38 CFR 3.52 - Marriages deemed valid.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Marriages deemed valid. 3... Pension, Compensation, and Dependency and Indemnity Compensation Relationship § 3.52 Marriages deemed valid. Where an attempted marriage of a claimant to the veteran was invalid by reason of a legal...

Validation of Scales from the Deployment Risk and Resilience Inventory in a Sample of Operation Iraqi Freedom Veterans

ERIC Educational Resources Information Center

Vogt, Dawne S.; Proctor, Susan P.; King, Daniel W.; King, Lynda A.; Vasterling, Jennifer J.

2008-01-01

The Deployment Risk and Resilience Inventory (DRRI) is a suite of scales that can be used to assess deployment-related factors implicated in the health and well-being of military veterans. Although initial evidence for the reliability and validity of DRRI scales based on Gulf War veteran samples is encouraging, evidence with respect to a more…

Detecting symptom exaggeration in combat veterans using the MMPI-2 symptom validity scales: a mixed group validation.

PubMed

Tolin, David F; Steenkamp, Maria M; Marx, Brian P; Litz, Brett T

2010-12-01

Although validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) have proven useful in the detection of symptom exaggeration in criterion-group validation (CGV) studies, usually comparing instructed feigners with known patient groups, the application of these scales has been problematic when assessing combat veterans undergoing posttraumatic stress disorder (PTSD) examinations. Mixed group validation (MGV) was employed to determine the efficacy of MMPI-2 exaggeration scales in compensation-seeking (CS) and noncompensation-seeking (NCS) veterans. Unlike CGV, MGV allows for a mix of exaggerating and nonexaggerating individuals in each group, does not require that the exaggeration versus nonexaggerating status of any individual be known, and can be adjusted for different base-rate estimates. MMPI-2 responses of 377 male veterans were examined according to CS versus NCS status. MGV was calculated using 4 sets of base-rate estimates drawn from the literature. The validity scales generally performed well (adequate sensitivity, specificity, and efficiency) under most base-rate estimations, and most produced cutoff scores that showed adequate detection of symptom exaggeration, regardless of base-rate assumptions. These results support the use of MMPI-2 validity scales for PTSD evaluations in veteran populations, even under varying base rates of symptom exaggeration.

Emotion Recognition Ability Test Using JACFEE Photos: A Validity/Reliability Study of a War Veterans' Sample and Their Offspring

PubMed Central

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. PMID:26147938

Evaluating diagnosis-based case-mix measures: how well do they apply to the VA population?

PubMed

Rosen, A K; Loveland, S; Anderson, J J; Rothendler, J A; Hankin, C S; Rakovski, C C; Moskowitz, M A; Berlowitz, D R

2001-07-01

Diagnosis-based case-mix measures are increasingly used for provider profiling, resource allocation, and capitation rate setting. Measures developed in one setting may not adequately capture the disease burden in other settings. To examine the feasibility of adapting two such measures, Adjusted Clinical Groups (ACGs) and Diagnostic Cost Groups (DCGs), to the Department of Veterans Affairs (VA) population. A 60% random sample of veterans who used health care services during FY 1997 was obtained from VA inpatient and outpatient administrative databases. A split-sample technique was used to obtain a 40% sample (n = 1,046,803) for development and a 20% sample (n = 524,461) for validation. Concurrent ACG and DCG risk adjustment models, using 1997 diagnoses and demographics to predict FY 1997 utilization (ambulatory provider encounters, and service days-the sum of a patient's inpatient and outpatient visit days), were fitted and cross-validated. Patients were classified into groupings that indicated a population with multiple psychiatric and medical diseases. Model R-squares explained between 6% and 32% of the variation in service utilization. Although reparameterized models did better in predicting utilization than models with external weights, none of the models was adequate in characterizing the entire population. For predicting service days, DCGs were superior to ACGs in most categories, whereas ACGs did better at discriminating among veterans who had the lowest utilization. Although "off-the-shelf" case-mix measures perform moderately well when applied to another setting, modifications may be required to accurately characterize a population's disease burden with respect to the resource needs of all patients.

Symptom validity test performance and consistency of self-reported memory functioning of Operation Enduring Freedom/Operation Iraqi freedom veterans with positive Veteran Health Administration Comprehensive Traumatic Brain Injury evaluations.

PubMed

Russo, Arthur C

2012-12-01

Operation Enduring Freedom and Operation Iraqi Freedom combat veterans given definite diagnoses of mild Traumatic Brain Injury (TBI) during the Veteran Health Administration (VHA) Comprehensive TBI evaluation and reporting no post-deployment head injury were examined to assess (a) consistency of self-reported memory impairment and (b) symptom validity test (SVT) performance via a two-part study. Study 1 found that while 49 of 50 veterans reported moderate to very severe memory impairment during the VHA Comprehensive TBI evaluation, only 7 had reported any memory problem at the time of their Department of Defense (DOD) post-deployment health assessment. Study 2 found that of 38 veterans referred for neuropsychological evaluations following a positive VHA Comprehensive TBI evaluation, 68.4% failed the Word Memory Test, a forced choice memory recognition symptom validity task. Together, these studies raise questions concerning the use of veteran symptom self-report for TBI assessments and argue for the inclusion of SVTs and the expanded use of contemporaneous DOD records to improve the diagnostic accuracy of the VHA Comprehensive TBI evaluation.

The validity and diagnostic efficiency of the Davidson Trauma Scale in military veterans who have served since September 11th, 2001.

PubMed

McDonald, Scott D; Beckham, Jean C; Morey, Rajendra A; Calhoun, Patrick S

2009-03-01

The present study examined the psychometric properties and diagnostic efficiency of the Davidson Trauma Scale (DTS), a self-report measure of posttraumatic stress disorder (PTSD) symptoms. Participants included 158 U.S. military veterans who have served since September 11, 2001 (post-9/11). Results support the DTS as a valid self-report measure of PTSD symptoms. The DTS demonstrated good internal consistency, concurrent validity, and convergent and divergent validity. Diagnostic efficiency was excellent when discriminating between veterans with PTSD and veterans with no Axis I diagnosis. However, although satisfactory by conventional standards, efficiency was substantially attenuated when discriminating between PTSD and other Axis I diagnoses. Thus, results illustrate that potency of the DTS as a diagnostic aid was highly dependent on the comparison group used for analyses. Results are discussed in terms of applications to clinical practice and research.

Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans.

PubMed

Calhoun, Patrick S; Wilson, Sarah M; Hertzberg, Jeffrey S; Kirby, Angela C; McDonald, Scott D; Dennis, Paul A; Bastian, Lori A; Dedert, Eric A; Beckham, Jean C

2017-11-01

Research using the Veterans Health Administration (VA) electronic medical records (EMR) has been limited by a lack of reliable smoking data. To evaluate the validity of using VA EMR "Health Factors" data to determine smoking status among veterans with recent military service. Sensitivity, specificity, area under the receiver-operating curve (AUC), and kappa statistics were used to evaluate concordance between VA EMR smoking status and criterion smoking status. Veterans (N = 2025) with service during the wars in Iraq/Afghanistan who participated in the VA Mid-Atlantic Post-Deployment Mental Health (PDMH) Study. Criterion smoking status was based on self-report during a confidential study visit. VA EMR smoking status was measured by coding health factors data entries (populated during automated clinical reminders) in three ways: based on the most common health factor, the most recent health factor, and the health factor within 12 months of the criterion smoking status data collection date. Concordance with PDMH smoking status (current, former, never) was highest when determined by the most commonly observed VA EMR health factor (κ = 0.69) and was not significantly impacted by psychiatric status. Agreement was higher when smoking status was dichotomized: current vs. not current (κ = 0.73; sensitivity = 0.84; specificity = 0.91; AUC = 0.87); ever vs. never (κ = 0.75; sensitivity = 0.85; specificity = 0.90; AUC = 0.87). There were substantial missing Health Factors data when restricting analyses to a 12-month period from the criterion smoking status date. Current smokers had significantly more Health Factors entries compared to never or former smokers. The use of computerized tobacco screening data to determine smoking status is valid and feasible. Results indicating that smokers have significantly more health factors entries than non-smokers suggest that caution is warranted when using the EMR to select cases for cohort studies as the risk for selection bias appears high.

The Utility of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in US Military Veterans With a History of Mild Traumatic Brain Injury.

PubMed

OʼRourke, Justin; Critchfield, Edan; Soble, Jason; Bain, Kathleen; Fullen, Chrystal; Eapen, Blessen

2018-05-31

To examine the utility of the Mayo-Portland Adaptability Inventory-4th Edition Participation Index (M2PI) as a self-report measure of functional outcome following mild traumatic brain injury (mTBI) in US Military veterans. Department of Veterans Affairs Polytrauma Rehabilitation Center specialty hospital. On hundred thirty-nine veterans with a history of self-reported mTBI. Retrospective cross-sectional examination of data collected from regular clinical visits. M2PI, Neurobehavioral Symptoms Inventory with embedded validity measures, Posttraumatic Stress Disorder Checklist-Military Version. Forty-one percent of the sample provided symptom reports that exceeded established cut scores on embedded symptom validity tests. Invalid responders had higher levels of unemployment and endorsed significantly greater functional impairment, posttraumatic stress symptoms, and postconcussive complaints. For valid responders, regression analyses revealed that self-reported functioning was primarily related to posttraumatic stress complaints, followed by postconcussive cognitive complaints. For invalid responders, posttraumatic stress complaints also predicted self-reported functioning. Caution is recommended when utilizing the M2PI to measure functional outcome following mTBI in military veterans, particularly in the absence of symptom validity tests.

Validation of a Multimethod Assessment of Posttraumatic Stress Disorders in Vietnam Veterans.

ERIC Educational Resources Information Center

Malloy, Paul F.; And Others

1983-01-01

Studied whether posttraumtic stress disorders (PTSD) could be distinguished through use of videotaped mild combat stimuli. Results of anxiety measures showed that this assessment device clearly distinguished the PTSD Veterans from both veterans without combat exposure but who sought psychiatric help for other problems, and well adjusted veterans.…

The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) semistructured interview: evidence of research utility and validity.

PubMed

Fortier, Catherine Brawn; Amick, Melissa M; Grande, Laura; McGlynn, Susan; Kenna, Alexandra; Morra, Lindsay; Clark, Alexandra; Milberg, William P; McGlinchey, Regina E

2014-01-01

Report the prevalence of lifetime and military-related traumatic brain injuries (TBIs) in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and validate the Boston Assessment of TBI-Lifetime (BAT-L). The BAT-L is the first validated, postcombat, semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span. Community-dwelling convenience sample of 131 OEF/OIF veterans. TBI criteria (alteration of mental status, posttraumatic amnesia, and loss of consciousness) were evaluated for all possible TBIs, including a novel evaluation of blast exposure. BAT-L, Ohio State University TBI Identification Method (OSU-TBI-ID). About 67% of veterans incurred a TBI in their lifetime. Almost 35% of veterans experienced at least 1 military-related TBI; all were mild in severity, 40% of them were due to blast, 50% were due to some other (ie, blunt) mechanism, and 10% were due to both types of injuries. Predeployment TBIs were frequent (45% of veterans). There was strong correspondence between the BAT-L and the OSU-TBI-ID (Cohen κ = 0.89; Kendall τ-b = 0.95). Interrater reliability of the BAT-L was strong (κs >0.80). The BAT-L is a valid instrument with which to assess TBI across a service member's lifetime and captures the varied and complex nature of brain injuries across OEF/OIF veterans' life span.

Determining pain scale preference in a veteran population experiencing chronic pain.

PubMed

Douglas, Mary E; Randleman, Mary L; DeLane, Alice M; Palmer, Glen A

2014-09-01

The purpose of this study was to determine veteran pain scale preference of four common pain scales: the Faces Scale, the Visual Analog Scale, the Numeric Rating Scale, and the Mankoski Pain Scale. The study also examined the reliability and validity of the Mankoski Pain Scale with the other three scales. A sample of veterans (N = 200) with chronic pain receiving treatment in a residential rehabilitation treatment program (RRTP) and a surgical and specialty care (SSC) outpatient clinic at a Department of Veterans Affairs (VA) medical center participated in the study. There was a significant difference between scales in regard to preference, χ2(3) = 64.59, p < .001. A large percentage of the sample preferred the Mankoski Pain Scale (46%). Test-retest of the reliability was comparable for all the scales. Validity of the Mankoski scale was excellent, as it correlated very well with the Numeric (r = .84, p < .001), Analog (r = .83, p < .001), and Faces (r = .78, p < .001) scales. The findings indicate that the Mankoski Pain Scale is a valid and reliable tool for pain with veterans, and it was the preferred scale by veterans for use when describing pain. Published by Elsevier Inc.

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

PubMed Central

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. PMID:28168094

Clinician versus Veteran ratings on the Mayo-Portland Participation Index in veterans with a history of mild traumatic brain injury.

PubMed

McCulloch, Katie; Pastorek, Nicholas J; Miller, Brian I; Romesser, Jennifer; Linck, John; Sim, Anita H; Troyanskaya, Maya; Maestas, Kacey Little

2015-01-01

The Department of Veterans Affairs is encouraging administration of the Mayo-Portland Adaptability Inventory-4 Participation Index (M2PI) to identify long-term psychosocial outcomes of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with a history of traumatic brain injury (TBI). To evaluate clinician and Veteran interrater reliability and how response validity influences M2PI item ratings. A total of 122 OEF/OIF/OND Veterans who reported a history consistent with mild TBI during deployment and were referred for neuropsychological evaluation following Comprehensive TBI Evaluation. Interrater reliability study. M2PI; Minnesota Multiphasic Personality Inventory-2 Symptom Validity Scale (FBS). Veterans reported greater perceived restrictions than clinicians across all M2PI items and total score. Interrater correlations ranged from rs = 0.27 (residence) to rs = 0.58 (money management) across items, with a total score correlation of rs = 0.60. When response bias was indicated, both Veterans and clinicians reported greater participation restrictions than those reported by Veterans without evidenced response bias. Low interrater correlation is consistent with previous findings. As ratings of clinicians and Veterans should not be interpreted as equivalent, documenting the rater's identity is important for interpretation. Using objective indicators of functional outcome may assist clinician raters, particularly when self-report may be biased.

38 CFR 21.5076 - Entitlement charge-overpayment cases.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Entitlement charge-overpayment cases. 21.5076 Section 21.5076 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

38 CFR 21.5076 - Entitlement charge-overpayment cases.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Entitlement charge-overpayment cases. 21.5076 Section 21.5076 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

38 CFR 21.5076 - Entitlement charge-overpayment cases.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Entitlement charge-overpayment cases. 21.5076 Section 21.5076 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

38 CFR 21.5076 - Entitlement charge-overpayment cases.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Entitlement charge-overpayment cases. 21.5076 Section 21.5076 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational...

Psychometric properties of the Portuguese version of the Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS): A study with Portuguese Colonial War Veterans.

PubMed

Pinto-Gouveia, José; Carvalho, Teresa; Cunha, Marina; Duarte, Joana; Walser, Robyn D

2015-10-01

The Acceptance and Action Questionnaire-Trauma Specific (AAQ-TS) is a self-report measure designed to assess-trauma-related psychological (in)flexibility, as conceptualized in Acceptance and Commitment Therapy. However, there are no studies to date regarding its psychometric properties. This study explores such properties in the Portuguese version of the AAQ-TS, in Portuguese Colonial War Veterans. A Principal Components Analysis (PCA) was conducted in a sample from the general population of war Veterans (N=371). Confirmatory Factor Analysis (CFA) as well as reliability and convergent validity studies were performed in a different sample from the same population (N=312). For the discriminant validity a clinical sample with a war-related PTSD (N=42) and a non-clinical sample without PTSD (N=44) were used. The CFA suggested a re-specified 15-item model with good global adjustment and factorial validity. The AAQ-TS showed internal consistency, a good temporal reliability, convergent validity with psychopathological symptoms (related to PTSD, anxiety, depression and stress) and peritraumatic dissociation (altered awareness and depersonalization/derealization). The questionnaire also discriminates between war Veterans with and without a PTSD diagnosis. The major limitation relates to the samples' characteristics and sampling methods, which can limit the generalization of results. The Portuguese version of the AAQ-TS is a reliable and valid measure to assess experiential avoidance related to trauma in Portuguese Colonial War Veterans. Copyright © 2015 Elsevier B.V. All rights reserved.

38 CFR 12.23 - Recognition of valid claim against the General Post Fund.

Code of Federal Regulations, 2012 CFR

2012-07-01

... claim against the General Post Fund. 12.23 Section 12.23 Pensions, Bonuses, and Veterans' Relief... claim against the General Post Fund. Effective December 26, 1941, the assets of the estate of a veteran theretofore or thereafter deposited to the General Post Fund are subject to the valid claims of creditors...

38 CFR 12.23 - Recognition of valid claim against the General Post Fund.

Code of Federal Regulations, 2010 CFR

2010-07-01

... claim against the General Post Fund. 12.23 Section 12.23 Pensions, Bonuses, and Veterans' Relief... claim against the General Post Fund. Effective December 26, 1941, the assets of the estate of a veteran theretofore or thereafter deposited to the General Post Fund are subject to the valid claims of creditors...

38 CFR 12.23 - Recognition of valid claim against the General Post Fund.

Code of Federal Regulations, 2011 CFR

2011-07-01

... claim against the General Post Fund. 12.23 Section 12.23 Pensions, Bonuses, and Veterans' Relief... claim against the General Post Fund. Effective December 26, 1941, the assets of the estate of a veteran theretofore or thereafter deposited to the General Post Fund are subject to the valid claims of creditors...

38 CFR 12.23 - Recognition of valid claim against the General Post Fund.

Code of Federal Regulations, 2014 CFR

2014-07-01

... claim against the General Post Fund. 12.23 Section 12.23 Pensions, Bonuses, and Veterans' Relief... claim against the General Post Fund. Effective December 26, 1941, the assets of the estate of a veteran theretofore or thereafter deposited to the General Post Fund are subject to the valid claims of creditors...

38 CFR 12.23 - Recognition of valid claim against the General Post Fund.

Code of Federal Regulations, 2013 CFR

2013-07-01

... claim against the General Post Fund. 12.23 Section 12.23 Pensions, Bonuses, and Veterans' Relief... claim against the General Post Fund. Effective December 26, 1941, the assets of the estate of a veteran theretofore or thereafter deposited to the General Post Fund are subject to the valid claims of creditors...

High Prevalence of Malnutrition among Elderly Veterans in Home Based Primary Care.

PubMed

Win, A Z; Ceresa, C; Arnold, K; Allison, T A

2017-01-01

Elderly Veterans enrolled in VA Home Based Primary Care (HBPC) programs suffer from many diseases including malnutrition. Nutrition screening tools exist in the VA system but they are inconsistently utilized across ambulatory care programs and are neither research validated nor comparable with non-VA populations. The Mini-Nutritional Assessment short-form (MNA-SF) has been validated in international studies in a variety of settings. The primary aim of this study was to find the prevalence of malnutrition among Veterans enrolled in HBPC programs. The secondary objective was to determine the feasibility of adopting a validated nutrition screening tool (Mini-Nutritional Assessment short-form (MNA-SF)). 2252 veterans age 65 and older from 18 HBPC programs from across the country participated in the study. The study period was between April and September 2012. WinPepi (version 11.25) was used for descriptive analysis. We found that the prevalence of malnutrition was 15% (344/2252) and the prevalence of at risk for malnutrition was 40.3% (909/2252). The MNA-SF is an efficient nutrition screening tool and it can be successfully used for the elderly veterans. The prevalence of malnutrition among veterans was high compared to the community dwelling U.S. civilian elderly population. By preventing and treating malnutrition, health care systems should be able to reduce overall health care costs.

Veterans' Transitions to Community College: A Case Study

ERIC Educational Resources Information Center

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.…

Military Families' Perceptions of Neighborhood Characteristics Affecting Reintegration: Development of an Aggregate Measure.

PubMed

Beehler, Sarah; Ahern, Jennifer; Balmer, Brandi; Kuhlman, Jennifer

2017-01-01

This pilot study evaluated the validity and reliability of an Experience of Neighborhood (EON) measure developed to assess neighborhood characteristics that shape reintegration opportunities for returning service members and their families. A total of 91 post-9/11 veterans and spouses completed a survey administered at the Minnesota State Fair. Participants self-reported on their reintegration status (veterans), social functioning (spouses), social support, and mental health. EON factor structure, internal consistency reliability, and validity (discriminant, content, criterion) were analyzed. The EON measure showed adequate reliability, discriminant validity, and content validity. More work is needed to assess criterion validity because EON scores were not correlated with scores on a Census-based index used to measure quality of military neighborhoods. The EON may be useful in assessing broad local factors influencing health among returning veterans and spouses. More research is needed to understand geographic variation in neighborhood conditions and how those affect reintegration and mental health for military families.

Military Families’ Perceptions of Neighborhood Characteristics Affecting Reintegration: Development of an Aggregate Measure

PubMed Central

Beehler, Sarah; Ahern, Jennifer; Balmer, Brandi; Kuhlman, Jennifer

2017-01-01

This pilot study evaluated the validity and reliability of an Experience of Neighborhood (EON) measure developed to assess neighborhood characteristics that shape reintegration opportunities for returning service members and their families. A total of 91 post-9/11 veterans and spouses completed a survey administered at the Minnesota State Fair. Participants self-reported on their reintegration status (veterans), social functioning (spouses), social support, and mental health. EON factor structure, internal consistency reliability, and validity (discriminant, content, criterion) were analyzed. The EON measure showed adequate reliability, discriminant validity, and content validity. More work is needed to assess criterion validity because EON scores were not correlated with scores on a Census-based index used to measure quality of military neighborhoods. The EON may be useful in assessing broad local factors influencing health among returning veterans and spouses. More research is needed to understand geographic variation in neighborhood conditions and how those affect reintegration and mental health for military families. PMID:28936370

Symptom and performance validity with veterans assessed for attention-deficit/hyperactivity disorder (ADHD).

PubMed

Shura, Robert D; Denning, John H; Miskey, Holly M; Rowland, Jared A

2017-12-01

Little is known about attention-deficit/hyperactivity disorder (ADHD) in veterans. Practice standards recommend the use of both symptom and performance validity measures in any assessment, and there are salient external incentives associated with ADHD evaluation (stimulant medication access and academic accommodations). The purpose of this study was to evaluate symptom and performance validity measures in a clinical sample of veterans presenting for specialty ADHD evaluation. Patients without a history of a neurocognitive disorder and for whom data were available on all measures (n = 114) completed a clinical interview structured on DSM-5 ADHD symptoms, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), and the Test of Memory Malingering Trial 1 (TOMM1) as part of a standardized ADHD diagnostic evaluation. Veterans meeting criteria for ADHD were not more likely to overreport symptoms on the MMPI-2-RF nor to fail TOMM1 (score ≤ 41) compared with those who did not meet criteria. Those who overreported symptoms did not endorse significantly more ADHD symptoms; however, those who failed TOMM1 did report significantly more ADHD symptoms (g = 0.90). In the total sample, 19.3% failed TOMM1, 44.7% overreported on the MMPI-2-RF, and 8.8% produced both an overreported MMPI-2-RF and invalid TOMM1. F-r had the highest correlation to TOMM1 scores (r = -.30). These results underscore the importance of assessing both symptom and performance validity in a clinical ADHD evaluation with veterans. In contrast to certain other conditions (e.g., mild traumatic brain injury), ADHD as a diagnosis is not related to higher rates of invalid report/performance in veterans. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The Minnesota Multiphasic Personality Inventory-2-RF in Treatment-Seeking Veterans with History of Mild Traumatic Brain Injury.

PubMed

Jurick, S M; Crocker, L D; Keller, A V; Hoffman, S N; Bomyea, J; Jacobson, M W; Jak, A J

2018-05-30

This study examined the Minnesota Multiphasic Personality Inventory-Second Edition-Restructured Form (MMPI-2-RF) to better understand symptom presentation in a sample of treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with self-reported history of mild traumatic brain injury (mTBI). Participants underwent a comprehensive clinical neuropsychological battery including performance and symptom validity measures and self-report measures of depressive, posttraumatic, and post-concussive symptomatology. Those with possible symptom exaggeration (SE+) on the MMPI-2-RF were compared with those without (SE-) with regard to injury, psychiatric, validity, and cognitive variables. Between 50% and 87% of participants demonstrated possible symptom exaggeration on one or more MMPI-2-RF validity scales, and a large majority were elevated on content scales related to cognitive, somatic, and emotional complaints. The SE+ group reported higher depressive, posttraumatic, and post-concussive symptomatology, had higher scores on symptom validity measures, and performed more poorly on neuropsychological measures compared with the SE- group. There were no group differences with regard to injury variables or performance validity measures. Participants were more likely to exhibit possible symptom exaggeration on cognitive/somatic compared with traditional psychopathological validity scales. A sizable portion of treatment-seeking OEF/OIF Veterans demonstrated possible symptom exaggeration on MMPI-2-RF validity scales, which was associated with elevated scores on self-report measures and poorer cognitive performance, but not higher rates of performance validity failure, suggesting symptom and performance validity are distinct concepts. These findings have implications for the interpretation of clinical data in the context of possible symptom exaggeration and treatment in Veterans with persistent post-concussive symptoms.

Screening for novel central nervous system biomarkers in veterans with Gulf War Illness.

PubMed

Abou-Donia, Mohamed B; Conboy, Lisa A; Kokkotou, Efi; Jacobson, Eric; Elmasry, Eman M; Elkafrawy, Passent; Neely, Megan; Bass, Cameron R 'Dale'; Sullivan, Kimberly

2017-05-01

Gulf War illness (GWI) is primarily diagnosed by symptom report; objective biomarkers are needed that distinguish those with GWI. Prior chemical exposures during deployment have been associated in epidemiologic studies with altered central nervous system functioning in veterans with GWI. Previous studies from our group have demonstrated the presence of autoantibodies to essential neuronal and glial proteins in patients with brain injury and autoantibodies have been identified as candidate objective markers that may distinguish GWI. Here, we screened the serum of 20 veterans with GWI and 10 non-veteran symptomatic (low back pain) controls for the presence of such autoantibodies using Western blot analysis against the following proteins: neurofilament triplet proteins (NFP), tubulin, microtubule associated tau proteins (Tau), microtubule associated protein-2 (MAP-2), myelin basic protein (MBP), myelin associated glycoprotein (MAG), glial fibrillary acidic protein (GFAP), calcium-calmodulin kinase II (CaMKII) and glial S-100B protein. Serum reactivity was measured as arbitrary chemiluminescence units. As a group, veterans with GWI had statistically significantly higher levels of autoantibody reactivity in all proteins examined except S-100B. Fold increase of the cases relative to controls in descending order were: CaMKII 9.27, GFAP 6.60, Tau 4.83, Tubulin 4.41, MAG 3.60, MBP 2.50, NFP 2.45, MAP-2 2.30, S-100B 1.03. These results confirm the continuing presence of neuronal injury/gliosis in these veterans and are in agreement with the recent reports indicating that 25years after the war, the health of veterans with GWI is not improving and may be getting worse. Such serum autoantibodies may prove useful as biomarkers of GWI, upon validation of the findings using larger cohorts. Copyright © 2017 Elsevier Inc. All rights reserved.

38 CFR 21.96 - Review of the plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... reaching the goals of the plan will be reviewed and evaluated as scheduled in the plan by the case manager and the veteran. (b) Comprehensive review required. The case manager and the veteran will review all... such review the veteran and the case manager will agree whether the plan should be: (1) Retained in its...

Novel Autoantibody Serum and Cerebrospinal Fluid Biomarkers in Veterans with Gulf War Illness

DTIC Science & Technology

2017-10-01

health of veterans with GWI is not improving. Such blood-based autoantibodies may prove useful as biomarkers of GWI, upon validation of the findings using...status 1-3 1-4 1b. Obtain DOD Human Research Protections Office (HRPO) approvals or Exempt Status 1-3 1-4 Milestone(s) Achieved: Regulatory...Syndrome (IBS), OP pesticide and nerve agent exposures in GW veterans  Biomarkers of prior brain injury in GW veterans against their

The Boston Assessment of Traumatic Brain Injury–Lifetime (BAT-L) Semistructured Interview: Evidence of Research Utility and Validity

PubMed Central

Fortier, Catherine Brawn; Amick, Melissa M.; Grande, Laura; McGlynn, Susan; Kenna, Alexandra; Morra, Lindsay; Clark, Alexandra; Milberg, William P.; McGlinchey, Regina E.

2014-01-01

Objective Report the prevalence of lifetime and military-related traumatic brain injuries (TBIs) in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and validate the Boston Assessment of TBI–Lifetime (BAT-L). Setting The BAT-L is the first validated, postcombat, semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span. Participants Community-dwelling convenience sample of 131 OEF/OIF veterans. Design TBI criteria (alteration of mental status, posttraumatic amnesia, and loss of consciousness) were evaluated for all possible TBIs, including a novel evaluation of blast exposure. Main Measures BAT-L, Ohio State University TBI Identification Method (OSU-TBI-ID). Results About 67% of veterans incurred a TBI in their lifetime. Almost 35% of veterans experienced at least 1 military-related TBI; all were mild in severity, 40% of them were due to blast, 50% were due to some other (ie, blunt) mechanism, and 10% were due to both types of injuries. Predeployment TBIs were frequent (45% of veterans). There was strong correspondence between the BAT-L and the OSU-TBI-ID (Cohen κ = 0.89; Kendall τ-b 0.95). Interrater reliability of the BAT-L was strong (κs >0.80). Conclusions The BAT-L is a valid instrument with which to assess TBI across a service member’s lifetime and captures the varied and complex nature of brain injuries across OEF/OIF veterans’ life span. PMID:23535389

Validation of the Modified Fatigue Impact Scale in mild to moderate traumatic brain injury.

PubMed

Schiehser, Dawn M; Delano-Wood, Lisa; Jak, Amy J; Matthews, Scott C; Simmons, Alan N; Jacobson, Mark W; Filoteo, J Vincent; Bondi, Mark W; Orff, Henry J; Liu, Lin

2015-01-01

To evaluate the validity of the Modified Fatigue Impact Scale (MFIS) in veterans with a history of mild to moderate traumatic brain injury (TBI). Veterans (N = 106) with mild (92%) or moderate (8%) TBI. Veterans Administration Health System. Factor structure, internal consistency, convergent validity, sensitivity, and specificity of the MFIS were examined. Principal component analysis identified 2 viable MFIS factors: a Cognitive subscale and a Physical/Activities subscale. Item analysis revealed high internal consistency of the MFIS Total scale and subscale items. Strong convergent validity of the MFIS scales was established with 2 Beck Depression Inventory II fatigue items. Receiver operating characteristic curve analysis revealed good to excellent accuracy of the MFIS in classifying fatigued versus nonfatigued individuals. The MFIS is a valid multidimensional measure that can be used to evaluate the impact of fatigue on cognitive and physical functioning in individuals with mild to moderate TBI. The psychometric properties of the MFIS make it useful for evaluating fatigue and provide the potential for improving research on fatigue in this population.

Characteristics of the Highest Users of Emergency Services in Veterans Affairs Hospitals: Homeless and Non-Homeless.

PubMed

Gundlapalli, Adi V; Jones, Audrey L; Redd, Andrew; Suo, Ying; Pettey, Warren B P; Mohanty, April; Brignone, Emily; Gawron, Lori; Vanneman, Megan; Samore, Matthew H; Fargo, Jamison D

2017-01-01

Efforts are underway to understand recent increases in emergency department (ED) use and to offer case management to those patients identified as high utilizers. Homeless Veterans are thought to use EDs for non-emergent conditions. This study identifies the highest users of ED services in the Department of Veterans Affairs and provides descriptive analyses of these Veterans, the diagnoses for which they were seen in the ED, and differences based on their homeless status. Homeless Veterans were more likely than non-homeless Veterans to have >10 visits in the 2014 calendar year (12% vs. <1%). Homeless versus non-homeless Veterans with >10 visits were more often male, <age 60, and non-married. Non-homeless Veterans with >10 ED visits were often treated for chest and abdominal pain, and back problems, whereas homeless Veterans were frequently treated for mental health/substance use. Tailored case management approaches may be needed to better link homeless Veterans with high ED use to appropriate outpatient care.

Factors Affecting Service Learning Implementation: A Comparison of Novice and Veteran Teachers

ERIC Educational Resources Information Center

Losser, Janet L.; Caldarella, Paul; Black, Sharon J.; Pate, P. Elizabeth

2018-01-01

This qualitative study investigated factors that facilitate and hinder implementation of service learning for novice and veteran teachers. We conducted case studies of three novice teachers and three veteran teachers, using a cross-case analysis within and across groups. Confirming prior research, facilitating factors included teachers' knowledge…

38 CFR 17.115 - Claims in cases of incompetent patients.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Claims in cases of incompetent patients. 17.115 Section 17.115 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Reimbursement for Loss by Natural Disaster of Personal Effects of Hospitalized Or Nursing...

38 CFR 17.115 - Claims in cases of incompetent patients.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Claims in cases of incompetent patients. 17.115 Section 17.115 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Reimbursement for Loss by Natural Disaster of Personal Effects of Hospitalized Or Nursing...

Military to civilian questionnaire: a measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care.

PubMed

Sayer, Nina A; Frazier, Patricia; Orazem, Robert J; Murdoch, Maureen; Gravely, Amy; Carlson, Kathleen F; Hintz, Samuel; Noorbaloochi, Siamak

2011-12-01

The primary objective of this study was to describe the development, reliability, and construct validity of scores on the Military to Civilian Questionnaire (M2C-Q), a 16-item self-report measure of postdeployment community reintegration difficulty. We surveyed a national, stratified sample of 1,226 Iraq and Afghanistan veterans who used U.S. Department of Veterans Affairs (VA) medical care; 745 completed the M2C-Q and validated mental health screening measures. All analyses were based on weighted estimates. The internal consistency of the M2C-Q was .95 in this sample. Factor analyses indicated a single total score was the best-fitting model. Total scores were associated with measures theoretically related to reintegration difficulties including perception of overall difficulty readjusting back into civilian life (R(2) = .49), probable PTSD (d = 1.07), probable problem drug or alcohol use (d = 0.34), and overall mental health (r = -.83). Subgroup analyses revealed a similar pattern of findings in those who screened negative for PTSD. Nonwhite and unemployed veterans reported greater community reintegration difficulty (d = 0.20 and 0.45, respectively). Findings offer preliminary support for the reliability and construct validity of M2C-Q scores. Published 2011. This article is a US Government work and is in the public domain in the USA.

Understanding health-related quality of life in caregivers of civilians and service members/veterans with traumatic brain injury: Establishing the reliability and validity of PROMIS Fatigue and Sleep Disturbance item banks.

PubMed

Carlozzi, Noelle E; Ianni, Phillip A; Tulsky, David S; Brickell, Tracey A; Lange, Rael T; French, Louis M; Cella, David; Kallen, Michael A; Miner, Jennifer A; Kratz, Anna L

2018-06-19

To examine the reliability and validity of Patient Reported Outcomes Measurement Information System (PROMIS) measures of sleep disturbance and fatigue in TBI caregivers and to determine the severity of fatigue and sleep disturbance in these caregivers. Cross-sectional survey data collected through an online data capture platform. Four rehabilitation hospitals and Walter Reed National Military Medical Center. Caregivers (N=560) of civilians (n=344) and service member/veterans (n=216) with TBI. Not Applicable MAIN OUTCOME MEASURES: PROMIS sleep and fatigue measures administered as both computerized adaptive tests (CATs) and 4-item short forms (SFs). For both samples, floor and ceiling effects for the PROMIS measures were low (<11%), internal consistency was very good (all alphas ≥0.80), and test-retest reliability was acceptable (all r≥0.70 except for the fatigue CAT in the service member/veteran sample r=0.63). Convergent validity was supported by moderate correlations between the PROMIS and related measures. Discriminant validity was supported by low correlations between PROMIS measures and measures of dissimilar constructs. PROMIS scores indicated significantly worse sleep and fatigue for those caring for someone with high levels versus low levels of impairment. Findings support the reliability and validity of the PROMIS CAT and SF measures of sleep disturbance and fatigue in caregivers of civilians and service members/veterans with TBI. Copyright © 2018. Published by Elsevier Inc.

The effects of misclassification biases on veteran suicide rate estimates.

PubMed

Huguet, Nathalie; Kaplan, Mark S; McFarland, Bentson H

2014-01-01

We assessed the impact that possible veteran suicide misclassification biases (i.e., inaccuracy in ascertainment of veteran status on the death certificate and misclassification of suicide as other manner of death) have on veteran suicide rate estimates. We obtained suicide mortality data from the 2003-2010 National Violent Death Reporting System and the 2003-2010 Department of Defense Casualty Analysis System. We derived population estimates from the 2003-2010 American Community Survey and 2003-2010 Department of Veterans Affairs data. We computed veteran and nonveteran suicide rates. The results showed that suicide rates were minimally affected by the adjustment for the misclassification of current military personnel suicides as veterans. Moreover, combining suicides and deaths by injury of undetermined intent did not alter the conclusions. The National Violent Death Reporting System is a valid surveillance system for veteran suicide. However, more than half of younger (< 25 years) male and female suicides, labeled as veterans, were likely to have been current military personnel at the time of their death and misclassified on the death certificate.

Perioperative and ICU Healthcare Analytics within a Veterans Integrated System Network: a Qualitative Gap Analysis.

PubMed

Mudumbai, Seshadri; Ayer, Ferenc; Stefanko, Jerry

2017-08-01

Health care facilities are implementing analytics platforms as a way to document quality of care. However, few gap analyses exist on platforms specifically designed for patients treated in the Operating Room, Post-Anesthesia Care Unit, and Intensive Care Unit (ICU). As part of a quality improvement effort, we undertook a gap analysis of an existing analytics platform within the Veterans Healthcare Administration. The objectives were to identify themes associated with 1) current clinical use cases and stakeholder needs; 2) information flow and pain points; and 3) recommendations for future analytics development. Methods consisted of semi-structured interviews in 2 phases with a diverse set (n = 9) of support personnel and end users from five facilities across a Veterans Integrated Service Network. Phase 1 identified underlying needs and previous experiences with the analytics platform across various roles and operational responsibilities. Phase 2 validated preliminary feedback, lessons learned, and recommendations for improvement. Emerging themes suggested that the existing system met a small pool of national reporting requirements. However, pain points were identified with accessing data in several information system silos and performing multiple manual validation steps of data content. Notable recommendations included enhancing systems integration to create "one-stop shopping" for data, and developing a capability to perform trends analysis. Our gap analysis suggests that analytics platforms designed for surgical and ICU patients should employ approaches similar to those being used for primary care patients.

Concurrent Validity of the Defense and Veterans Pain Rating Scale in VA Outpatients.

PubMed

Nassif, Thomas H; Hull, Amanda; Holliday, Stephanie Brooks; Sullivan, Patrick; Sandbrink, Friedhelm

2015-11-01

The purpose of this report is to investigate the concurrent validity of the Defense and Veterans Pain Rating Scale (DVPRS) with other validated self-report measures in U.S. veterans. This correlational study was conducted using two samples of outpatients at the Washington, DC Veterans Affairs Medical Center who completed self-report measures relevant to pain conditions, including pain disability, quality of life, and mental health. Study 1 and 2 consisted of n = 204 and n = 13 participants, respectively. Bivariate Spearman correlations were calculated to examine the correlation among total scores and subscale scores for each scale of interest. Multiple linear regressions were also computed in Study 1. In Study 1, the DVPRS interference scale (DVPRS-II) was significantly correlated with the Pain Disability Questionnaire (PDQ) (ρ = 0.69, P < 0.001) and the Veterans RAND 36-item Health Survey physical and mental component scales (ρ = -0.37, P < 0.001; ρ = -0.46, P < 0.001, respectively). When controlling for sex, age, and other self-report measures, the relationship between the DVPRS-II and PDQ remained significant. In Study 2, pain interference on the DVPRS and Brief Pain Inventory were highly correlated (ρ = 0.90, P < 0.001); however, the intensity scale of each measure was also highly associated with the interference summary scores. These findings provide preliminary evidence for the concurrent validity of the DVPRS as a brief, multidimensional measure of pain interference that make it a practical tool for use in primary care settings to assess the impact of pain on daily functioning and monitor chronic pain over time. Wiley Periodicals, Inc.

Excess incidence of ALS in young Gulf War veterans.

