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Sample records for veteran inpatient population

  1. The Veteran Population Projection 2014

    Data.gov (United States)

    Department of Veterans Affairs — VetPop2014 is an actuarial projection model developed by the Office of the Actuary (OACT) for Veteran population projection from Fiscal Year FY2014 to FY2043. Using...

  2. The prevalence and psychosocial correlates of suicide attempts among inpatient adolescent offspring of Croatian PTSD male war veterans.

    Science.gov (United States)

    Boričević Maršanić, Vlatka; Margetić, Branka Aukst; Zečević, Iva; Herceg, Miroslav

    2014-10-01

    Despite evidence that children of male war veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk for behavior problems, very little is currently known about suicidal behaviors in this population of youth. This study aimed to examine the prevalence and psychosocial correlates of suicide attempts among psychiatrically hospitalized adolescent offspring of Croatian male PTSD veterans. Participants were psychiatric inpatients, ages 12-18 years. Self-report questionnaires assessed demographics, suicide attempts, psychopathology, parenting style, and family functioning. The prevalence of suicide attempts was 61.5% (65.2% for girls and 58.0% for boys). Internalizing symptoms, family dysfunction, lower levels of maternal and paternal care, and paternal overcontrol were significantly associated with suicide attempts. Our findings suggest that suicide attempts are common among inpatient adolescent offspring of male PTSD veterans and that interventions targeting both adolescent psychopathology and family relationships are needed for adolescents who have attempted suicide.

  3. High utilization of inpatient detoxification: predictors among US veterans.

    Science.gov (United States)

    Chang, Grace; Raffi, Edwin; Tang, Michael; Fernando, Gerard I; Zucker, Jarred; Schein, Abigail Z

    2016-05-01

    Readmissions are among the most problematic and expensive problems in the treatment of substance use disorders. To evaluate the characteristics associated with four or more inpatient medically managed detoxification admissions in FY 2012, when all had post-discharge appointments within 7 days. A retrospective case control study. A total of 38 (6.0%) of 623 unique veterans had four or more detoxification admissions (high utilizers). A random sample of 42 was selected from the remaining 585 people (comparison group). In all, 264 detoxification and 70 hospital admissions for other reasons were reviewed. The high utilizers had more alcohol use disorder (AUD, 82% versus 59%, p = 0.03) of significantly longer duration (mean 28.9 years [SD = 17] vs. 19.6 [SD = 13.4], p = 0.01). AUD increased the odds of being a high utilizer three-fold [OR = 3.0, 95% CI 1.1, 8.4], and every additional year of AUD, increased the number of admissions 1.3%, p = 0.0006. The high utilizers did not differ from the comparison group with regards to either number of hospitalizations for other reasons (mean 1.2 [SD = 1.9] vs. 0.57 [SD = 0.8], p = 0.06) or rate of 7 day post discharge appointments kept (46.9% vs. 49.3%, p = 0.82). High utilizers were a small percentage of patients (6.0%) who accounted for a disproportionate number (23%) of 977 detoxification admissions. They had greater disease severity as manifest by more years of AUD. They were not more likely to have hospitalizations for other reasons or less likely to keep post discharge appointments. These patients may warrant different services tailored to prevent hospital readmissions for detoxification.

  4. Assessment of validity with polytrauma Veteran populations.

    Science.gov (United States)

    Bush, Shane S; Bass, Carmela

    2015-01-01

    Veterans with polytrauma have suffered injuries to multiple body parts and organs systems, including the brain. The injuries can generate a triad of physical, neurologic/cognitive, and emotional symptoms. Accurate diagnosis is essential for the treatment of these conditions and for fair allocation of benefits. To accurately diagnose polytrauma disorders and their related problems, clinicians take into account the validity of reported history and symptoms, as well as clinical presentations. The purpose of this article is to describe the assessment of validity with polytrauma Veteran populations. Review of scholarly and other relevant literature and clinical experience are utilized. A multimethod approach to validity assessment that includes objective, standardized measures increases the confidence that can be placed in the accuracy of self-reported symptoms and physical, cognitive, and emotional test results. Due to the multivariate nature of polytrauma and the multiple disciplines that play a role in diagnosis and treatment, an ideal model of validity assessment with polytrauma Veteran populations utilizes neurocognitive, neurological, neuropsychiatric, and behavioral measures of validity. An overview of these validity assessment approaches as applied to polytrauma Veteran populations is presented. Veterans, the VA, and society are best served when accurate diagnoses are made.

  5. CORRELATION OF INPATIENT AND OUTPATIENT MEASURES OF STROKE CARE QUALITY WITHIN VETERANS HEALTH ADMINISTRATION HOSPITALS

    Science.gov (United States)

    Ross, Joseph S.; Arling, Greg; Ofner, Susan; Roumie, Christianne L.; Keyhani, Salomeh; Williams, Linda S.; Ordin, Diana L.; Bravata, Dawn M.

    2011-01-01

    Background Quality of care delivered in the inpatient and ambulatory settings may be correlated within an integrated health system such as the Veterans Health Administration (VHA). We examined the correlation between stroke care quality at hospital discharge and within 6 months post-discharge. Methods Cross-sectional hospital-level correlation analyses of chart-abstracted data for 3467 veterans discharged alive after an acute ischemic stroke from 108 VHA medical centers and 2380 veterans with post-discharge follow-up within 6 months, in fiscal year 2007. Four risk-standardized processes of care represented discharge care quality: prescription of anti-thrombotic and anti-lipidemic therapy, anti-coagulation for atrial fibrillation, and tobacco cessation counseling, along with a composite measure of defect-free care. Five risk-standardized intermediate outcomes represented post-discharge care quality: achievement of blood pressure, low-density lipoprotein (LDL), international normalized ratio (INR), and glycosylated hemoglobin target levels, and delivery of appropriate treatment for post-stroke depression, along with a composite measure of achieved outcomes. Results Median risk-standardized composite rate of defect-free care at discharge was 79%. Median risk-standardized post-discharge rates of achieving goal were 56% for blood pressure, 36% for LDL, 41% for INR, 40% for glycosylated hemoglobin, and 39% for depression management and the median risk-standardized composite six-month outcome rate was 44%. The hospital composite rate of defect-free care at discharge was correlated with meeting the LDL goal (r=0.31; p=0.007) and depression management (r=0.27; p=0.03) goal, but was not correlated with blood pressure, INR, or glycosylated hemoglobin goals, nor with the composite measure of achieved post-discharge outcomes (p-values >0.15). Conclusions Hospital discharge care quality was not consistently correlated with ambulatory care quality. PMID:21719771

  6. Foot Complications in a Representative Australian Inpatient Population

    Directory of Open Access Journals (Sweden)

    Peter A. Lazzarini

    2017-01-01

    Full Text Available We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes. We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD, peripheral neuropathy (PN, and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p<0.01. Previous amputation (4.1% was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p<0.01. Previous foot ulceration (9.8% was associated with PN, PAD, past podiatry, and past nurse treatment (p<0.02. PAD (21.0% was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p<0.02. PN (22.0% was associated with older age, diabetes, mobility impairment, and PAD (p<0.05. Foot deformity (22.4% was associated with older age, mobility impairment, past podiatry treatment, and PN (p<0.01. Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.

  7. Creating a sampling frame for population-based veteran research: Representativeness and overlap of VA and Department of Defense databases

    OpenAIRE

    Donna L. Washington, MD, MPH; Su Sun, MPH; Mark Canning, BA

    2010-01-01

    Most veteran research is conducted in Department of Veterans Affairs (VA) healthcare settings, although most veterans obtain healthcare outside the VA. Our objective was to determine the adequacy and relative contributions of Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and Department of Defense (DOD) administrative databases for representing the U.S. veteran population, using as an example the creation of a sampling frame for the National Survey of Women Vete...

  8. Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population

    OpenAIRE

    Raji, Cyrus A.; Willeumier, Kristen; Taylor, Derek; Tarzwell, Robert; Newberg, Andrew; Henderson, Theodore A.; Amen, Daniel G.

    2015-01-01

    PTSD and TBI are two common conditions in veteran populations that can be difficult to distinguish clinically. The default mode network (DMN) is abnormal in a multitude of neurological and psychiatric disorders. We hypothesize that brain perfusion SPECT can be applied to diagnostically separate PTSD from TBI reliably in a veteran cohort using DMN regions. A group of 196 veterans (36 with PTSD, 115 with TBI, 45 with PTSD/TBI) were selected from a large multi-site population cohort of individua...

  9. Decreasing Physical Inactivity in the Veterans Health Administration Employee Population.

    Science.gov (United States)

    Schult, Tamara M; Schmunk, Sandra K; Awosika, Ebi R

    2016-12-01

    The aim of this study was to describe a comprehensive approach to decrease physical inactivity in the Veterans Health Administration (VHA) employee population. The approach included (1) initiatives to decrease physical inactivity in the workplace; (2) two operational surveys to assess system-wide service provision; and (3) two national employee surveys. From 2010 to 2012, 86 employee fitness centers were completed in VA medical centers. A grants program (2010 to 2015) funded smaller projects designed to decrease physical inactivity in the workplace. Projects involved the provision of equipment to decrease sedentary behaviors, including stability balls, treadmill and sit-to-stand desks, stairwell projects, and funding for on-site fitness classes, bicycle racks, and outdoor par courses and walking paths among others. A comprehensive approach to decrease physical inactivity in VHA employees was successful. Overall, self-reported, age-adjusted physical inactivity in VHA employees decreased from 25.3% in 2010 to 16.1% in 2015.

  10. The Australian Vietnam Veterans Health Study: II. self-reported health of veterans compared with the Australian population.

    Science.gov (United States)

    O'Toole, B I; Marshall, R P; Grayson, D A; Schureck, R J; Dobson, M; Ffrench, M; Pulvertaft, B; Meldrum, L; Bolton, J; Vennard, J

    1996-04-01

    Self-reported physical health status of Australian Vietnam veterans was determined 20-25 years after the war and its relation to combat was investigated. An epidemiological cohort study of a simple random sample of Army veterans posted to Vietnam between 1964 and 1972 was conducted with personal interviews using the Australian Bureau of Statistics Health Interview Survey questionnaire to compare veterans with the Australian population and a 21-item combat exposure index used to measure the relationship of combat to physical health. Veterans reported greater health service usage and more recent health actions than population expectations. They also reported excess health problems in almost all recent illness disease categories except endocrine conditions and cardiovascular conditions; only 6 of 37 chronic disease groups were not elevated compared to the population. Adjustment for non-response changed estimates only slightly. Combat exposure was significantly related to reports of recent and chronic mental disorders, recent hernia and chronic ulcer, recent eczema and chronic rash, deafness, chronic infective and parasitic disease, chronic back disorders and symptoms, signs and ill-defined conditions. Combat exposure may have significantly increased reports of only some health problems. A general position to complain as a result of psychological conditions due to combat is not consistent with the lack of relationship between combat and reports of physical conditions.

  11. Patient perceptions of environmental control units: experiences of Veterans with spinal cord injuries and disorders receiving inpatient VA healthcare.

    Science.gov (United States)

    Etingen, Bella; Martinez, Rachael N; Vallette, Marissa A; Dendinger, Ryan; Bidassie, Balmatee; Miskevics, Scott; Khan, Hira T; Cozart, Huberta T; Locatelli, Sara M; Weaver, Frances M

    2018-05-01

    To assess patients' perceptions of environmental control units (ECUs) at Veterans Affairs Spinal Cord Injury Centers. A brief questionnaire was conducted with patients in real-time while they were hospitalised ("on-the-spot questionnaire"); a survey was mailed to patients who had recently been discharged from a hospital stay ("discharge survey"). Data were analysed using descriptive statistics. Seventy on-the-spot questionnaires and 80 discharge surveys were collected. ECU features used most frequently were comparable in responses from both surveys: watching TV/movies (81%, 85%), calling the nurse (68%, 61%), turning lights on/off (63%, 52%), adjusting the bed (53%, 33%), and playing games (39%, 24%). Many on-the-spot questionnaire respondents felt the ECU met their need for independence a great deal (42%). Most respondents to both surveys were satisfied with the ECU (71%, 57%). Areas for improvement included user training, improved functionality of the device and its features, and device design. ECUs were well-accepted by persons with spinal cord injuries/disorders (SCI/D) in the inpatient setting, and increased patients' perceptions of independence. To maximise usability and satisfaction, facilities should ensure that comprehensive training on ECU use and features available is offered to all patients, and resources are available for timely troubleshooting and maintenance. Implications for rehabilitation An environmental control unit (ECU) is a form of assistive technology that allows individuals with disabilities (such as spinal cord injuries and disorders [SCI/D]) to control functional and entertainment-related aspects of their environment. ECU use can increase functioning, independence and psychosocial well-being among individuals with SCI/D, by allowing users to reclaim control over day-to-day activities that are otherwise limited by their disability. Our study results indicate that, among persons with SCI/D, ECUs are well-accepted and increase perceptions of

  12. Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs.

    Science.gov (United States)

    Eibner, Christine; Krull, Heather; Brown, Kristine M; Cefalu, Matthew; Mulcahy, Andrew W; Pollard, Michael; Shetty, Kanaka; Adamson, David M; Amaral, Ernesto F L; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M; Weinick, Robin M; Woods, Dulani; Hosek, Susan D; Farmer, Carrie M

    2016-05-09

    The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade.

  13. Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

    Science.gov (United States)

    Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M.; Weinick, Robin M.; Woods, Dulani; Hosek, Susan D.; Farmer, Carrie M.

    2016-01-01

    Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade. PMID:28083423

  14. Creating a sampling frame for population-based veteran research: representativeness and overlap of VA and Department of Defense databases.

    Science.gov (United States)

    Washington, Donna L; Sun, Su; Canning, Mark

    2010-01-01

    Most veteran research is conducted in Department of Veterans Affairs (VA) healthcare settings, although most veterans obtain healthcare outside the VA. Our objective was to determine the adequacy and relative contributions of Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), and Department of Defense (DOD) administrative databases for representing the U.S. veteran population, using as an example the creation of a sampling frame for the National Survey of Women Veterans. In 2008, we merged the VHA, VBA, and DOD databases. We identified the number of unique records both overall and from each database. The combined databases yielded 925,946 unique records, representing 51% of the 1,802,000 U.S. women veteran population. The DOD database included 30% of the population (with 8% overlap with other databases). The VHA enrollment database contributed an additional 20% unique women veterans (with 6% overlap with VBA databases). VBA databases contributed an additional 2% unique women veterans (beyond 10% overlap with other databases). Use of VBA and DOD databases substantially expands access to the population of veterans beyond those in VHA databases, regardless of VA use. Adoption of these additional databases would enhance the value and generalizability of a wide range of studies of both male and female veterans.

  15. Civilian social work: serving the military and veteran populations.

    Science.gov (United States)

    Savitsky, Laura; Illingworth, Maria; DuLaney, Megan

    2009-10-01

    This article discusses social work practice areas for civilian social workers who provide services to military service members,veterans, and their families. These practice areas include education, child welfare, domestic violence, mental health, health care, substance abuse, and criminal justice. The authors examine the impact of the contemporary military lifestyle and current military operations on service members and their families in the context of these practice areas, with the goal of compelling civilian social workers to acknowledge their responsibility to competently serve military and veteran clients.

  16. Suicide in a large population of former psychiatric inpatients.

    Science.gov (United States)

    Sani, Gabriele; Tondo, Leonardo; Koukopoulos, Athanasios; Reginaldi, Daniela; Kotzalidis, Giorgio D; Koukopoulos, Alexia E; Manfredi, Giovanni; Mazzarini, Lorenzo; Pacchiarotti, Isabella; Simonetti, Alessio; Ambrosi, Elisa; Angeletti, Gloria; Girardi, Paolo; Tatarelli, Roberto

    2011-04-01

    The aim of this study was to identify predictors of completed suicide in a wide sample of psychiatric inpatients receiving retrospective and prospective DSM-IV diagnoses. We followed up 4441 severe psychiatric patients who were hospitalized for some time during a 35-year period in a private hospital setting. We collected sociodemographic, clinical and temperamental data. Ninety-six patients from the sample committed suicide. There were no sex differences in suicide completion and no differences between major psychiatric disorders, but people who had been hospitalized for anxiety disorders did not commit suicide and people with bipolar disorders were more likely to commit suicide than people with unipolar major depression. Shorter-term treatment with lithium and anticonvulsants, longer-term treatment with antidepressants, history of suicide attempts, suicidal thinking, and single status positively predicted completed suicide. Suicide tended to occur after a mean period of about 14 years of duration of disease. Patients' symptoms during the period preceding suicide were assessed through interviewing patients' physicians or family members. Symptoms occurring in >10% of cases were, in decreasing order, inner tension, racing/crowded thoughts, aggressive behavior, guilt, psychomotor agitation, persecutory ideation, anxiety, and hallucinations. Surprisingly, cyclothymic temperament was less associated with completed suicide as compared to other temperaments. Suicide is likely to occur in a milieu of agitation, mixed anxiety and depression, and psychosis. Longer-term mood stabilizer treatment may reduce the rate of completed suicide. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

  17. An estimate of the veteran population in England: based on data from the 2007 Adult Psychiatric Morbidity Survey.

    Science.gov (United States)

    Woodhead, Charlotte; Sloggett, Andy; Bray, Issy; Bradbury, Jason; McManus, Sally; Meltzer, Howard; Brugha, Terry; Jenkins, Rachel; Greenberg, Neil; Wessely, Simon; Fear, Nicola

    2009-01-01

    The health and well-being of military veterans has recently generated much media and political interest. Estimating the current and future size of the veteran population is important to the planning and allocation of veteran support services. Data from a 2007 nationally representative residential survey of England (the Adult Psychiatric Morbidity Survey) were extrapolated to the whole population to estimate the number of veterans currently residing in private households in England. This population was projected forward in two ten-year blocks up to 2027 using a current life table. It was estimated that in 2007, 3,771,534 (95% CI: 2,986,315-4,910,205) veterans were living in residential households in England. By 2027, this figure was predicted to decline by 50.4 per cent, mainly due to large reductions in the number of veterans in the older age groups (65-74 and 75+ years). Approximately three to five million veterans are currently estimated to be living in the community in England. As the proportion of National Service veterans reduces with time, the veteran population is expected to halve over the next 20 years.

  18. Isoniazid Toxicity among an Older Veteran Population: A Retrospective Cohort Study.

    Science.gov (United States)

    Vinnard, Christopher; Gopal, Anand; Linkin, Darren R; Maslow, Joel

    2013-01-01

    our objective was to determine the incidence of toxicity among veterans initiating isoniazid therapy for latent tuberculosis infection (LTBI) and determine whether advancing age was a risk factor for toxicity. we performed a retrospective cohort study among all adults initiating isoniazid treatment for LTBI at a Veterans Medical Center from 1999 to 2005. We collected data on patient demographics, co-morbidities, site of initiation, and treatment outcome. 219 patients initiated isoniazid therapy for LTBI during the period of observation, and the completion of therapy was confirmed in 100 patients (46%). Among 18/219 patients (8%) that discontinued therapy due to a documented suspected toxicity, the median time to onset was 3 months (IQR 1-5 months). In an adjusted Cox regression model, there was no association between discontinuation due to suspected toxicity and advancing age (HR 1.03, 95% CI 0.99, 1.07). In contrast, hepatitis C infection was a significant predictor of cessation due to toxicity in the adjusted analysis (HR 3.03, 95% CI 1.08, 8.52). cessation of isoniazid therapy due to suspected toxicity was infrequently observed among a veteran population and was not associated with advancing age. Alternative LTBI treatment approaches should be further examined in the veteran population.

  19. Isoniazid Toxicity among an Older Veteran Population: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Christopher Vinnard

    2013-01-01

    Full Text Available Background: our objective was to determine the incidence of toxicity among veterans initiating isoniazid therapy for latent tuberculosis infection (LTBI and determine whether advancing age was a risk factor for toxicity. Methods: we performed a retrospective cohort study among all adults initiating isoniazid treatment for LTBI at a Veterans Medical Center from 1999 to 2005. We collected data on patient demographics, co-morbidities, site of initiation, and treatment outcome. Results: 219 patients initiated isoniazid therapy for LTBI during the period of observation, and the completion of therapy was confirmed in 100 patients (46%. Among 18/219 patients (8% that discontinued therapy due to a documented suspected toxicity, the median time to onset was 3 months (IQR 1–5 months. In an adjusted Cox regression model, there was no association between discontinuation due to suspected toxicity and advancing age (HR 1.03, 95% CI 0.99, 1.07. In contrast, hepatitis C infection was a significant predictor of cessation due to toxicity in the adjusted analysis (HR 3.03, 95% CI 1.08, 8.52. Conclusions: cessation of isoniazid therapy due to suspected toxicity was infrequently observed among a veteran population and was not associated with advancing age. Alternative LTBI treatment approaches should be further examined in the veteran population.

  20. Gambling in a National U.S. Veteran Population: Prevalence, Socio-demographics, and Psychiatric Comorbidities.

    Science.gov (United States)

    Stefanovics, Elina A; Potenza, Marc N; Pietrzak, Robert H

    2017-12-01

    This study aimed to examine associations between gambling level and clinically relevant measures, including psychiatric disorders and suicidality, in a nationally representative sample of U.S. veterans. Data on 3157 U.S. veterans were analyzed from the National Health and Resilience in Veterans Study. Chi square tests and analyses of variance were used to assess associations between gambling level, and demographic, military, and personality characteristics. Multinomial logistic regressions using stepwise selection were used to identify independent correlates of recreational gambling and at-risk/problem gambling (ARPG). A significant proportion of U.S. veterans engage in gambling activities, with 35.1% gambling recreationally and 2.2% screening positive for ARPG. ARPG was associated with greater prevalence of substance use, anxiety, and depressive disorders, as well as with a history of physical trauma or sexual trauma, having sought mental health treatment (particularly from the Veterans Administration), and minority group status. A similar pattern was found associated with recreational gambling, although the magnitudes of association were lower relative to ARPG. Younger age, self-identifying as black, being retired, and trauma burden were associated with increased odds of ARPG, whereas older age, being single, non-white Hispanic, being retired or not having a job, screening positive for alcohol- and drug-use disorders, and trauma burden were associated with increased odds of recreational gambling. More than a third of U.S. veterans gamble recreationally, with a significant minority (2.2%) screening positive for ARPG. Both recreational and ARPG were associated with elevated trauma burden and psychiatric comorbidities. These findings underscore the importance of routine screening and monitoring of gambling severity, and interventions for ARPG in this population.

  1. Improving the care of veterans: The role of nurse practitioners in team-based population health management.

    Science.gov (United States)

    Hobson, Alexandra; Curtis, Alexa

    2017-11-01

    Improving healthcare delivery for U.S. veterans is a national priority. The Veterans Health Administration (VHA) employs a variety of team-based, population health strategies to address critical issues in veterans' health including the effective management of chronic disease. Nurse practitioners (NPs) are integral members of the VHA patient care team with a substantial role to play in the organization and delivery of healthcare services for veterans. This report explores the contributions of NPs in team-based, population health strategies within the VHA. This review of the literature examines peer-reviewed articles published between 2006 and 2017 to explore the contributions of NPs in team-based, population health strategies within the VHA. Search words include veterans, VHA, NPs, population health, panel management, and chronic disease. NPs are vital members of the VHA primary care team; however, there is a dearth of available evidence reflecting the unique contribution of NPs within VHA team-based, population health management strategies. The VHA adoption of full practice authority for NP practice provides NPs with an expanded capacity to lead improvements in veterans' health. Future research is needed to fully understand the unique role of the NP in the delivery of population health management strategies for veterans. ©2017 American Association of Nurse Practitioners.

  2. Recent Trends in Veteran Unemployment as Measured in the Current Population Survey and the American Community Survey

    National Research Council Canada - National Science Library

    Savych, Bogdan; Klerman, Jacob A; Loughran, David S

    2008-01-01

    This technical report explores recent trends in the unemployment of recent veterans as estimated from two nationally representative surveys, the Current Population Survey "CPS" and the American Community Survey "ACS...

  3. Functional neuroimaging with default mode network regions distinguishes PTSD from TBI in a military veteran population.

    Science.gov (United States)

    Raji, Cyrus A; Willeumier, Kristen; Taylor, Derek; Tarzwell, Robert; Newberg, Andrew; Henderson, Theodore A; Amen, Daniel G

    2015-09-01

    PTSD and TBI are two common conditions in veteran populations that can be difficult to distinguish clinically. The default mode network (DMN) is abnormal in a multitude of neurological and psychiatric disorders. We hypothesize that brain perfusion SPECT can be applied to diagnostically separate PTSD from TBI reliably in a veteran cohort using DMN regions. A group of 196 veterans (36 with PTSD, 115 with TBI, 45 with PTSD/TBI) were selected from a large multi-site population cohort of individuals with psychiatric disease. Inclusion criteria were peacetime or wartime veterans regardless of branch of service and included those for whom the traumatic brain injury was not service related. SPECT imaging was performed on this group both at rest and during a concentration task. These measures, as well as the baseline-concentration difference, were then inputted from DMN regions into separate binary logistic regression models controlling for age, gender, race, clinic site, co-morbid psychiatric diseases, TBI severity, whether or not the TBI was service related, and branch of armed service. Predicted probabilities were then inputted into a receiver operating characteristic analysis to compute sensitivity, specificity, and accuracy. Compared to PSTD, persons with TBI were older, male, and had higher rates of bipolar and major depressive disorder (p SPECT separated PTSD from TBI in the veterans with 92 % sensitivity, 85 % specificity, and 94 % accuracy. With concentration scans, there was 85 % sensitivity, 83 % specificity and 89 % accuracy. Baseline-concentration (the difference metric between the two scans) scans were 85 % sensitivity, 80 % specificity, and 87 % accuracy. In separating TBI from PTSD/TBI visual readings of baseline scans had 85 % sensitivity, 81 % specificity, and 83 % accuracy. Concentration scans had 80 % sensitivity, 65 % specificity, and 79 % accuracy. Baseline-concentration scans had 82 % sensitivity, 69 % specificity, and 81

  4. Psychiatric inpatient expenditures and public health insurance programmes: analysis of a national database covering the entire South Korean population

    Directory of Open Access Journals (Sweden)

    Chung Woojin

    2010-09-01

    Full Text Available Abstract Background Medical spending on psychiatric hospitalization has been reported to impose a tremendous socio-economic burden on many developed countries with public health insurance programmes. However, there has been no in-depth study of the factors affecting psychiatric inpatient medical expenditures and differentiated these factors across different types of public health insurance programmes. In view of this, this study attempted to explore factors affecting medical expenditures for psychiatric inpatients between two public health insurance programmes covering the entire South Korean population: National Health Insurance (NHI and National Medical Care Aid (AID. Methods This retrospective, cross-sectional study used a nationwide, population-based reimbursement claims dataset consisting of 1,131,346 claims of all 160,465 citizens institutionalized due to psychiatric diagnosis between January 2005 and June 2006 in South Korea. To adjust for possible correlation of patients characteristics within the same medical institution and a non-linearity structure, a Box-Cox transformed, multilevel regression analysis was performed. Results Compared with inpatients 19 years old or younger, the medical expenditures of inpatients between 50 and 64 years old were 10% higher among NHI beneficiaries but 40% higher among AID beneficiaries. Males showed higher medical expenditures than did females. Expenditures on inpatients with schizophrenia as compared to expenditures on those with neurotic disorders were 120% higher among NHI beneficiaries but 83% higher among AID beneficiaries. Expenditures on inpatients of psychiatric hospitals were greater on average than expenditures on inpatients of general hospitals. Among AID beneficiaries, institutions owned by private groups treated inpatients with 32% higher costs than did government institutions. Among NHI beneficiaries, inpatients medical expenditures were positively associated with the proportion of

  5. [Kennedy V Axis assessment in an Italian outpatient and inpatient population].

    Science.gov (United States)

    Mundo, Emanuela; Bonalume, Laura; Del Corno, Franco; Madeddu, Fabio; Lang, Margherita

    2010-01-01

    Kennedy Axis V or K Axis acts is an alternative tool to the DSM-IVTR Global Assessment of Functioning (GAF) Scale, that many researchers describe as a scale with poor inter-rater reliability and clinical utility. Unlike the GAF scale, K Axis provides a multidimensional and multiaxial approach to measure personal, social and interpersonal functioning in psychiatric outpatients and inpatients. In this study, we examined K Axis's inter-raters reliability by using it with an Italian clinical population. Clinicians used Kennedy Axis V to assess global functioning among 180 inpatients, in 9 psychiatric services in Lombardia and Piemonte. Patients were divided into 4 different diagnostic groups, according to the DSM-IV-TR criteria. Intraclass correlations between two independent raters's scores reveal high level of interrater reliability for all K Axis scales (0,633 < ICC < 0,813). Highly significant results in the Kruskal-Wallis test demonstrate that the patient diagnosis influence all the scales scores. Significant differences in patients functioning profiles in all K Axis scales, apart from Violence one, were noted between different diagnosis groups. In this study high level of raters agreement was noted, even if K Axis scales were used in different mental health services from different clinicians. K Axis scales provide a useful profile of patient global functioning, in line with the specific pathology.

  6. Evidence that dry eye is a comorbid pain condition in a U.S. veteran population

    Science.gov (United States)

    Lee, Charity J.; Levitt, Roy C.; Felix, Elizabeth R.; Sarantopoulos, Constantine D.; Galor, Anat

    2017-01-01

    Abstract Introduction: Recent evidence suggests that dry eye (DE) may be comorbid with other chronic pain conditions. Objectives: To evaluate DE as a comorbid condition in the U.S. veteran population. Methods: Retrospective review of veterans seen in the Veterans Administration Healthcare System (Veteran Affairs) between January 1, 2010, and December 31, 2014. Dry eye and nonocular pain disorders were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. Dry eye was further separated into ICD-9 codes representing tear film dysfunction or ocular pain. χ2 and logistic regression analyses were used to examine frequency and risk of DE, ocular pain, and tear film dysfunction by pain disorders. Results: Of 3,265,894 veterans, 959,881 had a DE diagnosis (29.4%). Dry eye frequency increased with the number of pain conditions reported (P < 0.0005). Ocular pain was most strongly associated with headache (odds ratio [OR] 2.98; 95% confidence interval [CI] 2.95–3.01), tension headache (OR 2.64; 95% CI 2.58–2.71), migraine (OR 2.58; 95% CI 2.54–2.61), temporomandibular joint dysfunction (OR 2.39; 95% CI 2.34–2.44), pelvic pain (OR 2.30; 95% CI 2.24–2.37), central pain syndrome (OR 2.24; 95% CI 1.94–2.60), and fibromyalgia/muscle pain (OR 2.23; 95% CI 2.20–2.26), all P < 0.0005. Tear film dysfunction was most closely associated with osteoarthritis (OR 1.97; 95% CI 1.96–1.98) and postherpetic neuralgia (OR 1.95; 95% CI 1.90–2.00), both P < 0.0005. Conclusions: Dry eye, including both ocular pain and tear film dysfunction, is comorbid with pain conditions in this nationwide population, implying common mechanisms. PMID:29392243

  7. Evaluating the Use of Medicare Part D in the Veteran Population With Spinal Cord Injury/Disorder.

    Science.gov (United States)

    Hatch, Maya N; Raad, Jason; Suda, Katie; Stroupe, Kevin T; Hon, Alice J; Smith, Bridget M

    2018-02-06

    To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D). Retrospective, cross-sectional, observational study. Outpatient clinics and pharmacies. Veterans (N=13,442) with SCI/D using Medicare or Veteran Affairs pharmacy benefits. Not applicable. Characteristics and top 10 most common drug classes were examined in veterans who (1) used VA pharmacies only; (2) used both VA and Medicare Part D pharmacies; or (3) used Part D pharmacies only. Chi-square tests and multinomial logistic regression analyses were used to determine associations between various patient variables and source of medications. Patient level frequencies were used to determine the most common drug classes. A total of 13,442 veterans with SCI/D were analyzed in this study: 11,788 (87.7%) used VA pharmacies only, 1281 (9.5%) used both VA and Part D pharmacies, and 373 (2.8%) used Part D pharmacies only. Veterans older than 50 years were more likely to use Part D pharmacies, whereas those with traumatic injury, or secondary conditions, were less associated with the use of Part D pharmacies. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, antidepressants (other category), anticonvulsants, and antilipemics. Approximately 12% of veterans with SCI/D are receiving medication outside the VA system. Polypharmacy in this population of veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population. Published by Elsevier Inc.

  8. Korean War Veterans by State

    Data.gov (United States)

    Department of Veterans Affairs — The spreadsheet of Korean War Veterans by State includes the total Korean War Veteran population for each state and broken out by age and gender. It also includes...

  9. Interdisciplinary Approach to Fall Prevention in a High-Risk Inpatient Pediatric Population: Quality Improvement Project.

    Science.gov (United States)

    Stubbs, Kendra E; Sikes, Lindsay

    2017-01-01

    Within a tertiary care pediatric medical center, the largest number of inpatient falls (8.84 falls per 1,000 patient days) occurred within a 14-bed rehabilitation/transitional care unit between February and September 2009. An interdisciplinary fall prevention program, called "Red Light, Green Light," was developed to better educate all staff and family members to ensure safety of transfers and ambulation of children with neurological impairments. The purpose of this study was to develop and implement an interdisciplinary pediatric fall prevention program to reduce total falls and falls with family members present in this population. Preintervention 2009 data and longitudinal data from 2010-2014 were obtained from retrospective review of event/incident reports. This quality improvement project was based on inpatient pediatric admissions to a rehabilitation care unit accommodating children with neurological impairments. Data extraction included: total falls, falls with caregiver (alone versus staff versus family), type of falls, and falls by diagnosis. Descriptive statistics were obtained on outcome measures; chi-square statistics were calculated on preintervention and postintervention comparisons. Total falls decreased steadily from 8.84 falls per 1,000 patient days in 2009 to 1.79 falls per 1,000 patient days in 2014 (χ12=3.901, P=.048). Falls with family members present decreased 50% postintervention. (χ12=6.26, P=.012). Limitations included unit size nearly doubled postintervention, event reporting changed to both uncontrolled and controlled therapy falls (safely lowering patient to bed, chair, or floor), and enhanced reporting increased numbers of postintervention falls. The Red Light, Green Light program has resulted in reductions in overall fall rates, falls with family members present, increased staff collaboration, heightened staff and family safety awareness, and a safer environment for patients at high risk for neurological or musculoskeletal impairments

  10. Impact of obesity on the risk of venous thromboembolism in an inpatient pediatric population.

    Science.gov (United States)

    Stokes, Sean; Breheny, Patrick; Radulescu, Aurelia; Radulescu, Vlad Calin

    2014-08-01

    The incidence of venous thromboembolism in children has increased significantly over the past 20 years. Over the same period of time, there was an increase in the prevalence of obesity in the pediatric population. Obesity is a known risk factor for VTE in adults, but little information is available in children. This study evaluates the relation between obesity and VTE using a retrospective, case-control design, comparing the body mass index (BMI) of patients admitted with a diagnosis of VTE versus patients admitted with other diagnoses, at a single institution, between 2007 and 2011. We studied 48 inpatients diagnosed with deep venous thrombosis or pulmonary embolism and a control group of 274 age and gender matched patients admitted with other diagnoses. We found obese patients (BMI > 95th percentile) to have significantly higher risk of VTE (odds ratio 2.1, with 95% CI 1.1-4.2) than patients of normal weight (BMI obesity and VTE in a group of hospitalized children, showing a risk for VTE in obese children similar to the one described in much larger adult cohorts.

  11. Honoring our Nation's Veterans

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2015-11-01

    Full Text Available No abstract available. Article truncated at 150 words. Today is Armistice Day, renamed Veterans Day in 1954, to honor our Nation's Veterans. In Washington the rhetoric from both the political right and left supports our Veterans. My cynical side reminds me that this might have something to do with Veterans voting in a higher percentage than the population as a whole, but let me give the politicians this one. Serving our Country in the military is something that deserves to be honored. I was proud to serve our Veterans over 30 years at the four Department of Veterans Affairs (VA hospitals. However, the VA has had a very bad year. First, in Washington there were the resignations of the Secretary of Veterans Affairs, Eric Shinseki; the undersecretary for the Veterans Health Administration, Robert Petzel; and the undersecretary for the Veterans Benefits Administration, Allison Hickey. Locally, in the light of the VA wait scandal there were the firing of ...

  12. The Prevalence and Investigation of Risk Factors of Oral Mucositis in a Pediatric Oncology Inpatient Population; a Prospective Study.

    Science.gov (United States)

    Allen, Gabrielle; Logan, Richard; Revesz, Tom; Keefe, Dorothy; Gue, Sam

    2018-01-01

    Oral mucositis can be a frequent and severe complication of chemotherapy in children. It can result in pain, infection, depression, prolonged admission, treatment delays, increase in patient morbidity, and increased costs. To record the prevalence and severity of oral mucositis among inpatients and explore the relationship of risks factors and the development of oral mucositis. During an 18-month period 643 clinical inpatient assessments were completed on 73 children who were admitted and had received chemotherapy in the last 14 days. There were 43 episodes of oral mucositis in 31 children; 42.5% of the inpatient population. World Health Organization assessment identified 32.6% of episodes were grade 1, 34.9% grade 2, 14.0% grade 3, and 18.6% grade 4. Analysis revealed significant associations between patient diagnosis (P<0.0001), chemotherapy cycles (P<0.0001), day 8 and 9 of the chemotherapy cycle (P<0.05), and neutropenia (P<0.0001) and oral mucositis. Children had increased length of admission with increasing severity of oral mucositis (P=0.0005). The prevalence of oral mucositis was 42.5% among inpatients and admission length was increased with increasing severity. Patient diagnosis, chemotherapy treatment block, day of chemotherapy cycle, and neutropenic status were shown to influence the risk of developing oral mucositis.

  13. Veterans Experiencing Elder Abuse: Improving Care of a High-Risk Population About Which Little Is Known.

    Science.gov (United States)

    Makaroun, Lena K; Taylor, Laura; Rosen, Tony

    2018-02-01

    At least 10% of older adults experience abuse, neglect, or exploitation annually in the United States, and this problem is expected to grow as our population ages. Little is known about the prevalence and characteristics of elder abuse of veterans, but it is likely that this population is at high risk based on established elder abuse risk factors. Veterans who receive their care through the Veterans Health Administration (VHA) have a higher prevalence of poor psychological health, poor physical health, functional impairment, cognitive impairment, and social isolation than the general population. As the largest integrated healthcare system in the United States, the VHA has long been a leader in the development of innovative, integrated care programs for older adults. The VHA has another opportunity to lead by promoting research, clinical care, and education on elder abuse, furthering their mission of serving those who served. This article outlines the rationale for developing a research agenda for elder abuse in the VHA, as well as potential first steps toward understanding more about this complex problem affecting veterans. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  14. Examination of Veterans Affairs disability compensation as a disincentive for employment in a population-based sample of Veterans under age 65.

    Science.gov (United States)

    Tsai, Jack; Rosenheck, Robert A

    2013-12-01

    Concerns that disability benefits may create disincentives for employment may be especially relevant for young American military veterans, particularly veterans of the recent wars in Iraq and Afghanistan who are facing a current economic recession and turning in large numbers to the Department of Veterans Affairs (VA) for disability compensation. This study describes the rate of employment and VA disability compensation among a nationally representative sample of veterans under the age of 65 and examines the association between levels of VA disability compensation and employment, adjusting for sociodemographics and health status. Data on a total of 4,787 veterans from the 2010 National Survey of Veterans were analyzed using multinomial logistic regressions to compare employed veterans with two groups that were not employed. Two-thirds of veterans under the age of 65 were employed, although only 36 % of veterans with a VA service-connected disability rating of 50 % or higher were employed. Veterans who received no VA disability compensation or who were service-connected 50 % or more were more likely to be unemployed and not looking for employment than veterans who were not service-connected or were service-connected less than 50 %, suggesting high but not all levels of VA disability compensation create disincentives for employment. Results were similar when analyses were limited to veterans who served in Iraq and Afghanistan. Education and vocational rehabilitation interventions, as well as economic work incentives, may be needed to maximize employment among veterans with disabilities.

  15. Addressing long-term physical healthcare needs in a forensic mental health inpatient population using the UK primary care Quality and Outcomes Framework (QOF): an audit

    OpenAIRE

    Ivbijaro, GO; Kolkiewicz, LA; McGee, LSF; Gikunoo, M

    2008-01-01

    Objectives This audit aims to evaluate the effectiveness of delivering an equivalent primary care service to a long-term forensic psychiatric inpatient population, using the UK primary care national Quality and Outcomes Framework (QOF).

  16. A Systematic Chart Review of Inpatient Population with Childhood Dissociative Disorder

    Science.gov (United States)

    Prabhuswamy, Mukesh; Jairam, Rajeev; Srinath, Shoba; Girimaji, Satish; Seshadri, Shekhar P.

    2006-01-01

    Objective: To study the socio-demographic factors, clinical characteristics, and long-term outcome of dissociative disorders in inpatient children and adolescents. Methods: Chart data of forty-four subjects (8-15 years) with a diagnosis of dissociative disorder admitted to a specialist Child and Adolescent Psychiatry (CAP) unit between September…

  17. Sleep Quality and Factors Influencing Self-Reported Sleep Duration and Quality in the General Internal Medicine Inpatient Population.

    Directory of Open Access Journals (Sweden)

    Selina Dobing

    Full Text Available Sleep quality in hospitalized Canadian General Internal Medicine patients is not well characterized. Our goals were to characterize hospital sleep quality in this population and identify potentially modifiable barriers to good sleep.GIM inpatients at a quaternary centre in Edmonton, Canada completed a survey, including the Verran-Snyder Halpern (VSH questionnaire, to characterize the previous night's sleep within 48 hours prior to discharge. A chart review was also completed to assess comorbidities, discharge diagnoses, and pharmaceutical sleep aid use.Patients reported significantly worse nighttime sleep duration in hospital compared with home (mean 5.5 versus 7.0 hours per night, p < 0.0001. Sleep quality was poor, as measured by the VSH disturbance (mean 371, effectiveness (190, and supplementation (115 subscales. Variables independently associated with poorer sleep duration in multivariable regression include prior diagnosis of sleep disorder and multi-patient occupancy rooms. Age, sex, admitting diagnosis, length of stay, frequency of vital checks, and use of sleep pharmaceuticals during the index hospitalization were not associated with sleep duration. The most frequently reported reasons for poor sleep included noise (59%, nursing interruptions (30%, uncomfortable beds (18%, bright lights (16%, unfamiliar surroundings (14%, and pain (9%.Sleep quality for GIM inpatients is significantly worse in hospital than at home. There is a need to test non-pharmacologic interventions to address the most frequently identified factors causing poor sleep hygiene for GIM inpatients.

  18. The Role of PTSD in Bi-directional Intimate Partner Violence in Military and Veteran Populations: A Research Review

    Directory of Open Access Journals (Sweden)

    Gabriela Misca

    2017-08-01

    Full Text Available Evidence supporting the higher prevalence of PTSD linked to combat-related trauma in military personnel and veteran populations is well-established. Consequently, much research has explored the effects that combat related trauma and the subsequent PTSD may have on different aspects of relationship functioning and adjustment. In particular, PTSD in military and veterans has been linked with perpetrating intimate partner violence (IPV. New research and theoretical perspectives suggest that in order to respond effectively to IPV, a more accurate understanding of the direction of the violence experienced within each relationship is critical. In both civilian and military populations, research that has examined the direction of IPV's, bi-directional violence have been found to be highly prevalent. Evidence is also emerging as to how these bi-directional violence differ in relation to severity, motivation, physical and psychological consequences and risk factors. Of particular importance within military IPV research is the need to deepen understanding about the role of PTSD in bi-directional IPV not only as a risk factor for perpetration but also as a vulnerability risk factor for victimization, as findings from recent research suggest. This paper provides a timely, critical review of emergent literature to disentangle what is known about bi-directional IPV patterns in military and veteran populations and the roles that military or veterans' PTSD may play within these patterns. Although, this review aimed to identify global research on the topic, the majority of research meeting the inclusion criteria was from US, with only one study identified from outside, from Canada. Strengths and limitations in the extant research are identified. Directions for future research are proposed with a particular focus on the kinds of instruments and designs needed to better capture the complex interplay of PTSD and bi-directional IPV in military populations and

  19. Inpatient treatment of patients with acute idiopathic peripheral facial palsy: A population-based healthcare research study.

    Science.gov (United States)

    Plumbaum, K; Volk, G F; Boeger, D; Buentzel, J; Esser, D; Steinbrecher, A; Hoffmann, K; Jecker, P; Mueller, A; Radtke, G; Witte, O W; Guntinas-Lichius, O

    2017-12-01

    To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany. Population-based study. All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [OR=12.939; 95% confidence interval [CI]=3.599 to 46.516), gustatory testing (OR=6.878; CI=1.064 to 44.474) and audiometry (OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination (OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤II. A pathological stapedial reflex test (Hazard ratio [HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg (HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy (HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials. © 2017 John Wiley & Sons Ltd.

  20. Interpersonal trauma, attachment insecurity and anxiety in an inpatient psychiatric population.

    Science.gov (United States)

    Wiltgen, Anika; Arbona, Consuelo; Frankel, Leslie; Frueh, B Christopher

    2015-10-01

    Current research suggests that interpersonal trauma has an impact on insecure attachment and anxiety. Some research further suggests that attachment may play a mediating role between traumatic events and psychopathology. The purpose of this study was to examine the relationship between the experience of interpersonal trauma, attachment anxiety, attachment avoidance and clinical anxiety severity among adult psychiatric inpatients who reported having experienced interpersonal trauma after the age of 16. It was hypothesized that attachment anxiety and attachment avoidance would mediate the relationship between interpersonal trauma and clinical anxiety level. This study used archival data on 414 adult psychiatric inpatients in a large city in the Southwest U.S. Results suggest that interpersonal trauma was correlated to attachment avoidance but not to attachment anxiety and that attachment avoidance partially mediated the relation of interpersonal trauma to anxiety. The attachment framework appositely explains how a negative model of other contributes to the relation between experiences of interpersonal trauma and anxiety in adulthood. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

    OpenAIRE

    Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii

    2016-01-01

    The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next...

  2. The influence of diagnosis on psychotherapy missed opportunities in a veteran population.

    Science.gov (United States)

    Keeley, Jared Wayne; Cardin, Scott; Gonzalez, Rose

    2016-01-01

    Canceled or unattended psychotherapy sessions are a source of concern for patients, providers, and health-care systems. Veterans are particularly likely to experience mental health problems, and yet they are also especially susceptible to variables leading to premature termination of services. This study examined a large (n = 2285) sample of veterans receiving psychotherapy services to determine if mental health diagnosis had an impact upon missed psychotherapy opportunities. There were differential cancelation rates for individuals with different classes of disorder, and the total number of appointments a person scheduled changed the nature of the effect. Health-care administrators and treatment providers should consider the specific effects of individuals with differing diagnoses when planning courses of treatment and coordinating care.

  3. Psychiatric Factors and Weight Loss Patterns Following Gastric Bypass Surgery in a Veteran Population

    OpenAIRE

    Rutledge, Thomas; Groesz, Lisa M.; Savu, Michelle

    2009-01-01

    Background Although pre-surgical psychological evaluations are commonly administered to patients considered for weight loss surgeries, the value of these evaluations for predicting weight loss success has been questioned. In this study, we addressed this issue by examining patient’s total number of psychiatric indicators rather than individual psychological factors as predictors of weight loss/weight regain. Methods Sixty adult veterans completed gastric bypass surgery or laparoscopic gastric...

  4. The validity of three fall risk screening tools in an acute geriatric inpatient population.

    Science.gov (United States)

    Latt, Mark Dominic; Loh, K Florence; Ge, Ludi; Hepworth, Annie

    2016-09-01

    We examined the validity of the Ontario Modified STRATIFY (OM) (St Thomas's Risk Assessment Tool in Falling Elderly Inpatients), The Northern Hospital Modified STRATIFY (TNH) and STRATIFY in predicting falls in an acute aged care unit. Data were collected prospectively from 217 people presenting consecutively and falls identified during hospitalisation. Sensitivities of OM (80.0, 95% confidence interval (CI) 58.4 to 91.9%), TNH (85, CI 64.0 to 94.8%) and STRATIFY (80.0, CI 58.4 to 91.0%) were similar. The STRATIFY had higher specificity (61.4, CI 54.5 to 67.9%) than OM (37.1, CI 30.6 to 44.0%) and TNH (51.3, CI 44.3 to 58.2%). Accuracy (percentage of patients correctly classified as 'faller' or 'non-faller') was higher using STRATIFY (63.1, CI 56.5 to 69.3%) and TNH (54.4, CI 47.8 to 61.0%) than with OM (41.0, CI 34.7 to 47.7%, P patients at high risk of falls. © 2016 AJA Inc.

  5. Pressure Ulcers in the United States' Inpatient Population From 2008 to 2012: Results of a Retrospective Nationwide Study.

    Science.gov (United States)

    Bauer, Karen; Rock, Kathryn; Nazzal, Munier; Jones, Olivia; Qu, Weikai

    2016-11-01

    Pressure ulcers are common, increase patient morbidity and mortality, and costly for patients, their families, and the health care system. A retrospective study was conducted to evaluate the impact of pressure ulcers on short-term outcomes in United States inpatient populations and to identify patient characteristics associated with having 1 or more pressure ulcers. The US Nationwide Inpatient Sample (NIS) database was analyzed using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes as the screening tool for all inpatient pressure ulcers recorded from 2008 to 2012. Patient demographics and comorbid conditions, as identified by ICD-9 code, were extracted, along with primary outcomes of length of stay (LOS), total hospital charge (TC), inhospital mortality, and discharge disposition. Continuous variables with normal distribution were expressed in terms of mean and standard deviation. Group comparisons were performed using t-test or ANOVA test. Continuous nonnormal distributed variables such as LOS and TC were expressed in terms of median, and nonparametric tests were used to compare the differences between groups. Categorical data were presented in terms of percentages of the number of cases within each group. Chi-squared tests were used to compare categorical data in different groups. For multivariate analysis, linear regressions (for continuous variable) and logistic regression (for categorical variables) were used to analyze the possible risk factors for the investigated outcomes of LOS, TC, inhospital mortality, and patient disposition. Coefficients were calculated with multivariate regression with all included patients versus patients with pressure ulcers alone. The 5-year average number of admitted patients with at least 1 pressure ulcer was determined to be 670 767 (average overall rate: 1.8%). Statistically significant differences between patients with and without pressure ulcers were observed for

  6. Addressing long-term physical healthcare needs in a forensic mental health inpatient population using the UK primary care Quality and Outcomes Framework (QOF): an audit.

    Science.gov (United States)

    Ivbijaro, Go; Kolkiewicz, LA; McGee, Lsf; Gikunoo, M

    2008-03-01

    Objectives This audit aims to evaluate the effectiveness of delivering an equivalent primary care service to a long-term forensic psychiatric inpatient population, using the UK primary care national Quality and Outcomes Framework (QOF).Method The audit compares the targets met by the general practitioner with special interest (GPwSI) service, using local and national QOF benchmarks (2005-2006), and determines the prevalence of chronic disease in a long-term inpatient forensic psychiatry population.Results The audit results show that the UK national QOF is a useful tool for assessment and evaluation of physical healthcare needs in a non-community based population. It shows an increased prevalence of all QOF-assessed long-term physical conditions when compared to the local East London population and national UK population, confirming previously reported elevated levels of physical healthcare need in psychiatric populations.Conclusions This audit shows that the UK General Practice QOF can be used as a standardised instrument for commissioning and monitoring the delivery of physical health services to in-patient psychiatric populations, and for the evaluation of the effectiveness of clinical interventions in long-term physical conditions. The audit also demonstrates the effectiveness of using a GPwSI in healthcare delivery in non-community based settings. We suggest that the findings may be generalisable to other long-term inpatient psychiatric and prison populations in order to further the objective of delivering an equivalent primary care service to all populations.The QOF is a set of national primary care audit standards and is freely available on the British Medical Association website or the UK Department of Health website. We suggest that primary care workers in health economies who have not yet developed their own national primary care standards can access and adapt these standards in order to improve the clinical standards of care given to the primary care

  7. Inpatient Psychiatric Admission Rates in a U.S. Air Force Basic Military Training Population

    Science.gov (United States)

    2017-05-20

    Please know that if you are a Graduate Health Sciences Education student and your department has told you they cannot fund your publication, the 59th...author must complete page two of this form: a. In Section 2, add the funding source for your study (e.g., S9 MOW CRD Graduate Health Sciences...U.S. AIR FORCE BASIC MILITARY TRAINING POPULATION Background: Mental health admission rates for those with no active mental health disorders have

  8. Dementia, post-traumatic stress disorder and major depressive disorder: a review of the mental health risk factors for dementia in the military veteran population.

    Science.gov (United States)

    Rafferty, L A; Cawkill, P E; Stevelink, S A M; Greenberg, K; Greenberg, N

    2018-07-01

    Dementia is currently incurable, irreversible and a major cause of disability for the world's older population. The association between mental health difficulties, such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), and dementia has a long history within the civilian population. Despite the increased importance of this link within the military veteran population, who suffer a greater propensity of mental health difficulties and consist largely of over 65s, attention is only recently being paid to the salience of such an association for this group. This paper aims to explore the relationship between PTSD and MDD with dementia within the military veteran population. A systematic review was conducted on articles from 1990 to July 2016 on MEDLINE, EMBASE, EBSCO and Web of Science electronic databases with an update conducted in February 2017. Six empirical studies were identified from the review, the majority of which originated from the USA. Five of the studies asserted that veterans with a diagnosis of either PTSD or MDD are at a significantly greater risk of developing dementia than 'healthy' controls. The final study, conducted in Australia, found only a small, but non-significant, correlation between earlier MDD and future dementia, but no concurrent correlation. While causality cannot be determined, it is likely that PTSD and depressive disorders are related to an increased risk of dementia in military veterans. Potential pathological explanations and risk factors are reviewed and the clinical and neuroscience implications of these findings are explored.

  9. Military veteran mortality following a survived suicide attempt

    Directory of Open Access Journals (Sweden)

    Conigliaro Joseph

    2011-05-01

    Full Text Available Abstract Background Suicide is a global public health problem. Recently in the U.S., much attention has been given to preventing suicide and other premature mortality in veterans returning from Iraq and Afghanistan. A strong predictor of suicide is a past suicide attempt, and suicide attempters have multiple physical and mental comorbidities that put them at risk for additional causes of death. We examined mortality among U.S. military veterans after hospitalization for attempted suicide. Methods A retrospective cohort study was conducted with all military veterans receiving inpatient treatment during 1993-1998 at United States Veterans Affairs (VA medical facilities following a suicide attempt. Deaths occurring during 1993-2002, the most recent available year at the time, were identified through VA Beneficiary and Records Locator System data and National Death Index data. Mortality data for the general U.S. adult population were also obtained from the National Center for Health Statistics. Comparisons within the veteran cohort, between genders, and against the U.S. population were conducted with descriptive statistics and standardized mortality ratios. The actuarial method was used estimate the proportion of veterans in the cohort we expect would have survived through 2002 had they experienced the same rate of death that occurred over the study period in the U.S. population having the age and sex characteristics. Results During 1993-1998, 10,163 veterans were treated and discharged at a VA medical center after a suicide attempt (mean age = 44 years; 91% male. There was a high prevalence of diagnosed alcohol disorder or abuse (31.8%, drug dependence or abuse (21.8%, psychoses (21.2%, depression (18.5%, and hypertension (14.2%. A total of 1,836 (18.1% veterans died during follow up (2,941.4/100,000 person years. The cumulative survival probability after 10 years was 78.0% (95% CI = 72.9, 83.1. Hence the 10-year cumulative mortality risk was 22

  10. Recent Trends in Veteran Unemployment as Measured in the Current Population Survey and the American Community Survey

    National Research Council Canada - National Science Library

    Savych, Bogdan; Klerman, Jacob A; Loughran, David S

    2008-01-01

    ...". Analyses of CPS data indicates that veteran youth unemployment increased relative to nonveteran youth unemployment between 2003 and 2005 "and that this relative increase is statistically significant...

  11. [Inpatient psychotherapy].

    Science.gov (United States)

    Spitzer, C; Rullkötter, N; Dally, A

    2016-01-01

    In German-speaking countries inpatient psychotherapy plays a major role in the mental healthcare system. Due to its characteristic features, i. e. multiprofessionalism, multimodality and method integration, the inpatient approach represents a unique and independent type of psychotherapy. In order to be helpful, the manifold verbal and non-verbal methods need to be embedded into an overall treatment plan. Additionally, the therapeutic milieu of the hospital represents an important effective factor and its organization requires a more active construction. The indications for inpatient psychotherapy are not only based on the mental disorder but also on illness, setting and healthcare system-related criteria. In integrative concepts, the multiprofessional team is a key component with many functions. The effectiveness of psychotherapeutic hospital treatment has been proven by meta-analysis studies; however, 20-30% of patients do not benefit from inpatient psychotherapy and almost 13% drop-out prematurely.

  12. The Trail Making test: a study of its ability to predict falls in the acute neurological in-patient population.

    Science.gov (United States)

    Mateen, Bilal Akhter; Bussas, Matthias; Doogan, Catherine; Waller, Denise; Saverino, Alessia; Király, Franz J; Playford, E Diane

    2018-05-01

    To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. Prospective cohort study. Tertiary neurological and neurosurgical center. In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). The principal outcome was a fall during the in-patient stay ( n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P Test data (Wilcoxon signed-rank P test of cognitive function, the Trail Making test.

  13. Precision Medicine for CRC Patients in the Veteran Population: State-of-the-Art, Challenges and Research Directions.

    Science.gov (United States)

    Mohapatra, Shyam S; Batra, Surinder K; Bharadwaj, Srinivas; Bouvet, Michael; Cosman, Bard; Goel, Ajay; Jogunoori, Wilma; Kelley, Michael J; Mishra, Lopa; Mishra, Bibhuti; Mohapatra, Subhra; Patel, Bhaumik; Pisegna, Joseph R; Raufman, Jean-Pierre; Rao, Shuyun; Roy, Hemant; Scheuner, Maren; Singh, Satish; Vidyarthi, Gitanjali; White, Jon

    2018-05-01

    Colorectal cancer (CRC) accounts for ~9% of all cancers in the Veteran population, a fact which has focused a great deal of the attention of the VA's research and development efforts. A field-based meeting of CRC experts was convened to discuss both challenges and opportunities in precision medicine for CRC. This group, designated as the VA Colorectal Cancer Cell-genomics Consortium (VA4C), discussed advances in CRC biology, biomarkers, and imaging for early detection and prevention. There was also a discussion of precision treatment involving fluorescence-guided surgery, targeted chemotherapies and immunotherapies, and personalized cancer treatment approaches. The overarching goal was to identify modalities that might ultimately lead to personalized cancer diagnosis and treatment. This review summarizes the findings of this VA field-based meeting, in which much of the current knowledge on CRC prescreening and treatment was discussed. It was concluded that there is a need and an opportunity to identify new targets for both the prevention of CRC and the development of effective therapies for advanced disease. Also, developing methods integrating genomic testing with tumoroid-based clinical drug response might lead to more accurate diagnosis and prognostication and more effective personalized treatment of CRC.

