wyatt, Janet P Tate
BACKGROUND: HIV-positive individuals (HIV+) on antiretrovirals commonly take enough other medications to cross a threshold for polypharmacy but little is known about associated outcomes. We asked whether non-antiretroviral polypharmacy is associated with hospitalization and mortality and whether associations differ by HIV status. METHODS: Data on HIV+ and uninfected individuals in the US Veterans Affairs Healthcare System were analyzed. Eligible HIV+ were on antiretrovirals with suppressed HIV-1 RNA and uninfected individuals received at least one medication...
March 27, 2018: AIDS
Steven L Sayers, Frances K Barg, Shahrzad Mavandadi, Tanya H Hess, Andreea Crauciuc
This concurrent embedded mixed methods study explored important aspects of communication occurring between military service members and their intimate partners during a combat deployment to Iraq or Afghanistan. Fifty-eight participants (32 military veterans and 26 non-veteran partners) participated in an interview using standardized self-report measures assessing the current level of relationship satisfaction, trauma symptoms of the veteran, and the veterans' trauma exposure. Participants also participated in a semistructured interview focused on combat deployment and reintegration experiences...
February 2018: Journal of Family Psychology: JFP
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