PubMed

Haley, Robert W

2003-09-23

Reported cases of ALS in young veterans of the 1991 Gulf War have suggested excess incidence. To compare observed and expected incidence of ALS in Gulf War veterans diagnosed before age 45 years (young veterans). Cases of ALS diagnosed from 1991 through 1998 were collected from military registries and a publicity campaign in late 1998. Diagnoses were established from neurologists' medical records using El Escorial criteria. Expected incidence was estimated from the age distribution of the Gulf War veteran population, weighted by age-specific death rates of the US population. Secular changes in nationwide ALS rates were assessed using calculations of the age-specific US population death rates from vital statistics data of 1979 to 1998. During 8 postwar years, 20 ALS cases were confirmed in approximately 690,000 Gulf War veterans, and 17 were diagnosed before age 45 years. All developed bulbar and spinal involvement, and 11 have died. In young veterans, the expected incidence increased from 0.93 cases/year in 1991 to 1.57 cases/year in 1998, but the observed incidence increased from 1 to 5 cases/year. The observed incidence was 0.94 (95% CI, 0.26 to 2.41) times that expected in the baseline period from 1991 to 1994 (4 vs 4.25 cases; p = 0.6); it increased to 2.27 (95% CI, 1.27 to 3.88) times that expected during the 4-year period from 1995 to 1998 (13 vs 5.72 cases; p = 0.006); and it peaked at 3.19 (95% CI, 1.03 to 7.43) times that expected in 1998 (5 vs 1.57 cases; p = 0.02). The magnitude of the excess of ALS cases over the expected incidence increased during the 8-year period (Poisson trend test, p = 0.05), and the increase was not explained by a change in the interval from onset to diagnosis or by a change in the US population death rate of ALS in those aged <45 years. The observed incidence of ALS in young Gulf War veterans exceeded the expected, suggesting a war-related environmental trigger.

Neuropsychological Function in a Case of Dandy-Walker Variant in a 68-Year-Old Veteran.

PubMed

Gross, Patricia L; Kays, Jill L; Shura, Robert D

2016-01-01

Dandy-Walker syndrome (DWS) is a congenital brain malformation that is characterized by partial or complete agenesis of the cerebellar vermis and cystic dilatation of the 4th ventricle that shifts ventrolaterally to displace the cerebellar hemispheres. This case is a 68-year-old male veteran with complaints of new-onset cognitive disorder who was found to have previously unsuspected DWS on head computed tomography. This is one of the first case studies to present complete neuropsychological test results in a veteran with DWS. Despite the level of abnormality on imaging, the veteran functioned well until onset of mild cognitive impairments in late adulthood.

Homeless Veterans: Management Improvements Could Help VA Better Identify Supportive Housing Projects

DTIC Science & Technology

2016-12-01

HOMELESS VETERANS Management Improvements Could Help VA Better Identify Supportive-Housing Projects Report to...VETERANS Management Improvements Could Help VA Better Identify Supportive-Housing Projects What GAO Found As of September 2016, for veterans who...disabled veterans. These supportive-housing EULs receive project -based HUD-VASH vouchers, which provide housing subsidies, on-site case management

Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

PubMed

Bovin, Michelle J; Marx, Brian P; Weathers, Frank W; Gallagher, Matthew W; Rodriguez, Paola; Schnurr, Paula P; Keane, Terence M

2016-11-01

This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans.

PubMed

Breland, Jessica Y; Phibbs, Ciaran S; Hoggatt, Katherine J; Washington, Donna L; Lee, Jimmy; Haskell, Sally; Uchendu, Uchenna S; Saechao, Fay S; Zephyrin, Laurie C; Frayne, Susan M

2017-04-01

Most US adults are overweight or obese. Understanding differences in obesity prevalence across subpopulations could facilitate the development and dissemination of weight management services. To inform Veterans Health Administration (VHA) weight management initiatives, we describe obesity prevalence among subpopulations of VHA patients. Cross-sectional descriptive analyses of fiscal year 2014 (FY2014) national VHA administrative and clinical data, stratified by gender. Differences ≥5% higher than the population mean were considered clinically significant. Veteran VHA primary care patients with a valid weight within ±365 days of their first FY2014 primary care visit, and a valid height (98% of primary care patients). We used VHA vital signs data to ascertain height and weight and calculate body mass index, and VHA outpatient, inpatient, and fee basis data to identify sociodemographic- and comorbidity-based subpopulations. Among nearly five million primary care patients (347,112 women, 4,567,096 men), obesity prevalence was 41% (women 44%, men 41%), and overweight prevalence was 37% (women 31%, men 38%). Across the VHA's 140 facilities, obesity prevalence ranged from 28% to 49%. Among gender-stratified subpopulations, obesity prevalence was high among veterans under age 65 (age 18-44: women 40%, men 46%; age 45-64: women 49%, men 48%). Obesity prevalence varied across racial/ethnic and comorbidity subpopulations, with high obesity prevalence among black women (51%), women with schizophrenia (56%), and women and men with diabetes (68%, 56%). Overweight and obesity are common among veterans served by the VHA. VHA's weight management initiatives have the potential to avert long-term morbidity arising from obesity-related conditions. High-risk groups-such as black women veterans, women veterans with schizophrenia, younger veterans, and Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native veterans-may require particular attention to ensure that systems improvement efforts at the population level do not inadvertently increase health disparities.

38 CFR 3.206 - Divorce.

Code of Federal Regulations, 2013 CFR

2013-07-01

... a divorce decree regular on its face, will be questioned by the Department of Veterans Affairs only... Department of Veterans Affairs benefits would be affected thereby. In cases where recognition of the decree... veteran following a divorce, the matter of recognition of the divorce by the Department of Veterans...

38 CFR 3.206 - Divorce.

Code of Federal Regulations, 2012 CFR

2012-07-01

... a divorce decree regular on its face, will be questioned by the Department of Veterans Affairs only... Department of Veterans Affairs benefits would be affected thereby. In cases where recognition of the decree... veteran following a divorce, the matter of recognition of the divorce by the Department of Veterans...

38 CFR 3.206 - Divorce.

Code of Federal Regulations, 2014 CFR

2014-07-01

... a divorce decree regular on its face, will be questioned by the Department of Veterans Affairs only... Department of Veterans Affairs benefits would be affected thereby. In cases where recognition of the decree... veteran following a divorce, the matter of recognition of the divorce by the Department of Veterans...

38 CFR 3.206 - Divorce.

Code of Federal Regulations, 2010 CFR

2010-07-01

... a divorce decree regular on its face, will be questioned by the Department of Veterans Affairs only... Department of Veterans Affairs benefits would be affected thereby. In cases where recognition of the decree... veteran following a divorce, the matter of recognition of the divorce by the Department of Veterans...

38 CFR 3.206 - Divorce.

Code of Federal Regulations, 2011 CFR

2011-07-01

... a divorce decree regular on its face, will be questioned by the Department of Veterans Affairs only... Department of Veterans Affairs benefits would be affected thereby. In cases where recognition of the decree... veteran following a divorce, the matter of recognition of the divorce by the Department of Veterans...

A Collective Case Study of Veterans inside an Arts and Crafts Room and Their Perceptions Regarding Empowerment

ERIC Educational Resources Information Center

Hasio, Cindy Lee

2013-01-01

This dissertation is "A Collective Case Study of Veterans Inside an Arts and Crafts Room and Their Perceptions Regarding Empowerment." This research examined to what degree art making, and in what ways a community of learning contributed to veterans' self-worth and empowerment through their creative activities and interactions inside an…

[Preliminary construction of a questionnaire about knowledge of HIV/AIDS in Colombian veterans].

PubMed

Segura-Cardona, Angela; Berbesí-Fernández, Dedsy; Cardona-Arango, Doris; Ordóñez-Molina, Jaime

2011-01-01

In order to identify the level of knowledge about HIV/AIDS in Colombia veterans of war in the year 2009, a questionnaire was designed, built and validated, using a mixed design, for which three stages were followed: 1) Bibliographic review and construction of items of the questionnaire using a focus group, 2) Evaluation of content validity by a pannel of experts, 3) APLICACION of the final questionnaire, we selected non-randomly 323 people who were part of group of veterans in Colombia, and 4) Validation of the questionnaire through the evaluation of internal consistency and principal component analysis. We found that the questionnaire explored three factors: forms of infection, inadequate beliefs, and HIV prevention, which accounted for 52% of the variance. The survey showed adequate internal consistency values (Cronbach's α = 0.77). These results suggest the use of the questionnaire to assess knowledge level related to the form of infection, inaccurate beliefs and prevention of HIV-AIDS in this population.

Development of CRIS: Measure of community reintegration of injured service members

PubMed Central

Resnik, Linda; Plow, Matthew; Jette, Alan

2012-01-01

Identification and prevention of community reintegration problems of veterans is an important public health mandate. However, no veteran-specific measure exists. Study purposes were to (1) develop the Community Reintegration for Service Members (CRIS) measure and (2) test the validity and reliability of the measure. Formative research identified challenges in community reintegration postdeployment. The World Health Organization’s International Classification of Functioning, Disability and Health participation domain guided item-bank development. Items were refined through cognitive interviews and clinician consultation. Pilot studies with 126 veterans examined unidimensionality, internal consistency, reliability, and construct validity. Three unidimensional CRIS scales were developed. Working subjects had better CRIS scores then unemployed subjects. Subjects with posttraumatic stress disorder, substance abuse, or mental health problems had worse scores than subjects without these conditions. The correlations between the CRIS and the 36-Item Short Form Health Survey scales of role physical, role emotional, and social functioning were 0.44–0.80. CRIS has strong reliability, conceptual integrity, and construct validity. PMID:19882482

Quantitative Tractography and Volumetric MRI in Blast and Blunt Force TBI: Predictors of Neurocognitive and Behavioral Outcome

DTIC Science & Technology

2013-10-01

veterans with mTBI. Further, presence of post-traumatic amnesia may affect subtype of fatigue experienced by veterans with mTBI. The fornix, a limbic...physical fatigue, but not cognitive fatigue, were associated with the presence of post-traumatic amnesia at injury. Conclusion: The MFIS is a valid...pathways. Cognitive and Psychiatric Dissociations between Fractional Anisotropy and Cortical Thickness in Veterans with Mild TBI: (Scott Sorg, Mark

Defense.gov - Special Report: Veterans Employment

Science.gov Websites

. Veterans' employment case manager Angela Eberle helped Rivera rewrite his resume and translated his Obama launched the Veterans Employment Center, the first online one-stop shopping tool for veterans Jobs Troops, Vets Want 'Fair Shot' at Employment, Battaglia Says First Lady Asks Governors to Aid

Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen.

PubMed

Louise Bender Pape, Theresa; Smith, Bridget; Babcock-Parziale, Judith; Evans, Charlesnika T; Herrold, Amy A; Phipps Maieritsch, Kelly; High, Walter M

2018-01-31

To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) Traumatic Brain Injury (TBI) Clinical Reminder Screen (TCRS). Cross-sectional, prospective, observational study using the Standards for Reporting of Diagnostic Accuracy criteria. Three VA Polytrauma Network Sites. Operation Iraqi Freedom, Operation Enduring Freedom veterans (N=433). TCRS, Comprehensive TBI Evaluation, Structured TBI Diagnostic Interview, Symptom Attribution and Classification Algorithm, and Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale. Forty-five percent of veterans screened positive on the TCRS for TBI. For detecting occurrence of historical TBI, the TCRS had a sensitivity of .56 to .74, a specificity of .63 to .93, a positive predictive value (PPV) of 25% to 45%, a negative predictive value (NPV) of 91% to 94%, and a diagnostic odds ratio (DOR) of 4 to 13. For accuracy of attributing active symptoms to the TBI, the TCRS had a sensitivity of .64 to .87, a specificity of .59 to .89, a PPV of 26% to 32%, an NPV of 92% to 95%, and a DOR of 6 to 9. The sensitivity was higher for veterans with PTSD (.80-.86) relative to veterans without PTSD (.57-.82). The specificity, however, was higher among veterans without PTSD (.75-.81) relative to veterans with PTSD (.36-.49). All indices of diagnostic accuracy changed when participants with questionably valid (QV) test profiles were eliminated from analyses. The utility of the TCRS to screen for mild TBI (mTBI) depends on the stringency of the diagnostic reference standard to which it is being compared, the presence/absence of PTSD, and QV test profiles. Further development, validation, and use of reproducible diagnostic algorithms for symptom attribution after possible mTBI would improve diagnostic accuracy. Published by Elsevier Inc.

Portuguese version of the PTSD Checklist-Military Version (PCL-M)-I: Confirmatory Factor Analysis and reliability.

PubMed

Carvalho, Teresa; Cunha, Marina; Pinto-Gouveia, José; Duarte, Joana

2015-03-30

The PTSD Checklist-Military Version (PCL-M) is a brief self-report instrument widely used to assess Post-traumatic Stress Disorder (PTSD) symptomatology in war Veterans, according to DSM-IV. This study sought out to explore the factor structure and reliability of the Portuguese version of the PCL-M. A sample of 660 Portuguese Colonial War Veterans completed the PCL-M. Several Confirmatory Factor Analyses were conducted to test different structures for PCL-M PTSD symptoms. Although the respecified first-order four-factor model based on King et al.'s model showed the best fit to the data, the respecified first and second-order models based on the DSM-IV symptom clusters also presented an acceptable fit. In addition, the PCL-M showed adequate reliability. The Portuguese version of the PCL-M is thus a valid and reliable measure to assess the severity of PTSD symptoms as described in DSM-IV. Its use with Portuguese Colonial War Veterans may ease screening of possible PTSD cases, promote more suitable treatment planning, and enable monitoring of therapeutic outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Systemic Vulnerabilities to Suicide among Veterans from the Iraq and Afghanistan Conflicts: Review of Case Reports from a National Veterans Affairs Database

ERIC Educational Resources Information Center

Mills, Peter D.; Huber, Samuel J.; Watts, Bradley Vince; Bagian, James P.

2011-01-01

While suicide among recently returned veterans is of great concern, it is a relatively rare occurrence within individual hospitals and clinics. Root cause analysis (RCA) generates a detailed case report that can be used to identify system-based vulnerabilities following an adverse event. Review of a national database of RCA reports may identify…

Ensuring Success for Veterans with Disabilities in STEM Degree Programs: Recommendations from a Workshop and Case Study of an Evidence-Based Transition Program

ERIC Educational Resources Information Center

Goldberg, Mary; Cooper, Rory; Milleville, Maria; Barry, Anne; Schein, Michelle L.

2015-01-01

This article describes a workshop with academic professionals and military leaders and includes the case study of a veterans' transition program that served as a resource for identifying best practices for programs for Veterans with Disabilities in STEM Degree Programs. The information collected during this workshop, along with the theoretical…

Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001.

PubMed

Crawford, Eric F; Fulton, Jessica J; Swinkels, Cindy M; Beckham, Jean C; Calhoun, Patrick S

2013-09-01

Alcohol screening with the 3-item alcohol use disorders identification test (AUDIT-C) has been implemented throughout the U.S. Veterans Health Administration. Validation of the AUDIT-C, however, has been conducted with samples of primarily older veterans. This study examined the diagnostic efficiency of the AUDIT-C in a younger cohort of veterans who served during Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). Veteran participants (N=1775) completed the alcohol use disorders identification test (AUDIT) and underwent the structured clinical interview for DSM-IV-TR for Axis I disorders (SCID) in research settings within four VA medical Centers. Areas under receiver operating characteristic curves (AUCs) measured the effiency of the full AUDIT and AUDIT-C in identifying SCID-based diagnoses of past year alcohol abuse or dependence. Both measures performed well in detecting alcohol use disorders. In the full sample, the AUDIT had a better AUC (.908; .881-.935) than the AUDIT-C (.859; .826-.893; p<.0001). It is notable that this same result was found among men but not women, perhaps due to reduced power. Diagnostic efficiency statistics for the AUDIT and AUDIT-C were consistent with results from older veteran samples. The diagnostic efficiency of both measures did not vary with race or age. Both the AUDIT and AUDIT-C appear to be valid instruments for identifying alcohol abuse or dependence among the most recent cohort of U.S. veterans with service during OEF/OIF within research settings. Published by Elsevier Ireland Ltd.

Career Development for Transitioning Veterans. Monograph Series

ERIC Educational Resources Information Center

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…

The Entrepreneurship Bootcamp for Veterans' Families Program: Transformative Learning for Discontinuous Life Transition

ERIC Educational Resources Information Center

Redmon, Stephen Thomas

2013-01-01

This multiple-case study explored the nature of the experiences of family members of service-disabled veterans who participated in the Entrepreneurship Bootcamp for Veterans Family Program (EBV-F), an entrepreneurial learning and coaching program designed to assist family members of service-disabled veterans to support the discontinuous life…

Leadership Tenets of Military Veterans Working as School Administrators

ERIC Educational Resources Information Center

Bolles, Elliot; Patrizio, Kami

2016-01-01

This study investigates the leadership tenets informing veterans' work as school leaders. Drawing on 15 interviews and surveys with military veterans working as educational leaders, the study relies on Stake's (2006) case study method to substantiate assertions that veterans: 1) come into education without the support of a transitional program, 2)…

Supporting Veteran Transitions to the Academic Setting: VA on Campus

ERIC Educational Resources Information Center

O'Connor, Ashley; Herbst, Ellen; McCaslin, Shannon; Armstrong, Keith; Leach, Bridget; Jersky, Brandina

2018-01-01

In this case study, we assessed academic functioning, service satisfaction, and needs of student veterans at a community college who had accessed the Veterans Health Administration (VHA) Student Veteran Health Program (SVHP) (n = 36). The SVHP provides outreach and behavioral health services directly on a large community college campus to overcome…

Factorial invariance of posttraumatic stress disorder symptoms across three veteran samples.

PubMed

McDonald, Scott D; Beckham, Jean C; Morey, Rajendra; Marx, Christine; Tupler, Larry A; Calhoun, Patrick S

2008-06-01

Research generally supports a 4-factor structure of posttraumatic stress disorder (PTSD) symptoms. However, few studies have established factor invariance by comparing multiple groups. This study examined PTSD symptom structure using the Davidson Trauma Scale (DTS) across three veteran samples: treatment-seeking Vietnam-era veterans, treatment-seeking post-Vietnam-era veterans, and Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veteran research participants. Confirmatory factor analyses of DTS items demonstrated that a 4-factor structural model of the DTS (reexperiencing, avoidance, numbing, and hyperarousal) was superior to five alternate models, including the conventional 3-factor model proposed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994). Results supported factor invariance across the three veteran cohorts, suggesting that cross-group comparisons are interpretable. Implications and applications for DSM-IV nosology and the validity of symptom measures are discussed.

Veterans treatment courts: A case study of their efficacy for Veterans' needs.

PubMed

Erickson, John W

Veterans Treatment Courts (VTCs) were created to: (1) address issues unique to U.S. Military Veterans; and, (2) where possible, avoid punishing veterans for crimes that may have been committed as a direct result of their mental conditions (e.g., Posttraumatic Stress Disorder (PTSD) and/or Traumatic Brain Injury (TBI)). Little research has been undertaken to ascertain whether VTCs are accomplishing their intended goals. To that end, the present case study examined three operating VTCs in order to determine if they are meeting their objectives. The research provides further information about VTC operations and recidivism rates. The research further reveals that, while the three VTCs examined are arguably benefitting veterans, they are not reaching a greater part of the population due largely to the gatekeeping role of VTC prosecutors, and the rigid eligibility requirements established by the three VTCs for veteran participation. Consequently, it's possible that the low recidivism rates reported by the three VTCs examined are inflated or constitute false positives. Copyright © 2016 Elsevier Ltd. All rights reserved.

Development and Validation of a Computerized-Adaptive Test for PTSD (P-CAT).

PubMed

Eisen, Susan V; Schultz, Mark R; Ni, Pengsheng; Haley, Stephen M; Smith, Eric G; Spiro, Avron; Osei-Bonsu, Princess E; Nordberg, Sam; Jette, Alan M

2016-10-01

The primary purpose was to develop, field test, and validate a computerized-adaptive test (CAT) for posttraumatic stress disorder (PTSD) to enhance PTSD assessment and decrease the burden of symptom monitoring. Data sources included self-report and interviewer-administered diagnostic interviews. The sample included 1,288 veterans. In phase 1, 89 items from a previously developed PTSD item pool were administered to a national sample of 1,085 veterans. A multidimensional graded-response item response theory model was used to calibrate items for incorporation into a CAT for PTSD (P-CAT). In phase 2, in a separate sample of 203 veterans, the P-CAT was validated against three other self-report measures (PTSD Checklist, Civilian Version; Mississippi Scale for Combat-Related PTSD; and Primary Care PTSD Screen) and the PTSD module of the Structured Clinical Interview for DSM-IV. A bifactor model with one general PTSD factor and four subfactors consistent with DSM-5 (reexperiencing, avoidance, negative mood-cognitions, and arousal), yielded good fit. The P-CAT discriminated veterans with PTSD from those with other mental health conditions and those with no mental health conditions (Cohen's d effect sizes >.90). The P-CAT also discriminated those with and without a PTSD diagnosis and those who screened positive versus negative for PTSD. Concurrent validity was supported by high correlations (r=.85-.89) with the validation measures. The P-CAT appears to be a promising tool for efficient and accurate assessment of PTSD symptomatology. Further testing is needed to evaluate its responsiveness to change. With increasing availability of computers and other technologies, CAT may be a viable and efficient assessment method.

Acute Kidney Injury Risk Prediction in Patients Undergoing Coronary Angiography in a National Veterans Health Administration Cohort With External Validation.

PubMed

Brown, Jeremiah R; MacKenzie, Todd A; Maddox, Thomas M; Fly, James; Tsai, Thomas T; Plomondon, Mary E; Nielson, Christopher D; Siew, Edward D; Resnic, Frederic S; Baker, Clifton R; Rumsfeld, John S; Matheny, Michael E

2015-12-11

Acute kidney injury (AKI) occurs frequently after cardiac catheterization and percutaneous coronary intervention. Although a clinical risk model exists for percutaneous coronary intervention, no models exist for both procedures, nor do existing models account for risk factors prior to the index admission. We aimed to develop such a model for use in prospective automated surveillance programs in the Veterans Health Administration. We collected data on all patients undergoing cardiac catheterization or percutaneous coronary intervention in the Veterans Health Administration from January 01, 2009 to September 30, 2013, excluding patients with chronic dialysis, end-stage renal disease, renal transplant, and missing pre- and postprocedural creatinine measurement. We used 4 AKI definitions in model development and included risk factors from up to 1 year prior to the procedure and at presentation. We developed our prediction models for postprocedural AKI using the least absolute shrinkage and selection operator (LASSO) and internally validated using bootstrapping. We developed models using 115 633 angiogram procedures and externally validated using 27 905 procedures from a New England cohort. Models had cross-validated C-statistics of 0.74 (95% CI: 0.74-0.75) for AKI, 0.83 (95% CI: 0.82-0.84) for AKIN2, 0.74 (95% CI: 0.74-0.75) for contrast-induced nephropathy, and 0.89 (95% CI: 0.87-0.90) for dialysis. We developed a robust, externally validated clinical prediction model for AKI following cardiac catheterization or percutaneous coronary intervention to automatically identify high-risk patients before and immediately after a procedure in the Veterans Health Administration. Work is ongoing to incorporate these models into routine clinical practice. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Impact of Supported Housing on Social Relationships Among Homeless Veterans.

PubMed

O'Connell, Maria J; Kasprow, Wesley J; Rosenheck, Robert A

2017-02-01

This study examined social network structure and function among a sample of 460 homeless veterans who participated in an experimental trial of the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program. Participants were randomly assigned to HUD-VASH (housing subsidies and case management), case management only, or standard care. Mixed-model longitudinal analysis was used to compare treatment groups on social network outcomes over 18 months. Veterans in HUD-VASH reported significantly greater increases in social support than veterans in the two other groups, as well as greater frequency of contacts, availability of tangible and emotional support, and satisfaction with nonkin relationships over time. These gains largely involved relationships with providers and other veterans encountered in treatment. Supported housing may play a pivotal role in fostering constructive new relationships with persons associated with service programs but may have a more limited impact on natural support networks.

Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: Three Studies in Reliabilty and Validity.

ERIC Educational Resources Information Center

Keane, Terence M.; And Others

1988-01-01

Explored the psychometric properties of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder to assess its internal consistency and factor structure. Administered the test to Vietnam veterans seeking help at Veteran Centers. Demonstrated high test-retest reliability, sensitivity of .93, specificity .89, and overall hit rate .90…

Molecular Mechanisms Underlying Individual Differences in Response to Stress in a Previously Validated Animal Model of PTSD

DTIC Science & Technology

2012-04-01

CONTRACTING ORGANIZATION: Bronx Veterans Medical Research Foundation, Inc... Bronx , NY 10468-3904 REPORT DATE: April 2012 TYPE OF REPORT: Final PREPARED FOR: U.S. Army...WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Bronx Veterans Medical Research

77 FR 56714 - Agency Information Collection (Statement of Accredited Representative in Appealed Case...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-13

... Representative in Appealed Case, VA Form 646. OMB Control Number: 2900-0042. Type of Review: Extension of a... (Statement of Accredited Representative in Appealed Case) Activities Under OMB Review AGENCY: Board of Veterans' Appeals, Department of Veterans Affairs. ACTION: Notice. SUMMARY: In compliance with the...

The challenges of exposure assessment in health studies of Gulf War veterans

PubMed Central

Glass, Deborah C; Sim, Malcolm R

2006-01-01

A variety of exposures have been investigated in Gulf War veterans' health studies. These have most commonly been by self-report in a postal questionnaire but modelling and bio-monitoring have also been employed. Exposure assessment is difficult to do well in studies of any workplace environment. It is made more difficult in Gulf War studies where there are a number and variety of possible exposures, no agreed metrics for individual exposures and few contemporary records associating the exposure with an individual. In some studies, the exposure assessment was carried out some years after the war and in the context of media interest. Several studies have examined different ways to test the accuracy of exposure reporting in Gulf War cohorts. There is some evidence from Gulf War studies that self-reported exposures were subject to recall bias but it is difficult to assess the extent. Occupational exposure-assessment methodology can provide insights into the exposure-assessment process and how to do it well. This is discussed in the context of the Gulf War studies. Alternative exposure-assessment methodologies are presented, although these may not be suitable for widespread use in veteran studies. Due to the poor quality of and accessibility of objective military exposure records, self-assessed exposure questionnaires are likely to remain the main instrument for assessing the exposure for a large number of veterans. If this is to be the case, then validation methods with more objective methods need to be included in future study designs. PMID:16687267

Veterans Affairs: Presumptive Service Connection and Disability Compensation

DTIC Science & Technology

2011-03-28

Orange] dioxin have slightly higher rates of diabetes or prostate cancer, have resulted in an inexorable push to compensate all veterans with... diabetes /prostate cancer even if it is likely that [Agent Orange] dioxin exposure is a determinative factor in only a small percentage of cases. Since it...is impossible to know what role dioxin played in any particular case, all Vietnam veterans with diabetes and prostate cancer have been and are being

Veterans Affairs: Presumptive Service Connection and Disability Compensation

DTIC Science & Technology

2010-09-13

that those exposed to [Agent Orange] dioxin have slightly higher rates of diabetes or prostate cancer, have resulted in an inexorable push to...compensate all veterans with diabetes /prostate cancer even if it is likely that [Agent Orange] dioxin exposure is a determinative factor in only a small...percentage of cases. Since it is impossible to know what role dioxin played in any particular case, all Vietnam veterans with diabetes and prostate

Fatal motor vehicle crashes among veterans of the 1991 Gulf War and exposure to munitions demolitions at Khamisiyah: a nested case-control study.

PubMed

Gackstetter, Gary D; Hooper, Tomoko I; DeBakey, Samar F; Johnson, Amy; Nagaraj, Barbara E; Heller, Jack M; Kang, Han K

2006-04-01

A proposed explanation for the observed higher risk of fatal motor vehicle crashes (MVC) among 1991 Gulf War-deployed veterans is neurocognitive deficits resulting from nerve agent exposure at Khamisiyah, Iraq. Our objective was to assess any association between postwar fatal MVC and possible nerve agent exposure based on 2000 modeled plume data. Cases were defined as MVC deaths with a record in the Department of Transportation Fatality Analysis Reporting System through 1995. Cases (n = 282) and controls (n = 3,131) were derived from a larger nested case-control study of Gulf War-era veterans and limited to Army, male, deployed personnel. Exposure and cumulative dose by case-control status were analyzed using multivariate techniques. Exposure status was not associated with fatal MVC (OR 0.96, 95% CI 0.72-1.26), nor were tertiles of cumulative dose. Findings do not support an association between possible exposures at Khamisiyah and postwar fatal MVC among Gulf War veterans.

Effects of a brief education and treatment-planning group on evidence-based PTSD treatment utilization and completion among veterans.

PubMed

DeViva, Jason C; Bassett, Gwendolyn A; Santoro, Gia M; Fenton, Lisa

2017-08-01

Veterans with posttraumatic stress disorder (PTSD) presenting for care with Veterans Affairs Health Care System (VA) tend not to engage in evidence-based psychotherapies (EBPs) despite widespread availability of these treatments. Though there is little evidence that "readiness for treatment" affects treatment choice, many VA providers believe that interventions to increase readiness would be helpful. This naturalistic study examined the effects of a 4-session education/treatment-planning group on treatment choice among veterans in a VA outpatient PTSD treatment program. Treatment choices and completion rates of 114 veterans who received at least 1 session of the group (EG) were compared with those of 68 veterans who did not receive the group and received PTSD program treatment as usual (TAU). TAU and EG cases were matched on gender and service era. Of 114 EG cases, 52 (45.6%) chose to receive EBPs, compared with 10 of 68 TAU cases (14.7%). These rates were significantly different, χ2(1) = 18.1, p < .0001. Among cases choosing EBPs, 52.2% of EG cases completed the EBPs as planned, compared with 60% of TAU cases. These percentages were not significantly different. Among EG cases choosing EBPs, lower likelihood of treatment completion was related to psychiatric medication prescription, presence of PTSD service connection, and higher overall service-connection level. The education/treatment-planning group was associated with higher likelihood of selecting but not completing EBPs for PTSD. The decision to engage in trauma-focused treatment may be a different process from the decision to complete such treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Personality assessment inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: associations with aggression.

PubMed

Van Voorhees, Elizabeth E; Dennis, Paul A; Elbogen, Eric B; Clancy, Carolina P; Hertzberg, Michael A; Beckham, Jean C; Calhoun, Patrick S

2014-01-01

Posttraumatic stress disorder (PTSD) is associated with aggressive behavior in veterans, and difficulty controlling aggressive urges has been identified as a primary postdeployment readjustment concern. Yet only a fraction of veterans with PTSD commit violent acts. The goals of this study were to (1) examine the higher-order factor structure of Personality Assessment Inventory (PAI) scales in a sample of U.S. military veterans seeking treatment for PTSD; and (2) to evaluate the incremental validity of higher-order latent factors of the PAI over PTSD symptom severity in modeling aggression. The study sample included male U.S. Vietnam (n = 433) and Iraq/Afghanistan (n = 165) veterans who were seeking treatment for PTSD at an outpatient Veterans Affairs (VA) clinic. Measures included the Clinician Administered PTSD Scale, the PAI, and the Conflict Tactics Scale. The sample was randomly split into two equal subsamples (n's = 299) to allow for cross-validation of statistically derived factors. Parallel analysis, variable clustering analysis, and confirmatory factor analyses were used to evaluate the factor structure, and regression was used to examine the association of factor scores with self-reports of aggression over the past year. Three factors were identified: internalizing, externalizing, and substance abuse. Externalizing explained unique variance in aggression beyond PTSD symptom severity and demographic factors, while internalizing and substance abuse did not. Service era was unrelated to reports of aggression. The constructs of internalizing versus externalizing dimensions of PTSD may have utility in identifying characteristics of combat veterans in the greatest need of treatment to help manage aggressive urges. Published 2014 Wiley Periodicals, Inc.

Standing in the middle: Insider/outsider positionality while conducting qualitative research with opposing military veteran political groups

Treesearch

David Flores

2018-01-01

This case study describes the process and challenges of conducting qualitative research on two opposing military veteran political groups: Iraq Veterans Against the War and Vets for Freedom. The discussion is based on a dissertation project that compelled me to reflect on my simultaneous "insider" status as a military veteran and "outsider" status...

Veterans Affairs: The U.S. Court of Appeals for Veterans Claims - Judicial Review of VA Decision Making

DTIC Science & Technology

2011-03-28

Court—Henderson v. Shinseki.........................................................................6 Figures Figure 1. Simplified CAVC Case Review... cases filed and the ultimate disposition of those cases .13 1 See the CAVC’s “History” at...hear witness testimony, or receive new evidence.28 In deciding a case , the CAVC considers the BVA decision, the briefs submitted by the parties

77 FR 39346 - Proposed Information Collection (Statement of Accredited Representative in Appealed Case, VA Form...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

... in Appealed Case, VA Form 646. OMB Control Number: 2900-0042. Type of Review: Extension of a... (Statement of Accredited Representative in Appealed Case, VA Form 646) Activity: Comment Request AGENCY: The Board of Veterans' Appeals (BVA), Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Board of...

38 CFR 3.378 - Changes from activity in pulmonary tuberculosis pension cases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Changes from activity in pulmonary tuberculosis pension cases. 3.378 Section 3.378 Pensions, Bonuses, and Veterans' Relief DEPARTMENT... tuberculosis pension cases. A permanent and total disability rating in effect during hospitalization will not...

38 CFR 3.378 - Changes from activity in pulmonary tuberculosis pension cases.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Changes from activity in pulmonary tuberculosis pension cases. 3.378 Section 3.378 Pensions, Bonuses, and Veterans' Relief DEPARTMENT... tuberculosis pension cases. A permanent and total disability rating in effect during hospitalization will not...

38 CFR 3.378 - Changes from activity in pulmonary tuberculosis pension cases.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Changes from activity in pulmonary tuberculosis pension cases. 3.378 Section 3.378 Pensions, Bonuses, and Veterans' Relief DEPARTMENT... tuberculosis pension cases. A permanent and total disability rating in effect during hospitalization will not...

38 CFR 3.378 - Changes from activity in pulmonary tuberculosis pension cases.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Changes from activity in pulmonary tuberculosis pension cases. 3.378 Section 3.378 Pensions, Bonuses, and Veterans' Relief DEPARTMENT... tuberculosis pension cases. A permanent and total disability rating in effect during hospitalization will not...

38 CFR 3.378 - Changes from activity in pulmonary tuberculosis pension cases.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Changes from activity in pulmonary tuberculosis pension cases. 3.378 Section 3.378 Pensions, Bonuses, and Veterans' Relief DEPARTMENT... tuberculosis pension cases. A permanent and total disability rating in effect during hospitalization will not...

Military Service, Deployments, and Exposures in Relation to Amyotrophic Lateral Sclerosis Etiology

PubMed Central

Beard, John D.; Engel, Lawrence S.; Richardson, David B.; Gammon, Marilie D.; Baird, Coleen; Umbach, David M.; Allen, Kelli D.; Stanwyck, Catherine L.; Keller, Jean; Sandler, Dale P.; Schmidt, Silke; Kamel, Freya

2016-01-01

Background Factors underlying a possible excess of amyotrophic lateral sclerosis (ALS) among military veterans remain unidentified. Limitations of previous studies on this topic include reliance on ALS mortality as a surrogate for ALS incidence, low statistical power, and sparse information on military-related factors. Objectives We evaluated associations between military-related factors and ALS using data from a case-control study of U.S. military veterans. Methods From 2005 to 2010, we identified medical record-confirmed ALS cases via the National Registry of Veterans with ALS and controls via the Veterans Benefits Administration’s Beneficiary Identification and Records Locator System database. In total, we enrolled 621 cases and 958 frequency-matched controls in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study. We collected information on military service and deployments and 39 related exposures. We used unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). We used inverse probability weighting to adjust for potential bias from confounding, missing covariate data, and selection arising from a case group that disproportionately included long-term survivors and a control group that may or may not differ from U.S. military veterans at large. Results The odds of ALS did not differ for veterans of the Air Force, Army, Marines, and Navy. We found higher odds of ALS for veterans whose longest deployment was World War II or the Korean War and a positive trend with total years of all deployments (OR = 1.27; 95% CI: 1.06, 1.52). ALS was positively associated with exposure to herbicides for military purposes, nasopharyngeal radium, personal pesticides, exhaust from heaters or generators, high-intensity radar waves, contaminated food, explosions within one mile, herbicides in the field, mixing and application of burning agents, burning agents in the field, and Agent Orange in the field, with ORs between 1.50 and 7.75. Conclusions Although our results need confirmation, they are potentially important given the large number of U.S. military veterans, and they provide clues to potential factors underlying the apparent increase of ALS in veteran populations. PMID:26923711

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis etiology.

PubMed

Beard, John D; Engel, Lawrence S; Richardson, David B; Gammon, Marilie D; Baird, Coleen; Umbach, David M; Allen, Kelli D; Stanwyck, Catherine L; Keller, Jean; Sandler, Dale P; Schmidt, Silke; Kamel, Freya

2016-05-01

Factors underlying a possible excess of amyotrophic lateral sclerosis (ALS) among military veterans remain unidentified. Limitations of previous studies on this topic include reliance on ALS mortality as a surrogate for ALS incidence, low statistical power, and sparse information on military-related factors. We evaluated associations between military-related factors and ALS using data from a case-control study of U.S. military veterans. From 2005 to 2010, we identified medical record-confirmed ALS cases via the National Registry of Veterans with ALS and controls via the Veterans Benefits Administration's Beneficiary Identification and Records Locator System database. In total, we enrolled 621 cases and 958 frequency-matched controls in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study. We collected information on military service and deployments and 39 related exposures. We used unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). We used inverse probability weighting to adjust for potential bias from confounding, missing covariate data, and selection arising from a case group that disproportionately included long-term survivors and a control group that may or may not differ from U.S. military veterans at large. The odds of ALS did not differ for veterans of the Air Force, Army, Marines, and Navy. We found higher odds of ALS for veterans whose longest deployment was World War II or the Korean War and a positive trend with total years of all deployments (OR=1.27; 95% CI: 1.06, 1.52). ALS was positively associated with exposure to herbicides for military purposes, nasopharyngeal radium, personal pesticides, exhaust from heaters or generators, high-intensity radar waves, contaminated food, explosions within one mile, herbicides in the field, mixing and application of burning agents, burning agents in the field, and Agent Orange in the field, with ORs between 1.50 and 7.75. Although our results need confirmation, they are potentially important given the large number of U.S. military veterans, and they provide clues to potential factors underlying the apparent increase of ALS in veteran populations. Published by Elsevier Ltd.

Assessment of the validity of the CUDIT-R in a subpopulation of cannabis users.

PubMed

Loflin, Mallory; Babson, Kimberly; Browne, Kendall; Bonn-Miller, Marcel

2018-01-01

The Cannabis Use Disorders Identification Test-Revised (CUDIT-R) is an 8-item measure used to screen for cannabis use disorders (CUD). Despite widespread use of the tool, assessments of the CUDIT-R's validity in subpopulations are limited. The current study tested the structural validity and internal consistency of one of the most widely used screening measures for CUD (i.e., CUDIT-R) among a sample of military veterans who use cannabis for medicinal purposes. The present study used confirmatory factor analysis (CFA) to test the internal consistency and validity of the single-factor structure of the original screener among a sample of veterans who use cannabis for medicinal purposes (n = 90 [90% male]; M age  = 55.31, SD = 15.37). Measures included demographics and the CUDIT-R, obtained from the baseline assessment of an ongoing longitudinal study. The CFA revealed that the single-factor model previously validated in recreational using samples only accounted for 38.34% of total variance in responses on the CUDIT-R (χ 2  = 66.09, df = 28, p < 0.05; RMSEA = 0.06) and demonstrated acceptable but modest internal consistency (Cronbach's α = 0.73). More psychometric work is needed to determine the reliability and validity of using the CUDIT-R to screen for CUD among military veterans who use medicinal cannabis and other subpopulations of cannabis users.

Recruitment and retention of young adult veteran drinkers using Facebook

PubMed Central

Pedersen, Eric R.; Naranjo, Diana; Marshall, Grant N.