  14. Veterans' homecomings

    DEFF Research Database (Denmark)

    Sørensen, Birgitte Refslund

    2015-01-01

    provided the soldier by rank, function, and mission vanishes and translates into an imperative ontological question about possible veteran subjectivity. In this article I argue that the veterans’ struggle to create postdeployment, postmilitary social identities entails profound secrecy work where past...... experiences, present conditions, and future ambitions are embedded in webs of concealment, disclosure, exposure, deception, lying, silence, and so forth, only partially controlled by the veterans themselves. The intricacies and anxieties associated with secrecy work are discussed in relation to three veteran...

  15. Can personality traits predict the future development of heart disease in hospitalized psychiatric veterans?

    Science.gov (United States)

    Williams, Wright; Kunik, Mark E; Springer, Justin; Graham, David P

    2013-11-01

    To examine which personality traits are associated with the new onset of chronic coronary heart disease (CHD) in psychiatric inpatients within 16 years after their initial evaluation. We theorized that personality measures of depression, anxiety, hostility, social isolation, and substance abuse would predict CHD development in psychiatric inpatients. We used a longitudinal database of psychological test data from 349 Veterans first admitted to a psychiatric unit between October 1, 1983, and September 30, 1987. Veterans Affairs and national databases were assessed to determine the development of new-onset chronic CHD over the intervening 16-year period. New-onset CHD developed in 154 of the 349 (44.1%) subjects. Thirty-one psychometric variables from five personality tests significantly predicted the development of CHD. We performed a factor analysis of these variables because they overlapped and four factors emerged, with positive adaptive functioning the only significant factor (OR=0.798, p=0.038). These results support previous research linking personality traits to the development of CHD, extending this association to a population of psychiatric inpatients. Compilation of these personality measures showed that 31 overlapping psychometric variables predicted those Veterans who developed a diagnosis of heart disease within 16 years after their initial psychiatric hospitalization. Our results suggest that personality variables measuring positive adaptive functioning are associated with a reduced risk of developing chronic CHD.

  16. Military veterans and Social Security.

    Science.gov (United States)

    Olsen, Anya

    There are 9.4 million military veterans receiving Social Security benefits, which means that almost one out of every four adult Social Security beneficiaries has served in the United States military. In addition, veterans and their families make up almost 40 percent of the adult Social Security beneficiary population. Policymakers are particularly interested in military veterans and their families and have provided them with benefits through several government programs, including Social Security credits, home loan guarantees, and compensation and pension payments through the Department of Veterans Affairs. It is therefore important to understand the economic and demographic characteristics of this population. Information in this article is based on data from the March 2004 Current Population Survey, a large, nationally representative survey of U.S. households. Veterans are overwhelmingly male compared with all adult Social Security beneficiaries who are more evenly split between males and females. Military veterans receiving Social Security are more likely to be married and to have finished high school compared with all adult Social Security beneficiaries, and they are less likely to be poor or near poor than the overall beneficiary population. Fourteen percent of veterans receiving Social Security benefits have income below 150 percent of poverty, while 25 percent of all adult Social Security beneficiaries are below this level. The higher economic status among veterans is also reflected in the relatively high Social Security benefits they receive. The number of military veterans receiving Social Security benefits will remain high over the next few decades, while their make-up and characteristics will change. In particular, the number of Vietnam War veterans who receive Social Security will increase in the coming decades, while the number of veterans from World War II and the Korean War will decline.

  17. Examining the prevalence and characteristics of abfractionlike cervical lesions in a population of U.S. veterans.

    Science.gov (United States)

    Piotrowski, B T; Gillette, W B; Hancock, E B

    2001-12-01

    Abfraction is believed to be caused by biomechanical loading forces. It may be due to flexure and ultimate fatigue of tooth tissues that occur away from the point of occlusal loading. Other possible causes of cervical lesions include toothbrush abrasion and erosion. The purpose of this study was to investigate the characteristics and prevalence of abfraction-like lesions in a population of U.S. veterans. The authors evaluated 103 teeth with noncarious cervical lesions in 32 subjects and characterized them based on the surface on which the lesion was located, history of toothbrush abrasion, size of the lesion, presence of plaque, surface texture, and presence and size of occlusal wear facets. Clinical examination revealed that adjacent control teeth had a significantly lower percentage of surfaces with plaque than did teeth with cervical lesions. Control teeth also had significantly less gingival recession than did affected teeth. Seventy-five percent of subjects reported a history of using a firm toothbrush, and 78.1 percent reported using a brushing technique that is known to cause toothbrush abrasion in the affected area. Affected teeth had neither significantly different occlusal wear facets nor occlusal contacts than control teeth. No significant correlations were found between cervical lesion dimensions and facet area. Toothbrush abrasion is strongly suspected as contributing to the formation of the majority of wedge-shaped lesions in this group of subjects. A small subset of lesions is thought to have resulted from some other phenomenon. Although the presence or contribution of occlusal stresses in the direct formation of these lesions could not be measured directly, the possibility of abfraction could not be eliminated. Because the existence of abfraction could not be ruled out in about 15 percent of the cases, teeth with noncarious, wedge-shaped lesions warrant careful occlusal evaluation, with the possible need for occlusal adjustment or bitesplint therapy

  18. The effect of post-traumatic-stress-disorder on intra-operative analgesia in a veteran population during cataract procedures carried out using retrobulbar or topical anesthesia: a retrospective study.

    Science.gov (United States)

    Rapoport, Yuna; Wayman, Laura L; Chomsky, Amy S

    2017-06-07

    A growing proportion of veterans treated at the Veterans Health Administration (VA) have a history of post-traumatic-stress-disorder (PTSD), and there exists a higher rate of PTSD amongst veterans than the general population. The purpose of this study is to determine the correlation between PTSD and intra-operative analgesia, intra-operative time, and anesthesia type for cataract surgery in a veteran population. Secondary objectives are to determine if patient age, and first or second eye surgery affect intra-operative pain control or are correlated with type of anesthesia modality. A retrospective study of 330 cataract surgeries performed by resident physicians between January and September 2012 at the Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville and Murfreesboro Campuses was completed. Three hundred and thirty veteran patients were selected if their cataract surgery was performed between January and September 2012. Combined cases were excluded. The primary outcome evaluated was intra-operative analgesia. Secondary outcomes included history of post-traumatic-stress-disorder, anesthesia type, first or second eye, pain control, intra-operative heart rate and blood pressure, age, and case complexity. Data was analyzed using an unpaired two-sample Welch's t-test assuming unequal variance and Z test of comparison of proportions. Patients with post-traumatic-stress-disorder reported higher pain scores, had longer operative times, and were more likely to have received a retrobulbar block. Operative time was not associated with an increased pain score, irrespective of anesthesia type, when controlled for PTSD. Complex cases had longer operative times, more sedation, and higher pain scores. P < 0.05 was used consistently. Post-traumatic stress disorder and anxiety are more prevalent in the veteran population. Our data suggests that a history of post-traumatic-stress-disorder was correlated with higher pain scores, longer operative times

  19. Women Veteran Report

    Data.gov (United States)

    Department of Veterans Affairs — This report summarizes the history of women Veterans in the military and as Veterans. It profiles the characteristics of women Veterans in 2015, and illustrates how...

  20. Veteran Services - Welcome Employers

    Science.gov (United States)

    Assistance Crosswalk websites Transition GPS National Career Readiness Certificate Post Traumatic Stress Credits (PDF) Fidelity Bonding Program National Career Readiness (PDF) Veteran Recruitment State/Federal veteran recruitment process Military Veteran Employment Guide Veterans Hiring Toolkit Other Information

  1. The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation

    Science.gov (United States)

    Doran, Tim; Cookson, Richard

    2016-01-01

    Background There are substantial socioeconomic inequalities in both life expectancy and healthcare use in England. In this study, we describe how these two sets of inequalities interact by estimating the social gradient in hospital costs across the life course. Methods Hospital episode statistics, population and index of multiple deprivation data were combined at lower-layer super output area level to estimate inpatient hospital costs for 2011/2012 by age, sex and deprivation quintile. Survival curves were estimated for each of the deprivation groups and used to estimate expected annual costs and cumulative lifetime costs. Results A steep social gradient was observed in overall inpatient hospital admissions, with rates ranging from 31 298/100 000 population in the most affluent fifth of areas to 43 385 in the most deprived fifth. This gradient was steeper for emergency than for elective admissions. The total cost associated with this inequality in 2011/2012 was £4.8 billion. A social gradient was also observed in the modelled lifetime costs where the lower life expectancy was not sufficient to outweigh the higher average costs in the more deprived populations. Lifetime costs for women were 14% greater than for men, due to higher costs in the reproductive years and greater life expectancy. Conclusions Socioeconomic inequalities result in increased morbidity and decreased life expectancy. Interventions to reduce inequality and improve health in more deprived neighbourhoods have the potential to save money for health systems not only within years but across peoples’ entire lifetimes, despite increased costs due to longer life expectancies. PMID:27189975

  2. Is exposure to Agent Orange a risk factor for hepatocellular cancer?-A single-center retrospective study in the U.S. veteran population.

    Science.gov (United States)

    Krishnamurthy, Padmini; Hazratjee, Nyla; Opris, Dan; Agrawal, Sangeeta; Markert, Ronald

    2016-06-01

    factors for HCC development in this U.S. veteran population. There was no significant association between exposure to Agent Orange and HCC, although larger studies are needed in the U.S. military veteran population to evaluate further this toxic herbicide from the Vietnam War era.

  3. Women Veterans, a Population at Risk for Fibromyalgia: The Associations Between Fibromyalgia, Symptoms, and Quality of Life.

    Science.gov (United States)

    D'Aoust, Rita F; Rossiter, Alicia Gill; Elliott, Amanda; Ji, Ming; Lengacher, Cecile; Groer, Maureen

    2017-07-01

    The Institute of Federal Health Care recently published an executive summary from a round table discussion indicating that active duty and retired female military personnel are at high risk for adverse health outcomes unique to military service including complications related to post-traumatic stress disorder (PTSD), unreported sexual trauma, and musculoskeletal problems. In 2008, the Institute of Medicine began to review, evaluate, and summarize the literature on health outcomes in Gulf War-deployed and found sufficient evidence of a causal relationship with PTSD and suggestive evidence of an association with fibromyalgia (FM). This study examines the prevalence and impact of FM in women veterans and to explore the association between other comorbidities to improve risk differentiation for treatment and improve outcomes. This study is designed as a nested, cross-sectional study within a larger project funded by the U.S. Army at the University of South Florida, College of Nursing entitled "Nursing Health Initiative for Empowering Women Veterans." A sample of 76 participants completed a battery of study instruments related to physical and psychological stressors. Over half of the sample had a positive FM screening score (56.68%) although only 14.42% were deployed to the Middle East. More than 70% of participants reported harassment in life in the military and 32.9% reported sexual assault while in the military. Results of the 1-way analysis of variances find that there was a significant association of FM with the psychological symptoms of stress, depression, and PTSD. There was a significant association of FM with quality of life and sleep difficulty. The results from this pilot study suggest there is a significant relationship between FM and the psychological symptoms of depression and PTSD. Nearly two-thirds of these women screened positive for depressive symptoms and just over one-quarter of participants had symptoms indicative of PTSD. Only a small proportion of

  4. Seasonality of hospital admissions and birth dates among inpatients with eating disorders: a nationwide population-based retrospective study.

    Science.gov (United States)

    Liang, Chih-Sung; Chung, Chi-Hsiang; Tsai, Chia-Kuang; Chien, Wu-Chien

    2018-04-01

    Seasonal variation exists in the psychopathology of eating disorders. However, it is still unknown whether there is seasonal variation in eating disorder symptom severity. This study investigated seasonal trends in hospital admissions and birth dates among patients with eating disorders in Taiwan (25°N). Subgroup analyses by gender and comorbid affective disorders were also of interest. Data on all hospital admissions between 2000 and 2013 were collected from the Taiwan National Health Insurance Research Database, and 1954 patients with eating disorders were identified. Hospital admissions and birth dates were recorded by day. The four seasons and cross-seasons were defined by solstices and equinoxes. The expected distribution of births was determined using data from all patients hospitalized from 2000 to 2013 (n = 13,139,306). Hospital admissions among patients with eating disorders exceeded the rate of expected hospital admissions in the summer season (p distributions of birth dates among these patients did not differ from the expected distributions. Interestingly, hospital admissions among patients with comorbid affective disorders exceeded the rates of hospital admissions among non-affective patients during the spring (p = 0.004). Moreover, the number of non-affective patients born during autumn exceeded the birth rates of affective patients during this season (p = 0.001). Gender and comorbid affective disorders were not associated with cross-seasonal differences in either hospitalizations or dates of birth. Affective psychopathology in inpatients with eating disorders may substantially contribute to symptom severity that waxes and wanes with the seasons. Moreover, the seasonal distribution of birth dates was significantly different in patients without comorbid affective disorders.

  5. Treatment-seeking veterans of Iraq and Afghanistan: comparison with veterans of previous wars.

    Science.gov (United States)

    Fontana, Alan; Rosenheck, Robert

    2008-07-01

    Differences in the characteristics and mental health needs of veterans of the Iraq/Afghanistan war when compared with those of veterans who served in the Persian Gulf war and in the Vietnam war may have important implications for Veterans Affairs (VA) program and treatment planning. Subjects were drawn from administrative data bases of veterans who sought treatment from specialized VA programs for treatment of posttraumatic stress disorder (PTSD). Current Iraq/Afghanistan veterans were compared with 4 samples of outpatient and inpatient Persian Gulf and Vietnam veterans whose admission to treatment was either contemporaneous or noncontemporaneous with their admission. A series of analyses of covariance was used hierachically to control for program site and age. In analyses of contemporaneous veterans uncontrolled for age, Iraq/Afghanistan veterans differed most notably from Vietnam veterans by being younger, more likely to be female, less likely to be either married or separated/divorced, more often working, less likely to have ever been incarcerated, and less likely to report exposure to atrocities in the military. Regarding clinical status, Iraq/Afghanistan veterans were less often diagnosed with substance abuse disorders, manifested more violent behavior, and had lower rates of VA disability compensation because of PTSD. Differences are more muted in comparisons with Persian Gulf veterans, particularly in those involving noncontemporaneous samples, or those that controlled for age differences. Among recent war veterans with PTSD, social functioning has largely been left intact. There is a window of opportunity, therefore, for developing and focusing on treatment interventions that emphasize the preservation of these social assets.

  6. Utilizing risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) scores to prioritize offer of rescue naloxone in an outpatient veteran population: A telephone-based project.

    Science.gov (United States)

    Yates, Derek; Frey, Theresa; Montgomery, Jean Charles

    2018-03-26

    Since 2014, the Department of Veterans Affairs (VA) has been working to address the ongoing opioid epidemic through opioid-education initiatives, the development of risk calculators, and other risk stratification tools. One primary focus of VA efforts has been the distribution of rescue naloxone kits to veterans at greatest risk of opioid-related adverse events. The purpose of this project was to identify primary care veterans at highest risk for serious opioid-related adverse events using the Risk Index for Overdose and Serious Opioid-Induced Respiratory Depression (RIOSORD) and offer rescue naloxone kits by telephone-based outreach. RIOSORD is a risk-stratification tool developed and validated within the veteran population. Veterans identified at highest risk of overdose or opioid-related adverse effects were contacted by telephone or letter to offer to provide a rescue naloxone kit between November 1 st , 2016 and February 1 st , 2017. The primary outcome of the project was the percentage of patients contacted that agreed to a naloxone prescription. Secondary outcomes included comparative efficacy of phone versus letter contact and reasons for refusal of naloxone if the offer was declined. Of 41 veterans targeted by this project, most were successfully reached by telephone within three attempts (92.7%, n = 38). Approximately two-thirds of those reached by telephone agreed to a prescription for rescue naloxone (n = 26, 63.4%). The veterans that requested rescue naloxone selected the nasal formulation (n = 17) over the intramuscular auto-injector (n = 9). This project demonstrated that telephone-based outreach can be one method of distributing rescue naloxone to a high-risk patient population without requiring an in-person visit to a provider.

  7. Risk Factors and Predictive Model Development of Thirty-Day Post-Operative Surgical Site Infection in the Veterans Administration Surgical Population.

    Science.gov (United States)

    Li, Xinli; Nylander, William; Smith, Tracy; Han, Soonhee; Gunnar, William

    2018-04-01

    Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population. In a retrospective observation study, surgical patients who underwent surgery from October 2013 to September 2016 from 136 VA hospitals were included. The Veteran Affairs Surgical Quality Improvement Program (VASQIP) database was used for the pre-operative demographic and clinical characteristics, intra-operative characteristics, and 30-day post-operative outcomes. The study population represents 11 surgical specialties: neurosurgery, urology, podiatry, otolaryngology, general, orthopedic, plastic, thoracic, vascular, cardiac coronary artery bypass graft (CABG), and cardiac valve/other surgery. Multivariable logistic regression models were developed for the 30-day post-operative SSIs. Among 354,528 surgical procedures, 6,538 (1.8%) had SSIs within 30 days. Surgical site infection rates varied among surgical specialty (0.7%-3.0%). Surgical site infection rates were higher in emergency procedures, procedures with long operative duration, greater complexity, and higher relative value units. Other factors associated with increased SSI risk were high level of American Society of Anesthesiologists (ASA) classification (level 4 and 5), dyspnea, open wound/infection, wound classification, ascites, bleeding disorder, chemotherapy, smoking, history of severe chronic obstructive pulmonary disease (COPD), radiotherapy, steroid use for chronic conditions, and weight loss. Each surgical specialty had a distinct combination of risk factors. Accurate SSI risk-predictive surgery specialty

  8. Patterns of Return to Oral Intake and Decannulation Post-tracheostomy across Clinical Populations in an Acute Inpatient Setting

    Science.gov (United States)

    Pryor, Lee; Ward, Elizabeth; Cornwell, Petrea; O'Connor, Stephanie; Chapman, Marianne

    2016-01-01

    Background: Dysphagia is often a comorbidity in patients who require a tracheostomy, yet little is known about patterns of oral intake commencement in tracheostomized patients, or how patterns may vary depending on the clinical population and/or reason for tracheostomy insertion. Aims: To document patterns of clinical management around the…

  9. Utilizing Clinical Pharmacy Specialists to Address Access to Care Barriers in the Veteran Population for the Management of Diabetes.

    Science.gov (United States)

    Edwards, Krystal L; Hadley, Ryan L; Baby, Nidhu; Yeary, Julianne C; Chastain, Lisa M; Brown, Crystal D

    2017-08-01

    To show that clinical pharmacy specialists (CPSs) can be utilized in remote facilities to provide appropriate diabetes outcomes along with potential cost savings. A retrospective cohort chart review conducted at the Veterans Affairs North Texas Healthcare System (VANTHCS) evaluated outcomes in patients with type 2 diabetes mellitus referred to CPSs at Fort Worth Outpatient Clinic (FWOPC) or the endocrinologist-managed specialty clinic at the Dallas VA Medical Center (DVAMC). The primary outcome was percentage of patients reaching hemoglobin A1c (HbA1c) goal of facility if patients continued to be referred to CPS. CPSs can be utilized in diabetes management to provide similar health outcomes as the endocrinologist-managed clinic and to potentially allow for facility cost savings.

  10. Veterans Crisis Line

    Data.gov (United States)

    Department of Veterans Affairs — The caring responders at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances. Some of the responders are...

  11. Off-Label Prescribing of Second-Generation Antipsychotics to Elderly Veterans with Posttraumatic Stress Disorder and Dementia.

    Science.gov (United States)

    Semla, Todd P; Lee, Austin; Gurrera, Ronald; Bajor, Laura; Li, Mingfei; Miller, Donald R; Smith, Eric G; Wang, Chao; Wan, Yun; Kazis, Lewis E; Bauer, Mark S

    2017-08-01

    To determine whether elderly veterans with posttraumatic stress disorder (PTSD) and dementia are more likely to be prescribed second-generation antipsychotics (SGAs) than those with PTSD alone. National serial cross-sectional study. Veterans Health Affairs inpatient and outpatient settings. Veterans aged 65 and older with PTSD (excluding schizophrenia or bipolar disorder) with or without concomitant dementia who received care from the Veterans Health Administration between 2003 and 2010 were identified using International Classification of Diseases, Ninth Revision, codes (N = 93,068; 11.1% with dementia). Trends in SGA prescribing and odds of being prescribed an SGA were determined using a multivariable logistic regression model adjusted for clinical, sociodemographic, and geographic covariates. Between 2004 and 2009, SGA prescribing declined annually from 7.0% to 5.1% of elderly veterans with PTSD without dementia and 13.2% to 8.9% in those with dementia; findings over time consistently indicated that veterans with PTSD and dementia had at least twice the odds of being prescribed an SGA as those without PTSD (odds ratios 2.03 (95% confidence interval (CI) = 1.82-2.26) to 2.33 (95% CI = 2.10-2.58). Although the prescribing of SGAs to elderly veterans with PTSD has decreased, prescribing an SGA to those with dementia remained consistently higher than for those with PTSD alone and is problematic given the high prevalence of medical comorbidities in this aging population coupled with the lack of compelling evidence for effectiveness of SGAs in individuals with dementia. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  12. Sexual Function in Female Veterans: A Review.

    Science.gov (United States)

    Rosebrock, Laina; Carroll, Richard

    2017-04-03

    Women comprise a significant proportion of the veteran population. Much research has been devoted to physical and mental health outcomes in veterans, both of which show significant decreases in quality of life. However, little is known about the effects of female veterans' unique military experience on sexual function. In particular, military sexual trauma, general military stressors, mental health diagnoses, and other vulnerability factors contribute to sexual dysfunction, dissatisfaction, and decreases in mental health-related quality of life. We propose a model whereby all of these factors interact and contribute to sexual dysfunction in female veterans, and areas for growth in assessment and treatment are discussed.

  13. The Veterans Health Administration’s Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans

    Science.gov (United States)

    2012-02-01

    make it more difficult for veterans with PTSD to seek or maintain treatment. VHA provides treatment for PTSD at VHA hospitals , outpatient clinics ...measured in days of inpatient hospital care and outpatient clinic visits. A veteran may have had several outpatient visits on a sin- gle day, each...reproduce the same results precisely. The DSS system takes clinical and financial information from other VHA databases and uses algorithms that merge

  14. Dose-specific adverse drug reaction identification in electronic patient records: temporal data mining in an inpatient psychiatric population.

    Science.gov (United States)

    Eriksson, Robert; Werge, Thomas; Jensen, Lars Juhl; Brunak, Søren

    2014-04-01

    Data collected for medical, filing and administrative purposes in electronic patient records (EPRs) represent a rich source of individualised clinical data, which has great potential for improved detection of patients experiencing adverse drug reactions (ADRs), across all approved drugs and across all indication areas. The aim of this study was to take advantage of techniques for temporal data mining of EPRs in order to detect ADRs in a patient- and dose-specific manner. We used a psychiatric hospital's EPR system to investigate undesired drug effects. Within one workflow the method identified patient-specific adverse events (AEs) and links these to specific drugs and dosages in a temporal manner, based on integration of text mining results and structured data. The structured data contained precise information on drug identity, dosage and strength. When applying the method to the 3,394 patients in the cohort, we identified AEs linked with a drug in 2,402 patients (70.8 %). Of the 43,528 patient-specific drug substances prescribed, 14,736 (33.9 %) were linked with AEs. From these links we identified multiple ADRs (p patient population, larger doses were prescribed to sedated patients than non-sedated patients; five antipsychotics [corrected] exhibited a significant difference (p<0.05). Finally, we present two cases (p < 0.05) identified by the workflow. The method identified the potentially fatal AE QT prolongation caused by methadone, and a non-described likely ADR between levomepromazine and nightmares found among the hundreds of identified novel links between drugs and AEs (p < 0.05). The developed method can be used to extract dose-dependent ADR information from already collected EPR data. Large-scale AE extraction from EPRs may complement or even replace current drug safety monitoring methods in the future, reducing or eliminating manual reporting and enabling much faster ADR detection.

  15. Using the MMPI 168 with Medical Inpatients

    Science.gov (United States)

    Erickson, Richard C.; Freeman, Charles

    1976-01-01

    Explores the potential utility of the MMPI 168 with two inpatient medical populations. Correlations and clinically relevant comparisons suggest that the MMPI 168 predicted the standard MMPI with a high degree accuracy. (Editor/RK)

  16. Will Veterans Answer Sexual Orientation and Gender Identity Questions?

    Science.gov (United States)

    Ruben, Mollie A; Blosnich, John R; Dichter, Melissa E; Luscri, Lorry; Shipherd, Jillian C

    2017-09-01

    The Veterans Health Administration does not routinely collect and document sexual orientation and gender identity (SOGI) data, despite existing health disparities among sexual and gender minority Veterans. Because of the legacy of previous Department of Defense (DoD) policies that prohibited disclosure of sexual or gender minority identities among active duty personnel, Veterans may be reluctant to respond to SOGI questions. This population-based study assesses item nonresponse to SOGI questions by Veteran status. This is a secondary analysis of data from a population-based sample of adults in 20 US states that elected to administer a SOGI module in the 2014 Behavioral Risk Factor Surveillance System survey. Prevalence of SOGI refusals and responses of "don't know" were compared for Veterans and non-Veterans. Veterans (n=22,587) and non-Veterans (n=146,475) were surveyed. Nearly all Veteran respondents (≥98%) completed the SOGI questions, with 95.4% identifying as heterosexual, 1.2% as gay or lesbian, 1.2% as bisexual, and 0.59% as transgender. A significantly lower proportion of Veterans than non-Veterans refuse to answer sexual orientation (1.5% vs. 1.9%). There was no difference between Veterans and non-Veterans in responses for gender identity. Veterans are just as likely as non-Veterans to complete SOGI items in survey research. Asking Veterans about SOGI is unlikely to yield significant nonresponse. These data suggest that future research should investigate Veterans' perspectives on being asked about SOGI in research settings and as part of routine clinical care.

  17. Temporal Trends of Non-alcoholic Fatty Liver Disease-related Hepatocellular Carcinoma in the Veteran Affairs Population

    Science.gov (United States)

    Mittal, Sahil; Sada, Yvonne H.; El-Serag, Hashem B.; Kanwal, Fasiha; Duan, Zhigang; Temple, Sarah; May, Sarah B.; Kramer, Jennifer R.; Richardson, Peter A.; Davila, Jessica A.

    2014-01-01

    Background & Aims Non-alcoholic fatty liver disease (NAFLD) is a risk factor for hepatocellular carcinoma (HCC). However, no systemic studies from the United States have examined temporal trends, HCC surveillance practices, and outcomes of NAFLD-related HCC. Methods We identified a national cohort of 1500 patients who developed HCC from 2005 through 2010 from Veterans Administration (VA) hospitals. We reviewed patients’ full VA medical records; NAFLD was diagnosed based on histologic evidence for, or the presence of, metabolic syndrome in the absence of hepatitis C virus (HCV) infection, hepatitis B, or alcoholic liver disease. We compared annual prevalence values for the main risk factors (NAFLD, alcohol abuse, HCV), as well HCC surveillance and outcomes, among HCC patients. Results NAFLD was the underlying risk factor for HCC in 120 patients (8.0%); the annual proportion of NAFLD-related HCC remained relatively stable (7.5%–12.0%). In contrast, the proportion of HCC cases associated with HCV increased from 61.0% in 2005 (95% confidence interval, 53.1%–68.9%) to 74.9% in 2010 (95% confidence interval, 69.0%–80.7%). The proportion of HCC cases associated with only alcohol abuse decreased from 21.9% in 2005 to 15.7% in 2010, and the annual proportion of HCC cases associated with hepatitis B remained relatively stable (1.4%–3.5%). A significantly lower proportion of patients with NAFLD-related HCC had cirrhosis (58.3%) compared to patients with alcohol- or HCV-related HCC (72.4% and 85.6%, respectively; P<.05). A significantly higher percentage of patients with NAFLD-related HCC did not receive HCC surveillance in the 3 years before their HCC diagnosis, compared to patients with alcohol- or HCV-associated HCC. A lower proportion of patients with NAFLD-related HCC received HCC-specific treatment (61.5%) than of patients with HCV-related HCC (77.5%; P<.01). However, 1-year survival did not differ among patients with HCC related to different risk factors

  18. 2007 Veterans Employability Research Survey

    Data.gov (United States)

    Department of Veterans Affairs — The 2007 Veterans Employability Research Survey (VERS) was conducted to determine the factors that impact veterans' employability resulting from participation in the...

  19. Lower urinary tract dysfunction in male Iraq and Afghanistan war veterans: association with mental health disorders: a population-based cohort study.

    Science.gov (United States)

    Breyer, Benjamin N; Cohen, Beth E; Bertenthal, Daniel; Rosen, Raymond C; Neylan, Thomas C; Seal, Karen H

    2014-02-01

    To determine the prevalence and correlates of lower urinary tract symptoms (LUTS) among returned Iraq and Afghanistan veterans; in particular its association with mental health diagnoses and medication use. We performed a retrospective cohort study of Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs health care. Mental health diagnoses were defined by International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes from medical records. LUTS was defined by ICD-9-CM code, use of prescription medication for LUTS, or procedure for LUTS. We determined the independent association of mental health diagnoses and LUTS after adjusting for sociodemographic and military service characteristics, comorbidities, and medications. Of 519,189 veterans, 88% were men and the mean age was 31.8 years (standard deviation ± 9.3). The overall prevalence of LUTS was 2.2% (11,237/519,189). Veterans with post-traumatic stress disorder (PTSD) were significantly more likely to have a LUTS diagnosis, prescription, or related procedure (3.5%) compared with veterans with no mental health diagnoses (1.3%) or a mental health diagnosis other than PTSD (3.1%, P <.001). In adjusted models, LUTS was significantly more common in veterans with PTSD with and without other mental health disorders vs those without mental health disorders (adjusted relative risk [ARR] = 2.04, 95% confidence interval [CI] = 1.94-2.15) and in veterans prescribed opioids (ARR = 2.46, 95% CI = 2.36-2.56). In this study of young returned veterans, mental health diagnoses and prescription for opioids were independently associated with increased risk of receiving a diagnosis, treatment, or procedure for LUTS. Provider awareness may improve the detection and treatment of LUTS, and improve patient care and quality of life. Copyright © 2014. Published by Elsevier Inc.

  20. Risk Factors for Serious Prescription Opioid-Induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations.

    Science.gov (United States)

    Nadpara, Pramit A; Joyce, Andrew R; Murrelle, E Lenn; Carroll, Nathan W; Carroll, Norman V; Barnard, Marie; Zedler, Barbara K

    2018-01-01

    To characterize the risk factors associated with overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids in a commercially insured population (CIP) and to compare risk factor profiles between the CIP and Veterans Health Administration (VHA) population. Analysis of data from 18,365,497 patients in the IMS PharMetrics Plus health plan claims database (CIP) who were dispensed a prescription opioid in 2009 to 2013. Baseline factors associated with an event of serious OIRD among 7,234 cases and 28,932 controls were identified using multivariable logistic regression. The CIP risk factor profile was compared with that from a corresponding logistic regression among 817 VHA cases and 8,170 controls in 2010 to 2012. The strongest associations with serious OIRD in CIP were diagnosed substance use disorder (odds ratio [OR] = 10.20, 95% confidence interval [CI] = 9.06-11.40) and depression (OR = 3.12, 95% CI = 2.84-3.42). Other strongly associated factors included other mental health disorders; impaired liver, renal, vascular, and pulmonary function; prescribed fentanyl, methadone, and morphine; higher daily opioid doses; and concurrent psychoactive medications. These risk factors, except depression, vascular disease, and specific opioids, largely aligned with VHA despite CIP being substantially younger, including more females and less chronic disease, and having greater prescribing prevalence of higher daily opioid doses, specific opioids, and most selected nonopioids. Risk factor profiles for serious OIRD among US medical users of prescription opioids with private or public health insurance were largely concordant despite substantial differences between the populations in demographics, clinical conditions, health care delivery systems, and clinical practices. © 2017 American Academy of Pain Medicine.

  1. Inpatient care of patients with type 1 diabetes mellitus by duration of diabetes and sex: A nationwide population-based longitudinal study

    Directory of Open Access Journals (Sweden)

    Markku J Akkanen

    2009-07-01

    Full Text Available Markku J Akkanen1,4, Sirkka-Liisa Kivelä2, Veli Koistinen3, Harri Sintonen4, Jaakko Tuomilehto41Welfare and Health Promotion Division, Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare (THL, Helsinki, Finland; 2Turku University of Central Hospital, Turku, Finland; 3Department of Health Policy and Management, University of Kuopio, Kuopio, Finland; 4Department of Public Health, University of Helsinki, Helsinki, FinlandAims: To describe hospitalizations of a cohort of patients with type 1 diabetes mellitus (T1DM during 1973–1998 in the main complication groups by sex and T1DM lasting on average 9.5 or 16.5 years.Material and methods: The population (N = 5166 consisted of all Finnish patients with T1DM diagnosed before the age of 18 years between 1965–1979, derived from the Finnish population-based register of T1DM patients. Data on hospitalizations were obtained from the Finnish Hospital Discharge Register.Results: In the early stages of T1DM, the majority of the use of hospitalizations was due to the treatment of T1DM without complications. Enormous increases were found for complications when diabetes lasted longer (from 9.5 to 16.5 years. For women, the yearly number of bed-days for renal complications increased 4.8-fold, for peripheral vascular disease 4.3-fold, and for ophthalmic complications 2.5-fold. For men, the corresponding increases were as follows: 5-fold, 6.9-fold, and 2.5-fold. The yearly number of bed-days for nephropathy increased 7-fold. Bed-days for T1DM without complications dropped dramatically. The length of stay in hospitalizations decreased notably, but hospital visits increased when the duration of T1DM increased.Conclusions: Hospitalizations due to complications substantially increase with aging of T1DM patients. Prevention of T1DM is strongly needed. Keywords: T1DM, inpatient care, hospitalizations, complications

  2. Using a Cognitive Information Processing Approach to Group Career Counseling with Visually Impaired Veterans

    Science.gov (United States)

    Osborne, Lauren K.

    2014-01-01

    Unemployment continues to be a growing concern among both civilian and veteran populations. As 14% of the veteran population currently identify as disabled because of service, this population's need for specialized vocational rehabilitation is increasing. Specifically in Veterans Affairs (VA) Blind Rehabilitation Centers (BRC) where holistic…

  3. Minority Veteran Report 2014

    Data.gov (United States)

    Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

  4. Veterans and Homelessness

    National Research Council Canada - National Science Library

    Perl, Libby

    2007-01-01

    .... The Department of Veterans Affairs (VA) estimates that it has served approximately 300 returning veterans in its homeless programs and has identified over 1,000 more as being at risk of homelessness...

  5. Paralyzed Veterans of America

    Science.gov (United States)

    ... Connected Twitter @PVA1946 Facebook @Paralyzed Veterans of America Instagram @PVA1946 National Veterans Wheelchair Games App Download Now ... 838-7782 CONNECT WITH US Facebook Twitter YouTube Instagram Flickr STAY INFORMED WITH NEWS & UPDATES Enter your ...

  6. Master Veteran Index (MVI)

    Data.gov (United States)

    Department of Veterans Affairs — As of June 28, 2010, the Master Veteran Index (MVI) database based on the enhanced Master Patient Index (MPI) is the authoritative identity service within the VA,...

  7. Minority Veteran Report

    Data.gov (United States)

    Department of Veterans Affairs — This report is the first comprehensive report that chronicles the history of racial and ethnic minorities in the military and as Veterans, profiles characteristics...

  8. The health and wellbeing needs of veterans: a rapid review.

    Science.gov (United States)

    Oster, Candice; Morello, Andrea; Venning, Anthony; Redpath, Paula; Lawn, Sharon

    2017-12-29

    For the majority of serving members, life in the military has a positive effect on wellbeing. However, the type, intensity and duration of service, along with the transition from fulltime military to civilian life, may have a negative effect on veterans' wellbeing. Such negative consequences, alongside the growing veteran population, indicate the need for greater exploration of veterans' physical, mental and social wellbeing. The current paper reports on the findings of a rapid review of the literature on the health and wellbeing needs of veterans, commissioned by the Australian Department of Veterans' Affairs to inform future programs and services. The databases Embase, Medline, Cinahl, PubMed, Web of Science and Cochrane Database were searched for systematic reviews reporting on veterans' physical, mental and social wellbeing published in English in peer-reviewed journals. A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and social health problems affecting veterans. While there was limited information on prevalence rates of physical, mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the interconnection between these domains and the effect of demographic and military service factors. A key finding of the review is the interconnection of the mental, physical, and social health of veterans, highlighting the importance that an integrated approach to veterans' wellbeing is adopted. It is suggested that understanding key factors, such as demographic factors and factors relating to military service, can support improved service provision for veterans.

  9. Examining burnout profiles in relation to health and well-being in the Veterans Health Administration employee population.

    Science.gov (United States)

    Schult, Tamara M; Mohr, David C; Osatuke, Katerine

    2018-04-23

    The goals of this paper were twofold: (a) To provide a population overview of burnout profiles by occupation in a large, health care sector employee population and (b) to investigate how burnout profiles relate to self-reported health behaviours, chronic conditions, and absenteeism. Burnout profiles were considered by 5 main occupational groups (physicians, nurses, other clinical, administrative, and wage grade [trade, craft, and labor workers]) in survey respondents (n = 86,257 employees). Logistic regression analyses were conducted to examine how burnout profiles were associated with health controlling for gender, age, race, ethnicity, and occupational group. Employees in the "Frustrated/Burning Up" and "Withdrawing/Burned Out" profiles, respectively, had significantly increased odds of anxiety (OR = 2.17; 99% CI [2.04, 2.31]; OR = 2.21; 99% CI [2.05, 2.38]), depression (OR = 2.06; 99% CI [1.93, 2.20]; OR = 2.20; 99% CI [2.04, 2.38]), sleep disorders (OR = 1.98; 99% CI [1.85, 2.12]; OR = 1.97; 99% CI [1.81, 2.13]), low back disease (OR = 1.60; 99% CI [1.50, 1.71]; OR = 1.58; 99% CI [1.47, 1.70]), physical inactivity (OR = 1.49; 99% CI [1.38, 1.60]; OR = 1.68; 99% CI [1.54, 1.83]), and 5 or more days away from work (OR = 1.74; 99% CI [1.65, 1.85]; OR = 2.15; 99% CI [2.01, 2.30]). Burnout is related to the health of employees. Burnout profiles offer a way to assess patterns of burnout by occupational group and may help customize future interventions. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

  10. The Role of Parenting Styles in the Relation Between Functions of Aggression and Internalizing Symptoms in a Child Psychiatric Inpatient Population.

    Science.gov (United States)

    Pederson, Casey A; Rathert, Jamie L; Fite, Paula J; Stoppelbein, Laura; Greening, Leilani

    2016-10-01

    Psychiatric inpatient hospitalization is a costly intervention for youth. With rates of hospitalization rising, efforts to refine prevention and intervention are necessary. Aggression often precedes severe internalizing behaviors, and proactive and reactive functions of aggression are differentially associated with internalizing symptomatology. Thus, further understanding of the links between functions of aggression and internalizing symptomatology could aid in the improvement of interventions for hospitalized youth. The current study examined parenting styles, gender, and age as potential moderators of the relations between proactive and reactive aggression and internalizing symptoms. Participants included 392 children, 6-12 years of age admitted consecutively to a psychiatric inpatient unit. Reactive aggression was uniquely associated with anxiety symptoms. However, proactive aggression was associated with internalizing problems only when specific parenting styles and demographic factors were present. Although both proactive and reactive subtypes of aggression were associated with internalizing symptoms, differential associations were evident. Implications of findings are discussed.

  11. Suicide among War Veterans

    Directory of Open Access Journals (Sweden)

    Vsevolod Rozanov

    2012-07-01

    Full Text Available Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its’ frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles.

  12. Suicide among war veterans.

    Science.gov (United States)

    Rozanov, Vsevolod; Carli, Vladimir

    2012-07-01

    Studies aiming to identify if war veterans are at higher risk of suicide have often produced inconsistent results; this could be due to the complexity of comparisons and different methodological approaches. It should be noted that this contingent has many risk factors, such as stressful exposures, wounds, brain trauma and pain syndrome. Most recent observations confirm that veterans are really more likely to die of suicide as compared to the general population; they are also more likely to experience suicidal ideation and suffer from mental health problems. Suicides are more frequent in those who develop PTSD, depression and comorbid states due to war exposure. Combat stress and its' frequency may be an important factor leading to suicide within the frame of the stress-vulnerability model. According to this model, the effects of stress may interact with social factors, interpersonal relations and psychological variables producing suicidal tendencies. Modern understanding of stress-vulnerability mechanisms based on genetic predispositions, early life development, level of exposure to stress and stress-reactivity together with interpersonal aspects may help to build more effective suicide prevention programs based on universal/selective/indicated prevention principles.

  13. Mindfulness as a Weight Loss Treatment for Veterans

    Directory of Open Access Journals (Sweden)

    Michael Vicente Stanton

    2016-08-01

    Full Text Available Despite substantial evidence for their effectiveness in treating disordered eating and obesity, mindfulness-based treatments have not been broadly implemented among Veterans. A number of reviews have reported mindfulness to be beneficial in promoting healthy eating behaviors and weight loss among non-Veteran samples. We discuss this approach in the context of the Veterans Affairs system, the largest integrated healthcare provider in the United States and in the context of Veterans, among whom obesity is at epidemic proportions. In this article, we discuss what is known about treating obesity using a mindfulness approach, mindfulness interventions for Veterans, a new pilot mindfulness-based weight loss program designed for Veterans, and future directions for this type of obesity treatment in Veterans. We conclude that this population may be uniquely poised to benefit from mindfulness-based treatments.

  14. Mindfulness as a Weight Loss Treatment for Veterans.

    Science.gov (United States)

    Stanton, Michael V; Matsuura, Justin; Fairchild, Jennifer Kaci; Lohnberg, Jessica A; Bayley, Peter J

    2016-01-01

    Despite substantial evidence for their effectiveness in treating disordered eating and obesity, mindfulness-based treatments have not been broadly implemented among Veterans. A number of reviews have reported mindfulness to be beneficial in promoting healthy eating behaviors and weight loss among non-Veteran samples. We discuss this approach in the context of the Veterans Affairs system, the largest integrated healthcare provider in the U.S. and in the context of Veterans, among whom obesity is at epidemic proportions. In this article, we discuss what is known about treating obesity using a mindfulness approach, mindfulness interventions for Veterans, a new pilot mindfulness-based weight loss program designed for Veterans, and future directions for this type of obesity treatment in Veterans. We conclude that this population may be uniquely poised to benefit from mindfulness-based treatments.

  15. Trends in peptic ulcer disease and the identification of Helicobacter Pylori as a causative organism: Population-based estimates from the US nationwide inpatient sample

    Directory of Open Access Journals (Sweden)

    Bronislava Bashinskaya

    2011-01-01

    Full Text Available Background: Peptic ulcer disease can lead to serious complications including massive hemorrhage or bowel perforation. The modern treatment of peptic ulcer disease has transitioned from the control of gastric acid secretion to include antibiotic therapy in light of the identification of Helicobacter pylori as a causative infectious organism. We sought to determine trends related to this discovery by using a national database. Materials and Methods: Patient discharges with peptic ulcer disease and associated sequelae were queried from the Nationwide Inpatient Sample, 1993 to 2007, under the auspices of a data user agreement. To account for the Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used. Standard error was calculated using SUDAAN software (Research Triangle International, NC, USA. Results: Decreases in the incidences of gastrointestinal perforation, gastrointestinal hemorrhage, and surgical procedures most specific to peptic ulcer disease were statistically significant over the study period [range of P value (two tailed = 0.000 - 0.00353; significant at P < 0.001 to < 0.01]. The incidence of H. pylori rose dramatically, peaking at an estimated 97,823 cases in 1998 [SE = 3155; 95% CI = 6,184]. Since that time it has decreased and then stabilized. Conclusions: The identification of H. pylori as the causative agent in the majority of peptic ulcer disease has revolutionized the understanding and management of the disease. Medical conditions and surgical procedures associated with end-stage peptic ulcer disease have significantly decreased according to analysis of selected index categories. Resident physician education objectives may need to be modified in light of these trends. Review Criteria: We reviewed patients with peptic ulcer disease. The database used was the Nationwide Inpatient Sample, 1993 to 2007. Message for the Clinic: Medical therapy has resulted in decreased morbidity from H. pylori infection as it

  16. Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study.

    Science.gov (United States)

    Fortin, Christian D; Voth, Jennifer; Jaglal, Susan B; Craven, B Catharine

    2015-11-01

    To compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI). A retrospective cohort design was employed, using data retrieved from administrative databases. Rehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011. Patients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation. Demographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics. There was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%). Despite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.

  17. PTSD Care Among Veterans With and Without Co-Occurring Substance Use Disorders.

    Science.gov (United States)

    Mansfield, Alyssa J; Greenbaum, Mark A; Schaper, Kim M; Banducci, Anne N; Rosen, Craig S

    2017-06-01

    This study examined whether a co-occurring substance use disorder contributed to disparities in receipt of Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) specialty care or psychotherapy. Logistic regression, controlling for sociodemographic characteristics, was used to examine predictors of PTSD care among 424,211 veterans with confirmed PTSD (two or more PTSD diagnosis encounters) who accessed care in a VHA facility between fiscal years 2009 and 2010. Overall, 16% of veterans had PTSD and a co-occurring substance use disorder diagnosis. In adjusted analyses, veterans with a co-occurring substance use disorder were more likely than veterans with PTSD alone to receive any outpatient PTSD specialty care and complete eight or more sessions of outpatient psychotherapy within 14 weeks, but they were less likely to be treated in inpatient PTSD specialty units. Co-occurring substance use disorders did not appear to hinder receipt of outpatient specialty PTSD treatment or of sufficient psychotherapy among VHA-enrolled veterans.

  18. The effect of race on postsurgical ambulatory medical follow-up among United States Veterans.

    Science.gov (United States)

    Schonberger, Robert B; Dai, Feng; Brandt, Cynthia; Burg, Matthew M

    2017-08-01

    To investigate the association between self-identified black or African American race and the presence of ambulatory internal medicine follow-up in the year after surgery. Our hypothesis was that among US Veterans who presented for surgery, black or African American race would be associated with a decreased likelihood to receive ambulatory internal medicine follow-up in the year after surgery. Retrospective observational. All US Veterans Affairs hospitals. A total of 236,200 Veterans undergoing surgery between 2006 and 2011 who were discharged within 10 days of surgery and survived the full 1-year exposure period. None. Attendance at an internal medicine follow-up appointment within 1 year after surgery. After controlling for year of surgery, age, age ≥65 years, sex, Hispanic ethnicity, and number of inpatient days, black or African American patients were 11% more likely to lack internal medicine follow-up after surgery (adjusted odds ratio, 1.11; 95% confidence interval, 1.06-1.16). When accounting for geographic region, this difference remained significant at the Bonferoni-corrected P < .007 level only in the Midwest United States where black or African American patients were 28% more likely to lack medical follow-up in the year after surgery (odds ratio, 1.28; 95% confidence interval, 1.16-1.42; P < .0001). The disparity in ambulatory medical follow-up following surgery among black or African American vs nonblack or non-African American Veterans in the Midwest region deserves further study and may lead to important quality improvement initiatives aimed specifically at this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Inpatient Psychiatric Facility PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Since October 1, 1983, most hospitals have been paid under the hospital inpatient prospective payment system (PPS). However, certain types of specialty hospitals and...

  20. Veterans in substance abuse treatment program self-initiate box gardening as a stress reducing therapeutic modality.

    Science.gov (United States)

    Lehmann, Lauren P; Detweiler, Jonna G; Detweiler, Mark B

    2018-02-01

    To assess the experiences of a veteran initiated horticultural therapy garden during their 28-day inpatient Substance Abuse Residential Rehabilitation Treatment Program (SARRTP). Retrospective study. Veterans Affairs Medical Center (VAMC), Salem, Virginia, USA INTERVENTIONS: Group interviews with veterans from the last SARRTP classes and individual interviews with VAMC greenhouse staff in summer of 2016. Time spent in garden, frequency of garden visits, types of passive and active garden activities, words describing the veterans' emotional reactions to utilizing the garden. In 3 summer months of 2016, 50 percent of the 56 veterans interviewed visited and interacted with the gardens during their free time. Frequency of visits generally varied from 3 times weekly to 1-2 times a day. Amount of time in the garden varied from 10min to 2h. The veterans engaged in active and/or passive gardening activities during their garden visits. The veterans reported feeling "calm", "serene", and "refreshed" during garden visitation and after leaving the garden. Although data was secured only at the end of the 2016 growing season, interviews of the inpatient veterans revealed that they used their own initiative and resources to continue the horticulture therapy program for 2 successive growing years after the original pilot project ended in 2014. These non-interventionist, therapeutic garden projects suggest the role of autonomy and patient initiative in recovery programs for veterans attending VAMC treatment programs and they also suggest the value of horticulture therapy as a meaningful evidence- based therapeutic modality for veterans. Published by Elsevier Ltd.

  1. Veterans' Employment and Training Service

    Science.gov (United States)

    ... Find a Job Veterans.Gov Apprenticeship Occupations and Careers Women Who Served Programs & Services Transition GPS Frequently Asked Questions Hire a Veteran Find qualified Veterans Policy & Compliance Employer Toolkit Apprenticeships HIRE Vets Medallion Program Service Providers Grants & ...

  2. National Coalition for Homeless Veterans

    Science.gov (United States)

    ... Continues Support of National Campaign to End Veteran Homelessness Nov. 14, 2017 This Veterans Day, Harbor Freight ... support of the national campaign to end veteran homelessness through generous contributions to the National Coalition for ...

  3. For Homeless Veterans

    Science.gov (United States)

    ... Business with VA Acquisition, Logistics, & Construction Small & Veteran Business Programs VetBiz.gov Financial & Asset Enterprise Management Security Investigation Center/Background Clearances Freedom of Information ...

  4. Center for Women Veterans

    Science.gov (United States)

    ... Business with VA Acquisition, Logistics, & Construction Small & Veteran Business Programs VetBiz.gov Financial & Asset Enterprise Management Security Investigation Center/Background Clearances Freedom of Information ...

  5. Veterans Administration Databases

    Science.gov (United States)

    The Veterans Administration Information Resource Center provides database and informatics experts, customer service, expert advice, information products, and web technology to VA researchers and others.

  6. FUNDAMENTALS OF OPTIMIZING INPATIENT CARE FOR CHILDREN

    Directory of Open Access Journals (Sweden)

    A.A. Baranov

    2006-01-01

    Full Text Available Inpatient care for children has been considered to play an important role and to be influential in Russian healthcare system. However, a long lasting extensive development of health care system lacking sufficient finance and recourses has created a gap between the healthcare structure and capacity to provide healthcare and the needs of qualitative healthcare in the population. High number of limited ability hospitals without appropriate recourse base has already had its's day as a stage of inpatients care development. These hospitals could not provide a base for modern technology implementation and provision of present day high b quality medical care. Moreover, the current mechanism of financing «the hospital bed» but the patient has hampered medical care intensification and implementation of new technologies through loss of result orientation in medical specialists. Elaboration of efficacious means to optimize inpatient care would allow to control the rates assessing TH children's health in the country's population and to promote medical, social and economic efficacy of the inpatient care system.Key words: inpatient care, healthcare quality.

  7. US veterans and their unique issues: enhancing health care professional awareness

    Directory of Open Access Journals (Sweden)

    Olenick M

    2015-12-01

    Full Text Available Maria Olenick,1 Monica Flowers,1 Valerie J Diaz1,21Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami, FL, USA; 2Operational Health Support Unit Jacksonville, United States Navy Nurse Corps, Jacksonville, FL, USAAbstract: United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies

  8. Night eating among veterans with obesity.

    Science.gov (United States)

    Dorflinger, Lindsey M; Ruser, Christopher B; Masheb, Robin M

    2017-10-01

    The obesity rate is higher among veterans than the general population, yet few studies have examined their eating behaviors, and none have examined the presence of night eating and related comorbidities. This study examines night eating syndrome (NES) among veterans seeking weight management treatment, and relationships between NES and weight, insomnia, disordered eating, and psychological variables. The sample consisted of 110 veterans referred to a weight management program at VA Connecticut Healthcare System. More than one out of ten veterans screened positive for NES, and one-third screened positive for insomnia. Most individuals screening positive for NES also screened positive for insomnia. Night eating was associated with higher BMI, and with higher scores on measures of binge eating, emotional overeating, and eating disorder symptomatology. Veterans screening positive for NES were also significantly more likely to screen positive for depression and PTSD. When controlling for insomnia, only the relationships between night eating and binge and emotional eating remained significant. Those screening positive for PTSD were more likely to endorse needing to eat to return to sleep. Findings suggest that both NES and insomnia are common among veterans seeking weight management services, and that NES is a marker for additional disordered eating behavior, specifically binge eating and overeating in response to emotions. Additional studies are needed to further delineate the relationships among NES, insomnia, and psychological variables, as well as to examine whether specifically addressing NES within behavioral weight management interventions can improve weight outcomes and problematic eating behaviors. Published by Elsevier Ltd.

  9. Arthritis and Veterans

    Centers for Disease Control (CDC) Podcasts

    2015-11-09

    One in three veterans has arthritis. This podcast provides information on how veterans can improve their quality of life with physical activity and other arthritis management strategies.  Created: 11/9/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 11/9/2015.

  10. Inpatient Therapeutic Assessment With Narcissistic Personality Disorder.

    Science.gov (United States)

    Hinrichs, Jon

    2016-01-01

    Growing evidence supporting the effectiveness of Collaborative/Therapeutic Assessment (C/TA) has led clinicians and researchers to apply C/TA to a variety of clinical populations and treatment settings. This case example presents a C/TA inpatient adaptation illustrated with narcissistic personality disorder. After a brief overview of salient concepts, I provide a detailed account of the clinical interview, test interpretation paired with diagnostic considerations specific to narcissism, planned intervention, and discussion of assessment results. Throughout the case study, I attempt to demonstrate defining features of C/TA, inpatient adaptations, and clinical techniques that encourage meaningful engagement with a "hard to reach" personality.

  11. "FIND Technology": investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bird, M L; Cannell, J; Callisaya, M L; Moles, E; Rathjen, A; Lane, K; Tyson, A; Smith, S

    2016-04-16

    Stroke results in significant disability, which can be reduced by physical rehabilitation. High levels of repetition and activity are required in rehabilitation, but patients are typically sedentary. Using clinically relevant and fun computer games may be one way to achieve increased activity in rehabilitation. A single-blind randomized controlled trial will be conducted to evaluate the feasibility, efficacy and safety of novel stroke-specific rehabilitation software. This software uses controller-free client interaction and inertial motion sensors. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, enjoyment and ease of use of the games. Efficacy will be determined by measuring activity and using upper-limb tasks as well as measures of balance and mobility. The hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group will be tested. Results from this study will provide a basis for discussion of feasibility of this interactive video technological solution in an inpatient situation. Differences in activity levels between groups will be the primary measure of efficacy. It will also provide data on measures of upper-limb function, balance and mobility. ACTRN12614000427673 . Prospectively registered 17 April 2014.

  12. Assessing Suicide Risk in Veterans: The Role of the Nurse Practitioner

    OpenAIRE

    Kathy Puskar; Giuliana Mazza

    2012-01-01

    Background: Statistics have shown that veteran men and women are at greater risk for suicide than the general population. In order to decrease the incidence of suicide in veterans, nurse practitioners (NPs) and other health care professionals must not only become more aware of the risk factors for veteran suicides but also develop strong psychiatric interviewing skills. Purpose: To discuss the risk factors associated with veteran suicide, the assessment tools to ensure a comprehensive...

  13. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program

    Science.gov (United States)

    Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-01-01

    Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. Results More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Conclusion Integrating social determinants of health into clinical care can be effective for high

  14. Optometry within hospitals at the Veterans Administration.

    Science.gov (United States)

    Soroka, Mort; Crump, Trafford; Bennett, Amy

    2005-11-01

    This study was designed to determine the use of optometrists with the Veterans Health Administration hospital system and to develop accurate statistics regarding the number and type of services these doctors provide. The findings help describe their responsibilities in the treatment and management of ocular diseases and their use of diagnostic and therapeutic drugs. The study also investigated what, if any, role optometrists play beyond care in the education and research practices of the hospital. A descriptive analysis was conducted through the use of surveys and interviews of department chiefs or medical directors. A survey was sent out to 149 Veterans Affairs (VA) Hospitals, located using the VA facility locator Web site. Data were tabulated, aggregated, and analyzed. A response rate of 81% was achieved (122 surveys returned), 98% of which (120 facilities) provide eye services to their patients in either an outpatient or inpatient capacity. One hundred seventeen (98%) of these had optometrists affiliated with their facility. These optometrists were responsible for providing a range of services, prescribing the use of diagnostic or therapeutic drugs, and participating in educational training of other health personnel. Optometry has developed a strong partnership with the Veterans Health Administration, and act as an integral part of its hospital services. The VA has developed a workforce mix that should serve as a model for managed care organizations.

  15. Inpatient preanalytic process improvements.

    Science.gov (United States)

    Wagar, Elizabeth A; Phipps, Ron; Del Guidice, Robert; Middleton, Lavinia P; Bingham, John; Prejean, Cheryl; Johnson-Hamilton, Martha; Philip, Pheba; Le, Ngoc Han; Muses, Waheed

    2013-12-01

    Phlebotomy services are a common target for preanalytic improvements. Many new, quality engineering tools have recently been applied in clinical laboratories. However, data on relatively few projects have been published. This example describes a complete application of current, quality engineering tools to improve preanalytic phlebotomy services. To decrease the response time in the preanalytic inpatient laboratory by 25%, to reduce the number of incident reports related to preanalytic phlebotomy, and to make systematic process changes that satisfied the stakeholders. The Department of Laboratory Medicine, General Services Section, at the University of Texas MD Anderson Cancer Center (Houston) is responsible for inpatient phlebotomy in a 24-hour operation, which serves 689 inpatient beds. The study director was project director of the Division of Pathology and Laboratory Medicine's Quality Improvement Section and was assisted by 2 quality technologists and an industrial engineer from MD Anderson Office of Performance Improvement. After implementing each solution, using well-recognized, quality tools and metrics, the response time for blood collection decreased by 23%, which was close to meeting the original responsiveness goal of 25%. The response time between collection and arrival in the laboratory decreased by 8%. Applicable laboratory-related incident reports were reduced by 43%. Comprehensive application of quality tools, such as statistical control charts, Pareto diagrams, value-stream maps, process failure modes and effects analyses, fishbone diagrams, solution prioritization matrices, and customer satisfaction surveys can significantly improve preset goals for inpatient phlebotomy.

  16. The efficacy of interactive, motion capture-based rehabilitation on functional outcomes in an inpatient stroke population: a randomized controlled trial.

    Science.gov (United States)

    Cannell, John; Jovic, Emelyn; Rathjen, Amy; Lane, Kylie; Tyson, Anna M; Callisaya, Michele L; Smith, Stuart T; Ahuja, Kiran Dk; Bird, Marie-Louise

    2018-02-01

    To compare the efficacy of novel interactive, motion capture-rehabilitation software to usual care stroke rehabilitation on physical function. Randomized controlled clinical trial. Two subacute hospital rehabilitation units in Australia. In all, 73 people less than six months after stroke with reduced mobility and clinician determined capacity to improve. Both groups received functional retraining and individualized programs for up to an hour, on weekdays for 8-40 sessions (dose matched). For the intervention group, this individualized program used motivating virtual reality rehabilitation and novel gesture controlled interactive motion capture software. For usual care, the individualized program was delivered in a group class on one unit and by rehabilitation assistant 1:1 on the other. Primary outcome was standing balance (functional reach). Secondary outcomes were lateral reach, step test, sitting balance, arm function, and walking. Participants (mean 22 days post-stroke) attended mean 14 sessions. Both groups improved (mean (95% confidence interval)) on primary outcome functional reach (usual care 3.3 (0.6 to 5.9), intervention 4.1 (-3.0 to 5.0) cm) with no difference between groups ( P = 0.69) on this or any secondary measures. No differences between the rehabilitation units were seen except in lateral reach (less affected side) ( P = 0.04). No adverse events were recorded during therapy. Interactive, motion capture rehabilitation for inpatients post stroke produced functional improvements that were similar to those achieved by usual care stroke rehabilitation, safely delivered by either a physical therapist or a rehabilitation assistant.

  17. Investigation of the Impact of Sports, Exercise, and Recreation Participation on Psychosocial Outcomes in a Population of Veterans with Disabilities: A Cross-sectional Study.

    Science.gov (United States)

    Laferrier, Justin Z; Teodorski, Emily; Cooper, Rory A

    2015-12-01

    The aim of this study was to investigate possible effects that participation in sports, exercise, and recreation may have on self-esteem and quality-of-life in service members/veterans with disabilities. Two hundred twenty service members/veterans with disabilities who were participants in one of three annual adaptive sporting events took part in this cross-sectional study. Variables of interest were years of sport, exercise, and recreation participation since the onset of disability as well as the type of activity they engaged in. Main outcome measures were self-esteem and quality-of-life. A positive relationship was found between participant quality-of-life and the number of years spent participating in sports, exercise, and recreation since the onset of their disability. A significant difference was found between pre-event and postevent self-esteem scores. A significant difference was also found in self-esteem scores between the levels of years of participation in sports, exercise, and recreation when averaged across activity type. Finally, there were significant differences found on self-esteem scores between the levels of type of activity averaged across years of participation. Our results indicate that participation in sports, exercise, and recreation has a positive influence on self-esteem and quality-of-life in individuals with disabilities.

  18. Veterans Affairs Suicide Prevention Synthetic Dataset

    Data.gov (United States)

    Department of Veterans Affairs — The VA's Veteran Health Administration, in support of the Open Data Initiative, is providing the Veterans Affairs Suicide Prevention Synthetic Dataset (VASPSD). The...

  19. Brief report: Comparison of methods to identify Iraq and Afghanistan war veterans using Department of Veterans Affairs administrative data.

    Science.gov (United States)

    Bangerter, Ann; Gravely, Amy; Cutting, Andrea; Clothier, Barb; Spoont, Michele; Sayer, Nina

    2010-01-01

    The Department of Veterans Affairs (VA) has made treatment and care of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans a priority. Researchers face challenges identifying the OIF/OEF population because until fiscal year 2008, no indicator of OIF/OEF service was present in the Veterans Health Administration (VHA) administrative databases typically used for research. In this article, we compare an algorithm we developed to identify OIF/OEF veterans using the Austin Information Technology Center administrative data with the VHA Support Service Center OIF/OEF Roster and veterans' self-report of military service. We drew data from two different institutional review board-approved funded studies. The positive predictive value of our algorithm compared with the VHA Support Service Center OIF/OEF Roster and self-report was 92% and 98%, respectively. However, this method of identifying OIF/OEF veterans failed to identify a large proportion of OIF/OEF veterans listed in the VHA Support Service Center OIF/OEF Roster. Demographic, diagnostic, and VA service use differences were found between veterans identified using our method and those we failed to identify but who were in the VHA Support Service Center OIF/OEF Roster. Therefore, depending on the research objective, this method may not be a viable alternative to the VHA Support Service Center OIF/OEF Roster for identifying OIF/OEF veterans.

  20. Perspectives of family and veterans on family programs to support reintegration of returning veterans with posttraumatic stress disorder.

    Science.gov (United States)

    Fischer, Ellen P; Sherman, Michelle D; McSweeney, Jean C; Pyne, Jeffrey M; Owen, Richard R; Dixon, Lisa B

    2015-08-01

    Combat deployment and reintegration are challenging for service members and their families. Although family involvement in mental health care is increasing in the U.S. Department of Veterans Affairs (VA) system, little is known about family members' preferences for services. This study elicited the perspectives of returning Afghanistan and Iraq war veterans with posttraumatic stress disorder and their families regarding family involvement in veterans' mental health care. Semistructured qualitative interviews were conducted with 47 veterans receiving care for posttraumatic stress disorder at the Central Arkansas Veterans Healthcare System or Oklahoma City VA Medical Center and 36 veteran-designated family members. Interviews addressed perceived needs related to veterans' readjustment to civilian life, interest in family involvement in joint veteran/family programs, and desired family program content. Interview data were analyzed using content analysis and constant comparison. Both groups strongly supported inclusion of family members in programs to facilitate veterans' postdeployment readjustment and reintegration into civilian life. Both desired program content focused on information, practical skills, support, and gaining perspective on the other's experience. Although family and veteran perspectives were similar, family members placed greater emphasis on parenting-related issues and the kinds of support they and their children needed during and after deployment. To our knowledge, this is the first published report on preferences regarding VA postdeployment reintegration support that incorporates the perspectives of returning male and female veterans and those of their families. Findings will help VA and community providers working with returning veterans tailor services to the needs and preferences of this important-to-engage population. (c) 2015 APA, all rights reserved).

  1. Borderline personality disorder associates with violent criminality in women: A population based follow-up study of adolescent psychiatric inpatients in Northern Finland.

    Science.gov (United States)

    Arola, Riikka; Antila, Henna; Riipinen, Pirkko; Hakko, Helinä; Riala, Kaisa; Kantojärvi, Liisa

    2016-09-01

    Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals. The study sample consisted of 508 adolescents (age 13-17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare. A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24-29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38-13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61-38.76, pdisorder (OR 7.74, CI 2.30-26.10, p=0.001). In men, no association was observed between PD and any kind of criminal behaviour. Significant predictors for violent criminality in males were conduct disorder (OR 4.05, CI 1.75-9.38, p=0.001), substance use disorder (OR 2.51, CI 1.22-5.17, p=0.012) and special services at school (OR 2.58, CI 1.16-5.76, p=0.021). Females with Borderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Veterans Choice Program

    Data.gov (United States)

    Department of Veterans Affairs — If you are already enrolled in VA health care, the Choice Program allows you to receive health care within your community. Using this program does NOT impact your...

  3. Department of Veterans Affairs

    Science.gov (United States)

    ... Whistleblower Rights & Protections Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  4. Veterans Health Administration

    Science.gov (United States)

    ... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  5. Health Programs for Veterans

    Science.gov (United States)

    ... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  6. Veterans Health Administration (VHA)

    Data.gov (United States)

    Social Security Administration — The purpose of this agreement is for SSA to verify SSNs and other identifying information for the Department of Veterans Affairs, VHA. DVA will use the information...

  7. Suicide in Scottish military veterans: a 30-year retrospective cohort study.

    Science.gov (United States)

    Bergman, B P; Mackay, D F; Smith, D J; Pell, J P

    2017-07-01

    Although reassuring data on suicide risk in UK veterans of the 1982 Falklands conflict and 1991 Gulf conflict have been published, there have been few studies on long-term overall suicide risk in UK veterans. To examine the risk of suicide in a broad population-based cohort of veterans in Scotland, irrespect ive of length of service or exposure to conflict, in comparison with people having no record of military service. A retrospective 30-year cohort study of 56205 veterans born 1945-85 and 172741 matched non-veterans, using Cox proportional hazard models to compare the risk of suicide and fatal self-harm overall, by sex, birth cohort, length of service and year of recruitment. There were 267 (0.48%) suicides in the veterans compared with 918 (0.53%) in non-veterans. The difference was not statistically significant overall [adjusted hazard ratio (HR) 0.99; 95% confidence interval (CI) 0.86-1.13]. The incidence was lower in younger veterans and higher in veterans aged over 40. Early service leavers were at non-significantly increased risk (adjusted HR 1.13; 95% CI 0.91-1.40) but only in the older age groups. Women veterans had a significantly higher risk of suicide than non-veteran women (adjusted HR 2.44; 95% CI 1.32-4.51, P suicide did not differ significantly between veterans and non-veterans, for either sex. The Scottish Veterans Health Study adds to the emerging body of evidence that there is no overall difference in long-term risk of suicide between veterans and non-veterans in the UK. However, female veterans merit further study. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  8. The effects of homelessness on Veterans' health care service use: an evaluation of independence from comorbidities.

    Science.gov (United States)

    LePage, J P; Bradshaw, L D; Cipher, D J; Crawford, A M; Hoosyhar, D

    2014-11-01

    This study evaluates the prevalence of Multiple Comorbid Chronic Disease (MCCD) within homeless and non-homeless Veterans and the association between MCCD and inpatient medical care. All individuals seen in the VA North Texas Health Care System between October 1, 2009 and September 30, 2010 (n = 102,034) were evaluated. Homelessness during the year and the number of common chronic diseases were evaluated for an association with likelihood of medical and psychiatric hospitalizations, bed days of care, inpatient substance treatment, rehabilitation admissions, and emergency department visits. Homeless Veterans had higher all-cause mortality rates and rates of use of almost all resources after controlling for chronic disease burden using the Charlson Comorbidity Index, psychiatric illnesses, substance use disorders, and demographic variables. Homelessness Veterans are vulnerable to a high use of resources and mortality, independent of medical and psychiatric conditions. This finding should focus additional attention on reducing homelessness. Published by Elsevier Ltd.

  9. 78 FR 59426 - Board of Veterans Appeals, Veterans Information Office, Voice of the Veteran Call Center Survey...

    Science.gov (United States)

    2013-09-26

    ... Information Office, Voice of the Veteran Call Center Survey; Correction AGENCY: Board of Veterans Appeals... comment on the proposed collection. The department name should read ``Board of Veterans' Appeals (BVA... ``Board of Veterans' Appeals, Veterans Information Office, Voice of the Veterans Call Center Survey''. We...

  10. Health Disparities in Veterans: A Map of the Evidence.

    Science.gov (United States)

    Kondo, Karli; Low, Allison; Everson, Teresa; Gordon, Christine D; Veazie, Stephanie; Lozier, Crystal C; Freeman, Michele; Motu'apuaka, Makalapua; Mendelson, Aaron; Friesen, Mark; Paynter, Robin; Friesen, Caroline; Anderson, Johanna; Boundy, Erin; Saha, Somnath; Quiñones, Ana; Kansagara, Devan

    2017-09-01

    Goals for improving the quality of care for all Veterans and eliminating health disparities are outlined in the Veterans Health Administration Blueprint for Excellence, but the degree to which disparities in utilization, health outcomes, and quality of care affect Veterans is not well understood. To characterize the research on health care disparities in the Veterans Health Administration by means of a map of the evidence. We conducted a systematic search for research studies published from 2006 to February 2016 in MEDLINE and other data sources. We included studies of Veteran populations that examined disparities in 3 outcome categories: utilization, quality of health care, and patient health. We abstracted data on study design, setting, population, clinical area, outcomes, mediators, and presence of disparity for each outcome category. We grouped the data by population characteristics including race, disability status, mental illness, demographics (age, era of service, rural location, and distance from care), sex identity, socioeconomic status, and homelessness, and created maps illustrating the evidence. We reviewed 4249 citations and abstracted data from 351 studies which met inclusion criteria. Studies examining disparities by race/ethnicity comprised by far the vast majority of the literature, followed by studies examining disparities by sex, and mental health condition. Very few studies examined disparities related to lesbian, gay, bisexual, or transgender identity or homelessness. Disparities findings vary widely by population and outcome. Our evidence maps provide a "lay of the land" and identify important gaps in knowledge about health disparities experienced by different Veteran populations.

  11. Rural Veterans by State (2015)

    Data.gov (United States)

    Department of Veterans Affairs — This spreadsheet contains data from the 2015 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...

  12. Rural Veterans by State (2014)

    Data.gov (United States)

    Department of Veterans Affairs — This speadsheet contains data from the 2014 American Community Survey and shows the demographic and socioeconomic characteristics of Veterans who live in rural and...

  13. Veteran Religious Affiliation by State

    Data.gov (United States)

    Department of Veterans Affairs — This dataset provide a count of Veteran by their religious affiliation and state of residence. The dataset set covers all 50 states, District of Columbia and other...

  14. House Committee on Veterans' Affairs

    Science.gov (United States)

    ... the beaches of Normandy, from t... [...] Read Article House Doubles Down on Commitment to Veterans 08 Nov ... R-Tenn.) released the following statement after the House of Representatives passed nine veterans bills Tuesday and ...

  15. Inpatient Consultative Dermatology.

    Science.gov (United States)

    Biesbroeck, Lauren K; Shinohara, Michi M

    2015-11-01

    Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Patterns of care and survival after a cancer of unknown primary (CUP) diagnosis: A population-based nested cohort study in Australian Government Department of Veterans' Affairs clients.

    Science.gov (United States)

    Schaffer, Andrea L; Pearson, Sallie-Anne; Dobbins, Timothy A; Er, Chuang C; Ward, Robyn L; Vajdic, Claire M

    2015-08-01

    Little is known about patterns of care after a cancer of unknown primary (CUP) diagnosis. We performed a retrospective cohort study to describe and compare the treatment, health service use and survival of patients with CUP and metastatic cancer of known primary among 143,956 Australian Government Department of Veterans' Affairs clients, 2004-2007. We randomly matched clients with CUP (C809; n=252) with clients with a first diagnosis of metastatic solid cancer of known primary (n=980). We ascertained health services from the month of diagnosis up to 2 months post-diagnosis for consultations, hospitalizations and emergency department visits, and up to 1 year for treatment. We compared cancer treatments using conditional logistic regression; consultation rates using negative binomial regression; and survival using stratified Cox regression. 30% of CUP patients and 70% of patients with known primary received cancer treatment and the median survival was 37 days and 310 days respectively. CUP patients received fewer cancer medicines (odds ratio (OR)=0.54, 95% confidence interval (CI) 0.33-0.89) and less cancer-related surgery (OR=0.25, 95% CI 0.15-0.41); males with CUP received more radiation therapy (OR=2.88, 95% CI 1.69-4.91). CUP patients had more primary care consultations (incidence rate ratio (IRR)=1.25, 95% CI 1.11-1.41), emergency department visits (IRR=1.86, 95% CI 1.50-2.31) and hospitalizations (IRR=1.18, 95% CI 1.03-1.35), and a higher risk of death within 30 days (hazard ratio=3.30, 95% CI 1.69-6.44). Patients with CUP receive less treatment but use more health services, which may reflect underlying patient and disease characteristics. Copyright © 2015 Commonwealth of Australia. Published by Elsevier Ltd.. All rights reserved.

  17. Prevalence of Human Immunodeficiency Virus, Hepatitis C Virus, and Hepatitis B Virus Among Homeless and Nonhomeless United States Veterans.

    Science.gov (United States)

    Noska, Amanda J; Belperio, Pamela S; Loomis, Timothy P; O'Toole, Thomas P; Backus, Lisa I

    2017-07-15

    Veterans are disproportionately affected by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Homeless veterans are at particularly high risk for HIV, HCV, and HBV due to a variety of overlapping risk factors, including high rates of mental health disorders and substance use disorders. The prevalence of HIV, HCV, and HBV among homeless veterans nationally is currently unknown. This study describes national testing rates and prevalence of HIV, HCV, and HBV among homeless veterans. Using data from the Department of Veterans Affairs (VA) Corporate Warehouse Data from 2015, we evaluated HIV, HCV, and HBV laboratory testing and infection confirmation rates and diagnoses on the Problem List for nonhomeless veterans and for veterans utilizing homeless services in 2015. Among 242740 homeless veterans in VA care in 2015, HIV, HCV, and HBV testing occurred in 63.8% (n = 154812), 78.1% (n = 189508), and 52.8% (n = 128262), respectively. The HIV population prevalence was 1.52% (3684/242740) among homeless veterans, compared with 0.44% (23797/5424685) among nonhomeless veterans. The HCV population prevalence among homeless veterans was 12.1% (29311/242740), compared with 2.7% (148079/5424685) among nonhomeless veterans, while the HBV population prevalence was 0.99% (2395/242740) for homeless veterans and 0.40% (21611/5424685) among nonhomeless veterans. To our knowledge this work represents the most comprehensive tested prevalence and population prevalence estimates of HIV, HCV, and HBV among homeless veterans nationally. The data demonstrate high prevalence of HIV, HCV, and HBV among homeless veterans, and reinforce the need for integrated healthcare services along with homeless programming. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  18. Do Veterans With Posttraumatic Stress Disorder Receive First-Line Pharmacotherapy? Results From the Longitudinal Veterans Health Survey

    Science.gov (United States)

    Greenbaum, Mark A.; Rosen, Craig S.

    2012-01-01

    Objective: Guidelines addressing the treatment of veterans with posttraumatic stress disorder (PTSD) strongly recommend a therapeutic trial of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This study examined veteran characteristics associated with receiving such first-line pharmacotherapy, as well as how being a veteran of the recent conflicts in Afghanistan and Iraq impact receipt of pharmacotherapy for PTSD. Method: This was a national study of 482 Veterans Affairs (VA) outpatients between the ages of 18 and 69 years who had been newly diagnosed with PTSD (DSM-IV criteria: 309.81) during a VA outpatient visit between May 31, 2006, and December 7, 2007. Participants completed a mailed survey between August 11, 2006, and April 6, 2008. Veterans from the Afghanistan and Iraq conflicts and female veterans were intentionally oversampled. Logistic regression models were developed to predict 2 dependent variables: odds of initiating an SSRI/SNRI and, among veterans who initiated an SSRI/SNRI, odds of receiving an adequate therapeutic trial. Each dependent variable was regressed on a variety of sociodemographic and survey characteristics. Results: Of the 377 veterans prescribed a psychotropic medication, 73% (n = 276) received an SSRI/SNRI, of whom 61% (n = 168) received a therapeutic trial. Afghanistan and Iraq veterans were less likely to receive a therapeutic trial (odds ratio [OR] = 0.45; 95% CI, 0.27–0.75; P < .01), with presence of a comorbid depression diagnosis in the year after the index episode moderating this relationship, which further decreased the odds of completing a therapeutic trial (OR = 0.29; 95% CI, 0.09–0.95; P < .05). Conclusions: Reduced levels of receipt of first-line pharmacotherapy among recent veteran returnees parallel previous findings of less mental health treatment utilization in this population and warrant investigation. PMID:22943028

  19. Neuroepidemiologic Case Definition of Gulf War Illness from Neuroimaging and EEG in a Population-Representative Nested Case-Control Sample of Gulf War Veterans

    Science.gov (United States)

    2017-10-01

    papers published – months 9-36 The purpose of this project is to complete the statistical analyses and write scientific papers describing various aspects...sample (N=8,020) of the 1991 U.S. military population. Survey research; population sample; disease description; longitudinal study; statistical ...interventions;  new business creation; and  other. Nothing to Report. 13 7. PARTICIPANTS & OTHER COLLABORATING

  20. Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study.

    Science.gov (United States)

    Chang, Su-Hsin; Luo, Suhong; O'Brian, Katiuscia K; Thomas, Theodore S; Colditz, Graham A; Carlsson, Nils P; Carson, Kenneth R

    2015-01-01

    Multiple myeloma is one of the most common haematological malignancies in the USA and is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). We aimed to assess the association between metformin use and progression of MGUS to multiple myeloma. We did a retrospective cohort study of patients registered in the US Veterans Health Administration database and diagnosed with MGUS between Oct 1, 1999, and Dec 31, 2009. We included patients (aged >18 years) with at least one International Classification of Diseases (9th revision) code for diabetes mellitus and one treatment for their diabetes before MGUS diagnosis. We reviewed patient-level clinical data to verify diagnoses and extract any available data for size of baseline M-protein and type of MGUS. We defined metformin users as patients with diabetes who were given metformin consistently for 4 years after their diabetes diagnosis and before multiple myeloma development, death, or censorship. Our primary outcome was time from MGUS diagnosis to multiple myeloma diagnosis. We used Kaplan-Meier curves and Cox models to analyse the association between metformin use and MGUS progression. We obtained data for 3287 patients, of whom 2003 (61%) were included in the final analytical cohort. Median follow-up was 69 months (IQR 49–96). 463 (23%) participants were metformin users and 1540 (77%) participants were non-users. 13 (3%) metformin users progressed to multiple myeloma compared with 74 (5%) non-users. After adjustment, metformin use was associated with a reduced risk of progression to multiple myeloma (hazard ratio 0·47, 95% CI 0·25–0·87). For patients with diabetes diagnosed with MGUS, metformin use for 4 years or longer was associated with a reduced risk of progression of MGUS to multiple myeloma. Prospective studies are needed to establish whether this association is causal and whether these results can be extrapolated to non-diabetic individuals. Barnes-Jewish Hospital Foundation

  1. Social phobia and PTSD in Vietnam veterans.

    Science.gov (United States)

    Orsillo, S M; Heimberg, R G; Juster, H R; Garrett, J

    1996-04-01

    Posttraumatic stress disorder (PTSD) is the most prevalent psychological disorder experienced by Vietnam veterans. However, there are many other disorders and problems of adjustment, like social anxiety and social phobia, that have not been fully investigated in this population. This study examined the prevalence of social phobia and the comorbidity of social phobia and PTSD, and tested out a theory of the etiology of social anxiety in trauma victims. Forty one Vietnam combat veterans were interviewed and completed self-report measures assessing PTSD and social phobia. Adversity of homecoming was also assessed. Using a conservative multi-method assessment approach, 32% of the sample were found to be positive for both social phobia and PTSD. Veterans with PTSD were significantly more likely to carry an additional diagnosis of social phobia as compared to veterans without PTSD. Adversity of homecoming and shame about one's experience in Vietnam were significant predictors of current level of social anxiety over and above the effects of pre-military anxiety and severity of combat exposure. These observations suggest that social anxiety and social phobia may be significant problems among individuals with PTSD. Further, these findings offer preliminary support for the theory that posttrauma environment may impact upon the later development of social anxiety.

  2. Late-life functional capacity and health among Finnish war veterans:Veteran Project 1992 and 2004 surveys

    OpenAIRE

    Leskinen, R. (Riitta)

    2015-01-01

    Abstract Becoming involved in war is an experience that has the potential to shape later-life health. The aim of the present study was to explore Finnish Second World War veterans’ health status and the determinants of self-rated health (SRH) and functional capacity, especially the ability to walk, and to identify risk factors and their combinations that predict late-life mortality among veterans. The study population comprised Finnish Second World War veterans who participated in the ...

  3. Severe hearing impairment among military veterans--United States, 2010.

    Science.gov (United States)

    2011-07-22

    A substantial proportion of hearing loss in the United States is attributable to employment-related exposure to noise. Among military veterans, the most common service-connected disabilities are hearing impairments, suggesting that occupational noise exposure during military service might cause more veterans to have hearing loss than nonveterans. However, a recent analysis of data from the 1993-1995 Epidemiology of Hearing Loss Study did not find significant differences between the two groups. To further investigate hearing loss among veterans, specifically the prevalence of severe hearing impairment (SHI), data from the 2010 Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) were analyzed. This report describes the results of those analyses, which indicated that the prevalence of SHI among veterans was significantly greater than among nonveterans. Veterans were 30% more likely to have SHI than nonveterans after adjusting for age and current occupation, and veterans who served in the United States or overseas during September 2001-March 2010, the era of overseas contingency operations (including Operations Enduring Freedom and Iraqi Freedom), were four times more likely than nonveterans to have SHI. These findings suggest a need for increased emphasis on improving military hearing conservation programs (HCPs) and on hearing loss surveillance in military and veterans' health systems.

  4. All-Cause Mortality Among US Veterans of the Persian Gulf War

    Science.gov (United States)

    Kang, Han K.; Bullman, Tim

    2016-01-01

    Objective: We determined cause-specific mortality prevalence and risks of Gulf War deployed and nondeployed veterans to determine if deployed veterans were at greater risk than nondeployed veterans for death overall or because of certain diseases or conditions up to 13 years after conflict subsided. Methods: Follow-up began when the veteran left the Gulf War theater or May 1, 1991, and ended on the date of death or December 31, 2004. We studied 621   901 veterans who served in the 1990-1991 Persian Gulf War and 746   247 veterans who served but were not deployed during the Gulf War. We used Cox proportional hazard models to calculate rate ratios adjusted for age at entry to follow-up, length of follow-up, race, sex, branch of service, and military unit. We compared the mortality of (1) Gulf War veterans with non–Gulf War veterans and (2) Gulf War army veterans potentially exposed to nerve agents at Khamisiyah in March 1991 with those not exposed. We compared standardized mortality ratios of deployed and nondeployed Gulf War veterans with the US population. Results: Male Gulf War veterans had a lower risk of mortality than male non–Gulf War veterans (adjusted rate ratio [aRR] = 0.97; 95% confidence interval [CI], 0.95-0.99), and female Gulf War veterans had a higher risk of mortality than female non–Gulf War veterans (aRR = 1.15; 95% CI, 1.03-1.28). Khamisiyah-exposed Gulf War army veterans had >3 times the risk of mortality from cirrhosis of the liver than nonexposed army Gulf War veterans (aRR = 3.73; 95% CI, 1.64-8.48). Compared with the US population, female Gulf War veterans had a 60% higher risk of suicide and male Gulf War veterans had a lower risk of suicide (standardized mortality ratio = 0.84; 95% CI, 0.80-0.88). Conclusion: The vital status and mortality risk of Gulf War and non–Gulf War veterans should continue to be investigated. PMID:28123229

  5. Understanding the health of veterans who are homeless: A review of the literature.

    Science.gov (United States)

    Weber, Jillian; Lee, Rebecca C; Martsolf, Donna

    2017-09-01

    The United States Department of Housing and Urban Development estimates that almost 50,000 veterans are homeless on any given night. Homeless veterans are at greater risk of health disparities than their housed counterparts due to the multifactorial nature of their health and social needs. The Department of Veterans Affairs, in collaboration with more than a dozen other federal agencies, has concentrated efforts to improve the health of this vulnerable population while enacting a plan to eliminate veteran homelessness within the near future. Understanding the unique health needs of veterans who are homeless allows the profession of nursing to better support these efforts. The purpose of this literature review was to provide comprehensive knowledge to nurses about the health of homeless veterans for their use in clinical practice, research, and in contributing to the positive health outcomes for this vulnerable population. © 2017 Wiley Periodicals, Inc.

  6. Supported Employment for Veterans With Traumatic Brain Injury: Patient Perspectives.

    Science.gov (United States)

    Carlson, Kathleen F; Pogoda, Terri K; Gilbert, Tess A; Resnick, Sandra G; Twamley, Elizabeth W; O'Neil, Maya E; Sayer, Nina A

    2018-02-01

    To quantify the need for, and interest in, supported employment (SE) among recent military veterans with traumatic brain injury (TBI); and to examine characteristics associated with veterans' interest in SE. Stratified random sample of Iraq and Afghanistan War veterans confirmed to have TBI through the Veterans Health Administration (VHA) screening and evaluation system. Community-based via mailed survey. We recruited 1800 veterans with clinician-confirmed TBI (mild TBI: n=1080; moderate/severe TBI: n=720) through multiple mailings. Among 1451 surveys that were not returned undeliverable, N=616 (42%) responded. Not applicable. Veterans rated their interest in SE after reading a script describing the program. Additional measures assessed mental health and pain-related comorbidities, employment, financial/housing difficulties, demographics, and military service characteristics. Estimates were weighted to represent the population of veterans with VHA clinician-confirmed TBI. Unemployment was reported by 45% (95% confidence interval [CI], 43-47) of veterans with TBI. Although 42% (95% CI, 40-44) reported they would be interested in using SE if it were offered to them, only 12% had heard of SE (95% CI, 11-14) and interest in SE. However, those who were unemployed, looking for work, experiencing financial strain, or at risk for homelessness were more likely to be interested in SE. Our research highlights an important gap between veterans' vocational needs and interests and their use of SE. Systematically identifying and referring those with employment and financial/housing difficulties may help close this gap. Published by Elsevier Inc.

  7. Suicide and substance use among female veterans: a need for research.

    Science.gov (United States)

    Chapman, Shawna L Carroll; Wu, Li-Tzy

    2014-03-01

    The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Reliability and Validity of the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF) in a Homeless Substance Dependent Veteran Population

    Science.gov (United States)

    Garcia-Rea, Elizabeth A.; LePage, James P.

    2010-01-01

    With the high number of homeless, there is a critical need for rapid and accurate assessment of quality of life to assess program outcomes. The World Health Organization's WHOQOL-100 has demonstrated promise in accurately assessing quality-of-life in this population. However, its length may make large scale use impractical for working with a…

  9. Intimate partner violence among women veterans by sexual orientation.

    Science.gov (United States)

    Dardis, Christina M; Shipherd, Jillian C; Iverson, Katherine M

    2017-08-01

    National estimates suggest intimate partner violence (IPV) rates are equal or higher among lesbian, bisexual, or questioning (LBQ)-identified women than heterosexual-identified women. Women veterans are a population at high risk for IPV, yet the occurrence of lifetime and past-year IPV experiences by sexual orientation have not been examined in this population. Lifetime and past-year IPV experiences and current IPV-related posttraumatic stress disorder (PTSD) symptoms were assessed with validated screening measures as part of a 2014 web-based national survey of women veterans. Among 403 respondents, 9.7% (n = 39) identified as LBQ, and 90.3% (n = 364) identified as heterosexual. When controlling for age, LBQ-identified women veterans were significantly more likely to report lifetime sexual and physical IPV and lifetime intimate partner stalking. In the past year, LBQ-identified veterans were twice as likely to endorse emotional mistreatment and physical IPV, and three times more likely to endorse sexual IPV, than were heterosexual-identified women veterans. However, sexual orientation was unrelated to IPV-related PTSD symptoms, when controlling for age, race, and number IPV forms experienced. IPV is prevalent among LBQ-identified women veterans, suggesting the need to understand the potentially unique contextual factors and health-care needs of this group.

  10. Health service utilisation and investigations before diagnosis of cancer of unknown primary (CUP): A population-based nested case-control study in Australian Government Department of Veterans' Affairs clients.

    Science.gov (United States)

    Vajdic, Claire M; Schaffer, Andrea L; Dobbins, Timothy A; Ward, Robyn L; Er, Chuang C; Pearson, Sallie-Anne

    2015-08-01

    Population-based data on the use of health services and diagnostic investigations for patients with cancer of unknown primary (CUP) is scarce. It is uncertain whether the pathways to diagnosis are different for CUP compared to other cancers. We performed a population-based nested matched case-control study using linked routinely collected records for Australian Government Department of Veterans' Affairs clients, 2004-2007. We compared health care consultations, hospitalisations, emergency department visits, and diagnostic procedures in the three months prior and the month of diagnosis for 281 clients registered with a diagnosis of CUP (C809) and 1102 controls randomly selected from clients registered with a first diagnosis of metastatic cancer of known primary. Overall, the median age at cancer diagnosis was 83 years. CUP patients were slightly older and had significantly more comorbidities prior to diagnosis than those with known primary. Compared to known primary, a diagnosis of CUP was significantly more likely after an emergency department visit, less specialist input, fewer invasive diagnostic procedures such as resection or endoscopy, and more non-invasive procedures such as magnetic resonance imaging. There were no differences in primary care or allied health consultations and hospitalisations. This health care pathway suggests delayed recognition of cancer and scope for improvement in the medical management of high-risk individuals presenting to primary care. The pattern of diagnostic investigations reveals under-investigation in some CUP patients but this is likely to reflect recognition of limited treatment options and poor prognosis and is consistent with clinical guidelines. Copyright © 2015 Commonwealth of Australia. Published by Elsevier Ltd.. All rights reserved.

  11. Profile of Vietnam War Veterans (2015).

    Data.gov (United States)

    Department of Veterans Affairs — The Profile of Vietnam War Veterans uses the 2015 ACS to provide a view into the demographic characteristics and socioeconomic conditions of the Vietnam War Veteran...

  12. VA Veterans Health Administration Access Data

    Data.gov (United States)

    Department of Veterans Affairs — At the Department of Veterans Affairs (VA), our most important mission is to provide the high quality health care and benefits Veterans have earned and deserve —...

  13. Veterans Crisis Line: 1-800-273-8255

    Science.gov (United States)

    Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There ... Line FAQs Veteran Suicide Welcome to the Veterans Crisis Line Website The Veterans Crisis Line connects Veterans ...

  14. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from Veterans Health ... videos from Veterans Health Administration Talking About It Matters see more videos from Veterans Health Administration Stand ...

  15. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... About About the Veterans Crisis Line FAQs Veteran Suicide Spread the Word Videos Homeless Resources Additional Information ... About About the Veterans Crisis Line FAQs Veteran Suicide The Veterans Crisis Line text-messaging service does ...

  16. Gambling problems and the impact of family in UK armed forces veterans.

    Science.gov (United States)

    Dighton, Glen; Roberts, Elystan; Hoon, Alice E; Dymond, Simon

    2018-05-09

    Background and aims International evidence indicates elevated problem gambling rates in armed forces veterans compared with the general population. Gambling problems adversely impact one's family, and family-related variables may increase vulnerability to gambling-related harm. Little is known, however, about gambling problems in the United Kingdom (UK) veterans or to what extent family variables, such as parenting history and experience of domestic violence, influence veterans' gambling. Methods We compared veterans (n = 257) and sex- and age-matched controls (n = 514) drawn from the 2007 Adult Psychiatric Morbidity Survey on gambling, financial management, domestic violence, childhood parental presence, and experience of stressful life events. Veterans who left the military before or after 4 years of service were compared. Results Problem gambling was significantly more prevalent in veterans (1.4%) than non-veterans (0.2%), and the impact of gambling problems on the family was specific to male veterans, particularly those who had experienced a traumatic event after the age of 16, and those who were more likely to have been physically attacked by their partner. Overall, this study revealed that the UK armed forces veterans report a higher prevalence rate of problem gambling compared with non-veterans, with potential negative impact on family life.

  17. Utilization of Mental Health Services by Veterans Living in Rural Areas.

    Science.gov (United States)

    Teich, Judith; Ali, Mir M; Lynch, Sean; Mutter, Ryan

    2017-06-01

    There is concern that veterans living in rural areas may not be receiving the mental health (MH) treatment they need. This study uses recent national survey data to examine the utilization of MH treatment among military veterans with a MH condition living in rural areas, providing comparisons with estimates of veterans living in urban areas. Multivariable logistic regression is utilized to examine differences in MH service use by urban/rural residence, controlling for other factors. Rates of utilization of inpatient and outpatient treatment, psychotropic medication, any MH treatment, and perceived unmet need for MH care are examined. There were significant differences in MH treatment utilization among veterans by rural/urban residence. Multivariate estimates indicate that compared to veterans with a MH condition living in urban areas, veterans in rural areas had 70% lower odds of receiving any MH treatment. Veterans with a MH condition in rural areas have approximately 52% and 64% lower odds of receiving outpatient treatment and prescription medications, respectively, compared to those living in urban areas. Differences in perceived unmet need for mental health treatment were not statistically significant. While research indicates that recent efforts to improve MH service delivery have resulted in improved access to services, this study found that veterans' rates of MH treatment are lower in rural areas, compared to urban areas. Continued efforts to support the provision of behavioral health services to rural veterans are needed. Telemedicine, using rural providers to their maximum potential, and engagement with community stakeholder groups are promising approaches. © 2016 National Rural Health Association.

  18. Hospital System Performance within Veterans Affairs

    Data.gov (United States)

    Department of Veterans Affairs — Strategic Analytics for Improvement and Learning Value Model or SAIL, is a system for summarizing hospital system performance within Veterans Health Administration...

  19. Cancer in US Air Force veterans not involved with spraying herbicides during the Vietnam War

    Energy Technology Data Exchange (ETDEWEB)

    Pavuk, M. [SpecPro, Inc. (United States); Michalek, J.; Ketchum, N. [Air Force Research Laboratory, San Antonio, TX (United States); Akhtar, F. [The START Center, San Antonio, TX (United States)

    2004-09-15

    The Air Force Health Study is a 20-year prospective study examining the health, mortality and reproductive outcomes in US Air Force veterans of Operation Ranch Hand who sprayed herbicides in Vietnam from 1962 to 1971. Comparison veterans flew or serviced C-130 transport aircraft in Southeast Asia (SEA) during the same time period but did not spray herbicides. They were stationed mostly in Taiwan, the Philippines, Guam, Japan, and Thailand and spent on average less than 30% of their SEA service in Vietnam. Comparison veterans also spent approximately 30% more time in SEA than Ranch Hand veterans. No increases in Ranch Hand cancer mortality and morbidity were found in earlier investigations, but a recent study contrasting cancer rates in Air Force veterans and in the general US (white male) population reported increases in cancer at all SEER sites, prostate cancer and melanoma in Ranch Hand veterans and cancer at all SEER sites and prostate cancer in Comparison veterans. Associations between dioxin exposure category and cancer were found after restriction to Ranch Hand veterans who served in SEA no more than 2 years and to those who spent all of their SEA service in Vietnam. Overall cancer incidence in the general population in countries of SEA is about half of that in the United States, but cancers of the oral cavity/nasopharynx and liver are more prevalent in this region. Here we examine in more detail whether years served in SEA had any effect on the risk of cancer among Comparison veterans.

  20. Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010.

    Science.gov (United States)

    Britton, Peter C; Bohnert, Kipling M; Ilgen, Mark A; Kane, Cathleen; Stephens, Brady; Pigeon, Wilfred R

    2017-09-01

    The purpose of this study was to calculate suicide rates and identify correlates of risk in the year following discharge from acute Veterans Health Administration psychiatric inpatient units among male veterans discharged from 2005 to 2010 (fiscal years). Suicide rates and standardized mortality ratios were calculated. Descriptive analyses were used to describe suicides and non-suicides and provide base rates for interpretation, and unadjusted and adjusted proportional hazard models were used to identify correlates of suicide. From 2005 to 2010, 929 male veterans died by suicide in the year after discharge and the suicide rate was 297/100,000 person-years (py). The suicide rate significantly increased from 234/100,000 py (95% CI = 193-282) in 2005 to 340/100,000 py (95% CI = 292-393) in 2008, after which it plateaued. Living in a rural setting, HR (95% CI) = 1.20 (1.05, 1.36), and being diagnosed with a mood disorder such as major depression, HR (95% CI) = 1.60 (1.36, 1.87), or other anxiety disorder, HR (95% CI) = 1.52 (1.24, 1.87), were associated with increased risk for suicide. Among male veterans, the suicide rate in the year after discharge from acute psychiatric hospitalization increased from 2005 to 2008, after which it plateaued. Prevention efforts should target psychiatrically hospitalized veterans who live in rural settings and/or are diagnosed with mood or other anxiety disorders.

  1. Accuracy and completeness of mortality data in the Department of Veterans Affairs

    Directory of Open Access Journals (Sweden)

    Maynard Charles

    2006-04-01

    Full Text Available Abstract Background One of the national mortality databases in the U.S. is the Beneficiary Identification and Record Locator Subsystem (BIRLS Death File that contains death dates of those who have received any benefits from the Department of Veterans Affairs (VA. The completeness of this database was shown to vary widely from cohort to cohort in previous studies. Three other sources of death dates are available in the VA that can complement the BIRLS Death File. The objective of this study is to evaluate the completeness and accuracy of death dates in the four sources available in the VA and to examine whether these four sources can be combined into a database with improved completeness and accuracy. Methods A random sample of 3,000 was drawn from 8.3 million veterans who received benefits from the VA between 1997 and 1999 and were alive on January 1, 1999 according to at least one source. Death dates found in BIRLS Death File, Medical SAS Inpatient Datasets, Medicare Vital Status, and Social Security Administration (SSA Death Master File were compared with dates obtained from the National Death Index. A combined dataset from these sources was also compared with National Death Index dates. Results Compared with the National Death Index, sensitivity (or the percentage of death dates correctly recorded in a source was 77.4% for BIRLS Death File, 12.0% for Medical SAS Inpatient Datasets, 83.2% for Medicare Vital Status, and 92.1% for SSA Death Master File. Over 95% of death dates in these sources agreed exactly with dates from the National Death Index. Death dates in the combined dataset demonstrated 98.3% sensitivity and 97.6% exact agreement with dates from the National Death Index. Conclusion The BIRLS Death File is not an adequate source of mortality data for the VA population due to incompleteness. When the four sources of mortality data are carefully combined, the resulting dataset can provide more timely data for death ascertainment than the

  2. Treating Iraq and Afghanistan War Veterans with PTSD Who Are at High Risk for Suicide

    Science.gov (United States)

    Jakupcak, Matthew; Varra, Edward M.

    2011-01-01

    Iraq and Afghanistan War veterans diagnosed with psychiatric disorders commit suicide at a higher rate than the general population (Kang & Bullman, 2008). Posttraumatic stress disorder (PTSD) has been identified as a risk factor for suicide in veterans (Bullman & Kang, 1994) and is the most common mental disorder among Iraq and Afghanistan…

  3. From Camouflage to Classrooms: An Empirical Examination of Veterans at a Regional Midwestern University

    Science.gov (United States)

    Oberweis, Trish; Bradford, Matthew

    2017-01-01

    Despite a large and growing population of former military service members entering colleges and universities, there is very little empirical work that examines veterans' perspectives on service needs or their perceptions and attitudes about their college experience. Much of what we know of student veterans' views is based on a different generation…

  4. From Camouflage to Classroom: Designing a Transition Curriculum for New Student Veterans

    Science.gov (United States)

    Osborne, Nicholas J.

    2016-01-01

    The landscape of higher education necessitates that strategies be in place to meet the needs of an ever changing student population. Since 2009, the Post-9/11 GI Bill has spurred an increased enrollment of student veterans that is forecasted to rise. Students who are veterans have unique experiences related to their service, age, and work-life…

  5. Homeless Aging Veterans in Transition: A Life-Span Perspective

    Directory of Open Access Journals (Sweden)

    Carla J. Thompson

    2013-01-01

    Full Text Available The need for counseling and career/educational services for homeless veterans has captured political and economic venues for more than 25 years. Veterans are three times more likely to become homeless than the general population if veterans live in poverty or are minority veterans. This mixed methods study emphasized a life-span perspective approach for exploring factors influencing normative aging and life-quality of 39 homeless veterans in Alabama and Florida. Seven descriptive quantitative and qualitative research questions framed the investigation. Study participants completed a quantitative survey reflecting their preferences and needs with a subset of the sample (N=12 also participating in individual qualitative interview sessions. Thirty-two service providers and stakeholders completed quantitative surveys. Empirical and qualitative data with appropriate triangulation procedures provided interpretive information relative to a life-span development perspective. Study findings provide evidence of the need for future research efforts to address strategies that focus on the health and economic challenges of veterans before they are threatened with the possibility of homelessness. Implications of the study findings provide important information associated with the premise that human development occurs throughout life with specific characteristics influencing the individual’s passage. Implications for aging/homelessness research are grounded in late-life transitioning and human development intervention considerations.

  6. Gene expression associated with suicide attempts in US veterans (Open Access)

    Science.gov (United States)

    2017-09-05

    depression , bipolar disorder, alcohol use disorder9 and intermittent explosive disorder.8 However, because suicide attempts occur in the context of many... suicidal ideation in a genome wide associa- tion study of depressed inpatients.25 These results provide partial replication of gene expression...OPEN ORIGINAL ARTICLE Gene expression associated with suicide attempts in US veterans JD Flory1,2,7, D Donohue3,7, S Muhie3, R Yang4, SA Miller3, R

  7. Danish Gulf War Veterans Revisited

    DEFF Research Database (Denmark)

    Nissen, Lars Ravnborg; Stoltenberg, Christian; Nielsen, Anni B Sternhagen

    2016-01-01

    OBJECTIVE: To examine the assumption that postdeployment incidence of sickness and other absence from work are higher among Gulf War Veterans compared with nonveterans. METHODS: A prospective registry study including a cohort of 721 Danish Gulf War Veterans and a control cohort of 3,629 nonveterans...... and nonveterans in the incidence rate of long-term sickness absence. After an initial short period (3 months) with elevated incidence rate of long-term absence from work among veterans, there was no difference between the cohorts. CONCLUSION: Among Danish Gulf War Veterans, no postdeployment increased risk...... outcomes and information on deployment history was studied using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until April 27, 2014. RESULTS: As the main finding, no difference was found between veterans...

  8. Induced abortion among women veterans: data from the ECUUN study.

    Science.gov (United States)

    Schwarz, Eleanor Bimla; Sileanu, Florentina E; Zhao, Xinhua; Mor, Maria K; Callegari, Lisa S; Borrero, Sonya

    2018-01-01

    We compared rates of induced abortion among women veterans receiving Veterans Affairs (VA) healthcare to rates in the general US population, as current policy prohibits VA provision of abortion counseling or services even when pregnancy endangers a veteran's life. We analyzed data from 2298 women veterans younger than 45 years who completed a telephone-based, cross-sectional survey of randomly sampled English-speaking women from across the United States who had received VA healthcare. We compared lifetime, last-5-year and last-year rates of unintended pregnancy and abortion among participants to age-matched data from the National Survey of Family Growth. As few abortions were reported in the last year, we used multivariable logistic regression to examine associations between abortion in the last 5 years and age, race/ethnicity, income, education, religion, marital status, parity, geography, deployment history, housing instability, and past medical and mental health among VA patients. Women veterans were more likely than matched US women to report ever having an abortion [17.7%, 95% confidence interval (CI): 16.1%-19.3% vs. 15.2% of US women]. In the last 5 years, unintended pregnancy and abortion were reported by veterans at rates similar to US women. In multivariable models, VA patients were more likely to report abortion in the last 5 years if their annual income was less than $40,000 (adjusted odds ratio (OR) 2.95, 95% CI 1.30-6.70), they had experienced homelessness or housing instability (adjusted OR 1.91, 95% CI 1.01-3.62), they were single (adj. OR 2.46, 95% CI 1.23-4.91) and/or they had given birth (adjusted OR 2.29, 95% CI 1.19-4.40). Women veterans face unintended pregnancy and seek abortion as often as the larger US population. The Veterans Health Care Act, which prohibits provision of abortion services, increases vulnerable veterans' out-of-pocket healthcare costs and limits veterans' reproductive freedom. Copyright © 2017. Published by Elsevier Inc.

  9. Bone mineral density scans in veterans

    Directory of Open Access Journals (Sweden)

    Elizabeth Bass

    2007-07-01

    Full Text Available Elizabeth Bass1,2, Etienne Pracht1,3, Philip Foulis4,51VISN 8 Patient Safety Center of Inquiry, Tampa, FL; 2School of Aging Studies, University of South Florida, Tampa, FL, USA; 3College of Public Health, University of South Florida, Tampa, FL, USA; 4James A Haley VA Hospital, Tampa, FL, USA; 5Pathology and Laboratory Medicine, College of Medicine, University of South Florida, Tampa, FL, USAGoals: Recent findings suggest the prevalence of osteoporosis among men is under-recognized. The patient population of the Veterans Health Administration (VA is predominantly male and many elderly veterans may be at risk of osteoporosis. Given the lack of data on male osteoporosis, we provide initial insight into diagnostic procedures for patients at one VA medical center. Procedures: A review and descriptive analysis of patients undergoing radiological evaluation for osteoporosis at one VA medical center.Results: We identified 4,919 patients who had bone mineral density scans from 2001–2004. VA patients receiving bone mineral density scans were commonly white, male, over age 70 and taking medications with potential bone-loss side effects.Conclusions: While further research is needed, preliminary evidence suggests that the VA screens the most vulnerable age groups in both genders. Heightened awareness among primary care providers of elderly male patients at risk of osteoporosis can lead to early intervention and improved management of this age-related condition.Keywords: bone mineral density scans, osteoporosis, veterans

  10. Mortality among inpatients of a psychiatric hospital: Indian perspective.

    Science.gov (United States)

    Shinde, Shireesh Shatwaji; Nagarajaiah; Narayanaswamy, Janardhanan C; Viswanath, Biju; Kumar, Naveen C; Gangadhar, B N; Math, Suresh Bada

    2014-04-01

    The objective of this study is to assess mortality and its correlates among psychiatric inpatients of a tertiary care neuropsychiatric hospital. Given the background that such a study has never been undertaken in India, the findings would have a large bearing on policy making from a mental health-care perspective. The medical records of those psychiatric inpatients (n = 333) who died during their stay at the National Institute of Mental Health and Neurosciences in past 26 years (January 1983 to December 2008) constituted the study population. During the 26 years, there were a total of 103,252 psychiatric in-patient admissions, out of which 333 people died during their inpatient stay. Majority (n = 135, 44.6%) of the mortality was seen in the age group of 21-40 years. Most of the subjects were males (n = 202, 67%), married (n = 172, 56.8%) and from urban areas (n = 191, 63%). About, 54% of the subjects had short inpatient stay (history of physical illness. Leading cause of death were cardiovascular system disorders (n = 132, 43.6%), followed by respiratory system disorders (n = 45, 14.9%), nervous system disorders (n = 30, 9.9%) and infections (n = 31, 10.1%). In 21 (7%), cause of death was suicide. Identifying the factors associated with the death of inpatients is of utmost importance in assessing the care in a neuropsychiatric hospital and in formulating better treatment plan and policy in mental health. The discussion focuses on the analysis of different factors associated with inpatient mortality.

  11. Eating disorders and associated mental health comorbidities in female veterans.

    Science.gov (United States)

    Mitchell, Karen S; Rasmusson, Ann; Bartlett, Brooke; Gerber, Megan R

    2014-11-30

    Eating disorders (EDs) remain understudied among veterans, possibly due to the perception that primarily male population does not suffer from EDs. However, previous research suggests that male and female veterans do experience EDs. The high rates of posttraumatic stress disorder (PTSD), depression, and obesity observed among veterans may make this group vulnerable to disordered eating. Retrospective chart review was used to obtain data from 492 female veterans who were presented to a women's primary care center at a large, urban VA medical center between 2007 and 2009. A total of 2.8% of this sample had been diagnosed with an ED. In bivariate analyses, presence of PTSD and depression were significantly associated with having an ED diagnosis. However, when these two disorders were included in a multivariate model controlling for age, only depression diagnosis and lower age were significantly related to ED status. In sum, the rate of EDs in this sample is comparable to prevalence estimates of EDs in the general population. Current findings underscore the importance of assessing for EDs among VA patients and the need for further research among veterans. Published by Elsevier Ireland Ltd.

  12. Inpatient Dialysis Unit Project Development: Redesigning Acute Hemodialysis Care.

    Science.gov (United States)

    Day, Jennifer

    2017-01-01

    Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit. Copyright© by the American Nephrology Nurses Association.

  13. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide

    DEFF Research Database (Denmark)

    Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete

    2017-01-01

    trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during......People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time...... admission. Most studies are based on low power, thus compromising quality and generalisability. The few studies with sufficient statistical power mainly identified non-modifiable risk predictors such as male gender, diagnosis, or recent deliberate self-harm. Also, the predictive value of these predictors...

  14. Risk Estimates and Risk Factors Related to Psychiatric Inpatient Suicide

    DEFF Research Database (Denmark)

    Madsen, Trine; Erlangsen, Annette; Nordentoft, Merete

    2017-01-01

    People with mental illness have an increased risk of suicide. The aim of this paper is to provide an overview of suicide risk estimates among psychiatric inpatients based on the body of evidence found in scientific peer-reviewed literature; primarily focusing on the relative risks, rates, time...... trends, and socio-demographic and clinical risk factors of suicide in psychiatric inpatients. Psychiatric inpatients have a very high risk of suicide relative to the background population, but it remains challenging for clinicians to identify those patients that are most likely to die from suicide during...... is low. It would be of great benefit if future studies would be based on large samples while focusing on modifiable predictors over the course of an admission, such as hopelessness, depressive symptoms, and family/social situations. This would improve our chances of developing better risk assessment...

  15. [Inpatients days in patients with respiratory diseases and periodontal disease].

    Science.gov (United States)

    Fernández-Plata, Rosario; Olmedo-Torres, Daniel; Martínez-Briseño, David; González-Cruz, Herminia; Casa-Medina, Guillermo; García-Sancho, Cecilia

    2017-01-01

    Periodontal disease is a chronic inflammatory gingival process that has been associated with the severity of respiratory diseases. In Mexico a prevalence of 78% was found in population with social security and > 60 years old. The aim of this study is to establish the association between periodontal disease and respiratory diseases according to the inpatient days. A cross-sectional study was conducted from January to December 2011. We included hospitalized patients, ≥ 18 years of age, without sedation or intubated. A dentist classified patients into two groups according to the severity of the periodontal disease: mild-to-moderate and severe. We estimated medians of inpatient days by disease and severity. Negative binomial models were adjusted to estimate incidence rate ratios and predicted inpatient days. 3,059 patients were enrolled. The median of observed and predicted inpatient days was higher in the group of severe periodontal disease (p disease, tuberculosis, and influenza had the highest incidence rates ratios of periodontal disease (p periodontal disease is positively -associated with inpatient days of patients with respiratory diseases.

  16. The spiritual health of veterans with a history of suicide ideation

    Science.gov (United States)

    Kopacz, Marek S.

    2014-01-01

    Introduction: In recent years, considerable empirical attention has been devoted to examining the increased risk of suicide observed in some Veteran populations. This has led to a renewed focus on developing novel support options which can be used to respond to Veterans in distress, reducing their risk of suicide. Spirituality and religion, however, have been largely absent from any public discourse related to suicide prevention, not least of all in Veteran populations. Aim: The aim of this cross-sectional study is to compare the self-rated spiritual health of Veterans with and without suicide ideation. Identifying differences which may exist between these two groups could highlight the relevance of spiritual well-being to Veteran suicide prevention efforts. Materials and Methods: Data were collected using pencil-and-paper surveys, called Spiritual Assessments, distributed within the general population of in- and outpatients at a U.S. Department of Veterans Affairs Medical Center. Using Likert-type scales, this study examines the self-rated spiritual health, spiritual devotion, and significance ascribed to spirituality in a sample of 5378 Veterans. Statistical analysis took place using chi-squared to examine differences in the distribution of responses between ideators and non-ideators. Results: Ideators significantly more often rated their spiritual health as worse than that of non-ideators. Even with similar levels of spiritual devotion or significance ascribed to spiritual life, ideators continued to significantly more often rate their spiritual health as worse than that of non-ideators. Conclusion: The results show that Veterans with suicide ideation more often rate their spiritual health as worse than that of Veterans without suicide ideation. This suggests that spiritual well-being may indeed be relevant to suicide prevention efforts in Veteran populations. PMID:25750787

  17. Basic Stand Alone Medicare Inpatient Claims PUF

    Data.gov (United States)

    U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Inpatient Public Use Files (PUF) named CMS 2008 BSA Inpatient Claims PUF with information from 2008 Medicare...

  18. Medication errors in pediatric inpatients

    DEFF Research Database (Denmark)

    Rishoej, Rikke Mie; Almarsdóttir, Anna Birna; Christesen, Henrik Thybo

    2017-01-01

    The aim was to describe medication errors (MEs) in hospitalized children reported to the national mandatory reporting and learning system, the Danish Patient Safety Database (DPSD). MEs were extracted from DPSD from the 5-year period of 2010–2014. We included reports from public hospitals on pati...... safety in pediatric inpatients.(Table presented.)...

  19. Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Jaski, Brian E; Grigoriadis, Christopher E; Dai, Xuming; Meredith, Richard D; Ortiz, Bryan C; Stouffer, George A; Thomas, Lorie; Smith, Sidney C

    2016-08-01

    Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single-center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST-elevation myocardial infarction (STEMI). A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy. Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P PCI (50.7% vs 80.9%; P PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in-hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P PCI in both groups. Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in-hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes. © 2016, Wiley Periodicals, Inc.

  20. Inpatient Obstetric Care at Irwin Army Community Hospital: A Study to Determine the Most Efficient Organization

    National Research Council Canada - National Science Library

    Bergeron, Timothy

    2001-01-01

    This study attempts to compare, analyze, and recommend the most efficient model with which to deliver inpatient obstetrics and gynecological services to the served population of Irwin Army Community Hospital...

  1. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Science.gov (United States)

    2010-10-01

    ... under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... Services of Inpatient Psychiatric Facilities § 412.405 Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. The prospective payment system...

  2. The U.S. Department of Veterans' Affairs depleted uranium exposed cohort at 25 Years: Longitudinal surveillance results

    International Nuclear Information System (INIS)

    McDiarmid, Melissa A.; Gaitens, Joanna M.; Hines, Stella; Condon, Marian; Roth, Tracy; Oliver, Marc; Gucer, Patricia; Brown, Lawrence; Centeno, Jose A.; Dux, Moira; Squibb, Katherine S.

    2017-01-01

    Background: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored for health changes in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. Methods: During the spring of 2015, an in-patient clinical surveillance protocol was performed on 36 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. Results: On-going mobilization of U from embedded fragments is evidenced by elevated urine U concentrations. The DU isotopic signature is observed principally in participants possessing embedded fragments. Those with only an inhalation exposure have lower urine U concentration and a natural isotopic signature. Conclusions: At 25 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As U body burden continues to accrue from in-situ mobilization from metal fragment depots, and increases with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort. - Highlights: • Gulf War I veterans wounded with depleted uranium are monitored for health changes. • In 2015 in-patient clinical surveillance was performed on 36 members of the cohort. • Mobilization of U from embedded fragments is evidenced by elevated U in urine. • This cohort of continues to show no U-related health effects.

  3. The U.S. Department of Veterans' Affairs depleted uranium exposed cohort at 25 Years: Longitudinal surveillance results

    Energy Technology Data Exchange (ETDEWEB)

    McDiarmid, Melissa A.; Gaitens, Joanna M.; Hines, Stella [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States); Condon, Marian, E-mail: mcondon@medicine.umaryland.edu [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Roth, Tracy; Oliver, Marc; Gucer, Patricia [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States); Brown, Lawrence [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Pathology, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States); Centeno, Jose A. [US Food and Drug Administration, Center for Devices and Radiological Health Office of Science and Engineering Laboratories, Silver Spring, MD 20993 (United States); Dux, Moira [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Squibb, Katherine S. [Department of Veterans Affairs Medical Center Baltimore, Maryland, 10 N. Greene St., Baltimore, MD 21201 (United States); Department of Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201 (United States)

    2017-01-15

    Background: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored for health changes in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. Methods: During the spring of 2015, an in-patient clinical surveillance protocol was performed on 36 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. Results: On-going mobilization of U from embedded fragments is evidenced by elevated urine U concentrations. The DU isotopic signature is observed principally in participants possessing embedded fragments. Those with only an inhalation exposure have lower urine U concentration and a natural isotopic signature. Conclusions: At 25 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As U body burden continues to accrue from in-situ mobilization from metal fragment depots, and increases with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort. - Highlights: • Gulf War I veterans wounded with depleted uranium are monitored for health changes. • In 2015 in-patient clinical surveillance was performed on 36 members of the cohort. • Mobilization of U from embedded fragments is evidenced by elevated U in urine. • This cohort of continues to show no U-related health effects.