2017-01-01

The objective of this study was to describe the feasibility of using Facebook as a platform to recruit and retain young adult veteran drinkers into an online-alcohol use intervention study. Facebook’s wide accessibility and popularity among the age group that comprises the majority of veterans from the conflicts in Iraq and Afghanistan make it a compelling resource through which research can extend its reach to this otherwise hard-to-reach group. We developed a series of Facebook advertisement campaigns to reach veteran drinkers not specifically searching for alcohol treatment. In doing so, we recruited 793 valid veteran participants in approximately two weeks for an advertising cost of $4.53 per obtained participant. The study sample consisted primarily of male veterans, between 19 and 34 years of age, who were drinking at moderate to heavy levels. Although about half of the sample reported mental health comorbidity, few had received any mental health or substance use treatment in the past year. Facebook appears to be a valuable mechanism through which to recruit young veterans with unmet behavioral health needs, although more specific efforts may be needed to engage certain types of veterans after initial study enrollment. PMID:28249027

Recruitment and retention of young adult veteran drinkers using Facebook.

PubMed

Pedersen, Eric R; Naranjo, Diana; Marshall, Grant N

2017-01-01

The objective of this study was to describe the feasibility of using Facebook as a platform to recruit and retain young adult veteran drinkers into an online-alcohol use intervention study. Facebook's wide accessibility and popularity among the age group that comprises the majority of veterans from the conflicts in Iraq and Afghanistan make it a compelling resource through which research can extend its reach to this otherwise hard-to-reach group. We developed a series of Facebook advertisement campaigns to reach veteran drinkers not specifically searching for alcohol treatment. In doing so, we recruited 793 valid veteran participants in approximately two weeks for an advertising cost of $4.53 per obtained participant. The study sample consisted primarily of male veterans, between 19 and 34 years of age, who were drinking at moderate to heavy levels. Although about half of the sample reported mental health comorbidity, few had received any mental health or substance use treatment in the past year. Facebook appears to be a valuable mechanism through which to recruit young veterans with unmet behavioral health needs, although more specific efforts may be needed to engage certain types of veterans after initial study enrollment.

Access to Care for Transgender Veterans in the Veterans Health Administration: 2006–2013

PubMed Central

Shipherd, Jillian C.; Lindsay, Jan; Blosnich, John R.; Brown, George R.; Jones, Kenneth T.

2014-01-01

A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care. PMID:25100417

Access to care for transgender veterans in the Veterans Health Administration: 2006-2013.

PubMed

Kauth, Michael R; Shipherd, Jillian C; Lindsay, Jan; Blosnich, John R; Brown, George R; Jones, Kenneth T

2014-09-01

A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care.

Integrating Validity Theory with Use of Measurement Instruments in Clinical Settings

PubMed Central

Kelly, P Adam; O'Malley, Kimberly J; Kallen, Michael A; Ford, Marvella E

2005-01-01

Objective To present validity concepts in a conceptual framework useful for research in clinical settings. Principal Findings We present a three-level decision rubric for validating measurement instruments, to guide health services researchers step-by-step in gathering and evaluating validity evidence within their specific situation. We address construct precision, the capacity of an instrument to measure constructs it purports to measure and differentiate from other, unrelated constructs; quantification precision, the reliability of the instrument; and translation precision, the ability to generalize scores from an instrument across subjects from the same or similar populations. We illustrate with specific examples, such as an approach to validating a measurement instrument for veterans when prior evidence of instrument validity for this population does not exist. Conclusions Validity should be viewed as a property of the interpretations and uses of scores from an instrument, not of the instrument itself: how scores are used and the consequences of this use are integral to validity. Our advice is to liken validation to building a court case, including discovering evidence, weighing the evidence, and recognizing when the evidence is weak and more evidence is needed. PMID:16178998

Design and challenges for a randomized, multi-site clinical trial comparing the use of service dogs and emotional support dogs in Veterans with post-traumatic stress disorder (PTSD).

PubMed

Saunders, Gabrielle H; Biswas, Kousick; Serpi, Tracey; McGovern, Stephanie; Groer, Shirley; Stock, Eileen M; Magruder, Kathryn M; Storzbach, Daniel; Skelton, Kelly; Abrams, Thad; McCranie, Mark; Richerson, Joan; Dorn, Patricia A; Huang, Grant D; Fallon, Michael T

2017-11-01

Posttraumatic stress disorder (PTSD) is a leading cause of impairments in quality of life and functioning among Veterans. Service dogs have been promoted as an effective adjunctive intervention for PTSD, however published research is limited and design and implementation flaws in published studies limit validated conclusions. This paper describes the rationale for the study design, a detailed methodological description, and implementation challenges of a multisite randomized clinical trial examining the impact of service dogs on the on the functioning and quality of life of Veterans with PTSD. Trial design considerations prioritized participant and intervention (dog) safety, selection of an intervention comparison group that would optimize enrollment in all treatment arms, pragmatic methods to ensure healthy well-trained dogs, and the selection of outcomes for achieving scientific and clinical validity in a Veteran PTSD population. Since there is no blueprint for conducting a randomized clinical trial examining the impact of dogs on PTSD of this size and scope, it is our primary intent that the successful completion of this trial will set a benchmark for future trial design and scientific rigor, as well as guiding researchers aiming to better understand the role that dogs can have in the management of Veterans experiencing mental health conditions such as PTSD. Published by Elsevier Inc.

Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

PubMed

Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

2011-01-01

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

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

PubMed Central

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

The Moral Injury Symptom Scale-Military Version.

PubMed

Koenig, Harold G; Ames, Donna; Youssef, Nagy A; Oliver, John P; Volk, Fred; Teng, Ellen J; Haynes, Kerry; Erickson, Zachary D; Arnold, Irina; O'Garo, Keisha; Pearce, Michelle

2018-02-01

The purpose of this study was to develop a multi-dimensional measure of moral injury symptoms that can be used as a primary outcome measure in intervention studies that target moral injury (MI) in Veterans and Active Duty Military with PTSD. This was a multi-center study of 427 Veterans and Active Duty Military with PTSD symptoms recruited from VA Medical Centers in Augusta, Los Angeles, Durham, Houston, and San Antonio, and from Liberty University in Lynchburg. Internal reliability of the Moral Injury Symptom Scale-Military Version (MISS-M) was examined along with factor analytic, discriminant, and convergent validity. Participants were randomly split into two equal samples, with exploratory factor analysis conducted in the first sample and confirmatory factor analysis in the second. Test-retest reliability was assessed in a subsample of 64 Veterans. The 45-item MISS-M consists of 10 theoretically grounded subscales assessing guilt, shame, moral concerns, religious struggles, loss of religious faith/hope, loss of meaning/purpose, difficulty forgiving, loss of trust, and self-condemnation. The Cronbach's alpha of the overall scale was .92 and of individual subscales ranged from .56 to .91. The test-retest reliability was .91 for the total scale and ranged from .78 to .90 for subscales. Discriminant validity was demonstrated by relatively weak correlations with other psychosocial, religious, and physical health constructs, and convergent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms. The MISS-M is a reliable and valid multi-dimensional symptom measure of moral injury that can be used in studies targeting MI in Veterans and Active Duty Military with PTSD symptoms and may also be used by clinicians to identify those at risk.

Understanding mail survey response rates among male reserve component Gulf War era veterans.

PubMed

Schumm, W R; Bollman, S R; Jurich, A P; Castelo, C; Sanders, D; Webb, F J

2000-12-01

In this study of current and former male Reserve and National Guard members from the State of Ohio, it was expected that veterans who were older, had more years of military service, who had participated in the Persian Gulf War, who were Euro-Americans, who were higher in rank, who had higher residential stability in Ohio, who belonged to the Air Force, who had higher formal education, and who belonged to the National Guard would have a greater investment in U.S. society as defined by 11 demographic variables. It was assumed that those with greater investment in society would more often have valid addresses and would be more likely to respond to a survey on military issues, thereby biasing sample outcomes in those directions. Results for male veterans were consistent with the hypothesis that investment in the society system would predict validity of addresses and response rates. In other words, results supported the idea that those veterans who might be expected to have a greater investment in U.S. society were more likely to be located and to respond (once located) to a survey concerning Desert Storm-era military service and its aftermath. Implications for future Desert Storm research are discussed.

Detecting Symptom Exaggeration in Combat Veterans Using the MMPI-2 Symptom Validity Scales: A Mixed Group Validation

ERIC Educational Resources Information Center

Tolin, David F.; Steenkamp, Maria M.; Marx, Brian P.; Litz, Brett T.

2010-01-01

Although validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) have proven useful in the detection of symptom exaggeration in criterion-group validation (CGV) studies, usually comparing instructed feigners with known patient groups, the…

Research Driven Policy: Is Financial Capacity Related to Dangerousness?

PubMed

DeLeon, Patrick H; Paxton, Maegan M; Spencer, Tonya; Bajjani-Gebara, Jouhayna E

2018-05-22

Current Veterans administration policy directly links a Veteran's adjudged capacity to manage personal financial resources with their ability to purchase or possess a firearm, pursuant to the regulatory authority of the National Instant Criminal Background Check System (NICS). Preventing Veterans' suicide is a highly laudable public health objective. Effectively utilizing scientific research to "inform" public policy is equally important. The authors should be congratulated for their efforts. However, it is important in utilizing large set population-based data, especially social science data, to evaluate policy alternatives that there be substantial face (i.e., clinical) validity. Correlation does not necessarily represent causation.

Understanding Health-related Quality of Life in Caregivers of Civilians and Service Members/Veterans with Traumatic Brain Injury: Establishing the Reliability and Validity of PROMIS Mental Health Measures.

PubMed

Carlozzi, Noelle E; Hanks, Robin; Lange, Rael T; Brickell D Psych, Tracey A; Ianni, Phillip A; Miner, Jennifer A; French Psy D, Louis M; Kallen, Michael A; Sander, Angelle M

2018-06-19

To provide important reliability and validity data to support the use of the PROMIS Mental Health measures in caregivers of civilians or service members/veterans with traumatic brain injury (TBI). Patient-reported outcomes surveys administered through an electronic data collection platform. Three TBI Model Systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. 560 caregivers of individuals with a documented TBI (344 civilians and 216 military) INTERVENTION: Not Applicable MAIN OUTCOME MEASURES: PROMIS Anxiety, Depression, and Anger Item Banks RESULTS: Internal consistency for all of the PROMIS Mental Health item banks was very good (all α > .86) and three-week test retest reliability was good to adequate (ranged from .65 to .85). Convergent validity and discriminant validity of the PROMIS measures was also supported. Caregivers of individuals that were low functioning had worse emotional HRQOL (as measured by the three PROMIS measures) than caregivers of high functioning individuals, supporting known groups validity. Finally, levels of distress, as measured by the PROMIS measures, were elevated for those caring for low-functioning individuals in both samples (rates ranged from 26.2% to 43.6% for caregivers of low-functioning individuals). Results support the reliability and validity of the PROMIS Anxiety, Depression, and Anger item banks in caregivers of civilians and service members/veterans with TBI. Ultimately, these measures can be used to provide a standardized assessment of HRQOL as it relates to mental health in these caregivers. Copyright © 2018. Published by Elsevier Inc.

Associations between compulsory physical activity during military service and activity in later adulthood among male veterans compared with nonveterans.

PubMed

Littman, Alyson J; Forsberg, Christopher W; Boyko, Edward J

2013-08-01

Military veterans provide a large and diverse population to examine the extent to which compulsory physical activity (PA) in early adulthood is associated with PA later in life. We assessed self-reported and objectively measured PA and sedentary time in the 900 veterans and 2036 nonveterans with valid data from the 2003-2006 National Health and Nutrition Examination Surveys. Analyses were adjusted for the complex survey design and age, race/ethnicity, education, marital status, and poverty. Based on self-report, the proportion of veterans and nonveterans meeting PA Guidelines did not differ significantly (51.1% vs. 43.9%, P = .26). However, a greater proportion of veterans reported regular vigorous leisure-time activity (30.4% vs. 19.6%, P = .04) and muscle-strengthening activities (24.4 vs. 16.7, P = .051). Based on objective PA monitoring, activity levels between veterans and nonveterans also did not differ significantly, although mean counts and minutes per day were numerically greater in nonveterans. By self-report (P = .02) and PA monitors (P = .065), estimated sedentary time was greater in veterans than in demographically similar nonveterans. Veterans were no more likely than nonveterans to meet PA Guidelines, but may have been more likely to perform vigorous activities and conversely, to spend more time in sedentary activities.

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

PubMed

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.

Clinical findings for the first 1000 Gulf war veterans in the Ministry of Defence’s medical assessment programme

PubMed Central

Coker, W J; Bhatt, B M; Blatchley, N F; Graham, J T

1999-01-01

Objective To review the clinical findings in the first 1000 veterans seen in the Ministry of Defence’s Gulf war medical assessment programme to examine whether there was a particular illness related to service in the Gulf. Design Case series of 1000 veterans who presented to the programme between 11 October 1993 and 24 February 1997. Subjects Gulf war veterans. Main outcome measures Diagnosis of veterans’ conditions according to ICD-10 (international classification of diseases, 10th revision). Cases referred for psychiatric assessment were reviewed for available diagnostic information from consultant psychiatrists. Results 588 (59%) veterans had more than one diagnosed condition, 387 (39%) had at least one condition for which no firm somatic or psychological diagnosis could be given, and in 90 (9%) veterans no other main diagnosis was made. Conditions characterised by fatigue were found in 239 (24%) of patients. At least 190 (19%) patients had a psychiatric condition, which in over half was due to post-traumatic stress disorder. Musculoskeletal disorders and respiratory conditions were also found to be relatively common (in 182 (18%) and 155 (16%) patients respectively). Conclusion Many Gulf war veterans had a wide variety of symptoms. This initial review shows no evidence of a single illness, psychological or physical, to explain the pattern of symptoms seen in veterans in the assessment programme. As the veterans assessed by the programme were all self selected, the prevalence of illness in Gulf war veterans cannot be determined from this study. Furthermore, it is not known whether the veterans in this study were representative of sick veterans as a group. Key messagesMany Gulf war veterans present with a wide variety of symptoms No single cause has been found to explain these symptomsFrom a clinical standpoint the variety and multiplicity of symptoms makes it unlikely that any single cause will be found to underlie Gulf war illnessSome of the illnesses may be an example of a postwar syndrome PMID:9924053

Budget Impact Analysis of Veterans Affairs Medical Foster Homes versus Community Living Centers.

PubMed

Sutton, Bryce S; Pracht, Étienne; Williams, Arthur R; Alemi, Farrokh; Williams, Allison E; Levy, Cari

2017-02-01

The objectives were to determine whether and by what amounts the US Department of Veterans Affairs (VA) use of Medical Foster Homes (MFH) rather than Community Living Centers (CLC) reduced budget impacts to the VA. This was a retrospective, matched, case-control study of veterans residing in MFH or CLC in the VA health care system from 2008 to 2012. Administrative data sets, nearest neighbor matching, generalized linear models, and a secondary analysis were used to capture and analyze budget impacts by veterans who used MFH or CLC exclusively in 2008-2012. Controls of 1483 veterans in CLC were matched to 203 cases of veterans in MFH. Use of MFH instead of CLC reduced budget impacts to the VA by at least $2645 per veteran per month. A secondary analysis of the data using different matching criteria and statistical methods produced similar results, demonstrating the robustness of the estimates of budget impact. When the average out-of-pocket payments made by MFH residents, not made by CLC residents, were included in the analysis, the net reduction of budget impact ranged from $145 to $2814 per veteran per month or a savings of $1740 to $33,768 per veteran per year. Even though outpatient costs of MFH are higher, much of the reduced budget impact of MFH use arises from lower inpatient or hospital costs. Reduced budget impacts on the VA system indicate that expansion of the MFH program may be cost-effective. Implications for further research are suggested.

38 CFR 11.116 - Death of veteran before final settlement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to the beneficiary under section 501 of the World War Adjusted Compensation Act, as amended, payment... shall be made. In such case, payment of the certificate will be made under the World War Adjusted... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Death of veteran before...

38 CFR 11.116 - Death of veteran before final settlement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... to the beneficiary under section 501 of the World War Adjusted Compensation Act, as amended, payment... shall be made. In such case, payment of the certificate will be made under the World War Adjusted... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Death of veteran before...

Reaction of Vietnam Veterans to the Persian Gulf War.

ERIC Educational Resources Information Center

Kobrick, Felice R.

1993-01-01

Reviews evolution of the concept of combat-related posttraumatic stress disorder and analyzes reports of Vietnam veterans' reactions to the Persian Gulf War. Presents case study of Vietnam veteran whose traumatic memories were reawakened with the onset of the Persian Gulf War, and discusses implications for social work practice. (Author/NB)

Development and validation of an instrument to assess imminent risk of homelessness among veterans.

PubMed

Montgomery, Ann Elizabeth; Fargo, Jamison D; Kane, Vincent; Culhane, Dennis P

2014-01-01

Veterans are overrepresented within the homeless population compared with their non-veteran counterparts, particularly when controlling for poverty. The U.S. Department of Veterans Affairs (VA) aims to prevent new episodes of homelessness by targeting households at greatest risk; however, there are no instruments that systematically assess veterans' risk of homelessness. We developed and tested a brief screening instrument to identify imminent risk of homelessness among veterans accessing VA health care. The study team developed initial assessment items, conducted cognitive interviews with veterans experiencing homelessness, refined pilot items based on veterans' and experts' feedback and results of psychometric analyses, and assigned weights to items in the final instrument to indicate a measure of homelessness risk. One-third of veterans who responded to the field instrument reported imminent risk of homelessness (i.e., housing instability in the previous 90 days or expected in the next 90 days). The reliability coefficient for the instrument was 0.85, indicating good internal consistency. Veterans who had a recent change in income, had unpaid housing expenses, were living temporarily with family and friends, needed help to get or keep housing, and had poor rental and credit histories were more likely to report a risk of homelessness than those who did not. This study provides the field with an instrument to identify individuals and households at risk of or experiencing homelessness, which is necessary to prevent and end homelessness. In addition, it supports VA's investment in homelessness prevention and rapid rehousing services for veterans who are experiencing or are at risk for homelessness.

38 CFR 21.98 - Appeal of disagreement regarding development of, or change in, the plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... case manager will forward the request together with relevant comment to the VR&E Officer who will: (1... reviewed by the Director, VR&E in any case in which the VR&E Officer is the case manager. The veteran will... may appeal an adverse decision of the VR&E Officer, or the Director, VR&E to the Board of Veterans...

38 CFR 21.98 - Appeal of disagreement regarding development of, or change in, the plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... case manager will forward the request together with relevant comment to the VR&E Officer who will: (1... reviewed by the Director, VR&E in any case in which the VR&E Officer is the case manager. The veteran will... may appeal an adverse decision of the VR&E Officer, or the Director, VR&E to the Board of Veterans...

38 CFR 21.98 - Appeal of disagreement regarding development of, or change in, the plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

... case manager will forward the request together with relevant comment to the VR&E Officer who will: (1... reviewed by the Director, VR&E in any case in which the VR&E Officer is the case manager. The veteran will... may appeal an adverse decision of the VR&E Officer, or the Director, VR&E to the Board of Veterans...

38 CFR 21.98 - Appeal of disagreement regarding development of, or change in, the plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... case manager will forward the request together with relevant comment to the VR&E Officer who will: (1... reviewed by the Director, VR&E in any case in which the VR&E Officer is the case manager. The veteran will... may appeal an adverse decision of the VR&E Officer, or the Director, VR&E to the Board of Veterans...

38 CFR 21.98 - Appeal of disagreement regarding development of, or change in, the plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... case manager will forward the request together with relevant comment to the VR&E Officer who will: (1... reviewed by the Director, VR&E in any case in which the VR&E Officer is the case manager. The veteran will... may appeal an adverse decision of the VR&E Officer, or the Director, VR&E to the Board of Veterans...

Evaluating the Medical Symptom Validity Test (MSVT) in a Sample of Veterans Between the Ages of 18 to 64.

PubMed

Reslan, Summar; Axelrod, Bradley N

2017-01-01

The purpose of the current study was to compare three potential profiles of the Medical Symptom Validity Test (MSVT; Pass, Genuine Memory Impairment Profile [GMIP], and Fail) on other freestanding and embedded performance validity tests (PVTs). Notably, a quantitatively computed version of the GMIP was utilized in this investigation. Data obtained from veterans referred for a neuropsychological evaluation in a metropolitan Veteran Affairs medical center were included (N = 494). Individuals age 65 and older were not included to exclude individuals with dementia from this investigation. The sample revealed 222 (45%) in the Pass group. Of the 272 who failed the easy subtests of the MSVT, 221 (81%) met quantitative criteria for the GMIP and 51 (19%) were classified as Fail. The Pass group failed fewer freestanding and embedded PVTs and obtained higher raw scores on all PVTs than both GMIP and Fail groups. The differences in performances of the GMIP and Fail groups were minimal. Specifically, GMIP protocols failed fewer freestanding PVTs than the Fail group; failure on embedded PVTs did not differ between GMIP and Fail. The MSVT GMIP incorporates the presence of clinical correlates of disability to assist with this distinction, but future research should consider performances on other freestanding measures of performance validity to differentiate cognitive impairment from invalidity.

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

PubMed

Chao, Linda L

2018-05-18

Although not a "signature injury" of Operation Desert Shield/Desert Storm (i.e., Gulf War, GW), some GW veterans have a history traumatic brain injury (TBI). For example, a previous study found that 12.2% of the GW veterans from the Fort Devens Cohort Study had self-reported TBIs. The present study sought to build upon this finding by examining the relationship between TBI and chronic symptomatic illness in a different sample of GW veterans. Participants were 202 GW veterans recruited from 2014 to 2018 at the San Francisco Veterans Affairs Medical Center as part of a VA-funded study on the effects of predicted exposure to low levels of sarin and cyclosarin on brain structure and function. The Ohio State University TBI identification method was used to determine lifetime history of TBI. The Kansas Gulf War Military History and Health Questionnaire was used to assess symptoms and to determine cases of Kansas Gulf War Illness (GWI) and Centers for Disease Control and Prevention (CDC) Chronic Multisymptom Illness (CMI). Nearly half (47%) the sample had a history of TBI, but only 7% of the TBIs were sustained in injuries that occurred during the GW. Most of the TBIs were sustained in injuries that occurred prior to (73%) or after (34%) the GW. History of TBI was not associated with higher rates of symptomatic illness when it was narrowly defined (i.e., Kansas GWI cases or cases of severe CMI). History of TBI was only associated with higher rates of symptomatic illness when it is broadly defined (i.e., CDC CMI or mild-moderate CMI). There was suggestive evidence that veterans who sustained TBIs during the GW (only seven in the present sample) have poorer functional outcomes compared with GW veterans with non-GW related TBIs. While TBIs were uncommon during the GW, many GW veterans sustained TBIs prior or after the GW. Because TBI and GWI/CMI share some overlapping symptoms, history of TBI may appear to be associated with increased rates of chronic symptomatic illness in 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.

Courage to care for our United States veterans: A constructivist way of teaching and learning for future nurses.

PubMed

Magpantay-Monroe, Edna R

2018-01-01

The knowledge and skills in providing veteran centered care is essential. The purpose of this retrospective evaluation is to examine a faculty's reflections on a BSN psychiatric mental health curriculum initiative that provides knowledge and skills regarding veterans care through several avenues to senior nursing students. This qualitative study use self-reflections through a constructivist view of teaching and learning as the framework. Open discussions in didactic about the unique psychological health issues of veterans formed a foundational knowledge for the students. The seminar time was used to discuss real veteran case situations. Simulation provided opportunities to address veteran resources. Problem based projects use available evidence to solve veteran health issues. The educators show their commitment to the compassionate and caring ideals of our profession by fostering an educational environment where future nurses can truly learn about veteran centered care. Copyright © 2017. Published by Elsevier Ltd.

Engagement in the Hepatitis C Care Cascade Among Homeless Veterans, 2015.

PubMed

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

The Veterans Health Administration (VHA) is the largest provider of hepatitis C virus (HCV) care nationally and provides health care to >200 000 homeless veterans each year. We used the VHA's Corporate Data Warehouse and HCV Clinical Case Registry to evaluate engagement in the HCV care cascade among homeless and nonhomeless veterans in VHA care in 2015. We estimated that, among 242 740 homeless veterans in care and 5 424 712 nonhomeless veterans in care, 144 964 (13.4%) and 188 156 (3.5%), respectively, had chronic HCV infection. Compared with nonhomeless veterans, homeless veterans were more likely to be diagnosed with chronic HCV infection and linked to HCV care but less likely to have received antiviral therapy despite comparable sustained virologic response rates. Homelessness should not necessarily preclude HCV treatment eligibility with available all-oral antiviral regimens.

Leaders on the Front Line--Managing Emotion for Ethical Decision Making

ERIC Educational Resources Information Center

Tenuto, Penny L.; Gardiner, Mary E.; Yamamoto, Julie K.

2016-01-01

To build capacity for students in educational leadership programs, we developed a teaching case study focused on managing emotion for ethical decision making in supervision of personnel. The case offers troubling encounters between a secondary assistant principal and a novice teacher, a veteran teacher, and a veteran administrator. Scenarios…

Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

PubMed

Mohamed, Somaia

2013-03-01

There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

Transitioning home: comprehensive case management for America's heroes.

PubMed

Perla, Lisa Y; Jackson, Patricia D; Hopkins, Sherry L; Daggett, Margaret C; Van Horn, Linda J

2013-01-01

The conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, have created unique challenges for rehabilitation teams, including nurse and social work case managers. Active duty service members, National Guard and Reservists have deployed in large numbers and as many as 20% have been exposed to blast injury, which can result in polytrauma and traumatic brain injury, the "signature injury" of the war, as well as psychological trauma, and painful musculoskeletal injuries. In addition, there are also documented emotional injuries associated with the constant stress of war and the frequency of exposure to the graphic scenes of war. The Departments of Defense and Veterans Affairs work closely to provide comprehensive care coordination and case management for service members and veterans who have honorably served our country. This article describes the case management collaborative between Veterans Affairs and the Department of Defense that ensures service members and veterans receive their entitled healthcare services. The complex care needs of these returning service members require astute case management in addition to clinical care. This collaboration ensures the best life-long outcomes and will be discussed in detail in this article. © 2013 Association of Rehabilitation Nurses.

Web-Based Predictive Analytics to Improve Patient Flow in the Emergency Department

NASA Technical Reports Server (NTRS)

Buckler, David L.

2012-01-01

The Emergency Department (ED) simulation project was established to demonstrate how requirements-driven analysis and process simulation can help improve the quality of patient care for the Veterans Health Administration's (VHA) Veterans Affairs Medical Centers (VAMC). This project developed a web-based simulation prototype of patient flow in EDs, validated the performance of the simulation against operational data, and documented IT requirements for the ED simulation.

Survey results of Internet and computer usage in veterans with epilepsy.

PubMed

Pramuka, Michael; Hendrickson, Rick; Van Cott, Anne C

2010-03-01

After our study of a self-management intervention for epilepsy, we gathered data on Internet use and computer availability to assess the feasibility of computer-based interventions in a veteran population. Veterans were asked to complete an anonymous questionnaire that gathered information regarding seizures/epilepsy in addition to demographic data, Internet use, computer availability, and interest in distance education regarding epilepsy. Three hundred twenty-four VA neurology clinic patients completed the survey. One hundred twenty-six self-reported a medical diagnosis of epilepsy and constituted the epilepsy/seizure group. For this group of veterans, the need for remote/distance-based interventions was validated given the majority of veterans traveled long distances (>2 hours). Only 51% of the epilepsy/seizure group had access to the Internet, and less than half (42%) expressed an interest in getting information on epilepsy self-management on their computer, suggesting that Web-based interventions may not be an optimal method for a self-management intervention in this population. Published by Elsevier Inc.

Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

PubMed

Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

2016-01-01

The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

Masticatory muscle and temporomandibular joint pain in Croatian war veterans with posttraumatic stress disorder.

PubMed

Uhac, Ivone; Tariba, Petra; Kovac, Zoran; Simonić-Kocijan, Suncana; Lajnert, Vlatka; Mesić, Vesna Fugosić; Kuis, Davor; Braut, Vedrana

2011-12-01

The aim of this study was to investigate the prevalence and intensity of masticatory muscle and temporomandibular joint (TMJ) pain in Croatian war veterans with posttraumatic stress disorder (PTSD). The examined group consisted of 100 Croatian war veterans, in whom PTSD had previously been diagnosed. Patients were compared with 92 subjects who had not taken part in the war and in whom PTSD was excluded by psychiatric examination. The clinical examination consisted of palpation of the masticatory muscles, the prominent neck musculature, and TMJ. The examination technique used and the definition of items were previously tested for reliability and validity. 93% of the subjects with PTSD had masticatory muscle tenderness compared to 45.65% of the subjects in the control group (chi2 = 51.46, p < 0.0001). The most frequent painful location in the subjects with PTSD was the left lateral pterygoid site in 88%, and in subjects of the control group the right lateral pterygoid site in 28.26% of cases. The most painful location in the PTSD group was the left lateral pterygoid site in 72%, and in the control group the left posterior digastric in 4.35% of cases. 58% of the subjects with PTSD had TMJ tenderness compared to 3.26% of subjects in the control group (chi2 = 66.23, p < 0.0001). The most frequent painful location of TMJ in both groups was the left posterior capsule; in the PTSD group 38% and in subjects in the control group 2.17% of cases. The most painful location was the left posterior capsule in 28% of subjects with PTSD, while not one subject in the control group reported severe painful sensitivity. The very high frequency and intensity of pain in subjects with PTSD confirms the effect of stress on muscle and joint sensitivity, i.e. perception of pain.

Psychological health of Australian veterans of the 1991 Gulf War: an assessment using the SF-12, GHQ-12 and PCL-S.

PubMed

McKenzie, D P; Ikin, J F; McFarlane, A C; Creamer, M; Forbes, A B; Kelsall, H L; Glass, D C; Ittak, P; Sim, M R

2004-11-01

Elevated rates of psychological morbidity and symptomatology have been widely reported in 1991 Gulf War veterans. The present study used brief self-report instruments to compare the psychological health of Australian Gulf War veterans with that of a randomly sampled military comparison group. The 12-item Short Form Health Survey (SF-12), 12-item General Health Questionnaire (GHQ-12), Posttraumatic Stress Disorder Checklist--Specific (PCL-S) and Military Service Experience (MSE) questionnaire were administered to 1424 male Australian Gulf War veterans and 1548 male Australian Defence Force members who were operational at the time of the Gulf War conflict, but were not deployed there. The Gulf War veterans exhibited poorer psychological health, as measured by the above three instruments, than the comparison group members. For Gulf War veterans, the number of stressful experiences, as measured by the MSE questionnaire, was correlated with scores on the three instruments. SF-12 mental health component summary scores and PCL-S caseness, but not GHQ-12 caseness, differed significantly between Gulf War veterans and comparison group members who had been on at least one active deployment. More than a decade after the 1991 Gulf War, Australian Gulf War veterans are exhibiting higher levels of current (past month) psychological ill-health, as measured using the GHQ-12 and PCL-S, as well as lower mental health status, as measured by the SF-12, than the comparison group. Although not a replacement for formal psychiatric diagnosis, instruments such as those above may aid in the assessment of veterans' psychological health.

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.

PubMed

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, and with having received a retrobulbar block. Patients without a history of PTSD were more likely to have received topical anesthesia with or without sedation. The veteran population requires more sedation to allay anxiety and perceptions of discomfort, which may account for longer surgical times. The veteran population is a special population and it is important to investigate how PTSD in the veteran population affects intra-operative analgesia.

13 CFR 125.10 - Who does SBA consider to control an SDVO SBC?

Code of Federal Regulations, 2010 CFR

2010-01-01

... partners, with control over all partnership decisions. (d) Control over a limited liability company. In the case of a limited liability company, one or more service-disabled veterans (or in the case of a veteran... managing members, with control over all decisions of the limited liability company. (e) Control over a...

Intimate partner violence among women veterans by sexual orientation.

PubMed

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.

Veterans Coming Home to the Community College: Linking Research to Practice

ERIC Educational Resources Information Center

Persky, Karen R.; Oliver, Diane E.

2011-01-01

Community colleges must prepare for change as increasing numbers of students who are veterans of the Iraq and Afghanistan Wars use their post-9/11 GI Bill benefits to join the colleges' diverse student bodies. Based on the findings of a mixed methods case study, needs of veterans at the community college are framed and discussed within five major…

Posttraumatic Stress Disorder, Traumatic Brain Injury, and Suicide Attempt History among Veterans Receiving Mental Health Services

ERIC Educational Resources Information Center

Brenner, Lisa A.; Betthauser, Lisa M.; Homaifar, Beeta Y.; Villarreal, Edgar; Harwood, Jeri E. F.; Staves, Pamela J.; Huggins, Joseph A.

2011-01-01

History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center…

Severe Pain in Veterans: The Effect of Age and Sex, and Comparisons With the General Population.

PubMed

Nahin, Richard L

2017-03-01

This study provides national prevalence estimates of US military veterans with severe pain, and compares veterans with nonveterans of similar age and sex. Data used are from the 2010 to 2014 National Health Interview Survey on 67,696 adults who completed the Adult Functioning and Disability Supplement. Participants with severe pain were identified using a validated pain severity coding system imbedded in the National Health Interview Survey Adult Functioning and Disability Supplement. It was estimated that 65.5% of US military veterans reported pain in the previous 3 months, with 9.1% classified as having severe pain. Compared with veterans, fewer nonveterans reported any pain (56.4%) or severe pain (6.4%). Whereas veterans aged 18 to 39 years had significantly higher prevalence rates for severe pain (7.8%) than did similar-aged nonveterans (3.2%), veterans age 70 years or older were less likely to report severe pain (7.1%) than nonveterans (9.6%). Male veterans (9.0%) were more likely to report severe pain than male nonveterans (4.7%); however, no statistically significant difference was seen between the 2 female groups. The prevalence of severe pain was significantly higher in veterans with back pain (21.6%), jaw pain (37.5%), severe headaches or migraine (26.4%), and neck pain (27.7%) than in nonveterans with these conditions (respectively: 16.7%, 22.9%, 15.9%, and 21.4%). Although veterans (43.6%) were more likely than nonveterans (31.5%) to have joint pain, no difference was seen in the prevalence of severe pain associated with this condition. Prevalence of severe pain, defined as that which occurs "most days" or "every day" and bothers the individual "a lot," is strikingly more common in veterans than in members of the general population, particularly in veterans who served during recent conflicts. Additional assistance may be necessary to help veterans cope with their pain. Published by Elsevier Inc.

Severe Pain in Veterans: The Impact of Age and Sex, and Comparisons to the General Population

PubMed Central

Nahin, Richard L.

2016-01-01

This study provides national prevalence estimates of US military Veterans with severe pain, and compares Veterans to nonveterans of similar age and sex. Data used are from the 2010–2014 National Health Interview Survey (NHIS) on 67,696 adults who completed the Adult Functioning and Disability (AFD) Supplement. Participants with severe pain were identified using a validated pain severity coding system imbedded in the NHIS AFD. It was estimated that 65.5% of US military Veterans reported pain in the previous 3 months, with 9.1% classified as having severe pain. In comparison to Veterans, fewer nonveterans reported any pain (56.4%) or severe pain (6.4%). While Veterans aged 18–39 had significantly higher prevalence rates for severe pain (7.8%) than did similar-aged nonveterans (3.2%), Veterans age 70 or older were less likely to report severe pain (7.1%) than nonveterans (9.6%). Male Veterans (9.0%) were more likely to report severe pain than male nonveterans (4.7%); however, no statistically significant difference was seen between the two female groups. The prevalence of severe pain was significantly higher in Veterans with back pain (21.6%), jaw pain (37.5%), severe headaches or migraine (26.4%), and neck pain (27.7%) than in nonveterans with these conditions (respectively: 16.7%; 22.9%; 15.9%; and 21.4%). Although Veterans (43.6%) were more likely than nonveterans (31.5%) to have joint pain, no difference was seen in the prevalence of severe pain associated with this condition. Perspective Prevalence of severe pain, defined as that which occurs “most days” or “every day” and bothers the individual “a lot”, is strikingly more common in Veterans than in members of the general population, particularly in Veterans who served during recent conflicts. Additional assistance may be necessary to help Veterans cope with their pain. PMID:27884688

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival

PubMed Central

Beard, John D.; Engel, Lawrence S.; Richardson, David B.; Gammon, Marilie D.; Baird, Coleen; Umbach, David M.; Allen, Kelli D.; Stanwyck, Catherine L.; Keller, Jean; Sandler, Dale P.; Schmidt, Silke; Kamel, Freya

2017-01-01

Background Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases. Methods We followed 616 medical record-confirmed cases from enrollment (2005–2010) in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study until death or July 25, 2013, whichever came first. We ascertained vital status information from several sources within the Department of Veterans Affairs. We obtained information regarding military service, deployments, and 39 related exposures via standardized telephone interviews. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals. We adjusted for potential confounding and missing covariate data biases via inverse probability weights. We also used inverse probability weights to adjust for potential selection bias among a case group that included a disproportionate number of long-term survivors at enrollment. Results We observed 446 deaths during 24,267 person-months of follow-up (median follow-up: 28 months). Survival was shorter for cases who served before 1950, were deployed to World War II, or mixed and applied burning agents, with HRs between 1.58 and 2.57. Longer survival was associated with exposure to: paint, solvents, or petrochemical substances; local food not provided by the Armed Forces; or burning agents or Agent Orange in the field with HRs between 0.56 and 0.73. Conclusions Although most military-related factors were not associated with survival, associations we observed with shorter survival are potentially important because of the large number of military veterans. PMID:29016608

Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival.

PubMed

Beard, John D; Engel, Lawrence S; Richardson, David B; Gammon, Marilie D; Baird, Coleen; Umbach, David M; Allen, Kelli D; Stanwyck, Catherine L; Keller, Jean; Sandler, Dale P; Schmidt, Silke; Kamel, Freya

2017-01-01

Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases. We followed 616 medical record-confirmed cases from enrollment (2005-2010) in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study until death or July 25, 2013, whichever came first. We ascertained vital status information from several sources within the Department of Veterans Affairs. We obtained information regarding military service, deployments, and 39 related exposures via standardized telephone interviews. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals. We adjusted for potential confounding and missing covariate data biases via inverse probability weights. We also used inverse probability weights to adjust for potential selection bias among a case group that included a disproportionate number of long-term survivors at enrollment. We observed 446 deaths during 24,267 person-months of follow-up (median follow-up: 28 months). Survival was shorter for cases who served before 1950, were deployed to World War II, or mixed and applied burning agents, with HRs between 1.58 and 2.57. Longer survival was associated with exposure to: paint, solvents, or petrochemical substances; local food not provided by the Armed Forces; or burning agents or Agent Orange in the field with HRs between 0.56 and 0.73. Although most military-related factors were not associated with survival, associations we observed with shorter survival are potentially important because of the large number of military veterans.

Psychodynamic Treatment of Combat Veterans with PTSD at Risk for Suicide.

PubMed

Hendin, Herbert

2017-01-01

Posttraumatic stress disorder is a condition associated with suicide in both military personnel and combat veterans. Most veterans with PTSD, however, are not at risk of suicide. The major factor distinguishing those who attempted or were preoccupied with suicide is persistent severe guilt over behavior in combat while emotionally out of control. A 12-session short-term, psychodynamic psychotherapy, presented here, showed promise of success in dissipating the guilt from combat-related actions in veterans of the war in Vietnam. Preliminary work with combat veterans of the wars in Iraq and Afghanistan indicates it may be equally successful in treating them. Basic aspects of the psychodynamic approach could also be incorporated into current therapies and should improve their ability to treat veterans with PTSD at risk for suicide. Case examples are provided.

Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti-inflammatory drug prescription.