  4. Benefits and challenges of using service dogs for veterans with posttraumatic stress disorder.

    Science.gov (United States)

    Yarborough, Bobbi Jo H; Stumbo, Scott P; Yarborough, Micah T; Owen-Smith, Ashli; Green, Carla A

    2018-04-26

    Veterans with posttraumatic stress disorder (PTSD) are increasingly seeking service dogs to help them manage trauma-related symptoms, yet literature describing service dog use in this population is scant. The goal of this study was to document the benefits and challenges experienced by veterans with service dogs trained to assist with PTSD-related needs. Participants were veterans (N = 41) with service dogs, and their caregivers (n = 8), recruited through community-based service dog training agencies. We conducted in-depth interviews and observed training sessions as part of a larger study, and used thematic analysis to characterize data. Veterans reported that service dogs reduced hypervigilance by alerting and creating boundaries, and disrupted nightmares, improving sleep quality and duration. Dogs also helped veterans turn their attention away from invasive trauma-related thoughts. Additional reported benefits included improved emotional connections with others, increased community participation and physical activity, and reduced suicidal impulses and medication use. Demands of training, adjustment to life with a service dog, and delayed benefits were challenging for many veterans and caregivers. Veterans report that service dogs help reduce PTSD symptoms and facilitate recovery and realization of meaningful goals. Service dogs may be a reasonable option for veterans who are reluctant to pursue or persist with traditional evidence-based treatments. Additional rigorous research on the effectiveness of service dogs for this population is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  5. 29 CFR 825.114 - Inpatient care.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor Regulations... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

  6. Inpatient Suicide in a Chinese Psychiatric Hospital

    Science.gov (United States)

    Li, Jie; Ran, Mao-Sheng; Hao, Yuantao; Zhao, Zhenhuan; Guo, Yangbo; Su, Jinghua; Lu, Huixian

    2008-01-01

    Little is known about the risk factors for suicide among psychiatric inpatients in China. In this study we identified the risk factors of suicide among psychiatric inpatients at Guangzhou Psychiatric Hospital. All psychiatric inpatients who died by suicide during the 1956-2005 period were included in this study. Using a case-control design, 64…

  7. VeteranOtherInformationService

    Data.gov (United States)

    Department of Veterans Affairs — This service is used to create, read, delete and update additional information captured during the EVSS Disability Compensation interview in an effort to align with...

  8. Psychogeriatric inpatient unit design: a literature review.

    Science.gov (United States)

    Dobrohotoff, John T; Llewellyn-Jones, Robert H

    2011-03-01

    In many parts of the world the provision of psychogeriatric inpatient units (PGUs) remains limited. More units will be required over coming decades given rapid population aging. Medline (1950-2010), psycINFO (1806-2009), EMBASE (1980-2009) and CINAHL (1982-2009) were searched for papers about PGU design. Selected non-peer reviewed literature such as government reports and unpublished academic dissertations were also reviewed. Data were also obtained from the literature related to general adult psychiatry inpatient units where there was limited information from studies of units designed for older people. Over 200 papers were reviewed and 130 were included. There are few good quality studies to guide the design of acute PGUs and much of the existing literature is based on opinion and anecdote or, at best, based on observational studies. Randomized controlled studies comparing different designs and assessing outcomes are virtually non-existent. Several studies have identified violence and trauma resulting from hospitalization as significant problems with current acute PGU care. Despite its limitations the available literature provides useful guidance on how PGU design can optimize patient and staff safety and improve clinical outcomes. There are significant problems with current acute PGUs, and patient mix on existing units is an important issue. Future research should examine patient and staff perceptions of different PGU ward environments, the relationship between ward design and clinical outcomes, the effects of segregating patients with challenging behaviors in dementia and the benefits or otherwise of gender segregation.

  9. Using Facebook to Recruit Young Adult Veterans: Online Mental Health Research

    Science.gov (United States)

    2015-01-01

    Background Veteran research has primarily been conducted with clinical samples and those already involved in health care systems, but much is to be learned about veterans in the community. Facebook is a novel yet largely unexplored avenue for recruiting veteran participants for epidemiological and clinical studies. Objective In this study, we utilized Facebook to recruit a sample of young adult veterans for the first phase of an online alcohol intervention study. We describe the successful Facebook recruitment process, including data collection from over 1000 veteran participants in approximately 3 weeks, procedures to verify participation eligibility, and comparison of our sample with nationally available norms. Methods Participants were young adult veterans aged 18-34 recruited through Facebook as part of a large study to document normative drinking behavior among a large community sample of veterans. Facebook ads were targeted toward young veterans to collect information on demographics and military characteristics, health behaviors, mental health, and health care utilization. Results We obtained a sample of 1023 verified veteran participants over a period of 24 days for the advertising price of approximately US $7.05 per verified veteran participant. Our recruitment strategy yielded a sample similar to the US population of young adult veterans in most demographic areas except for race/ethnicity and previous branch of service, which when we weighted the sample on race/ethnicity and branch a sample better matched with the population data was obtained. The Facebook sample recruited veterans who were engaged in a variety of risky health behaviors such as binge drinking and marijuana use. One fourth of veterans had never since discharge been to an appointment for physical health care and about half had attended an appointment for service compensation review. Only half had attended any appointment for a mental health concern at any clinic or hospital. Despite more

  10. Using facebook to recruit young adult veterans: online mental health research.

    Science.gov (United States)

    Pedersen, Eric R; Helmuth, Eric D; Marshall, Grant N; Schell, Terry L; PunKay, Marc; Kurz, Jeremy

    2015-06-01

    Veteran research has primarily been conducted with clinical samples and those already involved in health care systems, but much is to be learned about veterans in the community. Facebook is a novel yet largely unexplored avenue for recruiting veteran participants for epidemiological and clinical studies. In this study, we utilized Facebook to recruit a sample of young adult veterans for the first phase of an online alcohol intervention study. We describe the successful Facebook recruitment process, including data collection from over 1000 veteran participants in approximately 3 weeks, procedures to verify participation eligibility, and comparison of our sample with nationally available norms. Participants were young adult veterans aged 18-34 recruited through Facebook as part of a large study to document normative drinking behavior among a large community sample of veterans. Facebook ads were targeted toward young veterans to collect information on demographics and military characteristics, health behaviors, mental health, and health care utilization. We obtained a sample of 1023 verified veteran participants over a period of 24 days for the advertising price of approximately US $7.05 per verified veteran participant. Our recruitment strategy yielded a sample similar to the US population of young adult veterans in most demographic areas except for race/ethnicity and previous branch of service, which when we weighted the sample on race/ethnicity and branch a sample better matched with the population data was obtained. The Facebook sample recruited veterans who were engaged in a variety of risky health behaviors such as binge drinking and marijuana use. One fourth of veterans had never since discharge been to an appointment for physical health care and about half had attended an appointment for service compensation review. Only half had attended any appointment for a mental health concern at any clinic or hospital. Despite more than half screening positive for

  11. Social participation and self-rated health among older male veterans and non-veterans.

    Science.gov (United States)

    Choi, Namkee G; DiNitto, Diana M; Marti, C Nathan

    2016-08-01

    To examine self-rated health (SRH) and its association with social participation, along with physical and mental health indicators, among USA male veterans and non-veterans aged ≥65 years. The two waves of the National Health and Aging Trend Study provided data (n = 2845 at wave 1; n = 2235 at wave 2). Multilevel mixed effects generalized linear models were fit to test the hypotheses. Despite their older age, veterans did not differ from non-veterans in their physical, mental and cognitive health, and they had better SRH. However, black and Hispanic veterans had lower SRH than non-Hispanic white veterans. Formal group activities and outings for enjoyment were positively associated with better SRH for veterans, non-veterans and all veteran cohorts. Aging veterans, especially black and Hispanic veterans, require programs and services that will help increase their social connectedness. Geriatr Gerontol Int 2016; 16: 920-927. © 2015 Japan Geriatrics Society.

  12. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Live Chat Veterans Text Homeless Veterans Live Chat Military Live Chat Deaf - Hard of Hearing Contact Us ... Live Chat Veterans Text Homeless Veterans Live Chat Military Live Chat Deaf - Hard of Hearing Contact Us ...

  13. Results from the Veterans Health Administration ICD-10-CM/PCS Coding Pilot Study.

    Science.gov (United States)

    Weems, Shelley; Heller, Pamela; Fenton, Susan H

    2015-01-01

    The Veterans Health Administration (VHA) of the US Department of Veterans Affairs has been preparing for the October 1, 2015, conversion to the International Classification of Diseases, Tenth Revision, Clinical Modification and Procedural Coding System (ICD-10-CM/PCS) for more than four years. The VHA's Office of Informatics and Analytics ICD-10 Program Management Office established an ICD-10 Learning Lab to explore expected operational challenges. This study was conducted to determine the effects of the classification system conversion on coding productivity. ICD codes are integral to VHA business processes and are used for purposes such as clinical studies, performance measurement, workload capture, cost determination, Veterans Equitable Resource Allocation (VERA) determination, morbidity and mortality classification, indexing of hospital records by disease and operations, data storage and retrieval, research purposes, and reimbursement. The data collection for this study occurred in multiple VHA sites across several months using standardized methods. It is commonly accepted that coding productivity will decrease with the implementation of ICD-10-CM/PCS. The findings of this study suggest that the decrease will be more significant for inpatient coding productivity (64.5 percent productivity decrease) than for ambulatory care coding productivity (6.7 percent productivity decrease). This study reveals the following important points regarding ICD-10-CM/PCS coding productivity: 1. Ambulatory care ICD-10-CM coding productivity is not expected to decrease as significantly as inpatient ICD-10-CM/PCS coding productivity. 2. Coder training and type of record (inpatient versus outpatient) affect coding productivity. 3. Inpatient coding productivity is decreased when a procedure requiring ICD-10-PCS coding is present. It is highly recommended that organizations perform their own analyses to determine the effects of ICD-10-CM/PCS implementation on coding productivity.

  14. Health Status of Gulf War and Era Veterans Serving in the US Military in 2000.

    Science.gov (United States)

    Porter, Ben; Long, Kyna; Rull, Rudolph P; Dursa, Erin K

    2018-05-01

    This research describes Gulf War and era veterans enrolled in the Millennium Cohort Study, who were sampled from US military personnel serving in 2000, and compares health characteristics of this sample to a Department of Veterans Affairs study sampled from the complete population. Demographics characteristics of this sample were described. Self-reported health characteristics were compared between the two studies. Gulf War and era veterans in the Millennium Cohort were generally healthier than in the VA study; they had fewer medical conditions and mental health disorders and better self-reported health. In both studies, Gulf War veterans had poorer health outcomes than era veterans. The Millennium Cohort Study is a unique resource for examining the long-term health effects of Gulf War deployment, particularly comparing deployed and nondeployed personnel and examining illnesses with long latencies.

  15. Diet quality is associated with mental health, social support, and neighborhood factors among Veterans.

    Science.gov (United States)

    Hoerster, Katherine D; Wilson, Sarah; Nelson, Karin M; Reiber, Gayle E; Masheb, Robin M

    2016-12-01

    United States Veterans have a higher prevalence of overweight and related chronic conditions compared to the general population. Although diet is a primary and modifiable contributor to these conditions, little is known about factors influencing diet quality among Veterans. The goal of this study is to examine individual, social environment, and physical environment correlates of general diet quality among Veterans. Study participants (N=653) received care at an urban VA Medical Center in Seattle, WA and completed a mailed survey in 2012 and 2013. Diet quality was assessed with Starting the Conversation, an instrument that measures consumption of unhealthy snacks, fast food, desserts, sugar-sweetened beverages, and fats; fruits and vegetables; and healthy proteins. Variables significantly (pfoods in neighborhood stores where the Veteran shops (Diff=-0.37; CI=-0.6, -0.2; pfoods are needed to improve Veteran diet quality. Published by Elsevier Ltd.

  16. Transboundary smoke haze pollution in Malaysia: Inpatient health impacts and economic valuation

    International Nuclear Information System (INIS)

    Othman, Jamal; Sahani, Mazrura; Mahmud, Mastura; Sheikh Ahmad, Md Khadzir

    2014-01-01

    This study assessed the economic value of health impacts of transboundary smoke haze pollution in Kuala Lumpur and adjacent areas in the state of Selangor, Malaysia. Daily inpatient data from 2005, 2006, 2008, and 2009 for 14 haze-related illnesses were collected from four hospitals. On average, there were 19 hazy days each year during which the air pollution levels were within the Lower Moderate to Hazardous categories. No seasonal variation in inpatient cases was observed. A smoke haze occurrence was associated with an increase in inpatient cases by 2.4 per 10,000 populations each year, representing an increase of 31 percent from normal days. The average annual economic loss due to the inpatient health impact of haze was valued at MYR273,000 ($91,000 USD). - Highlights: • Transboundary smoke haze is an annual phenomenon in Malaysia. • No evidence of seasonal factors in smoke haze related inpatient cases. • Inpatient rates during a haze event increased by 31% relative to normal days. • Annual economic loss due to inpatient health impact of haze valued at $91,000. • Present value of economic loss estimated at $1.1 million to $1.7 million. - Inpatient rates soared by 31% while economic loss valued at USD91,000 annually

  17. Post-traumatic Stress Disorder by Gender and Veteran Status.

    Science.gov (United States)

    Lehavot, Keren; Katon, Jodie G; Chen, Jessica A; Fortney, John C; Simpson, Tracy L

    2018-01-01

    Population-based data on the prevalence, correlates, and treatment utilization of post-traumatic stress disorder by gender and veteran status are limited. With changes in post-traumatic stress disorder diagnostic criteria in 2013, current information from a uniform data source is needed. This was a secondary analysis of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, which consisted of in-person interviews that were conducted with a representative sample of U.S. adults. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version was used to assess past-year and lifetime post-traumatic stress disorder among veterans (n=3,119) and civilians (n=32,982). Data were analyzed from January to March 2017. Adjusting for age and race/ethnicity, women veterans reported the highest rates of lifetime and past-year post-traumatic stress disorder (13.4%, 95% CI=8.8%, 17.9%, and 11.7%, 95% CI=7.1%, 16.4%) compared with women civilians (8.0%, 95% CI=7.4%, 8.6%, and 6.0%, 95% CI=5.5%, 6.6%); men veterans (7.7%, 95% CI=6.5%, 8.8%, and 6.7%, 95% CI=5.7%, 7.8%); and men civilians (3.4%, 95% CI=3.0%, 3.9%, and 2.6%, 95% CI=2.2%, 2.9%). Traumatic event exposure, correlates of lifetime post-traumatic stress disorder, and treatment seeking varied across subgroups. Men and women veterans were more likely than civilians to use a variety of treatment sources, with men civilians being least likely to seek treatment and men veterans exhibiting the longest delay in seeking treatment. Post-traumatic stress disorder is a common mental health disorder that varies by gender and veteran status. Women veterans' high rates of post-traumatic stress disorder highlight a critical target for prevention and intervention, whereas understanding treatment barriers for men veterans and civilians is necessary. Published by Elsevier Inc.

  18. The Epidemiology of Substance Use Disorders in US Veterans: A Systematic Review and Analysis of Assessment Methods

    Science.gov (United States)

    Lan, Chiao-Wen; Fiellin, David A.; Barry, Declan T.; Bryant, Kendall J.; Gordon, Adam J.; Edelman, E. Jennifer; Gaither, Julie R.; Maisto, Stephen A.; Marshall, Brandon D.L.

    2016-01-01

    Background Substance use disorders (SUDs), which encompass alcohol and drug use disorders (AUDs, DUDs), constitute a major public health challenge among US veterans. SUDs are among the most common and costly of all health conditions among veterans. Objectives This study sought to examine the epidemiology of SUDs among US veterans, compare the prevalence of SUDs in studies using diagnostic and administrative criteria assessment methods, and summarize trends in the prevalence of SUDs reported in studies sampling US veterans over time. Methods Comprehensive electronic database searches were conducted. A total of 3,490 studies were identified. We analyzed studies sampling US veterans and reporting prevalence, distribution, and examining AUDs and DUDs. Results Of the studies identified, 72 met inclusion criteria. The studies were published between 1995 and 2013. Studies using diagnostic criteria reported higher prevalence of AUDs (32% vs. 10%) and DUDs (20% vs. 5%) than administrative criteria, respectively. Regardless of assessment method, both the lifetime and past year prevalence of AUDs in studies sampling US veterans has declined gradually over time. Conclusion The prevalence of SUDs reported in studies sampling US veterans are affected by assessment method. Given the significant public health problems of SUDs among US veterans, improved guidelines for clinical screening using validated diagnostic criteria to assess AUDs and DUDs in US veteran populations are needed. Scientific Significance These findings may inform VA and other healthcare systems in prevention, diagnosis, and intervention for SUDs among US veterans. PMID:26693830

  19. Headache diagnoses among Iraq and Afghanistan war veterans enrolled in VA: a gender comparison.

    Science.gov (United States)

    Carlson, Kathleen F; Taylor, Brent C; Hagel, Emily M; Cutting, Andrea; Kerns, Robert; Sayer, Nina A

    2013-01-01

    To examine the prevalence and correlates of headache diagnoses, by gender, among Iraq and Afghanistan War Veterans who use Department of Veterans Affairs (VA) health care. Understanding the health care needs of recent Veterans, and how these needs differ between women and men, is a priority for the VA. The potential for a large burden of headache disorders among Veterans seeking VA services exists but has not been examined in a representative sample. We conducted a historical cohort study using national VA inpatient and outpatient data from fiscal year 2011. Participants were all (n = 470,215) Iraq and Afghanistan War Veteran VA users in 2011; nearly 13% were women. We identified headache diagnoses using International Classification of Diseases (ICD-9) diagnosis codes assigned during one or more VA inpatient or outpatient encounters. Descriptive analyses included frequencies of patient characteristics, prevalence and types of headache diagnoses, and prevalence of comorbid diagnoses. Prevalence ratios (PR) with 95% confidence intervals (CI) were used to estimate associations between gender and headache diagnoses. Multivariate models adjusted for age and race. Additional models also adjusted for comorbid diagnoses. In 2011, 56,300 (11.9%) Veterans received a headache-related diagnosis. While controlling for age and race, headache diagnoses were 1.61 times more prevalent (95% CI = 1.58-1.64) among women (18%) than men (11%). Most of this difference was associated with migraine diagnoses, which were 2.66 times more prevalent (95% CI = 2.59-2.73) among women. Cluster and post-traumatic headache diagnoses were less prevalent in women than in men. These patterns remained the same when also controlling for comorbid diagnoses, which were common among both women and men with headache diagnoses. The most prevalent comorbid diagnoses examined were depression (46% of women with headache diagnoses vs 40% of men), post-traumatic stress disorder (38% vs 58%), and back

  20. Strategies, barriers, and motivation for weight loss among veterans living with schizophrenia.

    Science.gov (United States)

    Klingaman, Elizabeth A; Viverito, Kristen M; Medoff, Deborah R; Hoffmann, Rebecca M; Goldberg, Richard W

    2014-12-01

    Weight loss programs for veterans living with schizophrenia have demonstrated mixed efficacy, highlighting unique obstacles faced by this population. Data from a large national sample provide an opportunity to characterize the unique factors related to weight loss for veterans with schizophrenia. The present study compared veterans living with schizophrenia (n = 5,388) to veterans with no mental health diagnoses (n = 81,422) on responses to the MOVE!23, a multidimensional assessment of factors related to weight management. Responses to the MOVE!23 between August, 2005 and May, 2013 by veterans with a body mass index in the overweight or obese range were used to describe clinical characteristics, current strategies, perceived barriers, stages of readiness, and importance of and confidence to change behaviors related to their weight management. Both groups reported similar stages of readiness and high ratings of importance and confidence regarding weight loss behaviors. Compared with veterans with no mental health diagnoses, over 5 times as many veterans living with schizophrenia reported smoking to control weight, and a greater number endorsed 18 of the 21 barriers to modifying eating and physical activity. RESULTS highlight the necessity of addressing healthy lifestyles from a holistic perspective for all veterans. Adding regular physical activity as part of daily treatment may address the accessibility, safety concerns, and lack of social support reported as physical activity barriers. Increased access to healthier food choices and addressing smoking in conjunction with weight loss are also warranted. (c) 2014 APA, all rights reserved.

  1. Evaluation of Cholesterol as a Biomarker for Suicidality in a Veteran Sample.

    Science.gov (United States)

    Reuter, Chuck; Caldwell, Barbara; Basehore, Heather

    2017-08-01

    A reduction in total cholesterol may alter the microviscosity of the brain-cell-membrane, reducing serotonin receptor exposure. The resulting imbalance between serotonin and dopamine may lead to an increased risk for suicidality. The objective of this research was to evaluate total cholesterol as a biological marker for suicidality in a sample of US military veterans. The study population consisted of veterans who received care at the Coatesville Veterans Affairs Medical Center (VAMC) and were included in the Suicide Prevention Coordinator's database for having suicidal ideation with evidence of escalating intent, a documented suicide attempt, or committed suicide between 2009 and 2015. The veterans' medical data were obtained from the facility's computerized patient record system. The final sample was 188 observations from 128 unique veterans. Veterans with total cholesterol levels below 168 mg/dl appeared to have a higher suicide risk than those with higher levels. The cholesterol levels of veterans reporting suicidal ideation or attempt were significantly lower than the group reporting neither [F(2, 185) = 30.19, p cholesterol levels from an earlier visit in which they did not report suicidality. A latent class analysis revealed that among other differences, suicidal veterans were younger, leaner, and had more anxiety, sleep problems, and higher education than those being seen for an issue unrelated to suicidality. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  2. Gambling Disorder in Veterans: A Review of the Literature and Implications for Future Research.

    Science.gov (United States)

    Levy, Lauren; Tracy, J Kathleen

    2018-02-09

    To review the scientific literature examining gambling behavior in military veterans in order to summarize factors associated with gambling behavior in this population. Database searches were employed to identify articles specifically examining gambling behavior in military veterans. Cumulative search results identified 52 articles (1983-2017) examining gambling behavior in veteran populations. Articles generally fell into one or more of the following categories: prevalence, psychological profiles and psychiatric comorbidities, treatment evaluations, measurement, and genetic contributions to gambling disorder. Results from reviewed articles are presented and implications for future research discussed. Research to date has provided an excellent foundation to inform potential screening, intervention and research activities going forward. The authors suggest that a public health approach to future research endeavors would strengthen the evidence base regarding gambling in veteran populations and better inform strategies for screening, prevention and treatment.

  3. World war II veterans, social support, and veterans' associations.

    Science.gov (United States)

    Hunt, N; Robbins, I

    2001-05-01

    People use many different coping strategies to deal with their traumatic recollections. Twenty-five British World War II veterans were interviewed regarding the ways they used social support both during the war and in the years afterwards. The findings demonstrate that social support is used in fundamentally different ways. During the war comradeship was particularly important and even fifty years after the war comrades are still a valuable resource for discussing war experiences, and dealing with the emotional content of traumatic recollections. Veterans rely on wives and families to help deal with the more physical and practical elements of coping, but tend not to discuss their traumatic memories with them. The findings show that social support is an important lifelong coping strategy for World War II veterans.

  4. Veterans Affairs Central Cancer Registry (VACCR)

    Data.gov (United States)

    Department of Veterans Affairs — The Veterans Affairs Central Cancer Registry (VACCR) receives and stores information on cancer diagnosis and treatment constraints compiled and sent in by the local...

  5. Benefits for Military Veterans with ALS

    Science.gov (United States)

    ... Chapters Certified Centers and Clinics Support Groups About ALS About Us Our Research In Your Community Advocate ... Veterans Resources for Military Veterans, Families & Survivors The ALS Association is working everyday to support people with ...

  6. Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study.

    Science.gov (United States)

    Houchens, Nathan; Harrod, Molly; Moody, Stephanie; Fowler, Karen; Saint, Sanjay

    2017-07-01

    Clinician educators face numerous obstacles to their joint mission of facilitating high-quality learning while also delivering patient-centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners. To describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds. An exploratory qualitative study of inpatient teaching conducted from 2014 to 2015. Inpatient general medicine wards in 11 US hospitals, including university-affiliated hospitals and Veterans Affairs medical centers. Participants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners. In-depth, semi-structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds. Interview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient-centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels. This study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds. © 2017 Society of Hospital Medicine

  7. 38 CFR 10.37 - Claim of widow not living with veteran at time of veteran's death.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Claim of widow not living with veteran at time of veteran's death. 10.37 Section 10.37 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUSTED COMPENSATION Adjusted Compensation; General § 10.37 Claim of widow not living with veteran at time of...

  8. A Descriptive Study of Veteran Students Attending The University of South Carolina, Fall 1975. No. 30-76.

    Science.gov (United States)

    Thurber, Robert G.; And Others

    The Office of Veteran Student Affairs (OVSA) at the University of South Carolina serves a total population of 3,310 veteran students. This survey, conducted during the fall semester of 1975, was designed to obtain data about the personal background of the respondents, their attitudes toward the services provided by the several offices serving…

  9. Awareness Status of Chronic Disabling Neurological Diseases among Elderly Veterans.

    Science.gov (United States)

    Tan, Ji-Ping; Zhu, Lin-Qi; Zhang, Jun; Zhang, Shi-Min; Lan, Xiao-Yang; Cui, Bo; Deng, Yu-Cheng; Li, Ying-Hao; Ye, Guang-Hua; Wang, Lu-Ning

    2015-05-20

    The awareness, treatment and prevention of chronic diseases are generally poor among the elderly population of China, whereas the prevention and control of chronic diseases in elderly veteran communities have been ongoing for more than 30 years. Therefore, investigating the awareness status of chronic disabling neurological diseases (CDND) and common chronic diseases (CCD) among elderly veterans may provide references for related programs among the elderly in the general population. A cross-sectional survey was conducted among veterans ≥60 years old in veteran communities in Beijing. The awareness of preventive strategies against dementia, Alzheimer's disease (AD), Parkinson's disease (PD), sleep disorders, cerebrovascular disease (CVD) and CCD such as hypertension, and the approaches used to access this information, including media, word of mouth (verbal communication among the elderly) and health care professionals, were investigated via face-to-face interviews. The awareness rates for CCD and CVD were approximately 100%, but that for AD was the lowest at word-of-mouth peer education.

  10. Disabled Veterans on the Job Front.

    Science.gov (United States)

    Walker, Michael J.

    1978-01-01

    The Disabled Veterans Outreach Program (DVOP) administered by the Department of Labor's Employment and Training Administration arranges training and placement for disabled veterans in local job service offices. These employees then assist in placing other disabled veterans on jobs. Some typical DVOP success stories are described. (MF)

  11. D-Day for Veterans' Jobs

    Science.gov (United States)

    Nathan, Robert R.

    1977-01-01

    Focuses on the unemployment problem among Vietnam veterans and on the various Federal and private employment programs open to these veterans. Discussion also covers labor force statistics, readjustment to civilian life, changes in the American economy, and the role of the Department of Defense and civilian employers in helping veterans to find…

  12. 77 FR 20849 - Homeless Veterans' Reintegration Program

    Science.gov (United States)

    2012-04-06

    .... Funding Opportunity Description: Section 2021 of Title 38 of the United States Code (U.S.C.) reauthorizes the Homeless Veterans Reintegration Program (HVRP) through fiscal year (FY) 2012 and indicates: ``the... DEPARTMENT OF LABOR Homeless Veterans' Reintegration Program AGENCY: Veterans' Employment and...

  13. Career Development for Transitioning Veterans. Monograph Series

    Science.gov (United States)

    McCormick, Carmen Stein; Osborn, Debra S.; Hayden, Seth C. W.; Van Hoose, Dan

    2013-01-01

    The purpose of this book is to increase career practitioners' awareness of the transition issues and resources specific to veterans and to provide several examples of how a practitioner might walk a veteran through the career planning process. Case studies based on interviews with real veterans by the authors and military consultants (Thomas…

  14. Gender, race & the veteran wage gap.

    Science.gov (United States)

    Vick, Brandon; Fontanella, Gabrielle

    2017-01-01

    This paper analyzes earnings outcomes of Iraq/Afghanistan-era veterans. We utilize the 2009-2013 American Community Survey and a worker-matching methodology to decompose wage differences between veteran and non-veteran workers. Among fully-employed, 25-40 year-olds, veteran workers make 3% less than non-veteran workers. While male veterans make 9% less than non-veterans, female and black veterans experience a wage premium (2% and 7% respectively). Decomposition of the earnings gap identifies some of its sources. Relatively higher rates of disability and lower rates of educational attainment serve to increase the overall wage penalty against veterans. However, veterans work less in low-paying occupations than non-veterans, serving to reduce the wage penalty. Finally, among male and white subgroups, non-veterans earn more in the top quintile due largely to having higher educational attainment and greater representation in higher-paying occupations, such as management. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. DefenseLink Special: Veterans Day 2005

    Science.gov (United States)

    our country, and for making a proud history. God bless you all. And God bless our wonderful country a special Veterans Day observance. Story * Command Sgt. Major Praises Women's Service Woman Vet Veterans Affairs * Center of Military History * White House: Honoring Our Veterans * Library of Congress

  16. 38 CFR 3.401 - Veterans.

    Science.gov (United States)

    2010-07-01

    ... compensation payable by reason of need for aid and attendance or housebound status shall also be awarded for... claim additional disability compensation payable to a veteran by reason of the veteran's spouse's need....) (Authority: 38 U.S.C. 5110 (f), (n)) (c) Divorce of veteran and spouse. See § 3.501(d). (d) Institutional...

  17. Validation of a Measure of Family Resilience among Iraq and Afghanistan Veterans.

    Science.gov (United States)

    Finley, Erin P; Pugh, Mary Jo; Palmer, Raymond F

    2016-01-01

    Although interactions within veterans' families may support or inhibit resilient coping to stress and trauma across the deployment cycle, research on family resilience has been hampered by the lack of a brief assessment. Using a three-stage mixed-method study, we developed and conducted preliminary validation of a measure of family resilience tailored for Iraq and Afghanistan veterans (IAV), the Family Resilience Scale for Veterans (FRS-V) , which was field-tested using a survey of 151 IAV. Our findings indicate the resulting 6-item measure shows strong initial reliability and validity and support the application of existing models of family resilience in this population.

  18. The Association Between Neighborhood Environment and Mortality: Results from a National Study of Veterans.

    Science.gov (United States)

    Nelson, Karin; Schwartz, Greg; Hernandez, Susan; Simonetti, Joseph; Curtis, Idamay; Fihn, Stephan D

    2017-04-01

    As the largest integrated US health system, the Veterans Health Administration (VHA) provides unique national data to expand knowledge about the association between neighborhood socioeconomic status (NSES) and health. Although living in areas of lower NSES has been associated with higher mortality, previous studies have been limited to higher-income, less diverse populations than those who receive VHA care. To describe the association between NSES and all-cause mortality in a national sample of veterans enrolled in VHA primary care. One-year observational cohort of veterans who were alive on December 31, 2011. Data on individual veterans (vital status, and clinical and demographic characteristics) were abstracted from the VHA Corporate Data Warehouse. Census tract information was obtained from the US Census Bureau American Community Survey. Logistic regression was used to model the association between NSES deciles and all-cause mortality during 2012, adjusting for individual-level income and demographics, and accounting for spatial autocorrelation. Veterans who had vital status, demographic, and NSES data, and who were both assigned a primary care physician and alive on December 31, 2011 (n = 4,814,631). Census tracts were used as proxies for neighborhoods. A summary score based on census tract data characterized NSES. Veteran addresses were geocoded and linked to census tract NSES scores. Census tracts were divided into NSES deciles. In adjusted analysis, veterans living in the lowest-decile NSES tract were 10 % (OR 1.10, 95 % CI 1.07, 1.14) more likely to die than those living in the highest-decile NSES tract. Lower neighborhood SES is associated with all-cause mortality among veterans after adjusting for individual-level socioeconomic characteristics. NSES should be considered in risk adjustment models for veteran mortality, and may need to be incorporated into strategies aimed at improving veteran health.

  19. Veterans Affairs Intensive Case Management for older veterans.

    Science.gov (United States)

    Mohamed, Somaia; Neale, Michael S; Rosenheck, Robert

    2009-08-01

    There is a growing need for information on evidence-based practices that may potentially address needs of elderly people with severe mental illness (SMI), and more specifically on community-based services such as assertive community treatment (ACT). This study examines national evaluation data from fiscal year 2001-2005 from Veterans Affairs Mental Health Intensive Case Management (MHICM) program (N = 5,222), an ACT-based service model, to characterize the age distribution of participants and the distinctive needs, patterns of service delivery, and treatment outcomes for elderly veterans. Altogether, 24.8% of participants were 55-64 years; 7.4% 65-74 years; and 2.8% were older than 75. Veterans over 75 formed a distinct subgroup that had a later age of onset of primarily nonpsychotic illnesses without comorbid substance abuse and had experienced more limited lifetime hospital treatment than younger participants. Older veterans were less symptomatic and more satisfied with their social relationships than younger clients. They mostly live independently or in minimally restrictive housing, but they received less recovery-focused services and more crisis intervention and medical services. They thus do not appear to be young patients with SMI who have aged but rather constitute a distinct group with serious late-onset problems. It is possible that MHICM services keep them in the community and avoid costly nursing home placement while providing a respite service that reduces family burden. These data highlight the unique characteristics of older veterans receiving ACT-like services and the need to focus greater attention on recovery-oriented services as well as community support for this subgroup.

  20. Dengue surveillance in Veterans Affairs healthcare facilities, 2007-2010.

    Directory of Open Access Journals (Sweden)

    Patricia L Schirmer

    Full Text Available BACKGROUND: Although dengue is endemic in Puerto Rico (PR, 2007 and 2010 were recognized as epidemic years. In the continental United States (US, outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL, in 2009-2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. METHODOLOGY: Outpatient encounters from 1/2007-12/2010 and inpatient admissions (only available from 10/2009-12/2010 with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE. Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. FINDINGS: Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. CONCLUSIONS: Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to

  1. Family Functioning in Suicidal Inpatients With Intimate Partner Violence

    Science.gov (United States)

    Heru, Alison M.; Stuart, Gregory L.; Recupero, Patricia Ryan

    2007-01-01

    Background: Intimate partner violence (IPV) is commonly bidirectional with both partners perpetrating and being victims of aggressive behaviors. In these couples, family dysfunction is reported across a broad range of family functions: communication, intimacy, problem solving, expression or control of anger, and designation of relationship roles. This study reports on the perceived family functioning of suicidal inpatients. Method: In this descriptive, cross-sectional study of adult suicidal inpatients, participants completed assessments of recent IPV and family functioning. Recruited patients were between 18 and 65 years of age and English fluent, had suicidal ideation, and were living with an intimate partner for at least the past 6 months. Intimate partner violence was assessed using the Conflict Tactics Scale-Revised, and family functioning was measured using the McMaster Family Assessment Device. The study was conducted from August 2004 through February 2005. Results: In 110 inpatients with suicidal ideation and IPV, family functioning was perceived as poor across many domains, although patients did report family strengths. Gender differences were not found in the overall prevalence of IPV, but when the sample was divided into good and poor family functioning, women with poorer family functioning reported more psychological abuse by a partner. For both genders, physical and psychological victimization was associated with poorer family functioning. Conclusion: Among psychiatric inpatients with suicidal ideation, IPV occurred in relationships characterized by general dysfunction. Poorer general family functioning was associated with the perception of victimization for both genders. The high prevalence of bidirectional IPV highlights the need for the development of couples treatment for this population of suicidal psychiatric inpatients. PMID:18185819

  2. Military Sexual Trauma Among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment.

    Science.gov (United States)

    Barth, Shannon K; Kimerling, Rachel E; Pavao, Joanne; McCutcheon, Susan J; Batten, Sonja V; Dursa, Erin; Peterson, Michael R; Schneiderman, Aaron I

    2016-01-01

    Military sexual trauma (MST) includes sexual harassment or sexual assault that occurs during military service and is of increasing public health concern. The population prevalence of MST among female and male veterans who served during Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) has not been estimated to our knowledge. The purpose of this study is to assess the population prevalence and identify military correlates of MST, sexual harassment, and sexual assault among OEF/OIF veterans. MST was assessed in the 2009-2011 National Health Study for a New Generation of U.S. Veterans, a survey of 60,000 veterans who served during the OEF/OIF eras (response rate, 34%, n=20,563). Weighted prevalence estimates and AORs of MST, sexual harassment, and sexual assault among women and men were calculated. Gender-stratified logistic regression models controlled for military and demographic characteristics. Data analyses were conducted in 2013-2014. Approximately 41% of women and 4% of men reported experiencing MST. Deployed men had lower risk for MST compared with non-deployed men, though no difference was found among women. However, veterans reporting combat exposure during deployment had increased risk for MST compared with those without, while controlling for OEF/OIF deployment. Among women, Marines and Navy veterans had increased risk for MST compared with Air Force veterans. MST was significantly higher among veterans who reported using Veterans Affairs healthcare services. These prevalence estimates underscore the importance of public awareness and continued investigation of the public health impact of MST. Published by Elsevier Inc.

  3. Research on PTSD prevalence in OEF/OIF Veterans: expanding investigation of demographic variables

    OpenAIRE

    Averill, Lynnette A.; Fleming, CJ Eubanks; Holens, Pamela L.; Larsen, Sadie E.

    2015-01-01

    Background: A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination.Objective: Many OEF/OIF Veterans do not use available Veterans Affairs (VA) servic...

  4. Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process.

    Science.gov (United States)

    Lisi, Anthony J; Salsbury, Stacie A; Hawk, Cheryl; Vining, Robert D; Wallace, Robert B; Branson, Richard; Long, Cynthia R; Burgo-Black, A Lucille; Goertz, Christine M

    2018-02-01

    The purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. The research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. The modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. This study offers an integrative care pathway that includes chiropractic care for veterans with low back pain. Copyright © 2018. Published by Elsevier Inc.

  5. Demographic characteristics associated with homelessness and risk among female and male veterans accessing VHA outpatient care.

    Science.gov (United States)

    Montgomery, Ann Elizabeth; Dichter, Melissa E; Thomasson, Arwin M; Fu, Xiaoying; Roberts, Christopher B

    2015-01-01

    This study explored demographic influences on veterans' reports of homelessness or imminent risk of homelessness with a particular focus on gender. We analyzed data for a cohort of veterans who responded to the U.S. Department of Veterans Affairs (VA), Veterans Health Administration (VHA) universal screener for homelessness and risk during a 3-month period. Multinomial mixed effects models-stratified by gender-predicted veterans' reports of homelessness or risk based on age, race, marital status, and receipt of VA compensation. The proportion of positive screens-homelessness or risk-was 2.7% for females and 1.7% for males. Women more likely to report being at risk of homelessness were aged 35 to 54 years, Black, and unmarried; those more likely to experience homelessness were Black and unmarried. Among male veterans, the greatest predictors of both homelessness and risk were Black race and unmarried status. Among both genders, receiving VA disability compensation was associated with lesser odds of being homeless or at risk. The findings describe the current population of veterans using VHA health care services who may benefit from homelessness prevention or intervention services, identify racial differences in housing stability, and distinguish subpopulations who may be in particular need of intervention. Interventions to address these needs are described. Published by Elsevier Inc.

  6. Barriers to patient portal access among veterans receiving home-based primary care: a qualitative study.

    Science.gov (United States)

    Mishuris, Rebecca G; Stewart, Max; Fix, Gemmae M; Marcello, Thomas; McInnes, D Keith; Hogan, Timothy P; Boardman, Judith B; Simon, Steven R

    2015-12-01

    Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them. To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services. Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory. Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members. We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV. Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use. © 2014 John Wiley & Sons Ltd.

  7. Immunotoxicological effects of Agent Orange exposure to the Vietnam War Korean veterans.

    Science.gov (United States)

    Kim, Hyoung-Ah; Kim, Eun-Mi; Park, Yeong-Chul; Yu, Ji-Yeon; Hong, Seung-Kwon; Jeon, Seong-Hoon; Park, Kui-Lea; Hur, Sook-Jin; Heo, Yong

    2003-07-01

    Immunomodulatory effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) demonstrated using animals are thymic atrophy, downregulation of cytotoxic T or B lymphocyte differentiation or activation, whereas human immunotoxicities have not been investigated well. This study was undertaken to evaluate overall immunologic spectrum of the Vietnam War Korean veterans exposed to Agent Orange contaminated with TCDD. Quantity of red blood cells, hemoglobin and hematocrit in the veterans suffered from chronic diseases associated with Agent Orange exposure (Veterans-patient group) were decreased in comparison with those of the veterans without the diseases and the age-matched healthy controls, but no differences in leukocyte populations. Plasma IgG levels were lowered in the veterans than the controls, owing to significant decrease in the IgG1 levels. Increase in the IgE levels was observed in the plasma from the veterans. Alteration of T cell-mediated immunity was also resulted from activation of peripheral blood mononuclear cells with polyclonal T cell activators. Production of IFNgamma, a major cytokine mediating host resistance against infection or tumoregenesis, was lowered in the veterans-patient group. However, production of IL-4 and IL-10, representative cytokines involved with hypersensitivity induction, was enhanced in the patient group. Overall, this study suggests that military service in Vietnam and/or Agent Orange exposure disturbs immune-homeostasis resulting in dysregulation of B and T cell activities.

  8. Dissociative disorders in acute psychiatric inpatients in Taiwan.

    Science.gov (United States)

    Chiu, Chui-De; Meg Tseng, Mei-Chih; Chien, Yi-Ling; Liao, Shih-Cheng; Liu, Chih-Min; Yeh, Yei-Yu; Hwu, Hai-Gwo; Ross, Colin A

    2017-04-01

    Dissociative disorders have been documented to be common psychiatric disorders which can be detected reliably with standardized diagnostic instruments in North American and European psychiatric inpatients and outpatients (20.6% and 18.4%, respectively). However, there are concerns about their cross-cultural manifestations as an apparently low prevalence rate has been reported in East Asian inpatients and outpatients (1.7% and 4.9%, respectively). It is unknown whether the clinical profile of dissociative disorders in terms of their core symptomatic clusters, associated comorbid disorders, and environmental risk factors that has emerged in western clinical populations can also be found in non-western clinical populations. A standardized structured interview for DSM-IV dissociative disorders, post-traumatic stress disorder, and a history of interpersonal victimization was administered in a sample of Taiwanese acute psychiatric inpatients. Our results showed that 19.5% of our participants met criteria for a DSM-IV dissociative disorder, mostly dissociative disorder not otherwise specified. More importantly, the western clinical profile of dissociative disorders also characterized our patients, including a poly-symptomatic presentation and a history of interpersonal trauma in both childhood and adulthood. Our results lend support to the conclusion that cross-cultural manifestations of dissociative pathology in East Asia are similar to those in North America and Europe. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population

    Directory of Open Access Journals (Sweden)

    Mordre Marianne

    2012-10-01

    Full Text Available Abstract Background Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. Methods Former Norwegian child-psychiatric in-patients (n = 257 were followed up 17–39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan–Meier survival analyses and logrank testing. Results At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01. Low psychosocial functioning (assessed by the Children’s Global Assessment Scale at admission uniquely predicted future DP (p = 0.04. Conclusions ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.

  10. The logistics of an inpatient dermatology service.

    Science.gov (United States)

    Rosenbach, Misha

    2017-03-01

    Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service. ©2017 Frontline Medical Communications.

  11. Improving risk assessment of violence among military veterans: an evidence-based approach for clinical decision-making.

    Science.gov (United States)

    Elbogen, Eric B; Fuller, Sara; Johnson, Sally C; Brooks, Stephanie; Kinneer, Patricia; Calhoun, Patrick S; Beckham, Jean C

    2010-08-01

    Increased media attention to post-deployment violence highlights the need to develop effective models to guide risk assessment among military Veterans. Ideally, a method would help identify which Veterans are most at risk for violence so that it can be determined what could be done to prevent violent behavior. This article suggests how empirical approaches to risk assessment used successfully in civilian populations can be applied to Veterans. A review was conducted of the scientific literature on Veteran populations regarding factors related to interpersonal violence generally and to domestic violence specifically. A checklist was then generated of empirically-supported risk factors for clinicians to consider in practice. To conceptualize how these known risk factors relate to a Veteran's violence potential, risk assessment scholarship was utilized to develop an evidence-based method to guide mental health professionals. The goals of this approach are to integrate science into practice, overcome logistical barriers, and permit more effective assessment, monitoring, and management of violence risk for clinicians working with Veterans, both in Department of Veteran Affairs settings and in the broader community. Research is needed to test the predictive validity of risk assessment models. Ultimately, the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment and potentially help prevent violence among Veterans. Published by Elsevier Ltd.

  12. Factors Concerning Veterans With Dementia, Their Caregivers, and Coordination of Care: A Systematic Literature Review.

    Science.gov (United States)

    Mileski, Michael; Scott Kruse, Clemens; Brooks, Matthew; Haynes, Christine; Collingwood, Ying; Rodriguez, Rachel

    2017-11-01

    Military veterans diagnosed with dementia compose a large portion of our population. Often ignored are their caregivers and their plight as well as the availability, quality, and accessibility of health care for this demographic. The purpose of this systematic literature review is three fold: to identify opportunities available to increase public awareness on the subject; to identify areas of improvement in the level of care and quality of life for our nation's veterans; and to identify if adequate resources are available to veterans with dementia and their caregivers. The authors conducted systematic searches of three databases: PubMed via The National Center for Biotechnology Information, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), and Google. Data were collected regarding providing care to veterans who are suffering from dementia or Alzheimer's disease and their caregivers between 2008 and June 2016. Search results were filtered by date range, full text, English language, Boolean operators, and academic journals (n = 14). The review confirmed there are many facilitators and barriers in the coordination of care offered to veterans with dementia. Facilitators of quality care include veteran's expectations, family support, program development, and the availability of services. These positive aspects are aided by several community-based support services, new technology, and preventative care. Barriers are caregiver expectations, coordination of care, providers, and informal and formal costs. These negative facets are due to lack of educational resources, an increased veteran population diagnosed with dementia, limited knowledge of resources, and limited medical service in rural areas. Overall, there are a number of community programs that want to, and can, help veterans with dementia. There are also a number of ways to help veterans with dementia cope with their issues, which include

  13. 76 FR 65321 - Gulf War Veterans' Illnesses Task Force

    Science.gov (United States)

    2011-10-20

    ... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force AGENCY: Department of... Veterans Affairs (VA) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA's approach to and programs addressing 1990-1991 Gulf War Veterans...

  14. 78 FR 28292 - Gulf War Veterans' Illnesses Task Force

    Science.gov (United States)

    2013-05-14

    ... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force AGENCY: Department of... Veterans Affairs (VA) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA's approach to and programs addressing 1990-1991 Gulf War Veterans...

  15. 75 FR 16577 - Gulf War Veterans' Illnesses Task Force

    Science.gov (United States)

    2010-04-01

    ... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force AGENCY: Department of... Veterans Affairs (VA) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA's approach to and programs addressing 1990-1991 Gulf War Veterans...

  16. 38 CFR 3.454 - Veterans disability pension.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Veterans disability pension. 3.454 Section 3.454 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS ADJUDICATION Pension, Compensation, and Dependency and Indemnity Compensation Apportionments § 3.454 Veterans...

  17. Military sexual trauma among homeless veterans.

    Science.gov (United States)

    Pavao, Joanne; Turchik, Jessica A; Hyun, Jenny K; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel

    2013-07-01

    Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men. National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010. All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization. Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST. A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless

  18. Transboundary smoke haze pollution in Malaysia: inpatient health impacts and economic valuation.

    Science.gov (United States)

    Othman, Jamal; Sahani, Mazrura; Mahmud, Mastura; Ahmad, Md Khadzir Sheikh

    2014-06-01

    This study assessed the economic value of health impacts of transboundary smoke haze pollution in Kuala Lumpur and adjacent areas in the state of Selangor, Malaysia. Daily inpatient data from 2005, 2006, 2008, and 2009 for 14 haze-related illnesses were collected from four hospitals. On average, there were 19 hazy days each year during which the air pollution levels were within the Lower Moderate to Hazardous categories. No seasonal variation in inpatient cases was observed. A smoke haze occurrence was associated with an increase in inpatient cases by 2.4 per 10,000 populations each year, representing an increase of 31 percent from normal days. The average annual economic loss due to the inpatient health impact of haze was valued at MYR273,000 ($91,000 USD). Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. "Homelessness and trauma go hand-in-hand": pathways to homelessness among women veterans.

    Science.gov (United States)

    Hamilton, Alison B; Poza, Ines; Washington, Donna L

    2011-01-01

    Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness. Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans. Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness. Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery. Published by Elsevier Inc.

  20. 77 FR 27252 - Veterans' Employment and Training; Veterans Workforce Investment Program

    Science.gov (United States)

    2012-05-09

    ... service delivery systems that will address the complex employability problems facing eligible veterans; and (c) to increase the skills and competency level of veteran participants through longer-term...

  1. Salt Lake Community College Veterans Services: A Model of Serving Veterans in Higher Education

    Science.gov (United States)

    Ahern, Aaron; Foster, Michael; Head, Darlene

    2015-01-01

    This chapter outlines the birth and growth of a veterans' program in Salt Lake City, Utah, and discusses next steps in spurring additional innovations and advancements to improve service for student veterans in community colleges.

  2. Workplace social support in job satisfaction among veterans with posttraumatic stress symptoms: A preliminary correlational study.

    Science.gov (United States)

    Harris, J I; Strom, Thad Q; Ferrier-Auerbach, Amanda G; Kaler, Matthew E; Hansen, Lucas P; Erbes, Christopher R

    2017-01-01

    For Veterans managing PTSD symptoms, returning to vocational functioning is often challenging; identifying modifiable variables that can contribute to positive vocational adjustment is critical to improved vocational rehabilitation services. Workplace social support has proven to be important in vocational adjustment in both general population and vocational rehabilitation samples, but this area of inquiry has received little attention among Veterans with PTSD symptoms. In this small correlational study, employed Veterans (N = 63) presenting for outpatient PTSD treatment at a VA Health Care System completed surveys assessing demographic variables, PTSD symptoms, workplace social support, and job satisfaction. Workplace social support contributed to the prediction of job satisfaction. It is of note that workplace social support predicted a larger proportion of the variance in employment satisfaction than PTSD symptoms. Further research on workplace social support as a vocational rehabilitation resource for Veterans with PTSD is indicated.

  3. Workplace social support in job satisfaction among veterans with posttraumatic stress symptoms: A preliminary correlational study.

    Directory of Open Access Journals (Sweden)

    J I Harris

    Full Text Available For Veterans managing PTSD symptoms, returning to vocational functioning is often challenging; identifying modifiable variables that can contribute to positive vocational adjustment is critical to improved vocational rehabilitation services. Workplace social support has proven to be important in vocational adjustment in both general population and vocational rehabilitation samples, but this area of inquiry has received little attention among Veterans with PTSD symptoms. In this small correlational study, employed Veterans (N = 63 presenting for outpatient PTSD treatment at a VA Health Care System completed surveys assessing demographic variables, PTSD symptoms, workplace social support, and job satisfaction. Workplace social support contributed to the prediction of job satisfaction. It is of note that workplace social support predicted a larger proportion of the variance in employment satisfaction than PTSD symptoms. Further research on workplace social support as a vocational rehabilitation resource for Veterans with PTSD is indicated.

  4. Use of outpatient mental health services by homeless veterans after hurricanes.

    Science.gov (United States)

    Brown, Lisa M; Barnett, Scott; Hickling, Edward; Frahm, Kathryn; Campbell, Robert R; Olney, Ronald; Schinka, John A; Casey, Roger

    2013-05-01

    Little is known about the impact of hurricanes on people who are homeless at the time a disaster occurs. Although researchers have extensively studied the psychosocial consequences of disaster produced homelessness on the general population, efforts focused on understanding how homeless people fare have been limited to a few media reports and the gray literature. In the event of a hurricane, homeless veterans may be at increased risk for negative outcomes because of their cumulative vulnerabilities. Health care statistics consistently document that homeless veterans experience higher rates of medical, emotional, substance abuse, legal, and financial problems compared with the general population. This study used the 2004 to 2006 Veterans Health Administration (VHA) Outpatient Medical Dataset to examine the effects of hurricanes on use of outpatient mental health services by homeless veterans. Homeless veterans residing in hurricane-affected counties were significantly more likely to participate in group psychotherapy (32.4% vs. 13.4%, p < .002), but less likely to participate in individual 30-40-min sessions with medical evaluations (3.5% vs. 17.3%, p < .001). The study findings have implications for homeless programs and the provision of VHA mental health services to homeless veterans postdisaster. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  5. Food insecurity is associated with unhealthy dietary practices among US veterans in California.

    Science.gov (United States)

    Becerra, Monideepa B; Hassija, Christina M; Becerra, Benjamin J

    2017-10-01

    US veterans (hereafter, 'veterans') are at risk for being overweight or obese and associated unhealthy behaviours, including poor diet; although limited studies have examined the underlying factors associated with such outcomes. As such, the present study evaluated the association between food insecurity and dietary practices among veterans. A secondary analysis of cross-sectional data from the California Health Interview Survey (2009, 2011/2012) was conducted. Survey weights were applied to identify univariate means, population estimates and weighted percentages. Bivariate analyses followed by survey-weighted negative binomial regression were used to model the association between food insecurity and dietary practices of fruit, vegetable, fast food and soda intakes. California Health Interview Survey 2009-2011/2012. The present study included a total of 11 011 veterans from California. Nearly 5 % of the studied veteran population reported living in poverty with food insecurity. Compared with those at or above the poverty level and those in poverty but food secure, the mean intakes of fruits and vegetables were lower, while the mean intakes of soda and fast foods (P for trend insecurity. Food insecurity was associated with 24 and 142 % higher average consumption of fast foods and soda, respectively, and 24 % lower fruit intake. Food insecurity remains a burden among veterans and is associated with unhealthy dietary practices. Targeted interventions to improve diet quality are imperative.

  6. Differences in suicide and death ideation among veterans and nonveterans with serious mental illness.

    Science.gov (United States)

    Jahn, Danielle R; Muralidharan, Anjana; Drapalski, Amy L; Brown, Clayton H; Fang, Li Juan; Lucksted, Alicia

    2018-02-01

    Individuals with serious mental illness and veterans are two populations at elevated risk for suicide; however, research has not examined whether veterans with serious mental illness may be at higher suicide risk than nonveterans with serious mental illness. Additionally, overlapping risk factors for suicide in these populations may account for differences in suicide-related outcomes between these groups. Therefore, the aim of this study was to identify differences in death ideation and suicide ideation among veterans and nonveterans with serious mental illness. We also aimed to explore these effects after adjusting for potentially shared risk factors. We found that veterans with serious mental illness reported death ideation and suicide ideation more than twice as often as nonveterans with serious mental illness. After adjusting for demographic, psychiatric, and theory-driven risk factors, the effect of veteran status on death ideation remained significant, though the effect on suicide ideation was no longer significant. Depressive and psychotic symptoms were significant predictors of death ideation; depressive symptoms and hostility were significant predictors of suicide ideation. Clinicians should particularly monitor death ideation and suicide ideation in veterans with serious mental illness, as well as associated clinical risk factors such as depression, psychotic symptoms, and hostility. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  7. Psychosocial function and health in veteran families

    DEFF Research Database (Denmark)

    Jensen, Mai Tødsø; Karmsteen, Kirstine; Jørgensen, Anne-Marie Klint

    to the veteran or the mental health of the partner while relatively few publications deal with the veteran family as a whole or its members social relations outside the primary family. Furthermore, there are relatively few publications focusing on relatives to veterans deployed other places than Iraq...... the research field of psychosocial functioning and health among relatives living with a veteran, including potential gaps within this research field. We have found 103 publications. Most of them are American, 7 are from Europe and none from Scandinavia. Most publications focus on the partner’s relationship...... and Afghanistan, publications focusing on relatives of veterans with physical injuries and few publications dealing with relatives to female veterans. The overall conclusion is that there is a potential need for addressing psychosocial functioning and health among these groups of relatives in research to provide...

  8. 2015 Veteran Economic Opportunity Report

    Science.gov (United States)

    2015-01-01

    Competitiveness For purposes of this Report, the definition of a barrier is anything that prevents or obstructs passage, access , or progress. Vulnerable...and data analysis to the VBA and stakeholders. PA&I developed the VBA Enterprise Data Warehouse to enable the generation of recurring and ad hoc...reports in response to VBA decision-making and business needs. PA&I will be a primary source of information on Veteran education, vocational

  9. Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes

    Directory of Open Access Journals (Sweden)

    Jia H

    2017-03-01

    Full Text Available Huanguang Jia,1 Qinglin Pei,1 Charles T Sullivan,1 Diane C Cowper Ripley,1 Samuel S Wu,1 W Bruce Vogel,1 Xinping Wang,1 Douglas E Bidelspach,2 Jennifer L Hale-Gallardo,1 Barbara E Bates3 1Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, 2Physical Medicine and Rehabilitation Service, Department of Veterans Affairs, Washington, DC, 3Aleda E. Lutz VA Medical Center, Saginaw, MI, USA Introduction: Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors’ functional recovery and daily living activities. The US Department of Veterans Affairs (VA places veterans needing post-acute institutional care in private community nursing homes (CNHs. These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans’ health services as well as the geographic variation of the service utilization. Aim: The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. Methods: This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents for the study CNHs was linked with veterans’ inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation

  10. Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care.

    Science.gov (United States)

    Bukowski, Leigh A; Blosnich, John; Shipherd, Jillian C; Kauth, Michael R; Brown, George R; Gordon, Adam J

    2017-09-01

    Research shows transgender individuals experience pronounced health disparities compared with their nontransgender peers. Yet, there remains insufficient research about health differences within transgender populations. This study seeks to fill this gap by exploring how current urban/rural status is associated with lifetime diagnosis of mood disorder, alcohol dependence disorder, illicit drug abuse disorder, tobacco use, posttraumatic stress disorder, human immunodeficiency virus, and suicidal ideation or attempt among veterans with transgender-related diagnoses. This study used a retrospective review of The Department of Veterans Affairs (VA) administrative data for transgender patients who received VA care from 1997 through 2014. Transgender patients were defined as individuals that had a lifetime diagnosis of any of 4 International Classification of Diseases-9 diagnosis codes associated with transgender status. Independent multivariable logistic regression models were used to explore associations of rural status with medical conditions. Veterans with transgender-related diagnoses residing in small/isolated rural towns had increased odds of tobacco use disorder (adjusted odds ratio=1.39; 95% confidence intervals, 1.09-1.78) and posttraumatic stress disorder (adjusted odds ratio=1.33; 95% confidence intervals, 1.03-1.71) compared with their urban transgender peers. Urban/rural status was not significantly associated with other medical conditions of interest. This study contributes the first empirical investigations of how place of residence is associated with medical diagnoses among veterans with transgender-related diagnoses. The importance of place as a determinant of health is increasingly clear, but for veterans with transgender-related diagnoses this line of research is currently limited. The addition of self-reported sex identity data within VA electronic health records is one way to advance this line of research.

  11. Pediatric Inpatient Headache Therapy: What is Available.

    Science.gov (United States)

    Kabbouche, Marielle

    2015-01-01

    Status migrainosus is defined by the international classification of headache disorders (ICHD) criteria as a debilitating migraine lasting more then 72 hours. The epidemiology of status migrainosus is still unknown in adult and children, and frequently underdiagnosed. Children and adolescents often end up in the emergency room with an intractable headache that failed outpatient therapy. Six to seven percent of these children do not respond to acute infusion therapy and require hospitalization. It is imperative that more aggressive therapy is considered when patients are affected by a severe intractable headache to prevent further disability and returning the child to baseline activity. Multiple therapies are available for adults and children. Studies for acute therapy in the emergency room are available in adults and pediatric groups. Small studies are available for inpatient therapy in children and, along with available therapies for children and adolescents, are described in this review. A review of the literature shows growing evidence regarding the use of dihydroergotamine intravenously once patients are hospitalized. Effectiveness and safety have been proven in the last decades in adults and small studies in the pediatric populations. © 2015 American Headache Society.

  12. A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans.

    Directory of Open Access Journals (Sweden)

    Navid Ghaffarzadegan

    Full Text Available Post-traumatic stress disorder (PTSD stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a "system of systems." This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources. The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed.

  13. Tobacco Product Use Among Military Veterans - United States, 2010-2015.

    Science.gov (United States)

    Odani, Satomi; Agaku, Israel T; Graffunder, Corinne M; Tynan, Michael A; Armour, Brian S

    2018-01-12

    In 2015, an estimated 18.8 million U.S. adults were military veterans (1). Although the prevalence of tobacco-attributable conditions is high among veterans (2), there is a paucity of data on use of tobacco products, other than cigarettes, in this population. To monitor tobacco product use among veterans, CDC analyzed self-reported current (i.e., past 30-day) use of five tobacco product types (cigarettes, cigars [big cigars, cigarillos, or little cigars], roll-your-own tobacco, pipes, and smokeless tobacco [chewing tobacco, snuff, dip, or snus]) from the National Survey on Drug Use and Health (NSDUH). Overall, 29.2% of veterans reported current use of any of the assessed tobacco products. Cigarettes were the most commonly used tobacco product (21.6%), followed by cigars (6.2%), smokeless tobacco (5.2%), roll-your-own tobacco (3.0%), and pipes (1.5%); 7.0% of veterans currently used two or more tobacco products. Within subgroups of veterans, current use of any of the assessed tobacco products was higher among persons aged 18-25 years (56.8%), Hispanics (34.0%), persons with less than a high school diploma (37.9%), those with annual family income <$20,000 (44.3%), living in poverty (53.7%), reporting serious psychological distress (48.2%), and with no health insurance (60.1%). By age and sex subgroups, use of any of the assessed tobacco products was significantly higher among all veteran groups than their nonveteran counterparts, except males aged ≥50 years. Expanding the reach of evidence-based tobacco control interventions among veterans could reduce tobacco use prevalence in this population.

  14. A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans

    Science.gov (United States)

    Ghaffarzadegan, Navid; Ebrahimvandi, Alireza; Jalali, Mohammad S.

    2016-01-01

    Post-traumatic stress disorder (PTSD) stands out as a major mental illness; however, little is known about effective policies for mitigating the problem. The importance and complexity of PTSD raise critical questions: What are the trends in the population of PTSD patients among military personnel and veterans in the postwar era? What policies can help mitigate PTSD? To address these questions, we developed a system dynamics simulation model of the population of military personnel and veterans affected by PTSD. The model includes both military personnel and veterans in a “system of systems.” This is a novel aspect of our model, since many policies implemented at the military level will potentially influence (and may have side effects on) veterans and the Department of Veterans Affairs. The model is first validated by replicating the historical data on PTSD prevalence among military personnel and veterans from 2000 to 2014 (datasets from the Department of Defense, the Institute of Medicine, the Department of Veterans Affairs, and other sources). The model is then used for health policy analysis. Our results show that, in an optimistic scenario based on the status quo of deployment to intense/combat zones, estimated PTSD prevalence among veterans will be at least 10% during the next decade. The model postulates that during wars, resiliency-related policies are the most effective for decreasing PTSD. In a postwar period, current health policy interventions (e.g., screening and treatment) have marginal effects on mitigating the problem of PTSD, that is, the current screening and treatment policies must be revolutionized to have any noticeable effect. Furthermore, the simulation results show that it takes a long time, on the order of 40 years, to mitigate the psychiatric consequences of a war. Policy and financial implications of the findings are discussed. PMID:27716776

  15. Veterans Crisis Line: Videos About Reaching out for Help

    Science.gov (United States)

    Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There ... see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from ...

  16. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... more videos from Veterans Health Administration Lost: The Power of One Connection see more videos from Veterans Health Administration The Power of 1 PSA see more videos from Veterans ...

  17. VA Is Here for the People Who Support Our Veterans

    Science.gov (United States)

    ... a Self-Check Quiz Resources Spread the Word Videos Homeless Resources Additional Information Make the Connection Get Help When To Call What To Expect Resource Locator Veterans Live Chat Veterans Text Homeless Veterans Live Chat Military Live ...

  18. An Exploration of Transition Experiences Shaping Student Veteran Life Flow

    Science.gov (United States)

    Gregg, Brian Tuan

    2016-01-01

    Educational institutions offer transformative opportunities for veterans transitioning from military service. Veteran-specific cultural supports in educational environments offer participation in occupations and development of skills needed to complete educational goals. However, veterans experience complex life circumstances atypical from…

  19. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... from Veterans Health Administration The Power of 1 PSA see more videos from Veterans Health Administration Commitments PSA see more videos from Veterans Health Administration The ...

  20. Employment of Veterans in the Federal Executive Branch

    Data.gov (United States)

    Department of Veterans Affairs — These quick facts use data from the 2011 Employment of Veterans in the Federal Executive Branch to compare Veteran employment in the Federal Government by agency,...

  1. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... videos from Veterans Health Administration Talking About It Matters see more videos from Veterans Health Administration Stand ... Health Administration I am A Veteran Family/Friend Active Duty/Reserve and Guard Signs of Crisis Identifying ...

  2. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury

    OpenAIRE

    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore; Matheny, Michael E

    2015-01-01

    Objective Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention.

  3. British Nuclear Test Veterans' Association. Radiation exposure and subsequent health history of veterans and their children

    International Nuclear Information System (INIS)

    Urquhart, J.

    1993-01-01

    The present study of veterans' health carried out in association with Tyne Tees Television presents new and disturbing evidence of significant health effects in both veterans and their children, based on the health records of 1,454 members of the British Nuclear Test Veterans' Association, of whom 1,147 were fathers. (orig./MG)

  4. Heroes or Health Victims?: Exploring How the Elite Media Frames Veterans on Veterans Day.

    Science.gov (United States)

    Rhidenour, Kayla B; Barrett, Ashley K; Blackburn, Kate G

    2017-11-27

    We examine the frames the elite news media uses to portray veterans on and surrounding Veterans Day 2012, 2013, 2014, and 2015. We use mental health illness and media framing literature to explore how, why, and to what extent Veterans Day news coverage uses different media frames across the four consecutive years. We compiled a Media Coverage Corpora for each year, which contains the quotes and paraphrased remarks used in all veterans news stories for that year. In our primary study, we applied the meaning extraction method (MEM) to extract emergent media frames for Veterans Day 2014 and compiled a word frequency list, which captures the words most commonly used within the corpora. In post hoc analyses, we collected news stories and compiled word frequency lists for Veterans Day 2012, 2013, and 2015. Our findings reveal dissenting frames across 2012, 2013, and 2014 Veterans Day media coverage. Word frequency results suggest the 2012 and 2013 media frames largely celebrate Veterans as heroes, but the 2014 coverage depicts veterans as victimized by their wartime experiences. Furthermore, our results demonstrate how the prevailing 2015 media frames could be a reaction to 2014 frames that portrayed veterans as health victims. We consider the ramifications of this binary portrayal of veterans as either health victims or heroes and discuss the implications of these dueling frames for veterans' access to healthcare resources.

  5. Dissociative Disorders Among Chinese Inpatients Diagnosed With Schizophrenia

    Science.gov (United States)

    Yu, Junhan; Ross, Colin A.; Keyes, Benjamin B.; Li, Ying; Dai, Yunfei; Zhang, Tianhong; Wang, Lanlan; Fan, Qing; Xiao, Zeping

    2010-01-01

    The purpose of the study was to assess the prevalence of dissociative disorders in a sample of Chinese psychiatric inpatients. Participants in the study consisted of 569 consecutively admitted inpatients at Shanghai Mental Health Center, China, of whom 84.9% had a clinical diagnosis of schizophrenia based on the Chinese Classification and Diagnostic Criteria for Mental Disorders, Version 3 (CCMD-3). All participants completed a self-report measure of dissociation, the Dissociative Experiences Scale (DES) and none had a prior diagnosis of a dissociative disorder. Ninety-six randomly selected participants were interviewed with a structured interview, the Dissociative Disorders Interview Schedule (DDIS) and a clinical interview. These 96 patients did not differ significantly from the 473 patients who were not interviewed on any demographic measures or on the self-report measure dissociation. A total of 28 (15.3%, after weighting of the data) patients received a clinical diagnosis of a dissociative disorder based on DSM-IV-TR criteria. Dissociative identity disorder was diagnosed in 2 (0.53%, after weighting) patients. Compared to the patients without a dissociative disorder, patients with dissociative disorders were significantly more likely to report childhood abuse (57.1% versus 22.1%), but the two groups did not differ significantly on any demographic measures. Dissociative disorders were readily identified in an inpatient psychiatric population in China. PMID:20603768

  6. Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.

    Science.gov (United States)

    Krinsky, Sam; Ryan, Andrew M; Mijanovich, Tod; Blustein, Jan

    2017-04-01

    To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates. © Health Research and Educational Trust.

  7. Trauma-related nightmares among American Indian veterans: views from the dream catcher.

    Science.gov (United States)

    Shore, Jay H; Orton, Heather; Manson, Spero M

    2009-01-01

    Dreams hold particular relevance in mental health work with American Indians (AIs). Nightmares are a common sequelae of trauma and a frequent defining feature of post-traumatic stress disorder (PTSD). Despite mounting evidence of the prevalence of trauma and PTSD among AIs and the important cultural role of dreams, no work to date has directly examined nightmares in trauma. Drawing from epidemiological and clinical sources, data are presented about nightmares among Northern Plains AI veterans. Nightmares are common among these veterans: 97% of combat veterans with PTSD report nightmares. These rates are higher than rates among other veteran populations. The frequency of nightmares and sleep disturbances increases with trauma and PTSD severity in this population. Qualitative materials, in the form of a brief cultural overview and a case presentation, are included to illustrate clinical and cultural contexts of nightmares in the Northern Plains. Clinicians working with this population should be aw are of the high frequency and cultural context of nightmares for AI veterans. In order to improve culturally appropriate care, further research is needed to better understand the frequency, meaning, and context of nightmares in trauma and PTSD for AI populations.

  8. 75 FR 61860 - Advisory Committee on Women Veterans; Notice of Meeting

    Science.gov (United States)

    2010-10-06

    ... on mental health, prosthetic services for women Veterans, readjustment counseling, women Veterans' legislative issues, special health initiatives, women Veterans' research, rural health, and homeless... Veterans Affairs regarding the needs of women Veterans with respect to health care, rehabilitation...

  9. Race-ethnicity and gender differences in VA health care service utilization among U.S. veterans of recent conflicts.

    Science.gov (United States)

    Koo, Kelly H; Madden, Erin; Maguen, Shira

    2015-05-01

    The purpose of this study was to compare health care utilization patterns by race-ethnicity and gender among veterans returning from Iraq and Afghanistan. A retrospective analysis was conducted with records from U.S. service members and veterans returning from Iraq and Afghanistan who enrolled in health care through the Veterans Health Administration, who received a psychiatric diagnosis, and who had used primary or mental health outpatient care between October 7, 2001, and December 31, 2012 (N=309,050). Racial-ethnic minority groups were first collapsed together and compared with whites and then separated by racial-ethnic group. Gender was also tested as a moderator of utilization. Although rates of mental health outpatient care, primary care, and emergency service utilization were relatively similar for racial-ethnic minority groups and whites, minority groups were admitted to psychiatric inpatient care at lower rates than whites. When veterans were separately categorized by specific racial-ethnic groups, some differences in utilization rates emerged; most notably, only black and Hispanic men were admitted less frequently to psychiatric inpatient care, and male and female Asian/Pacific Islander veterans used emergency services less, than their white counterparts. Gender moderated the association between race-ethnicity and mental health outpatient use, such that American Indian and Hispanic women used mental health outpatient services less than white women, but American Indian and Hispanic men showed the opposite pattern. Furthermore, black men were more likely than white men to use mental health outpatient services, but there was no difference between these women. Although service utilization rates between minority groups and whites were similar when minority groups were combined, examination of utilization by racial-ethnic groups and by men and women separately yielded more robust findings.

  10. Medicare Provider Utilization and Payment Data - Inpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...

  11. Pediatric Inpatient Nurses' Perceptions of Child Maltreatment.

    Science.gov (United States)

    Lavigne, Jenifer L; Portwood, Sharon G; Warren-Findlow, Jan; Brunner Huber, Larissa R

    The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses. A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses. Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws. Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment. There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Inpatient Psychiatric Prospective Payment System (IPF PPS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file contains case level data for inpatient psychiatric stays and is derived from 2011 MEDPAR data file and the latest available provider specific file. The...

  13. Declining Rates of Inpatient Parathyroidectomy for Primary Hyperparathyroidism in the US

    Science.gov (United States)

    Kim, Sun Moon; Shu, Aimee D.; Long, Jin; Montez-Rath, Maria E.; Leonard, Mary B.; Norton, Jeffrey A.; Chertow, Glenn M.

    2016-01-01

    Parathyroidectomy is the only curative therapy for patients with primary hyperparathyroidism. However, the incidence, correlates and consequences of parathyroidectomy for primary hyperparathyroidism across the entire US population are unknown. We evaluated temporal trends in rates of inpatient parathyroidectomy for primary hyperparathyroidism, and associated in-hospital mortality, length of stay, and costs. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) from 2002–2011. Parathyroidectomies for primary hyperparathyroidism were identified using International Classification of Diseases, Ninth Revision codes. Unadjusted and age- and sex- adjusted rates of inpatient parathyroidectomy for primary hyperparathyroidism were derived from the NIS and the annual US Census. We estimated 109,583 parathyroidectomies for primary hyperparathyroidism between 2002 and 2011. More than half (55.4%) of patients were younger than age 65, and more than three-quarters (76.8%) were female. The overall rate of inpatient parathyroidectomy was 32.3 cases per million person-years. The adjusted rate decreased from 2004 (48.3 cases/million person-years) to 2007 (31.7 cases/million person-years) and was sustained thereafter. Although inpatient parathyroidectomy rates declined over time across all geographic regions, a steeper decline was observed in the South compared to other regions. Overall in-hospital mortality rates were 0.08%: 0.02% in patients younger than 65 years and 0.14% in patients 65 years and older. Inpatient parathyroidectomy rates for primary hyperparathyroidism have declined in recent years. PMID:27529699

  14. Predicting violence in veterans with posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Jovanović Aleksandar A.

    2009-01-01

    Full Text Available Background/Aim. Frequent expression of negative affects, hostility and violent behavior in individuals suffering from posttraumatic stress disorder (PTSD were recognized long ago, and have been retrospectively well documented in war veterans with PTSD who were shown to have an elevated risk for violent behavior when compared to both veterans without PTSD and other psychiatric patients. The aim of this study was to evaluate the accuracy of clinical prediction of violence in combat veterans suffering from PTSD. Methods. The subjects of this study, 104 male combat veterans with PTSD were assessed with the Historical, Clinical and Risk Management 20 (HCR-20, a 20-item clinicianrated instrument for assessing the risks for violence, and their acts of violence during one-year follow-up period were registered based on bimonthly check-up interviews. Results. Our findings showed that the HCR-20, as an actuarial measure, had good internal consistency reliability (α = 0.82, excellent interrater reliability (Interaclass Correlation ICC = 0.85, as well as excellent predictive validity for acts of any violence, non-physical violence or physical violence in the follow-up period (AUC = 0.82-0.86. The HCR-20 also had good interrater reliability (Cohen's kappa = 0.74, and acceptable predictive accuracy for each outcome criterion (AUC = 0.73-0.79. Conclusion. The results of this research confirm that the HCR-20 may also be applied in prediction of violent behavior in the population of patients suffering from PTSD with reliability and validity comparable with the results of previous studies where this instrument was administered to other populations of psychiatric patients.

  15. Elderly homeless veterans in Los Angeles: chronicity and precipitants of homelessness.

    Science.gov (United States)

    van den Berk-Clark, Carissa; McGuire, James

    2013-12-01

    We compared the characteristics of chronically homeless and acutely homeless elderly veterans to better understand precipitants of homelessness. We conducted interviews with 33 chronically and 26 acutely homeless veterans aged 65 years and older receiving transitional housing services in Los Angeles, California, between 2003 and 2005. We asked questions regarding their sociodemographic characteristics and other social status measures. Other precipitants of homelessness were acquired via observation and open-ended and structured questions. Both veterans groups were more similar than different, with substantial levels of physical, psychiatric, and social impairment. They differed significantly in homelessness history, with chronically homeless veterans having more homelessness episodes and more total time homeless. They were also less educated and had smaller social networks. In response to open-ended questioning, elderly homeless veterans revealed how health and substance use issues interacted with loss of social support and eviction to exacerbate homelessness. Assessment of a range of factors is needed to address risk factors and events leading to homelessness. Further research with larger samples is needed to confirm the characteristics and needs of the elderly homeless veteran population.

  16. Exploring Demographics and Health as Predictors of Risk-Taking in UK Help-Seeking Veterans

    Directory of Open Access Journals (Sweden)

    Rachel Ashwick

    2018-06-01

    Full Text Available Risk-taking amongst veterans has severe consequences, yet few studies have examined factors that may predict risk-taking in help-seeking veteran populations. This paper presents a cross-sectional study involving a random sample of 667 UK help-seeking veterans, investigating the role of demographics, mental health and physical health presentations on the propensity for risk-taking. Out of 403 (73.4% veterans, 350 (86.8% reported risk-taking in the past month. We found that younger age, being in a relationship, probable PTSD, common mental health difficulties and traumatic brain injury were significantly associated with risk-taking. Additionally, a direct association was found between increased risk-taking and PTSD symptom clusters, including higher hyperarousal, elevated negative alterations in mood and cognition. Our findings provide initial evidence for demographic and mental health presentations as predictors of risk-taking in help-seeking veterans. Further research and longitudinal studies are needed to facilitate valid risk assessments, and early intervention for veteran services.

  17. Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012

    OpenAIRE

    Wright, Brad; O'Shea, Amy M.J.; Glasgow, Justin M.; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

    2016-01-01

    Abstract Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals. The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals. Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient...

  18. Cancer incidence in Dutch Balkan veterans

    NARCIS (Netherlands)

    Bogers, R.P.; Leeuwen, F.E. van; Grievink, L.; Schouten, L.J.; Kiemeney, L.A.L.M.; Schram-Bijkerk, D.

    2013-01-01

    Suspicion has been raised about an increased cancer risk among Balkan veterans because of alleged exposure to depleted uranium. The authors conducted a historical cohort study to examine cancer incidence among Dutch Balkan veterans. Male military personnel (n=18,175, median follow-up 11 years) of

  19. DefenseLink Special: Veterans Day 2006

    Science.gov (United States)

    information so we can address your issue or question. U.S. Department of Defense Header Image (click to return especially important this year as America's military members put their lives in danger to protect the country Service. Story Cities Carry ASY Banner to Honor Past, Present Veterans WASHINGTON, Nov. 8, 2006 - Veterans

  20. Association Between Chronic Conditions and Physical Function Among Veteran and Non-Veteran Women With Diabetes

    Science.gov (United States)

    Gray, Kristen E.; Katon, Jodie G.; Rillamas-Sun, Eileen; Bastian, Lori A.; Nelson, Karin M.; LaCroix, Andrea Z.; Reiber, Gayle E.

    2016-01-01

    Abstract Purpose of the Study: To compare the number of chronic conditions among a list of 12 and their association with physical function among postmenopausal non-Veteran and Veteran women with diabetes. Design and Methods: Among women with diabetes from the Women’s Health Initiative, we compared the average number of chronic conditions between non-Veterans and Veterans and the association between total number of chronic conditions on subsequent RAND-36 physical function. To examine associations between each condition and subsequent physical function, we compared women with diabetes plus one chronic condition to women with diabetes alone using linear regression in separate models for each condition and for non-Veterans and Veterans. Results: Both non-Veterans ( N = 23,542) and Veterans ( N = 618) with diabetes had a median of 3 chronic conditions. Decreases in physical function for each additional condition were larger among Veterans than non-Veterans (−6.3 vs. −4.1 points). Decreases in physical function among women with diabetes plus one chronic condition were greater than that reported for diabetes alone for all combinations and were more pronounced among Veterans (non-Veterans: −11.1 to −24.2, Veterans: −16.6 to −40.4 points). Hip fracture, peripheral artery disease, cerebrovascular disease, and coronary disease in combination with diabetes were associated with the greatest decreases in physical function. Implications: Chronic conditions were common among postmenopausal women with diabetes and were associated with large declines in physical function, particularly among Veterans. Interventions to prevent and reduce the impact of these conditions and facilitate coordination of care among women with diabetes may help them maintain physical function. PMID:26768385

  1. Educating nurses to care for military veterans in civilian hospitals: An integrated literature review.

    Science.gov (United States)

    Cooper, Linda; Andrew, Sharon; Fossey, Matt

    2016-12-01

    In the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. To conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. A systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. The search generated sixteen papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. Civilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Telehealth at the US Department of Veterans Affairs after Hurricane Sandy.

    Science.gov (United States)

    Der-Martirosian, Claudia; Griffin, Anne R; Chu, Karen; Dobalian, Aram

    2018-01-01

    Background Like other integrated health systems, the US Department of Veterans Affairs has widely implemented telehealth during the past decade to improve access to care for its patient population. During major crises, the US Department of Veterans Affairs has the potential to transition healthcare delivery from traditional care to telecare. This paper identifies the types of Veterans Affairs telehealth services used during Hurricane Sandy (2012), and examines the patient characteristics of those users. Methods This study conducted both quantitative and qualitative analyses. Veterans Affairs administrative and clinical data files were used to illustrate the use of telehealth services 12 months pre- and 12 months post- Hurricane Sandy. In-person interviews with 31 key informants at the Manhattan Veterans Affairs Medical Center three-months post- Hurricane Sandy were used to identify major themes related to telecare. Results During the seven-month period of hospital closure at the Manhattan Veterans Affairs Medical Center after Hurricane Sandy, in-person patient visits decreased dramatically while telehealth visits increased substantially, suggesting that telecare was used in lieu of in-person care for some vulnerable patients. The most commonly used types of Veterans Affairs telehealth services included primary care, triage, mental health, home health, and ancillary services. Using qualitative analyses, three themes emerged from the interviews regarding the use of Veterans Affairs telecare post- Hurricane Sandy: patient safety, provision of telecare, and patient outreach. Conclusion Telehealth offers the potential to improve post-disaster access to and coordination of care. More information is needed to better understand how telehealth can change the processes and outcomes during disasters. Future studies should also evaluate key elements, such as adequate resources, regulatory and technology issues, workflow integration, provider resistance, diagnostic fidelity and

  3. Motivation for Psychotherapy and Illness Beliefs in Turkish Immigrant Inpatients in Germany: Results of a Cultural Comparison Study.

    Science.gov (United States)

    Reich, Hanna; Bockel, Luisa; Mewes, Ricarda

    2015-03-01

    Some immigrant populations, for instance, Turkish immigrants, suffer from worse mental health than the general population. Moreover, psychotherapeutic treatment does not work well in this group. This might be explained by lower motivation for psychotherapy and particular illness beliefs as important early predictors of treatment outcome. We investigate differences in these predictors between Turkish immigrant inpatients and inpatients without a migration background and evaluate whether particular illness beliefs have a negative impact on motivation for psychotherapy. Turkish immigrant inpatients and inpatients without a migration background (N = 100), suffering from depressive disorder, somatoform disorder, and/or adjustment disorder, completed questionnaires assessing motivation for psychotherapy, depressive and somatic symptoms, illness perception, illness-related locus of control, and causal illness attributions. Despite a higher symptom burden, motivation for psychotherapy was lower in Turkish immigrant inpatients than in inpatients without a migration background (d = 0.54). This was fully explained by stronger beliefs in supernatural causes of illness and higher fatalistic-external illness-related locus of control in the Turkish immigrant sample (mediation analysis; R (2) = 0.27). Turkish immigrants believe in supernatural or fatalistic causes of illness and fatalistic-external locus of control to a greater extent than German inpatients without a migration background. These beliefs reduce motivation for psychotherapy and need to be addressed in psychotherapeutic treatment in order to secure positive treatment outcomes.

  4. Posttraumatic stress disorder among black Vietnam veterans.

    Science.gov (United States)

    Allen, I M

    1986-01-01

    Because of racism in the military and racial and social upheaval in the United States during the Vietnam War years, as well as limited opportunities for blacks in the postwar period, black veterans of the Vietnam War often harbor conflicting feelings about their wartime experiences and have difficulty rationalizing brutality against the Vietnamese. As a result, black veterans suffer from posttraumatic stress disorder (PTSD) at a higher rate than white veterans. Diagnosis and treatment of PTSD in black veterans is complicated by the tendency to misdiagnose black patients, by the varied manifestations of PTSD, and by patients' frequent alcohol and drug abuse and medical, legal, personality, and vocational problems. The author presents his and others' recommendations about ways to treat black veterans with PTSD.

  5. Colorectal cancer screening in patients with spinal cord injury yields similar results to the general population with an effective bowel preparation: a retrospective chart audit.

    Science.gov (United States)

    Teng, Brandon J; Song, Shawn H; Svircev, Jelena N; Dominitz, Jason A; Burns, Stephen P

    2018-03-01

    Retrospective chart audit. To compare adequacy of colonoscopy bowel preparation and diagnostic findings between persons with SCI receiving an extended inpatient bowel preparation and the general population. Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA. We reviewed an electronic database of all colonoscopies performed at a tertiary Veterans Affairs medical center between 7/12/13 and 15/10/15. Patients with SCI received a multi-day bowel preparation with magnesium citrate, and 8-10 liters of polyethylene glycol-3350 and electrolyte colonic lavage solution (PEG-ELS) over two and one half days. The control population received a standard bowel preparation consisting of magnesium citrate and 4 liters of PEG-ELS over 1 day. Two hundred and fifty-five patients were included in the study, including 85 patients with SCI. Average risk screening was a more common colonoscopy indication in patients with SCI vs. the control population (24 vs. 13% p = 0.03). There was no difference in adequacy of bowel preparation (87 vs. 85%, p = 0.73) or adenoma detection rate (55 vs. 51%, p = 0.59) when comparing patients with SCI with the control population. No difference in polyp histopathology was detected (p = 0.748). Our study demonstrated that an extended bowel preparation for patients with SCI produces similar bowel preparation results and diagnostic yield when compared to patients without SCI undergoing colonoscopy.

  6. Depression and Anxiety in Greek Male Veterans After Retirement.

    Science.gov (United States)

    Kypraiou, Aspa; Sarafis, Pavlos; Tsounis, Andreas; Bitsi, Georgia; Andreanides, Elias; Constantinidis, Theodoros; Kotrotsiou, Evaggelia; Malliarou, Maria

    2017-03-01

    depression scale. The sense of satisfaction derived from fulfilling work-related expectations when finishing a career, with changes in everyday life, and smoking and alcohol reduction, may contribute to a better adjustment during the retirement period. To our knowledge, this was the first study examining depression and anxiety levels in Greek veterans, and the sample size was large, covering a randomly chosen veteran population. On the other, it was a convenient sample, although the study results could not focus on direct-term effects of retirement (up to 3 years of retirement from active service). Primitive data may be used for research directions in the future. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  7. The Relationship Between Traumatic Brain Injury and Rates of Chronic Symptomatic Illness in 202 Gulf War Veterans.

    Science.gov (United States)

    Chao, Linda L

    2018-05-18

    GW veterans if chronic symptomatic illness is defined broadly (i.e., CDC CMI or mild-moderate CMI). History of pre-GW TBI did not affect the veterans' response to exposures/experiences from the GW; however, there was suggestive evidence that veterans who sustained TBIs during the GW may have poorer functional outcomes that GW veterans without TBI or even GW veterans with non-GW-related TBIs. Future, better powered studies with randomly and systematically select participants from the larger population of GW veterans will need to confirm this finding.

  8. 42 CFR 424.14 - Requirements for inpatient services of inpatient psychiatric facilities.

    Science.gov (United States)

    2010-10-01

    ... psychiatric facilities. 424.14 Section 424.14 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Certification and Plan Requirements § 424.14 Requirements for inpatient services of inpatient psychiatric... requirements differ from those for other hospitals because the care furnished in psychiatric hospitals is often...

  9. Health Information Seeking and Technology Use Among Veterans With Spinal Cord Injuries and Disorders.

    Science.gov (United States)

    Hogan, Timothy P; Hill, Jennifer N; Locatelli, Sara M; Weaver, Frances M; Thomas, Florian P; Nazi, Kim M; Goldstein, Barry; Smith, Bridget M

    2016-02-01

    Access to health information is crucial to persons living with a spinal cord injury or disorder (SCI/D). Although previous research has provided insights on computer and Internet use among persons with SCI/D, as well as how and where persons with SCI/D gather health information, few studies have focused on U.S. veterans with SCI/D. To characterize health information seeking among veterans with SCI/D and to examine the association between technology use and the characteristics of veterans with SCI/D. Cross-sectional. Veterans Health Administration (VHA). Sample of 290 veterans with SCI/D who utilize services at 2 VHA SCI/D Centers. Postal mail survey. Extent of computer, Internet, and text messaging use, information source use, and e-Health literacy rates. The survey response rate was 38%. The majority of respondents were male (97.2%), younger than 65 years (71.0%), and white (71.7%). Of the respondents, 64.8% indicated that they use a computer, 62.9% reported use of the Internet, and 26.2% reported use of text messaging. The mean overall e-Health Literacy Scale score was 27.3 (standard deviation = 7.2). Similar to findings reported in studies focused outside the veteran population, the most frequent source that veterans turned to for information about SCI/D was a health professional (85.1%); this was also the most frequent source that veterans indicated they would turn to first to get information about SCI/D (75.9%). Other frequently reported sources of information included other persons with SCI/D (41.0%), Internet resources (31.0%), and family and friends (27.9%). Fairly high levels of computer and Internet use exist among veterans with SCI/D. Veterans with SCI/D also have a strong preference for people-particularly health professionals, and to a lesser extent peers and family and friends-as sources of information about SCI/D. These findings highlight the importance of combining technology and human interaction to meet the information needs of this population

  10. Adverse Childhood Experiences and the Mental Health of Veterans.

    Science.gov (United States)

    McGuinness, Teena M; Waldrop, Jessica R

    2015-06-01

    Many U.S. Veterans have experienced the burdens of mental illness and suicide. The current article focuses on Veterans who served from 2001-2015. Although combat exposure and suicidal ideation are linked, approximately one half of all suicides among Active Duty service members (who have served since 2001) occurred among those who never deployed. Researchers who sought additional risks for suicide found that Veterans have greater odds of adversities in childhood than the general population. Adverse childhood experiences are stressful and traumatic experiences, including abuse and neglect, as well as witnessing household dysfunction, or growing up with individuals with mental illness or substance abuse. Further, childhood physical abuse has been shown to be a significant predictor for posttraumatic stress disorder and suicide. Adverse childhood experiences confer additional risk for the mental health of service members. Psychiatric nursing implications include the importance of assessing early childhood adversity during psychosocial assessments. Providing trauma-informed strategies for treatment is an essential element of psychiatric nursing care. Copyright 2015, SLACK Incorporated.

  11. Insomnia symptoms and behavioural health symptoms in veterans 1 year after traumatic brain injury.

    Science.gov (United States)

    Farrell-Carnahan, Leah; Barnett, Scott; Lamberty, Gregory; Hammond, Flora M; Kretzmer, Tracy S; Franke, Laura M; Geiss, Meghan; Howe, Laura; Nakase-Richardson, Risa

    2015-01-01

    Insomnia and behavioural health symptoms 1 year after traumatic brain injury (TBI) were examined in a clinical sample representative of veterans who received inpatient treatment for TBI-related issues within the Veterans Health Administration. This was a cross-sectional sub-study (n = 112) of the Polytrauma Rehabilitation Centres' traumatic brain injury model system programme. Prevalence estimates of insomnia, depression, general anxiety, nightmares, headache and substance use, stratified by injury severity, were derived. Univariate logistic regression was used to examine unadjusted effects for each behavioural health problem and insomnia by injury severity. Participants were primarily male, insomnia; those with mild TBI were significantly more likely to meet criteria (43%) than those with moderate/severe TBI (22%), χ(2)(1, n = 112) = 5.088, p ≤ 0.05. Univariable logistic regression analyses revealed depressive symptoms and general anxiety were significantly associated with insomnia symptoms after TBI of any severity. Headache and binge drinking were significantly inversely related to insomnia symptoms after moderate/severe TBI, but not MTBI. Veterans with history of TBI, of any severity, and current insomnia symptoms may be at increased risk for depression and anxiety 1 year after TBI.

  12. The impact of stigma on community reintegration of Veterans with traumatic brain injury and the well-being of their caregivers.

    Science.gov (United States)

    Phelan, Sean M; Bangerter, Lauren R; Friedemann-Sanchez, Greta; Lackore, Kandace A; Morris, Megan A; Van Houtven, Courtney H; Carlson, Kathleen F; van Ryn, Michelle; Harden, Kristin J; Griffin, Joan M

    2018-05-02

    To assess the association between perceived stigma and discrimination and caregiver strain, caregiver well-being, and patient community reintegration. A cross-sectional survey study of 564 informal caregivers of Veterans of US wars in Iraq and Afghanistan who experienced traumatic brain injuries or polytrauma (TBI/PT). Care settings of community dwelling former inpatients of any US Veterans Polytrauma Rehabilitation Center. 564 (67%) caregivers of former inpatients, identified through next-of-kin records and subsequent nominations INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Caregiver strain, depression, anxiety, loneliness, and self-esteem; as well as care recipient community reintegration, a key aspect of TBI/PT rehabilitation. Family stigma was associated with strain (b=.40, preintegration (b=-.17, p=.001). Caregiver stigma-by-association was associated with strain (b=.39, preintegration (b=-.11, p=.001). Perceived stigma may be a substantial source of stress for caregivers of Veterans with TBI/PT, and may contribute to caregivers' poor health outcomes and the community reintegration of the Veterans for whom they provide care. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. 77 FR 18307 - Gulf War Veterans' Illnesses Task Force Report

    Science.gov (United States)

    2012-03-27

    ... DEPARTMENT OF VETERANS AFFAIRS Gulf War Veterans' Illnesses Task Force Report AGENCY: Department...) established the Gulf War Veterans' Illnesses Task Force (GWVI-TF) in August 2009 to conduct a comprehensive review of VA policies and programs addressing 1990-1991 Gulf War Veterans' illnesses. The GWVI-TF...

  14. Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.

    Science.gov (United States)

    Chou, Ann F; Graber, Christopher J; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Kelly, Allison; Glassman, Peter A

    2016-06-01

    BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.

  15. Military veterans and canine assistance for post-traumatic stress disorder: A narrative review of the literature.

    Science.gov (United States)

    Krause-Parello, Cheryl A; Sarni, Sarah; Padden, Eleni

    2016-12-01

    Veterans with post-traumatic stress disorder (PTSD) are a vulnerable population at high risk for depression, isolation, and suicide. A substantial body of anecdotal evidence exists supporting the use of canines as an effective adjunct treatment for this population. However, a comprehensive review of its use based on scientific literature has thus far not been conducted. A narrative literature review was conducted to examine the current state of the science on canine assistance for veterans diagnosed with PTSD in order to synthesize current empirical knowledge on the subject. Articles were retrieved among the small body of recent literature using computerized database searches. Inclusion criteria included peer-reviewed journal publications published through October 1st, 2015. Only originally published articles that examined the outcomes of canine assistance on veterans with PTSD were examined. Additionally, each included article was specific to veterans, dogs, and, PTSD in combination rather than article that discuss the concepts separately. Exclusion criteria included symposia and conference material, dissertations, media articles, and no mention of canines as a treatment modality. 563 articles were retrieved; 6 met the criteria. When evaluating data, information and themes were extracted into an Excel table; this table was employed in the synthesis of information into manuscript form. The following themes were explored within the selected publications: What is Canine Assistance; Why Use Canine Assistance for PTSD in Veterans; Concerns; and Future Directions. The literature endorsed canine assistance for PTSD in veterans as a promising modality. Authors also raised concerns about lack of protocols, cost and availability barriers, and animal welfare calling for additional, rigorous research to advance its use as a treatment for veterans with PTSD. PTSD continues to pose significant psychological, health, and welfare challenges to veterans and the multi

  16. Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans.

    Science.gov (United States)

    Liu, Winnie; Saxon, David R; McNair, Bryan; Sanagorski, Rebecca; Rasouli, Neda

    2016-09-01

    Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) (P Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes. © 2016 Diabetes Technology Society.

  17. Risk Factors for Homelessness Among US Veterans

    Science.gov (United States)

    Tsai, Jack; Rosenheck, Robert A.

    2015-01-01

    Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. PMID:25595171

  18. Associations between Relational Aggression, Depression, and Suicidal Ideation in a Child Psychiatric Inpatient Sample

    Science.gov (United States)

    Fite, Paula J.; Stoppelbein, Laura; Greening, Leilani; Preddy, Teresa M.

    2011-01-01

    The current study examined relations between relational aggression, depressive symptoms, and suicidal ideation in a child clinical population. Participants included 276 children (M age = 9.55 years; 69% Male) who were admitted to a child psychiatric inpatient facility. Findings suggested that relational aggression was associated with depressive…

  19. Systematic review of women veterans' mental health.

    Science.gov (United States)

    Runnals, Jennifer J; Garovoy, Natara; McCutcheon, Susan J; Robbins, Allison T; Mann-Wrobel, Monica C; Elliott, Alyssa

    2014-01-01

    Given recent, rapid growth in the field of women veterans' mental health, the goal of this review was to update the status of women veterans' mental health research and to identify current themes in this literature. The scope of this review included women veterans' unique mental health needs, as well as gender differences in veterans' mental health needs. Database searches were conducted for relevant articles published between January 2008 and July 2011. Searches were supplemented with bibliographic reviews and consultation with subject matter experts. The database search yielded 375 titles; 32 met inclusion/exclusion criteria. The women veterans' mental health literature crosses over several domains, including prevalence, risk factors, health care utilization, treatment preferences, and access barriers. Studies were generally cross-sectional, descriptive, mixed-gender, and examined Department of Veterans Affairs (VA) health care users from all service eras. Results indicate higher rates of specific disorders (e.g., depression) and comorbidities, with differing risk factors and associated medical and functional impairment for female compared with male veterans. Although satisfaction with VA health care is generally high, unique barriers to care and indices of treatment satisfaction exist for women. There is a breadth of descriptive knowledge in many content areas of women veterans' mental health; however, the research base examining interventional and longitudinal designs is less developed. Understudied content areas and targets for future research and development include certain psychiatric disorders (e.g., schizophrenia), the effects of deployment on woman veterans' families, and strategies to address treatment access, attrition, and provision of gender-sensitive care. Published by Elsevier Inc.

  20. 75 FR 22164 - Urban Non-Urban Homeless Female Veterans and Homeless Veterans With Families' Reintegration Into...

    Science.gov (United States)

    2010-04-27

    ... Non-Urban Homeless Female Veterans and Homeless Veterans With Families' Reintegration Into Employment... addresses complex problems facing Homeless Female Veterans and/or Veterans with Families eligible to... (including job readiness, literacy training, and skills training) to expedite the reintegration of homeless...

  1. Recovery orientation in mental health inpatient settings

    DEFF Research Database (Denmark)

    Waldemar, Anna Kristine; Esbensen, Bente Appel; Korsbek, Lisa

    2018-01-01

    Offering mental health treatment in line with a recovery-oriented practice has become an objective in the mental health services in many countries. However, applying recovery-oriented practice in inpatient settings seems challenged by unclear and diverging definitions of the concept......-structured interviews were conducted with 14 inpatients from two mental health inpatient wards using an interview guide based on factors from the Recovery Self-Assessment. Qualitative content analysis was applied in the analysis. Six themes covering the participants’ experiences were identified. The participants felt...... accepted and protected in the ward and found comfort in being around other people but missed talking and engaging with health professionals. They described limited choice and influence on the course of their treatment, and low information levels regarding their treatment, which they considered to consist...

  2. Irrational ideas. Older vs. younger inpatients.

    Science.gov (United States)

    Hyer, L A; Jacobsen, R; Harrison, W R

    1985-04-01

    The relationship to age of irrational beliefs among psychiatric inpatients has not been explored using the rational-emotive model. This study addressed the following two questions: 1) Do older and younger psychiatric inpatients differ in irrational beliefs? 2) Do older depressives differ from older nondepressives in irrational beliefs? Upon admission to a large medical center, 58 younger (less than 45 years old) and 54 older (greater than 55 years old) subjects were assessed on a battery of psychological tests, including the Idea Inventory and the Beck Depression Inventory. Results showed that older and younger inpatients did not differ on irrational beliefs. Results also showed that older and younger groups of depressives did not differ on the irrationality scores. When a correlational analysis was used, depression was related to irrationality within the older group but not within the younger group.

  3. Variation in Veteran Identity as a Factor in Veteran-Targeted Interventions.

    Science.gov (United States)

    Hack, Samantha M; DeForge, Bruce R; Lucksted, Alicia

    2017-07-01

    The sociocultural identities that people self-assign or accept influence their interpersonal interactions and decision making. Identity-based interventions attempt to influence individuals by associating healthy behaviors with in-group membership. Outreach and educational efforts aimed at veterans may rely on "typical" veteran identity stereotypes. However, as discussed in this Open Forum, there is evidence that veteran identity is not monolithic but rather fluctuates on the basis of personal characteristics and individual military service experiences. Overall, the impact of veteran identity on veterans' health behaviors and use of health care is not known and has been understudied. A major limiting factor is the lack of a standardized measure of veteran identity that can assess variations in salience, prominence, and emotional valence.

  4. An outcome study of an inpatient treatment program for pathological gamblers.

    Science.gov (United States)

    Russo, A M; Taber, J I; McCormick, R A; Ramirez, L F

    1984-08-01

    In 1972 the Brecksville Unit of the Cleveland Veterans Administration Medical Center began the first inpatient treatment program for pathological gambling in the United States. The 30-day, highly structured gambling treatment program aims for abstinence from gambling, reduction of the urge to gamble, and restoration of a maximum level of social functioning. The authors report the results of a preliminary outcome study of 60 former patients who completed a survey form rating various aspects of their lives one year postdischarge. Fifty-five percent of the respondents reported complete abstinence from gambling since discharge. Chi-square analyses demonstrated significant relationships between abstinence from gambling and improved interpersonal relationships, better financial status, decreased depression, and participation in professional aftercare and Gamblers Anonymous. The authors believe that their initial results support the contention that pathological gambling is a treatable disorder.

  5. Veteran family reintegration, primary care needs, and the benefit of the patient-centered medical home model.

    Science.gov (United States)

    Hinojosa, Ramon; Hinojosa, Melanie Sberna; Nelson, Karen; Nelson, David

    2010-01-01

    Men and women returning from the wars in Afghanistan and Iraq face a multitude of difficulties while integrating back into civilian life, but the importance of their veteran status is often overlooked in primary care settings. Family physicians have the potential to be the first line of defense to ensure the well-being of veterans and their families because many will turn to nonmilitary and non-Veterans Affairs providers for health care needs. An awareness of the unique challenges faced by this population is critical to providing care. A patient-centered medical home orientation can help the family physician provide veterans and their families the care they need. Specific recommendations for family physicians include screening their patient population; providing timely care; treating the whole family; and integrating care from multiple disciplines and specialties, providing veterans and families with "one-stop shopping" care. An awareness of the unique challenges faced by veterans and their families translates into better overall outcomes for this population.

  6. Rising utilization of inpatient pediatric asthma pathways.

    Science.gov (United States)

    Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D

    2018-02-01

    Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.

  7. Alcohol and Drug Abuse Among U.S. Veterans: Comparing Associations with Intimate Partner Substance Abuse and Veteran Psychopathology

    Science.gov (United States)

    Miller, Mark W.; Reardon, Annemarie F.; Wolf, Erika J.; Prince, Lauren B.; Hein, Christina L.

    2013-01-01

    This study examined the relative influences of PTSD, other psychopathology, and intimate partner alcohol and drug use on substance-related problems in U.S. veterans (242 couples, N = 484). Hierarchical regression analyses revealed that partner alcohol and drug use severity explained more variance in veteran alcohol use and drug use (20% and 13%, respectively) than did veteran PTSD, adult antisocial behavior, or depression symptoms combined (6% for veteran alcohol use; 7% for veteran drug use). Findings shed new light on the influence of relationship factors on veteran alcohol and drug use and underscore the importance of couples-oriented approaches to treating veterans with comorbid PTSD and substance abuse. PMID:23325433

  8. Developing a Leadership Development Program for the Veterans Benefits Administration within the Department of Veterans Affairs

    Science.gov (United States)

    2014-06-13

    highest priorities: Veteran homelessness, “ VBA access ” to allow improved awareness of available VA services and benefits, and the backlog of benefits...Veterans by 2015. VBA access refers to improved Veteran awareness of the various VA benefits and services available, particularly through outreach and...claim completion time. While all three of these priorities impact VBA , the second two--increased access and decreased backlog--directly relate to

  9. Alcohol use and substance use disorders in Gulf War, Afghanistan, and Iraq War veterans compared with nondeployed military personnel.

    Science.gov (United States)

    Kelsall, Helen Louise; Wijesinghe, Millawage Supun Dilara; Creamer, Mark Christopher; McKenzie, Dean Philip; Forbes, Andrew Benjamin; Page, Matthew James; Sim, Malcolm Ross

    2015-01-01

    Although recent veterans have been found to be at increased risk of psychiatric disorders, limited research has focused on alcohol or substance use disorders. This systematic review and meta-analysis examined whether alcohol or substance use disorders were more common in Gulf War, Afghanistan, and Iraq War veterans compared with military comparison groups nondeployed to the corresponding conflict, including never deployed personnel. Literature was searched (1990-2014) in multiple electronic databases. Studies were assessed for eligibility and quality, including risk of bias. Eighteen studies (1997-2014) met inclusion criteria. Pooled analysis based on a random-effects model yielded a summary odds ratio of 1.33 (95% confidence interval (CI): 1.22, 1.46) for alcohol (7 studies) and 2.13 (95% CI: 0.96, 4.72) for substance use (3 studies) disorders among Gulf War veterans, as well as 1.36 (95% CI: 1.11, 1.66) for alcohol (7 studies) and 1.14 (95% CI: 1.04, 1.25) for substance use (4 studies) disorders among Iraq/Afghanistan veterans; meta-regressions found no statistically significant association between theater of war and alcohol use or substance use disorders. Our findings indicate that Gulf and Iraq/Afghanistan war veterans are at higher alcohol use disorder risk than nondeployed veterans, but further studies with increased power are needed to assess substance use disorder risk in Gulf War veteran populations. © Commonwealth of Australia 2015.

  10. Factors influencing the adoption of telemedicine for treatment of military veterans with post-traumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Clemens Scott Kruse

    2018-04-01

    Full Text Available Background: Military veterans returning from a combat zone often face mental health challenges as a result of traumatic experiences. The veteran in the United States has been underdiagnosed and underserved. Since its advancement in the 1990s, telemedicine has become a more prevalent means of delivering services for post-traumatic stress disorder among veterans in the United States, but its adoption is not ubiquitous. Objective: To clarify the association of telemedicine and the treatment of veterans with post-traumatic stress disorder through identification of facilitators and barriers to the adoption of the modality. Methods: Reviewers analysed articles from CINAHL and PubMed databases, using relative key words, selecting the 28 most germane to the study objective. Results: The most common adoption facilitators were: improving access to rural populations of veterans (22%, effective treatment outcomes (16%, and decreased costs related to care (13%. The most prevalent barriers were: veterans lacking access to necessary modalities (25%, availability of physicians competent in post-traumatic stress disorder treatment (20%, and complications with technology (20%. Five themes surfaced for facilitators: accessibility, effectiveness, cost reduction, positive patient perception, and supportive community; and 5 themes for barriers: access to technology, technical complications, physician availability, negative patient perception, and uninformed patients. Conclusion: This literature review identifies cost and outcomes-effectiveness. The association of telemedicine with the treatment of veterans with post-traumatic stress disorder is feasible, beneficial and effective.

  11. Veterans Integrated Services Networks (VISN), Markets, Submarkets, Sectors and Counties by Geographic Location

    Data.gov (United States)

    Department of Veterans Affairs — The Department of Veterans Affairs (VA) provides healthcare services to its veterans across the USA including territories and possessions. Healthcare services are...

  12. Factores de mal pronóstico en pacientes internados con Neutropenia al inicio del episodio febril Prognostic risk factors for serious complications in an inpatient population with neutropenia at the onset of a febrile episode

    Directory of Open Access Journals (Sweden)

    Carlos Gómez Roca

    2006-10-01

    Full Text Available Los pacientes con neutropenia y fiebre constituyen una población heterogénea con riesgo variable para el desarrollo de complicaciones serias y mortalidad. El objetivo de este trabajo es identificar factores que, presentes al ingreso, estuvieran asociados a mayor riesgo de complicaciones graves en pacientes que se internan por neutropenia y fiebre. Se trata de un estudio de seguimiento de una cohorte de 238 episodios de neutropenia y fiebre (neutrófilos 38.3 °C en 167 pacientes internados en sala general en nuestra institución desde 1997 a 2004. Ochenta y dos por ciento de los pacientes tenían enfermedad hematológica, 14% tumores sólidos y 4% no asociados a quimioterapia. Se registraron 67 eventos adversos (46% de insuficiencia renal, 27% de hipotensión refractaria, 15% de insuficiencia respiratoria y 12% con sangrado mayor. Se hallaron diferencias significativas en presencia de comorbilidades previas, temperatura mayor a 39 °C, frecuencia cardíaca mayor a 120 latidos por minuto, frecuencia respiratoria mayor a 24 por minuto, tensión arterial sistólica menor a 90 mm Hg, presencia de 3 o más valores de laboratorio alterados al ingreso, presencia de foco clínico y hemocultivos positivos. En el análisis multivariado de regresión logística mantuvieron asociación independiente con mayor riesgo de eventos graves: hipotensión arterial sistólica (OR=7, pPatients with neutropenia and fever conform a heterogeneous population with a variable risk of serious complications and mortality. The goal of this study was to identify prognostic risk factors present at the beginning of the episode, for adverse events and serious complications in patients admitted in a general ward with fever and neutropenia. A cohort of 238 episodes with neutropenia and fever (neutrophils 38.3 °C in 167 patients admitted to our general hospital between 1997 and 2004 was followed. Eighty two percent of the patients had hematologic malignancies, 14% solid tumors

  13. Børn af veteraner

    DEFF Research Database (Denmark)

    Frederiksen, Signe; Lausten, Mette

    Siden starten af 1990’erne har Danmark sendt over 30.000 soldater og andet personel på internationale missioner – langt de fleste til Eks-Jugoslavien, Afghanistan og Irak. Denne undersøgelse handler om de børn, hvis fædre har været udsendt på militære missioner i udlandet. For hvordan håndterer...... spørgsmål er fokus for undersøgelsen. Undersøgelsen bygger på en spørgeskemaundersøgelse blandt børn af veteraner på henholdsvis 7, 11 og 15 år. Undersøgelsen er gennemført for og i samarbejde med Veterancentrets Videncenter, som er en del af Forsvarsministeriets Personalestyrelse....

  14. Department of Veterans Affairs, Gulf War Veterans’ Illnesses Task Force to the Secretary of Veterans Affairs

    Science.gov (United States)

    2010-09-29

    National Health and Nutrition Examination Survey (NHANES); and the National Health Interview Survey ( NHIS ). As of July 1, 2010, VA has submitted to...NHANES and NHIS staff specific questions that if answered positively, will identify Veteran study subjects beginning in 2011 in both these National...several discussions with investigators on the NHANES and NHIS . Staffs from both surveys are willing to include Veteran-specific questions and to plan

  15. Association of Mild Traumatic Brain Injury With and Without Loss of Consciousness With Dementia in US Military Veterans.

    Science.gov (United States)

    Barnes, Deborah E; Byers, Amy L; Gardner, Raquel C; Seal, Karen H; Boscardin, W John; Yaffe, Kristine

    2018-05-07

    Traumatic brain injury (TBI) is common in both veteran and civilian populations. Prior studies have linked moderate and severe TBI with increased dementia risk, but the association between dementia and mild TBI, particularly mild TBI without loss of consciousness (LOC), remains unclear. To examine the association between TBI severity, LOC, and dementia diagnosis in veterans. This cohort study of all patients diagnosed with a TBI in the Veterans Health Administration health care system from October 1, 2001, to September 30, 2014, and a propensity-matched comparison group. Patients with dementia at baseline were excluded. Researchers identified TBIs through the Comprehensive TBI Evaluation database, which is restricted to Iraq and Afghanistan veterans, and the National Patient Care Database, which includes veterans of all eras. The severity of each TBI was based on the most severe injury recorded and classified as mild without LOC, mild with LOC, mild with LOC status unknown, or moderate or severe using Department of Defense or Defense and Veterans Brain Injury Center criteria. International Classification of Diseases, Ninth Revision codes were used to identify dementia diagnoses during follow-up and medical and psychiatric comorbidities in the 2 years prior to the index date. Dementia diagnosis in veterans who had experienced TBI with or without LOC and control participants without TBI exposure. The study included 178 779 patients diagnosed with a TBI in the Veterans Health Administration health care system and 178 779 patients in a propensity-matched comparison group. Veterans had a mean (SD) age of nearly 49.5 (18.2) years at baseline; 33 250 (9.3%) were women, and 259 136 (72.5%) were non-Hispanic white individuals. Differences between veterans with and without TBI were small. A total of 4698 veterans (2.6%) without TBI developed dementia compared with 10 835 (6.1%) of those with TBI. After adjustment for demographics and medical and psychiatric

  16. Leading from the Middle: Replication of a Re-Engagement Program for Veterans with Mental Disorders Lost to Follow-Up Care

    Directory of Open Access Journals (Sweden)

    David E. Goodrich

    2012-01-01

    Full Text Available Objectives. Persons with mental disorders experience functional impairments and premature mortality. Limited continuity of care may contribute to disparities in this group. We describe the replication of an evidence-based outreach program (Re-Engage to reconnect Veterans with mental disorders into care who have dropped out of services. Methods. Using the Enhanced Replicating Effective Programs framework, population-based registries were used to identify Veterans lost-to-care, and providers used this information to determine Veteran disposition and need for care. Providers recorded Veteran preferences, health status, and care utilization, and formative process data was collected to document implementation efforts. Results. Among Veterans who dropped out of care (n=126, the mean age was 49 years, 10% were women, and 29% were African-American. Providers determined that 39% of Veterans identified for re-engagement were deceased, hospitalized, or ineligible for care. Of the remaining 68 Veterans, outreach efforts resulted in contact with 20, with 7 returning to care. Providers averaged 14.2 hours over 4 months conducting re-engagement services and reported that gaining facility leadership support and having service agreements for referrals were essential for program implementation. Conclusions. Population-level, panel management strategies to re-engage Veterans with mental disorders are potentially feasible if practices are identified to facilitate national rollout.

  17. Cost effectiveness of day stay versus inpatient radiofrequency (RF) ablation for the treatment of supraventricular tachyarrhythmias

    International Nuclear Information System (INIS)

    Weerasooriya, H.R.; Harris, A.H.; Davis, M.J.E.

    1996-01-01

    It is well established that radiofrequency (RF) ablation is the most cost effective treatment strategy for patients with supraventricular tachycardia. Previous cost estimates assumed at least an overnight stay following RF ablation. Day stay RF ablation however appears to be a safe alternative. The aim of this study was to compare day stay and inpatient catheter ablation in terms of cost, efficacy and safety. This was a retrospective cost effectiveness analysis. The study population consisted of 25 consecutive patients who underwent impatient RF ablation (historical controls). Economic analysis was based upon a detailed clinical costing. The mean overall cost per patient of inpatient RF ablation in 1994 Australian dollar values is $2354 (SD, $642) compared with $1876 (SD, $595) for day stay RF ablation (p<0.01). Day stay RF ablation is a cost effective alternative to inpatient RF ablation. 16 refs., 2 tabs

  18. Spiritual and religious experiences of adolescent psychiatric inpatients versus healthy peers.

    Science.gov (United States)

    Grossoehme, Daniel H; Cotton, Sian; Leonard, Anthony

    2007-01-01

    One hundred twenty-two adolescent psychiatric inpatients with depressive disorders and 80 healthy peers were administered the INSPIRIT, a measure of core spiritual experiences. Healthy adolescents reported a greater frequency of spiritual experiences and a more positive impact of such experiences on their belief in God than did their inpatient peers. Adolescent inpatients reported higher frequencies of experiencing angels, demons, God or guiding spirits; feeling unity with the earth and other living things; and with near death or life after death as compared to healthy peers. Overall, females reported higher frequency of spiritual experiences and higher impact of the experience on their belief in God than did males. It was concluded that the INSPIRIT is a feasible spiritual assessment tool for adolescent populations and may be used by chaplains as a means for guiding clinical conversations with adolescents.

  19. Protocol for the evaluation of a digital storytelling approach to address stigma and improve readiness to seek services among veterans.

    Science.gov (United States)

    Bunnell, Brian E; Davidson, Tatiana M; Hamblen, Jessica L; Cook, Danna L; Grubaugh, Anouk L; Lozano, Brian E; Tuerk, Peter W; Ruggiero, Kenneth J

    2017-01-01

    Research suggests that at least 10% of veterans returning from Iraq and Afghanistan meet criteria for posttraumatic stress disorder (PTSD) related to their military experiences. National dissemination initiatives have increased veterans' access to best-practice interventions. However, treatment-seeking remains low among veterans with PTSD, often due to perceived stigma and other associated barriers. The National Center for PTSD recently developed and launched AboutFace , a digital storytelling (DST) resource designed to help veterans recognize PTSD and motivate them to seek evidence-based treatment. The Ralph H. Johnson Veterans Affairs Medical Center (VAMC) and the National Center for PTSD have partnered to conduct pilot work to evaluate veterans' reactions to AboutFace to set the stage for a large-scale study to examine whether AboutFace effectively reduces stigma and improves attitudes toward treatment-seeking among veterans. If effective, this DST approach may serve as a valuable national model for a variety of treatment-seeking populations. During the first phase of the pilot, in-person usability assessments of AboutFace will be conducted via semi-structured interviews with 20 veterans. Audio recordings of interviews will undergo transcription and coding. A report of the results of qualitative analyses of these interviews will be provided to the National Center for PTSD and will inform revisions to the site. In the second phase of the pilot, 60 veterans referred to a specialized PTSD clinic will be recruited to demonstrate and refine the methodology that we propose to use in a larger randomized controlled trial evaluation of AboutFace . Veterans will be randomly assigned to receive AboutFace plus standard education vs . standard education alone. Baseline and 2-week telephone assessments will be conducted with participating veterans to measure stigma, attitudes toward seeking mental health services, and treatment access/engagement. The feedback we receive in

  20. SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

    Science.gov (United States)

    Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

    2016-01-01

    The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

  1. Developing a Student Veterans Center: The Confluence of Academic and Military Cultures

    Science.gov (United States)

    Francis, Lynette Cook; Kraus, Amanda

    2012-01-01

    While student veterans share characteristics with other student populations, they also bring to campuses a host of unique gifts and challenges whose impact can be profound, not only on the vets themselves but also on the institution and the individuals who work with them. Therefore, college professionals should proceed with humility and caution as…

  2. VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans

    Science.gov (United States)

    2016-12-01

    Congressional Requesters December 2016 GAO-17-52 United States Government Accountability Office United States Government Accountability Office...VHA officials said not all facilities require onsite gynecologists and facilities may authorize gynecological services from non-VA providers. They...including previously closed combat positions, which could contribute to the increase in the women veteran population. See GAO, Military Personnel: DOD Is

  3. War stress and late-life mortality in World War II civilian resistance veterans.

    NARCIS (Netherlands)

    den Velde, Wybrand Op; Deeg, Dorly J. H.; Hovens, Johannes E.; Van Duijn, Marijtje A. J.; Aarts, Petra G. H.