PubMed

Abraham, N S; Cohen, D C; Rivers, B; Richardson, P

2006-07-15

To validate veterans affairs (VA) administrative data for the diagnosis of nonsteroidal anti-inflammatory drug (NSAID)-related upper gastrointestinal events (UGIE) and to develop a diagnostic algorithm. A retrospective study of veterans prescribed an NSAID as identified from the national pharmacy database merged with in-patient and out-patient data, followed by primary chart abstraction. Contingency tables were constructed to allow comparison with a random sample of patients prescribed an NSAID, but without UGIE. Multivariable logistic regression analysis was used to derive a predictive algorithm. Once derived, the algorithm was validated in a separate cohort of veterans. Of 906 patients, 606 had a diagnostic code for UGIE; 300 were a random subsample of 11 744 patients (control). Only 161 had a confirmed UGIE. The positive predictive value (PPV) of diagnostic codes was poor, but improved from 27% to 51% with the addition of endoscopic procedural codes. The strongest predictors of UGIE were an in-patient ICD-9 code for gastric ulcer, duodenal ulcer and haemorrhage combined with upper endoscopy. This algorithm had a PPV of 73% when limited to patients >or=65 years (c-statistic 0.79). Validation of the algorithm revealed a PPV of 80% among patients with an overlapping NSAID prescription. NSAID-related UGIE can be assessed using VA administrative data. The optimal algorithm includes an in-patient ICD-9 code for gastric or duodenal ulcer and gastrointestinal bleeding combined with a procedural code for upper endoscopy.

Reengagement in PTSD psychotherapy: A case-control study.

PubMed

Buchholz, Katherine R; Bohnert, Kipling M; Pfeiffer, Paul N; Valenstein, Marcia; Ganoczy, Dara; Anderson, RaeAnn E; Sripada, Rebecca K

2017-09-01

This study sought to identify patient characteristics and care processes related to reengagement in VA psychotherapy. Using national VA data, a retrospective cohort was constructed (N=24,492) of veterans who received a new PTSD diagnosis in FY08/FY09 and attended only one to five PTSD psychotherapy sessions. A nested case-control study was conducted comparing veterans who reengaged in psychotherapy (n=9649) in a 1:5 ratio with those who did not reengage by the end of FY12. Conditional logistic regression models were run to examine differences in sociodemographic, mental health, and service utilization factors between cases and controls. Among veterans in the study cohort, 39.4% reengaged in psychotherapy. In adjusted analyses, all measured types of health system encounters (primary care [OR=1.61], primary care mental health [OR=1.61], non-PTSD psychotherapy [OR=1.76], other non-PTSD mental health care [OR=1.43], other non-psychotherapy PTSD care [OR=3.31], emergency room [OR=1.14], and psychiatric hospitalization [OR=1.56]) were related to greater odds of reengagement in PTSD psychotherapy. Veterans' receipt of a broad range of care services may play an important role in reengagement in PCT psychotherapy, suggesting providers across care settings should be knowledgeable in how to support a Veteran's return to psychotherapy for PTSD. Published by Elsevier Inc.

Screening for Moral Injury: The Moral Injury Symptom Scale - Military Version Short Form.

PubMed

Koenig, Harold G; Ames, Donna; Youssef, Nagy A; Oliver, John P; Volk, Fred; Teng, Ellen J; Haynes, Kerry; Erickson, Zachary D; Arnold, Irina; O'Garo, Keisha; Pearce, Michelle

2018-03-26

To develop a short form (SF) of the 45-item multidimensional Moral Injury Symptom Scale - Military Version (MISS-M) to use when screening for moral injury and monitoring treatment response in veterans and active duty military with PTSD. A total of 427 veterans and active duty military with PTSD symptoms were recruited from VA Medical Centers in Augusta, GA; Los Angeles, CA; Durham, NC; Houston, TX; and San Antonio, TX; and from Liberty University, Lynchburg, Virginia. The sample was randomly split in two. In the first half (n = 214), exploratory factor analysis identified the highest loading item on each of the 10 MISS scales (guilt, shame, moral concerns, loss of meaning, difficulty forgiving, loss of trust, self-condemnation, religious struggle, and loss of religious faith) to form the 10-item MISS-M-SF; confirmatory factor analysis was then performed to replicate results in the second half of the sample (n = 213). Internal reliability, test-retest reliability, and convergent, discriminant, and concurrent validity were examined in the overall sample. The study was approved by the institutional review boards and the Research & Development (R&D) Committees at Veterans Administration medical centers in Durham, Los Angeles, Augusta, Houston, and San Antonio, and the Liberty University and Duke University Medical Center institutional review boards. The 10-item MISS-M-SF had a median of 50 and a range of 12-91 (possible range 10-100). Over 70% scored a 9 or 10 (highest possible) on at least one item. Cronbach's alpha was 0.73 (95% CI 0.69-0.76), and test-retest reliability was 0.87 (95% CI 0.79-0.92). Convergent validity with the 45-item MISS-M was r = 0.92. Discriminant validity was demonstrated by relatively weak correlations with social, religious, and physical health constructs (r = 0.21-0.35), and concurrent validity was indicated by strong correlations with PTSD, depression, and anxiety symptoms (r = 0.54-0.58). The MISS-M-SF is a reliable and valid measure of MI symptoms that can be used to screen for MI and monitor response to treatment in veterans and active duty military with PTSD.

Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study.

PubMed

Park, Tae Woo; Saitz, Richard; Ganoczy, Dara; Ilgen, Mark A; Bohnert, Amy S B

2015-06-10

To study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics. Case-cohort study. Veterans Health Administration (VHA), 2004-09. US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420,386) who received VHA medical services and opioid analgesics. Death from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index. During the study period 27% (n=112,069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose. Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion. © Park et al 2015.

Benzodiazepine prescribing patterns and deaths from drug overdose among US veterans receiving opioid analgesics: case-cohort study

PubMed Central

Saitz, Richard; Ganoczy, Dara; Ilgen, Mark A; Bohnert, Amy S B

2015-01-01

Objective To study the association between benzodiazepine prescribing patterns including dose, type, and dosing schedule and the risk of death from drug overdose among US veterans receiving opioid analgesics. Design Case-cohort study. Setting Veterans Health Administration (VHA), 2004-09. Participants US veterans, primarily male, who received opioid analgesics in 2004-09. All veterans who died from a drug overdose (n=2400) while receiving opioid analgesics and a random sample of veterans (n=420 386) who received VHA medical services and opioid analgesics. Main outcome measure Death from drug overdose, defined as any intentional, unintentional, or indeterminate death from poisoning caused by any drug, determined by information on cause of death from the National Death Index. Results During the study period 27% (n=112 069) of veterans who received opioid analgesics also received benzodiazepines. About half of the deaths from drug overdose (n=1185) occurred when veterans were concurrently prescribed benzodiazepines and opioids. Risk of death from drug overdose increased with history of benzodiazepine prescription: adjusted hazard ratios were 2.33 (95% confidence interval 2.05 to 2.64) for former prescriptions versus no prescription and 3.86 (3.49 to 4.26) for current prescriptions versus no prescription. Risk of death from drug overdose increased as daily benzodiazepine dose increased. Compared with clonazepam, temazepam was associated with a decreased risk of death from drug overdose (0.63, 0.48 to 0.82). Benzodiazepine dosing schedule was not associated with risk of death from drug overdose. Conclusions Among veterans receiving opioid analgesics, receipt of benzodiazepines was associated with an increased risk of death from drug overdose in a dose-response fashion. PMID:26063215

Faith-Based Organizations and Veteran Reintegration: Enriching the Web of Support

DTIC Science & Technology

2015-01-01

health care , physi- cal health, family, and social networks. In some cases, the support is offered to veterans directly; in other instances, the...locating meaningful civilian employment, pursuing higher education, securing housing, and building a social network after spending years or even...the prevalence of reintegration challenges. Approximately one-fourth to one-half of these veterans experienced difficulty in social functioning (e.g

38 CFR 21.8010 - Definitions and abbreviations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Children of Vietnam Veterans-Spina Bifida and Covered Birth Defects General § 21.8010 Definitions and....814(c)(3) of this title. Vietnam veteran means, in the case of a child suffering from spina bifida...

38 CFR 13.104 - Accounts of court-appointed fiduciaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... an interested party, will be sent to the Veterans Service Center Manager for review, distribution and... will not be required, in the discretion of the Veterans Service Center Manager, in cases where the...

Initial psychometric evaluation of the Moral Injury Questionnaire--Military version.

PubMed

Currier, Joseph M; Holland, Jason M; Drescher, Kent; Foy, David

2015-01-01

Moral injury is an emerging construct related to negative consequences associated with war-zone stressors that transgress military veterans' deeply held values/beliefs. Given the newness of the construct, there is a need for instrumentation that might assess morally injurious experiences (MIEs) in this population. Drawing on a community sample of 131 Iraq and/or Afghanistan Veterans and clinical sample of 82 returning Veterans, we conducted an initial psychometric evaluation of the newly developed Moral Injury Questionnaire-Military version (MIQ-M)-a 20-item self-report measure for assessing MIEs. Possibly due to low rates of reporting, an item assessing sexual trauma did not yield favourable psychometric properties and was excluded from analyses. Veterans in the clinical sample endorsed significantly higher scores across MIQ-M items. Factor analytic results for the final 19 items supported a unidimensional structure, and convergent validity analyses revealed that higher scores (indicative of more MIEs) were correlated with greater general combat exposure, impairments in work/social functioning, posttraumatic stress and depression in the community sample. In addition, when controlling for demographics, deployment-related factors and exposure to life threat stressors associated with combat, tests of incremental validity indicated that MIQ-M scores were also uniquely linked with suicide risk and other mental health outcomes. These findings provide preliminary evidence for the validity of the MIQ-M and support the applicability of this measure for further research and clinical work with Veterans. Military service can confront service members with experiences that undermine their core sense of humanity and violate global values and beliefs. These types of experiences increase the risk for posttraumatic maladjustment in this population, even when accounting for rates of exposure to life threat traumas. Moral injury is an emerging construct to more fully capture the many possible psychological, ethical, and spiritual/existential challenges among persons who served in modern wars and other trauma-exposed professional groups. There is currently a need for psychometrically sound instrumentation for assessing morally injurious experiences (MIEs). The Moral Injury Questionnaire - Military Version (MIQ-M) was developed to provide a tool for assessing possible MIEs among military populations. This study provides preliminary evidence of the validity - including factorial, concurrent, and incremental - and clinical utility of the MIQ-M for further applications in clinical and research contexts. Copyright © 2013 John Wiley & Sons, Ltd.

A Patient-Centered Transitional Care Case Management Program: Taking Case Management to the Streets and Beyond.

PubMed

Lovelace, Derenda; Hancock, Diane; Hughes, Sabrina S; Wyche, Phyllis R; Jenkins, Claire; Logan, Cindy

In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%. To examine the impact of the McGuire VAMC TCP on Veteran ED and hospital utilization and costs. Veterans being discharged to home following an inpatient admission, ED visit, and/or short rehab stay. The primary means of identifying patients for the program is through daily screening of the previous 24-hour admission and ED report, which the inpatient nurse practitioner performs. She completes an extensive review of each Veteran's electronic medical record to determine the number of ED visits and inpatient admissions at the VAMC and in the community. Initial criteria for consideration in the program included the following: more than two hospital admissions and/or ED visits in the past 90 days or at high risk for readmission based on a Care Assessment Need score of greater than 95. Two hundred Veterans participated in the program in fiscal year (FY) 2013, with 146 participating in FY 2014. A retrospective chart review of Veterans participating in the TCP in FYs 2013 and 2014 was conducted, with a focus on number of admissions and ED visits 90 days prior to admission to the TCP and 90 days following TCP admission. Average admission and ED costs for this VA were calculated to determine cost savings from pre- to post-90 days of admission and ED visits. Veterans who obtained TCP services in FYs 2013 and 2014 experienced a 67% decrease in hospital admissions and a 61% decrease in ED visits in the 90 days following participation in this program compared with the 90 days prior to participation. This produced an estimated net savings of $3,823,673 in medical center costs. In addition, registered nurse case managers (RN CMs) noted improved patient compliance and satisfaction with care and the licensed clinical social worker noted reduced caregiver burden. The results of this program demonstrate how using an interdisciplinary approach to develop patient-centered transition plans of care through intensive case management interventions improves resource utilization with substantial financial savings. This program represents a feasible option for other VAMCs as well as civilian hospitals seeking to provide cost-effective transitional care to patients upon discharge and prevent untimely readmissions. With an RN CM at the hub of patient care, this program successfully demonstrates the value of smooth care transitions.

Skin disease in Gulf war veterans.

PubMed

Higgins, E M; Ismail, K; Kant, K; Harman, K; Mellerio, J; Du Vivier, A W P; Wessely, S

2002-10-01

Gulf war veterans report more symptomatic ill-health than other military controls, and skin disease is one of the most frequent reasons for military personnel to seek medical care. To compare the nature and prevalence of skin disease in UK Gulf veterans with non-Gulf veterans, and to assess whether skin disease is associated with disability. Prospective case comparison study. Disabled (n=111) and non-disabled (n=98) Gulf veterans and disabled non-Gulf veterans (n=133) were randomly selected from representative cohorts of those who served in the Gulf conflict 1990-1991, UN Bosnia Peacekeeping Force 1992-1997, or veterans in active service between 1990-91, but not deployed to the Gulf. Disability was defined as reduced physical functioning as measured by the Short Form 36 [score <72.2]. All subjects recruited were examined by a dermatologist, blind to the military and health status of the veteran. The prevalences of skin disease in disabled Gulf, non-disabled Gulf and disabled non-Gulf veterans were 47.7, 36.7, and 42.8% respectively. Seborrhoeic dermatitis was twice as common as expected in the Gulf veterans (both disabled and non-disabled). Skin disease does not appear to be contributing to ill health in Gulf war veterans, with the exception of an unexplained two-fold increase in seborrhoeic dermatitis.

The health of Australian veterans of the 1991 Gulf War: factor analysis of self-reported symptoms.

PubMed

Forbes, A B; McKenzie, D P; Mackinnon, A J; Kelsall, H L; McFarlane, A C; Ikin, J F; Glass, D C; Sim, M R

2004-12-01

A recent report showed that Australian veterans of the 1991 Gulf War displayed a greater prevalence of a multitude of self-reported symptoms than a randomly sampled comparison group of military personnel who were eligible for deployment but were not deployed to the Gulf. To investigate whether the pattern, rather than frequency, of symptom reporting in these Australian Gulf War veterans differed from that of the comparison group personnel. Factor analysis was used to determine whether the co-occurrence of 62 symptoms in 1322 male Gulf War veterans can be explained by a number of underlying dimensions, called factors. The methodology was also applied to 1459 male comparison group subjects and the factor solutions of the two groups were compared. For the Gulf War veterans, a three factor solution displayed replicability and construct validity. The three factors were labelled as psycho-physiological distress, somatic distress, and arthro-neuromuscular distress, and were broadly similar to those described in previous studies of Gulf War veterans. A concordant three factor solution was also found for the comparison group subjects, with strong convergence of the factor loadings and factor scores across the two groups being displayed. Results did not display evidence of a unique pattern of self-reported symptoms among Gulf War veterans. Results also indicated that the differences between the groups lie in the degrees of expression of the three underlying factors, consistent with the well documented evidence of increased self-reported symptom prevalence in Gulf War veterans.

Derivation and Validation of a Clostridium difficile Infection Recurrence Prediction Rule in a National Cohort of Veterans.

PubMed

Reveles, Kelly R; Mortensen, Eric M; Koeller, Jim M; Lawson, Kenneth A; Pugh, Mary Jo V; Rumbellow, Sarah A; Argamany, Jacqueline R; Frei, Christopher R

2018-03-01

Prior studies have identified risk factors for recurrent Clostridium difficile infection (CDI), but few studies have integrated these factors into a clinical prediction rule that can aid clinical decision-making. The objectives of this study were to derive and validate a CDI recurrence prediction rule to identify patients at risk for first recurrence in a national cohort of veterans. Retrospective cohort study. Veterans Affairs Informatics and Computing Infrastructure. A total of 22,615 adult Veterans Health Administration beneficiaries with first-episode CDI between October 1, 2002, and September 30, 2014; of these patients, 7538 were assigned to the derivation cohort and 15,077 to the validation cohort. A 60-day CDI recurrence prediction rule was created in a derivation cohort using backward logistic regression. Those variables significant at p<0.01 were assigned an integer score proportional to the regression coefficient. The model was then validated in the derivation cohort and a separate validation cohort. Patients were then split into three risk categories, and rates of recurrence were described for each category. The CDI recurrence prediction rule included the following predictor variables with their respective point values: prior third- and fourth-generation cephalosporins (1 point), prior proton pump inhibitors (1 point), prior antidiarrheals (1 point), nonsevere CDI (2 points), and community-onset CDI (3 points). In the derivation cohort, the 60-day CDI recurrence risk for each score ranged from 7.5% (0 points) to 57.9% (8 points). The risk score was strongly correlated with recurrence (R 2  = 0.94). Patients were split into low-risk (0-2 points), medium-risk (3-5 points), and high-risk (6-8 points) classes and had the following recurrence rates: 8.9%, 20.2%, and 35.0%, respectively. Findings were similar in the validation cohort. Several CDI and patient-specific factors were independently associated with 60-day CDI recurrence risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were strongly correlated with CDI recurrence. This clinical prediction rule can be used by providers to identify patients at high risk for CDI recurrence and help guide preventive strategy decisions, while accounting for clinical judgment. © 2018 Pharmacotherapy Publications, Inc.

Ethnic-related stressors in the war zone: case studies of Asian American Vietnam veterans.

PubMed

Loo, Chalsa M; Lim, Brian R; Koff, Gabriel; Morton, Robert K; Kiang, Peter N C

2007-09-01

Empirical research has shown that exposure to race-related stressors in the military by Asian American Pacific Islander Vietnam veterans, now reliably measurable, contributes uniquely and significantly to post-traumatic stress disorder (PTSD) symptoms and generalized psychiatric distress; moreover, studies reveal that adverse race-related events can meet Diagnostic and Statistical Manual of Mental Disorders-IV criteria for a PTSD diagnosis. Competence in treating PTSD or general psychiatric distress requires understanding the types of, and effects of, adverse race-related events experienced by ethnic minority veterans. Case studies highlight two types of race-related stressors-"bicultural identification and conflict" and "racial stigmatization"-which placed the veteran at greater risk of death and reduced cohesion with fellow service members. The studies demonstrate the presence of race-related stressors in one or more of the four major types of war zone stressors: traditional combat, atrocities-abusive violence, perceived threat, and malevolent environment. These case studies supplement the empirical findings on race-related stressors and PTSD, enlarging the clinician's understanding of this unique type of mental health risk factor.

Multi-symptom illnesses, unexplained illness and Gulf War Syndrome

PubMed Central

Ismail, Khalida; Lewis, Glyn

2006-01-01

Explanatory models for the increased prevalence of ill health in Gulf veterans compared to those not deployed to the Gulf War 1990–1991 remain elusive. This article addresses whether multi-symptom reporting in Gulf veterans are types of medically unexplained symptoms and whether the alleged Gulf War Syndrome is best understood as a medically unexplained syndrome. A review of the epidemiological studies, overwhelmingly cross-sectional, describing ill health was conducted including those that used factor analysis to search for underlying or latent clinical constructs. The overwhelming evidence was that symptoms in Gulf veterans were either in keeping with currently defined psychiatric disorders such as depression and anxiety or were medically unexplained. The application of factor analysis methods had varied widely with a risk of over interpretation in some studies and limiting the validity of their findings. We concluded that ill health in Gulf veterans and the alleged Gulf War Syndrome is best understood within the medically unexplained symptoms and syndromes constructs. The cause of increased reporting in Gulf veterans are still not clear and requires further inquiry into the interaction between sociological factors and symptomatic distress. PMID:16687260

Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.

PubMed

Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Byrne, Thomas Hugh; Smelson, David A

2017-03-09

Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet. ClinicalTrials.gov NCT01430741.

38 CFR 21.6420 - Coordination with the Veterans Service Center.

Code of Federal Regulations, 2010 CFR

2010-07-01

... evaluation being provided a veteran under age 45, who is required to participate in such evaluation, is... changes if the case manager learns of such changes in the normal course of performing his or her duties...

38 CFR 21.6420 - Coordination with the Veterans Service Center.

Code of Federal Regulations, 2011 CFR

2011-07-01

... evaluation being provided a veteran under age 45, who is required to participate in such evaluation, is... changes if the case manager learns of such changes in the normal course of performing his or her duties...

Validation of Case Finding Algorithms for Hepatocellular Cancer from Administrative Data and Electronic Health Records using Natural Language Processing

PubMed Central

Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica

2013-01-01

Background Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC ICD-9 codes, and evaluated whether natural language processing (NLP) by the Automated Retrieval Console (ARC) for document classification improves HCC identification. Methods We identified a cohort of patients with ICD-9 codes for HCC during 2005–2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared to manual classification. PPV, sensitivity, and specificity of ARC were calculated. Results 1138 patients with HCC were identified by ICD-9 codes. Based on manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. Conclusion A combined approach of ICD-9 codes and NLP of pathology and radiology reports improves HCC case identification in automated data. PMID:23929403

Validation of Case Finding Algorithms for Hepatocellular Cancer From Administrative Data and Electronic Health Records Using Natural Language Processing.

PubMed

Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica

2016-02-01

Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC International Classification of Diseases, 9th Revision (ICD-9) codes, and evaluated whether natural language processing by the Automated Retrieval Console (ARC) for document classification improves HCC identification. We identified a cohort of patients with ICD-9 codes for HCC during 2005-2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared with manual classification. PPV, sensitivity, and specificity of ARC were calculated. A total of 1138 patients with HCC were identified by ICD-9 codes. On the basis of manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. A combined approach of ICD-9 codes and natural language processing of pathology and radiology reports improves HCC case identification in automated data.

Reliability, validity and administrative burden of the community reintegration of injured service members computer adaptive test (CRIS-CAT)".

PubMed

Resnik, Linda; Borgia, Matthew; Ni, Pensheng; Pirraglia, Paul A; Jette, Alan

2012-09-17

The Computer Adaptive Test version of the Community Reintegration of Injured Service Members measure (CRIS-CAT) consists of three scales measuring Extent of, Perceived Limitations in, and Satisfaction with community integration. The CRIS-CAT was developed using item response theory methods. The purposes of this study were to assess the reliability, concurrent, known group and predictive validity and respondent burden of the CRIS-CAT.The CRIS-CAT was developed using item response theory methods. The purposes of this study were to assess the reliability, concurrent, known group and predictive validity and respondent burden of the CRIS-CAT. This was a three-part study that included a 1) a cross-sectional field study of 517 homeless, employed, and Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans; who completed all items in the CRIS item set, 2) a cohort study with one year follow-up study of 135 OEF/OIF Veterans, and 3) a 50-person study of CRIS-CAT administration. Conditional reliability of simulated CAT scores was calculated from the field study data, and concurrent validity and known group validity were examined using Pearson product correlations and ANOVAs. Data from the cohort were used to examine the ability of the CRIS-CAT to predict key one year outcomes. Data from the CRIS-CAT administration study were used to calculate ICC (2,1) minimum detectable change (MDC), and average number of items used during CAT administration. Reliability scores for all scales were above 0.75, but decreased at both ends of the score continuum. CRIS-CAT scores were correlated with concurrent validity indicators and differed significantly between the three Veteran groups (P < .001). The odds of having any Emergency Room visits were reduced for Veterans with better CRIS-CAT scores (Extent, Perceived Satisfaction respectively: OR = 0.94, 0.93, 0.95; P < .05). CRIS-CAT scores were predictive of SF-12 physical and mental health related quality of life scores at the 1 year follow-up. Scales had ICCs >0.9. MDCs were 5.9, 6.2, and 3.6, respectively for Extent, Perceived and Satisfaction subscales. Number of items (mn, SD) administered at Visit 1 were 14.6 (3.8) 10.9 (2.7) and 10.4 (1.7) respectively for Extent, Perceived and Satisfaction subscales. The CRIS-CAT demonstrated sound measurement properties including reliability, construct, known group and predictive validity, and it was administered with minimal respondent burden. These findings support the use of this measure in assessing community reintegration.

Some contributions of the Department of Veterans Affairs to the epidemiology of multiple sclerosis.

PubMed

Kurtzke, J F

2008-09-01

The first class 1 treatment trial ever conducted in multiple sclerosis (MS) was a Veterans Administration Cooperative Study. This led us to explore MS in the military-veteran populations of the United States in three main series: Army men hospitalized with final diagnoses of MS in World War II, all veterans of World War II and the Korean Conflict, and veterans of later service up to 1994. In each series, all cases had been matched with pre-illness military peers. These series provide major information on its clinical features, course and prognosis, including survival, by sex and race (white men and women; black men), as well as risk factors for occurrence, course, and survival. They comprise the only available nationwide morbidity distributions of MS in the United States. Veterans who are service-connected for MS by the Department of Veterans Affairs and matched with their military peers remain a unique and currently available resource for further clinical and epidemiological study of this disease.

Therapeutic horse back riding of a spinal cord injured veteran: a case study.

PubMed

Asselin, Glennys; Penning, Julius H; Ramanujam, Savithri; Neri, Rebecca; Ward, Constance

2012-01-01

To determine an incomplete spinal cord injured veteran's experience following participation in a therapeutic horseback riding program. Following the establishment of a nationwide therapeutic riding program for America's wounded service veterans in 2007, a Certified Rehabilitation Registered Nurse from the Michael E. DeBakey Veteran Affairs Medical Center worked with an incomplete spinal cord injured veteran who participated in the Horses for Heroes program. This program resulted in many benefits for the veteran, including an increase in balance, muscle strength, and self-esteem. A physical, psychological, and psychosocial benefit of therapeutic horseback riding is shown to have positive results for the spinal cord injured. Therapeutic riding is an emerging field where the horse is used as a tool for physical therapy, emotional growth, and learning. Veterans returning from the Iraq/Afghanistan war with traumatic brain injuries, blast injuries, depression, traumatic amputations, and spinal cord injuries may benefit from this nurse-assisted therapy involving the horse. © 2012 Association of Rehabilitation Nurses.

Abstinence Reinforcement Therapy (ART) for Rural Veterans: Methodology for an mHealth Smoking Cessation Intervention

PubMed Central

Wilson, Sarah M.; Hair, Lauren P.; Hertzberg, Jeffrey S.; Kirby, Angela C.; Olsen, Maren K.; Lindquist, Jennifer H.; Maciejewski, Matthew L.; Beckham, Jean C.; Calhoun, Patrick S.

2016-01-01

Introduction Smoking is the most preventable cause of morbidity and mortality in U.S. veterans. Rural veterans in particular have elevated risk for smoking and smoking-related illness. However, these veterans underutilize smoking cessation treatment, which suggests that interventions for rural veterans should optimize efficacy and reach. Objective The primary goal of the current study is to evaluate the effectiveness of an intervention that combines evidenced based treatment for smoking cessation with smart-phone based, portable contingency management on smoking rates compared to a contact control intervention in a randomized controlled trial among rural Veteran smokers. Specifically, Veterans will be randomized to receive Abstinence Reinforcement Therapy (ART) which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mobile contingency management (mCM) or a control condition (i.e., TC and NRT alone) that will provide controls for therapist, medication, time and attention effects. Methods Smokers were identified using VHA electronic medical records and recruited proactively via telephone. Participants (N = 310) are randomized to either ART or a best practice control consisting of telephone counseling and telemedicine. Participating patients will be surveyed at 3-months, 6-months and 12-months post-randomization. The primary outcome measure is self-reported and biochemically validated prolonged abstinence at 6-month follow-up. Discussion This trial is designed to test the relative effectiveness of ART compared to a telehealth-only comparison group. Dissemination of this mHealth intervention for veterans in a variety of settings would be warranted if ART improves smoking outcomes for rural veterans and is cost-effective. PMID:27521811

Posttraumatic Stress Disorder and Interpersonal Process in Homeless Veterans Participating in a Peer Mentoring Intervention: Associations With Program Benefit.

PubMed

Van Voorhees, Elizabeth E; Resnik, Linda; Johnson, Erin; O'Toole, Thomas

2018-01-25

Homelessness among veterans has dropped dramatically since the expansion of services for homeless veterans in 2009, and now engaging homeless veterans in existing programs will be important to continuing to make progress. While one promising approach for engaging homeless veterans in care is involving peer mentors in integrated services, posttraumatic stress disorder (PTSD) may diminish the effects of peer mentorship. This mixed methods study examined how interpersonal and emotional processes in homeless veterans with and without PTSD impacted their capacity to engage in relationships with peer mentors. Four focus groups of 5-8 homeless male veterans (N = 22) were drawn from a larger multisite randomized trial. Qualitative analysis identified five primary themes: disconnectedness; anger, hostility, or resentment; connecting with others; positive view of self; and feeling like an outsider. Thematic comparisons between participants with and without a self-reported PTSD diagnosis, and between those who did and did not benefit from the peer mentor program, were validated by using quantitative methods. Disconnectedness was associated with self-reported PTSD diagnosis and with lack of program benefit; feeling like an outsider was associated with program benefit. Results suggest that disruption to the capacity to develop and maintain social bonds in PTSD may interfere with the capacity to benefit from peer mentorship. Social rules and basic strategies for navigating interpersonal relationships may differ somewhat within the homeless community and outside of it; for veterans who feel disconnected from the domiciled community, a formerly homeless veteran peer may serve as a critical "bridge" between the two social worlds. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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

PubMed

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.

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

PubMed Central

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

Case Study: South Texas Veterans Health Care System’s Communication Center

DTIC Science & Technology

2008-07-14

appropriate access to health care; technical quality is providing world-class care to our veterans; customer satisfaction is ensuring the STVHCS patients and...were not called. These results not only improved access to health care, but also positively affected customer service. 111 Case Study: South Texas...increased waiting times for the patient . With current regulatory requirements calling for improved access to health care services, many hospital and

Agent Orange exposure and attributed health effects in Vietnam veterans.

PubMed

Young, Alvin L; Cecil, Paul F

2011-07-01

Serum dioxin studies of Vietnam (VN) veterans, military historical records of tactical herbicide use in Vietnam, and the compelling evidence of the photodegradation of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and other aspects of environmental fate and low bioavailability of TCDD are consistent with few, if any, ground troop veterans being exposed to Agent Orange. That conclusion, however, is contrary to the presumption by the Department of Veterans Affairs (DVA) that military service in Vietnam anytime from January 9, 1962 to May 7, 1975 is a proxy for exposure to Agent Orange. The DVA assumption is inconsistent with the scientific principles governing determinations of disease causation. The DVA has nonetheless awarded Agent Orange-related benefits and compensation to an increasing number of VN veterans based on the presumption of exposure and the published findings of the Institute of Medicine that there is sufficient evidence of a "statistical association" (a less stringent standard than "causal relationship") between exposure to tactical herbicides or TCDD and 15 different human diseases. A fairer and more valid approach for VN veterans would have been to enact a program of "Vietnam experience" benefits for those seriously ill, rather than benefits based on the dubious premise of injuries caused by Agent Orange.

Cooperation, Technology, and Performance: A Case Study.

ERIC Educational Resources Information Center

Cavanagh, Thomas; Dickenson, Sabrina; Brandt, Suzanne

1999-01-01

Describes the CTP (Cooperation, Technology, and Performance) model and explains how it is used by the Department of Veterans Affairs-Veteran's Benefit Administration (VBA) for training. Discusses task analysis; computer-based training; cooperative-based learning environments; technology-based learning; performance-assessment methods; courseware…

Assisting American Indian Veterans of Iraq and Afghanistan Cope with Posttraumatic Stress Disorder: Lessons from Vietnam Veterans and the Writings of Jim Northrup

ERIC Educational Resources Information Center

Gross, Lawrence W.

2007-01-01

The country is at war in Iraq and Afghanistan, and, as has been the case throughout the history of the United States, American Indians have answered the call and are serving bravely in the armed forces. As in years past, there are also a cadre of American Indian veterans returning from the battlefield, scarred and wounded in body, heart, and mind.…

A Study to Develop Alternative Approaches for Implementing Product Line Management in the South Texas Veterans Health Care System

DTIC Science & Technology

1997-05-01

Transformation of the Veterans Healthcare System." Department of Veterans Affairs, Washington, D.C., March, 1996. 88 Kotler , Philip . "Managing...time lines are developed so management and staff can begin thinking about business from a different perspective (Manning 1987,29). Philip Lathrop...organized around product lines will the full effects of this approach be known. 86 WORKS CITED Benz, Philip D., and Janet Burnham. "Case Study

A Pilot Study of Seeking Safety Therapy with OEF/OIF Veterans

PubMed Central

Norman, Sonya B.; Wilkins, Kendall C.; Tapert, Susan F.; Lang, Ariel J.; Najavits, Lisa M.

2010-01-01

PTSD and substance use disorder (SUD) are highly prevalent among Veterans returning from Iraq and Afghanistan (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF). Seeking Safety (SS) is a cognitive-behavioral psychotherapy for co-occurring PTSD/SUD. This pilot study with fourteen male OEF/OIF Veterans suggests that SS may help to reduce alcohol use, PTSD, and depression in some participants at clinically significant levels, even when providing less than half of the full model. We emphasize several SS features as especially helpful: the case management component to help engage clients in further mental health and SUD care; offering PTSD as an entry point, and emphasis on community resources. Issues particular to Veterans include reintegration to civilian life and supporting Veterans’ connection with other Veterans. PMID:20464809

Dengue Surveillance in Veterans Affairs Healthcare Facilities, 2007–2010

PubMed Central

Schirmer, Patricia L.; Lucero-Obusan, Cynthia A.; Benoit, Stephen R.; Santiago, Luis M.; Stanek, Danielle; Dey, Achintya; Martinez, Mirsonia; Oda, Gina; Holodniy, Mark

2013-01-01

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 emphasize use of diagnostic testing to better understand the magnitude of dengue among Veterans. PMID:23516642

Alcohol and drug misuse, abuse, and dependence in women veterans.

PubMed

Hoggatt, Katherine J; Jamison, Andrea L; Lehavot, Keren; Cucciare, Michael A; Timko, Christine; Simpson, Tracy L

2015-01-01

We conducted a systematic literature review on substance misuse, abuse, and dependence in women veterans, including National Guard/reserve members. We identified 837 articles published between 1980 and 2013. Of 56 included studies, 32 reported rates of alcohol misuse, binge drinking, or other unhealthy alcohol use not meeting diagnostic criteria for abuse or dependence, and 33 reported rates of drug misuse or diagnosed alcohol or drug use disorders. Rates ranged from 4% to 37% for alcohol misuse and from 7% to 25% for binge drinking; among Veterans Health Administration (VA) health-care system outpatients, rates ranged from 3% to 16% for substance use disorder. Studies comparing women veterans and civilians reported no clear differences in binge or heavy drinking. Substance misuse rates were generally lower among women veterans than men veterans. Substance misuse was associated with higher rates of trauma, psychiatric and medical conditions, and increased mortality and suicide rates. Most studies included only VA patients, and many used only VA medical record data; therefore, the reported substance misuse rates likely do not reflect true prevalence. Rates also varied by assessment method, source of data, and the subgroups studied. Further efforts to develop epidemiologically valid prevalence estimates are needed to capture the true health burden of substance misuse in women veterans, particularly those not using VA care. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure: analysis of 197 cases.

PubMed

Emad, A; Rezaian, G R

1997-09-01

To find out the late pulmonary sequelae of sulfur mustard gas inhalation in 197 veterans, 10 years after their exposure. Cross-sectional clinical study. University hospital. One hundred ninety-seven veterans with a single, heavy exposure to sulfur mustard gas in 1986 and 86 nonexposed veterans as their control group. Pulmonary function tests, carbon monoxide diffusion capacity, bronchoscopy, and high-resolution CT of the chest were performed in all patients. Transbronchial lung biopsy was done in 24 suspected cases of pulmonary fibrosis. Asthma was diagnosed in 21 (10.65%), chronic bronchitis in 116 (58.88%), bronchiectasis in 17 (8.62%), airway narrowing due to searing or granulation tissue in 19 (9.64%), and pulmonary fibrosis in 24 (12.18%) cases. None of these were found among the control group except for a single case of chronic bronchitis. Although the respiratory symptoms of an acute sulfur mustard gas inhalation are usually transient and nonspecific, it can lead to the development of a series of chronic destructive pulmonary sequelae in such cases.

Implementing effective policy in a national mental health re-engagement program for Veterans

PubMed Central

Smith, Shawna N.; Lai, Zongshan; Almirall, Daniel; Goodrich, David E.; Abraham, Kristen M.; Nord, Kristina M.; Kilbourne, Amy M.

2016-01-01

Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This paper used validated measures of organizational resources, culture and climate to predict uptake of a nationwide VA policy aimed at implementing Re-Engage, a brief care management program that re-establishes contact with Veterans with serious mental illness lost to care. Patient care databases were used to identify 2,738 Veterans lost to care. Local Recovery Coordinators (LRCs) were to update disposition for 2,738 Veterans at 158 VA facilities and, as appropriate, facilitate a return to care. Multivariable regression assessed organizational culture and climate as predictors of early policy compliance (via LRC presence) and uptake at six months. Higher composite climate and culture scores were associated with higher odds of having a designated LRC, but were not predictive of higher uptake. Sites with LRCs had significantly higher rates of updated documentation than sites without LRCs. PMID:27668352

Cannabis Use Disorder and Suicide Attempts in Iraq/Afghanistan-Era Veterans

PubMed Central

Kimbrel, Nathan A.; Newins, Amie R.; Dedert, Eric A.; Van Voorhees, Elizabeth E.; Elbogen, Eric B.; Naylor, Jennifer C.; Wagner, H. Ryan; Brancu, Mira; Beckham, Jean C.; Calhoun, Patrick S.

2017-01-01

The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3,233) using a battery of well-validated instruments. As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure. Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time. PMID:28129565

Veterans Affairs Intensive Case Management for older veterans.

PubMed

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.

Systemic vulnerabilities to suicide among veterans from the Iraq and Afghanistan Conflicts: review of case reports from a National Veterans Affairs Database.

PubMed

Mills, Peter D; Huber, Samuel J; Vince Watts, Bradley; Bagian, James P

2011-02-01

While suicide among recently returned veterans is of great concern, it is a relatively rare occurrence within individual hospitals and clinics. Root cause analysis (RCA) generates a detailed case report that can be used to identify system-based vulnerabilities following an adverse event. Review of a national database of RCA reports may identify common vulnerabilities and assist in the development of more robust prevention strategies. Our objective was to identify and compare common themes among reports of suicide among veterans of Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) in the Veterans Affairs system. Common themes among root causes of suicide as identified in RCA reports were collected and compared as the primary outcome--systematic vulnerabilities. Actions recommended within the reports were coded as the secondary outcome--prevention strategies. Fifty-one RCA reports of OIF/OEF suicides were identified by our search. Coding generated 16 common categories among 132 root causes, and 13 categories among 108 recommended actions. Assessment of suicidal risk, coordination of care, timely access to care, and communication among providers were the most common root causes. Actions identified by RCA teams to reduce suicide included improving referral processes, staff education in suicide assessment, and follow-up with suicidal veterans. Review of multiple RCA reports can identify organizational vulnerabilities detected at the local level that may be applicable system wide. Attention to improving suicide assessment, coordination of care, and timely access may have the largest impact on reducing suicide among OIF/OEF veterans. © 2011 The American Association of Suicidology.

38 CFR 14.601 - Investigation and development.

Code of Federal Regulations, 2011 CFR

2011-07-01

... development. 14.601 Section 14.601 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... development. (a) Development of untoward incidents. (1) A report of any collision involving a Government-owned.... (b) Development of medical malpractice claims. In medical malpractice cases, the Regional Counsel may...

38 CFR 14.601 - Investigation and development.

Code of Federal Regulations, 2010 CFR

2010-07-01

... development. 14.601 Section 14.601 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... development. (a) Development of untoward incidents. (1) A report of any collision involving a Government-owned.... (b) Development of medical malpractice claims. In medical malpractice cases, the Regional Counsel may...

38 CFR 17.902 - Preauthorization.

Code of Federal Regulations, 2011 CFR

2011-07-01

....900 through 17.905: rental or purchase of durable medical equipment with a total rental or purchase... Section 17.902 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Health Care... where there is a demonstrated medical need. In cases of other covered birth defects, authorization will...

Idiopathic pulmonary fibrosis in a Christmas Island nuclear test veteran

PubMed Central

Parfrey, H; Babar, J; Fiddler, CA; Chilvers, ER

2010-01-01

We describe the case of a 71-year-old man with idiopathic pulmonary fibrosis (usual interstitial pneumonia (UIP) pattern) diagnosed on clinical, radiological and lung function criteria, in accordance with the American Thoracic Society/European Respiratory Society consensus criteria (2000), who had been in close proximity to three atmospheric nuclear bomb blasts during military service in 1957. He does not have clubbing and clinically and radiologically his lung disease is stable. He also has bladder carcinoma and carotid arteriosclerosis, both recognised consequences of radiation injury. This is the first reported case of UIP in a nuclear test veteran. Awareness of this potential association is important given the current attempts of the British Nuclear Test Veterans Association to gain compensation for claimed injuries. PMID:22797205

77 FR 23543 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

...As required by the Privacy Act of 1974 (5 U.S.C. 552a(e)(4), (11)), notice is hereby given that the Department of Veterans Affairs (VA) is amending the system of records entitled ``Veterans Tracking Application (VTA).'' VA is amending the system of records by revising the System Name to ``Veterans Tracking Application (VTA)/Federal Case Management Tool (FCMT)'' and System Location to include the ``Federal Case Management Tool (FCMT).'' The VTA data will also be accessed using the FCMT. Further, the Routine Uses have been updated in conjunction with VA's Virtual Lifetime Electronic Record (VLER), to reflect the nature of electronic coordination that will fully support the users of this application. VA is republishing the system notice in its entirety.

Diagnoses Treated in Ambulatory Care Among Homeless-Experienced Veterans

PubMed Central

Gabrielian, Sonya; Yuan, Anita H.; Andersen, Ronald M.; Gelberg, Lillian

2016-01-01

Purpose: Little is known about how permanent supported housing influences ambulatory care received by homeless persons. To fill this gap, we compared diagnoses treated in VA Greater Los Angeles (VAGLA) ambulatory care between Veterans who are formerly homeless—now housed/case managed through VA Supported Housing (“VASH Veterans”)—and currently homeless. Methods: We performed secondary database analyses of homeless-experienced Veterans (n = 3631) with VAGLA ambulatory care use from October 1, 2010 to September 30, 2011. We compared diagnoses treated—adjusting for demographics and need characteristics in regression analyses—between VASH Veterans (n = 1904) and currently homeless Veterans (n = 1727). Results: On average, considering 26 studied diagnoses, VASH (vs currently homeless) Veterans received care for more (P < .05) diagnoses (mean = 2.9/1.7). Adjusting for demographics and need characteristics, VASH Veterans were more likely (P < .05) than currently homeless Veterans to receive treatment for diagnoses across categories: chronic physical illness, acute physical illness, mental illness, and substance use disorders. Specifically, VASH Veterans had 2.5, 1.7, 2.1, and 1.8 times greater odds of receiving treatment for at least 2 condition in these categories, respectively. Among participants treated for chronic illnesses, adjusting for predisposing and need characteristics, VASH (vs currently homeless) Veterans were 9%, 8%, and 11% more likely to have 2 or more visits for chronic physical illnesses, mental illnesses, and substance use disorder, respectively. Conclusion: Among homeless-experienced Veterans, permanent supported housing may reduce disparities in the treatment of diagnoses commonly seen in ambulatory care. PMID:27343544

Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care.

PubMed

Blosnich, John R; Brown, George R; Shipherd Phd, Jillian C; Kauth, Michael; Piegari, Rebecca I; Bossarte, Robert M

2013-10-01

We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009-2011) of suicide-related events among all VHA users to examine suicide risk. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.

Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

PubMed Central

Brown, George R.; Shipherd, PhD, Jillian C.; Kauth, Michael; Piegari, Rebecca I.; Bossarte, Robert M.

2013-01-01

Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis. Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk. Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population. Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care. PMID:23947310

The Mental Disability Military Assessment Tool: A Reliable Tool for Determining Disability in Veterans with Post-traumatic Stress Disorder.

PubMed

Fokkens, Andrea S; Groothoff, Johan W; van der Klink, Jac J L; Popping, Roel; Stewart, Roy E; van de Ven, Lex; Brouwer, Sandra; Tuinstra, Jolanda

2015-09-01

An assessment tool was developed to assess disability in veterans who suffer from post-traumatic stress disorder (PTSD) due to a military mission. The objective of this study was to determine the reliability, intra-rater and inter-rater variation of the Mental Disability Military (MDM) assessment tool. Twenty-four assessment interviews of veterans with an insurance physician were videotaped. Each videotaped interview was assessed by a group of five independent raters on limitations of the veterans using the MDM assessment tool. After 2 months the raters repeated this procedure. Next the intra-rater and inter-rater variation was assessed with an adjusted version of AG09 computing weighted percentage agreement. The results of this study showed that both the intra-rater variation and inter-rater variation on the ten subcategories of the MDM assessment tool were small, with an agreement of 84-100% within raters and 93-100% between raters. The MDM assessment tool proves to be a reliable instrument to measure PTSD limitations in functioning in Dutch military veterans who apply for disability compensation. Further research is needed to assess the validity of this instrument.

Posttraumatic stress disorder, depression, and suicidal ideation in veterans: Results from the mind your heart study.

PubMed

Arenson, Melanie B; Whooley, Mary A; Neylan, Thomas C; Maguen, Shira; Metzler, Thomas J; Cohen, Beth E

2018-04-22

Veterans with PTSD or depression are at increased risk for suicidal ideation. However, few studies have examined that risk in those with comorbid PTSD and depression, instead focusing on these disorders individually. This study investigates the association of suicidal ideation with comorbid PTSD and depression and examines the role of military and psychosocial covariates. We evaluated 746 veterans using the CAPS to assess PTSD and the PHQ-9 to measure depression and suicidal ideation. Covariates were assessed via validated self-report measures. 49% of veterans with comorbid PTSD and depression endorsed suicidal ideation, making them more likely to do so than those with depression alone (34%), PTSD alone (11%), or neither (2%). In multivariate logistic regression models, this association remained significant after controlling for demographics and symptom severity. Anger, hostility, anxiety, alcohol use, optimism and social support did not explain the elevated risk of suicidal ideation in the comorbid group in fully adjusted models. As suicidal ideation is a known risk factor for suicide attempts and completions, veterans with comorbid PTSD and depression represent a vulnerable group who may need more intensive monitoring and treatment to reduce risk of suicide. Published by Elsevier B.V.

"Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans": Correction to Bovin et al. (2016).

PubMed

2017-06-01

Reports an error in "Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans" by Michelle J. Bovin, Brian P. Marx, Frank W. Weathers, Matthew W. Gallagher, Paola Rodriguez, Paula P. Schnurr and Terence M. Keane ( Psychological Assessment , 2016[Nov], Vol 28[11], 1379-1391). In the article, the departments and affiliations were incorrectly listed for authors Michelle J. Bovin, Brian P. Marx, Matthew W. Gallagher, Paola Rodriguez, Paula P. Schnurr, and Terence M. Keane. The first department and affiliation for authors Michelle J. Bovin, Brian P. Marx, Matthew W. Gallagher, Paola Rodriguez, and Terence M. Keane and should have read "National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts". The first department and affiliation for author Paula P. Schnurr should have read "National Center for PTSD, White River Junction, Vermont." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2015-55809-001.) This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Diagnoses Treated in Ambulatory Care Among Homeless-Experienced Veterans: Does Supported Housing Matter?

PubMed

Gabrielian, Sonya; Yuan, Anita H; Andersen, Ronald M; Gelberg, Lillian

2016-10-01

Little is known about how permanent supported housing influences ambulatory care received by homeless persons. To fill this gap, we compared diagnoses treated in VA Greater Los Angeles (VAGLA) ambulatory care between Veterans who are formerly homeless-now housed/case managed through VA Supported Housing ("VASH Veterans")-and currently homeless. We performed secondary database analyses of homeless-experienced Veterans (n = 3631) with VAGLA ambulatory care use from October 1, 2010 to September 30, 2011. We compared diagnoses treated-adjusting for demographics and need characteristics in regression analyses-between VASH Veterans (n = 1904) and currently homeless Veterans (n = 1727). On average, considering 26 studied diagnoses, VASH (vs currently homeless) Veterans received care for more (P < .05) diagnoses (mean = 2.9/1.7). Adjusting for demographics and need characteristics, VASH Veterans were more likely (P < .05) than currently homeless Veterans to receive treatment for diagnoses across categories: chronic physical illness, acute physical illness, mental illness, and substance use disorders. Specifically, VASH Veterans had 2.5, 1.7, 2.1, and 1.8 times greater odds of receiving treatment for at least 2 condition in these categories, respectively. Among participants treated for chronic illnesses, adjusting for predisposing and need characteristics, VASH (vs currently homeless) Veterans were 9%, 8%, and 11% more likely to have 2 or more visits for chronic physical illnesses, mental illnesses, and substance use disorder, respectively. Among homeless-experienced Veterans, permanent supported housing may reduce disparities in the treatment of diagnoses commonly seen in ambulatory care. © The Author(s) 2016.

Screening for postdeployment conditions: development and cross-validation of an embedded validity scale in the neurobehavioral symptom inventory.

PubMed

Vanderploeg, Rodney D; Cooper, Douglas B; Belanger, Heather G; Donnell, Alison J; Kennedy, Jan E; Hopewell, Clifford A; Scott, Steven G

2014-01-01

To develop and cross-validate internal validity scales for the Neurobehavioral Symptom Inventory (NSI). Four existing data sets were used: (1) outpatient clinical traumatic brain injury (TBI)/neurorehabilitation database from a military site (n = 403), (2) National Department of Veterans Affairs TBI evaluation database (n = 48 175), (3) Florida National Guard nonclinical TBI survey database (n = 3098), and (4) a cross-validation outpatient clinical TBI/neurorehabilitation database combined across 2 military medical centers (n = 206). Secondary analysis of existing cohort data to develop (study 1) and cross-validate (study 2) internal validity scales for the NSI. The NSI, Mild Brain Injury Atypical Symptoms, and Personality Assessment Inventory scores. Study 1: Three NSI validity scales were developed, composed of 5 unusual items (Negative Impression Management [NIM5]), 6 low-frequency items (LOW6), and the combination of 10 nonoverlapping items (Validity-10). Cut scores maximizing sensitivity and specificity on these measures were determined, using a Mild Brain Injury Atypical Symptoms score of 8 or more as the criterion for invalidity. Study 2: The same validity scale cut scores again resulted in the highest classification accuracy and optimal balance between sensitivity and specificity in the cross-validation sample, using a Personality Assessment Inventory Negative Impression Management scale with a T score of 75 or higher as the criterion for invalidity. The NSI is widely used in the Department of Defense and Veterans Affairs as a symptom-severity assessment following TBI, but is subject to symptom overreporting or exaggeration. This study developed embedded NSI validity scales to facilitate the detection of invalid response styles. The NSI Validity-10 scale appears to hold considerable promise for validity assessment when the NSI is used as a population-screening tool.

Prostate Cancer Mortality and Herbicide Exposure in Vietnam Veterans

DTIC Science & Technology

2006-04-01

death rates , proportional mortality ratios (PMR), standardized mortality ratios (SMR), and logistic regression methods, using unexposed veterans as a reference population. RESULTS. NDI queries yielded causes of death for claimants who had died by 12 December 1999. Overall mortality was elevated for malignancies which the Institute of Medicine deemed sufficient evidence of association with herbicides. Microfilm record abstraction of military unit histories was completed for prostate cancer cases and controls. Exposure assessment for veterans serving in stable Army and Air

38 CFR 74.3 - Who does the Center for Veterans Enterprise (CVE) consider to own a veteran-owned small business?

Code of Federal Regulations, 2010 CFR

2010-07-01

... limited liability company. In the case of a concern that is a limited liability company, at least 51... interests that are held by investment companies licensed under part 107 of title 13, Code of Federal...

Improving Performance through Knowledge Translation in the Veterans Health Administration

ERIC Educational Resources Information Center

Francis, Joseph; Perlin, Jonathan B.

2006-01-01

The Veterans Health Administration (VA) provides a case study for linking performance measurement, information technology, and aligned research efforts to facilitate quality improvement in a large, complex health system. Dialogue between clinical researchers and VA leaders occurs through structured activities (e.g., the Quality Enhancement…

38 CFR 21.198 - “Discontinued” status.

Code of Federal Regulations, 2011 CFR

2011-07-01

... personal or other problems; or (ii) Inability of the veteran to benefit from rehabilitation services... of entitlement. (4) Medical and related problems. A veteran's case will be discontinued and assigned... program because of a serious physical or emotional problem for an extended period; and (ii) VA medical...

38 CFR 21.198 - “Discontinued” status.

Code of Federal Regulations, 2010 CFR

2010-07-01

... personal or other problems; or (ii) Inability of the veteran to benefit from rehabilitation services... of entitlement. (4) Medical and related problems. A veteran's case will be discontinued and assigned... program because of a serious physical or emotional problem for an extended period; and (ii) VA medical...

Informatics can identify systemic sclerosis (SSc) patients at risk for scleroderma renal crisis.

PubMed

Redd, Doug; Frech, Tracy M; Murtaugh, Maureen A; Rhiannon, Julia; Zeng, Qing T

2014-10-01

Electronic medical records (EMR) provide an ideal opportunity for the detection, diagnosis, and management of systemic sclerosis (SSc) patients within the Veterans Health Administration (VHA). The objective of this project was to use informatics to identify potential SSc patients in the VHA that were on prednisone, in order to inform an outreach project to prevent scleroderma renal crisis (SRC). The electronic medical data for this study came from Veterans Informatics and Computing Infrastructure (VINCI). For natural language processing (NLP) analysis, a set of retrieval criteria was developed for documents expected to have a high correlation to SSc. The two annotators reviewed the ratings to assemble a single adjudicated set of ratings, from which a support vector machine (SVM) based document classifier was trained. Any patient having at least one document positively classified for SSc was considered positive for SSc and the use of prednisone≥10mg in the clinical document was reviewed to determine whether it was an active medication on the prescription list. In the VHA, there were 4272 patients that have a diagnosis of SSc determined by the presence of an ICD-9 code. From these patients, 1118 patients (21%) had the use of prednisone≥10mg. Of these patients, 26 had a concurrent diagnosis of hypertension, thus these patients should not be on prednisone. By the use of natural language processing (NLP) an additional 16,522 patients were identified as possible SSc, highlighting that cases of SSc in the VHA may exist that are unidentified by ICD-9. A 10-fold cross validation of the classifier resulted in a precision (positive predictive value) of 0.814, recall (sensitivity) of 0.973, and f-measure of 0.873. Our study demonstrated that current clinical practice in the VHA includes the potentially dangerous use of prednisone for veterans with SSc. This present study also suggests there may be many undetected cases of SSc and NLP can successfully identify these patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

Dimensional structure of DSM-5 posttraumatic stress disorder symptoms: results from the National Health and Resilience in Veterans Study.

PubMed

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.

Intimate partner violence among women veterans: previous interpersonal violence as a risk factor.

PubMed

Iverson, Katherine M; Mercado, Rowena; Carpenter, Sarah L; Street, Amy E

2013-12-01

Experiences of abuse during childhood or military service may increase women veterans' risk for intimate partner violence (IPV) victimization. This study examined the relative impact of 3 forms of interpersonal violence exposure (childhood physical abuse [CPA], childhood sexual abuse [CSA], and unwanted sexual experiences during military service) and demographic and military characteristics on past-year IPV among women veterans. Participants were 160 female veteran patients at Veterans Afffairs hospitals in New England who completed a paper-and-pencil mail survey that included validated assessments of past-year IPV and previous interpersonal violence exposures. Women who reported CSA were 3.06 times, 95% confidence interval (CI) [1.14, 8.23], more likely to report past-year IPV relative to women who did not experience CSA. Similarly, women who reported unwanted sexual experiences during military service were 2.33 times, 95% CI [1.02, 5.35], more likely to report past-year IPV compared to women who did not report such experiences. CPA was not associated with IPV risk. Having less education and having served in the Army (vs. other branches) were also associated with greater risk of experiencing IPV in the past year. Findings have implications for assisting at risk women veterans in reducing their risk for IPV through detection and intervention efforts. Published 2013. This article is a US Government work and is in the public domain in the USA.

Comparison of serum levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin with indirect estimates of Agent Orange exposure among Vietnam veterans. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1989-09-01

The report tests the validity of several indirect methods for estimating the exposure of ground troops to Agent Orange in Vietnam during 1966-69. The study identified a sample of U.S. Army Vietnam veterans of that era and asked them to have blood drawn so that the level of 2,3,7,8-tetrachlorodibenzo-p- dioxin (TCDD) in serum could be measured. These veterans were selected from among those who served in 65 combat battalions in III Corps, a heavily sprayed part of Vietnam around Saigon. The men selected had all served only one tour in Vietnam and had been discharged with a pay grade ofmore » E1-E5, after having spent, on the average, over 300 days in Vietnam. The sample was chosen after the veterans had been stratified on likelihood of exposure (time and space proximity to recorded sprays) according to military records. For comparison, a sample of non-Vietnam U.S. Army veterans of the same era was also examined. The results show no meaningful association between TCDD levels and indirect estimate of Agent Orange exposure in Vietnam, with or without adjustment for other characteristics of the veterans, including age, race, body mass index, and self-reported civilian occupational and home herbicide exposure.« less

Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans.

PubMed

Vable, Anusha M; Kawachi, Ichiro; Canning, David; Glymour, M Maria; Jimenez, Marcia P; Subramanian, S V

2016-01-01

The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated. Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent's educational attainment in a subset of analyses. Husband's Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28). We found no evidence of a relationship between husband's Korean War GI Bill eligibility and wives' mental health in these data, however there may be a true effect that our analysis was underpowered to detect.

Prediction Models for 30-Day Mortality and Complications After Total Knee and Hip Arthroplasties for Veteran Health Administration Patients With Osteoarthritis.

PubMed

Harris, Alex Hs; Kuo, Alfred C; Bowe, Thomas; Gupta, Shalini; Nordin, David; Giori, Nicholas J

2018-05-01

Statistical models to preoperatively predict patients' risk of death and major complications after total joint arthroplasty (TJA) could improve the quality of preoperative management and informed consent. Although risk models for TJA exist, they have limitations including poor transparency and/or unknown or poor performance. Thus, it is currently impossible to know how well currently available models predict short-term complications after TJA, or if newly developed models are more accurate. We sought to develop and conduct cross-validation of predictive risk models, and report details and performance metrics as benchmarks. Over 90 preoperative variables were used as candidate predictors of death and major complications within 30 days for Veterans Health Administration patients with osteoarthritis who underwent TJA. Data were split into 3 samples-for selection of model tuning parameters, model development, and cross-validation. C-indexes (discrimination) and calibration plots were produced. A total of 70,569 patients diagnosed with osteoarthritis who received primary TJA were included. C-statistics and bootstrapped confidence intervals for the cross-validation of the boosted regression models were highest for cardiac complications (0.75; 0.71-0.79) and 30-day mortality (0.73; 0.66-0.79) and lowest for deep vein thrombosis (0.59; 0.55-0.64) and return to the operating room (0.60; 0.57-0.63). Moderately accurate predictive models of 30-day mortality and cardiac complications after TJA in Veterans Health Administration patients were developed and internally cross-validated. By reporting model coefficients and performance metrics, other model developers can test these models on new samples and have a procedure and indication-specific benchmark to surpass. Published by Elsevier Inc.

A Randomized Clinical Trial of a Money Management Intervention for Veterans With Psychiatric Disabilities.

PubMed

Elbogen, Eric B; Hamer, Robert M; Swanson, Jeffrey W; Swartz, Marvin S

2016-10-01

The study evaluated an intervention to help veterans with psychiatric disabilities, who face a unique set of challenges concerning money management. A randomized clinical trial was conducted of a brief (one to three hours) psychoeducational, recovery-oriented money management intervention called $teps for Achieving Financial Empowerment ($AFE). Analyses revealed no main effects on outcomes of random assignment to $AFE (N=67) or a control condition consisting of usual care (N=77). Veterans who reported using $AFE skills showed significantly lower impulsive buying, more responsible spending, higher rates of engaging in vocational activities, and greater number of work hours compared with veterans in the control condition. Findings have clinical implications for case management services involving informal money management assistance. Offering veterans with psychiatric disabilities a one-time money management intervention is unlikely to lead to substantial changes. Results imply that efforts to improve psychosocial outcomes among veterans must not only teach but also increase use of money management skills.

Veteran Transfer Students and Concealed Weapons on Campus

ERIC Educational Resources Information Center

Pesetski, Christine; Ofstein, Jennifer; Outlaw, Stacy; Brooks, Racheal

2014-01-01

This case details the challenges faced by various members of a 4-year university regarding Kathryn, a non-traditional transfer student and military veteran who recently returned from a traumatic deployment in Afghanistan. Precisely, this study identifies ambiguities pertaining to (a) threat assessment, (b) university weapons policies, (c) transfer…

Veterans Education: Coming Home to the Community College Classroom

ERIC Educational Resources Information Center

Persky, Karen Rae

2010-01-01

The purpose of this study was to identify the needs of veterans who are community college students and to examine community college programs and services essential to meeting their needs. A qualitative case study design using interviews, observations, field notes, document reviews, a focus group, and a preinterview demographic questionnaire…

Strategies and Perceptions of Administrative Duties of Veteran Special Education Teachers

ERIC Educational Resources Information Center

Berg, Michael

2014-01-01

In this qualitative descriptive case study, strategies used to manage special education administrative duties and current perspectives of administrative responsibilities of three veteran special education teachers were investigated. The three participants were also identified as teacher leaders within the department of special education for their…

38 CFR 12.3 - Deceased veteran's cases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... beneficiary at a field facility, as defined in § 12.0(b), a survey and inventory of the funds and effects of... occurred during hospitalization, a complete inventory (VA Form 10-2687, Inventory of Funds and Effects... death of incompetent veterans after November 30, 1959, the inventory will be completed to show...

38 CFR 21.130 - Educational and vocational courses outside the United States.

Code of Federal Regulations, 2010 CFR

2010-07-01

... vocational courses outside a State if the case manager determines that such training is in the best interest... vocational courses outside the United States. 21.130 Section 21.130 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Vocational Rehabilitation...

Reliability, validity and administrative burden of the community reintegration of injured service members computer adaptive test (CRIS-CAT)”

PubMed Central

2012-01-01

Background The Computer Adaptive Test version of the Community Reintegration of Injured Service Members measure (CRIS-CAT) consists of three scales measuring Extent of, Perceived Limitations in, and Satisfaction with community integration. The CRIS-CAT was developed using item response theory methods. The purposes of this study were to assess the reliability, concurrent, known group and predictive validity and respondent burden of the CRIS-CAT. The CRIS-CAT was developed using item response theory methods. The purposes of this study were to assess the reliability, concurrent, known group and predictive validity and respondent burden of the CRIS-CAT. Methods This was a three-part study that included a 1) a cross-sectional field study of 517 homeless, employed, and Operation Enduring Freedom / Operation Iraqi Freedom (OEF/OIF) Veterans; who completed all items in the CRIS item set, 2) a cohort study with one year follow-up study of 135 OEF/OIF Veterans, and 3) a 50-person study of CRIS-CAT administration. Conditional reliability of simulated CAT scores was calculated from the field study data, and concurrent validity and known group validity were examined using Pearson product correlations and ANOVAs. Data from the cohort were used to examine the ability of the CRIS-CAT to predict key one year outcomes. Data from the CRIS-CAT administration study were used to calculate ICC (2,1) minimum detectable change (MDC), and average number of items used during CAT administration. Results Reliability scores for all scales were above 0.75, but decreased at both ends of the score continuum. CRIS-CAT scores were correlated with concurrent validity indicators and differed significantly between the three Veteran groups (P < .001). The odds of having any Emergency Room visits were reduced for Veterans with better CRIS-CAT scores (Extent, Perceived Satisfaction respectively: OR = 0.94, 0.93, 0.95; P < .05). CRIS-CAT scores were predictive of SF-12 physical and mental health related quality of life scores at the 1 year follow-up. Scales had ICCs >0.9. MDCs were 5.9, 6.2, and 3.6, respectively for Extent, Perceived and Satisfaction subscales. Number of items (mn, SD) administered at Visit 1 were 14.6 (3.8) 10.9 (2.7) and 10.4 (1.7) respectively for Extent, Perceived and Satisfaction subscales. Conclusion The CRIS-CAT demonstrated sound measurement properties including reliability, construct, known group and predictive validity, and it was administered with minimal respondent burden. These findings support the use of this measure in assessing community reintegration. PMID:22984850

Six Sessions of Emotional Freedom Techniques Remediate One Veteran's Combat-Related Post-Traumatic Stress Disorder

PubMed Central

2017-01-01

Abstract Background: Reports show high rates of post-traumatic stress disorder (PTSD) in Veterans who served in the Gulf Wars. Emotional Freedom Techniques (EFT) comprises an evidence-based practice that is highly effective at reducing symptom severity in Veterans with PTSD. The case report here is of one of the Veterans who participated in a replication study of the first Veteran Stress Research Study conducted by Church et al. Results of that study demonstrated that EFT was highly effective at treating the psychologic symptoms of PTSD. Similar results have been found in the replication study conducted by Geronilla et al. Case: RM is a young Marine Reservist who served in Iraq and returned with PTSD. He participated in the Veteran Stress Project replication study wherein he received 6 sessions of EFT. EFT is explained and a sample treatment session is described. A discussion of some of the changes that have occurred for RM is included. Results: The patient's PTSD scores dropped from a high clinical score of 60 before treatment to 40 after 6 sessions and to a clinical score of 22 at 6 months follow-up. His insomnia, which had been at a clinical level, reduced as did his pain and measures of psychologic distress, as measured in the Symptom Assessment–45 instrument. Conclusion: Six sessions of EFT reduced PTSD scores dramatically and improved RM's life. He continues to use EFT to manage any stress in his life. PMID:28874927

Faith-Based Organizations and Veteran Reintegration: Enriching the Web of Support.

PubMed

Werber, Laura; Derose, Kathryn Pitkin; Rudnick, Mollie; Harrell, Margaret C; Naranjo, Diana

2015-11-30

Faith-based organizations (FBOs) are an important community-based resource for veterans as they readjust to civilian life. Through interviews with both national-level and smaller, local FBOs, the authors sought to understand better the current and potential roles for FBOs in veteran reintegration. Interviewees suggested that veterans may look to FBOs for support because they offer privacy and confidentiality, two features that may be especially critical when a potential stigma is involved. Some FBOs have also developed a reputation as safe places for veterans, providing supportive, judgment-free environments. FBOs not only help veterans with spiritual matters but address diverse areas of veteran health and wellness, including vocation, education, financial and legal stability, shelter, access to goods and services, mental health, access to health care, physical health, family, and social networks. In some cases, the support is offered to veterans directly; in other instances, the support is indirect, via training individuals to help veterans or educating the public about them. In the process of providing support, FBOs interact with varied organizations, including government entities, private nonprofits, and one another, for training, outreach, referrals, information exchange, obtaining donations, and collaboration. Yet challenges exist, including insufficient connections with chaplains working in different settings and others in the web of support, resource and capacity constraints, lack of awareness of experience with veterans, issues related to religious philosophy or orientation, and characteristics of veterans themselves. To move forward, the authors offer recommendations for policymakers, organizations that interact with FBOs, and FBOs themselves to help FBOs engage fully in the web of reintegration support.

Cardiovascular Risk Factor Burden in Veterans and Non-Veterans with Parkinson Disease

PubMed Central

Kotagal, Vikas; Albin, Roger L.; Müller, Martijn L.T.M; Bohnen, Nicolaas I.

2018-01-01

Background Medical comorbidities, including cardiovascular risk factors such as hypertension and diabetes, influence disease progression in Parkinson disease (PD) and may be variably present in different clinical populations. Objective/Methods We conducted a retrospective nested case-control study of 29 Veterans with PD and 29 non-Veteran PD controls. The groups were matched for age, gender, and disease duration. Both groups underwent clinical and imaging testing as part of their participation in a larger cross-sectional PD observational study at our research center. Veterans were recruited primarily from movement disorders neurology clinics at the Ann Arbor Veterans Affairs (VA) Health System. Non-Veterans were recruited primarily from analogous clinics at the University of Michigan Health System. We explored differences in cardiovascular risks factor burden between the groups. Results Veterans with PD showed higher scores on the simplified Framingham 10-year general cardiovascular disease risk calculator (FR score; 27.3% (11.5) vs. 20.7% (6.8); t = −2.66, p = 0.011) and fewer years of self-reported education (14.5 (2.5) vs. 16.7 (2.6); t = 3.33, p = 0.002). After adjusting for age, disease duration, education, and the use of antihypertensive medications, Veterans showed higher FR scores (t = 2.95, p = 0.005) and a higher intra-subject ratio of FR score to age-and-gender normalized FR score (t = 2.49, p = 0.016), representing an elevated component of modifiable cardiovascular risk factor burden. Conclusion Cardiovascular comorbidities are common in Veterans with PD and may be more severe than in non-Veteran PD populations. These findings merit replication in other representative cohorts. Veterans may be a preferred population for clinical trials evaluating cardiovascular risk factor management on PD progression. PMID:29480230

New to care: demands on a health system when homeless veterans are enrolled in a medical home model.

PubMed

O'Toole, Thomas P; Bourgault, Claire; Johnson, Erin E; Redihan, Stephen G; Borgia, Matthew; Aiello, Riccardo; Kane, Vincent

2013-12-01

We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use. We used case-control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011. We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use.

Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey (.).

PubMed

Young, J Christopher; Roper, Brad L; Arentsen, Timothy J

2016-05-01

A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias. Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams. Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported. Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA's role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.

South Korean military service promotes smoking: a quasi-experimental design.

PubMed

Allem, Jon-Patrick; Ayers, John W; Irvin, Veronica L; Hofstetter, C Richard; Hovell, Melbourne F

2012-03-01

The South Korean (SK) government monopolizes the tobacco industry and is accused of pushing smoking on captive military personnel. However, estimating the association between military service and smoking is difficult, since military service is required for all SK men and the few civilian waivers are usually based on smoking determinants, e.g., social status. Using a quasi-experimental design we validly estimate the association between military service and smoking. Military service was assigned by immigration patterns to the United States, instead of an experimenter, by comparing Korean Americans who happened to immigrate before or after the age(s) of mandated service. Smoking promotion in the military was also described among SK veterans, to identify the probable mechanisms for veterans' smoking tendencies. Veterans were 15% [95% confidence interval (CI), 4 to 27] more likely to ever-puff and 10% (95% CI, 0 to 23) more likely to ever-smoke cigarettes, compared to a similar group of civilians. Among veterans, 92% (95% CI, 89 to 95) recalled cigarettes were free, 30% (95% CI, 25 to 35) recalled smokers were given more work breaks and 38% (95% CI, 32 to 43) felt explicit "social pressure" to smoke. Free cigarettes was the strongest mechanism for veterans' smoking tendencies, e.g., veterans recalling free cigarette distribution were 16% (95% CI, 1 to 37) more likely to ever-smoke than veterans not recalling. These patterns suggest military service is strongly associated with smoking, and differences between veterans and civilians smoking may carry over long after military service. Given military service remains entirely in government purview, actively changing military smoking policies may prove most efficacious. This highlights the importance of recent bans on military cigarette distribution, but policies eliminating other smoking encouragements described by veterans are necessary and could effectively reduce the smoking prevalence by as much as 10% in SK.

Do different case-mix measures affect assessments of provider efficiency? Lessons from the Department of Veterans Affairs.

PubMed

Rosen, Amy K; Loveland, Susan A; Rakovski, Carter C; Christiansen, Cindy L; Berlowitz, Dan R

2003-01-01

Although case-mix adjustment is critical for provider profiling, little is known regarding whether different case-mix measures affect assessments of provider efficiency. We examine whether two case-mix measures, Adjusted Clinical Groups (ACGs) and Diagnostic Cost Groups (DCGs), result in different assessments of efficiency across service networks within the Department of Veterans Affairs (VA). Three profiling indicators examine variation in resource use. Although results from the ACGs and DCGs generally agree on which networks have greater or lesser efficiency than average, assessments of individual network efficiency vary depending upon the case-mix measure used. This suggests that caution should be used so that providers are not misclassified based on reported efficiency.

A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer.

PubMed

Chang, Ellen T; Boffetta, Paolo; Adami, Hans-Olov; Cole, Philip; Mandel, Jack S

2014-10-01

To inform risk assessment and regulatory decision-making, the relationship between 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and prostate cancer requires clarification. This article systematically and critically reviews the epidemiologic evidence on the association between exposure to TCDD or Agent Orange, a TCDD-contaminated herbicide used during the Vietnam War, and prostate cancer risk. Articles evaluated include 11 studies of three cohorts, four case-control or cross-sectional studies, and three case-only studies of military veterans with information on estimated Agent Orange or TCDD exposure; 13 studies of seven cohorts, one case-control study, and eight proportionate morbidity or mortality studies of Vietnam veterans without information on Agent Orange exposure; 11 cohort studies of workers with occupational exposure to TCDD; and two studies of one community cohort with environmental exposure to TCDD. The most informative studies, including those of Vietnam veterans involved in Agent Orange spraying or other handling, herbicide manufacturing or spraying workers with occupational TCDD exposure, and community members exposed to TCDD through an industrial accident, consistently reported no significant increase in prostate cancer incidence or mortality. Only some potentially confounded studies of Vietnam veterans compared with the general population, studies with unreliable estimates of Agent Orange exposure, and analyses of selected subgroups of Vietnam veterans reported positive associations. Overall, epidemiologic research offers no consistent or convincing evidence of a causal relationship between exposure to Agent Orange or TCDD and prostate cancer. More accurate exposure assessment is needed in large epidemiologic studies to rule out a causal association more conclusively.

Finding the Forgotten: Motivating Military Veterans to Register with a Primary Healthcare Practice.

PubMed

Finnegan, Alan; Jackson, Robin; Simpson, Robin

2018-05-09

In the UK, primary healthcare practices choose from a series of Read codes to detail certain characteristics onto a patient's medical documentation. One of these codes is for military veterans indicating a history relating to military service. However, veterans are poor at seeking help, with research indicating that this code is only applied in 7.9% of cases. Clinical staff have a clear role in motivating veterans to declare their ex-Forces status or register with a primary healthcare center. The aim of this study was to motivate veterans to notify primary healthcare staff of their armed forces status or register with a general practitioner, and to improve primary healthcare staff's understanding of veterans' health and social care issues. Data were provided by four primary healthcare centers' containing 40,470 patients in Lancashire, England during 2017. Pre- and post-patient medical record Read Code searches were conducted either side of a 6-wk intervention period centered on an advertising campaign. The data identified those veterans with the military specific Read code attached to their medical record and their age, gender, marital status and mental health disorders. Further information was gathered from interviews with eight members of staff, some of whom had completed an e-learning veteran healthcare academic module. The study was approved by the University of Chester's Research Ethics Committee. The pre-intervention search indicated that 8.7% (N = 180) of veterans were registered and had the correct military specific code applied to their medical record. Post-intervention, this figure increased by nearly 200% to N = 537. Mental health disorders were present in 28% (N = 152) of cases, including 15% (N = 78) with depression. Interviews revealed the primary healthcare staff's interpretation of the factors that motivated patients to declare their ex-Forces status and the key areas for development. The primary healthcare staff took ownership and responsibility for this initiative. They were creative in introducing new ways of engaging with the local armed forces community. Many veterans' and staff were unaware of veterans' entitlement to priority medical services, or the wider provisions available to them. It is probable that veterans declaring their military status within primary healthcare, or registering with a general practitioner for the first time is likely to increase. Another review will be undertaken after 12 mo, which will provide a better indication of success. There remains however an ongoing need to reach out to those veterans who never access a primary healthcare practice. This paper adds to the limited international empirical evidence undertaken to explore help-seeking behavior in an armed forces community. The positive outcomes of increased awareness and staff commitment provide a template for improvement across the UK, and will potentially stimulate similar initiatives with international colleagues.

Pro Patria: Limits to Military Obedience and Soldierly Honor in Modern Continental Europe: Case Studies from Polish and German Military History

DTIC Science & Technology

2007-03-01

history, caused the Waffen -SS veterans public dissatisfaction. In response, the ministry spokesman explained that the Bundeswehr was not against the...individual, not involved in crimes of Waffen -SS veterans, but against individuals who empathized with Nazis ideology.160 Although, the Bundeswehr

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

38 CFR 21.129 - Home study course.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Home study course. 21.129... Educational and Vocational Training Services § 21.129 Home study course. (a) Definition. A home study course... inclusion of home study courses, in rehabilitation plans. A veteran and his or her case manager may include...

38 CFR 21.188 - “Extended evaluation” status.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false âExtended evaluationâ.... Chapter 31 Case Status § 21.188 “Extended evaluation” status. (a) Purpose. The purposes of extended evaluation status are to: (1) Identify a veteran for whom a period of extended evaluation is needed; and (2...

38 CFR 21.188 - “Extended evaluation” status.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false âExtended evaluationâ.... Chapter 31 Case Status § 21.188 “Extended evaluation” status. (a) Purpose. The purposes of extended evaluation status are to: (1) Identify a veteran for whom a period of extended evaluation is needed; and (2...

38 CFR 21.188 - “Extended evaluation” status.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false âExtended evaluationâ.... Chapter 31 Case Status § 21.188 “Extended evaluation” status. (a) Purpose. The purposes of extended evaluation status are to: (1) Identify a veteran for whom a period of extended evaluation is needed; and (2...

38 CFR 21.188 - “Extended evaluation” status.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false âExtended evaluationâ.... Chapter 31 Case Status § 21.188 “Extended evaluation” status. (a) Purpose. The purposes of extended evaluation status are to: (1) Identify a veteran for whom a period of extended evaluation is needed; and (2...

38 CFR 21.188 - “Extended evaluation” status.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false âExtended evaluationâ.... Chapter 31 Case Status § 21.188 “Extended evaluation” status. (a) Purpose. The purposes of extended evaluation status are to: (1) Identify a veteran for whom a period of extended evaluation is needed; and (2...

VA and HRS Local Coordination of Florida's Home-Based Services to the Elderly.

ERIC Educational Resources Information Center

Bradham, Douglas D.; Chico, Innette Mary

Florida's District 12 Veterans Administration (VA) wanted to deliver medical case-management services to veterans not receiving home-based services due to the geographic restrictions of the VA's Hospital-Based Home Care Program. The Florida Department of Health and Rehabilitative Services (HRS) desired to demonstrate the effectiveness of nurse…

38 CFR 21.8340 - Leaves of absence.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Leaves of absence. 21... Vietnam Veterans-Spina Bifida and Covered Birth Defects Leaves of Absence § 21.8340 Leaves of absence. (a... absence. The VR&E case manager may grant the child leaves of absence for periods during which the child...

Combat veterans with comorbid PTSD and mild TBI exhibit a greater inhibitory processing ERP from the dorsal anterior cingulate cortex.

PubMed

Shu, I-Wei; Onton, Julie A; O'Connell, Ryan M; Simmons, Alan N; Matthews, Scott C

2014-10-30

Posttraumatic stress disorder (PTSD) is common among combat personnel with mild traumatic brain injury (mTBI). While patients with either PTSD or mTBI share abnormal activation of multiple frontal brain areas, anterior cingulate cortex (ACC) activity during inhibitory processing may be particularly affected by PTSD. To further test this hypothesis, we recorded electroencephalography from 32 combat veterans with mTBI-17 of whom were also comorbid for PTSD (mTBI+PTSD) and 15 without PTSD (mTBI-only). Subjects performed the Stop Task, a validated inhibitory control task requiring inhibition of initiated motor responses. We observed a larger inhibitory processing eventrelated potential (ERP) in veterans with mTBI+PTSD, including greater N200 negativity. Furthermore, greater N200 negativity correlated with greater PTSD severity. This correlation was most dependent on contributions from the dorsal ACC. Support vector machine analysis demonstrated that N200 and P300 amplitudes objectively classified veterans into mTBI-only or mTBI+PTSD groups with 79.4% accuracy. Our results support a model where, in combat veterans with mTBI, larger ERPs from cingulate areas are associated with greater PTSD severity and likely related to difficulty controlling ongoing brain processes, including trauma-related thoughts and feelings. Published by Elsevier Ireland Ltd.

Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide.