    The mental and physical health of 146 Dutch males exposed to severe war stress during their young adulthood were examined in 1986-1987 when they were at ages 61 to 66 years. The veterans' data were compared with a randomly selected population-based sample of same-aged males. In 2005, 70% of the war

  4. Family problems among recently returned military veterans referred for a mental health evaluation.

    Science.gov (United States)

    Sayers, Steven L; Farrow, Victoria A; Ross, Jennifer; Oslin, David W

    2009-02-01

    Existing evidence suggests that military veterans with mental health disorders have poorer family functioning, although little research has focused on this topic. To test whether psychiatric symptoms are associated with family reintegration problems in recently returned military veterans. Cross-sectional survey of a clinical population. Respondents who were referred to behavioral health evaluation from April 2006 through August 2007 were considered for the survey. Philadelphia Veterans Affairs Medical Center, Pa. 199 military veterans who served in Iraq or Afghanistan after 2001 and were referred for behavioral health evaluation from primary care (mean age = 32.7 years, SD = 9.1). Measures included the Mini-International Neuropsychiatric Interview for psychiatric diagnoses, the 9-item Patient Health Questionnaire for depression diagnosis and severity, and screening measures of alcohol abuse and illicit substance use. A measure of military family readjustment problems and a screening measure of domestic abuse were developed for this study. Three fourths of the married/cohabiting veterans reported some type of family problem in the past week, such as feeling like a guest in their household (40.7%), reporting their children acting afraid or not being warm toward them (25.0%), or being unsure about their family role (37.2%). Among veterans with current or recently separated partners, 53.7% reported conflicts involving "shouting, pushing, or shoving," and 27.6% reported that this partner was "afraid of them." Depression and posttraumatic stress disorder symptoms were both associated with higher rates of family reintegration problems. Mental health problems may complicate veterans' readjustment and reintegration into family life. The findings suggest an opportunity to improve the treatment of psychiatric disorders by addressing family problems. Copyright 2009 Physicians Postgraduate Press, Inc.

  5. Helping Veterans and Their Families Fight On!

    Directory of Open Access Journals (Sweden)

    Megan Hazle

    2012-04-01

    Full Text Available This new generation of veterans is coming home to families, friends, employers, and communities that likely do not understand military culture, nor the effects that military service and reintegration have on a veteran’s life, leading to the next war – the Reintegration War. Military servicemembers, veterans, and their families face challenges within the Reintegration War that are different from their civilian counterparts and are complicated by military-specific circumstances. In order to more effectively and efficiently address the challenges servicemembers, veterans, and their families face, we need to work together in a comprehensive effort. Strategies are presented to help win the Reintegration War and ease the transition for servicemembers, veterans, and their families.

  6. Veterans and agent orange: update 2000

    National Research Council Canada - National Science Library

    Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Third Biennial Update), Division of Health Promotion and Disease Prevention

    2001-01-01

    Veterans and Agent Orange: Update 2000 examines the state of the scientific evidence regarding associations between diseases and exposure to dioxin and other chemical compounds in herbicides used in Vietnam...

  7. Women Veterans Health Care: Frequently Asked Questions

    Science.gov (United States)

    ... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  8. Chronic Fatigue Syndrome in Gulf War Veterans

    Science.gov (United States)

    ... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  9. Sexual Trauma: Women Veterans Health Care

    Science.gov (United States)

    ... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  10. Aging Veterans and Posttraumatic Stress Symptoms

    Science.gov (United States)

    ... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  11. HCUP State Inpatient Databases (SID) - Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Inpatient Databases (SID) contain the universe of hospital inpatient discharge abstracts in States participating in HCUP that release their data through...

  12. Inpatient management of borderline personality disorder at Helen ...

    African Journals Online (AJOL)

    Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg. ... South African Journal of Psychiatry ... to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over ...

  13. The physical and mental health of Australian Vietnam veterans 3 decades after the war and its relation to military service, combat, and post-traumatic stress disorder.

    Science.gov (United States)

    O'Toole, Brian I; Catts, Stanley V; Outram, Sue; Pierse, Katherine R; Cockburn, Jill

    2009-08-01

    The long-term health consequences of war service remain unclear, despite burgeoning scientific interest. A longitudinal cohort study of a random sample of Australian Vietnam veterans was designed to assess veterans' postwar physical and mental health 36 years after the war (2005-2006) and to examine its relation to Army service, combat, and post-traumatic stress disorder (PTSD) assessed 14 years previously (1990-1993). Prevalences in veterans (n = 450) were compared with those in the Australian general population. Veterans' Army service and data from the first assessments were evaluated using multivariate logistic regression prediction modeling. Veterans' general health and some health risk factors were poorer and medical consultation rates were higher than Australian population expectations. Of 67 long-term conditions, the prevalences of 47 were higher and the prevalences of 4 were lower when compared with population expectations. Half of all veterans took some form of medication for mental well-being. The prevalence of psychiatric diagnoses exceeded Australian population expectations. Military and war service characteristics and age were the most frequent predictors of physical health endpoints, while PTSD was most strongly associated with psychiatric diagnoses. Draftees had better physical health than regular enlistees but no better mental health. Army service and war-related PTSD are associated with risk of illness in later life among Australian Vietnam veterans.

  14. Differences in aerobic fitness between inpatients and outpatients with severe mental disorders

    Directory of Open Access Journals (Sweden)

    Helene Daae-Qvale Holmemo

    2014-08-01

    Full Text Available AbstractBackgroundPatients with severe mental disorders have increased mortality, and cardiovascular disease (CVD accounts for a large part. Physical inactivity and low aerobic fitness have been recognized as significant risk factors for CVD. In this study, we investigated the differences in aerobic fitness and physical activity between in- and outpatients with severe mental disorders. Method and subjectsFifty in- and outpatients from a regional psychiatric department were included. The patients filled in a questionnaire on physical activity and completed a clinical examination. An estimation of aerobic fitness was calculated for each patient, using gender, age, waist circumference, resting heart rate and physical activity level as variables.ResultsInpatients had lower estimated aerobic fitness than outpatients (VO₂peak 42 vs 50 mL•kg-1•min-1, p<0.001. Compared to population data matched for age and gender, inpatients had lower aerobic fitness, while outpatients were not different from the population average.ConclusionInpatients at a psychiatric department had lower estimated aerobic fitness than outpatients, and a lower aerobic fitness compared to the general population. Our findings suggest that inpatients with severe mental disorders should be considered a high risk group for CVD.

  15. Gender-specific mental health care needs of women veterans treated for psychiatric disorders in a Veterans Administration Women's Health Clinic.

    Science.gov (United States)

    Miller, Laura J; Ghadiali, Nafisa Y

    2015-04-01

    This pilot study aims to ascertain the prevalence of self-reported premenstrual, perinatal, and perimenopausal influences on mental health, and of gynecologic conditions that could interact with psychiatric conditions, among women veterans receiving psychiatric care within a Veterans Administration (VA) Women's Health Clinic (WHC). Participants included all women veterans (N=68) who received psychiatric evaluations within a VA WHC over a 5-month period. This setting encompasses colocated and coordinated primary care, gynecologic and mental health services. Evaluations included a Women's Mental Health Questionnaire, a psychiatric interview, and medical record review. Deidentified data were extracted from a clinical data repository for this descriptive study. High proportions of study participants reported that their emotional problems intensified premenstrually (42.6%), during pregnancy (33.3%), in the postpartum period (33.3%), or during perimenopause (18.2%). Unintended pregnancy (70.0% of pregnancies) and pregnancy loss (63.5% of women who had been pregnant) were prominent sex-linked stressors. Dyspareunia (22.1% of participants) and pelvic pain (17.6% of participants) were frequent comorbidities. Among women veterans receiving psychiatric care within a VA WHC, there are high rates of self-reported premenstrual, perinatal, and perimenopausal influences on mental health. This population also has substantial comorbidity of psychiatric disorders with dyspareunia and pelvic pain. This underscores the importance of recognizing and addressing women veterans' sex-specific care needs, including interactions among reproductive cycle phases, gynecologic pain, and psychiatric symptoms. The findings support the need for greater awareness of the sex-specific mental health needs of women veterans, and for more definitive studies to further characterize these needs.

  16. Impulse control disorders in psychiatric inpatients.

    Science.gov (United States)

    Müller, Astrid; Rein, Katharina; Kollei, Ines; Jacobi, Andrea; Rotter, Andrea; Schütz, Patricia; Hillemacher, Thomas; de Zwaan, Martina

    2011-08-15

    The aim of this study was to examine the prevalence of impulse control disorders (ICDs) in a European psychiatric inpatient sample. Two hundred thirty four consecutive psychiatric inpatients (62% female) were examined using a module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) that has been developed for ICDs (SCID-ICD). In addition to intermittent explosive disorder, pyromania, kleptomania, pathological gambling, and trichotillomania, the proposed ICDs not otherwise specified were assessed, including compulsive buying, nonparaphilic compulsive sexual behavior, pathological internet use, and pathological skin picking. Based on the SCID-ICD, a lifetime ICD rate of 23.5% and a current ICD rate of 18.8% were found. The most frequent ICDs were pathological skin picking (lifetime 7.3%, current 6.8%), compulsive buying (lifetime 6.8%, current 6.0%), and intermittent explosive disorder (lifetime 5.6%, current 3.4%). In contrast, referring to admission diagnoses taken from patients' charts only 3.8% of the inpatients were diagnosed with any current ICD. Individuals with comorbid ICD were significantly younger and had more admission diagnoses other than ICD. The results suggest high rates of ICDs among psychiatric inpatients that remain to be under-diagnosed in clinical routine. 2011 Elsevier Ireland Ltd. All rights reserved.

  17. Psychiatric nurses' experiences with inpatient aggression

    NARCIS (Netherlands)

    Nijman, H.; Bowers, L.; Oud, N.; Jansen, G.

    2005-01-01

    Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this "Perceptions of Prevalence Of Aggression Scale" (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff

  18. Onconeural Antibodies in Acute Psychiatric Inpatient Care

    DEFF Research Database (Denmark)

    Sæther, Sverre Georg; Schou, Morten; Stoecker, Winfried

    2017-01-01

    , GLRA1B, DPPX, GRM1, GRM5, DNER, Yo, ZIC4, GAD67, amphiphysin, CV2, Hu, Ri, Ma2, and recoverin. Only one sample was positive (antirecoverin IgG). The present findings suggest that serum onconeural antibody positivity is rare among patients acutely admitted for inpatient psychiatric care. The clinical...

  19. Qualify of Life of Forensic Psychiatric Inpatients

    NARCIS (Netherlands)

    Nieuwenhuizen, C. van; Nijman, H.L.I.

    2009-01-01

    In this article, the quality of life (QoL) of mentally disordered offenders was investigated. The data of 44 forensic psychiatric inpatients were analyzed using the Lancashire Quality of Life Profile (LQoLP), Rehabilitation Evaluation Hall and Baker (REHAB), and the Psychopathy Checklist-Revised

  20. Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making.

    Science.gov (United States)

    Lich, Kristen Hassmiller; Tian, Yuan; Beadles, Christopher A; Williams, Linda S; Bravata, Dawn M; Cheng, Eric M; Bosworth, Hayden B; Homer, Jack B; Matchar, David B

    2014-07-01

    Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35,517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27,856) and hypertension control among diabetics (23,100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained. © 2014 American Heart Association, Inc.

  1. Veterans transitioning from isolation to integration: a look at veteran/service dog partnerships.

    Science.gov (United States)

    Crowe, Terry K; Sánchez, Victoria; Howard, Alyse; Western, Brenna; Barger, Stephanie

    2017-08-13

    This study explored the dynamics of veteran/service dog partnerships by gathering the perspectives of veterans with a history of post-traumatic stress disorder and/or traumatic brain injury. Exploratory qualitative methods (focus groups and individual interviews) were used to investigate veteran/service dog relationships related to community involvement, family and friend relationships, self-care, work, and leisure. Nine male veterans, Paws, and Stripes program graduates participated. Data were audio recorded and transcribed by two research team members who used qualitative analytic software to manage and code the data. The full research team discussed themes and reached consensus on the themes that emerged from analysis. Five themes emerged about the perceived benefit of veteran/service dog relationship: Secluded but Seeking Society (moving from isolation to reconnection); Opening Opportunities (navigating daily life); Bridging the Gap (facilitating social opportunities); and Reclaiming Life (transforming sense of worth and purpose). An overarching theme, Calming Catalyst, connected the other four themes. Veterans in this study reported that their goal was to reclaim and develop key aspects of their lives and they perceived service dogs as a support in their transition from isolation to reintegration. This study found that service dogs supported the veterans to meet their goal. Implications for rehabilitation There are a significant number of veterans with post-traumatic stress disorder and/or traumatic brain injury who are facing life challenges including self-care, securing work, participating in leisure activities, and integrating into the community. Service dogs are an emerging intervention used to assist veterans with reintegration into civilian life. There is a need for professionals to be aware of potential benefits of service dog/veteran partnerships. Based on our findings, veterans could benefit from being paired with a service dog to facilitate their

  2. Psychological skills of veteran athletes. DOI: 10.5007/1980-0037.2011v13n5p404

    Directory of Open Access Journals (Sweden)

    Sanderson Soares Silva

    2011-08-01

    Full Text Available At the beginning of the study of veteran athletes, most investigations involving this population have focused on the physiological aspects of performance and their relationship with the aging process. With respect to sport psychology, there are few studies on the use of psychological skills by veteran athletes. In view of this gap, further studies are needed to increase the understanding of psychological skills used by veteran athletes. In this respect, our point of view shows that veteran athletes use a set of psychological skills to enhance their competitive performance and to overcome obstacles during the competition. In addition, the study of these psychological skills provides relevant information regarding the cognitive processes that occur in older adults, since a series of cognitive changes have been reported to occur as a result of the aging process.

  3. Predictors of Readmission after Inpatient Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Umang Jain

    2014-03-01

    Full Text Available Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020, previous percutaneous coronary intervention (PCI (OR, 2.69; CI, 1.21-5.97; P=0.015, hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001, bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046, American Society of Anesthesiologists (ASA class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004, and obesity (body mass index ≥30 (OR, 1.43; CI, 1.09-1.88, P=0.011 to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.

  4. Creation of a national resource with linked genealogy and phenotypic data: the Veterans Genealogy Project.

    Science.gov (United States)

    Cannon-Albright, Lisa A; Dintelman, Sue; Maness, Tim; Backus, Steve; Thomas, Alun; Meyer, Laurence J

    2013-07-01

    Creation of a genealogy of the United States and its ancestral populations is under way. When complete, this US genealogy will be record linked to the National Veteran's Health Administration medical data representing more than 8 million US veterans. Genealogical data are gathered from public sources, primarily the Internet. Record linking using data from relatives is accomplished to integrate multiple data sources and then to link genealogical data to the veteran's demographic data. This resource currently includes genealogy for more than 22 million individuals representing the Intermountain West and the East Coast. The demographic data for more than 40,000 veteran patients using Veterans Hospital Administration services in Utah and Massachusetts have already been record linked. The resource is only in its second year of creation and already represents the largest such combination of genealogy and medical data in the world. The data sources, the creation of the genealogy, record-linking methods and results, proposed genetic analyses, and future directions are discussed.

  5. Will the war for the Croatian Homeland War veterans ever end?

    Science.gov (United States)

    Rak, Davor; Matić, Aldenita; Rak, Benedict

    2014-12-01

    The aim of this paper is to show the psychological consequences of participation in the Homeland War and experienced trauma which can indirectly be seen through drawing even after more than 15 years after the war had ended. The research was conducted on a sample of 125 patients of both genders treated in the Daily Hospital program of University Hospital Dubrava, Psychiatry Clinics. All the tested had trauma in their medical history and all of them met the PTSD diagnostic criteria, 75 examinees participated in the Homeland War and they represent the veteran group, and 50 examinees went through a stressful situation during peacetime and they represent the civilian group. All the examinees had to make two individual drawings, and the task was to portray feelings of term "love" (first drawing) and term "hate" (second drawing). They could choose motifs and colors freely. When portraying the term love, choice of motifs between the civilian and the veteran group wasn't considerably different, and only a small number of male veteran population (6.6%) drawings hinted at the connection with the Homeland War. The results between two groups are completely different in portraying the term hate. As much as 76% examinees from the veteran group have unequivocally and directly decided to portray wartime motifs, unlike the civilian group whose use of wartime motifs was just 10%. When choosing color, nearly 90% of the veteran group used neutral and cool colors to portray the term hate.

  6. The role of sexual assault on the risk of PTSD among Gulf War veterans.

    Science.gov (United States)

    Kang, Han; Dalager, Nancy; Mahan, Clare; Ishii, Erick

    2005-03-01

    The 1991 Gulf War was the first major military deployment where female troops were integrated into almost every military unit, except for combat ground units. We evaluated the impact of reported sexual trauma during this deployment on the risk of post-traumatic stress disorder (PTSD) after the war. A nested case-control analysis was conducted using the data collected in a population-based health survey of 30,000 Gulf War era veterans. A total of 1381 Gulf War veterans with current PTSD were compared with 10,060 Gulf veteran controls without PTSD for self-reported in-theater experiences of sexual harassment/assault and combat exposure. The adjusted odds ratio (aOR) for PTSD associated with a report of sexual assault was 5.41 (95% confidence interval [CI], 3.19-9.17) in female veterans and 6.21 (95% CI, 2.26-17.04) in male veterans. The aOR for PTSD associated with "high" combat exposure was also statistically significant (aOR, 4.03 [95% CI, 1.97-8.23] for females; aOR, 4.45 [95% CI, 3.54-5.60] for males). Notwithstanding a possibility of recall bias of combat and sexual trauma, for both men and women, sexual trauma as well as combat exposure appear to be strong risk factors for PTSD.

  7. Physical health status of female veterans: contributions of sex partnership and in-military rape.

    Science.gov (United States)

    Booth, Brenda M; Davis, Teri D; Cheney, Ann M; Mengeling, Michelle A; Torner, James C; Sadler, Anne G

    2012-01-01

    The aim of this study was to determine whether current physical health status in female veterans is associated with rape during military service and same-sex partnership. Retrospective computer-assisted telephone interviews of 1004 Midwestern US female veterans identified from Veterans Affairs electronic records were conducted. Data included rape history including rape in military, sex partnership history, demographics, and medical history including chronic pain, mental health (depression and posttraumatic stress disorder [PTSD]), and the physical health component of the Short-Form 12-item interview (PCS-12). Physical health in this sample was lower than norm values [PCS-12: mean (standard deviation) = 43 [12]; norm: mean (standard deviation) = 50 [10]). Fifty-one percent of the participants reported rape in their lifetime, 25% reported rape in military, 11% reported history of women as sex partners, and 71% reported history of chronic pain. Multiple regression analysis indicated that physical health (PCS-12) was associated with chronic pain history (β = -.40, p rape in military (β = -.09, p = .002), and current PTSD (β = .07, p = .03), adjusting for demographic data. Mediational analysis indicated that chronic pain history significantly mediated relationships of women who have sex with women, childhood rape, PTSD, depression, and current substance use disorder with PCS-12. Both rape and sex partnership are adversely associated with lower physical functioning in female veterans. Clinicians evaluating the physical health of this population should therefore consider obtaining detailed sexual histories, and a multidisciplinary team is needed to address mental health issues in female veterans.

  8. Perceptions of barriers and facilitators to health behavior change among veteran cancer survivors.

    Science.gov (United States)

    Beehler, Gregory P; Rodrigues, Amy E; Kay, Morgan A; Kiviniemi, Marc T; Steinbrenner, Lynn

    2014-09-01

    This study aimed to identify barriers and facilitators to health behavior change related to body size in a sample of veteran cancer survivors. A qualitative study was conducted with a sample of 35 male and female cancer survivors receiving care at a Veterans Administration comprehensive cancer center. Participants completed individual interviews regarding barriers and facilitators to lifestyle change and responded to a brief questionnaire regarding current health behaviors. Participants reported suboptimal adherence to recommended health behavior goals and the majority were overweight or obese (80%). Qualitative analysis revealed numerous barriers and facilitators to health behavior change across six broad categories: environmental factors, health services delivery factors, health-related factors, factors related to attitudes toward change, factors related to enacting change, and motivational factors. Veteran cancer survivors were impacted by common barriers to change affecting the general population, cancer-specific factors related to personal diagnosis and treatment history, and health service delivery factors related to the Veterans Administration health care system. There are many barriers and facilitators that exist in diverse domains for veteran cancer survivors, each of which offers unique challenges and opportunities for improving engagement in behavior change following cancer diagnosis and treatment. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

  9. Negative emotions in veterans relate to suicide risk through feelings of perceived burdensomeness and thwarted belongingness.

    Science.gov (United States)

    Rogers, Megan L; Kelliher-Rabon, Jessica; Hagan, Christopher R; Hirsch, Jameson K; Joiner, Thomas E

    2017-01-15

    Suicide rates among veterans are disproportionately high compared to rates among the general population. Veterans may experience a number of negative emotions (e.g., anger, self-directed hostility, shame, guilt) during periods of postwar adjustment and reintegration into civilian life that may uniquely confer risk for suicide. Mechanisms of these associations, however, are less well studied. The purpose of the present study was to examine the relationship between negative emotions and suicide risk in veterans through the theoretical framework of the interpersonal theory of suicide. A large sample of veterans (N = 541) completed measures assessing their negative emotions, perceived burdensomeness, thwarted belongingness, and suicide risk. Self-directed hostility and shame related indirectly to suicide risk through both perceived burdensomeness and thwarted belongingness. Thwarted belongingness accounted for the association between anger and suicide risk, whereas perceived burdensomeness accounted for the relationship between guilt and suicide risk. This study had a cross-sectional design and relied solely on self-report measures. These findings provide evidence for the role of negative emotions in conferring risk for suicide in veterans. Clinical implications, limitations, and future research directions are discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Perceived barriers to physical activity in older and younger veterans with serious mental illness.

    Science.gov (United States)

    Muralidharan, Anjana; Klingaman, Elizabeth A; Molinari, Victor; Goldberg, Richard W

    2018-03-01

    Individuals with serious mental illness endorse many more medical and psychosocial barriers to physical activity (PA) than the general population. However, it is unknown if older adults with serious mental illness are at greater risk of experiencing barriers to PA than their younger counterparts. The present study utilized a national VA dataset to compare veterans with serious mental illness ages 55 and older (n = 9,044) to veterans with serious mental illness ages 54 and younger (n = 8,782) on their responses to a questionnaire assessment of barriers to PA. Older veterans were more likely to endorse arthritis and cardiopulmonary disease, and less likely to endorse work schedule, as barriers to PA. Interventions designed to increase PA for young/middle-aged adults with serious mental illness may be broadly useful for older adults with serious mental illness, with some modification to address specific health concerns. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  11. Typhoid fever in a South African in-patient population

    NARCIS (Netherlands)

    Khan, Mohammad Enayet Hossain

    2004-01-01

    In conclusion, the data presented herein show that no single clinical or paraclinical parameter is reliable in arriving at a correct clinical diagnosis of typhoid fever and that bacteriologic confirmation is necessary for the diagnosis of typhoid fever. Patients ’ age and sex influence the clinical

  12. Obsessions and worry beliefs in an inpatient OCD population.

    Science.gov (United States)

    Calleo, Jessica S; Hart, John; Björgvinsson, Thröstur; Stanley, Melinda A

    2010-12-01

    Dysfunctional beliefs in obsessive-compulsive disorder (OCD) and worry are thought to contribute to vulnerability and maintenance of pathological anxiety. In this study, five belief domains concerning responsibility/threat estimation, perfectionism, intolerance of uncertainty, importance/control of thoughts and thought-action fusion were examined to see whether they differentially predicted worry and obsession severity in patients with severe OCD. Correlational analysis revealed that perfectionism and intolerance of uncertainty were associated with worry, whereas beliefs in the importance and control of thoughts and thought-action fusion were associated with obsession severity when obsession severity and worry, respectively, were controlled. In regression analyses, thought-action fusion and intolerance of uncertainty predicted OCD severity. The relation between dysfunctional beliefs and specific subtypes of OCD symptoms was also examined. Specific relationships were identified, including perfectionism with ordering, obsessions with control/importance of thoughts and checking and washing with threat estimation. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. Cannabis use and dependence among French schizophrenic inpatients

    Directory of Open Access Journals (Sweden)

    Michel eLejoyeux

    2014-07-01

    Full Text Available Background: To assess the prevalence of cannabis use and dependence in a population of schizophrenic inpatients and to compare schizophrenics with and without cannabis consumption. Methods: 101 schizophrenic patients were examined during their first week of hospitalization. They answered the PANNS scale of schizophrenia, the CAGE and the Fagerström questionnaire and the DSM-IV-TR criteria for cannabis, alcohol, opiates and nicotine use dependence were checked. We also assessed socio-demographic characteristics, the motive of cannabis consumption and the number of cannabis joints and alcoholic drinks taken.Results: The prevalence of cannabis consumption was 33.6% among schizophrenic inpatients. Schizophrenics consuming cannabis were younger than non-schizophrenics (33.3 vs 44.7 years pConclusion: 33.6 % of the schizophrenic patients hospitalized in psychiatry consume cannabis and most of them are dependent on cannabis and alcohol. Hospitalization in psychiatry may provide an opportunity to systematically identify a dependence disorder and to offer appropriate information and treatment

  14. Reduction in mental distress among substance users receiving inpatient treatment

    Directory of Open Access Journals (Sweden)

    Friborg Oddgeir

    2010-12-01

    Full Text Available Abstract Background Substance users being admitted to inpatient treatment experience a high level of mental distress. In this study we explored changes in mental distress during treatment. Methods Mental distress, as measured by the HSCL-10, was registered at admission and at discharge among 164 substance users in inpatient treatment in Northern Norway. Predictors of reduction in mental distress were examined utilizing hierarchical regression analysis. Results We found a significant reduction in mental distress in the sample, but the number of patients scoring above cut-off on the HSCL-10 at discharge was still much higher than in the general population. A more severe use of substances as measured by the AUDIT and the DUDIT, and being female, predicted a higher level of mental distress at admission to treatment as well as greater reduction in mental distress during treatment. Holding no education beyond 10 year compulsory school only predicted a reduction in mental distress. Conclusions The toxic and withdrawal effects of substances, level of education as well as gender, contributed to the differences in change in mental distress during treatment. Regression to the mean may in part explain some of the findings.

  15. External review and validation of the Swedish national inpatient register

    Directory of Open Access Journals (Sweden)

    Kim Jeong-Lim

    2011-06-01

    Full Text Available Abstract Background The Swedish National Inpatient Register (IPR, also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973 but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. Methods and results In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV was found to differ between diagnoses in the IPR, but is generally 85-95%. Conclusions In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.

  16. 75 FR 77956 - Agency Information Collection (Annual Certification of Veteran Status and Veteran-Relatives...

    Science.gov (United States)

    2010-12-14

    ... Administration (VBA), Department of Veterans Affairs, will submit the collection of information abstracted below... Review: Extension of a currently approved collection. Abstract: VBA employees, non-VBA employees in VBA space and Veteran Service Organization employees who have access to VA's benefit records complete VA...

  17. Accessibility and acceptability of the Department of Veteran Affairs health care: diverse veterans' perspectives.

    Science.gov (United States)

    Damron-Rodriguez, JoAnn; White-Kazemipour, Whitney; Washington, Donna; Villa, Valentine M; Dhanani, Shawkat; Harada, Nancy D

    2004-03-01

    Diverse veteran's perspectives on the accessibility and acceptability of the Department of Veteran Affairs (VA) health services are presented. The qualitative methodology uses 16 focus groups (N = 178) stratified by war cohort (World War II and Korean Conflict versus Vietnam War and Persian Gulf War) and four ethnic/racial categories (African American, Asian American, European American, Hispanic American). Five themes emerged regarding veterans' health care expectations: (1) better information regarding available services, (2) sense of deserved benefits, (3) concern about welfare stigma, (4) importance of physician attentiveness, and (5) staff respect for patients as veterans. Although veterans' ethnic/racial backgrounds differentiated their military experiences, it was the informants' veteran identity that framed what they expected of VA health services. Accessibility and acceptability of VA health care is related to veterans' perspectives of the nature of their entitlement to service. Provider education and customer service strategies should consider the identified factors to increase access to VA as well as improve veterans' acceptance of the care.

  18. More Research on Veteran Employment Would Show What’s Good for Business and for Veterans

    Science.gov (United States)

    2016-01-01

    approaches to addressing sexual harassment , sexual assault, hazing, and other problematic behaviors in the armed forces. ...indicate that certain cohorts of veterans are excelling in the workplace . For example, post-9/11 veterans’ median earnings are 11 percent higher than those...and programs, the October workshop focused on studies and research needs regarding leveraging skills that veterans bring to the workplace , effective

  19. 76 FR 20823 - Agency Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

    Science.gov (United States)

    2011-04-13

    ... AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In... to VA's OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room... benefit claim within 30 days prior to the fielding period. The sample will be stratified as follows: (1...

  20. A review of research on smoking behavior in three demographic groups of veterans: women, racial/ethnic minorities, and sexual orientation minorities.

    Science.gov (United States)

    Weinberger, Andrea H; Esan, Hannah; Hunt, Marcia G; Hoff, Rani A

    2016-05-01

    Veterans comprise a large segment of the U.S. population and smoke at high rates. One significant way to reduce healthcare costs and improve the health of veterans is to reduce smoking-related illnesses for smokers who have high smoking rates and/or face disproportionate smoking consequences (e.g. women, racial/ethnic minorities, sexual orientation minorities). We reviewed published studies of smoking behavior in three demographic subgroups of veterans - women, racial/ethnic minorities, and sexual orientation minorities - to synthesize current knowledge and identify areas in need of more research. A MEDLINE search identified papers on smoking and veterans published through 31 December 2014. Twenty-five studies were identified that focused on gender (n = 17), race/ethnicity (n = 6), or sexual orientation (n = 2). Female and sexual orientation minority veterans reported higher rates of smoking than non-veteran women and sexual orientation majority veterans, respectively. Veterans appeared to be offered VA smoking cessation services equally by gender and race. Few studies examined smoking behavior by race/ethnicity or sexual orientation. Little information was identified examining the outcomes of specific smoking treatments for any group. There is a need for more research on all aspects of smoking and quit behavior for women, racial/ethnic minorities, and sexual orientation minority veterans. The high rates of smoking by these groups of veterans suggest that they may benefit from motivational interventions aimed at increasing quit attempts and longer and more intense treatments to maximize outcomes. Learning more about these veterans can help reduce costs for those who experience greater consequences of smoking.

  1. Veteran status, disability rating, and public sector employment.

    Science.gov (United States)

    Winters, John V

    2018-06-01

    This paper used microdata from the 2013-2015 American Community Survey to examine differences in federal government, state and local government, private sector, and self-employment among employed veterans and nonveterans. The U.S. federal and state governments have hiring preferences to benefit veterans, especially disabled veterans. Other factors may also push veterans toward public sector employment. I found that veteran status substantially increased the likelihood of federal employment, with the largest magnitudes for severely disabled veterans. Differences in state and local government employment were modest and exhibited heterogeneity by disability severity. Copyright © 2018 John Wiley & Sons, Ltd.

  2. Zolpidem prescribing and adverse drug reactions in hospitalized general medicine patients at a Veterans Affairs hospital.

    Science.gov (United States)

    Mahoney, Jane E; Webb, Melissa J; Gray, Shelly L

    2004-03-01

    Zolpidem is prescribed for sleep disruption in hospitalized patients, but data on the incidence of adverse drug reactions (ADRs) are based largely on outpatient studies. Thus, the incidence of ADRs in hospitalized patients may be much higher. The goal of this study was to describe prescribing patterns of zolpidem for hospitalized medical patients aged 50 years, the incidence of ADRs possibly and probably associated with its use, and the factors associated with central nervous system (CNS) ADRs. This case series was conducted in 4 general medicine wards at a Veterans Affairs hospital and was a consecutive sample of patients aged 50 years who were hospitalized between 1993 and 1997 and received zolpidem as a hypnotic during hospitalization, but had not received it in the previous 3 months. Chart review was conducted by 2 evaluators. Data extracted from the medical records included admission demographic characteristics, medications, comorbidities, and levels of function in performing basic and instrumental activities of daily living. The main outcome measure was ADRs possibly or probably related to zolpidem use. The association between zolpidem and the occurrence of CNS ADRs (eg, confusion, dizziness, daytime somnolence) was analyzed separately. The review included 119 medical patients aged > or =50 years who had newly received zolpidem for sleep disruption during hospitalization. The median age of the population was 70 years; 86 (72.3%) patients were aged 65 years. The initial zolpidem dose was 5 mg in 42 patients (35.3%) and 10 mg in 77 patients (64.7%). Twenty-three patients had a respective 16 and 10 ADRs possibly and probably related to zolpidem use (19.3% incidence). Of a total of 26 ADRs, 21 (80.8%) were CNS ADRs, occurring with both zolpidem 5 mg (10.8% of users) and 10 mg (18.3% of users). On univariate analyses, the only factor significantly associated with a CNS ADR was functional impairment at baseline (P = 0.003). Zolpidem was discontinued in 38.8% of

  3. Association Between Mental Health Burden and Coronary Artery Disease in U.S. Women Veterans Over 45: A National Cross-Sectional Study.

    Science.gov (United States)

    Gerber, Megan R; King, Matthew W; Iverson, Katherine M; Pineles, Suzanne L; Haskell, Sally G

    2018-03-01

    The women Veteran population accessing Veterans Health Administration (VA) care has grown rapidly. Women Veterans exhibit high rates of mental health conditions that increase coronary artery disease (CAD) risk; however, the relationship between specific conditions and increasing mental health burden to CAD in this population is unknown. Using VA National Patient Care Data for 2009, we identified women Veterans over 45 (N = 157,195). Logistic regression models examined different mental health diagnoses and increasing mental health burden (number of diagnostic clusters) as predictors of CAD. CAD prevalence was 4.16%, and 36% of women Veterans were current smokers. Depression exhibited the strongest association with CAD (odds ratio [OR] 1.60, 95% confidence interval [CI] [1.50-1.71]), similar to that of current smoking (OR 1.68 [1.58-1.78]). Controlling for demographic variables, smoking, diabetes, and obesity, each additional mental health diagnosis increased the odds of CAD by 44%. Women Veterans over age 45 accessing VA care exhibited a high degree of mental health burden, which is associated with elevated odds of CAD; those with depression alone had 60% higher odds of CAD. For women Veterans using VA, mental health diagnoses may act as CAD risk factors that are potentially modifiable. Novel interventions in primary care and mental health are needed to address heart disease in this growing and aging population.

  4. Veterans Health Administration Behavioral Health Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of VHA hospitals with behavioral health measure data. VHA reports data on a set of core performance measures for Hospital-Based Inpatient Psychiatric Services...

  5. Internet Use and Technology-Related Attitudes of Veterans and Informal Caregivers of Veterans.

    Science.gov (United States)

    Duan-Porter, Wei; Van Houtven, Courtney H; Mahanna, Elizabeth P; Chapman, Jennifer G; Stechuchak, Karen M; Coffman, Cynthia J; Hastings, Susan Nicole

    2017-12-18

    Healthcare systems are interested in technology-enhanced interventions to improve patient access and outcomes. However, there is uncertainty about feasibility and acceptability for groups who may benefit but are at risk for disparities in technology use. Thus, we sought to describe characteristics of Internet use and technology-related attitudes for two such groups: (1) Veterans with multi-morbidity and high acute care utilization and (2) informal caregivers of Veterans with substantial care needs at home. We used survey data from two ongoing trials, for 423 Veteran and 169 caregiver participants, respectively. Questions examined Internet use in the past year, willingness to communicate via videoconferencing, and comfort with new technology devices. Most participants used Internet in the past year (81% of Veterans, 82% of caregivers); the majority of users (83% of Veterans, 92% of caregivers) accessed Internet at least a few times a week, and used a private laptop or computer (81% of Veterans, 89% of caregivers). Most were willing to use videoconferencing via private devices (77-83%). A majority of participants were comfortable attempting to use new devices with in-person assistance (80% of Veterans, 85% of caregivers), whereas lower proportions were comfortable "on your own" (58-59% for Veterans and caregivers). Internet use was associated with comfort with new technology devices (odds ratio 2.76, 95% confidence interval 1.70-4.53). Findings suggest that technology-enhanced healthcare interventions are feasible and acceptable for Veterans with multi-morbidity and high healthcare utilization, and informal caregivers of Veterans. In-person assistance may be important for those with no recent Internet use.

  6. Epidemiology of inpatient gout in Australia and New Zealand: temporal trends, comorbidities and gout flare site.

    Science.gov (United States)

    Robinson, Philip C; Kempe, Sarina; Tebbutt, Ian; Roberts, Lynden

    2017-06-01

    To assess the epidemiology of inpatient gout in Australia and New Zealand during the years 2009-2014. Using the Health Roundtable Limited (HRT) dataset, all patients with a coded ICD10 primary or secondary discharge diagnosis of gout from a HRT participating Australian or New Zealand hospital between the years 2009 and 2014 were identified. The number of inpatient gout admissions, length of stay, body site of gout flare, temporal trends and comorbidities were assessed. During 2009-2014, the number of gout admissions increased significantly in Australia and New Zealand. The rate of inpatient gout admissions relative to the population and total HRT admissions rose in Australia and stayed static in New Zealand. Lower limb presentations were the commonest anatomical site of gout in admitted patients. Length of stay over the course of the study decreased both in patients admitted for gout and in those in the entire HRT dataset. Patients admitted for gout have longer length of stay compared to patients admitted for other reasons. Cardiovascular disease, infection and stroke were the commonest conditions that were complicated by an episode of inpatient gout. There was no influence of month or season on the pattern of gout admissions. The number of gout admissions rose in Australia numerically and as a proportion of the total population and total admissions. Gout is an increasing problem affecting individuals and the community as a whole in Australia. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  7. Evaluation of the International Outcome Inventory for Hearing Aids in a veteran sample.

    Science.gov (United States)

    Smith, Sherri L; Noe, Colleen M; Alexander, Genevieve C

    2009-06-01

    confirmed that the psychometric properties of the IOI-HA questionnaire are strong and are essentially the same for the veteran sample and the original private-pay sample. The veteran norms, however, produced higher outcomes than those established originally, possibly because of differences in the population samples and/or hearing aid technology. Clinical and research applications of the current findings are presented. Based on the results from the current study, the norms established here should replace the original norms for use in veterans with current hearing aid technology.

  8. Suicidal ideation among young Afghanistan/Iraq War Veterans and civilians: Individual, social, and environmental risk factors and perception of unmet mental healthcare needs, United States, 2013.

    Science.gov (United States)

    Logan, Joseph; Bohnert, Amy; Spies, Erica; Jannausch, Mary

    2016-11-30

    Suicidal Ideation among Afghanistan/Iraq War Veterans remains a health concern. As young Veterans adjust to civilian life, new risk factors might emerge and manifest differently in this group versus those in the general population. We explored these differences. With 2013 National Survey on Drug Use and Health data, we examined differences in risk of past-year suicidal ideation between Veterans of the Afghanistan/Iraq War periods aged 18-34 years (N=328) and age-comparable civilians (N=23,222). We compared groups based on individual and socio-environmental risk factors as well as perceptions of unmet mental healthcare needs. We report adjusted rate ratios (aRRs); interaction terms tested for between-group differences. PY suicidal ideation rates for Veterans and civilians did not differ (52 versus 59 per 1,000, p=0.60) and both groups shared many risk factors. However, drug problems and perceived unmet mental health care needs were vastly stronger risk factors among Veterans versus civilians (interaction terms indicated that the aRRs were 3.8-8.0 times higher for Veterans versus civilians). Other differences were discovered as well. Past-year suicidal ideation rates did not differ by Veteran status among young adults. However, different risk factors per group were detected, which can inform Veteran suicide prevention efforts. Published by Elsevier Ireland Ltd.

  9. Sleep diaries of Vietnam War veterans with chronic PTSD: the relationships among insomnia symptoms, psychosocial stress, and nightmares.

    Science.gov (United States)

    Gehrman, Philip R; Harb, Gerlinde C; Cook, Joan M; Barilla, Holly; Ross, Richard J

    2015-01-01

    Impaired sleep and nightmares are known symptoms of posttraumatic stress disorder (PTSD) in the veteran population. In order to assess prospectively the sleep disturbances in this population, sleep diaries are an effective way to obtain information over an extended period of time. In this investigation, a sample of veterans (N = 105) completed daily sleep diaries for a 6-week period. Greater PTSD severity and nightmare-related distress were correlated with more awakenings, shorter duration of sleep, longer sleep latency, and greater frequency of nightmares. Perceived frequency of daytime stressors was associated with an increased number of nightmares, nightmare-related distress, and longer sleep latency. The use of sleep diaries in future investigations may allow targeted treatments for veteran populations with PTSD and sleep disturbances.

  10. The effects of simultaneous exercise and psychotherapy on depressive symptoms in inpatient, psychiatric older adults.

    Science.gov (United States)

    Jacquart, Son D; Marshak, Helen H; Dos Santos, Hildemar; Luu, Sen M; Berk, Lee S; McMahon, Paul T; Riggs, Matt

    2014-01-01

    Depression is the leading cause of early death, affecting 15% of Americans older than 65 y and costing $43 billion each year. The current mental health service system for seniors, particularly for the population hospitalized in acute inpatient psychiatric units, is fragmented because of poor funding and a shift to a transitory health care paradigm, leading to inadequate treatment modalities, questionable quality of care, and lack of research demonstrating the superiority of a particular treatment. These issues are likely to lead to a public health crisis in the coming years. To investigate the effectiveness of combining exercise and psychotherapy in improving acute depressive symptoms among older adults who were receiving treatment in an inpatient psychiatric unit. Based on rolling admissions, inpatients were randomly assigned to 1 of 3 treatment groups. The study was blinded and controlled. This study took place in inpatient psychiatric units at the Loma Linda University's Behavioral Medicine Center (LLUBMC) in Redlands, California. Participants were 78 inpatients, aged 50-89 y. Participants in the simultaneous exercise and psychotherapy (STEP) group (n = 26) took part in exercise and received psychotherapy for 30 min per session, whereas those in the TALK group (n = 26) received individual psychotherapy for 30 min per session. Participants in the control group (n = 26) served as a comparison group, receiving standard therapy. The effects of the interventions were determined by assessing differences from baseline to postintervention in the symptomatology of all 3 groups. The research team also administered the Behavioral and Symptom Identification Scale (BASIS-32) and the Geriatric Depression Scale (GDS) pre- and postintervention. At posttest, the STEP group (M = 4.24, SE = 0.62) had a better response than the TALK group (M = 11.34, SE = 0.62, P exercise program consisting of 30 min of walking in conjunction with individual psychotherapy was an effective

  11. The relationship between inpatient discharge timing and emergency department boarding.

    Science.gov (United States)

    Powell, Emilie S; Khare, Rahul K; Venkatesh, Arjun K; Van Roo, Ben D; Adams, James G; Reinhardt, Gilles

    2012-02-01

    Patient crowding and boarding in Emergency Departments (EDs) impair the quality of care as well as patient safety and satisfaction. Improved timing of inpatient discharges could positively affect ED boarding, and this hypothesis can be tested with computer modeling. Modeling enables analysis of the impact of inpatient discharge timing on ED boarding. Three policies were tested: a sensitivity analysis on shifting the timing of current discharge practices earlier; discharging 75% of inpatients by 12:00 noon; and discharging all inpatients between 8:00 a.m. and 4:00 p.m. A cross-sectional computer modeling analysis was conducted of inpatient admissions and discharges on weekdays in September 2007. A model of patient flow streams into and out of inpatient beds with an output of ED admitted patient boarding hours was created to analyze the three policies. A mean of 38.8 ED patients, 22.7 surgical patients, and 19.5 intensive care unit transfers were admitted to inpatient beds, and 81.1 inpatients were discharged daily on September 2007 weekdays: 70.5%, 85.6%, 82.8%, and 88.0%, respectively, occurred between noon and midnight. In the model base case, total daily admitted patient boarding hours were 77.0 per day; the sensitivity analysis showed that shifting the peak inpatient discharge time 4h earlier eliminated ED boarding, and discharging 75% of inpatients by noon and discharging all inpatients between 8:00 a.m. and 4:00 p.m. both decreased boarding hours to 3.0. Timing of inpatient discharges had an impact on the need to board admitted patients. This model demonstrates the potential to reduce or eliminate ED boarding by improving inpatient discharge timing in anticipation of the daily surge in ED demand for inpatient beds. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Implementation of inpatient models of pharmacogenetics programs.

    Science.gov (United States)

    Cavallari, Larisa H; Lee, Craig R; Duarte, Julio D; Nutescu, Edith A; Weitzel, Kristin W; Stouffer, George A; Johnson, Julie A

    2016-12-01

    The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted. Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics. Pharmacists have assumed important roles in implementing inpatient pharmacogenetics programs. This includes programs designed to incorporate genetic test results to optimize antiplatelet drug selection after percutaneous coronary intervention and personalize warfarin dosing. Pharmacist involvement occurs on many levels, including championing and leading pharmacogenetics implementation efforts, establishing clinical processes to support genotype-guided therapy, assisting the clinical staff with interpreting genetic test results and applying them to prescribing decisions, and educating other healthcare providers and patients on genomic medicine. The three inpatient pharmacogenetics programs described use reactive versus preemptive genotyping, the most feasible approach under the current third-party payment structure. All three sites also follow Clinical Pharmacogenetics Implementation Consortium guidelines for drug therapy recommendations based on genetic test results. With the clinical emergence of pharmacogenetics into the inpatient setting, it is important that pharmacists caring for hospitalized patients are well prepared to serve as experts in interpreting and applying genetic test results to guide drug therapy decisions. Since genetic test results may not be available until after patient discharge, pharmacists practicing in the ambulatory care setting should also be prepared to assist with genotype-guided drug therapy as part of transitions in care. Copyright © 2016 by the American Society of Health

  13. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... v/K5u3sb-Dbkc Watch additional videos about getting help. Behind the Scenes see more videos from Veterans Health Administration Be There: Help Save a Life see more videos from Veterans ...

  14. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... for help. Bittersweet More Videos from Veterans Health Administration Embedded YouTube video: https://www.youtube.com/v/ ... the Scenes see more videos from Veterans Health Administration Be There: Help Save a Life see more ...

  15. 75 FR 5767 - Veterans' Advisory Board on Dose Reconstruction; Meeting

    Science.gov (United States)

    2010-02-04

    ... Nagasaki, Japan; and veterans who were prisoners of war in those regions at the conclusion of World War II... Veterans' Advisory Board on Dose Reconstruction. Written statements should be no longer than two type...

  16. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... facility near you. Spread the Word Download logos, Web ads, and materials and help get the word ... Veteran Suicide The Veterans Crisis Line text-messaging service does not store mobile phone numbers of users ...

  17. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... out for help. Bittersweet More Videos from Veterans Health Administration Embedded YouTube video: https://www.youtube.com/ ... Behind the Scenes see more videos from Veterans Health Administration Be There: Help Save a Life see ...

  18. Caring for Wounded Veterans: A Strategy in the GWOT

    National Research Council Canada - National Science Library

    Talley, Steve

    2007-01-01

    ... and physical well-being of its veterans. This project examines what needs to be done to ensure that the United States Government provides immediate and long-term care and support to America's wounded veterans, regardless of their physical...

  19. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Text Homeless Veterans Live Chat Military Live Chat Deaf - Hard of Hearing Contact Us About About the ... Text Homeless Veterans Live Chat Military Live Chat Deaf - Hard of Hearing Contact Us About About the ...

  20. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... Live Chat Military Live Chat Deaf - Hard of Hearing Contact Us About About the Veterans Crisis Line ... Live Chat Military Live Chat Deaf - Hard of Hearing Contact Us About About the Veterans Crisis Line ...

  1. 78 FR 26698 - Report: Strategies for Serving Our Women Veterans

    Science.gov (United States)

    2013-05-07

    ... expressed that the organizational chart should indicate that the Director of the Center for Women Veterans..., about 30 percent of women Veterans surveyed did not think they were eligible for VA benefits.'' The...

  2. Exercise for mental illness: a systematic review of inpatient studies.

    Science.gov (United States)

    Stanton, Robert; Happell, Brenda

    2014-06-01

    A substantial body of evidence supports the role of exercise interventions for people with a mental illness. However, much of this literature is conducted using outpatient and community-based populations. We undertook a systematic review examining the effect of exercise interventions on the health of people hospitalized with depression, schizophrenia, bipolar disorder, or anxiety disorders. Eight studies met our inclusion criteria. Several studies show positive health outcomes from short-term and long-term interventions for people hospitalized due to depression. Although positive, the evidence for inpatients with schizophrenia, bipolar disorder, or anxiety disorders is substantially less. There is an urgent need to address the paucity of literature in this area, in particular the optimal dose and delivery of exercise for people hospitalized as a result of mental illness. Standardization of reporting exercise programme variables, the assessment of mental illness, and the reporting of adverse events must accompany future studies. © 2013 Australian College of Mental Health Nurses Inc.

  3. Factors impeding flexible inpatient unit design.

    Science.gov (United States)

    Pati, Debajyoti; Evans, Jennie; Harvey, Thomas E; Bazuin, Doug

    2012-01-01

    To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units. A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility. An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010. The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial. Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.

  4. Thwarted interpersonal needs and suicide ideation: Comparing psychiatric inpatients with bipolar and non-bipolar mood disorders.

    Science.gov (United States)

    Taylor, Nathanael J; Mitchell, Sean M; Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Cukrowicz, Kelly C

    2016-12-30

    Psychiatric inpatients are at heightened risk for suicide, and evidence suggests that psychiatric inpatients with bipolar mood disorders may be at greater risk for suicide ideation compared to those with non-bipolar mood disorders. There is a paucity of research directly comparing risk factors for suicide ideation in bipolar versus non-bipolar mood disorders in an inpatient sample. The current study sought to clarify the association between two constructs from the interpersonal theory of suicide (i.e., perceived burdensomeness and thwarted belongingness) in leading to suicide ideation among psychiatric inpatients with bipolar and non-bipolar mood disorders. Participants were (N=90) psychiatric inpatients with a bipolar (n = 20) or non-bipolar mood disorder (n=70; per their medical charts). Perceived burdensomeness, but not thwarted belongingness, was significantly associated with suicide ideation after adjusting for other covariates. This suggests perceived burdensomeness may play a key role in suicide ideation among psychiatric inpatients with any mood disorder and highlights the importance of assessment and intervention of perceived burdensomeness in this population. Contrary to our hypothesis, mood disorder group (i.e., bipolar versus non-bipolar) did not moderate the relations between perceived burdensomeness/thwarted belongingness and suicide ideation. Published by Elsevier Ireland Ltd.

  5. Mortality in Postmenopausal Women by Sexual Orientation and Veteran Status

    Science.gov (United States)

    Lehavot, Keren; Rillamas-Sun, Eileen; Weitlauf, Julie; Kimerling, Rachel; Wallace, Robert B.; Sadler, Anne G.; Woods, Nancy Fugate; Shipherd, Jillian C.; Mattocks, Kristin; Cirillo, Dominic J.; Stefanick, Marcia L.; Simpson, Tracy L.

    2016-01-01

    Abstract Purpose of the Study: To examine differences in all-cause and cause-specific mortality by sexual orientation and Veteran status among older women. Design and Methods: Data were from the Women’s Health Initiative, with demographic characteristics, psychosocial factors, and health behaviors assessed at baseline (1993–1998) and mortality status from all available data sources through 2014. Women with baseline information on lifetime sexual behavior and Veteran status were included in the analyses ( N = 137,639; 1.4% sexual minority, 2.5% Veteran). The four comparison groups included sexual minority Veterans, sexual minority non-Veterans, heterosexual Veterans, and heterosexual non-Veterans. Cox proportional hazard models were used to estimate mortality risk adjusted for demographic, psychosocial, and health variables. Results: Sexual minority women had greater all-cause mortality risk than heterosexual women regardless of Veteran status (hazard ratio [HR] = 1.20, 95% confidence interval [CI]: 1.07–1.36) and women Veterans had greater all-cause mortality risk than non-Veterans regardless of sexual orientation (HR = 1.14, 95% CI: 1.06–1.22), but the interaction between sexual orientation and Veteran status was not significant. Sexual minority women were also at greater risk than heterosexual women for cancer-specific mortality, with effects stronger among Veterans compared to non-Veterans (sexual minority × Veteran HR = 1.70, 95% CI: 1.01–2.85). Implications: Postmenopausal sexual minority women in the United States, regardless of Veteran status, may be at higher risk for earlier death compared to heterosexuals. Sexual minority women Veterans may have higher risk of cancer-specific mortality compared to their heterosexual counterparts. Examining social determinants of longevity may be an important step to understanding and reducing these disparities. PMID:26768389

  6. Major traumatic limb loss among women veterans and servicemembers

    OpenAIRE

    Jodie G. Katon, PhD; Gayle E. Reiber, PhD

    2013-01-01

    The number of women veterans is rapidly growing, and little is known regarding the health and healthcare needs of women veterans with traumatic limb loss. The objective of this study was to summarize physical and mental health conditions and rates of prosthetic prescriptions among women servicemembers and veterans with major traumatic limb loss. Researchers and clinicians who administered the Survey for Prosthetic Use contacted and enrolled 283 servicemembers and veterans of Operation Iraqi F...

  7. Visual symptomatology and referral patterns for Operation Iraqi Freedom and Operation Enduring Freedom veterans with traumatic brain injury.

    Science.gov (United States)

    Bulson, Ryan; Jun, Weon; Hayes, John

    2012-01-01

    Advances in protective armor technology and changes in the "patterns of war" have created a population of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with traumatic brain injury (TBI) that provide a unique challenge to Department of Veterans Affairs (VA) healthcare practitioners. The purpose of the study was to determine the frequency of symptomatic ocular and visual sequelae of TBI in OIF/OEF veterans at the Portland VA Medical Center, a Polytrauma Support Clinic Team site. A retrospective analysis of 100 OIF/OEF veterans with TBI was conducted to determine the prevalence of ocular and visual complaints. Referral patterns were also investigated. Visual symptoms were reported in approximately 50% of veterans with TBI. Loss of consciousness, but not number of deployments or number of blast exposures, was found to have a statistically significant association with severity of reported visual symptoms. The most commonly reported symptoms included blurred vision (67%), photosensitivity (50%), and accommodative problems (40%). Visual symptoms of OIF/OEF veterans at the Portland VA Medical Center are reported at slightly lower rates than similar studies conducted at the Palo Alto and Edward Hines Jr VA facilities.

  8. Feasibility and acceptability of shared decision-making to promote alcohol behavior change among women Veterans: Results from focus groups.

    Science.gov (United States)

    Abraham, Traci H; Wright, Patricia; White, Penny; Booth, Brenda M; Cucciare, Michael A

    2017-01-01

    Although rates of unhealthy drinking are high among women Veterans with mental health comorbidities, most women Veterans with mental comorbidities who present to primary care with unhealthy drinking do not receive alcohol-related care. Barriers to alcohol-related treatment could be reduced through patient-centered approaches to care, such as shared decision-making. We assessed the feasibility and acceptability of a telephone-delivered shared decision-making intervention for promoting alcohol behavior change in women Veterans with unhealthy drinking and co-morbid depression and/or probable post-traumatic stress disorder. We used 3, 2-hour focus group discussions with 19 women Veterans to identify barriers and solicit recommendations for using the intervention with women Veterans who present to primary care with unhealthy drinking and mental health comorbidities. Transcripts from the focus groups were qualitatively analyzed using template analysis. Although participants perceived that the intervention was feasible and acceptable for the targeted patient population, they identified the treatment delivery modality, length of telephone sessions, and some of the option grid content as potential barriers. Facilitators included strategies for enhancing the telephone-delivered shared decision-making sessions and diversifying the treatment options contained in the option grids. Focus group feedback resulted in preliminary adaptations to the intervention that are mindful of women Veterans' individual preferences for care and realistic in the everyday context of their busy lives.

  9. Psychometric validation of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool for older Chinese inpatients.

    Science.gov (United States)

    Zhang, Junhong; Wang, Min; Liu, Yu

    2016-10-01

    To culturally adapt and evaluate the reliability and validity of the Chinese version of the Johns Hopkins Fall Risk Assessment Tool among older inpatients in the mainland of China. Patient falls are an important safety consideration within hospitals among older inpatients. Nurses need specific risk assessment tools for older inpatients to reliably identify at-risk populations and guide interventions that highlight fixable risk factors for falls and consequent injuries. In China, a few tools have been developed to measure fall risk. However, they lack the solid psychometric development necessary to establish their validity and reliability, and they are not widely used for elderly inpatients. A cross-sectional study. A convenient sampling was used to recruit 201 older inpatients from two tertiary-level hospitals in Beijing and Xiamen, China. The Johns Hopkins Fall Risk Assessment Tool was translated using forward and backward translation procedures and was administered to these 201 older inpatients. Reliability of the tool was calculated by inter-rater reliability and Cronbach's alpha. Validity was analysed through content validity index and construct validity. The Inter-rater reliability of Chinese version of Johns Hopkins Fall Risk Assessment Tool was 97·14% agreement with Cohen's Kappa of 0·903. Cronbach's α was 0·703. Content of Validity Index was 0·833. Two factors represented intrinsic and extrinsic risk factors were explored that together explained 58·89% of the variance. This study provided evidence that Johns Hopkins Fall Risk Assessment Tool is an acceptable, valid and reliable tool to identify older inpatients at risk of falls and falls with injury. Further psychometric testing on criterion validity and evaluation of its advanced utility in geriatric clinical settings are warranted. The Chinese version of Johns Hopkins Fall Risk Assessment Tool may be useful for health care personnel to identify older Chinese inpatients at risk of falls and falls

  10. Military-related trauma is associated with eating disorder symptoms in male veterans.

    Science.gov (United States)

    Arditte Hall, Kimberly A; Bartlett, Brooke A; Iverson, Katherine M; Mitchell, Karen S

    2017-11-01

    Eating disorders are understudied among male veterans, who may be at increased risk due to the high rates of trauma exposure and experiences of multiple traumatization in this population. This study sought to examine the associations between specific types of trauma (i.e., childhood physical abuse, adult physical assault, childhood sexual abuse, adult sexual assault, and military-related trauma) and eating disorder symptoms in a large, nationally-representative sample of trauma-exposed male veterans. Survey data were collected from N = 642 male veterans. Traumatic experiences in childhood and adulthood were assessed using the Trauma History Screen and the National Stressful Events Survey. Eating disorder symptoms were assessed with the Eating Disorder Diagnostic Scale. Analyses also controlled for age and body mass index. Multiple traumatization was associated with increased eating disorder symptoms. However, military-related trauma was the only trauma type that was uniquely associated with eating disorder symptoms when controlling for other trauma types. Examination of different types of military-related trauma indicated that this association was not driven by exposure to combat. Noncombat, military-related trauma was associated with eating disorder symptom severity in male veterans. Results highlight the need for better assessment of eating disorder symptoms in this population. © 2017 Wiley Periodicals, Inc.