PubMed

Omalu, Bennet; Hammers, Jennifer L; Bailes, Julian; Hamilton, Ronald L; Kamboh, M Ilyas; Webster, Garrett; Fitzsimmons, Robert P

2011-11-01

Following his discovery of chronic traumatic encephalopathy (CTE) in football players in 2002, Dr. Bennet Omalu hypothesized that posttraumatic stress disorder (PTSD) in military veterans may belong to the CTE spectrum of diseases. The CTE surveillance at the Brain Injury Research Institute was therefore expanded to include deceased military veterans diagnosed with PTSD. The authors report the case of a 27-year-old United States Marine Corps (USMC) Iraqi war veteran, an amphibious assault vehicle crewman, who committed suicide by hanging after two deployments to Fallujah and Ramadi. He experienced combat and was exposed to mortar blasts and improvised explosive device blasts less than 50 m away. Following his second deployment he developed a progressive history of cognitive impairment, impaired memory, behavioral and mood disorders, and alcohol abuse. Neuropsychiatric assessment revealed a diagnosis of PTSD with hyperarousal (irritability and insomnia) and numbing. He committed suicide approximately 8 months after his honorable discharge from the USMC. His brain at autopsy appeared grossly unremarkable except for congestive brain swelling. There was no atrophy or remote focal traumatic brain injury such as contusional necrosis or hemorrhage. Histochemical and immunohistochemical brain tissue analysis revealed CTE changes comprising multifocal, neocortical, and subcortical neurofibrillary tangles and neuritic threads (ranging from none, to sparse, to frequent) with the skip phenomenon, accentuated in the depths of sulci and in the frontal cortex. The subcortical white matter showed mild rarefaction, sparse perivascular and neuropil infiltration by histiocytes, and mild fibrillary astrogliosis. Apolipoprotein E genotype was 3/4. The authors report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.

Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study

PubMed Central

Chalder, T; Hotopf, M; Unwin, C; Hull, L; Ismail, K; David, A; Wessely, S

2001-01-01

Objectives To determine how many veterans in a random sample of British veterans who served in the Gulf war believe they have “Gulf war syndrome,” to examine factors associated with the presence of this belief, and to compare the health status of those who believe they have Gulf war syndrome with those who do not. Design Questionnaire study asking British Gulf war veterans whether they believe they have Gulf war syndrome and about symptoms, fatigue, psychological distress, post-traumatic stress, physical functioning, and their perception of health. Participants 2961 respondents to questionnaires sent out to a random sample of 4250 Gulf war veterans (69.7%). Main outcome measure The proportion of veterans who believe they have Gulf war syndrome. Results Overall, 17.3% (95% confidence interval 15.9 to 18.7) of the respondents believed they had Gulf war syndrome. The belief was associated with the veteran having poor health, not serving in the army when responding to the questionnaire, and having received a high number of vaccinations before deployment to the Gulf. The strongest association was knowing another person who also thought they had Gulf war syndrome. Conclusions Substantial numbers of British Gulf war veterans believe they have Gulf war syndrome, which is associated with psychological distress, a high number of symptoms, and some reduction in activity levels. A combination of biological, psychological, and sociological factors are associated with the belief, and these factors should be addressed in clinical practice. What is already known on this topicThe term Gulf war syndrome has been used to describe illnesses and symptoms experienced by veterans of the 1991 Gulf warConcerns exist over the validity of Gulf war syndrome as a unique entityWhat this study adds17% of Gulf war veterans believe they have Gulf war syndromeHolding the belief is associated with worse health outcomesKnowing someone else who believes they have Gulf war syndrome and receiving more vaccinations were associated with holding the belief PMID:11532836

Chronic obstructive pulmonary disease in Scottish military veterans.

PubMed

Bergman, Beverly P; Mackay, D F; Pell, J P

2018-02-01

Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). Serving military personnel have previously been shown to be more likely to smoke, and to smoke more heavily, than civilians, but there is no clear consensus as to whether in later life, as veterans, they experience a higher prevalence and mortality from COPD than do non-veterans. We examined the risk of COPD in Scottish veterans and assessed the impact of changes in military smoking. Retrospective 30-year cohort study of 56 205 veterans born 1945-1985, and 172 741 people with no record of military service, matched for age, sex and area of residence, using Cox proportional hazard models to examine the association between veteran status, birth cohort, length of service and risk of COPD resulting in hospitalisation or death. There were 1966 (3.52%) cases of COPD meeting the definition in veterans, compared with 5434 (3.19%) in non-veterans. The difference was statistically significant (p=0.001) in the unadjusted model although it became non-significant after adjusting for deprivation. The highest risk was seen in the oldest (1945-1949) birth cohort and in veterans with the shortest service (Early Service Leavers). The risk was significantly reduced in veterans born from 1960, and in those with over 12 years' service. Our findings are consistent with falling rates of military smoking since the 1960s, and with the reduction in smoking with longer service. The oldest veterans, and those with the shortest service, are least likely to have benefited from this, as reflected in their higher risk for COPD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Diverse veterans' pre- and post-intervention perceptions of home telemental health for posttraumatic stress disorder delivered via tablet.

PubMed

Whealin, Julia M; King, L; Shore, P; Spira, J L

2017-01-01

Objectives Home telemental health services have the potential to overcome many individual and systemic barriers to care facing military veterans with posttraumatic stress disorder. However, little is known about the home telemental health-related attitudes and experiences of highly underserved rural or ethnically, racially diverse veterans. This study evaluated whether ethnically/racially diverse U.S. veterans residing in the rural Pacific Islands would find the delivery of evidence-based treatment for posttraumatic stress disorder via home telemental health tablet devices useful and helpful. Method Clinicians located in a central urban location delivered Cognitive Processing Therapy for posttraumatic stress disorder directly into patients' homes via a tablet device and secure WiFi connection. Pre- and post-treatment measures were collected from a clinical sample of 47 veterans (average age: 49.3 years). Most (74.4%) self-identified as being of ethnic/racial minority background. Attitudinal, satisfaction, and usability scales were collected from home telemental health engaging ( n = 29) and non-engaging ( n = 18) veterans. Results Ratings on measures of home telemental health comfort, satisfaction with care, and usability were uniformly positive. Veterans were equally open to receiving mental health services at home via home telemental health or in the clinic. In the case of services for a physical problem, however, veterans preferred in-clinic care. Following treatment, veterans' attitudinal scores increased on items such as "There is enough therapist contact in home telemental health interventions." However, a small portion of veterans (7%) reported having technical or privacy concerns. Conclusion The provision of evidence-based posttraumatic stress disorder treatment directly into the patients' homes proved feasible and was well received by the large majority of rural ethnically/racially diverse veterans.

A British Second World War veteran with disseminated strongyloidiasis.

PubMed

Gill, G V; Beeching, N J; Khoo, S; Bailey, J W; Partridge, S; Blundell, J W; Luksza, A R

2004-06-01

A case is described of a 78-year-old British veteran of the Second World War (1939-45) who was stationed in Southeast Asia and who developed a recurrent pneumonia with blood eosinophilia. He was treated with steroids, and eventually died with a severe Pseudomonas pneumonia. Just prior to death, larvae of Strongyloides stercoralis were identified in his sputum, and a specific serum ELISA test was later positive. At autopsy no other organs were involved, but bronchoalveolar carcinoma was found. Longstanding (57 years) chronic strongyloidiasis in a veteran who served in Southeast Asia but who was not a prisoner of war is very unusual. The pattern of dissemination was also not that of a true hyperinfection syndrome, and the case demonstrates the continued need for diagnostic vigilance amongst former soldiers who were based in the Far East.

Heart rate variability (HRV) and posttraumatic stress disorder (PTSD): a pilot study.

PubMed

Tan, Gabriel; Dao, Tam K; Farmer, Lorie; Sutherland, Roy John; Gevirtz, Richard

2011-03-01

Exposure to combat experiences is associated with increased risk of developing Post Traumatic Stress Disorder. Prolonged exposure therapy and cognitive processing therapy have garnered a significant amount of empirical support for PTSD treatment; however, they are not universally effective with some patients continuing to struggle with residual PTSD symptoms. Heart rate variability (HRV) is a measure of the autonomic nervous system functioning and reflects an individual's ability to adaptively cope with stress. A pilot study was undertaken to determine if veterans with PTSD (as measured by the Clinician-Administered PTSD Scale and the PTSD Checklist) would show significantly different HRV prior to an intervention at baseline compared to controls; specifically, to determine whether the HRV among veterans with PTSD is more depressed than that among veterans without PTSD. The study also aimed at assessing the feasibility, acceptability, and potential efficacy of providing HRV biofeedback as a treatment for PTSD. The findings suggest that implementing an HRV biofeedback as a treatment for PTSD is effective, feasible, and acceptable for veterans. Veterans with combat-related PTSD displayed significantly depressed HRV as compared to subjects without PTSD. When the veterans with PTSD were randomly assigned to receive either HRV biofeedback plus treatment as usual (TAU) or just TAU, the results indicated that HRV biofeedback significantly increased the HRV while reducing symptoms of PTSD. However, the TAU had no significant effect on either HRV or symptom reduction. A larger randomized control trial to validate these findings appears warranted.

Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans

PubMed Central

Vable, Anusha M.; Kawachi, Ichiro; Canning, David; Glymour, M. Maria; Jimenez, Marcia P.; Subramanian, S. V.

2016-01-01

Background The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated. Methods Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent’s educational attainment in a subset of analyses. Results Husband’s Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28). Conclusions We found no evidence of a relationship between husband’s Korean War GI Bill eligibility and wives’ mental health in these data, however there may be a true effect that our analysis was underpowered to detect. PMID:27186983

Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition.

PubMed

Gates, Margaret A; Holowka, Darren W; Vasterling, Jennifer J; Keane, Terence M; Marx, Brian P; Rosen, Raymond C

2012-11-01

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that affects 7-8% of the general U.S. population at some point during their lifetime; however, the prevalence is much higher among certain subgroups, including active duty military personnel and veterans. In this article, we review the empirical literature on the epidemiology and screening of PTSD in military and veteran populations, including the availability of sensitive and reliable screening tools. Although estimates vary across studies, evidence suggests that the prevalence of PTSD in deployed U.S. military personnel may be as high as 14-16%. Prior studies have identified trauma characteristics and pre- and posttrauma factors that increase risk of PTSD among veterans and military personnel. This information may help to inform prevention and screening efforts, as screening programs could be targeted to high-risk populations. Large-scale screening efforts have recently been implemented by the U.S. Departments of Defense and Veterans Affairs. Given the prevalence and potential consequences of PTSD among veterans and active duty military personnel, development and continued evaluation of effective screening methods is an important public health need.

Characteristics and service utilization of homeless veterans entering VA substance use treatment.

PubMed

Cox, Koriann B; Malte, Carol A; Saxon, Andrew J

2017-05-01

This article compares characteristics and health care utilization patterns of homeless veterans entering substance use disorder (SUD) treatment. Baseline self-report and medical record data were collected from 181 homeless veterans participating in a randomized trial of SUD/housing case management. Veterans, categorized as newly (n = 45), episodically (n = 61), or chronically homeless (n = 75), were compared on clinical characteristics and health care utilization in the year prior to baseline. Between-groups differences were seen in stimulant use, bipolar, and depressive disorders. A significant majority accessed VA emergency department services, and nearly half accessed inpatient services, with more utilization among chronically versus newly homeless. A majority in all groups attended VA primary care (73.5%) and mental health (56.9%) visits, and 26.7% newly, 32.8% episodically, and 56.0% chronically homeless veterans initiated multiple SUD treatment episodes (p = .002). A significant proportion of veterans struggling with homelessness and SUDs appear to remain unstable despite high utilization of VA acute and preventative services. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Integrating care coordination home telehealth and home based primary care in rural Oklahoma: a pilot study.

PubMed

Sorocco, Kristen H; Bratkovich, Kristi L; Wingo, Rita; Qureshi, Saleem M; Mason, Patrick J

2013-08-01

The purpose of this program was to evaluate the benefits of integrating VA Care Coordination Home Telehealth and Telemental health within HBPC. A case study design was used to determine quality assurance and quality improvement of incorporating additional home telehealth equipment within Home Based Primary Care (HBPC). Veterans with complex medical conditions and their caregivers living in rural Oklahoma were enrolled. Veterans received the same care other HBPC patients received with the addition of home telehealth equipment. Members from the interdisciplinary treatment team were certified to use the telehealth equipment. Veterans and their caregivers were trained on use of the equipment in their homes. Standard HBPC program measures were used to assess the program success. Assessments from all disciplines on the HBPC team were at baseline, 3, and 6 months, and participants provided satisfaction and interview data to assess the benefits of integrating technology into standard care delivery within an HBPC program. Six veterans were enrolled (mean age = 72 yrs) with a range of physical health conditions including: chronic obstructive pulmonary disease, cerebrovascular accident, spinal cord injury, diabetes, hypertension, and syncope. Primary mental health conditions included depression, dementia, anxiety, and PTSD. Scores on the Mini-Mental State Examination ranged from 18 to 30. Over a 6-month period, case studies indicated improvements in strength, social functioning, decreased caregiver burden, and compliance with treatment plan. This integration of CCHT and HBPC served previously underserved rural veterans having complex medical conditions and appears both feasible and clinically beneficial to veterans and their caregivers. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Behavioral Health and Adjustment to College Life for Student Service Members/Veterans.

PubMed

Schonfeld, Lawrence; Braue, Lawrence A; Stire, Sheryl; Gum, Amber M; Cross, Brittany L; Brown, Lisa M

2015-01-01

Increasing numbers of student service members/veterans (SSM/Vs) are enrolling in college. However, little is known about how their previous military experience affects their adjustment to this new role. The present study tested the hypothesis that SSM/Vs who report adjustment problems in college have a higher incidence of posttraumatic stress disorder (PTSD), depression, and other behavioral health problems compared with those who do not report adjustment problems. SSM/Vs (N = 173) at a large, southeastern, public university completed online surveys that included well-validated screens measuring substance use, depression, PTSD, and other mental disorders. Those reporting difficulties adjusting to university life (28%) reported significantly higher frequencies of behavioral and health problems while in the military, and significantly higher levels of PTSD, depression, and mental health disorders, but no difference in substance use. Implications for improved behavioral health screening and coordination of university behavioral health services with veterans' health systems are discussed.

The Dissociative Subtype of PTSD Scale (DSPS): Initial Evaluation in a National Sample of Trauma-Exposed Veterans

PubMed Central

Wolf, Erika J.; Mitchell, Karen S.; Sadeh, Naomi; Hein, Christina; Fuhrman, Isaac; Pietrzak, Robert H.; Miller, Mark W.

2015-01-01

The fifth edition of the Diagnostic and Statistical Manual (DSM-5) includes a dissociative subtype of posttraumatic stress disorder (PTSD), but no existing measures specifically assess it. This paper describes the initial evaluation of a 15-item self-report measure of the subtype called the Dissociative Subtype of PTSD Scale (DSPS) in an on-line survey of 697 trauma-exposed military veterans representative of the US veteran population. Exploratory factor analyses of the lifetime DSPS items supported the intended structure of the measure consisting of three factors reflecting derealization/depersonalization, loss of awareness, and psychogenic amnesia. Consistent with prior research, latent profile analyses assigned 8.3% of the sample to a highly dissociative class distinguished by pronounced symptoms of derealization and depersonalization. Overall, results provide initial psychometric support for the lifetime DSPS scales; additional research in clinical and community samples is needed to further validate the measure. PMID:26603115

The Dissociative Subtype of PTSD Scale: Initial Evaluation in a National Sample of Trauma-Exposed Veterans.

PubMed

Wolf, Erika J; Mitchell, Karen S; Sadeh, Naomi; Hein, Christina; Fuhrman, Isaac; Pietrzak, Robert H; Miller, Mark W

2017-06-01

The fifth edition of the Diagnostic and Statistical Manual includes a dissociative subtype of posttraumatic stress disorder, but no existing measures specifically assess it. This article describes the initial evaluation of a 15-item self-report measure of the subtype called the Dissociative Subtype of Posttraumatic Stress Disorder Scale (DSPS) in an online survey of 697 trauma-exposed military veterans representative of the U.S. veteran population. Exploratory factor analyses of the lifetime DSPS items supported the intended structure of the measure consisting of three factors reflecting derealization/depersonalization, loss of awareness, and psychogenic amnesia. Consistent with prior research, latent profile analyses assigned 8.3% of the sample to a highly dissociative class distinguished by pronounced symptoms of derealization and depersonalization. Overall, results provide initial psychometric support for the lifetime DSPS scales; additional research in clinical and community samples is needed to further validate the measure.

Providing intensive addiction/housing case management to homeless veterans enrolled in addictions treatment: A randomized controlled trial.

PubMed

Malte, Carol A; Cox, Koriann; Saxon, Andrew J

2017-05-01

This study sought to determine whether homeless veterans entering Veterans Affairs (VA) substance use treatment randomized to intensive addiction/housing case management (AHCM) had improved housing, substance use, mental health, and functional outcomes and lower acute health care utilization, compared to a housing support group (HSG) control. Homeless veterans (n = 181) entering outpatient VA substance use treatment were randomized to AHCM and HSG and received treatment for 12 months. AHCM provided individualized housing, substance use and mental health case management, life skills training, and community outreach. The control condition was a weekly drop-in housing support group. Adjusted longitudinal analyses compared groups on baseline to month 12 change in percentage of days housed and functional status, substance use, and mental health outcomes (36-Item Short-Form Health Survey; Addiction Severity Index [ASI]). Negative binomial regression models compared groups on health care utilization. Both conditions significantly increased percentage of days housed, with no differences detected between conditions. In total, 74 (81.3%) AHCM and 64 (71.1%) HSG participants entered long-term housing (odds ratio = 1.9, 95% confidence interval [0.9, 4.0], p = .088). HSG participants experienced a greater decrease in emergency department visits than AHCM (p = .037), whereas AHCM participants remained in substance use treatment 52.7 days longer (p = .005) and had greater study treatment participation (p < .001) than HSG. ASI alcohol composite scores improved more for HSG than AHCM (p = .006), and both conditions improved on ASI drug and psychiatric scores and alcohol/drug abstinence. AHCM did not demonstrate overarching benefits beyond standard VA housing and substance use care. For those veterans not entering or losing long-term housing, different approaches to outreach and ongoing intervention are required. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Multiple sclerosis in US veterans of the Vietnam era and later military service: race, sex, and geography.

PubMed

Wallin, Mitchell T; Page, William F; Kurtzke, John F

2004-01-01

We identified 5345 cases of multiple sclerosis (MS) among US veterans who first entered military service between 1960 and 1994, and who were "service-connected" for MS by the Department of Veterans Affairs (VA). Two controls per case were matched on age, date of service entry, and branch of service. Available for service and VA files were demographic and military data for 4951 cases and 9378 controls. Versus white men, relative risk of MS was significantly higher for all women, at 2.99 for whites, 2.86 for blacks, and 3.51 for those of other races. This was a significant increase from our prior series of veterans of World War II and the Korean Conflict, where white women had a relative risk of 1.79. Risk for black men was higher now (0.67 vs 0.44), while other men remained low (0.30 vs 0.22). Residence at service entry in the northern tier of states had a relative risk of 2.02 versus the southern tier, which was significantly less than the 2.64 for the earlier series. Residence by individual state at birth and service entry for white men further supported this decreasing geographic differential. Such marked changes in geography, sex, and race in such a short interval strongly imply a primary environmental factor in the cause or precipitation of this disease.

“They’re Going to Die Anyway”: Smoking Shelters at Veterans’ Facilities

PubMed Central

Smith, Elizabeth A.; Malone, Ruth E.

2013-01-01

Military personnel and veterans are disadvantaged by inadequate tobacco control policies. We conducted a case study of a Department of Veterans Affairs (VA) effort to disallow smoking and tobacco sales in VA facilities. Despite strong VA support, the tobacco industry created a public relations–focused grassroots veterans’ opposition group, eventually pushing the US Congress to pass a law requiring smoking areas in every VA health facility. Arguing that it would be unpatriotic to deny veterans this “freedom” they had ostensibly fought for and that banning smoking could even harm veterans’ health, industry consultants exploited veterans’ organizations to protect tobacco industry profits. Civilian public health advocates should collaborate with veterans to expose the industry’s manipulation, reframe the debate, and repeal the law. PMID:23409899

Self-report and longitudinal predictors of violence in Iraq and Afghanistan war era veterans.

PubMed

Elbogen, Eric B; Johnson, Sally C; Newton, Virginia M; Fuller, Sara; Wagner, H Ryan; Beckham, Jean C

2013-10-01

This study, using a longitudinal design, attempted to identify whether self-reported problems with violence were empirically associated with future violent behavior among Iraq and Afghanistan war veterans and whether and how collateral informant interviews enhanced the risk assessment process. Data were gathered from N = 300 participants (n = 150 dyads of Iraq and Afghanistan war veterans and family/friends). The veterans completed baseline and follow-up interviews 3 years later on average, and family/friends provided collateral data on dependent measures at follow-up. Analyses showed that aggression toward others at follow-up was associated with younger age, posttraumatic stress disorder, combat exposure, and a history of having witnessed parental violence growing up. Self-reported problems controlling violence at baseline had robust statistical power in predicting aggression toward others at follow-up. Collateral report enhanced detection of dependent variables: 20% of cases positive for violence toward others would have been missed relying only on self-report. The results identify a subset of Iraq and Afghanistan war veterans at higher risk for problematic postdeployment adjustment and indicate that the veterans' self-report of violence was useful in predicting future aggression. Underreporting of violence was not evidenced by most veterans but could be improved upon by obtaining collateral information.

Clinical findings of the second 1000 UK Gulf War veterans who attended the Ministry of Defence's Medical Assessment Programme.

PubMed

Lee, H A; Gabriel, R; Bale, A J; Bolton, P; Blatchley, N F

2001-06-01

To review the diagnoses made in the second 1000 veterans of the Gulf conflict 1990-91 seen in the Ministry of Defence's Gulf Veterans' Medical Assessment Programme and to determine the main conditions related to Gulf service. Case series of 1000 consecutive Gulf veterans who presented to the programme between 25 February 1997 and 19 February 1998. Gulf War veterans. Assessment of the patient's health status. Diagnosis of medical and psychiatric conditions using ICD-10. 204 patients were unwell. 309 patients had organic disease, of whom 248 were well, 252 had psychiatric conditions which remained active in 173. The remaining 79, now well, had had psychiatric disorders following Gulf service. The principal psychiatric diagnosis was post traumatic stress disorder and the majority arose as a result of Gulf service. 796 (80%) veterans were well. There were 309 (31%) patients with organic disease. 252 (25%) veterans had psychiatric conditions of which 173 (69%) had an active diagnosed disorder and post traumatic stress disorder was the predominant condition. The pattern of disease is similar to that seen in NHS practice. We found, like others, no evidence to support a unique Gulf War syndrome. Post conflict illnesses have many common features.

Virtual reality exposure therapy using a virtual Iraq: case report.

PubMed

Gerardi, Maryrose; Rothbaum, Barbara Olasov; Ressler, Kerry; Heekin, Mary; Rizzo, Albert

2008-04-01

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.

Virtual Reality Exposure Therapy Using a Virtual Iraq: Case Report

PubMed Central

Gerardi, Maryrose; Rothbaum, Barbara Olasov; Ressler, Kerry; Heekin, Mary; Rizzo, Albert

2013-01-01

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment. PMID:18404648

Neuropsychologic assessment of a population-based sample of Gulf War veterans.

PubMed

Wallin, Mitchell T; Wilken, Jeffrey; Alfaro, Mercedes H; Rogers, Catherine; Mahan, Clare; Chapman, Julie C; Fratto, Timothy; Sullivan, Cynthia; Kang, Han; Kane, Robert

2009-09-01

The objective of this project was to compare neuropsychologic performance and quality of life in a population-based sample of deployed Gulf War (GW) veterans with and without multisymptom complaints. The study participants were obtained from the 30,000 member population-based National Health Survey of GW-era veterans conducted in 1995. Cases (N=25) were deployed to the year 1990 and 1991 GW and met Center for Disease Control and Prevention criteria for multisymptom GW illness (GWI). Controls (N=16) were deployed to the 1990 and 1991 GW but did not meet Center for Disease Control and Prevention criteria for GWI. There were no significant differences in composite scores on the traditional and computerized neuropsychologic battery (automated neuropsychologic assessment metrics) between GW cases and controls using bivariate techniques. Multiple linear regression analyses controlling for demographic and clinical variables revealed composite automated neuropsychologic assessment metrics scores were associated with age (b=-7.8; P=0.084), and education (b=22.9; P=0.0012), but not GW case or control status (b=-63.9; P=0.22). Compared with controls, GW cases had significantly more impairment on the Personality Assessment Inventory and the short form-36. Compared with GW controls, GW cases meeting criteria for GWI had preserved cognition function but had significant psychiatric symptoms and lower quality of life.

Development and Validation of a Natural Language Processing Tool to Identify Patients Treated for Pneumonia across VA Emergency Departments.

PubMed

Jones, B E; South, B R; Shao, Y; Lu, C C; Leng, J; Sauer, B C; Gundlapalli, A V; Samore, M H; Zeng, Q

2018-01-01

Identifying pneumonia using diagnosis codes alone may be insufficient for research on clinical decision making. Natural language processing (NLP) may enable the inclusion of cases missed by diagnosis codes. This article (1) develops a NLP tool that identifies the clinical assertion of pneumonia from physician emergency department (ED) notes, and (2) compares classification methods using diagnosis codes versus NLP against a gold standard of manual chart review to identify patients initially treated for pneumonia. Among a national population of ED visits occurring between 2006 and 2012 across the Veterans Affairs health system, we extracted 811 physician documents containing search terms for pneumonia for training, and 100 random documents for validation. Two reviewers annotated span- and document-level classifications of the clinical assertion of pneumonia. An NLP tool using a support vector machine was trained on the enriched documents. We extracted diagnosis codes assigned in the ED and upon hospital discharge and calculated performance characteristics for diagnosis codes, NLP, and NLP plus diagnosis codes against manual review in training and validation sets. Among the training documents, 51% contained clinical assertions of pneumonia; in the validation set, 9% were classified with pneumonia, of which 100% contained pneumonia search terms. After enriching with search terms, the NLP system alone demonstrated a recall/sensitivity of 0.72 (training) and 0.55 (validation), and a precision/positive predictive value (PPV) of 0.89 (training) and 0.71 (validation). ED-assigned diagnostic codes demonstrated lower recall/sensitivity (0.48 and 0.44) but higher precision/PPV (0.95 in training, 1.0 in validation); the NLP system identified more "possible-treated" cases than diagnostic coding. An approach combining NLP and ED-assigned diagnostic coding classification achieved the best performance (sensitivity 0.89 and PPV 0.80). System-wide application of NLP to clinical text can increase capture of initial diagnostic hypotheses, an important inclusion when studying diagnosis and clinical decision-making under uncertainty. Schattauer GmbH Stuttgart.

Making a Case for Personal Safety: Perceptions of Vulnerability and Desire for Self-Defense Training Among Female Veterans

ERIC Educational Resources Information Center

David, Wendy S.; Cotton, Ann J.; Simpson, Tracy L.; Weitlauf, Julie C.

2004-01-01

We assessed perceptions of vulnerability and the desire for personal safety/self-defense (PS/SD) training among 67 female veterans receiving outpatient mental health treatment, primarily for post-traumatic stress disorder (PTSD) from sexual and/or physical trauma. Consistent with the literature on the impact of such training on nonclinical…

A Comparative Case Study of Veteran Superintendent's Leadership and Organizational Processes in Addressing the Academic Achievement of Students in Low Performing School Districts

ERIC Educational Resources Information Center

Reimer, Catherine Nicole

2010-01-01

This research study investigated the leadership behaviors and organizational frames utilized by two veteran superintendents of medium sized school districts in California to address issues of academic performance in their respective districts as perceived by the superintendents and their respective board members and principals. Current…

Paraoxonase in Persian Gulf War veterans.

PubMed

Hotopf, Matthew; Mackness, Michael Ian; Nikolaou, Vasilis; Collier, David A; Curtis, Charles; David, Anthony; Durrington, Paul; Hull, Lisa; Ismail, Khalida; Peakman, Mark; Unwin, Catherine; Wessely, Simon; Mackness, Bharti

2003-07-01

Serum paraoxonase (PON1) is responsible for the metabolism of organophosphates in serum, and PON1 activity is a major determinant of their toxicity in humans. There have been reports linking lowered PON1 activity to physical symptoms after deployment to the Persian Gulf War (PGW) of 1990 to 1991. Therefore, the object of this study was to determine (1) whether PON1 activity was decreased among symptomatic PGW veterans compared with asymptomatic PGW veterans and (2) to determine whether PGW veterans as a whole had lower PON1 activity compared with other military control groups. This was a case control study nested in occupational cohort study of military personnel. Four groups of military personnel were identified from a large epidemiological study of health effects of deployment to the PGW and Bosnia: (1) symptomatic PGW veterans, n = 115; (2) healthy PGW veterans, n = 95; (3) symptomatic Bosnia peacekeeping veterans, n = 52; and (4) symptomatic nondeployed military controls, n = 85. The main outcome measures were PON1 activity and genotype for PON1-55 and -192. We found significant differences in PON1 activity among these four groups, and although the two Gulf groups did not differ in PON1 activity, those deployed to the Gulf had significantly lower PON1 activity compared with the non-PGW groups (median difference = 70.9; 95% CI: 20.2, 121.5, P = 0.012). These differences were not explained by a range of potential confounders, or differences in PON1 coding region polymorphisms. PON1 activity is reduced in PGW veterans compared with military control groups. The effect is independent of ill health in PGW veterans.

The dissociative post-traumatic stress disorder (PTSD) subtype: A treatment outcome cohort study in veterans with PTSD.

PubMed

Haagen, Joris F G; van Rijn, Allison; Knipscheer, Jeroen W; van der Aa, Niels; Kleber, Rolf J

2018-06-01

Dissociation is a prevalent phenomenon among veterans with post-traumatic stress disorder (PTSD) that may interfere with the effectiveness of treatment. This study aimed to replicate findings of a dissociative PTSD subtype, to identify corresponding patterns in coping style, symptom type, and symptom severity, and to investigate its impact on post-traumatic symptom improvement. Latent profile analysis (LPA) was applied to baseline data from 330 predominantly (97%) male treatment-seeking veterans (mean age 39.5 years) with a probable PTSD. Multinomial logistic models were used to identify predictors of dissociative PTSD. Eighty veterans with PTSD that commenced with psychotherapy were invited for a follow-up measure after 6 months. The majority (n = 64, 80% response rate) completed the follow-up measure. Changes in post-traumatic stress between baseline and follow-up were explored as a continuous distal outcome. Latent profile analysis revealed four distinct patient profiles: 'low' (12.9%), 'moderate' (33.2%), 'severe' (45.1%), and 'dissociative' (8.8%) PTSD. The dissociative PTSD profile was characterized by more severe pathology levels, though not post-traumatic reactions symptom severity. Veterans with dissociative PTSD benefitted equally from PTSD treatment as veterans with non-dissociative PTSD with similar symptom severity. Within a sample of veterans with PTSD, a subsample of severely dissociative veterans was identified, characterized by elevated severity levels on pathology dimensions. The dissociative PTSD subtype did not negatively impact PTSD treatment. The present findings confirmed the existence of a distinct subgroup veterans that fit the description of dissociative PTSD. Patients with dissociative PTSD subtype symptoms uniquely differed from patients with non-dissociative PTSD in the severity of several psychopathology dimensions. Dissociative and non-dissociative PTSD patients with similar post-traumatic severity levels showed similar levels of improvement after PTSD treatment. The observational design and small sample size caution interpretation of the treatment outcome data. The IES-R questionnaire does not assess all PTSD DSM-IV diagnostic criteria (14 of 17), although it is considered a valid measure for an indication of PTSD. © 2018 The British Psychological Society.

Combat veterans with PTSD after mild TBI exhibit greater ERPs from posterior-medial cortical areas while appraising facial features.

PubMed

Shu, I-Wei; Onton, Julie A; Prabhakar, Nitin; O'Connell, Ryan M; Simmons, Alan N; Matthews, Scott C

2014-02-01

Posttraumatic stress disorder (PTSD) worsens prognosis following mild traumatic brain injury (mTBI). Combat personnel with histories of mTBI exhibit abnormal activation of distributed brain networks-including emotion processing and default mode networks. How developing PTSD further affects these abnormalities has not been directly examined. We recorded electroencephalography in combat veterans with histories of mTBI, but without active PTSD (mTBI only, n=16) and combat veterans who developed PTSD after mTBI (mTBI+PTSD, n=16)-during the Reading the Mind in the Eyes Test (RMET), a validated test of empathy requiring emotional appraisal of facial features. Task-related event related potentials (ERPs) were identified, decomposed using independent component analysis (ICA) and localized anatomically using dipole modeling. We observed larger emotional face processing ERPs in veterans with mTBI+PTSD, including greater N300 negativity. Furthermore, greater N300 negativity correlated with greater PTSD severity, especially avoidance/numbing and hyperarousal symptom clusters. This correlation was dependent on contributions from the precuneus and posterior cingulate cortex (PCC). Our results support a model where, in combat veterans with histories of mTBI, larger ERPs from over-active posterior-medial cortical areas may be specific to PTSD, and is likely related to negative self-referential activity. © 2013 Published by Elsevier B.V.

Can Social Policy Influence Socio-Economic Disparities? Korean War GI Bill Eligibility and Markers of Depression

PubMed Central

Vable, Anusha M.; Canning, David; Glymour, M. Maria; Kawachi, Ichiro; Jimenez, Marcia P.; Subramanian, S. V.

2017-01-01

Background The Korean War GI Bill provided socio-economic benefits to veterans, however its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities. Methods Data from 246 Korean War GI Bill eligible veterans and 240 non-veterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age=78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling / missing data, N=167) or high (both parents ≥ 8 years schooling, N=319) childhood socio-economic status (cSES) groups. Results Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β=-0.64, 95% Confidence Interval (CI):(-1.18, -0.09), p=0.022]. Socio-economic disparities were smaller among veterans than non-veterans for number of depressive symptoms [β=-0.76, 95% (CI):(-1.33, -0.18), P = 0.010] and elevated depressive symptoms [β=-11.7, 95%CI:(-8.2, -22.6), P = 0.035]. Conclusions Korean War GI Bill eligibility predicted smaller socio-economic disparities in depression markers. PMID:26778285

Improving the Diagnosis of Legionella Pneumonia within a Healthcare System through a Systematic Consultation and Testing Program.

PubMed

Decker, Brooke K; Harris, Patricia L; Muder, Robert R; Hong, Jae H; Singh, Nina; Sonel, Ali F; Clancy, Cornelius J

2016-08-01

Legionella testing is not recommended for all patients with pneumonia, but rather for particular patient subgroups. As a result, the overall incidence of Legionella pneumonia may be underestimated. To determine the incidence of Legionella pneumonia in a veteran population in an endemic area after introduction of a systematic infectious diseases consultation and testing program. In response to a 2011-2012 outbreak, the VA Pittsburgh Healthcare System mandated infectious diseases consultations and testing for Legionella by urine antigen and sputum culture in all patients with pneumonia. Between January 2013 and December 2015, 1,579 cases of pneumonia were identified. The incidence of pneumonia was 788/100,000 veterans per year, including 352/100,000 veterans per year and 436/100,000 veterans per year with community-associated pneumonia (CAP) and health care-associated pneumonia, respectively. Ninety-eight percent of patients with suspected pneumonia were tested for Legionella by at least one method. Legionella accounted for 1% of pneumonia cases (n = 16), including 1.7% (12/706) and 0.6% (4/873) of CAP and health care-associated pneumonia, respectively. The yearly incidences of Legionella pneumonia and Legionella CAP were 7.99 and 5.99/100,000 veterans, respectively. The sensitivities of urine antigen and sputum culture were 81% and 60%, respectively; the specificity of urine antigen was >99.97%. Urine antigen testing and Legionella cultures increased by 65% and 330%, respectively, after introduction of our program. Systematic testing of veterans in an endemic area revealed a higher incidence of Legionella pneumonia and CAP than previously reported. Widespread urine antigen testing was not limited by false positivity.

Transcatheter Aortic Valve Replacement Improves Health Status in Elderly Veterans.

PubMed

Gurevich, Sergey; Reiff, Chris; Bertog, Stefan; Mbai, Mackenzie; Kelly, Rosemary F; Soule, Matthew; Yannopoulos, Demetris; Garcia, Santiago

2018-06-01

United States veterans have substantially worse baseline health status than the general population, which may limit the health benefits of transcatheter aortic valve replacement (TAVR). The aim of this study is to quantify the health benefits of TAVR in veterans undergoing the procedure within the United States Department of Veterans Affairs (VA) health-care system. We prospectively evaluated heath status in 131 elderly veterans undergoing TAVR in the VA healthcare system between 2015 and 2017. Health status was assessed at baseline and 30 days post procedure using the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Totals and domain-specific (physical limitation, symptoms, quality of life, and social limitation) health statuses were measured and analyzed with a paired t-test. We also conducted stratified analysis by baseline New York Heart Association functional class and N-terminal pro-b type natriuretic peptide levels. Mean patient age was 77 ± 8 years and average Society of Thoracic Surgeons (STS) score was 4.4 (interquartile range, 3-7). Transfemoral access and balloon-expandable valves were used in 118 cases (92%) and 108 cases (83%), respectively. At baseline, overall health status was poor (overall score, 43 ± 19). After TAVR, significant improvements in overall health status (30 ± 18) and domain-specific health status were seen (improvements in physical limitation, 12 ± 20; symptoms, 23 ± 23; quality of life, 20 ± 17; social limitation, 22 ± 21; all P<.001). The majority of patients (88%) had moderate to large improvements in health status. A favorable outcome (alive with KCCQ-12 overall score >60 at 30 days) was seen in 78% of patients. Among elderly veterans with severe aortic stenosis, TAVR is associated with significant improvements in short-term health status.

A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

PubMed

Hernandez, Susan E; Taylor, Leslie; Grembowski, David; Reid, Robert J; Wong, Edwin; Nelson, Karin M; Liu, Chuan-Fen; Fihn, Stephan D; Hebert, Paul L

2016-03-01

Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration. Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility. Cross-sectional, facility-level analysis of PACT implementation measures in 2012. Veterans Health Administration hospital-based and community-based primary care facilities. We used a previously validated PACT Implementation Progress Index (Pi) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low (<5.2%, n=208), medium (5.2%-25.8%, n=413), and high (>25.8%, n=206) percent minority based on the percent of their own veteran population. Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and high minority facilities scored 0.773 (P=0.009) and 0.930 (P=0.008) points lower on the Pi score relative to low minority facilities. Relative to low minority facilities, both medium and high minority facilities were less likely of having high Pi scores (≥2) and more likely of having low Pi scores (≤-2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management). Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having a lower implementation scores.

Association of Alcohol Misuse With Sexual Identity and Sexual Behavior in Women Veterans.

PubMed

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.

38 CFR 21.180 - Case status system.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., treatment, and other related services, the VR&E case manager will coordinate with Veterans Health... process have been completed. The case status system will: (1) Assist VR&E staff to fulfill its case... case status at each point in the rehabilitation process. (c) Case manager. The VR&E (Vocational...

38 CFR 21.180 - Case status system.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., treatment, and other related services, the VR&E case manager will coordinate with Veterans Health... process have been completed. The case status system will: (1) Assist VR&E staff to fulfill its case... case status at each point in the rehabilitation process. (c) Case manager. The VR&E (Vocational...

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

PubMed

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.

Screening, diagnosis, and treatment of post-traumatic stress disorder.

PubMed

Wisco, Blair E; Marx, Brian P; Keane, Terence M

2012-08-01

Post-traumatic stress disorder (PTSD) is a prevalent problem among military personnel and veterans. Identification of effective screening tools, diagnostic technologies, and treatments for PTSD is essential to ensure that all individuals in need of treatment are offered interventions with proven efficacy. Well-validated methods for screening and diagnosing PTSD are now available, and effective pharmacological and psychological treatments can be offered. Despite these advances, many military personnel and veterans do not receive evidence-based care. We review the literature on screening, diagnosis, and treatment of PTSD in military populations, and discuss the challenges to implementing the best evidence-based practices in clinical settings.

A temporal interestingness measure for drug interaction signal detection in post-marketing surveillance.

PubMed

Ji, Yanqing; Ying, Hao; Tran, John; Dews, Peter; Mansour, Ayman; Massanari, R Michael

2014-01-01

Drug-drug interactions (DDIs) can result in serious consequences, including death. Existing methods for identifying potential DDIs in post-marketing surveillance primarily rely on the FDA's (Food and Drug Administration) spontaneous reporting system. However, this system suffers from severe underreporting, which makes it difficult to timely collect enough valid cases for statistical analysis. In this paper, we study how to signal potential DDIs using patient electronic health data. Specifically, we focus on discovery of potential DDIs by analyzing the temporal relationships between the concurrent use of two drugs of interest and the occurrences of various symptoms using novel temporal association mining techniques we developed. A new interestingness measure called functional temporal interest was proposed to assess the degrees of temporal association between two drugs of interest and each symptom. The measure was employed to screen potential DDIs from 21,405 electronic patient cases retrieved from the Veterans Affairs Medical Center in Detroit, Michigan. The preliminary results indicate the usefulness of our method in finding potential DDIs for further analysis (e.g., epidemiology study) and investigation (e.g., case review) by drug safety professionals.