  11. Examining weight and eating behavior by sexual orientation in a sample of male veterans.

    Science.gov (United States)

    Bankoff, Sarah M; Richards, Lauren K; Bartlett, Brooke; Wolf, Erika J; Mitchell, Karen S

    2016-07-01

    Eating disorders are understudied in men and in sexual minority populations; however, extant evidence suggests that gay men have higher rates of disordered eating than heterosexual men. The present study examined the associations between sexual orientation, body mass index (BMI), disordered eating behaviors, and food addiction in a sample of male veterans. Participants included 642 male veterans from the Knowledge Networks-GfK Research Panel. They were randomly selected from a larger study based on previously reported trauma exposure; 96% identified as heterosexual. Measures included the Eating Disorder Diagnostic Scale, the Yale Food Addiction Scale, and self-reported height and weight. Heterosexual and sexual minority men did not differ significantly in terms of BMI. However, gay and bisexual men (n=24) endorsed significantly greater eating disorder symptoms and food addiction compared to heterosexual men. Our findings that sexual minority male veterans may be more likely to experience eating disorder and food addiction symptoms compared to heterosexual male veterans highlight the importance of prevention, assessment, and treatment efforts targeted to this population. Published by Elsevier Inc.

  12. Firearm Ownership Among Military Veterans With PTSD: A Profile of Demographic and Psychosocial Correlates.

    Science.gov (United States)

    Heinz, Adrienne J; Cohen, Nicole L; Holleran, Lori; Alvarez, Jennifer A; Bonn-Miller, Marcel O

    2016-10-01

    Post-traumatic stress disorder (PTSD), a condition that disproportionately affects military veterans, is associated with heightened rates of aggression and suicide. Although experience with firearms is common among this population, virtually nothing is known regarding who is more likely to own a firearm and whether firearm ownership is differentially associated with psychological and behavioral risk factors among veterans with PTSD. Of 465 veterans (79% male) entering PTSD treatment, 28% owned a firearm (median number of firearms among owners = 3, range = 1-40). Firearm owners reported higher income were less likely to be unemployed, and were more likely to be male, Caucasian, married, and living in permanent housing. Ownership was associated with higher combat exposure and driving aggression, yet lower rates of childhood and military sexual trauma, suicidal ideation, and incarceration. Ownership was not associated with previous suicide attempt, arrest history, number of traumas experienced, PTSD symptoms, or depression. Together, among a sample of treatment-seeking military veterans with PTSD, those who owned a firearm appeared to demonstrate greater stability across a number of domains of functioning. Importantly though, routine firearm safety discussions (e.g., accessibility restrictions; violence risk assessments) and bolstering of anger management skills remain critical when working with this high-risk population. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  13. Traumatic Brain Injury Severity, Comorbidity, Social Support, Family Functioning, and Community Reintegration Among Veterans of the Afghanistan and Iraq Wars.

    Science.gov (United States)

    Pugh, Mary Jo; Swan, Alicia A; Carlson, Kathleen F; Jaramillo, Carlos A; Eapen, Blessen C; Dillahunt-Aspillaga, Christina; Amuan, Megan E; Delgado, Roxana E; McConnell, Kimberly; Finley, Erin P; Grafman, Jordan H

    2018-02-01

    To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Retrospective observational cohort study. Mail/online survey fielded to a national sample of veterans. Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Not applicable. Deployment Risk and Resilience Inventory-2 family functioning and social support subscales; Military to Civilian Questionnaire; and employment status. Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population. Published by Elsevier Inc.

  14. Yoga versus education for Veterans with chronic low back pain: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Saper, Robert B; Lemaster, Chelsey M; Elwy, A Rani; Paris, Ruth; Herman, Patricia M; Plumb, Dorothy N; Sherman, Karen J; Groessl, Erik J; Lynch, Susan; Wang, Shihwe; Weinberg, Janice

    2016-04-29

    Chronic low back pain is the most frequent pain condition in Veterans and causes substantial suffering, decreased functional capacity, and lower quality of life. Symptoms of post-traumatic stress, depression, and mild traumatic brain injury are highly prevalent in Veterans with back pain. Yoga for low back pain has been demonstrated to be effective for civilians in randomized controlled trials. However, it is unknown if results from previously published trials generalize to military populations. This study is a parallel randomized controlled trial comparing yoga to education for 120 Veterans with chronic low back pain. Participants are Veterans ≥18 years old with low back pain present on at least half the days in the past six months and a self-reported average pain intensity in the previous week of ≥4 on a 0-10 scale. The 24-week study has an initial 12-week intervention period, where participants are randomized equally into (1) a standardized weekly group yoga class with home practice or (2) education delivered with a self-care book. Primary outcome measures are change at 12 weeks in low back pain intensity measured by the Defense and Veterans Pain Rating Scale (0-10) and back-related function using the 23-point Roland Morris Disability Questionnaire. In the subsequent 12-week follow-up period, yoga participants are encouraged to continue home yoga practice and education participants continue following recommendations from the book. Qualitative interviews with Veterans in the yoga group and their partners explore the impact of chronic low back pain and yoga on family relationships. We also assess cost-effectiveness from three perspectives: the Veteran, the Veterans Health Administration, and society using electronic medical records, self-reported cost data, and study records. This study will help determine if yoga can become an effective treatment for Veterans with chronic low back pain and psychological comorbidities. ClinicalTrials.gov: NCT02224183.

  15. Correlates of CVD and discussing sexual issues with physicians among male military veterans.

    Science.gov (United States)

    Smith, Matthew Lee; Goltz, Heather Honoré; Motlagh, Audry S; Ahn, SangNam; Bergeron, Caroline D; Ory, Marcia G

    2016-10-01

    This study aims to identify socio-demographic and health behavior factors associated with cardiovascular disease (CVD) diagnosis and patient-physician communication concerning sexual issues among older Veterans. Cross-sectional data were collected from 635 male Veterans over age 55 years as part of the 2010 National Social Life, Health and Aging Project, a nationally-representative, population-based study of community-dwelling older Americans. Two independent logistic regression analyses were performed. Over 33% of Veterans were aged 75 years or older. Over one-half of participants reported having a CVD diagnosis (58%) and sexual intercourse within the previous year (58%); over one-third (37%) reported having one or more sexual dysfunctions and discussing sexual issues with their physician (42%). Veterans diagnosed with CVD were significantly more likely to self-identify as racial/ethnic minorities (OR=1.89, P=0.021), have more chronic disease comorbidities (OR=1.23, P=0.041), and have more sexual dysfunctions (OR=1.19, P=0.028). Veterans diagnosed with CVD were significantly less likely to report having sex within the previous year (OR=0.53, P=0.005). Veterans who reported discussing sexual issues with a physician were significantly more likely to be ≥75 years (OR=1.79, P=0.010), and report more than a high school education (OR=1.62, P=0.016), CVD diagnosis (OR=1.59, P=0.015), sex within the previous year (OR=1.69, P=0.033), and trouble achieving/maintaining an erection (OR=3.39, Paging and sexual health/counseling services. These services should promote increased patient-physician communication as well as referrals between physicians and sex health/counseling specialists. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Hazardous drinking and its association with homelessness among veterans in care.

    Science.gov (United States)

    Ghose, T; Fiellin, D A; Gordon, A J; Metraux, S; Goetz, M B; Blackstock, O; McInnes, K; Rodriguez-Barradas, M C; Justice, A C

    2013-09-01

    While scholarship on alcohol use and homelessness has focused on the impact of alcohol abuse and dependence, little is known about the effects of lower levels of misuse such as hazardous use. Veterans receiving care in the Department of Veterans Affairs Health Care System (VA) constitute a population that is vulnerable to alcohol misuse and homelessness. This research examines the effects of hazardous drinking on homelessness in the Veterans Aging Cohort Study, a sample of 2898 older veterans (mean age=50.2), receiving care in 8 VAs across the country. Logistic regression models examined the associations between (1) hazardous drinking at baseline and homelessness at 1-year follow-up, (2) transitions into and out of hazardous drinking from baseline to follow-up and homelessness at follow-up, and (3) transitioning to hazardous drinking and transitioning to homelessness from baseline to follow-up during that same time-period. After controlling for other correlates including alcohol dependence, hazardous drinking at baseline increased the risk of homelessness at follow-up (adjusted odds ratio [AOR]=1.39, 95% confidence interval [CI]=1.02, 1.88). Transitioning to hazardous drinking more than doubled the risk of homelessness at follow-up (AOR=2.42, 95% CI=1.41, 4.15), while more than doubling the risk of transitioning from being housed at baseline to being homeless at follow-up (AOR=2.49, 95% CI=1.30, 4.79). Early intervention that seeks to prevent transitioning into hazardous drinking could increase housing stability among veterans. Brief interventions which have been shown to be effective at lower levels of alcohol use should be implemented with veterans in VA care. Published by Elsevier Ireland Ltd.

  17. The Relationship Between Emotion Dysregulation and Impulsive Aggression in Veterans With Posttraumatic Stress Disorder Symptoms.

    Science.gov (United States)

    Miles, Shannon R; Menefee, Deleene S; Wanner, Jill; Teten Tharp, Andra; Kent, Thomas A

    2016-06-01

    While Veterans in general are no more dangerous than the civilian population, Veterans with posttraumatic stress disorder (PTSD) have stronger associations with anger and hostility and certain forms of aggression, such as intimate partner violence, than civilians with PTSD. This is alarming because up to 21% of Veterans seeking Veterans Affairs (VA) health care are diagnosed with PTSD. Emotion regulation difficulties (emotion dysregulation) are also related to increased PTSD symptom severity and may play a role in aggressive behavior. Because the predominant form of aggression in PTSD appears to be the impulsive subtype, the authors sought to clarify the relationship between PTSD, emotion dysregulation, and impulsive aggression. We examined how emotion dysregulation influenced impulsive aggression in a Veteran sample (N = 479) seeking treatment for trauma sequelae. All Veterans completed measures that assessed demographic information, emotion dysregulation, aggression frequency and subtype, and PTSD symptoms. Men generally reported more aggression than women. The emotion dysregulation, aggression, and PTSD measures were significantly correlated. Two cross-sectional mediation models showed emotion dysregulation fully accounted for the relationship between PTSD and impulsive aggression (indirect path for men: b = .07, SE = .026, bias-correct and accelerated confidence interval [BCa CI] = [0.02, 0.13]; indirect path for women: b = .08, SE = .022, BCa CI = [0.05, 0.13]). PTSD can increase negative emotions yet does not always lead to aggressive behaviors. The ability to regulate emotions may be pivotal to inhibiting aggression in those with PTSD. PTSD interventions may benefit from augmentation with emotion regulation skills training. © The Author(s) 2015.

  18. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available Veterans Crisis Line Skip to Main Content SuicidePreventionLifeline.org Get Help Materials Get Involved Crisis Centers About Be There ... see more videos from Veterans Health Administration Veterans Crisis Line -- After the Call see more videos from ...

  19. Searching the Soul: Veterans and Their Arts and Crafts

    Science.gov (United States)

    Hasio, Cindy

    2011-01-01

    For military veterans suffering from the long-term trauma of warfare, arts and crafts become much more than the fabrication of relics; they can literally save the spirit. Dialogue and interaction between the veterans, volunteers, and staff are crucial to the success of veterans' arts and crafts program. The purpose of this research was threefold.…

  20. Veterans' Transitions to Community College: A Case Study

    Science.gov (United States)

    Wheeler, Holly A.

    2012-01-01

    Veterans on college campuses are not new; however, the recent influx of veterans returning home from war-time service present challenges to the colleges they attend. The purpose of this qualitative case study was to examine the transition process experienced by veterans leaving military service and attending community college for the first time.…

  1. Veterans Crisis Line: Videos About Reaching out for Help

    Medline Plus

    Full Text Available ... a Self-Check Quiz Resources Spread the Word Videos Homeless Resources Additional Information Make the Connection Get Help When To Call What To Expect Resource Locator Veterans Live Chat Veterans Text Homeless Veterans Live Chat Military Live ...

  2. Use of Psychotherapy by Rural and Urban Veterans

    Science.gov (United States)

    Cully, Jeffrey A.; Jameson, John P.; Phillips, Laura L.; Kunik, Mark E.; Fortney, John C.

    2010-01-01

    Purpose: To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions. Methods: Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted…

  3. Colleges' Experiences: Integrating Support Services for Military Veterans

    Science.gov (United States)

    Karp, Melinda Mechur; Klempin, Serena

    2017-01-01

    To improve the educational experiences and outcomes of student veterans, the Kisco Foundation developed the Kohlberg Prize in 2015. Two cohorts of colleges were awarded competitive grants to enhance their veterans services. This piece examines the process of creating integrated services for student veterans through the institutionalization of…

  4. Military Veterans' Midlife Career Transition and Life Satisfaction

    Science.gov (United States)

    Robertson, Heather C.; Brott, Pamelia E.

    2014-01-01

    Many military veterans face the challenging transition to civilian employment. Military veteran members of a national program, Troops to Teachers, were surveyed regarding life satisfaction and related internal/external career transition variables. Participants included military veterans who were currently or had previously transitioned to K-12…

  5. 38 CFR 17.39 - Certain Filipino veterans.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Certain Filipino veterans... Enrollment Provisions and Medical Benefits Package § 17.39 Certain Filipino veterans. (a) Any Filipino... organized Filipino guerilla forces, or any new Philippine Scout is eligible for hospital care, nursing home...

  6. Three Generations, Three Wars: African American Veterans.

    Science.gov (United States)

    Black, Helen K

    2016-02-01

    This article emerged from pilot research exploring experiences of war and suffering among African American veterans who served in World War II, Korean War, and Vietnam War. Men's experiences as soldiers reflected both racism and the social change that occurred in the Unites States while they served. We used techniques of narrative elicitation, conducting qualitative, ethnographic interviews with each of five veterans in his home. Interviews focused on unique and shared experiences as an African American man and a soldier. Three important themes emerged: (a) Expectations related to War--Although men viewed service to country as an expected part of life, they also expected equal treatment in war, which did not occur; (b) Suffering as an African American--Informants interpreted experiences of suffering in war as related to the lower status of African American servicemen; and (c) Perception of present identity--Each man was honed by the sum of his experiences, including those of combat, racism, and postwar opportunities and obstacles. From 40 to 70 years after the wars were fought, there are few scholarly narrative studies on African American veterans, despite the fact that Korean War Veterans are entering old-old age and few World War II Veterans are alive. The value of pilot research that offers narratives of unheard voices is significant; larger studies can interview more African American veterans to advance knowledge that might soon be lost. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Overweight in adolescent, psychiatric inpatients: A problem of general or food-specific impulsivity?

    Science.gov (United States)

    Deux, Natalie; Schlarb, Angelika A; Martin, Franziska; Holtmann, Martin; Hebebrand, Johannes; Legenbauer, Tanja

    2017-05-01

    Adolescent psychiatric patients are vulnerable to weight problems and show an overrepresentation of overweight compared to the healthy population. One potential factor that can contribute to the etiology of overweight is higher impulsivity. As of yet, it is unclear whether it is a general impulse control deficit or weight-related aspects such as lower impulse control in response to food that have an impact on body weight. As this may have therapeutic implications, the current study investigated differences between overweight and non-overweight adolescent psychiatric inpatients (N = 98; aged 12-20) in relation to trait impulsivity and behavioral inhibition performance. The Barratt Impulsiveness Scale and two go/no-go paradigms with neutral and food-related stimulus materials were applied. Results indicated no significant differences concerning trait impulsivity, but revealed that overweight inpatients had significantly more difficulties in inhibition performance (i.e. they reacted more impulsively) in response to both food and neutral stimuli compared to non-overweight inpatients. Furthermore, no specific inhibition deficit for high-caloric vs. low-caloric food cues emerged in overweight inpatients, whereas non-overweight participants showed significantly lower inhibition skills in response to high-caloric than low-caloric food stimuli. The results highlight a rather general, non-food-specific reduced inhibition performance in an overweight adolescent psychiatric population. Further research is necessary to enhance the understanding of the role of impulsivity in terms of body weight status in this high-risk group of adolescent inpatients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Pediatric malignant hyperthermia: risk factors, morbidity, and mortality identified from the Nationwide Inpatient Sample and Kids' Inpatient Database.

    Science.gov (United States)

    Salazar, Jose H; Yang, Jingyan; Shen, Liang; Abdullah, Fizan; Kim, Tae W

    2014-12-01

    Malignant Hyperthermia (MH) is a potentially fatal metabolic disorder. Due to its rarity, limited evidence exists about risk factors, morbidity, and mortality especially in children. Using the Nationwide Inpatient Sample and the Kid's Inpatient Database (KID), admissions with the ICD-9 code for MH (995.86) were extracted for patients 0-17 years of age. Demographic characteristics were analyzed. Logistic regression was performed to identify patient and hospital characteristics associated with mortality. A subset of patients with a surgical ICD-9 code in the KID was studied to calculate the prevalence of MH in the dataset. A total of 310 pediatric admissions were seen in 13 nonoverlapping years of data. Patients had a mortality of 2.9%. Male sex was predominant (64.8%), and 40.5% of the admissions were treated at centers not identified as children's hospitals. The most common associated diagnosis was rhabdomyolysis, which was present in 26 cases. Regression with the outcome of mortality did not yield significant differences between demographic factors, age, sex race, or hospital type, pediatric vs nonpediatric. Within a surgical subset of 530,449 admissions, MH was coded in 55, giving a rate of 1.04 cases per 10,000 cases. This study is the first to combine two large databases to study MH in the pediatric population. The analysis provides an insight into the risk factors, comorbidities, mortality, and prevalence of MH in the United States population. Until more methodologically rigorous, large-scale studies are done, the use of databases will continue to be the optimal method to study rare diseases. © 2014 John Wiley & Sons Ltd.

  9. Disability correlates in Canadian Armed Forces Regular Force Veterans.

    Science.gov (United States)

    Thompson, James M; Pranger, Tina; Sweet, Jill; VanTil, Linda; McColl, Mary Ann; Besemann, Markus; Shubaly, Colleen; Pedlar, David

    2015-01-01

    This study was undertaken to inform disability mitigation for military veterans by identifying personal, environmental, and health factors associated with activity limitations. A sample of 3154 Canadian Armed Forces Regular Force Veterans who were released during 1998-2007 participated in the 2010 Survey on Transition to Civilian Life. Associations between personal and environmental factors, health conditions and activity limitations were explored using ordinal logistic regression. The prevalence of activity reduction in life domains was higher than the Canadian general population (49% versus 21%), as was needing assistance with at least one activity of daily living (17% versus 5%). Prior to adjusting for health conditions, disability odds were elevated for increased age, females, non-degree post-secondary graduation, low income, junior non-commissioned members, deployment, low social support, low mastery, high life stress, and weak sense of community belonging. Reduced odds were found for private/recruit ranks. Disability odds were highest for chronic pain (10.9), any mental health condition (2.7), and musculoskeletal conditions (2.6), and there was a synergistic additive effect of physical and mental health co-occurrence. Disability, measured as activity limitation, was associated with a range of personal and environmental factors and health conditions, indicating multifactorial and multidisciplinary approaches to disability mitigation.

  10. Managed care and inpatient mortality in adults: effect of primary payer.

    Science.gov (United States)

    Hines, Anika L; Raetzman, Susan O; Barrett, Marguerite L; Moy, Ernest; Andrews, Roxanne M

    2017-02-08

    Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor. This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. A cross-sectional design was used to examine the association between managed care and inpatient mortality for four common inpatient conditions. Data from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases for 11 states were linked to data from the American Hospital Association Annual Survey Database. Hospital discharges were categorized as managed care or fee for service. A phased approach to multivariate logistic modeling examined the likelihood of inpatient mortality when adjusting for individual patient and hospital characteristics and for county fixed effects. Results showed different effects of managed care for Medicare and privately insured patients. Privately insured patients in managed care had an advantage over their fee-for-service counterparts in inpatient mortality for acute myocardial infarction, stroke, pneumonia, and congestive heart failure; no such advantage was found for the Medicare managed care population. To the extent that the study showed a protective effect of privately insured managed care, it was driven by individuals aged 65 years and older, who had consistently better outcomes than their non-managed care counterparts. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service plans

  11. Community Reintegration Problems Among Veterans and Active Duty Service Members With Traumatic Brain Injury.

    Science.gov (United States)

    McGarity, Suzanne; Barnett, Scott D; Lamberty, Greg; Kretzmer, Tracy; Powell-Cope, Gail; Patel, Nitin; Nakase-Richardson, Risa

    To examine community reintegration problems among Veterans and military service members with mild or moderate/severe traumatic brain injury (TBI) at 1 year postinjury and to identify unique predictors that may contribute to these difficulties. VA Polytrauma Rehabilitation Centers. Participants were 154 inpatients enrolled in the VA TBI Model Systems Program with available injury severity data (mild = 28.6%; moderate/severe = 71.4%) and 1-year postinjury outcome data. Prospective, longitudinal cohort. Community reintegration outcomes included independent driving, employability, and general community participation. Additional measures assessed depression, posttraumatic stress, and cognitive and motor functioning. In the mild TBI (mTBI) group, posttraumatic stress disorder and depressive symptoms were associated with lower levels of various community reintegration outcomes. In the moderate/severe TBI group, cognition and motor skills were significantly associated with lower levels of community participation, independent driving, and employability. Community reintegration is problematic for Veterans and active duty service members with a history of TBI. Unique comorbidities across injury severity groups inhibit full reintegration into the community. These findings highlight the ongoing rehabilitation needs of persons with TBI, specifically evidence-based mental healthcare, in comprehensive rehabilitation programs consistent with a chronic disease management model.

  12. The musculoskeletal diagnosis cohort: examining pain and pain care among veterans.

    Science.gov (United States)

    Goulet, Joseph L; Kerns, Robert D; Bair, Matthew; Becker, William C; Brennan, Penny; Burgess, Diana J; Carroll, Constance M; Dobscha, Steven; Driscoll, Mary A; Fenton, Brenda T; Fraenkel, Liana; Haskell, Sally G; Heapy, Alicia A; Higgins, Diana M; Hoff, Rani A; Hwang, Ula; Justice, Amy C; Piette, John D; Sinnott, Patsi; Wandner, Laura; Womack, Julie A; Brandt, Cynthia A

    2016-08-01

    Musculoskeletal disorders (MSDs) are highly prevalent, painful, and costly disorders. The MSD Cohort was created to characterize variation in pain, comorbidities, treatment, and outcomes among patients with MSD receiving Veterans Health Administration care across demographic groups, geographic regions, and facilities. We searched electronic health records to identify patients treated in Veterans Health Administration who had ICD-9-CM codes for diagnoses including, but not limited to, joint, back, and neck disorders, and osteoarthritis. Cohort inclusion criteria were 2 or more outpatient visits occurring within 18 months of one another or one inpatient visit with an MSD diagnosis between 2000 and 2011. The first diagnosis is the index date. Pain intensity numeric rating scale (NRS) scores, comorbid medical and mental health diagnoses, pain-related treatments, and other characteristics were collected retrospectively and prospectively. The cohort included 5,237,763 patients; their mean age was 59, 6% were women, 15% identified as black, and 18% reported severe pain (NRS ≥ 7) on the index date. Nontraumatic joint disorder (27%), back disorder (25%), and osteoarthritis (21%) were the most common MSD diagnoses. Patients entering the cohort in recent years had more concurrent MSD diagnoses and higher NRS scores. The MSD Cohort is a rich resource for collaborative pain-relevant health service research.

  13. Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals.

    Science.gov (United States)

    Cleary, Paul D; Meterko, Mark; Wright, Steven M; Zaslavsky, Alan M

    2014-07-01

    Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients. To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information. We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI. Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience. This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.

  14. Suicide after absconding from inpatient care in England: an exploration of mental health professionals' experiences.

    Science.gov (United States)

    Hunt, Isabelle M; Clements, Caroline; Saini, Pooja; Rahman, Mohammad Shaiyan; Shaw, Jenny; Appleby, Louis; Kapur, Nav; Windfuhr, Kirsten

    2016-06-01

    Absconding from inpatient care is associated with suicide risk in psychiatric populations. However, little is known about the real world context of suicide after absconding from a psychiatric ward or the experiences of clinical staff caring for these patients. To identify the characteristics of inpatients who died by suicide after absconding and to explore these and further key issues related to suicide risk from the perspective of clinical staff. A mixed-methods study using quantitative data of all patient suicides in England between 1997 and 2011 and a thematic analysis of semi-structured interviews with 21 clinical staff. Four themes were identified as areas of concern for clinicians: problems with ward design, staffing problems, difficulties in assessing risk, and patient specific factors. Results suggest that inpatients who died by suicide after absconding may have more complex and severe illness along with difficult life events, such as homelessness. Closer monitoring of inpatients and access points, and improved risk assessments are important to reduce suicide in this patient group.

  15. The Association between Air Pollution and Outpatient and Inpatient Visits in Shenzhen, China

    Science.gov (United States)

    Liu, Yachuan; Chen, Shanen; Xu, Jian; Liu, Xiaojian; Wu, Yongsheng; Zhou, Lin; Cheng, Jinquan; Ma, Hanwu; Zheng, Jing; Lin, Denan; Zhang, Li; Chen, Lili

    2018-01-01

    Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China). Generalized additive model was employed to analyze associations between six air pollutants (namely SO2, CO, NO2, O3, PM10, and PM2.5) and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m3 increase in air pollutant concentration ranged from 0.48% (O3 at lag 2) to 11.48% (SO2 with 2-day moving average); for overall inpatient visits ranged from 0.73% (O3 at lag 7) to 17.13% (SO2 with 8-day moving average). Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits. PMID:29360738

  16. The Association between Air Pollution and Outpatient and Inpatient Visits in Shenzhen, China

    Directory of Open Access Journals (Sweden)

    Yachuan Liu

    2018-01-01

    Full Text Available Nowadays, air pollution is a severe environmental problem in China. To investigate the effects of ambient air pollution on health, a time series analysis of daily outpatient and inpatient visits in 2015 were conducted in Shenzhen (China. Generalized additive model was employed to analyze associations between six air pollutants (namely SO2, CO, NO2, O3, PM10, and PM2.5 and daily outpatient and inpatient visits after adjusting confounding meteorological factors, time and day of the week effects. Significant associations between air pollutants and two types of hospital visits were observed. The estimated increase in overall outpatient visits associated with each 10 µg/m3 increase in air pollutant concentration ranged from 0.48% (O3 at lag 2 to 11.48% (SO2 with 2-day moving average; for overall inpatient visits ranged from 0.73% (O3 at lag 7 to 17.13% (SO2 with 8-day moving average. Our results also suggested a heterogeneity of the health effects across different outcomes and in different populations. The findings in present study indicate that even in Shenzhen, a less polluted area in China, significant associations exist between air pollution and daily number of overall outpatient and inpatient visits.

  17. Inpatient migration patterns in persons with spinal cord injury: A registry study with hospital discharge data

    Directory of Open Access Journals (Sweden)

    Elias Ronca

    2016-12-01

    Full Text Available This study investigated and compared patient migration patterns of persons with spinal cord injury, the general population and persons with morbid obesity, rheumatic conditions and bowel disease, for secondary health conditions, across administrative boundaries in Switzerland. The effects of patient characteristics and health conditions on visiting hospitals outside the residential canton were examined using complete, nationwide, inpatient health records for the years 2010 and 2011. Patients with spinal cord injury were more likely to obtain treatment outside their residential canton as compared to all other conditions. Facilitators of patient migration in persons with spinal cord injury and the general hospital population were private or accidental health insurances covering costs. Barriers of patient migration in persons with spinal cord injury were old age, severe multimorbidity, financial coverage by basic health insurance, and minority language region. Keywords: Spinal cord injury, Patient migration, Health services accessibility, Health care utilization, Inpatient hospital care

  18. Mental health and substance use disorder spending in the Department of Veterans Affairs, fiscal years 2000-2007.

    Science.gov (United States)

    Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M

    2011-04-01

    This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

  19. Patterns of zolpidem use among Iraq and Afghanistan veterans: A retrospective cohort analysis

    Science.gov (United States)

    Amuan, Megan E.; Jaramillo, Carlos A.; Eapen, Blessen C.

    2018-01-01

    Background Although concern exists regarding the adverse effects and rate of zolpidem use, especially long-term use, limited information is available concerning patterns of zolpidem use. Objective To examine the prevalence and correlates of zolpidem exposure in Iraq and Afghanistan Veterans (IAVs). Methods A retrospective cohort study of zolpidem prescriptions was performed with National Veterans Health Administration (VHA) data. We gathered national VA inpatient, outpatient, and pharmacy data files for IAV’s who received VA care between fiscal years (FY) 2013 and 2014. The VA pharmacy database was used to identify the prevalence of long term (>30 days), high-dose zolpidem exposure (>10mg immediate-release; >12.5mg extended-release) and other medications received in FY14. Baseline characteristics (demographics, diagnoses) were identified in FY13. Bivariate and multivariable analyses were used to examine the demographic, clinical, and medication correlates of zolpidem use. Results Of 493,683 IAVs who received VHA care in FY 2013 and 2014, 7.6% (n = 37,422) were prescribed zolpidem in FY 2014. Women had lower odds of high-dose zolpidem exposure than men. The majority (77.3%) of IAVs who received zolpidem prescriptions had long-term use with an average days’ supply of 189.3 days and a minority (0.9%) had high-dose exposure. In multivariable analyses, factors associated with long-term zolpidem exposure included age greater than 29 years old, PTSD, insomnia, Selim Index, physical 2–3 conditions, opioids, antidepressants, benzodiazepines, atypical antipsychotics, and stimulants. High dose exposure was associated with PTSD, depression, substance use disorder, insomnia, benzodiazepines, atypical antipsychotics, and stimulant prescriptions. Conclusion The current practices of insomnia pharmacotherapy in IAVs fall short of the clinical guidelines and may reflect high-risk zolpidem prescribing practices that put Iraq and Afghanistan Veterans at risk for adverse effects

  20. FIM-Minimum Data Set Motor Item Bank: Short Forms Development and Precision Comparison in Veterans.

    Science.gov (United States)

    Li, Chih-Ying; Romero, Sergio; Simpson, Annie N; Bonilha, Heather S; Simpson, Kit N; Hong, Ickpyo; Velozo, Craig A

    2018-03-01

    To improve the practical use of the short forms (SFs) developed from the item bank, we compared the measurement precision of the 4- and 8-item SFs generated from a motor item bank composed of the FIM and the Minimum Data Set (MDS). The FIM-MDS motor item bank allowed scores generated from different instruments to be co-calibrated. The 4- and 8-item SFs were developed based on Rasch analysis procedures. This article compared person strata, ceiling/floor effects, and test SE plots for each administration form and examined 95% confidence interval error bands of anchored person measures with the corresponding SFs. We used 0.3 SE as a criterion to reflect a reliability level of .90. Veterans' inpatient rehabilitation facilities and community living centers. Veterans (N=2500) who had both FIM and the MDS data within 6 days during 2008 through 2010. Not applicable. Four- and 8-item SFs of FIM, MDS, and FIM-MDS motor item bank. Six SFs were generated with 4 and 8 items across a range of difficulty levels from the FIM-MDS motor item bank. The three 8-item SFs all had higher correlations with the item bank (r=.82-.95), higher person strata, and less test error than the corresponding 4-item SFs (r=.80-.90). The three 4-item SFs did not meet the criteria of SE bank composed of existing instruments across the continuum of care in veterans. We also found that the number of items, not test specificity, determines the precision of the instrument. Copyright © 2017 American Congress of Rehabilitation Medicine. All rights reserved.

  1. Risk factors for oropharynx cancer in a cohort of HIV-infected veterans.

    Science.gov (United States)

    Chew, Erin Y; Hartman, Christine M; Richardson, Peter A; Zevallos, Jose P; Sikora, Andrew G; Kramer, Jennifer R; Chiao, Elizabeth Y

    2017-05-01

    To evaluate HIV-related and other clinical risk factors associated with oropharynx cancer (OPSCC) in HIV-infected U.S. Veterans. Retrospective cohort study utilizing Veterans Affairs HIV Clinical Case Registry (CCR) data from 1985 to 2010. Outcome was incident OPSCC as indicated by 1 inpatient or 2 outpatient ICD-9 codes. Cox proportional hazard models were used to determine hazard ratios (HR) and 95% confidence intervals (CI) for each risk factor on the time to OPSCC diagnosis. A total of 40,996 HIV-infected male veterans were included in the cohort with 97 cases of OPSCC. The age adjusted incidence rate was 23.2/100,000 [95% CI 17.8-29.2]. Age>50 (aHR=3.8, 95% CI 1.9-7.8), recent CD4<200 (aHR=3.8, 95% CI 2.0-7.3), and undetectable HIV viral loads 40-79% of the time (aHR=1.8, 95% CI 1.1-3.0) were associated with an increased risk of OPSCC. Era of HIV diagnosis, utilization of cART, nadir CD4 count, race, smoking history, and previous risk of HPV disease, including condyloma or invasive squamous cell carcinoma of the anus (SCCA) were not associated with increased risk of OPSCC. Patients who were older at beginning of follow up, had lower CD4 counts around the time of OPSCC diagnosis, and moderate HIV viral control during follow-up had an increased risk of OPSCC. Other HPV-related diseases such as SCCA and condyloma did not increase the risk for OPSCC. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. [Sarcopenia and functionality in elderly inpatient].

    Science.gov (United States)

    Chávez-Moreno, Diana Victoria; Infante-Sierra, Héctor; Serralde-Zúñiga, Aurora E

    2015-04-01

    Sarcopenia is a geriatric syndrome associated with adverse events. The aim of the present study was to assess the sarcopenia prevalence and its association with the functionality in elderly inpatient. A cross sectional study, during 6 months were included elderly inpatients to determine the presence of sarcopenia using the Baumgartner method. The functionality to perform basic activities of daily living (ABVD) was determined by the Katz index. Student's t test or U de Mann-Whitney was used to assess the differences between two groups and one-factor ANOVA or Kruskal Wallis for multiple comparisons; X2 and Fisher's exact test were used to compare the categorical variables and the Pearson correlation was calculated to determine the correlations between variables. 102 patients were included, 41 women and 61 man; subjects had a mean age of 71±8.6 years, body mass index 27.8±5.2 kg/m2, grip strength 14.9±8.3 kg, appendicular skeletal muscle mass (MMEA) 17.6±4.3 kg and skeletal muscle mass index (IMME) 7.1±1.2 kg/m2. The global prevalence of sarcopenia was 27.5%, was major in men (RR 1.33; CI 95% 1.06-1.67 psarcopenia was associated to a major dependence in both genders (pSarcopenia is a frequent condition in the elderly inpatients associated with the functionality's deterioration,identifying it help to perform a primary or secondary prevention and opportunity treatment.

  3. [Psychiatric Inpatient Treatment and Return to Work].

    Science.gov (United States)

    Mernyi, Lena; Hölzle, Patricia; Hamann, Johannes

    2017-05-12

    Objective People with mental diseases have a high risk of unemployment and they have only limited access to the labor market. The return to work is often associated with fears.The present study aims to provide an overview of the number of hospitalized psychiatric patients with permanent employment. Moreover it should give an insight into the process of return to work, the experiences patients gain and the support they receive. Methods In the participating clinics we measured the number of patients with permanent employment. The main inclusion criteria for further survey were the status of permanent employment and age between 18 and 65. The participating patients were interviewed on two occasions, at the time of inclusion and 3 months after the patient was discharged. The questions addressed working conditions, job satisfaction and the process of return-to-work. For statistical analysis, descriptive statistics (frequencies, means, standard deviations) were used. Results Only 21 % of n = 815 inpatients of the participating hospitals were permanently employed. Many patients did not return to work after being discharged. In many cases the interviewed patients saw a connection between their job and their current episode of illness. In this context patients reported unsatisfying workplace conditions such as long working hours, bad work organization and social conflicts. Conclusions For mentally ill patients, the employment rate in the primary labor market is devastating low. After psychiatric inpatient treatment patients are at high risk to lose their jobs. In order to prevent this development, work-related stress factors should be discussed with inpatients at an early stage and support should be provided during the return-to-work-process. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Prevalence of multimorbidity in medical inpatients.

    Science.gov (United States)

    Schneider, Florian; Kaplan, Vladimir; Rodak, Roksana; Battegay, Edouard; Holzer, Barbara

    2012-03-09

    To validate the estimates of the prevalence of multimorbidity based on administrative hospital discharge data, with medical records and chart reviews as benchmarks. Retrospective cohort study. Medical division of a tertiary care teaching hospital. A total of 170 medical inpatients admitted from the emergency unit in January 2009. The prevalence of multimorbidity for three different definitions (≥2 diagnoses, ≥2 diagnoses from different ICD-10 chapters, and ≥2 medical conditions as defined by Charlson/Deyo) and three different data sources (administrative data, chart reviews, and medical records). The prevalence of multimorbidity in medical inpatients derived from administrative data, chart reviews and medical records was very high and concurred for the different definitions of multimorbidity (≥2 diagnoses: 96.5%, 95.3%, and 92.9% [p = 0.32], ≥2 diagnoses from different ICD-10 chapters: 86.5%, 90.0%, and 85.9% [p = 0.46], and ≥2 medical conditions as defined by Charlson/Deyo: 48.2%, 50.0%, and 46.5% [p = 0.81]). The agreement of rating of multimorbidity for administrative data and chart reviews and administrative data and medical records was 94.1% and 93.0% (kappa statistics 0.47) for ≥2 diagnoses; 86.0% and 86.5% (kappa statistics 0.52) for ≥2 diagnoses from different ICD-10 chapters; and 82.9% and 85.3% (kappa statistics 0.69) for ≥2 medical conditions as defined by Charlson/Deyo. Estimates of the prevalence of multimorbidity in medical inpatients based on administrative data, chart reviews and medical records were very high and congruent for the different definitions of multimorbidity. Agreement for rating multimorbidity based on the different data sources was moderate to good. Administrative hospital discharge data are a valid source for exploring the burden of multimorbidity in hospital settings.

  5. Rural Veterans' dental utilization, Behavioral Risk Factor Surveillance Survey, 2014.

    Science.gov (United States)

    Wiener, R Constance; Shen, Chan; Sambamoorthi, Usha; Findley, Patricia A

    2017-09-01

    Rural residents are overrepresented in the military; however, access to Veteran services is limited in rural areas. There is a need to identify rural Veteran healthcare utilization. This study addresses that need and has two purposes: a) to determine if there is an association between rural dwelling and Veteran utilization of dental services; and b) to determine if there is an association between rural dwelling and the oral health outcome of missing teeth. Data from the 2014 Behavioral Risk Factor Surveillance Survey were used in this study. Chi square and logistic regression analyses were conducted. Rural Veterans were less likely to have a dental visit during the previous year as compared with metropolitan Veterans in unadjusted analysis (Odds ratio = 0.71, 95% Confidence Interval, 0.64, 0.77) and in adjusted analysis [0.87 (95% Confidence Interval, 0.78, 0.96)]. In cases in which all teeth were missing, rural Veterans had an unadjusted odds ratio of 1.79 [95% Confidence Interval, 1.55, 2.08] and an adjusted odds ratio of 1.37 [95% Confidence Interval, 1.17, 1.62] as compared with metropolitan Veterans. The Veterans Health Administration develops policies for establishing centers for care for Veterans. The policy development should take into consideration that rural Veterans have not been as likely as urban Veterans to utilize dental services and have poorer oral health outcomes. © 2017 American Association of Public Health Dentistry.

  6. Spiritual distress of military veterans at the end of life.

    Science.gov (United States)

    Chang, Bei-Hung; Stein, Nathan R; Skarf, Lara M

    2015-06-01

    Although combat experiences can have a profound impact on individuals' spirituality, there is a dearth of research in this area. Our recent study indicates that one unique spiritual need of veterans who are at the end of life is to resolve distress caused by combat-related events that conflict with their personal beliefs. This study sought to gain an understanding of chaplains' perspectives on this type of spiritual need, as well as the spiritual care that chaplains provide to help veterans ease this distress. We individually interviewed five chaplains who have provided spiritual care to veterans at the end of life in a Veterans Administration hospital. The interviews were recorded, transcribed, and analyzed based on "grounded theory." Chaplains reported that they frequently encounter veterans at the end of life who are still suffering from thoughts or images of events that occurred during their military career. Although some veterans are hesitant to discuss their experiences, chaplains reported that they have had some success with helping the veterans to open up. Additionally, chaplains reported using both religious (e.g., confessing sins) and nonreligious approaches (e.g., recording military experience) to help veterans to heal. Our pilot study provides some insight into the spiritual distress that many military veterans may be experiencing, as well as methods that a chaplain can employ to help these veterans. Further studies are needed to confirm our findings and to examine the value of integrating the chaplain service into mental health care for veterans.

  7. Veterans Medical Care: FY2010 Appropriations

    Science.gov (United States)

    2010-01-21

    including eyeglasses and hearing aids; home health services, hospice care, palliative care, and institutional respite care; and noninstitutional...claimed and an administrative determination was made regarding the veteran’s ability to bear the cost of such transportation.89 The Veterans

  8. 38 CFR 3.501 - Veterans.

    Science.gov (United States)

    2010-07-01

    ...); Pub. L. 87-825; § 3.700(a)). Day preceding entrance on active duty. See § 3.654. (b) Aid and... treatment. (n) Section 3.853. Incompetents; estate over $25,000. Incompetent veteran receiving compensation, without spouse, child, or dependent parent, whose estate exceeds $25,000: Last day of the first month in...

  9. MINDFULNESS BEHANDLING AF DANSKE VETERANER - ET PILOTSTUDIE

    DEFF Research Database (Denmark)

    Fjorback, Lone

    2015-01-01

    I foråret 2014 mødtes en gruppe på 12 danske veteraner en gang om ugen i 9 uger for at deltage i programmet Mindfulness Baseret Stress Reduktion (MBSR). Deltagerne havde meldt sig frivilligt, og gruppen var blandet mht. alder, køn, antal udsendelser og diagnoser. Det, de havde til fælles, var...

  10. Assessing Oral Hygiene in Hospitalized Older Veterans.

    Science.gov (United States)

    Jennings, Andrea

    2015-01-01

    Poor oral health for all older adults can result in higher risk for heart disease, stroke, diabetes, and oral cancer. Findings from this study indicated older veterans needed to improve their oral hygiene habits but barriers to oral hygiene performance prevented them from receiving and performing oral hygiene measures.

  11. Adapted Sport Programs for Veterans with Disabilities

    Science.gov (United States)

    Goff, Mandy

    2012-01-01

    The Paralympic games began as a way for World War II veterans to take part in elite-level competition. Thanks to various disability-sport organizations, men and women who have served in the military are still using sport as a form of rehabilitation and a way to transition into their new life.

  12. Potential Costs of Veterans’ Health Care

    Science.gov (United States)

    2010-10-01

    coverage, there is no rigid mathematical relationship among those proportions because veterans enrolled in Part A may choose to enroll in either Part B or...assumption is consistent with the statistical analysis by an actuarial firm with which VA contracted when developing its model for projecting

  13. 77 FR 20273 - Vietnam Veterans Day

    Science.gov (United States)

    2012-04-03

    ... showing a generation of veterans the respect and support of a grateful Nation. The Vietnam War is a story... with honor, and on March 29, 1973, the last of our troops left Vietnam. Yet, in one of the war's most... commemorate the 50-year anniversary of the Vietnam War. [[Page 20276

  14. Contracting between public agencies and private psychiatric inpatient facilities.

    Science.gov (United States)

    Fisher, W H; Dorwart, R A; Schlesinger, M; Davidson, H

    1991-08-01

    Purchasing human services through contracts with private providers has become an increasingly common practice over the past 20 years. Using data from a national survey of psychiatric inpatient facilities, this paper examines the extent to which psychiatric units in privately controlled general hospitals and private psychiatric specialty hospitals (N = 611) participate in contractual arrangements to provide services to governmental bodies. It also examines how the likelihood of such a practice is affected by hospital characteristics (general or specialty, for profit or nonprofit) and features of hospitals' environments, including the competitiveness of the market for psychiatric inpatient care and the population's need for services in the hospital's county. The findings indicate that nonprofit psychiatric specialty hospitals were more likely than other types of hospitals to enter into such contracts, and that forces such as local competition and need for services were not predictors of such involvement. Contracting was shown to have a significant impact on the level of referrals a hospital accepted, but these levels were also affected by competition and need. Among hospitals with public contracts, referral acceptance from public agencies was unaffected by these factors, but they did have a significant effect on referral acceptance by hospitals without public contracts. These data suggest that public agencies contracting for services with private hospitals may represent a means by which "public sector" patients may gain access to private providers. Further, this mechanism may impose sufficient structure and regulation on the acceptance of such patients that many concerns of hospital administrators regarding patients who are costly and difficult to treat and discharge can be allayed.

  15. Medical and psychosocial barriers to weight management in older veterans with and without serious mental illness.

    Science.gov (United States)

    Muralidharan, Anjana; Klingaman, Elizabeth A; Prior, Steven J; Molinari, Victor; Goldberg, Richard W

    2016-11-01

    Older adults with serious mental illness (SMI) are an understudied population with complex care needs and high rates of obesity/overweight. Little is known about the experiences of older adults with SMI with weight management. The present study is an observational study of veterans ages 55 and over with a body mass index in the overweight or obese range, comparing Veterans with schizophrenia or bipolar disorder (n = 9044) to their same-age peers with no mental health disorders (n = 71156), on their responses to a questionnaire assessment of medical and psychosocial factors related to weight management. Responses to the questionnaire between August, 2005 and May, 2013 were used to examine the following: demographics, clinical characteristics, medical barriers to weight management, current weight loss plan, reliability of social support, reasons for being overweight, and weight loss barriers. Physical health concerns were highly prevalent in both groups. Veterans in the SMI group endorsed more medical issues and were significantly more likely to endorse experiences that indicated that their medical conditions were poorly controlled (e.g., shortness of breath). Veterans in the SMI group were more likely to endorse many barriers to healthy eating and physical activity, across medical, psychological, social, and environmental domains. Even within a sample at medically high-risk for complications related to obesity and metabolic syndrome, older veterans with SMI and overweight/obesity experience more challenges with weight management than their same-age peers with overweight/obesity and no mental health disorders. Weight management interventions for this population should take a multifaceted approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Yoga for veterans with chronic low back pain: Design and methods of a randomized clinical trial.

    Science.gov (United States)

    Groessl, Erik J; Schmalzl, Laura; Maiya, Meghan; Liu, Lin; Goodman, Debora; Chang, Douglas G; Wetherell, Julie L; Bormann, Jill E; Atkinson, J Hamp; Baxi, Sunita

    2016-05-01

    Chronic low back pain (CLBP) afflicts millions of people worldwide, with particularly high prevalence in military veterans. Many treatment options exist for CLBP, but most have limited effectiveness and some have significant side effects. In general populations with CLBP, yoga has been shown to improve health outcomes with few side effects. However, yoga has not been adequately studied in military veteran populations. In the current paper we will describe the design and methods of a randomized clinical trial aimed at examining whether yoga can effectively reduce disability and pain in US military veterans with CLBP. A total of 144 US military veterans with CLBP will be randomized to either yoga or a delayed treatment comparison group. The yoga intervention will consist of 2× weekly yoga classes for 12weeks, complemented by regular home practice guided by a manual. The delayed treatment group will receive the same intervention after six months. The primary outcome is the change in back pain-related disability measured with the Roland-Morris Disability Questionnaire at baseline and 12-weeks. Secondary outcomes include pain intensity, pain interference, depression, anxiety, fatigue/energy, quality of life, self-efficacy, sleep quality, and medication usage. Additional process and/or mediational factors will be measured to examine dose response and effect mechanisms. Assessments will be conducted at baseline, 6-weeks, 12-weeks, and 6-months. All randomized participants will be included in intention-to-treat analyses. Study results will provide much needed evidence on the feasibility and effectiveness of yoga as a therapeutic modality for the treatment of CLBP in US military veterans. Published by Elsevier Inc.

  17. Where schizophrenic patients commit suicide: a review of suicide among inpatients and former inpatients.

    Science.gov (United States)

    Pompili, Maurizio; Mancinelli, Iginia; Ruberto, Amedeo; Kotzalidis, Giorgio D; Girardi, Paolo; Tatarelli, Roberto

    2005-01-01

    To review the literature on suicide of inpatients with schizophrenia, to identify suicide risk factors as well as typical patterns of behavior and to suggest a rationale and strategies for future interventions. A computerized MedLine, Excerpta Medica and PsycLit search supplemented by an examination of cross-references and reviews. Up to half the suicides among patients with schizophrenia occur during inpatient admission. Inpatient suicides were found among those of a young age group who were predominantly single, childless and socially isolated. The vast majority experienced an illness characterized by long duration and prolonged psychiatric hospitalizations or multiple admissions and discharges. Up to 50% of the suicides occurred in the first few weeks and months following discharge from the hospital. The paranoid subtype of schizophrenia, where positive symptoms prevail and negative symptoms are few, is associated with a suicide risk that is three times greater than that associated with nonparanoid subtypes and eight times greater than the risk associated with the deficit subtype. Treatment of suicide is a major problem among inpatients with schizophrenia. Evidence suggests that suicide is generally carried-out by patients who have been recently discharged or by those who manage to get away from the hospital. Strategies aimed at preventing this phenomenon have been introduced to the medical personnel, but suicide in these patients does not seem to have been reduced. We emphasize the need to establish guidelines for the prevention of suicide in hospitalized patients with schizophrenia.

  18. Race and vitamin D status and monitoring in male veterans.

    Science.gov (United States)

    Peiris, Alan N; Bailey, Beth A; Peiris, Prith; Copeland, Rebecca J; Manning, Todd

    2011-06-01

    African Americans have lower vitamin D levels and reduced health outcomes compared to white Americans. Vitamin D deficiency may contribute to adverse health outcomes in African Americans. We hypothesized that race would be associated with vitamin D status and testing in African Americans veterans, and that vitamin D status is a major contributor to health care costs in African American veterans compared to white veterans. A retrospective analysis of the medical data in the Veterans Integrated Service Network 9 (southeastern United States) was performed, and 14148 male veterans were identified. Race was designated by the patient and its relationship to vitamin D levels/status and costs was assessed. Vitamin D levels were significantly lower and the percent of patients with vitamin D deficiency was significantly higher in African American veterans. This difference was independent of latitude and seasonality. Vitamin D testing was done significantly more in white veterans compared to African American veterans (5.4% vs 3.8%). While follow-up testing was 42% more likely if a patient was found to be vitamin D deficient, white veterans were 34% more likely than African American veterans to have at least 1 follow-up 25-hydroxyvitamin D performed. African American veterans had significantly higher health care costs, which were linked to lower vitamin D levels; however, the cost differential persisted even after adjusting for vitamin D status. Vitamin D deficiency is highly prevalent in African American veterans and needs improved management within the Veteran Administration system. Vitamin D status appears not to be the sole contributor to increased health care costs in African American veterans.

  19. Lower stress-reactive cortisol in female veterans associated with military status but not PTSD.

    Science.gov (United States)

    Pierce, Meghan E; Pritchard, Laurel M

    2016-09-01

    Female veterans are a growing yet understudied population. Currently, 14.6% of all troops deployed to Afghanistan and Iraq are female. Military service is associated with an increased risk for trauma exposure and subsequent development of posttraumatic stress disorder (PTSD). Dysregulation of the hypothalamic-pituitary-adrenal axis is frequently associated with PTSD. Few studies have examined females diagnosed with PTSD and only one study, to our knowledge, has examined HPA-axis dysregulation in female veterans. This study examined salivary cortisol in 52 female veterans and civilians both with and without PTSD. We collected saliva samples at bedtime and awakening, as well as in response to the Trier social stress test (TSST). We found that female veterans had blunted cortisol concentrations at all time points during the TSST compared to female civilians, regardless of PTSD status. Even though all groups showed the expected diurnal decline in cortisol, the difference between awakening and bedtime samples were significant only in civilians without PTSD. The results of our study suggest that stressors specific to the military may lead to lower than normal cortisol, which may not be associated with the expressions of PTSD.

  20. Self-perception of disability and prospects for employment among U.S. veterans.

    Science.gov (United States)

    Griffin, Christopher L; Stein, Michael Ashley

    2015-01-01

    Barriers to employment in the civilian labor force are increasingly difficult problems for returning veterans with disabilities. Reduced self-perception of disability status because of predominant military norms can be particularly harmful to reintegration efforts. We analyze rates of self-identified and externally determined disability status among U.S. veterans. Evidence of a lower self-report rate would confirm the hypothesis that armed forces culture might hold back truly deserving veterans from seeking the benefits owed, including specialized employment training programs. We use data from the Current Population Survey Veterans Supplement over the sample period 1995-2010 on disability status and associated demographic characteristics to present descriptive measures and limited statistical inference. Over the entire sample period, federal agencies considered 29% of the survey respondents to have a service-connected disability versus a 9% self-identification rate. The rate of more severe service-connected disabilities has risen steadily, while less drastic disability rates have fallen. Non-white respondents and those with lower education levels were less likely to self-identify. Large disparities in internal and external disability status identification raise questions about targeting soldiers re-entering the labor force. Employment policy should focus on overcoming negative cultural stereotypes and encouraging self-identification.

  1. Alcohol and drug abuse among U.S. veterans: comparing associations with intimate partner substance abuse and veteran psychopathology.

    Science.gov (United States)

    Miller, Mark W; Reardon, Annemarie F; Wolf, Erika J; Prince, Lauren B; Hein, Christina L

    2013-02-01

    This study examined the relative influences of posttraumatic stress disorder (PTSD), other psychopathology, and intimate partner alcohol and drug use on substance-related problems in U.S. veterans (242 couples, N = 484). Hierarchical regression analyses revealed that partner alcohol and drug use severity explained more variance in veteran alcohol use and drug use (20% and 13%, respectively) than did veteran PTSD, adult antisocial behavior, or depression symptoms combined (6% for veteran alcohol use; 7% for veteran drug use). Findings shed new light on the influence of relationship factors on veteran alcohol and drug use and underscore the importance of couples-oriented approaches to treating veterans with comorbid PTSD and substance abuse. Published 2013. This article is a US Government work and is in the public domain in the USA.

  2. The Future Impact of Vietnam Era Veterans on Inpatient Acute Care and Mental Health Product Lines at a Veterans Affairs Medical Center

    National Research Council Canada - National Science Library

    Parker, Robert

    2000-01-01

    .... This retrospective study uses descriptive statistics, inferential statistics, and trend analysis to observe, describe, explain, predict, test, and evaluate hypotheses associated with the relationship between non-VEV and VEV admissions. The results from this will be used to assist in developing a forecasting methodology using a best curve fit model.

  3. Assessment of psychological pain in suicidal veterans.

    Science.gov (United States)

    Reist, Christopher; Mee, Steven; Fujimoto, Ken; Rajani, Vivek; Bunney, William E; Bunney, Blynn G

    2017-01-01

    Psychological pain is a relatively understudied and potentially important construct in the evaluation of suicidal risk. Psychological pain also referred to as 'mental pain' or 'psychache' can be defined as an adverse emotional reaction to a severe trauma (e.g., the loss of a child) or may be associated with an illness such as depression. When psychological pain levels reach intolerable levels, some individuals may view suicide as the only and final means of escape. To better understand psychological pain, we previously developed and validated a brief self-rating 10-item scale, Mee-Bunney Psychological Pain Assessment Scale [MBP] in depressed patients and non-psychiatric controls. Our results showed a significant increase in psychological pain in the depressed patients compared to controls. We also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort. The current investigation extends our study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention program. In addition to the MBP, we administered the Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), and the Barratt Impulsiveness Scale (BIS-11). Suicidal patients scoring above a predetermined threshold for high psychological pain also had significantly elevated scores on all the other assessments. Among all of the evaluations, psychological pain accounted for the most shared variance for suicidality (C-SSRS). Stepwise regression analyses showed that impulsiveness (BIS) and psychological pain (MBP) contributed more to suicidality than any of the other combined assessments. We followed patients for 15 months and identified a subgroup (24/57) with serious suicide events. Within this subgroup, 29% (7/24) had a serious suicidal event (determined by the lethality subscale of the C-SSRS), including one completed suicide. Our results

  4. Inpatient Complexity in Radiology-a Practical Application of the Case Mix Index Metric.

    Science.gov (United States)

    Mabotuwana, Thusitha; Hall, Christopher S; Flacke, Sebastian; Thomas, Shiby; Wald, Christoph

    2017-06-01

    With ongoing healthcare payment reforms in the USA, radiology is moving from its current state of a revenue generating department to a new reality of a cost-center. Under bundled payment methods, radiology does not get reimbursed for each and every inpatient procedure, but rather, the hospital gets reimbursed for the entire hospital stay under an applicable diagnosis-related group code. The hospital case mix index (CMI) metric, as defined by the Centers for Medicare and Medicaid Services, has a significant impact on how much hospitals get reimbursed for an inpatient stay. Oftentimes, patients with the highest disease acuity are treated in tertiary care radiology departments. Therefore, the average hospital CMI based on the entire inpatient population may not be adequate to determine department-level resource utilization, such as the number of technologists and nurses, as case length and staffing intensity gets quite high for sicker patients. In this study, we determine CMI for the overall radiology department in a tertiary care setting based on inpatients undergoing radiology procedures. Between April and September 2015, CMI for radiology was 1.93. With an average of 2.81, interventional neuroradiology had the highest CMI out of the ten radiology sections. CMI was consistently higher across seven of the radiology sections than the average hospital CMI of 1.81. Our results suggest that inpatients undergoing radiology procedures were on average more complex in this hospital setting during the time period considered. This finding is relevant for accurate calculation of labor analytics and other predictive resource utilization tools.

  5. Recent national trends in the use of adolescent inpatient bariatric surgery: 2000 through 2009.

    Science.gov (United States)

    Kelleher, Deirdre C; Merrill, Chaya T; Cottrell, Linda T; Nadler, Evan P; Burd, Randall S

    2013-02-01

    To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009. Retrospective cross-sectional study. Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009. Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures. Inpatient bariatric surgery. The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009. The inpatient bariatric procedure rate increased from 0.8 per 100 000 in 2000 to 2.3 per 100 000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100 000) or 2009 (2.4 per 100 000), with 925 vs 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P = .002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients.

  6. Clinical outcomes following inpatient penicillin allergy testing: A systematic review and meta-analysis.

    Science.gov (United States)

    Sacco, K A; Bates, A; Brigham, T J; Imam, J S; Burton, M C

    2017-09-01

    A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of broader-spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization. We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library over the past 20 years. Inpatients having a documented penicillin allergy that underwent penicillin allergy testing were included. Twenty-four studies met eligibility criteria. Study sample size was between 24 and 252 patients in exclusively inpatient cohorts. Penicillin skin testing (PST) with or without oral amoxicillin challenge was the main intervention described (18 studies). The population-weighted mean for a negative PST was 95.1% [CI 93.8-96.1]. Inpatient penicillin allergy testing led to a change in antibiotic selection that was greater in the intensive care unit (77.97% [CI 72.0-83.1] vs 54.73% [CI 51.2-58.2], Pallergy testing was associated with decreased healthcare cost in four studies. Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy. The rate of negative tests is comparable to outpatient and perioperative data. Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  7. Utilization of inpatient care from private hospitals: trends emerging from Kerala, India.