Application of Short Screening Tools for Post-Traumatic Stress Disorder in the Korean Elderly Population

PubMed Central

Jang, Yu Jin; Chung, Hae Gyung; Choi, Jin Hee; Kim, Tae Yong; So, Hyung Seok

2016-01-01

Objective Post-traumatic stress disorder (PTSD) is often missed or incorrectly diagnosed in primary care settings. Although brief screening instruments may be useful in detecting PTSD, an adequate validation study has not been conducted with older adults. This study aimed to evaluate the reliability and validity of the Korean version of the primary care PTSD screen (PC-PTSD) and single-item PTSD screener (SIPS) in elderly veterans. Methods The PC-PTSD and SIPS assessments were translated into Korean, with a back-translation to the original language to verify accuracy. Vietnamese war veterans [separated into a PTSD group (n=41) and a non-PTSD group (n=99)] participated in several psychometric assessments, including the Korean versions of the PC-PTSD (PC-PTSD-K), SIPS (SIPS-K), a structured clinical interview from the Diagnostic and Statistical Manual of Mental Disorders-IV(SCID), and PTSD checklist(PCL). Results The PC-PTSD-K showed high internal consistency (Cronbach α=0.76), and the test-retest reliability of the PC-PTSD-K and SIPS-K were also high (r=0.97 and r=0.91, respectively). A total score of 3 from the PC-PTSD-K yielded the highest diagnostic efficiency, with sensitivity and specificity values of 0.90 and 0.86, respectively. The 'bothered a lot' response level from the SIPS-K showed the highest diagnostic efficiency, with sensitivity and specificity values of 0.85 and 0.89, respectively. Conclusion Our findings suggest that both PC-PTSD-K and SIPS-K have good psychometric properties with high validity and reliability for detecting PTSD symptoms in elderly Korean veterans. However, further research will be necessary to increase our understanding of PTSD characteristics in diverse groups with different types of trauma. PMID:27482241

Defining the high-risk patient for carotid endarterectomy: an analysis of the prospective National Surgical Quality Improvement Program database.

PubMed

Stoner, Michael C; Abbott, William M; Wong, Daniel R; Hua, Hong T; Lamuraglia, Glenn M; Kwolek, Chirstopher J; Watkins, Michael T; Agnihotri, Arvind K; Henderson, William G; Khuri, Shukri; Cambria, Richard P

2006-02-01

Carotid endarterectomy (CEA) is the gold standard for the treatment of carotid stenosis, but carotid angioplasty and stenting has been advocated in high-risk patients. The definition of such a population has been elusive, particularly because the data are largely retrospective. Our study examined results for CEA in the National Surgical Quality Improvement Program database (both Veterans Affairs and private sector). National Surgical Quality Improvement Program data were gathered prospectively for all patients undergoing primary isolated CEA during the interval 2000 to 2003 at 123 Veterans Affairs and 14 private sector academic medical centers. Study end points included the 30-day occurrence of any stroke, death, or cardiac event. A variety of clinical, demographic, and operative variables were assessed with multivariate models to identify risk factors associated with the composite (stroke, death, or cardiac event) end point. Adjudication of end points was by trained nurse reviewers (previously validated). A total of 13,622 CEAs were performed during the study period; 95% were on male patients, and 91% of cases were conducted within the Veterans Affairs sector. The average age was 68.6 +/- 0.1 years, and 42.1% of the population had no prior neurologic event. The composite stroke, death, or cardiac event rate was 4.0%; the stroke/death rate was 3.4%. Multivariate correlates of the composite outcome were (odds ratio, P value) as follows: deciles of age (1.13, .018), insulin-requiring diabetes (1.73, <.001), oral agent-controlled diabetes (1.39, .003), decade of pack-years smoking (1.04, >.001), history of transient ischemic attack (1.41, >.001), history of stroke (1.51, >.001), creatinine >1.5 mg/dL (1.48, >.001), hypoalbuminemia (1.49, >.001), and fourth quartile of operative time (1.44, >.001). Cardiopulmonary comorbid features did not affect the composite outcome in this model. Regional anesthesia was used in 2437 (18%) cases, with a resultant relative risk reduction for stroke (17%), death (24%), cardiac event (33%), and the composite outcome (31%; odds ratio, 0.69; P = .008). Carotid endarterectomy results across a spectrum of Veterans Affairs and private sector hospitals compare favorably to contemporary studies. These data will assist in selecting patients who are at an increased risk for adverse outcomes. Use of regional anesthetic significantly reduced perioperative complications in a risk-adjusted model, thus suggesting that it is the anesthetic of choice when CEA is performed in high-risk patients.

A systematic review of suicide prevention programs for military or veterans.

PubMed

Bagley, Steven C; Munjas, Brett; Shekelle, Paul

2010-06-01

Military personnel and veterans have important suicide risk factors. After a systematic review of the literature on suicide prevention, seven (five in the U.S.) studies of military personnel were identified containing interventions that may reduce the risk of suicide. The effectiveness of the individual components was not assessed, and problems in methodology or reporting of data were common. Overall, multifaceted interventions for active duty military personnel are supported by consistent evidence, although of very mixed quality, and in some cases during intervals of declines in suicide rates in the general population. There were insufficient studies of U.S. Veterans to reach conclusions.

Informatics can identify systemic sclerosis (SSc) patients at risk for scleroderma renal crisis

PubMed Central

Redd, Doug; Frech, Tracy M.; Murtaugh, Maureen A.; Rhiannon, Julia; Zeng, Qing T.

2016-01-01

Background Electronic medical records (EMR) provide an ideal opportunity for the detection, diagnosis, and management of systemic sclerosis (SSc) patients within the Veterans Health Administration (VHA). The objective of this project was to use informatics to identify potential SSc patients in the VHA that were on prednisone, in order to inform an outreach project to prevent scleroderma renal crisis (SRC). Methods The electronic medical data for this study came from Veterans Informatics and Computing Infrastructure (VINCI). For natural language processing (NLP) analysis, a set of retrieval criteria was developed for documents expected to have a high correlation to SSc. The two annotators reviewed the ratings to assemble a single adjudicated set of ratings, from which a support vector machine (SVM) based document classifier was trained. Any patient having at least one document positively classified for SSc was considered positive for SSc and the use of prednisone ≥ 10 mg in the clinical document was reviewed to determine whether it was an active medication on the prescription list. Results In the VHA, there were 4,272 patients that have a diagnosis of SSc determined by the presence of an ICD-9 code. From these patients, 1,118 patients (21%) had the use of prednisone ≥_10 mg. Of these patients, 26 had a concurrent diagnosis of hypertension, thus these patients should not be on prednisone. By the use of natural language processing (NLP) an additional 16,522 patients were identified as possible SSc, highlighting that cases of SSc in the VHA may exist that are unidentified by ICD-9. A 10-fold cross validation of the classifier resulted in a precision (positive predictive value) of 0.814, recall (sensitivity) of 0.973, and f-measure of 0.873. Conclusions Our study demonstrated that current clinical practice in the VHA includes the potentially dangerous use of prednisone for veterans with SSc. This present study also suggests there may be many undetected cases of SSc and NLP can successfully identify these patients. PMID:25168254

To establish the Veterans Crisis Response Corps, and for other purposes.

THOMAS, 113th Congress

Rep. Schiff, Adam B. [D-CA-28

2018-05-23

House - 05/23/2018 Referred to the Committee on Veterans' Affairs, and in addition to the Committees on Transportation and Infrastructure, Foreign Affairs, and Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Patient-Centered Perioperative Care for a Victim of Military Sexual Trauma.

PubMed

Hickey, Thomas R; Kirwin, Paul D; Gardner, Elizabeth C; Feinleib, Jessica

2017-05-01

The patient population seen in our nation's Veterans Affairs Healthcare system is increasingly female and an alarming percentage of our veterans, male and female alike, report a history of military sexual trauma (MST), which is associated with an increased burden of morbidities including post-traumatic stress disorder (PTSD) and substance abuse. The experience of surgery can produce symptoms of PTSD in a clinically significant percentage of patients. This article describes the challenges of achieving a patient-centered perioperative care plan in the case of a female veteran who suffers from PTSD as a result of MST. We provide a brief background on the changing demographics of our nation's veterans, a review of MST and patient-centered care, and a description of the interdisciplinary care plan created and implemented for our patient. We note how this care model employs key elements of the Perioperative Surgical Home Model as developed by the American Society of Anesthesiologists. Finally, we propose an agenda for improving perioperative care for this group of veterans. No institutional review board was required for this case report-based discussion. The patient-centered care plan developed and implemented by an interdisciplinary team was well received by the patient and enabled her to comply with her postsurgical physical therapy. This recent interdisciplinary experience was in stark contrast to her experience of former surgical procedures, and produced much higher patient satisfaction. Improvements are needed in patient-centered perioperative care for victims of MST, both within the Veterans Affairs system and in the larger health care system. We suggest an agenda to improve care for these patients including: (1) increasing provider awareness and education about MST and about the potential psychological trauma of surgery per se, (2) employing elements of the Perioperative Surgical Home to encourage patient-centered care involving collaboration within an interdisciplinary team, (3) and measurement of patient centered outcomes. Perioperative care for the victim of MST is heretofore not addressed in the literature. We hope this case report and review will stimulate further research into optimizing care for these vulnerable patients. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Project VALOR: design and methods of a longitudinal registry of post-traumatic stress disorder (PTSD) in combat-exposed veterans in the Afghanistan and Iraqi military theaters of operations.

PubMed

Rosen, Raymond C; Marx, Brian P; Maserejian, Nancy N; Holowka, Darren W; Gates, Margaret A; Sleeper, Lynn A; Vasterling, Jennifer J; Kang, Han K; Keane, Terence M

2012-03-01

Few studies have investigated the natural history of post-traumatic stress disorder (PTSD). Project VALOR (Veterans' After-discharge Longitudinal Registry) was designed as a longitudinal patient registry assessing the course of combat-related PTSD among 1600 male and female Veterans who served in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF). Aims of the study include investigating patterns and predictors of progression or remission of PTSD and treatment utilization. The study design was based on recommendations from the Agency for Healthcare Quality and Research for longitudinal disease registries and used a pre-specified theoretical model to select the measurement domains for data collection and interpretation of forthcoming results. The registry will include 1200 male and female Veterans with a recent diagnosis of PTSD in the Department of Veteran Affairs (VA) electronic medical record and a comparison group of 400 Veterans without a medical record-based PTSD diagnosis, to also allow for case-control analyses. Data are collected from administrative databases, electronic medical records, a self-administered questionnaire, and a semi-structured diagnostic telephone interview. Project VALOR is a unique and timely registry study that will evaluate the clinical course of PTSD, psychosocial correlates, and health outcomes in a carefully selected cohort of returning OEF/OIF Veterans. Copyright © 2011 John Wiley & Sons, Ltd.

Increased blood pressures in veterans with post traumatic stress disorder.

PubMed

Moazen-Zadeh, Ehsan; Khoshdel, Alireza; Avakh, Farhad; Rahmani, Arash

2016-08-01

Objective Veterans of war affected by posttraumatic stress disorder (PTSD) are at increased risk for cardiovascular diseases. We aimed to compare brachial and central blood pressures between veterans with PTSD and controls. Method In this case-control study on veterans of Iran-Iraq war, 50 veterans with PTSD and 50 veterans as controls were selected from an outpatient clinic and matched for age ±3 years. Exclusion criteria were malignancies, severe anatomical defects such as amputated extremities, history of PTSD before serving in war, comorbid psychiatric disorders other than anxiety or depressive disorders. Detailed history was taken concerning medical and social aspects. Beck Depression Inventory was used for depressive symptoms. Brachial blood pressures were measured using both auscultatory and oscillometric devices. Measures of central hemodynamics were estimated accordingly. Data on lipid profile were collected either through medical records or newly required lab tests. Results Brachial systolic, diastolic, and pulse pressures as well as estimated central systolic and diastolic pressures were significantly higher in the PTSD group. Beck Depression Inventory scores, frequency of diabetes mellitus, and hypertension were significantly higher in the PTSD group. PTSD status was an independent predictor of both brachial and central systolic and diastolic pressures. Conclusions We demonstrated increased measures of blood pressure in veterans with PTSD independent of depression and other risk factors. Further research is warranted to confirm our results.

Mental health service acceptability for the armed forces veteran community.

PubMed

Farrand, P; Jeffs, A; Bloomfield, T; Greenberg, N; Watkins, E; Mullan, E

2018-06-15

Despite developments in mental health services for armed forces veterans and family members, barriers to access associated with poor levels of acceptability regarding service provision remain. Adapting a Step 2 mental health service based on low-intensity cognitive behavioural therapy (CBT) interventions to represent a familiar context and meet the needs of the armed forces veteran community may serve to enhance acceptability and reduce help-seeking barriers. To examine acceptability of a Step 2 low-intensity CBT mental health service adapted for armed forces veterans and family members provided by a UK Armed Forces charity. Qualitative study using individual semi-structured interviews with armed forces veterans and family members of those injured or becoming unwell while serving in the British Armed Forces. Data analysis was undertaken using thematic alongside disconfirming case analysis. Adapting a Step 2 mental health service for armed forces veterans and family members enhanced acceptability and promoted help-seeking. Wider delivery characteristics associated with Step 2 mental health services within the Improving Access to Psychological Therapies (IAPT) programme also contributed to service acceptability. However, limitations of Step 2 mental health service provision were also identified. A Step 2 mental health service adapted for armed forces veterans and family members enhances acceptability and may potentially overcome help-seeking barriers. However, concerns remain regarding ways to accommodate the treatment of post-traumatic stress disorder and provide support for family members.

VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration.

PubMed

Shireman, Paula K; Rasmussen, Todd E; Jaramillo, Carlos A; Pugh, Mary Jo

2015-02-03

Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA). The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries. This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.

77 FR 63297 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-16

... Retail Pharmacy Program; OMB Number 0720-0032. Needs and Uses: Specifically, under the collection of... audit capabilities of the Pharmacy Data Transaction Service (PDTS) to validate refunds owed to the... beneficiaries through the TRICARE Retail Pharmacy Program subject to the pricing standards of the Veterans...

Leveraging Electronic Health Care Record Information to Measure Pressure Ulcer Risk in Veterans With Spinal Cord Injury: A Longitudinal Study Protocol.

PubMed

Luther, Stephen L; Thomason, Susan S; Sabharwal, Sunil; Finch, Dezon K; McCart, James; Toyinbo, Peter; Bouayad, Lina; Matheny, Michael E; Gobbel, Glenn T; Powell-Cope, Gail

2017-01-19

Pressure ulcers (PrUs) are a frequent, serious, and costly complication for veterans with spinal cord injury (SCI). The health care team should periodically identify PrU risk, although there is no tool in the literature that has been found to be reliable, valid, and sensitive enough to assess risk in this vulnerable population. The immediate goal is to develop a risk assessment model that validly estimates the probability of developing a PrU. The long-term goal is to assist veterans with SCI and their providers in preventing PrUs through an automated system of risk assessment integrated into the veteran's electronic health record (EHR). This 5-year longitudinal, retrospective, cohort study targets 12,344 veterans with SCI who were cared for in the Veterans Health Administration (VHA) in fiscal year (FY) 2009 and had no record of a PrU in the prior 12 months. Potential risk factors identified in the literature were reviewed by an expert panel that prioritized factors and determined if these were found in structured data or unstructured form in narrative clinical notes for FY 2009-2013. These data are from the VHA enterprise Corporate Data Warehouse that is derived from the EHR structured (ie, coded in database/table) or narrative (ie, text in clinical notes) data for FY 2009-2013. This study is ongoing and final results are expected in 2017. Thus far, the expert panel reviewed the initial list of risk factors extracted from the literature; the panel recommended additions and omissions and provided insights about the format in which the documentation of the risk factors might exist in the EHR. This list was then iteratively refined through review and discussed with individual experts in the field. The cohort for the study was then identified, and all structured, unstructured, and semistructured data were extracted. Annotation schemas were developed, samples of documents were extracted, and annotations are ongoing. Operational definitions of structured data elements have been created and steps to create an analytic dataset are underway. To our knowledge, this is the largest cohort employed to identify PrU risk factors in the United States. It also represents the first time natural language processing and statistical text mining will be used to expand the number of variables available for analysis. A major strength of this quantitative study is that all VHA SCI centers were included in the analysis, reducing potential for selection bias and providing increased power for complex statistical analyses. This longitudinal study will eventually result in a risk prediction tool to assess PrU risk that is reliable and valid, and that is sensitive to this vulnerable population. ©Stephen L Luther, Susan S Thomason, Sunil Sabharwal, Dezon K Finch, James McCart, Peter Toyinbo, Lina Bouayad, Michael E Matheny, Glenn T Gobbel, Gail Powell-Cope. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 19.01.2017.

Disaster preparedness and response practices among providers from the Veterans Health Administration and Veterans with spinal cord injuries and/or disorders

PubMed Central

Hogan, Timothy P.; Holmes, Sally A.; Rapacki, Lauren M.; Evans, Charlesnika T.; Lindblom, Laurie; Hoenig, Helen; Goldstein, Barry; Hahm, Bridget; Weaver, Frances M.

2011-01-01

Objectives Few empirical studies have examined the disaster preparedness and response practices of individuals with spinal cord injuries and/or disorders (SCI/D) and the healthcare providers who serve them. This study was conducted to understand the experiences of Veterans Health Administration (VHA) providers and Veterans with SCI/D in recent natural disasters, and to identify lessons learned for disaster preparedness and response in the context of SCI/D. Design Semi-structured interviews were conducted with providers and Veterans recruited through seven VHA facilities that had sustained a disaster since 2003. Audio recordings of the interviews were transcribed; transcripts were analyzed using constant comparative techniques. Results Forty participants completed an interview, including 21 VHA SCI/D providers and 19 Veterans with SCI/D. Disasters experienced by participants were weather related. While many Veterans were evacuated or admitted to nearby VHA facilities, others chose to stay in their communities. All facilities had formal disaster plans and engaged in related training; however, participants explained that many aspects of a response take shape ‘in the moment,’ and must address both provider and Veteran needs. Dispersion of resources hindered well-coordinated care, but effective communication, teamwork, advanced warnings, and VHA's electronic medical record facilitated efforts. Conclusions Even in the case of thorough planning, Veterans with SCI/D and their healthcare providers are faced with pressing needs during disasters, and identifying strategies to coordinate care is critical. The lessons learned are intended to inform the efforts of healthcare providers who may be involved in the care of individuals with SCI/D in future disasters. PMID:21903009

Validation of a Screening Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in a US Commercial Health Plan Claims Database

PubMed Central

Zedler, Barbara K; Saunders, William B; Joyce, Andrew R; Vick, Catherine C; Murrelle, E Lenn

2018-01-01

Abstract Objective To validate a risk index that estimates the likelihood of overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids. Subjects and Methods A case-control analysis of 18,365,497 patients with an opioid prescription from 2009 to 2013 in the IMS PharMetrics Plus commercially insured health plan claims database (CIP). An OIRD event occurred in 7,234 cases. Four controls were selected per case. Validity of the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD), developed previously using Veterans Health Administration (VHA) patient data, was assessed. Multivariable logistic regression was used within the CIP study population to develop a slightly refined RIOSORD. The composition and performance of the CIP-based RIOSORD was evaluated and compared with VHA-based RIOSORD. Results VHA-RIOSORD performed well in discriminating OIRD events in CIP (C-statistic = 0.85). Additionally, re-estimation of logistic model coefficients in CIP yielded a 0.90 C-statistic. The resulting comorbidity and pharmacotherapy variables most highly associated with OIRD and retained in the CIP-RIOSORD were largely concordant with VHA-RIOSORD. These variables included neuropsychiatric and cardiopulmonary disorders, impaired drug excretion, opioid characteristics, and concurrent psychoactive medications. The average predicted probability of OIRD ranged from 2% to 83%, with excellent agreement between predicted and observed incidence across risk classes. Conclusions RIOSORD had excellent predictive accuracy in a large population of US medical users of prescription opioids, similar to its performance in VHA. This practical risk index is designed to support clinical decision-making for safer opioid prescribing, and its clinical utility should be evaluated prospectively. PMID:28340046

Experience and Opinions of Forensic Psychiatrists Regarding PTSD in Criminal Cases.

PubMed

Cohen, Ziv E; Appelbaum, Paul S

2016-03-01

By the end of 2014, 1.5 million veterans of the Second Iraq and Afghan wars were to have returned home, up to 35 percent with PTSD. The potential use of PTSD as the basis for legal claims in criminal defense is therefore a pressing problem. Using a Web-based survey, we examined the experiences and attitudes of members of the American Academy of Psychiatry and the Law (AAPL) regarding PTSD in the criminal forensic setting. Of 238 respondents, 50 percent had been involved in a criminal case involving PTSD, 41 percent in the previous year. Eighty-six percent of cases involved violent crime and 40 percent homicides. Forty-two percent of defendants were soldiers in active service or veterans, of whom 89 percent had had combat exposure, mostly in the Second Iraq and Afghan wars. Outcomes reported were not guilty by reason of insanity (NGRI) (7%), guilty on the original charge (40%), and pleading guilty to a lesser charge (23%). The findings suggest that many forensic psychiatrists will be asked to evaluate PTSD in the criminal setting, with a growing number of cases related to combat exposure in recent veterans. The implications of these findings for the practice of forensic psychiatry are discussed. © 2016 American Academy of Psychiatry and the Law.

Long-Term Effects of Chemical Warfare on Post-traumatic Stress Disorder, Depression, and Chronic Medical Conditions in Veterans.

PubMed

Safi-Aghdam, Hamideh; Shafie, Mehrzad; Khoshdel, Alireza; Moazen-Zadeh, Ehsan; Avakh, Farhad; Rahmani, Arash

2018-04-24

We investigated the association between exposure to chemical warfare and chronic mental/physical conditions. This was a secondary analysis of data from a case-control study on Iranian male veterans. Participants with neuropsychiatric disorders other than depressive/anxiety disorders, anatomical defects, or malignancies were excluded. Compared to non-exposed veterans, exposed veterans demonstrated significantly higher odds of PTSD [OR (95% CI) = 5.23 (1.98-13.85)], hypertension [OR (95% CI) = 5.57 (1.68-18.48)], coronary heart disease [OR (95% CI) = 6.8 (1.62-28.49)], and diabetes [OR (95% CI) = 3.88 (1.35-11.16)], and marginally higher odds of moderate to severe depressive symptoms [OR (95% CI) = 2.21 (0.93-5.28)]. This study provides preliminary evidence on association of exposure to chemical warfare with long-term mental disorders as well as chronic medical conditions.

Facilitating reintegration for military service personnel, veterans, and their families: An introduction to the special issue.

PubMed

Elnitsky, Christine A; Kilmer, Ryan P

2017-01-01

As service members return from active duty and, in some cases, exit the military, they face a process of reintegration (also referred to as community reintegration) as they seek to resume participation in their life roles as civilians. Facilitating this dynamic process of reintegration for service members, veterans, and their families-including outlining potential strategies for supporting this return to civilian life and its demands, roles, and responsibilities-is the focus of this Special Issue. Reintegration has been framed as a national priority (U.S. Department of Veterans Affairs, 2015) and has been a point of emphasis of efforts at federal, state, and local levels. As the articles in this issue suggest, multiple public, private, and voluntary systems and the communities to which service members, veterans, and their families return can help influence their health outcomes and, ultimately, their reintegration. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Prolonged Exposure for Guilt and Shame in a Veteran of Operation Iraqi Freedom

PubMed Central

Paul, Lisa A.; Gros, Daniel F.; Strachan, Martha; Worsham, Glenna; Foa, Edna B.; Acierno, Ron

2014-01-01

Morally injurious events appear capable of producing posttraumatic stress disorder (PTSD), even though they may not involve actual or perceived life-threat or a response of fear, horror, or helplessness. Researchers have questioned whether exposure therapies can address these events. The current report presents evidence of the effectiveness of this treatment approach for addressing posttraumatic symptoms related to a morally injurious event through an illustrative case of an Operation Iraqi Freedom veteran with PTSD characterized by symptoms of guilt and shame. The veteran was successfully treated with nine sessions of prolonged exposure therapy, reporting minimal PTSD symptoms one week post-treatment and at a six-month follow-up assessment. Implications for the treatment of veterans with significant guilt and shame using exposure-based therapies, and with respect to the recent changes to the diagnostic criteria for PTSD, are discussed. PMID:25505798

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

PubMed

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.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

PubMed

Peterson, Rachel; Gundlapalli, Adi V; Metraux, Stephen; Carter, Marjorie E; Palmer, Miland; Redd, Andrew; Samore, Matthew H; Fargo, Jamison D

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

PubMed Central

Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

Assessing Medicare Part D Claim Completeness Using Medication Self-reports: The Role of Veteran Status and Generic Drug Discount Programs

PubMed Central

Zhou, Lei; Stearns, Sally C.; Thudium, Emily M.; Alburikan, Khalid A.; Rodgers, Jo Ellen

2015-01-01

Objective Medicare Part D claims are commonly used for research, but missing claims could compromise their validity. This study assessed two possible causes of missing claims: veteran status and Generic Drug Discount Programs (GDDP). Methods We merged medication self-reports from telephone interviews in the Atherosclerosis Risk in Communities Study (ARIC) with Part D claims for six medications (three were commonly in GDDP in 2009). Merged records (4,468) were available for 2,905 ARIC participants enrolled in Part D. Multinomial logit regression provided estimates of the association of concordance (self-report & Part D, self-report only, or Part D only) with veteran and GDDP status, controlling for participant socio-demographics. Results Sample participants were 74±5 years of age, 68% white and 63% female; 19% were male veterans. Compared to females, male veterans were 11% (95% CI: 7%–16%) less likely to have matched medications in self-report & Part D and 11% (95% CI: 7%–16%) more likely to have self-report only. Records for GDDP versus non-GDDP medications were 4% (95% CI: 1%–7%) more likely to be in self-report & Part D and 3% (95% CI: 1%–5%) less likely to be in Part D only, with no difference in self-report only. Conclusions Part D claims were more likely to be missing for veterans, but claims for medications commonly available through GDDP were more likely to match with self-reports. While researchers should be aware of the possibility of missing claims, GDDP status was associated with a higher rather than lower likelihood of claims being complete in 2009. PMID:25793271

Embedded performance validity tests within the Hopkins Verbal Learning Test - Revised and the Brief Visuospatial Memory Test - Revised.

PubMed

Sawyer, R John; Testa, S Marc; Dux, Moira

2017-01-01

Various research studies and neuropsychology practice organizations have reiterated the importance of developing embedded performance validity tests (PVTs) to detect potentially invalid neurocognitive test data. This study investigated whether measures within the Hopkins Verbal Learning Test - Revised (HVLT-R) and the Brief Visuospatial Memory Test - Revised (BVMT-R) could accurately classify individuals who fail two or more PVTs during routine clinical assessment. The present sample of 109 United States military veterans (Mean age = 52.4, SD = 13.3), all consisted of clinically referred patients and received a battery of neuropsychological tests. Based on performance validity findings, veterans were assigned to valid (n = 86) or invalid (n = 23) groups. Of the 109 patients in the overall sample, 77 were administered the HLVT-R and 75 were administered the BVMT-R, which were examined for classification accuracy. The HVLT-R Recognition Discrimination Index and the BVMT-R Retention Percentage showed good to adequate discrimination with an area under the curve of .78 and .70, respectively. The HVLT-R Recognition Discrimination Index showed sensitivity of .53 with specificity of .93. The BVMT-R Retention Percentage demonstrated sensitivity of .31 with specificity of .92. When used in conjunction with other PVTs, these new embedded PVTs may be effective in the detection of invalid test data, although they are not intended for use in patients with dementia.

The Act of Becoming a College Student: A Case Study of Student Veterans' Experiences Pre-During-Post Military Service

ERIC Educational Resources Information Center

Walburn, H. Lincoln

2017-01-01

Each year the number of individuals who join the military is around 150,000, and many only spend four to eight years in the military before leaving to find their next career as a civilian. Many of these veterans enroll in higher education and begin to utilize the educational benefits they earned through their military service. Student veterans…

A bill to amend title 38, United States Code, to require the Secretary of Veterans Affairs, in cases of overpayments of educational assistance under Post-9/11 Educational Assistance, to deduct amounts for repayment from the last months of educational assistance entitlement, and for other purposes.

THOMAS, 113th Congress

Sen. Bennet, Michael F. [D-CO

2013-05-13

Senate - 06/12/2013 Committee on Veterans' Affairs. Hearings held. Hearings printed: S.Hrg. 113-111. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Facilitators and barriers to employment among veterans with spinal cord injury receiving 12 months of evidence-based supported employment services.

PubMed

Cotner, Bridget A; Njoh, Eni N; Trainor, John K; O'Connor, Danielle R; Barnett, Scott D; Ottomanelli, Lisa

2015-01-01

Return to work is associated with positive rehabilitation outcomes for persons with spinal cord injury (SCI); however, more research is needed on vocational support for persons with disabilities seeking employment. The association between facilitators and barriers of employment and employment outcome was examined among Veterans with SCI who participated in an evidence-based supported employment (EBSE) program. Using a mixed-methods, nested case-control design, data on facilitators and barriers to employment were extracted from qualitative interviews and quantitative measures administered in person to 34 Veterans with SCI who completed 12 months of an EBSE program. Participants who did (case) and did not (control) obtain competitive employment were matched on time since SCI. Facilitators and barriers to employment were compared between the groups. Self-report measures administered at baseline were examined; there were no statistically significant factors that predicted employment outcomes after 12 months of EBSE program participation. Qualitative interview data revealed program-specific facilitators and Veteran characteristics that were associated with employment outcomes. Qualitative data illustrate how the integration of the vocational rehabilitation specialist on the medical team is helpful for addressing identified disability-specific barriers, including practical matters such as transportation and caregiving schedules, to facilitate employment outcomes.

Facilitators and Barriers to Employment Among Veterans with Spinal Cord Injury Receiving 12 Months of Evidence-Based Supported Employment Services

PubMed Central

Njoh, Eni N.; Trainor, John K.; O’Connor, Danielle R.; Barnett, Scott D.; Ottomanelli, Lisa

2015-01-01

Background: Return to work is associated with positive rehabilitation outcomes for persons with spinal cord injury (SCI); however, more research is needed on vocational support for persons with disabilities seeking employment. Objective: The association between facilitators and barriers of employment and employment outcome was examined among Veterans with SCI who participated in an evidence-based supported employment (EBSE) program. Methods: Using a mixed-methods, nested case-control design, data on facilitators and barriers to employment were extracted from qualitative interviews and quantitative measures administered in person to 34 Veterans with SCI who completed 12 months of an EBSE program. Participants who did (case) and did not (control) obtain competitive employment were matched on time since SCI. Facilitators and barriers to employment were compared between the groups. Results: Self-report measures administered at baseline were examined; there were no statistically significant factors that predicted employment outcomes after 12 months of EBSE program participation. Qualitative interview data revealed program-specific facilitators and Veteran characteristics that were associated with employment outcomes. Conclusions: Qualitative data illustrate how the integration of the vocational rehabilitation specialist on the medical team is helpful for addressing identified disability-specific barriers, including practical matters such as transportation and caregiving schedules, to facilitate employment outcomes. PMID:25762857

Comparing Posttraumatic Stress Disorder's Symptom Structure between Deployed and Nondeployed Veterans

ERIC Educational Resources Information Center

Engdahl, Ryan M.; Elhai, Jon D.; Richardson, J. Don; Frueh, B. Christopher

2011-01-01

We tested two empirically validated 4-factor models of posttraumatic stress disorder (PTSD) symptoms using the PTSD Checklist: King, Leskin, King, and Weathers' (1998) model including reexperiencing, avoidance, emotional numbing, and hyperarousal factors, and Simms, Watson, and Doebbeling's (2002) model including reexperiencing, avoidance,…

38 CFR 21.4135 - Discontinuance dates.

Code of Federal Regulations, 2013 CFR

2013-07-01

... receive educational assistance under the Montgomery GI Bill—Active Duty. If a veteran makes a valid election, as provided in § 21.7045(d), to receive educational assistance under the Montgomery GI Bill... assistance must be discontinued or who becomes restricted to payment of educational assistance allowance at a...

Penn Inventory for Posttraumatic Stress Disorder: Psychometric Properties.

ERIC Educational Resources Information Center

Hammarberg, Melvyn

1992-01-01

A three-phase study was conducted to develop and validate the Penn Inventory for Posttraumatic Stress Disorder (PTSD), a 26-item self-report measure. Results with 83 and 98 combat veterans and with 76 general population patients and disaster survivors support usefulness of the measure. (SLD)

Utility of an Occupational Therapy Driving Intervention for a Combat Veteran

PubMed Central

Monahan, Miriam; Canonizado, Maria; Winter, Sandra

2014-01-01

Many combat veterans are injured in motor vehicle crashes shortly after returning to civilian life, yet little evidence exists on effective driving interventions. In this single-subject design study, we compared clinical test results and driving errors in a returning combat veteran before and after an occupational therapy driving intervention. A certified driving rehabilitation specialist administered baseline clinical and simulated driving assessments; conducted three intervention sessions that discussed driving errors, retrained visual search skills, and invited commentary on driving; and administered a postintervention evaluation in conditions resembling those at baseline. Clinical test results were similar pre- and postintervention. Baseline versus postintervention driving errors were as follows: lane maintenance, 23 versus 7; vehicle positioning, 5 versus 1; signaling, 2 versus 0; speed regulation, 1 versus 1; visual scanning, 1 versus 0; and gap acceptance, 1 versus 0. Although the intervention appeared efficacious for this participant, threats to validity must be recognized and controlled for in a follow-up study. PMID:25005503

Credibility of neuropsychological performances of Persian Gulf War veterans and military control subjects participating in clinical epidemiological research.

PubMed

Barrash, Joseph; Denburg, Natalie L; Moser, David J; Woolson, Robert F; Schumacher, Amy J; Doebbeling, Bradley N

2007-07-01

We investigated whether Persian Gulf War veterans (GWVs) were more likely than Persian Gulf War-era veterans deployed elsewhere (GEVs) to have noncredible neuropsychological examinations. A total of 301 GWVs and 99 GEVs underwent neuropsychological testing. The credibility of 173 examinations showing impairment was evaluated based on test performances, clinical background, psychometric measures, and other self-report data. All 11 examinations judged less than fully credible by one neuropsychologist, plus 19 examinations judged impaired but credible, were then evaluated independently by two more neuropsychologists. Noncredibility was judged with excellent reliability (93% agreement). Seven examinations were judged noncredible. Rates of noncredibility did not differ between GWVs (1%) and GEVs (4%). The pattern of associations of noncredible examinations with cognitive, psychological, and clinical variables generally indicated defective neuropsychological scores, with no coherent pattern, and personality disorder. Findings supported the validity of noncredibility judgments and suggested that noncredible examinations are not a significant problem in neuropsychological investigations of GWVs.

An examination of the association between 5-HTTLPR, combat exposure, and PTSD diagnosis among U.S. veterans.

PubMed

Liu, Yutao; Garrett, Melanie E; Dennis, Michelle F; Green, Kimberly T; Ashley-Koch, Allison E; Hauser, Michael A; Beckham, Jean C; Kimbrel, Nathan A

2015-01-01

To examine the association between the 5-HTTLPR polymorphism of the serotonin transporter (SLC6A4) gene, combat exposure, and posttraumatic stress disorder (PTSD) diagnosis and among two samples of combat-exposed veterans. The first sample included 550 non-Hispanic Black (NHB) combat-exposed veterans. The second sample included 555 non-Hispanic White (NHW) combat-exposed veterans. Participants were genotyped for the 5-HTTLPR/rs25531 variants of the SLC6A4 gene. A structured clinical interview was used to diagnose PTSD. Combat and civilian trauma exposure were assessed with validated self-report instruments. Logistic regression was used to test for main effects of 5-HTTLPR on PTSD diagnosis as well as gene x environment (GxE) interactions after adjusting for sex, ancestry proportion scores, civilian trauma exposure, and combat exposure. Within the NHB sample, a significant additive effect was observed for 5-HTTLPR (OR = 1.502, p = .0025), such that the odds of having a current diagnosis of PTSD increased by 1.502 for each additional S' allele. No evidence for an association between 5-HTTLPR and PTSD was observed in the NHW sample. In addition, no evidence for combat x 5-HTTLPR effects were observed in either sample. The present study suggests that there may be an association between 5-HTTLPR genotype and PTSD diagnosis among NHB veterans; however, no evidence for the hypothesized 5-HTTLPR x combat interaction was found.

Reversal of overdose on fentanyl being illicitly sold as heroin with naloxone nasal spray: A case report.

PubMed

Fareed, Ayman; Buchanan-Cummings, Ann Marie; Crampton, Kelli; Grant, Angela; Drexler, Karen

2015-08-01

This is a case report describing a reversal of fentanyl overdose with naloxone nasal spray. The patient was not aware that he overdosed on fentanyl being sold as heroin. The Veterans Health Administration (VHA) has implemented an initiative to provide education for veterans, their families, friends and significant others about opioid overdose and use of naloxone reversal kits. The Atlanta VA Medical Center adopted this program to reduce the risk of opioid overdose in high risk patients. Over the past year, we provided educational sessions for 63 veterans and their families. We also prescribed 41 naloxone kits. We have received three reports of opioid overdose reversal with use of naloxone kits prescribed by the Atlanta VA Medical Center. The authors recommend that public health administrators and policy makers advocate for the implementation of these programs to reduce the rising number of overdose death in the United States and worldwide. © American Academy of Addiction Psychiatry.

The psychologist's role in transgender-specific care with U.S. veterans.

PubMed

Johnson, Laura; Shipherd, Jillian; Walton, Heather M

2016-02-01

Psychologists are integral to the care of transgender individuals. This article details the many roles for psychologists in transgender-specific care, including diagnosing and treating gender dysphoria; providing treatment for comorbid conditions; referring to medical services such as gender confirmation surgeries, voice modification, and cross-sex hormone therapies; serving as consultants within health care systems; and advocating for addressing barriers in systems in which transgender individuals live and work. Transgender veterans have unique experiences and vulnerabilities related to their military service that are detailed from a review of the literature, and we make the case that Veterans Health Administration (VHA) and community psychologists are well-positioned to provide care to transgender veterans (trans-vets). In this article, the authors describe the experiences that many trans-vets have faced, identify the importance of treatment for gender dysphoria (and draw the distinction between gender identity disorder and gender dysphoria) as well as psychologists' roles, and clarify which transgender-related services are available to eligible veterans though VHA per policy and how VHA providers have access to training to provide that care. In addition, we describe how veterans can connect to the VHA, even if they have (and want to continue working with) non-VHA psychologists or other community providers. (c) 2016 APA, all rights reserved).

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

PubMed

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.

Importation, Antibiotics, and Clostridium difficile Infection in Veteran Long-Term Care: A Multilevel Case-Control Study.