    Science.gov (United States)

    Dilip, T R

    2010-09-01

    There is a gap in knowledge on the overall role and characteristics of private health care providers in India. This research is aimed at understanding changes in the consumption of inpatient care services from private hospitals between 1986 and 2004, with a particular focus on equitable outreach. Secondary analysis of National Sample Survey data on the utilization of inpatient care services in Kerala is performed for the periods 1986-87, 1995-96 and 2004. Household survey data are examined to understand the users of the private health system as there are limitations in obtaining reliable data from unregulated private health care providers. The annual hospitalization rate increased from 69 per 1000 population in 1986-87 to 126 per 1000 population by 2004. The proportion of persons seeking care from private rather than government hospitals increased from 55% in 1986-87 to 65% by 2004. Concentration indices revealed that the year 1995-96 witnessed the highest income inequality in hospitalization rates. A decline both in hospitalization rates and in the relative preference for private hospitals over government hospitals among the poorest two quintiles between 1986-87 and 1995-96 indicates that the poor avoided inpatient treatment. The rich-poor divide in care seeking from private hospitals was moderated by 2004. Improvements in the purchasing power of the population, and the strategy of private hospitals in this highly competitive market to generate revenue from the poorer quintiles by offering different pricing options, have reduced the observed rich-poor divide in the consumption of inpatient treatment from this sector. However, while this gap in utilization has closed, the burden of out-of-pocket expenditure is higher among the poor.

  8. Impact of Paliperidone Palmitate Versus Oral Atypical Antipsychotics on Health Care Resource Use and Costs in Veterans With Schizophrenia and Comorbid Substance Abuse.

    Science.gov (United States)

    Lefebvre, Patrick; Muser, Erik; Joshi, Kruti; DerSarkissian, Maral; Bhak, Rachel H; Duh, Mei Sheng; Shiner, Brian; Young-Xu, Yinong

    2017-07-01

    Almost half of all patients diagnosed with schizophrenia have a history of substance abuse (SA). However, data on treatment of schizophrenia with paliperidone palmitate (PP) among patients with comorbid SA are limited. The objective of this study was to compare all-cause and SA-related health care resource utilization and costs in veterans with schizophrenia and co-occurring SA who were treated with PP versus oral atypical antipsychotics (OAAs). Veterans Health Administration electronic health record data were used to conduct a retrospective longitudinal study in veterans with schizophrenia who initiated PP or OAA between January 1, 2010 and June 30, 2016, had ≥12 months of enrollment before treatment initiation (baseline), were diagnosed with SA, and had ≥1 Global Assessment of Functioning score during baseline. Differences in baseline characteristics were adjusted for using inverse probability of treatment weighting. Adjusted cost differences and incidence rate ratios (IRR) for the association between PP versus OAA and all-cause and SA-related health care costs and health care resource utilization in the 12 months after treatment initiation were estimated with corresponding 95% CIs using weighted linear and Poisson regression models, respectively. Of 6872 veterans in the study, 1684 (25%) and 5188 (75%) were treated with PP and OAA, respectively. After adjustment, PP was associated with fewer all-cause inpatient (IRR = 0.88; 95% CI, 0.85 to 0.90), mental health-related inpatient (IRR = 0.88; 95% CI, 0.85 to 0.91), and long-term care stays (IRR = 0.53; 95% CI, 0.44 to 0.64), but more frequent mental health intensive case management visits (IRR = 1.51; 95% CI, 1.49 to 1.53) compared with OAA (all P schizophrenia and comorbid SA. Thus, PP appears to be a valuable treatment option for patients in this subpopulation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Prescribing patterns for inpatients with schizophrenia spectrum disorders in a psychiatric hospital in Slovenia: Results of 16-month prospective, non-interventional clinical research.

    Science.gov (United States)

    Bole, Cvetka Bačar; Pišlar, Mitja; Mrhar, Aleš; Tavčar, Rok

    2017-06-01

    In Slovenia, there has been no evidence about the prescribing patterns for inpatients with psychotic disorders. The research aims to analyze drug utilization patterns for inpatients with psychotic disorder that are coded as F20-F29 according to International Classification of Diseases (ICD) 10 th revision (schizophrenia spectrum disorders). Prospective research was conducted at the Psychiatric Hospital Idrija. The medical records of the inpatients admitted over a 12-month period were collected from the beginning to the end of their hospitalization. A total of 311 inpatients with 446 hospitalizations were included, producing a total of 3954 medication prescriptions. Medications prescribed pro re nata (the use of as needed) were also taken into account. Antipsychotics (N=1149, 43% of prescriptions) were the most often prescribed medications, followed by anxiolytics, antiparkinsonians, antidepressants, mood stabilizers and cardiovascular drugs. A total of 256 (82%) inpatients received at least one pro re nata medication. It was observed that the studied population was treated with one antipsychotic on 27 percent of prescriptions. Inpatients with schizophrenia spectrum disorders were exposed to a large number of different drugs. They were not received only psychotropic drugs but also other medications. With the knowledge about medications the implementation of clinical pharmacy services to the psychiatrists would significantly improve medication of inpatients with psychotic disorders and polypharmacotherapy.

  10. Veterans Health Administration: Actions Needed to Better Recruit and Retain Clinical and Administrative Staff

    Science.gov (United States)

    2017-03-22

    This Study VHA’s ability to attract, hire, and retain top talent is critical to its mission to provide quality and timely care for our nation’s...States’ military operations in Afghanistan and Iraq and the growing needs of an aging veteran population. Attracting, hiring, and retaining top talent ...police, and housekeepers.7 These employees are covered by three types of personnel systems:8 • Title 5 of the U.S. Code (Title 5): The majority of

  11. Suicide Risk Assessment and Prevention: A Systematic Review Focusing on Veterans.

    Science.gov (United States)

    Nelson, Heidi D; Denneson, Lauren M; Low, Allison R; Bauer, Brian W; O'Neil, Maya; Kansagara, Devan; Teo, Alan R

    2017-10-01

    Suicide rates in veteran and military populations in the United States are high. This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. Trials, observational studies, and systematic reviews relevant to U.S. veterans and military personnel were identified in searches of MEDLINE, PsycINFO, SocINDEX, and Cochrane databases (January 1, 2008, to September 11, 2015), on Web sites, and in reference lists. Investigators extracted and confirmed data and dual-rated risk of bias for included studies. Nineteen studies evaluated accuracy of risk assessment methods, including models using retrospective electronic records data and clinician- or patient-rated instruments. Most methods demonstrated sensitivity ≥80% or area-under-the-curve values ≥.70 in single studies, including two studies based on electronic records of veterans and military personnel, but specificity varied. Suicide rates were reduced in six of eight observational studies of population-level interventions. Only two of ten trials of individual-level psychotherapy reported statistically significant differences between treatment and usual care. Risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility. Research to refine these methods and examine clinical applications is needed. Studies of suicide prevention interventions are inconclusive; trials of population-level interventions and promising therapies are required to support their clinical use.

  12. Using an Inpatient Quality Improvement Curriculum for Internal Medicine Residents to Improve Pneumococcal Conjugate Vaccine Administration Rates.

    Science.gov (United States)

    Jolin, Jonathan; van Aalst, Robertus; Volpp, Bryan; Taylor, Thomas; Cohen, Emily

    2018-06-01

    Pneumococcal infections are an important source of morbidity and mortality in older adults and persons with compromised immune systems. New recommendations from the Advisory Committee on Immunization Practices (ACIP) became available September 2014, which included recommendations for the use of the 13-valent pneumococcal conjugate vaccine (PCV13). A study was conducted to increase the PCV13 vaccination rates of hospitalized patients at the White River Junction Veterans Affairs Medical Center (White River Junction, Vermont) through the use of a resident-driven quality improvement (QI) project. From December 2014 through April 2016, 16 internal medicine inpatient residents addressed inpatient PCV13 vaccination rates by participating in the facility's QI curriculum. Eight Plan-Do-Study-Act cycles were used, including discharge template editing, electronic reminders, and the discovery of a vaccination administration documentation error in the record through data validation. The measure was the monthly percentage of patients who received PCV13 vaccination (vaccination completion rate) of those discharged from the hospital medicine service who were due for PCV13 vaccination. The percentage of veterans discharged with an up-to-date PCV13 vaccination on discharge increased from approximately 30% to 87% and was sustained. Despite being driven by many different residents, this project demonstrates that continuous improvement can be achieved through a structured and iterative process while providing active learning of core QI concepts to residents. It also displays a method in which new guidelines can be incorporated into practice in an effective manner. Finally, this project is an example of how resident-driven data validation can lead to further improvement. Published by Elsevier Inc.

  13. 77 FR 69551 - Advisory Committee on Women Veterans; Notice of Meeting

    Science.gov (United States)

    2012-11-19

    ... Administration; and briefings on health care for women Veterans, mental health, women Veterans' legislative... regarding the needs of women Veterans with respect to health care, rehabilitation, compensation, outreach... DEPARTMENT OF VETERANS AFFAIRS Advisory Committee on Women Veterans; Notice of Meeting The...

  14. Emotion Recognition Ability Test Using JACFEE Photos: A Validity/Reliability Study of a War Veterans' Sample and Their Offspring.

    Science.gov (United States)

    Castro-Vale, Ivone; Severo, Milton; Carvalho, Davide; Mota-Cardoso, Rui

    2015-01-01

    Emotion recognition is very important for social interaction. Several mental disorders influence facial emotion recognition. War veterans and their offspring are subject to an increased risk of developing psychopathology. Emotion recognition is an important aspect that needs to be addressed in this population. To our knowledge, no test exists that is validated for use with war veterans and their offspring. The current study aimed to validate the JACFEE photo set to study facial emotion recognition in war veterans and their offspring. The JACFEE photo set was presented to 135 participants, comprised of 62 male war veterans and 73 war veterans' offspring. The participants identified the facial emotion presented from amongst the possible seven emotions that were tested for: anger, contempt, disgust, fear, happiness, sadness, and surprise. A loglinear model was used to evaluate whether the agreement between the intended and the chosen emotions was higher than the expected. Overall agreement between chosen and intended emotions was 76.3% (Cohen kappa = 0.72). The agreement ranged from 63% (sadness expressions) to 91% (happiness expressions). The reliability by emotion ranged from 0.617 to 0.843 and the overall JACFEE photo set Cronbach alpha was 0.911. The offspring showed higher agreement when compared with the veterans (RR: 41.52 vs 12.12, p < 0.001), which confirms the construct validity of the test. The JACFEE set of photos showed good validity and reliability indices, which makes it an adequate instrument for researching emotion recognition ability in the study sample of war veterans and their respective offspring.

  15. Emotion Recognition Ability Test Using JACFEE Photos: A Validity/Reliability Study of a War Veterans' Sample and Their Offspring.

    Directory of Open Access Journals (Sweden)

    Ivone Castro-Vale

    Full Text Available Emotion recognition is very important for social interaction. Several mental disorders influence facial emotion recognition. War veterans and their offspring are subject to an increased risk of developing psychopathology. Emotion recognition is an important aspect that needs to be addressed in this population. To our knowledge, no test exists that is validated for use with war veterans and their offspring. The current study aimed to validate the JACFEE photo set to study facial emotion recognition in war veterans and their offspring. The JACFEE photo set was presented to 135 participants, comprised of 62 male war veterans and 73 war veterans' offspring. The participants identified the facial emotion presented from amongst the possible seven emotions that were tested for: anger, contempt, disgust, fear, happiness, sadness, and surprise. A loglinear model was used to evaluate whether the agreement between the intended and the chosen emotions was higher than the expected. Overall agreement between chosen and intended emotions was 76.3% (Cohen kappa = 0.72. The agreement ranged from 63% (sadness expressions to 91% (happiness expressions. The reliability by emotion ranged from 0.617 to 0.843 and the overall JACFEE photo set Cronbach alpha was 0.911. The offspring showed higher agreement when compared with the veterans (RR: 41.52 vs 12.12, p < 0.001, which confirms the construct validity of the test. The JACFEE set of photos showed good validity and reliability indices, which makes it an adequate instrument for researching emotion recognition ability in the study sample of war veterans and their respective offspring.

  16. Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the National Health and Resilience in Veterans Study.

    Science.gov (United States)

    Tsai, Jack; Harpaz-Rotem, Ilan; Armour, Cherie; Southwick, Steven M; Krystal, John H; Pietrzak, Robert H

    2015-05-01

    To evaluate the prevalence of DSM-5 posttraumatic stress disorder (PTSD) and factor structure of PTSD symptomatology in a nationally representative sample of US veterans and examine how PTSD symptom clusters are related to depression, anxiety, suicidal ideation, hostility, physical and mental health-related functioning, and quality of life. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of 1,484 US veterans conducted from September through October 2013. Confirmatory factor analyses were conducted to evaluate the factor structure of PTSD symptoms, and structural equation models were constructed to examine the association between PTSD symptom clusters and external correlates. 12.0% of veterans screened positive for lifetime PTSD and 5.2% for past-month PTSD. A 5-factor dysphoric arousal model and a newly proposed 6-factor model both fit the data significantly better than the 4-factor model of DSM-5. The 6-factor model fit the data best in the full sample, as well as in subsamples of female veterans and veterans with lifetime PTSD. The emotional numbing symptom cluster was more strongly related to depression (P < .001) and worse mental health-related functioning (P < .001) than other symptom clusters, while the externalizing behavior symptom cluster was more strongly related to hostility (P < .001). A total of 5.2% of US veterans screened positive for past-month DSM-5 PTSD. A 6-factor model of DSM-5 PTSD symptoms, which builds on extant models and includes a sixth externalizing behavior factor, provides the best dimensional representation of DSM-5 PTSD symptom clusters and demonstrates validity in assessing health outcomes of interest in this population. © Copyright 2015 Physicians Postgraduate Press, Inc.

  17. The "Hand-in" Project: Jump-starting Communication Between Inpatient and Outpatient Providers.

    Science.gov (United States)

    Holleck, Jürgen L; Gunderson, Craig G; Antony, Sheila M; Gupta, Shaili; Chang, John J; Merchant, Naseema; Lin, Shin; Federman, Daniel G

    2017-11-01

    Communication between hospitalists and primary care providers (PCPs) upon discharge has been much discussed, but the transition from outpatient to inpatient has received less attention. We questioned whether a brief, standardized e-mail from the hospitalist to the PCP upon admission could facilitate information exchange, increase communication, elucidate PCP preferences, and improve outcomes. This prospective single-center study with a preintervention-to-postintervention design involved 300 inpatient admissions from June 2015 through October 2015 in the Veterans Affairs Connecticut Healthcare System. Hospitalists e-mailed an encrypted notification of admission along with standardized questions to PCPs within 1 day of admission. Measurements included the number of communications between PCPs and hospitalists, length of stay (LOS), 30-day readmissions, 30-day emergency department (ED) utilization rates, PCP preferences with regard to communication, and follow-up. Preintervention data for 94 patients during a 6-week period revealed 0.11 communications per patient, an LOS of 4.18 days, 30-day readmissions of 28.7%, and 30-day ED visits of 32%. Postintervention data on 206 patients during the next 12 weeks showed statistically significant increased communications per patient (0.5), and a nonsignificant decrease in LOS (3.96 days), 30-day readmissions (22.3%), and 30-day ED visits (31%). P values were communication upon discharge (40%) to telephone (25%) or instant messaging (13%), and 39% wanted a follow-up appointment within 2 weeks, regardless of what transpired. A hospitalist-led transition-of-care intervention designed to improve communication and information exchange between PCPs and hospitalists at the time of admission demonstrated that encrypted e-mail could be used as a tool to obtain useful additional medical and psychosocial information and to better understand PCP attitudes and preferences. The increased level of communication did not yield statistically

  18. Barriers and Health Beliefs Related to Weight Management Among Veterans With Human Immunodeficiency Virus.

    Science.gov (United States)

    Munro, Shannon; Dinatale, Emily; Hartley, Sarah; St Jacques, Monica; Oursler, Kris Ann

    2017-01-01

    The success of antiretroviral therapy has led to dramatic changes in causes of morbidity and mortality among U.S. Veterans with human immunodeficiency virus (HIV). Among the 25,000 Veterans treated for HIV, 70% are over age 50 and the rate of obesity has doubled in this population. Veterans with HIV have a 50% increased risk of myocardial infarction yet have limited presence in prevention-related programs designed to lower cardiovascular disease risk. This mixed methods study (focus groups, Schwarzer and Renner physical activity, and nutrition self-efficacy questionnaires) was used to explore factors related to health behavior and identify barriers that overweight Veterans with HIV face in enrolling in the MOVE weight management program. Institutional review board approval was granted before the start of the study. All participants were recruited from the Infectious Disease clinic if they met national inclusion criteria for the MOVE weight management program and had not previously participated in the program. Transcribed audio recordings were independently analyzed and coded by four of the researchers using an exploratory process to obtain consensus regarding themes. An interrater reliability analysis for the Kappa statistic was performed to determine consistency among raters. The relationship between physical activity self-efficacy scores and nutrition self-efficacy scores was tested using Spearman's correlation coefficient. The median age of the sample was 56 with high rates of diabetes (36%), hypertension (73%), hyperlipidemia (36%), and tobacco use history (82%). External barriers to participation were discussed in addition to 8 other themes, which influence treatment engagement for Veterans with obesity and HIV including adaptation, stigma, self-management, and support. Veterans held strong beliefs about responsibility and commitment to their health and wanted to assume an active and informed role in their health care. Veterans with high levels of perceived

  19. Patients overwhelmingly prefer inpatient boarding to emergency department boarding.

    Science.gov (United States)

    Viccellio, Peter; Zito, Joseph A; Sayage, Valerie; Chohan, Jasmine; Garra, Gregory; Santora, Carolyn; Singer, Adam J

    2013-12-01

    Boarding of admitted patients in the emergency department (ED) is a major cause of crowding. One alternative to boarding in the ED, a full-capacity protocol where boarded patients are redeployed to inpatient units, can reduce crowding and improve overall flow. Our aim was to compare patient satisfaction with boarding in the ED vs. inpatient hallways. We performed a structured telephone survey regarding patient experiences and preferences for boarding among admitted ED patients who experienced boarding in the ED hallway and then were subsequently transferred to inpatient hallways. Demographic and clinical characteristics, as well as patient preferences, including items related to patient comfort and safety using a 5-point scale, were recorded and descriptive statistics were used to summarize the data. Of 110 patients contacted, 105 consented to participate. Mean age was 57 ± 16 years and 52% were female. All patients were initially boarded in the ED in a hallway before their transfer to an inpatient hallway bed. The overall preferred location after admission was the inpatient hallway in 85% (95% confidence interval 75-90) of respondents. In comparing ED vs. inpatient hallway boarding, the following percentages of respondents preferred inpatient boarding with regard to the following 8 items: rest, 85%; safety, 83%; confidentiality, 82%; treatment, 78%; comfort, 79%; quiet, 84%; staff availability, 84%; and privacy, 84%. For no item was there a preference for boarding in the ED. Patients overwhelmingly preferred the inpatient hallway rather than the ED hallway when admitted to the hospital. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Psychiatric Morbidity Patterns in Referred Inpatients of Other Specialties

    Directory of Open Access Journals (Sweden)

    Ajay Risal

    2013-03-01

    Conclusions: Psychiatric consultation was sought mostly by medical ward that had maximum number of patients presenting with self-poisoning. The commonest diagnosis seen in the referred in-patients was depression and anxiety disorder. Keywords: consultation-liaison psychiatry; in-patient referral; psychiatric morbidity.

  1. Outcome of a 4-step treatment algorithm for depressed inpatients

    NARCIS (Netherlands)

    Birkenhäger, T.K.; Broek, W.W. van den; Moleman, P.; Bruijn, J.A.

    2006-01-01

    Objective: The aim of this study was to examine the efficacy and the feasibility of a 4-step treatment algorithm for inpatients with major depressive disorder. Method: Depressed inpatients, meeting DSM-IV criteria for major depressive disorder, were enrolled in the algorithm that consisted of

  2. The inpatient economic and mortality impact of hepatocellular carcinoma from 2005 to 2009: analysis of the US nationwide inpatient sample.

    Science.gov (United States)

    Mishra, Alita; Otgonsuren, Munkhzul; Venkatesan, Chapy; Afendy, Mariam; Erario, Madeline; Younossi, Zobair M

    2013-09-01

    Hepatocellular carcinoma (HCC) is an important complication of cirrhosis. Our aim was to assess the inpatient economic and mortality of HCC in the USA METHODS: Five cycles of Nationwide Inpatient Sample (NIS) conducted from 2005 to 2009 were used. Demographics, inpatient mortality, severity of illness, payer type, length of stay (LoS) and charges were available. Changes and associated factors related to inpatient HCC were assessed using simple linear regression. Odds ratios and 95% CIs for hospital mortality were analysed using log-linked regression model. To estimate the sampling variances for complex survey data, we used Taylor series approach. SAS(®) v.9.3 was used for statistical analysis. From 2005 to 2009, 32,697,993 inpatient cases were reported to NIS. During these 5 years, primary diagnosis of HCC increased from 4401 (2005), 4170 (2006), 5065 (2007), 6540 (2008) to 6364 (2009). HCC as any diagnosis increased from 68 per 100,000 discharges (2005) to 99 per 100,000 (2009). However, inpatient mortality associated with HCC decreased from 12% (2005) to 10% (2009) (P < 0.046) and LoS remained stable. However, median inflation-adjusted charges at the time of discharge increased from $29,466 per case (2005) to $31,656 per case (2009). Total national HCC charges rose from $1.0 billion (2005) to $2.0 billion (2009). In multivariate analysis, hospital characteristic was independently associated with decreasing in-hospital mortality (all P < 0.05). Liver transplantation for HCC was the main contributor to high inpatient charges. Longer LoS and other procedures also contributed to higher inpatient charges. There is an increase in the number of inpatient cases of HCC. Although inpatient mortality is decreasing and the LoS is stable, the inpatient charges associated with HCC continue to increase. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression.

    Science.gov (United States)

    Dack, C; Ross, J; Papadopoulos, C; Stewart, D; Bowers, L

    2013-04-01

    To combine the results of earlier comparison studies of in-patient aggression to quantitatively assess the strength of the association between patient factors and i) aggressive behaviour,ii) repetitive aggressive behaviour. A systematic review and meta-analysis of empirical articles and reports of comparison studies of aggression and non-aggression within adult psychiatric in-patient settings. Factors that were significantly associated with in-patient aggression included being younger, male, involuntary admissions, not being married, a diagnosis of schizophrenia, a greater number of previous admissions, a history of violence, a history of self-destructive behaviour and a history of substance abuse. The only factors associated with repeated in-patient aggression were not being male, a history of violence and a history of substance abuse. By comparing aggressive with non-aggressive patients, important differences between the two populations may be highlighted. These differences may help staff improve predictions of which patients might become aggressive and enable steps to be taken to reduce an aggressive incident occurring using actuarial judgements. However, the associations found between these actuarial factors and aggression were small. It is therefore important for staff to consider dynamic factors such as a patient's current state and the context to reduce in-patient aggression. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  4. Dizziness and Falls in Obese Inpatients Undergoing Metabolic Rehabilitation.

    Directory of Open Access Journals (Sweden)

    Stefano Corna

    Full Text Available The relationship between dizziness and falls in the obese population is a relatively unexplored issue. The aims of the present study were to define the 1-year prevalence of dizziness in an obese inpatient population undergoing metabolic rehabilitation and to investigate possible correlations with fall events.We recruited 329 obese subjects: 203 female (BMI 43,74 kg/m2 ± 0.5 SE; age 17-83 years, 58.33 ± 0.9 SE and 126 male (BMI 44,27kg/m2 ± 0.7 DE age 27-79 years, 58.84 ± 1 SE. To assess dizziness we used the validated Italian version (38 of the Dizziness Handicap Inventory (DHI.Out of the experimental sample, 100 subjects did not complain of dizziness and felt confident about their balance control, while 69.6% reported some degree of dizziness. Their mean DHI score was 22.3, which corresponds to mild dizziness. Twenty-one percent reported more severe dizziness (DHI score > 40. The majority of our sample reported minor dizziness and its perception appears to be independent from BMI: DHI scores were consistent across classes of obesity.The rate of dizziness and falls (30.1% in an this obese population was higher than that previously reported in a general matched population. However, obese subjects, in our sample, seem to underestimate their risk of fall and DHI score does not appear a reliable predictor of falls. Since complications associated with falls in obese persons generally require longer treatments than in lean individuals, our findings should be taken into account in order to identify other predictors, including cognitive and perceptual, of risk of fall and to implement fall prevention programs.

  5. Does certificate of need law enhance competition in inpatient care market? An empirical analysis.

    Science.gov (United States)

    Paul, Jomon A; Ni, Huan; Bagchi, Aniruddha

    2017-06-29

    This article investigates the impact of Certificate of Need (CON) laws on competition in the inpatient care market. One of the major criticisms of these laws is that it may hinder competition in the health care market, which can lead to higher prices. However, from a theoretical standpoint, CON laws could also promote competition by limiting excessive expansion from incumbents. Our main conclusion is that CON laws by and large enhanced competition in the inpatient market during the period of our study. This indicates that the effects of CON laws to hinder predatory behavior could dominate its effects of preventing new entrants into the inpatient care market. We do not find statistically significant evidence to reject the exogeneity assumption of either CON laws or their stringency in our study. We also find factors such as proportion of population aged 18-44, proportion of Asian American population, obesity rate, political environment, etc., in a state significantly impact competition. Our findings could shed some light to public policy makers when deciding the appropriate health programs or legislative framework to promote health care market competition and thereby facilitate quality health care.

  6. The epidemiology of assault-related hospital in-patient admissions and ED attendances.

    LENUS (Irish Health Repository)

    O'Farrell, A

    2013-03-01

    The aim of this study was to describe the epidemiology and impact of serious assault warranting in-patient care over six years and its impact on ED attendances in a large teaching hospital in Dublin over 2 years. There were 16,079 emergency assault-related inpatient hospital discharges reducing from 60.1 per 100,000 population in 2005 to 50.6 per 100,000 population in 2010. The median length of stay was 1 day (1-466) representing 49,870 bed days. The majority were young males (13,921, 86.6%; median age 26 years). Overall crime figures showed a similar reduction. However, knife crimes did not reduce over this period. Data on ED attendances confirmed the age and gender profile and also showed an increase at weekends. Alcohol misuse was recorded in 2,292\\/16079 (14%) of in-patient cases and 242\\/2484 (10%) in ED attendances. An inter-sectoral preventative approach specifically targeting knife crime is required to reduce this burden on health services.

  7. Women veterans' healthcare delivery preferences and use by military service era: findings from the National Survey of Women Veterans.

    Science.gov (United States)

    Washington, Donna L; Bean-Mayberry, Bevanne; Hamilton, Alison B; Cordasco, Kristina M; Yano, Elizabeth M

    2013-07-01

    The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis. To identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness. Cross-sectional 2008-2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population. Healthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era. Military service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women's health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras. Our findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs' higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.

  8. Influences on call outcomes among Veteran callers to the National Veterans Crisis Line

    Science.gov (United States)

    Britton, Peter C.; Bossarte, Robert M.; Thompson, Caitlin; Kemp, Janet; Conner, Kenneth R.

    2016-01-01

    This evaluation examined the association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls. From October 1-7, 2010, 665 Veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line, 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome, either a resolution or a referral, when compared to an unfavorable outcome, no resolution or referral. A multivariable logistic regression was used to identify correlates of responder-rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution and 59% with a referral to a local health care provider. Calls from high-risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high-risk Veteran callers. Responders appeared to use known risk and protective factors to determine caller risk. PMID:23611446

  9. Prediction of biodiversity hotspots in the Anthropocene: The case of veteran oaks.

    Science.gov (United States)

    Skarpaas, Olav; Blumentrath, Stefan; Evju, Marianne; Sverdrup-Thygeson, Anne

    2017-10-01

    Over the past centuries, humans have transformed large parts of the biosphere, and there is a growing need to understand and predict the distribution of biodiversity hotspots influenced by the presence of humans. Our basic hypothesis is that human influence in the Anthropocene is ubiquitous, and we predict that biodiversity hot spot modeling can be improved by addressing three challenges raised by the increasing ecological influence of humans: (i) anthropogenically modified responses to individual ecological factors, (ii) fundamentally different processes and predictors in landscape types shaped by different land use histories and (iii) a multitude and complexity of natural and anthropogenic processes that may require many predictors and even multiple models in different landscape types. We modeled the occurrence of veteran oaks in Norway, and found, in accordance with our basic hypothesis and predictions, that humans influence the distribution of veteran oaks throughout its range, but in different ways in forests and open landscapes. In forests, geographical and topographic variables related to the oak niche are still important, but the occurrence of veteran oaks is shifted toward steeper slopes, where logging is difficult. In open landscapes, land cover variables are more important, and veteran oaks are more common toward the north than expected from the fundamental oak niche. In both landscape types, multiple predictor variables representing ecological and human-influenced processes were needed to build a good model, and several models performed almost equally well. Models accounting for the different anthropogenic influences on landscape structure and processes consistently performed better than models based exclusively on natural biogeographical and ecological predictors. Thus, our results for veteran oaks clearly illustrate the challenges to distribution modeling raised by the ubiquitous influence of humans, even in a moderately populated region, but also

  10. Psychological resilience in U.S. military veterans: A 2-year, nationally representative prospective cohort study.

    Science.gov (United States)

    Isaacs, Kayla; Mota, Natalie P; Tsai, Jack; Harpaz-Rotem, Ilan; Cook, Joan M; Kirwin, Paul D; Krystal, John H; Southwick, Steven M; Pietrzak, Robert H

    2017-01-01

    Although many cross-sectional studies have examined the correlates of psychological resilience in U.S. military veterans, few longitudinal studies have identified long-term predictors of resilience in this population. The current prospective cohort study utilized data from a nationally representative sample of 2157 U.S. military veterans who completed web-based surveys in two waves (2011 and 2013) as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of cumulative lifetime exposure to potentially traumatic events and Wave 2 measures of current symptoms of posttraumatic stress, major depressive, and generalized anxiety disorders was performed to characterize different profiles of current trauma-related psychological symptoms. Different profiles were compared with respect to sociodemographic, clinical, and psychosocial characteristics. A three-group cluster analysis revealed a Control group with low lifetime trauma exposure and low current psychological distress (59.5%), a Resilient group with high lifetime trauma and low current distress (27.4%), and a Distressed group with both high trauma exposure and current distress symptoms (13.1%). These results suggest that the majority of trauma-exposed veterans (67.7%) are psychologically resilient. Compared with the Distressed group, the Resilient group was younger, more likely to be Caucasian, and scored lower on measures of physical health difficulties, past psychiatric history, and substance abuse. Higher levels of emotional stability, extraversion, dispositional gratitude, purpose in life, and altruism, and lower levels of openness to experiences predicted resilient status. Prevention and treatment efforts designed to enhance modifiable factors such as gratitude, sense of purpose, and altruism may help promote resilience in highly trauma-exposed veterans. Published by Elsevier Ltd.

  11. Association of Alcohol Misuse With Sexual Identity and Sexual Behavior in Women Veterans.

    Science.gov (United States)

    Lehavot, Keren; Williams, Emily C; Millard, Steven P; Bradley, Katharine A; Simpson, Tracy L

    2016-01-28

    Sexual minority women report greater alcohol misuse than heterosexual women in the general population, with more pronounced differences found among younger age groups. It is unknown whether these differences exist among women veterans. We evaluated differences in alcohol misuse across two dimensions of sexual orientation (identity and behavior) among women veterans, and examined whether these differences were modified by age. Women veterans were recruited via the internet to participate in an online survey. Participants provided information on their self-reported sexual identity and behavior and responded to the validated 3-item Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C). Regression models were used to compare the prevalence of alcohol misuse (AUDIT-C ≥ 3) and severity (AUDIT-C scores) across sexual identity and behavior and to test effect modification by age. Among the 702 participants (36% lesbian/bisexual), prevalence and severity of alcohol misuse varied by both sexual identity and behavior, but there were significant interactions with age. Prevalence and severity of alcohol misuse were higher among relatively younger self-identified lesbians compared to heterosexual women. Similarly, both prevalence and severity of alcohol misuse were generally higher among younger women who had any sex with women compared to those who had sex only with men. In this online study of women veterans, younger sexual minority women were more likely to screen positive for alcohol misuse, and they had more severe alcohol misuse, than their heterosexual counterparts. Prevention and treatment efforts focused specifically on sexual minority women veterans may be needed.

  12. Preliminary needs assessment of mobile technology use for healthcare among homeless veterans.

    Science.gov (United States)

    McInnes, D Keith; Fix, Gemmae M; Solomon, Jeffrey L; Petrakis, Beth Ann; Sawh, Leon; Smelson, David A

    2015-01-01

    Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans' IT use. This study examines homeless veterans' access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness. Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used. Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging. Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care.

  13. Research on PTSD prevalence in OEF/OIF Veterans: expanding investigation of demographic variables

    Directory of Open Access Journals (Sweden)

    Lynnette A. Averill

    2015-05-01

    Full Text Available Background: A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD screenings within the Operation Enduring Freedom (Afghanistan conflict/Operation Iraqi Freedom (Iraq conflict (OEF/OIF military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination. Objective: Many OEF/OIF Veterans do not use available Veterans Affairs (VA services, especially mental health care. This highlights the need to understand the differences between those who use and do not use the VA, especially as research with pre-OEF/OIF Veterans suggests that these two groups differ in significant ways. The high rates of PTSD-related concerns in non-VA users also points to a need to understand whether—and where—Veterans are seeking care outside the VA and the accessibility of evidence-based, trauma-focused treatments in the community and private sectors. Careful examination of relationship status is also paramount as little research has examined relationship status or other relationship context issues. Social support, especially from a spouse, can buffer the development of PTSD; however, relationship discord has the potential to greatly exacerbate PTSD symptomatology. Furthermore, given the additional risk factors for sexual minority Veterans to be exposed to trauma, the 2011 repeal of the US Military “Don't Ask, Don't Tell” policy, and the emergence of the VA as likely the largest health care provider for sexual minority Veterans, it will be critically important to study the trauma and mental health experiences of this group. Conclusions: Studies that examine prevalence rates of PTSD in the returning cohort contribute significantly to our understanding of the US OEF/OIF military population. Further study of PTSD in relation to demographic variables such as VA and non-VA use, relationship status, and sexual

  14. Research on PTSD prevalence in OEF/OIF Veterans: expanding investigation of demographic variables.

    Science.gov (United States)

    Averill, Lynnette A; Eubanks Fleming, C J; Holens, Pamela L; Larsen, Sadie E

    2015-01-01

    A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination. Many OEF/OIF Veterans do not use available Veterans Affairs (VA) services, especially mental health care. This highlights the need to understand the differences between those who use and do not use the VA, especially as research with pre-OEF/OIF Veterans suggests that these two groups differ in significant ways. The high rates of PTSD-related concerns in non-VA users also points to a need to understand whether-and where-Veterans are seeking care outside the VA and the accessibility of evidence-based, trauma-focused treatments in the community and private sectors. Careful examination of relationship status is also paramount as little research has examined relationship status or other relationship context issues. Social support, especially from a spouse, can buffer the development of PTSD; however, relationship discord has the potential to greatly exacerbate PTSD symptomatology. Furthermore, given the additional risk factors for sexual minority Veterans to be exposed to trauma, the 2011 repeal of the US Military "Don't Ask, Don't Tell" policy, and the emergence of the VA as likely the largest health care provider for sexual minority Veterans, it will be critically important to study the trauma and mental health experiences of this group. Studies that examine prevalence rates of PTSD in the returning cohort contribute significantly to our understanding of the US OEF/OIF military population. Further study of PTSD in relation to demographic variables such as VA and non-VA use, relationship status, and sexual orientation will provide rich data that will enhance our ability

  15. Community meetings on a military inpatient psychiatric unit: a question of balance.

    Science.gov (United States)

    Lange, C L; Bradley, J C

    2001-01-01

    Community meetings are a mainstay of any inpatient psychiatric unit. Although they differ in frequency, attendance, leadership, and size, they all maintain a similar purpose of acculturating the members to the values of the ward and encouraging responsible behavior and effective communication. The military inpatient psychiatric unit is no different, although it does have several unique factors that affect the management of the community meeting. Specifically, these factors are the inherent military rank structure, which often conflicts with the rank of staff and other patients, the incorporation of a civilian population into a military culture, and a greater focus on patient transitions from military to civilian society. We describe and discuss the common variables of community meetings, elucidate how the military aspects affect the meeting, and offer potential suggestions for the management of this unique large dynamic group.

  16. [The status of music therapy in inpatient child and adolescent psychiatry].

    Science.gov (United States)

    Stegemann, Thomas; Mauch, Christine; Stein, Vera; Romer, Georg

    2008-07-01

    Although music therapy is very common in child and adolescent psychiatry, no data are available that describe the working conditions for music therapists or the situation with regard to coverage of the patient population. A cross-sectional questionnaire study in all German hospitals of child and adolescent psychiatry with inpatient treatment programmes (n = 134) collected data on the structure and content of the respective music therapy treatment offered. 63.4% of the hospitals provide music therapy as a method of inpatient psychotherapy (77.7% response rate). This article focuses on the duties, setting, and clientele in music therapy, the available equipment and instruments, and the formation and methodological spectrum of music therapists. In summary, we conclude that music therapists working in child and adolescent psychiatry are well trained and experienced. To strengthen the professional identity of music therapists and to evaluate the efficacy of music therapy further research is needed and professional representation and proofs of efficacy must be emphasized.

  17. Mental health inpatient treatment expenditure trends in China, 2005-2012: evidence from Shandong.

    Science.gov (United States)

    Xu, Junfang; Wang, Jian; Liu, Ruiyun; Xing, Jinshui; Su, Lei; Yu, Fenghua; Lu, Mingshan

    2014-12-01

    hospitalization cost was 23.6%, with the inpatient cost reaching RMB 11,949 (US$ 1921.1) in 2012. The hospitalization cost was found to be strongly associated with hospital length of stay, level of care, age, employment status, admission diagnoses, and frequency of hospitalization. Our study found that mental health inpatient resources use, particularly hospitalization cost, has been growing at an increasing rate. In our sample, hospitalization cost nearly tripled from 2005 to 2012. Mental illnesses and the related economic burden on the population will continue to grow, making mental health a major public health issue in China. Hospital length of stay was found to be increasing in our sample, and positively correlated with hospitalization cost. Childhood and adolescence behavioral and emotional disorders were found to be significantly associated with higher inpatient cost. The policy implications generated from the results of this study are two-fold: first of all, in order to meet the growing need of mental health care in China, the government needs to significantly increase its spending in preventing and treating mental illnesses. Second, cost containment in inpatient care would become a major challenge for mental health policy makers in China. Government support, clinical practices and guideline development, as well as research are urgently needed to promote mental health prevention and improve the efficiency of mental health system in China. The current mental health system, like the overall healthcare system in China, relies heavily on hospital inpatient care. In order to build a sustainable mental health care system to meet increasing population need in China, it is crucial to integrate mental health care reform with the ongoing primary health care reform. Future mental health policy reform and research in China should put more focus on how to strengthen primary care system as well as community support, establish effective two-tier referring mechanism between hospital and

  18. Utility of home sleep apnea testing in high-risk veterans.

    Science.gov (United States)

    Cairns, Alyssa; Sarmiento, Kathleen; Bogan, Richard

    2017-09-01

    Many Veterans Affairs Medical Centers (VAMCs) have implemented home sleep apnea testing (HSAT) in lieu of traditional in-lab testing to establish a timely and cost-sensitive diagnosis of obstructive sleep apnea (OSA). However, concern remains for the sensitivity and specificity of said technology in this population as many veterans are at increased risk for many of the comorbid conditions that can limit the accuracy of HSAT results. Hence, the purpose of this study is to evaluate rate of incongruent outcomes (e.g., negative HSAT results despite high clinical symptomology) as well as differences in study quality metrics and predictors of OSA between veteran sleep patients and general sleep patients being evaluated by a home sleep test. A random sample of HSAT outcomes from 1500 veterans and 1500 general sleep clinic patients was retrieved from a repository of anonymized HSAT outcomes from 2009 to 2013. General sleep clinic data were from patients referred for home sleep testing from a variety of clinical practices across North America, whereas VAMC patients were tested using a central dissemination process. All patients were tested for OSA using the Apnea Risk and Evaluation System (ARES), an HSAT that simultaneously records airflow, pulse oximetry, snoring, accelerometry, and EEG. Sample differences and rates of comorbidities, HSAT outcomes, predictors of OSA, and pretest OSA risk information were evaluated between groups. The presence of OSA was defined as an apnea-hypopnea index (AHI; using 4% desaturation criterion) of ≥5 and ≥15 events per hour. Sample differences in predictors of OSA were evaluated using logistic multiple regression. Veterans (91.3% male) were more likely to report comorbidities, especially depression, insomnia, hypertension, diabetes, restless legs syndrome (RLS), and use of sleep and pain medications compared to general sleep clinic patients (57.1% male). Despite differences in the rate of medical comorbidities, no differences were

  19. Boarding admitted children in the emergency department impacts inpatient outcomes.

    Science.gov (United States)

    Bekmezian, Arpi; Chung, Paul J

    2012-03-01

    This study aimed to assess the relationship between boarding of admitted children in the emergency department (ED) and cost, inpatient length of stay (LOS), mortality, and readmission. This was a retrospective study of 1,792 pediatric inpatients admitted through the ED and discharged from the hospital between February 20, 2007 and June 30, 2008 at a major teaching hospital with an annual ED volume of 40,000 adult and pediatric patients.The main predictor variable was boarding time (time from admission decision to departure for an inpatient bed, in hours). Covariates were patient age, payer group, times of ED and inpatient bed arrival, ED triage acuity, type of inpatient service, intensive care unit admission, surgery, and severity of inpatient illness. The main outcome measures, cost (dollars) and inpatient LOS (hours), were log-transformed and analyzed using linear regressions. Secondary outcomes, mortality and readmission to the hospital within 72 hours of discharge, were analyzed using logistic regression. Mean ED LOS for admitted patients was 9.0 hours. Mean boarding time was 5.1 hours. Mean cost and inpatient LOS were $9893 and 147 hours, respectively. In general, boarding time was associated with cost (P boarding times were associated with greater inpatient LOS especially among patients triaged as low acuity (P = 0.008). In addition, longer boarding times were associated with greater probability of being readmitted among patients on surgical services (P = 0.01). Among low-acuity and surgical patients, longer boarding times were associated with longer inpatient LOS and more readmissions, respectively.

  20. Inpatient Portals for Hospitalized Patients and Caregivers: A Systematic Review.

    Science.gov (United States)

    Kelly, Michelle M; Coller, Ryan J; Hoonakker, Peter Lt

    2018-06-01

    Patient portals, web-based personal health records linked to electronic health records (EHRs), provide patients access to their healthcare information and facilitate communication with providers. Growing evidence supports portal use in ambulatory settings; however, only recently have portals been used with hospitalized patients. Our objective was to review the literature evaluating the design, use, and impact of inpatient portals, which are patient portals designed to give hospitalized patients and caregivers inpatient EHR clinical information for the purpose of engaging them in hospital care. Literature was reviewed from 2006 to 2017 in PubMed, Web of Science, CINALPlus, Cochrane, and Scopus to identify English language studies evaluating patient portals, engagement, and inpatient care. Data were analyzed considering the following 3 themes: inpatient portal design, use and usability, and impact. Of 731 studies, 17 were included, 9 of which were published after 2015. Most studies were qualitative with small samples focusing on inpatient portal design; 1 nonrandomized trial was identified. Studies described hospitalized patients' and caregivers' information needs and design recommendations. Most patient and caregiver participants in included studies were interested in using an inpatient portal, used it when offered, and found it easy to use and/or useful. Evidence supporting the role of inpatient portals in improving patient and caregiver engagement, knowledge, communication, and care quality and safety is limited. Included studies indicated providers had concerns about using inpatient portals; however, the extent to which these concerns have been realized remains unclear. Inpatient portal research is emerging. Further investigation is needed to optimally design inpatient portals to maximize potential benefits for hospitalized patients and caregivers while minimizing unintended consequences for healthcare teams. © 2017 Society of Hospital Medicine.

  1. [Termination of inpatient treatment for anorexia nervosa].

    Science.gov (United States)

    Zeeck, A; Herzog, T

    2000-07-01

    Dropout is a neglected area of research; patients with anorexia nervosa are a group with high risk for dropout. 1. What are the frequency and type of dropout in disorder-specific, integrated treatment programs for anorexic patients? 2. What are the predictors for dropout? Analysis of 80 prospectively documented, consecutive treatment episodes of anorexic inpatients, based on multimodal clinical and psychometric parameters. Twenty percent of patients terminated on their own initiative, often after reaching target weight; 10% were discharged by the treatment team. At least 43% of dropouts continued with some sort of psychotherapy within the 3 months after discharge. Previous dropout was a predictor for dropout in the present episodes. Patients with no comorbidity had a higher risk of dropout. Patients discharged by the team had personality disorders more often. Patients with comorbid depression stayed in treatment. The form of termination of treatment should be routinely assessed. Previous dropout and comorbidity are indicators of the risk of dropout.

  2. Can "patient keeper" help in-patients?

    Science.gov (United States)

    Al-Hinnawi, M F

    2009-06-01

    The aim of this paper is to present our "Patient Keeper" application, which is a client-server medical application. "Patient Keeper" is designed to run on a mobile phone for the client application and on a PC for the server application using J2ME and JAVA2, respectively. This application can help doctors during visits to their patients in hospitals. The client application allows doctors to store on their mobile phones the results of their diagnoses and findings such as temperature, blood pressure, medications, analysis, etc., and send this information to the server via short message service (SMS) for storage in a database. The server can also respond to any request from the client and send the result via Bluetooth, infrared, or over the air. Experimental results showed a significant improvement of the healthcare delivery and reduction for in-patient stay.

  3. The development and implications of peer emotional support for student service members/veterans and civilian college students.

    Science.gov (United States)

    Whiteman, Shawn D; Barry, Adam E; Mroczek, Daniel K; Macdermid Wadsworth, Shelley

    2013-04-01

    Student service members/veterans represent a growing population on college campuses. Despite this growth, scholarly investigations into their health- and adjustment-related issues are almost nonexistent. The limited research that is available suggests that student service members/veterans may have trouble connecting with their civilian counterparts and be at risk for social isolation. The present study compared the development and implications of emotional support from peers among 199 student service members/veterans and 181 civilian students through 3 distinct occasions over the course of 1 calendar year. Data were collected via electronic survey. Measured constructs included perceived emotional support from university friends, mental health, alcohol use, and academic functioning. A series of multilevel models revealed that student service members/veterans reported less emotional support from their peers compared with their civilian counterparts; yet, emotional support from peers increased similarly for both groups over time. Although, increasing peer emotional support was generally related to better academic and mental health outcomes for both groups, the links between emotional support and mental health were stronger for civilian students. Results suggest that mental health practitioners, particularly those on college campuses, should be prepared to deal with veteran-specific experiences that occur before and during college.

  4. Conduct disorder, war zone stress, and war-related posttraumatic stress disorder symptoms in American Indian Vietnam veterans.

    Science.gov (United States)

    Dillard, Denise; Jacobsen, Clemma; Ramsey, Scott; Manson, Spero

    2007-02-01

    This study examined whether conduct disorder (CD) was associated with war zone stress and war-related post-traumatic stress disorder (PTSD) symptoms in American Indian (AI) Vietnam veterans. Cross-sectional lay-interview data was analyzed for 591 male participants from the American Indian Vietnam Veterans Project. Logistic regression evaluated the association of CD with odds of high war zone stress and linear regression evaluated the association of CD and PTSD symptom severity. Childhood CD was not associated with increased odds of high war zone stress. Conduct disorder was associated with elevated war-related PTSD symptoms among male AI Vietnam Veterans independent of war zone stress level and other mediators. Future efforts should examine reasons for this association and if the association exists in other AI populations.

  5. Tuberculosis in Scottish military veterans: evidence from a retrospective cohort study of 57 000 veterans and 173 000 matched non-veterans.

    Science.gov (United States)

    Bergman, Beverly P; Mackay, D F; Pell, J P

    2017-02-01

    Tuberculosis was a major cause of morbidity and manpower loss in the Armed Forces during World War II. Military control programmes commenced in the 1950s but were initially limited in scope by the many recruits who were already tuberculin positive on enlistment. The aim of our study was to examine whether veterans have an increased risk of tuberculosis compared with non-veterans. Retrospective cohort study of 57 000 veterans born 1945-1985, and 173 000 people with no record of military service, resident in Scotland, matched for age, sex and area of residence, using Cox proportional hazard analysis to compare the risk of tuberculosis overall, by birth cohort, length of service and year of diagnosis and to examine comorbidities. Over mean 29 years follow-up, 69 (0.12%) veterans were recorded as having tuberculosis, compared with 267 (0.15%) non-veterans (unadjusted HR 0.90, 95% CIs 0.69 to 1.19, p=0.463). Only the 1945-1949 veterans' birth cohort was at higher risk, unadjusted HR 1.54, 95% CIs 0.98 to 2.45, p=0.061, although the difference in risk did not achieve significance. Veterans born from 1950 were at significantly reduced risk of tuberculosis compared with non-veterans after adjusting for deprivation, HR 0.67, 95% CI 0.47 to 0.95, p=0.026. The most common comorbidities were smoking-related and alcohol-related disease. The risk of comorbid hepatitis B or C was very low, in both veterans and non-veterans. No length of service was associated with an increased risk of tuberculosis in comparison with non-veterans. Scottish veterans born before 1950 are at moderately increased risk of tuberculosis compared with age, sex and geographically matched civilians with no record of service, although the difference is not statistically significant. Scottish veterans born from 1950 show a reduction in risk compared with civilians. Tuberculosis should be considered in the differential diagnosis of respiratory disease in the older veteran. Published by the BMJ Publishing

  6. Closing Discussion "The Future of Veterans Studies"

    OpenAIRE

    Committee Panel

    2014-01-01

    Our conference theme for 2014 is Humanizing the Discourse, a title that speaks to a two-fold aim. We hope to foster increasingly sophisticated dialogue regarding veterans. This requires recognizing the individual humanity of people who can sometimes be turned into one-dimensional caricatures behind headlines, statistics, and stereotypes. In particular, this year we invited contributors to draw on the tools of the arts, humanities, and social sciences in addressing veterans’ issues and shaping...

  7. The Veterans Choice Program (VCP): Program Implementation

    Science.gov (United States)

    2017-01-05

    First, veterans would send a notice of disagreement to their facility. Then the facility is to generate a statement of case (SOC). Lastly, the...an area agency on aging, or a state agency or a center for independent living. VA employees are excluded from providing care or services under VCP...unless the provider is an employee of VA, and is not acting within the scope of such employment while providing hospital care or medical services

  8. Women Veterans' Treatment Preferences for Disordered Eating.

    Science.gov (United States)

    Breland, Jessica Y; Donalson, Rosemary; Dinh, Julie; Nevedal, Andrea; Maguen, Shira

    2016-01-01

    Disordered eating, which includes subclinical and clinical maladaptive eating behaviors, is common among women, including those served by the Veterans Health Administration (VA). We used qualitative methods to determine whether and how women veterans want to receive treatment for disordered eating. Women veterans participated in one of seven focus groups/interviews and completed in-person demographic and psychological questionnaires. We used thematic analysis of focus groups/interviews to understand preferences for disordered eating treatment. Participants (n = 20) were mostly women of color (55%); mean age was 48 (SD = 15) and 65% had significant psychological symptoms. Few participants described being assessed for disordered eating, but all thought VA should provide treatment for disordered eating. Through thematic analysis, we identified six preferences: 1) treatment for disordered eating should be provided in groups, 2) treatment for disordered eating should provide concrete skills to facilitate the transition out of structured military environments, 3) treatment for disordered eating should address the relationship between eating and mental health, 4) disordered eating can be treated with mindfulness and cognitive-behavioral therapy, 5) disordered eating treatment providers should be experienced and take an interactive approach to care, but can come from diverse disciplines, and 6) referrals to treatment for disordered eating should be open ended, occur early, and allow for ongoing, flexible access to treatment. Women veterans are interested in treatment for disordered eating. Preferred treatments align with existing treatments, could be offered in conjunction with weight loss or primary care services, and should provide social support and interactive learning. Published by Elsevier Inc.

  9. Older veterans and emergency department discharge information.

    Science.gov (United States)

    Hastings, Susan; Stechuchak, Karen; Oddone, Eugene; Weinberger, Morris; Tucker, Dana; Knaack, William; Schmader, Kenneth

    2012-10-01

    Study goals were to assess older veterans' understanding of their emergency department (ED) discharge information and to determine the association between understanding discharge information and patient assessment of overall quality of care. Telephone interviews were conducted with 305 patients aged 65 or older (or their proxies) within 48 h of discharge from a Veterans Affairs Medical Center ED. Patients were asked about their perceived understanding (at the time of ED discharge) of information about their ED diagnosis, expected course of illness, contingency plan (ie, return precautions, who to call if it got worse, potential medication side effects) and follow-up care. Overall quality of ED care was rated on a four-point scale of poor, fair, good or excellent. Patients or their proxies reported not understanding information about their ED diagnosis (21%), expected course of illness (50%), contingency plan (43%), and how soon they needed to follow-up with their primary care provider (25%). In models adjusted for age and race, a positive association was observed between perceived understanding of the cause of the problem (OR 2.3; 95% CI 1.3 to 4.0), expected duration of symptoms (OR 1.6; 95% CI 1.0 to 2.5) and the contingency plan (OR 2.2; CI 1.3 to 3.4), and rating overall ED care as excellent. Older veterans may not understand key items of information at the time ED discharge, and this may have an impact on how they view the quality of ED care. Strategies are needed to improve communication of ED discharge information to older veterans and their families.

  10. Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database

    OpenAIRE

    Vin?Raviv, Neomi; Akinyemiju, Tomi; Meng, Qingrui; Sakhuja, Swati; Hayward, Reid

    2016-01-01

    Abstract The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. A total of 387,608 current marijuana users were identified based on ICD?9 codes for marijuana use among hospitalized patients in the Nationwide Inpatient Sample database between 2007 and 2011. Logistic regression analysis was performed to determine the association between marijuana use and heart failur...

  11. Accuracy of Veterans Affairs Databases for Diagnoses of Chronic Diseases

    OpenAIRE

    Singh, Jasvinder A.

    2009-01-01

    Introduction Epidemiologic studies usually use database diagnoses or patient self-report to identify disease cohorts, but no previous research has examined the extent to which self-report of chronic disease agrees with database diagnoses in a Veterans Affairs (VA) health care setting. Methods All veterans who had a medical care visit from October 1, 1996, through May 31, 1998, at any of the Veterans Integrated Service Network 13 facilities were surveyed about physician diagnosis of chronic ob...

  12. Women veterans' preferences for intimate partner violence screening and response procedures within the Veterans Health Administration.

    Science.gov (United States)

    Iverson, Katherine M; Huang, Kristin; Wells, Stephanie Y; Wright, Jason D; Gerber, Megan R; Wiltsey-Stirman, Shannon

    2014-08-01

    Intimate partner violence (IPV) is a significant health issue faced by women veterans, but little is known about their preferences for IPV-related care. Five focus groups were conducted with 24 women Veterans Health Administration (VHA) patients with and without a lifetime history of IPV to understand their attitudes and preferences regarding IPV screening and responses within VHA. Women veterans wanted disclosure options, follow-up support, transparency in documentation, and VHA and community resources. They supported routine screening for IPV and articulated preferences for procedural aspects of screening. Women suggested that these procedures could be provided most effectively when delivered with sensitivity and connectedness. Findings can inform the development of IPV screening and response programs within VHA and other healthcare settings. © 2014 Wiley Periodicals, Inc.

  13. Association between mental health conditions and rehospitalization, mortality, and functional outcomes in patients with stroke following inpatient rehabilitation.

    Science.gov (United States)

    Dossa, Almas; Glickman, Mark E; Berlowitz, Dan

    2011-11-15

    Limited evidence exists regarding the association of pre-existing mental health conditions in patients with stroke and stroke outcomes such as rehospitalization, mortality, and function. We examined the association between mental health conditions and rehospitalization, mortality, and functional outcomes in patients with stroke following inpatient rehabilitation. Our observational study used the 2001 VA Integrated Stroke Outcomes database of 2162 patients with stroke who underwent rehabilitation at a Veterans Affairs Medical Center. Separate models were fit to our outcome measures that included 6-month rehospitalization or death, 6-month mortality post-discharge, and functional outcomes post inpatient rehabilitation as a function of number and type of mental health conditions. The models controlled for patient socio-demographics, length of stay, functional status, and rehabilitation setting. Patients had an average age of 68 years. Patients with stroke and two or more mental health conditions were more likely to be readmitted or die compared to patients with no conditions (OR: 1.44, p = 0.04). Depression and anxiety were associated with a greater likelihood of rehospitalization or death (OR: 1.33, p = 0.04; OR:1.47, p = 0.03). Patients with anxiety were more likely to die at six months (OR: 2.49, p = 0.001). Patients with stroke with pre-existing mental health conditions may need additional psychotherapy interventions, which may potentially improve stroke outcomes post-hospitalization.

  14. 77 FR 7243 - Proposed Information Collection (Operation Enduring Freedom/Operation Iraqi Freedom Veterans...

    Science.gov (United States)

    2012-02-10

    ... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0728] Proposed Information Collection (Operation Enduring Freedom/ Operation Iraqi Freedom Veterans Health Needs Assessment) Activities Under OMB....'' SUPPLEMENTARY INFORMATION: Title: Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs...

  15. 78 FR 36309 - Research Advisory Committee on Gulf War Veterans' Illnesses, Notice of Meeting

    Science.gov (United States)

    2013-06-17

    ... DEPARTMENT OF VETERANS AFFAIRS Research Advisory Committee on Gulf War Veterans' Illnesses, Notice... Act, 5 U.S.C. App., that the Research Advisory Committee on Gulf War Veterans' Illnesses will meet on... operations during the Gulf War. [[Page 36310

  16. 77 FR 76074 - Advisory Committee on Veterans' Employment, Training and Employer Outreach (ACVETEO): Meeting

    Science.gov (United States)

    2012-12-26

    ... Department of Labor's Veterans' Employment and Training Services' (VETS) core programs and new initiatives... DEPARTMENT OF LABOR Advisory Committee on Veterans' Employment, Training and Employer Outreach (ACVETEO): Meeting AGENCY: Veterans' Employment and Training Service, Labor. ACTION: Notice of open meeting...

  17. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)

    Data.gov (United States)

    Department of Veterans Affairs — Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health care benefit program designed for the dependents of certain Veterans....

  18. 77 FR 65056 - Advisory Committee on Minority Veterans, Notice of Meeting

    Science.gov (United States)

    2012-10-24

    ..., Office of Health Equity, and a special panel discussion with Center for Women Veterans, Center for Faith... (VBA), Center for Minority Veterans, Office of Public and Intergovernmental Affairs, Veterans Health...

  19. America's Women Veterans: Military Service History and VA Benefit Utilization Statistics

    Data.gov (United States)

    Department of Veterans Affairs — This comprehensive report chronicles the history of women in the military and as Veterans, profiles the characteristics of women Veterans in 2009, illustrates how...

  20. 78 FR 68908 - Proposed Information Collection (Veterans Transportation Service Data Collection); Activity...

    Science.gov (United States)

    2013-11-15

    ... (Veterans Transportation Service Data Collection); Activity: Comment Request AGENCY: Veterans Health.... This notice solicits comments on the information needed to evaluate the Veterans Transportation Service... receive timely and reliable transportation for the purpose of examination, treatment and care. DATES...