PubMed

Brown, Kevin A; Jones, Makoto; Daneman, Nick; Adler, Frederick R; Stevens, Vanessa; Nechodom, Kevin E; Goetz, Matthew B; Samore, Matthew H; Mayer, Jeanmarie

2016-06-21

Although clinical factors affecting a person's susceptibility to Clostridium difficile infection are well-understood, little is known about what drives differences in incidence across long-term care settings. To obtain a comprehensive picture of individual and regional factors that affect C difficile incidence. Multilevel longitudinal nested case-control study. Veterans Health Administration health care regions, from 2006 through 2012. Long-term care residents. Individual-level risk factors included age, number of comorbid conditions, and antibiotic exposure. Regional risk factors included importation of cases of acute care C difficile infection per 10 000 resident-days and antibiotic use per 1000 resident-days. The outcome was defined as a positive result on a long-term care C difficile test without a positive result in the prior 8 weeks. 6012 cases (incidence, 3.7 cases per 10 000 resident-days) were identified in 86 regions. Long-term care C difficile incidence (minimum, 0.6 case per 10 000 resident-days; maximum, 31.0 cases per 10 000 resident-days), antibiotic use (minimum, 61.0 days with therapy per 1000 resident-days; maximum, 370.2 days with therapy per 1000 resident-days), and importation (minimum, 2.9 cases per 10 000 resident-days; maximum, 341.3 cases per 10 000 resident-days) varied substantially across regions. Together, antibiotic use and importation accounted for 75% of the regional variation in C difficile incidence (R2 = 0.75). Multilevel analyses showed that regional factors affected risk together with individual-level exposures (relative risk of regional antibiotic use, 1.36 per doubling [95% CI, 1.15 to 1.60]; relative risk of importation, 1.23 per doubling [CI, 1.14 to 1.33]). Case identification was based on laboratory criteria. Admission of residents with recent C difficile infection from non-Veterans Health Administration acute care sources was not considered. Only 25% of the variation in regional C difficile incidence in long-term care remained unexplained after importation from acute care facilities and antibiotic use were accounted for, which suggests that improved infection control and antimicrobial stewardship may help reduce the incidence of C difficile in long-term care settings. U.S. Department of Veterans Affairs and Centers for Disease Control and Prevention.

Epidemiology of multiple sclerosis in U.S. veterans: 1. Race, sex, and geographic distribution.

PubMed

Kurtzke, J F; Beebe, G W; Norman, J E

1979-09-01

Five thousand three hundred five World War II and Korean conflict veterans who have been compensated by the Veterans Administration for multiple sclerosis (MS) were matched to controls on the basis of age, date of entry into military service, and branch of service. Case/control ratios for white males, white females, and black males were 1.04, 1.86, and 0.45, respectively. The coterminous 48 states, divided into three tiers on the basis of latitude, exhibited the well-known north-south gradient in risk: For all races and both sexes, case/control ratios were 1.41, 1.00, and 0.53 for the North, Middle, and South tiers. Both white females and black males showed this same north-to-south variation in risk. The case/control ratio for males of races other than black or white was 0.23, with possible deficits in risk for American Indians and Japanese-Americans. Filipinos and Hawaiian Japanese were significantly low-risk groups. These findings suggest that both a racial and a possibly genetic predisposition, as well as a geographically determined differential exposure to an environmental agent, are related to the risk of MS.

20 CFR 408.1013 - What are the methods for reconsideration?

Code of Federal Regulations, 2010 CFR

2010-04-01

... WORLD WAR II VETERANS Determinations and the Administrative Review Process Reconsideration § 408.1013... present your case. How you can present your case depends upon the issue involved and whether you are...

Implementation of a Regional Virtual Tumor Board: A Prospective Study Evaluating Feasibility and Provider Acceptance

PubMed Central

Marshall, Christy L.; Petersen, Nancy J.; Naik, Aanand D.; Velde, Nancy Vander; Artinyan, Avo; Albo, Daniel; Berger, David H.

2014-01-01

Abstract Background: Tumor board (TB) conferences facilitate multidisciplinary cancer care and are associated with overall improved outcomes. Because of shortages of the oncology workforce and limited access to TB conferences, multidisciplinary care is not available at every institution. This pilot study assessed the feasibility and acceptance of using telemedicine to implement a virtual TB (VTB) program within a regional healthcare network. Materials and Methods: The VTB program was implemented through videoconference technology and electronic medical records between the Houston (TX) Veterans Affairs Medical Center (VAMC) (referral center) and the New Orleans (LA) VAMC (referring center). Feasibility was assessed as the proportion of completed VTB encounters, rate of technological failures/mishaps, and presentation duration. Validated surveys for confidence and satisfaction were administered to 36 TB participants to assess acceptance (1–5 point Likert scale). Secondary outcomes included preliminary data on VTB utilization and its effectiveness in providing access to quality cancer care within the region. Results: Ninety TB case presentations occurred during the study period, of which 14 (15%) were VTB cases. Although one VTB encounter had a technical mishap during presentation, all scheduled encounters were completed (100% completion rate). Case presentations took longer for VTB than for regular TB cases (p=0.0004). However, VTB was highly accepted with mean scores for satisfaction and confidence of 4.6. Utilization rate of VTB was 75%, and its effectiveness was equivalent to that observed for non-VTB cases. Conclusions: Implementation of VTB is feasible and highly accepted by its participants. Future studies should focus on widespread implementation and validating the effectiveness of this model. PMID:24845366

Benefits, Costs, and Harms of Osteoporosis Screening in Male Veterans

DTIC Science & Technology

2013-10-01

obtaining text files due to new requirement for real SSN access. However, NLP programming is completed, validated, and ready to run on the dataset...the diagnosis and management of osteoporosis in Canada : summary. CMAJ Canadian Medical Association Journal 2010, 182(17):1864-1873. 13. Qaseem A

41 CFR 60-250.44 - Required contents of affirmative action programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... veterans. (8) The contractor, in making hiring decisions, should consider applicants who are known special... decisions are based only on valid job requirements. The policy shall state that employees and applicants... career days, youth motivation programs, and related activities in their communities. (6) The contractor...

41 CFR 60-300.44 - Required contents of affirmative action programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... medal veterans. (8) The contractor, in making hiring decisions, should consider applicants who are known... decisions are based only on valid job requirements. The policy shall state that employees and applicants... participation in career days, youth motivation programs, and related activities in their communities. (6) The...

Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system.

PubMed

Haun, Jolie N; Lind, Jason D; Shimada, Stephanie L; Martin, Tracey L; Gosline, Robert M; Antinori, Nicole; Stewart, Max; Simon, Steven R

2014-03-06

The United States Department of Veterans Affairs has implemented an electronic asynchronous "Secure Messaging" tool within a Web-based patient portal (ie, My HealtheVet) to support patient-provider communication. This electronic resource promotes continuous and coordinated patient-centered care, but to date little research has evaluated patients' experiences and preferences for using Secure Messaging. The objectives of this mixed-methods study were to (1) characterize veterans' experiences using Secure Messaging in the My HealtheVet portal over a 3-month period, including system usability, (2) identify barriers to and facilitators of use, and (3) describe strategies to support veterans' use of Secure Messaging. We recruited 33 veterans who had access to and had previously used the portal's Secure Messaging tool. We used a combination of in-depth interviews, face-to-face user-testing, review of transmitted secure messages between veterans and staff, and telephone interviews three months following initial contact. We assessed participants' computer and health literacy during initial and follow-up interviews. We used a content-analysis approach to identify dominant themes in the qualitative data. We compared inferences from each of the data sources (interviews, user-testing, and message review) to identify convergent and divergent data trends. The majority of veterans (27/33, 82%) reported being satisfied with Secure Messaging at initial interview; satisfaction ratings increased to 97% (31/32, 1 missing) during follow-up interviews. Veterans noted Secure Messaging to be useful for communicating with their primary care team to manage health care needs (eg, health-related questions, test requests and results, medication refills and questions, managing appointments). Four domains emerged from interviews: (1) perceived benefits of using Secure Messaging, (2) barriers to using Secure Messaging, (3) facilitators for using Secure Messaging, and (4) suggestions for improving Secure Messaging. Veterans identified and demonstrated impediments to successful system usage that can be addressed with education, skill building, and system modifications. Analysis of secure message content data provided insights to reasons for use that were not disclosed by participants during interviews, specifically sensitive health topics such as erectile dysfunction and sexually transmitted disease inquiries. Veterans perceive Secure Messaging in the My HealtheVet patient portal as a useful tool for communicating with health care teams. However, to maximize sustained utilization of Secure Messaging, marketing, education, skill building, and system modifications are needed. Data from this study can inform a large-scale quantitative assessment of Secure Messaging users' experiences in a representative sample to validate qualitative findings.

The Effectiveness of University Programs, Services, and Practices in Retaining Student Veterans Transitioning to Higher Education: Voices of Student Veterans--A Case Study Analysis Approach at Two Universities

ERIC Educational Resources Information Center

Lopez, Eddie S.

2013-01-01

With an active war ongoing for nearly thirteen years, the nation has been experiencing hundreds of thousands of returning solders as a result of the military drawdown of troops from Iraq and Afghanistan. The intent of this research study was to understand the effectiveness of university programs, services, and practices in retaining student…

Characterizing Treatable Causes of Small Fiber Polyneuropathy in Gulf War Veterans

DTIC Science & Technology

2015-10-01

multisymptom illness CWP Chronic widespread pain DOD Department of Defense ESR Erythrocyte sedimentation rate GTT Glucose tolerance test Hgb Hemoglobin...War Veterans 5b. GRANT NUMBER W81XWH-14-1-0499 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Anne Louise Oaklander MD, PhD 5d. PROJECT NUMBER Max M...widespread pain, chronic multisymptom illness, small- fiber polyneuropathy, case definition ACCOMPLISHMENTS: What were the major goals of the project

Development and Initial Validation of Military Deployment-Related TBI Quality-of-Life Item Banks.

PubMed

Toyinbo, Peter A; Vanderploeg, Rodney D; Donnell, Alison J; Mutolo, Sandra A; Cook, Karon F; Kisala, Pamela A; Tulsky, David S

2016-01-01

To investigate unique factors that affect health-related quality of life (QOL) in individuals with military deployment-related traumatic brain injury (MDR-TBI) and to develop appropriate assessment tools, consistent with the TBI-QOL/PROMIS/Neuro-QOL systems. Three focus groups from each of the 4 Veterans Administration (VA) Polytrauma Rehabilitation Centers, consisting of 20 veterans with mild to severe MDR-TBI, and 36 VA providers were involved in early stage of new item banks development. The item banks were field tested in a sample (N = 485) of veterans enrolled in VA and diagnosed with an MDR-TBI. Focus groups and survey. Developed item banks and short forms for Guilt, Posttraumatic Stress Disorder/Trauma, and Military-Related Loss. Three new item banks representing unique domains of MDR-TBI health outcomes were created: 15 new Posttraumatic Stress Disorder items plus 16 SCI-QOL legacy Trauma items, 37 new Military-Related Loss items plus 18 TBI-QOL legacy Grief/Loss items, and 33 new Guilt items. Exploratory and confirmatory factor analyses plus bifactor analysis of the items supported sufficient unidimensionality of the new item pools. Convergent and discriminant analyses results, as well as known group comparisons, provided initial support for the validity and clinical utility of the new item response theory-calibrated item banks and their short forms. This work provides a unique opportunity to identify issues specific to individuals with MDR-TBI and ensure that they are captured in QOL assessment, thus extending the existing TBI-QOL measurement system.

But it's "Only a Theory!" Responding to Evolution Doubt, Distortion, and Denial.

NASA Astrophysics Data System (ADS)

Miller, K. R.

2014-12-01

Nearly 90 years after the infamous Scopes "monkey trial," resistance to the theory of evolution seems as persistent as ever in American life. Bills endorsing "critical analysis" of the evolution "controversy" or supporting "academic freedom" to question evolution are routinely introduced in state legislatures. Presidential candidates find evolution denial to be a winning strategy, and nearly half of all Americans reject any suggestion that evolution played a role in human origins. What's the best way to respond to such challenges, mingled as they are with elements of cultural warfare, resentment of academic elites, and religious doctrine? As a veteran of the "evolution wars," I will describe a strategy that actually uses each of these lines of attack to make a case for evolution that appeals to popular concern about the honesty, motivation, and validity of the scientific enterprise itself.

Increasing physical activity for veterans in the Mental Health Intensive Case Management Program: A community-based intervention.

PubMed

Harrold, S Akeya; Libet, Julian; Pope, Charlene; Lauerer, Joy A; Johnson, Emily; Edlund, Barbara J

2018-04-01

Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005;56(3):324-331; Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442), but research has shown that adverse health behaviors-including smoking, low rate of physical activity, poor diet, and high alcohol consumption-also significantly contribute to premature deaths (Jones J. Life expectancy in mental illness. Psychiatry Services. 2010. Retrieved from http://psychcentral.com/news/2010/07/13/life-expectancy-in-mental-illness). This quality improvement (QI) project sought to improve health and wellness for veterans in the Mental Health Intensive Case Management Program (MHICM), which is a community-based intensive program for veterans with SMI at risk for decompensation and frequent hospitalizations. At the time of this QI project, the program had 69 veterans who were assessed and treated weekly in their homes. The project introduced a pedometer steps intervention adapted from the VA MOVE! Program-a physical activity and weight management program-with the addition of personalized assistance from trained mental health professionals in the veteran's home environment. Because a large percentage of the veterans in the MHICM program had high blood pressure and increased weight, these outcomes were the focus of this project. Through mental health case management involvement and the comfort of their familiar living environment, veterans were assisted to meet their physical and mental health goals with a program that could easily be integrated into their daily lives. Healthy People 2020 developed goals to improve levels of physical activity and has ranked physical activity as a leading health indicator (US DHHS. Office of Disease Prevention and Health Promotion. Physical activity topic overview. In Healthy People 2020. 2016. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity). Individuals with SMI are significantly less active than the general population (Shor and Shalev, 2014). It is sometimes difficult for the average individual to obtain the recommended 10,000 steps and even more difficult for those with SMI. Lifestyle modifications, in particular diet and exercise, are recommended for improvement of chronic disease outcomes (US Preventive Services Counseling Task Force, 2016). The health benefits of physical activity for people with SMI are mixed (Pearsall R, Smith D, Pelosi A, Geddes J. Exercise therapy in adults with serious mental illness: A systematic review and meta-analysis. BMC Psychiatr. 2014;14:117). Some studies found significant physical health benefits, while others did not. However, according to a review by Soundy et al., physical exercise is shown to not only have physical benefits but also psychosocial benefits. One of the barriers that hinder participation in physical activities is accessibility (Shor and Shalev, 2014). Integrating a more personalized supported, and in-home pedometer program into mental healthcare should ensure better access to interventions that could possibly reverse the causes of premature death. The program was offered to 69 veterans in the MHICM. Forty-nine agreed to start the program and 20 declined. Twenty-five clients actually started the program with 17 veterans completing it. Preimplementation data included collecting blood pressure and weight measures for all veterans in the MHICM program. Additionally, a focus group was held with case managers to obtain a group perspective on motivating veterans to participate in this program. Further, a teaching session was held to review pedometers use, the client video, the client booklet, methods for getting veterans started, and the progression of the walking intervention. The pedometer physical activity intervention continued for 2 months. At the end of the 2 months, aggregate de-identified data on number of steps, blood pressure, and weight were collected. At the end of the program, the data were reviewed, synthesized, and analyzed, being careful to account for potentially intervening conditions and other chronic illnesses. The postimplementation data revealed that the mean weight decreased by 9 lbs. The percentage of controlled blood pressure increased from 60 to 84, while the percentage of uncontrolled blood pressure decreased from 40 to 16. Implementation of a multiple component personalized exercise intervention program for veterans with SMI contributed to reduction in weight and blood pressure. © 2017 Wiley Periodicals, Inc.

Results from a large-scale epidemiologic look-back investigation of improperly reprocessed endoscopy equipment.

PubMed

Holodniy, Mark; Oda, Gina; Schirmer, Patricia L; Lucero, Cynthia A; Khudyakov, Yury E; Xia, Guoliang; Lin, Yulin; Valdiserri, Ronald; Duncan, William E; Davey, Victoria J; Cross, Gerald M

2012-07-01

To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission.  Retrospective cohort study.  Four Veterans Affairs medical centers (VAMCs).  Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009.  Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness.  Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%.  Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown.

The association of selected cancers with service in the US military in Vietnam. I. Non-Hodgkin's lymphoma. The Selected Cancers Cooperative Study Group (see comments)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1990-12-01

As part of a series of investigations into the health of Vietnam veterans, we conducted a population-based, case-control study of non-Hodgkin's lymphoma between 1984 and 1988. All men born between 1929 and 1953 and diagnosed as having non-Hodgkin's lymphoma in an area covered by eight cancer registries were considered eligible. Control subjects were identified by random-digit dialing from these same regions and were frequency-matched to men with lymphoma by age. Analyses of 1157 men with pathologically confirmed lymphomas and 1776 control subjects showed that the risk of non-Hodgkin's lymphoma was approximately 50% higher among Vietnam veterans (odds ratio, 1.47; 95%more » confidence interval, 1.1 to 2.0) compared with men who did not serve in Vietnam. Vietnam veterans were also at higher risk relative to (1) men who had not served in the military, (2) other veterans, and (3) other veterans who served between 1964 and 1972. An analysis of the military histories of the 232 Vietnam veterans suggested that the relative risk (1) increased with length of service in Vietnam (P = .10), and (2) was higher among men in the sea-based Navy than among other veterans (P = .11). Little difference in risk, however, was noted according to dates of service, type of unit, military region, or any other characteristics that may have been associated with the use of Agent Orange. Although the cause remains uncertain, results of this study indicate that the risk of non-Hodgkin's lymphoma is higher among Vietnam veterans than among other men.« less

Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement.

PubMed

Argo, Joshua L; Vick, Catherine C; Graham, Laura A; Itani, Kamal M F; Bishop, Michael J; Hawn, Mary T

2009-11-01

This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system. CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities. Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive. Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.

Validity of the Wechsler Test of Adult Reading (WTAR): effort considered in a clinical sample of U.S. military veterans.

PubMed

Whitney, Kriscinda A; Shepard, Polly H; Mariner, Jennifer; Mossbarger, Brad; Herman, Steven M

2010-07-01

The current study represents an examination of the construct validity of the Wechsler Test of Adult Reading (WTAR) among a sample of U.S. military veterans referred for outpatient neuropsychological evaluation that included a measure of negative response bias, namely, the Test of Memory Malingering (TOMM). This retrospective data analysis examined the relationship between the WTAR and measures of current verbal general intellectual function and current cognitive skills. Findings showed that, among patients passing the TOMM (N = 98), WTAR scores were most highly correlated with current verbal IQ but also showed significant correlations with verbal memory and lesser, but still significant, correlations with measures of visual-spatial memory. Discriminant validity for the WTAR was also shown among the group passing the TOMM in the sense that the WTAR, which is designed to measure verbal premorbid general intellectual skill, was not as highly correlated with measures of learning and memory as was a measure of current verbal general intellectual skill. Whereas scores on most study measures did significantly differ between the groups that passed versus failed the TOMM (N = 26), scores on the WTAR did not, suggesting that the WTAR may remain robust even in the face of suboptimal effort.

Cultural adaptation of an instrument to assess physical fitness in cardiac patients.

PubMed

Domingues, Gabriela de Barros Leite; Gallani, Maria Cecília; Gobatto, Claudio Alexandre; Miura, Cinthya Tamie Passos; Rodrigues, Roberta Cunha Matheus; Myers, Jonathan

2011-04-01

To validate the content and to evaluate the reliability of the Veterans Specific Activity Questionnaire instrument, culturally adapted for use in the Brazilian population of cardiac patients. The instrument was translated and back-translated and subsequently analyzed by a committee of judges to evaluate its semantic-idiomatic and cultural equivalences. Physical activities were replaced when indicated in the instrument, but uncommon in the daily life of the target population. Another committee of specialists analyzed the metabolic equivalence of replaced activities. The proportion of agreement of evaluation of the judges was quantified by the Content Validity Index. The pre-test was performed in two stages (n1 and n2=15). Reliability was assessed using the test-retest (interval of 7-15 days, n = 50). In the evaluation of semantic-idiomatic and cultural equivalences, items with a Content Validity Index < 1 were reviewed until consensus among the judges was obtained. The second committee found 100% of agreement in the analysis of metabolic equivalence between original and replaced activities. Test-retest analysis indicated a Kappa coefficient of agreement (k = 0.86; (p<0.001), suggesting temporal stability of the instrument. The Brazilian version of the Veterans Specific Activity Questionnaire showed evidence of reliability, according to the temporal stability criterion and adequate cultural content.

Soft tissue sarcoma and military service in Vietnam: a case-control study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kang, H.; Enziger, F.; Breslin, P.

1987-10-01

A case-control study was conducted in men who were of draftable age during the Vietnam conflict to examine the association of soft tissue sarcomas (STSs) with military service in Vietnam as well as other host and environmental risk factors. A total of 217 STS cases selected from the Armed Forces Institute of Pathology were compared to 599 controls for Vietnam service, occupational and nonoccupational exposure to various chemicals, occupational history, medical history, and life-style (smoking, alcohol, coffee, etc.). Military service information was verified by a review of the patient's military personnel records. Other information was ascertained from a telephone interviewmore » with either subjects or their next of kin. Cases and controls were stratified on the basis of the hospital type (civilian, Veterans Administration, and military); the Mantel-Haenszel estimate of the odds ratio (OR), adjusted for the effects of the stratification variable, was calculated. Vietnam veterans in general did not have an increased risk of STS when compared to those men who had never been in Vietnam (OR, 0.85; 95% confidence interval, 0.54-1.36). Subgroups of Vietnam veterans who had higher estimated opportunities for Agent Orange exposure seemed to be at greater risk of STSs when their counterparts in Vietnam were taken as a reference group. However, this risk was not statistically significant.« less

Suicide Among Military Personnel and Veterans Aged 18-35 Years by County-16 States.

PubMed

Logan, Joseph E; Fowler, Katherine A; Patel, Nimeshkumar P; Holland, Kristin M

2016-11-01

Suicide among military personnel and young Veterans remains a health concern. This study examined stateside distribution of suicides by U.S. county to help focus prevention efforts. Using 2005-2012 National Violent Death Reporting System data from 16 states (963 counties, or county-equivalent entities), this study mapped the county-level distribution of suicides among current military and Veteran decedents aged 18-35 years. This study also compared incident circumstances of death between decedents in high-density counties (i.e., counties with the highest proportion of deaths) versus those in medium/low-density counties to better understand the precipitators of suicide in counties most affected. Last, this study identified potential military and Veteran Health Administration intervention sites. All analyses were conducted in 2015. Within the National Violent Death Reporting System participating states, an estimated 262 (33%) current military suicides occurred in just ten (1.0%) counties, and 391 (33%) Veteran suicides occurred in 33 (3.4%) counties. Mental health and intimate partner problems were common precipitating circumstances, and some circumstances differed between cases in high- versus those in medium/low-density counties. Multiple potential intervention sites were identified in high-density counties. These findings suggest that military and Veteran suicides are concentrated in a small number of counties. Increased efforts at these locales might be beneficial. Published by Elsevier Inc.

76 FR 39062 - Substitution in Case of Death of Claimant

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... Death of Claimant AGENCY: Department of Veterans Affairs. ACTION: Reopening of public comment period... comment period for the proposed rule, ``Substitution in Case of Death of Claimant'' (76 FR 8666... that they are submitted in response to ``RIN 2900-AN91--Substitution in Case of Death of Claimant...

Growth hormone deficiency after mild combat-related traumatic brain injury.

PubMed

Ioachimescu, Adriana G; Hampstead, Benjamin M; Moore, Anna; Burgess, Elizabeth; Phillips, Lawrence S

2015-08-01

Traumatic brain injury (TBI) has been recognized as a cause of growth hormone deficiency (GHD) in civilians. However, comparable data are sparse in veterans who incurred TBI during combat. Our objective was to determine the prevalence of GHD in veterans with a history of combat-related TBI, and its association with cognitive and psychosocial dysfunction. Single center prospective study. Twenty male veterans with mild TBI incurred during combat 8-72 months prior to enrollment. GHD was defined by a GH peak <3 μg/L during glucagon stimulation test. Differences in neuropsychological, emotional, and quality of life of the GHD Veterans were described using Cohen's d. Large effect sizes were considered meaningful. Mean age was 33.7 years (SD 7.8) and all subjects had normal thyroid hormone and cortisol levels. Five (25%) exhibited a subnormal response to glucagon. Sixteen participants (80%) provided sufficient effort for valid neuropsychological assessment (12 GH-sufficient, 4 GHD). There were large effect size differences in self-monitoring during memory testing (d = 1.46) and inhibitory control (d = 0.92), with worse performances in the GHD group. While fatigue and post-traumatic stress disorder were comparable, the GHD group reported more depression (d = 0.80) and lower quality of life (d = 0.64). Our study found a 25% prevalence of GHD in veterans with mild TBI as shown by glucagon stimulation. The neuropsychological findings raise the possibility that GHD has adverse effects on executive abilities and mood. Further studies are needed to determine whether GH replacement is an effective treatment in these patients.

Self-reported post-exertional fatigue in Gulf War veterans: roles of autonomic testing

PubMed Central

Li, Mian; Xu, Changqing; Yao, Wenguo; Mahan, Clare M.; Kang, Han K.; Sandbrink, Friedhelm; Zhai, Ping; Karasik, Pamela A.

2014-01-01

To determine if objective evidence of autonomic dysfunction exists from a group of Gulf War veterans with self-reported post-exertional fatigue, we evaluated 16 Gulf War ill veterans and 12 Gulf War controls. Participants of the ill group had self- reported, unexplained chronic post-exertional fatigue and the illness symptoms had persisted for years until the current clinical study. The controls had no self-reported post-exertional fatigue either at the time of initial survey nor at the time of the current study. We intended to identify clinical autonomic disorders using autonomic and neurophysiologic testing in the clinical context. We compared the autonomic measures between the 2 groups on cardiovascular function at both baseline and head-up tilt, and sudomotor function. We identified 1 participant with orthostatic hypotension, 1 posture orthostatic tachycardia syndrome, 2 distal small fiber neuropathy, and 1 length dependent distal neuropathy affecting both large and small fiber in the ill group; whereas none of above definable diagnoses was noted in the controls. The ill group had a significantly higher baseline heart rate compared to controls. Compound autonomic scoring scale showed a significant higher score (95% CI of mean: 1.72–2.67) among ill group compared to controls (0.58–1.59). We conclude that objective autonomic testing is necessary for the evaluation of self-reported, unexplained post-exertional fatigue among some Gulf War veterans with multi-symptom illnesses. Our observation that ill veterans with self-reported post-exertional fatigue had objective autonomic measures that were worse than controls warrants validation in a larger clinical series. PMID:24431987

Characteristics of U.S. Veteran Patients with Major Depressive Disorder who require "next-step" treatments: A VAST-D report.

PubMed

Zisook, Sidney; Tal, Ilanit; Weingart, Kimberly; Hicks, Paul; Davis, Lori L; Chen, Peijun; Yoon, Jean; Johnson, Gary R; Vertrees, Julia E; Rao, Sanjai; Pilkinton, Patricia D; Wilcox, James A; Sapra, Mamta; Iranmanesh, Ali; Huang, Grant D; Mohamed, Somaia

2016-12-01

Finding effective and lasting treatments for patients with Major Depressive Disorder (MDD) that fail to respond optimally to initial standard treatment is a critical public health imperative. Understanding the nature and characteristics of patients prior to initiating "next-step" treatment is an important component of identifying which specific treatments are best suited for individual patients. We describe clinical features and demographic characteristics of a sample of Veterans who enrolled in a "next-step" clinical trial after failing to achieve an optimal outcome from at least one well-delivered antidepressant trial. 1522 Veteran outpatients with nonpsychotic MDD completed assessments prior to being randomized to study treatment. Data is summarized and presented in terms of demographic, social, historical and clinical features and compared to a similar, non-Veteran sample. Participants were largely male and white, with about half unmarried and half unemployed. They were moderately severely depressed, with about one-third reporting recent suicidal ideation. More than half had chronic and/or recurrent depression. General medical and psychiatric comorbidities were highly prevalent, particularly PTSD. Many had histories of childhood adversity and bereavement. Participants were impaired in multiple domains of their lives and had negative self-worth. These results may not be generalizable to females, and some characteristics may be specific to Veterans of US military service. There was insufficient data on age of clinical onset and depression subtypes, and three novel measures were not psychometrically validated. Characterizing VAST-D participants provides important information to help clinicians understand features that may optimize "next-step" MDD treatments. Published by Elsevier B.V.

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

PubMed

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators.

PubMed

Mull, Hillary J; Borzecki, Ann M; Loveland, Susan; Hickson, Kathleen; Chen, Qi; MacDonald, Sally; Shin, Marlena H; Cevasco, Marisa; Itani, Kamal M F; Rosen, Amy K

2014-04-01

The Patient Safety Indicators (PSIs) use administrative data to screen for select adverse events (AEs). In this study, VA Surgical Quality Improvement Program (VASQIP) chart review data were used as the gold standard to measure the criterion validity of 5 surgical PSIs. Independent chart review was also used to determine reasons for PSI errors. The sensitivity, specificity, and positive predictive value of PSI software version 4.1a were calculated among Veterans Health Administration hospitalizations (2003-2007) reviewed by VASQIP (n = 268,771). Nurses re-reviewed a sample of hospitalizations for which PSI and VASQIP AE detection disagreed. Sensitivities ranged from 31% to 68%, specificities from 99.1% to 99.8%, and positive predictive values from 31% to 72%. Reviewers found that coding errors accounted for some PSI-VASQIP disagreement; some disagreement was also the result of differences in AE definitions. These results suggest that the PSIs have moderate criterion validity; however, some surgical PSIs detect different AEs than VASQIP. Future research should explore using both methods to evaluate surgical quality. Published by Elsevier Inc.

Exploring Reliability and Validity of the Deployment Risk and Resilience Inventory-2 Among a Nonclinical Sample of Discharged Soldiers Following Mandatory Military Service.

PubMed

Maoz, Hagai; Goldwin, Yiftach; Lewis, Yael Doreen; Bloch, Yuval

2016-12-01

The Deployment Risk and Resilience Inventory (DRRI) is a widely used questionnaire assessing deployment-related risk and resilience factors among war veterans. Its successor, the DRRI-2, has only been validated and used among veterans deployed for overseas military missions, but because many countries still enforce compulsory military service, validating it among nonclinical samples of healthy discharged soldiers following mandatory service is also a necessity. In the current study, a sample of 101 discharged Israeli soldiers (39 males, 62 females; mean time since discharge 13.92, SD = 9.09 years) completed the DRRI-2. There were 52 participants who completed the questionnaire at a second time point (mean time between assessments 19.02, SD = 6.21 days). Both physical and mental health status were examined, as well as symptomatology of depression, anxiety, and posttraumatic stress disorder. Cronbach's αs for all latent variables in the inventory ranged from .47 to .95. The DRRI-2 risk factors were negatively associated with psychological functioning, whereas resilience factors were positively associated with better self-reported mental health. Test-retest reliability coefficients were generally high (Pearson correlations were .61 to .94, all p values < .01). Our study provides evidence for the reliability and validity of the DRRI-2 in assessing salient deployment experiences among a nonclinical sample following mandatory military service. © 2016 The Authors. International Society for Traumatic Stress Studies published by The International Society for Traumatic Stress Studies.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

PubMed

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

The reliability of diagnostic coding and laboratory data to identify tuberculosis and nontuberculous mycobacterial disease among rheumatoid arthritis patients using anti-tumor necrosis factor therapy.

PubMed

Winthrop, Kevin L; Baxter, Roger; Liu, Liyan; McFarland, Bentson; Austin, Donald; Varley, Cara; Radcliffe, LeAnn; Suhler, Eric; Choi, Dongsoek; Herrinton, Lisa J

2011-03-01

Anti-tumor necrosis factor-alpha (anti-TNF) therapies are associated with severe mycobacterial infections in rheumatoid arthritis patients. We developed and validated electronic record search algorithms for these serious infections. The study used electronic clinical, microbiologic, and pharmacy records from Kaiser Permanente Northern California (KPNC) and the Portland Veterans Affairs Medical Center (PVAMC). We identified suspect tuberculosis and nontuberculous mycobacteria (NTM) cases using inpatient and outpatient diagnostic codes, culture results, and anti-tuberculous medication dispensing. We manually reviewed records to validate our case-finding algorithms. We identified 64 tuberculosis and 367 NTM potential cases, respectively. For tuberculosis, diagnostic code positive predictive value (PPV) was 54% at KPNC and 9% at PVAMC. Adding medication dispensings improved these to 87% and 46%, respectively. Positive tuberculosis cultures had a PPV of 100% with sensitivities of 79% (KPNC) and 55% (PVAMC). For NTM, the PPV of diagnostic codes was 91% (KPNC) and 76% (PVAMC). At KPNC, ≥ 1 positive NTM culture was sensitive (100%) and specific (PPV, 74%) if non-pathogenic species were excluded; at PVAMC, ≥1 positive NTM culture identified 76% of cases with PPV of 41%. Application of the American Thoracic Society NTM microbiology criteria yielded the highest PPV (100% KPNC, 78% PVAMC). The sensitivity and predictive value of electronic microbiologic data for tuberculosis and NTM infections is generally high, but varies with different facilities or models of care. Unlike NTM, tuberculosis diagnostic codes have poor PPV, and in the absence of laboratory data, should be combined with anti-tuberculous therapy dispensings for pharmacoepidemiologic research. Copyright © 2010 John Wiley & Sons, Ltd.

Non-Military Education and the United States Army: A History

DTIC Science & Technology

1972-01-01

exceed vets of the same age in every case . This study was supported by findings at Brooklyn College in " A Study of the Performance of Some 2400...34Educational Achievement of Veterans at Brooklyn College, A Study of the Performance of Some 2400 Veterans in the Period February 1946 to June 141949...34 The Educational Record, 28:207-218, April, 1947. 4 Harry D. Gideonse, "Educational Achievement of Vet- erans at Brooklyn College, A Study of the

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

DTIC Science & Technology

2016-12-01

November 2014. VHA officials also said that after reviewing information from sources such as veteran surveys and feedback from regional VA business...authorizations for care (of both men and women) from early calendar year 2016. In one case, almost a month and a half elapsed from the time of the...veteran’s initial pregnancy confirmation appointment at VA (when she was 6 weeks pregnant) to when the Choice authorization was sent by the VA facility to

To direct the Secretary of Veterans Affairs and the Secretary of Defense to submit to Congress an annual report on open burn pits, and for other purposes.

THOMAS, 111th Congress

Rep. Shea-Porter, Carol [D-NH-1

2018-05-22

House - 05/22/2018 Referred to the Committee on Veterans' Affairs, and in addition to the Committee on Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Miscarriage, stillbirth and congenital malformation in the offspring of UK veterans of the first Gulf war.

PubMed

Doyle, Pat; Maconochie, Noreen; Davies, Graham; Maconochie, Ian; Pelerin, Margo; Prior, Susan; Lewis, Samantha

2004-02-01

To assess whether the offspring of UK veterans of the first Gulf war are at increased risk of fetal death or congenital malformation. This was a retrospective reproductive cohort study of UK Gulf war veterans and a demographically similar comparison group who were in service at the time but were not deployed to the Gulf. Reproductive history was collected by means of a validated postal questionnaire between 1998 and 2001. In all, 27 959 pregnancies reported by men and 861 pregnancies reported by women were conceived after the first Gulf war and before November 1997. The risk of reported miscarriage was higher among pregnancies fathered by Gulf war veterans than by non-Gulf war veterans (OR = 1.4, 95% CI: 1.3, 1.5). Stillbirth risk was similar in both groups. Male Gulf war veterans reported a higher proportion of offspring with any type of malformation than the comparison cohort (OR = 1.5, 95% CI: 1.3, 1.7). Examination by type of malformation revealed some evidence for increased risk of malformations of the genital system, urinary system (renal and urinary tract), and 'other' defects of the digestive system, musculo-skeletal system, and non-chromosomal (non-syndrome) anomalies. These associations were weakened when analyses were restricted to clinically confirmed conditions. There was little or no evidence of increased risk for other structural malformations, specific syndromes, and chromosomal anomalies. Among female veterans, no effect of Gulf war service was found on the risk of miscarriage. The numbers of stillbirths and malformations reported by women were too small to allow meaningful analyses. We found no evidence for a link between paternal deployment to the Gulf war and increased risk of stillbirth, chromosomal malformations, or congenital syndromes. Associations were found between fathers' service in the Gulf war and increased risk of miscarriage and less well-defined malformations, but these findings need to be interpreted with caution as such outcomes are susceptible to recall bias. The finding of a possible relationship with renal anomalies requires further investigation. There was no evidence of an association between risk of miscarriage and mothers' service in the gulf.

Smoking outcome expectancies in military veteran smokers with posttraumatic stress disorder.

PubMed

Carmody, Timothy P; McFall, Miles; Saxon, Andrew J; Malte, Carol A; Chow, Bruce; Joseph, Anne M; Beckham, Jean C; Cook, Jessica W

2012-08-01

Smoking outcome expectancies were investigated in treatment-seeking military Veteran smokers with posttraumatic stress disorder (PTSD). The investigation of smoking outcome expectancies may enhance our understanding of the relationship between PTSD and cigarette smoking. Participants were 943 military Veterans with a diagnosis of PTSD who were current smokers enrolled in a randomized multisite effectiveness trial to test whether the integration of smoking cessation treatment into mental health care (integrated care) improves prolonged abstinence rates compared with referral to specialized smoking cessation clinics (usual care). Using confirmatory factor analysis (CFA), we evaluated the conceptual model of smoking outcome expectancies measured on the Smoking Consequences Questionnaire-Adult (SCQ-A) version. The Kraemer method of mediation analysis was used to investigate the role of smoking outcome expectancies in mediating relationships between PTSD symptoms and smoking behavior, tobacco dependence, and abstinence self-efficacy. The CFA supported the 10-factor structure of the SCQ-A in smokers with PTSD. Relationships between measures of PTSD symptoms and tobacco dependence were mediated by the smoking outcome expectancy regarding negative affect reduction. This same smoking outcome expectancy mediated relationships between PTSD symptoms and smoking abstinence self-efficacy. The findings support the use of the SCQ-A as a valid measure of smoking outcome expectancies in military Veteran smokers with PTSD. Moreover, they suggest that smoking outcome expectancies may play an important role in explaining the relationship between PTSD and cigarette smoking.

Race, Pain, and Beliefs Associated with Interest in Complementary and Alternative Medicine among Inner City Veterans.

PubMed

Goldstein, Jennifer N; Ibrahim, Said A; Frankel, Eitan S; Mao, Jun J

2015-08-01

To investigate the prevalence and determinants of complementary and alternative medicine (CAM) interest level among a racially diverse cohort of inner city veterans who receive primary care at the VA Medical Center. Cross-sectional survey study Philadelphia VA Medical Center Primary care patients (n = 258) METHODS: Interest in CAM was measured using a single item question. Patient treatment beliefs were assessed using validated instruments. We evaluated factors associated with patient interest in CAM using a multivariate logistic regression model. In this sample of 258 inner city primary care VA patients, interest in CAM was high 80% (n = 206). Interest in CAM was strongly associated with African American race [adjusted odds ratio (AOR) 2.19, 95% Confidence Interval (CI) 1.05-4.60, P = 0.037], higher levels of education (AOR 4.33, 95% CI 1.80-10.40, P = 0.001), presence of moderate to severe pain (AOR 2.02, 95% CI 1.02-4.78, P = 0.043), and expectations of benefit from CAM use (AOR 1.21, 95% CI 1.06-1.36, P = 0.004). CAM approaches have broad appeal within this inner city cohort of veterans, particularly among African Americans, those that experience pain and those that expect greater benefit from CAM. These findings may inform the development of patient-centered integrative pain management for veterans. Wiley Periodicals, Inc.

38 CFR 21.194 - “Employment services” status.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Chapter 31 Case Status § 21.194 “Employment services” status. (a) Purpose. The status employment services... veteran's case may be assigned or reassigned to employment services status under the provisions of §§ 21.84, 21.88, 21.94 and 21.98. (c) Continuation in employment services status. A case will remain in...

More than Just a Game? Combat-Themed Gaming Among Recent Veterans with Posttraumatic Stress Disorder.

PubMed

Elliott, Luther; Golub, Andrew; Price, Matthew; Bennett, Alexander

2015-08-01

This article examines recent combat veterans' experiences of "first-person shooter" (FPS) gaming and its relationship to posttraumatic stress disorder (PTSD). Current PTSD treatment approaches increasingly use virtual reality (VR) technologies, which have many similarities with FPS games. To explore these similarities, this article presents six case studies from recently separated veterans in New York City who reported both current PTSD symptoms and regular use of combat-themed FPS games. In open-ended interviews, participants discussed a range of benefits as well as the importance of regulating use and avoiding particular contextual dimensions of gaming to maintain healthy gaming habits. Findings demonstrate the need for more comprehensive study and dissemination of best-practices information about FPS gaming in the context of combat-related PTSD symptomatology.

The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010.

PubMed

Alexander, Melannie; Ray, Meredith A; Hébert, James R; Youngstedt, Shawn D; Zhang, Hongmei; Steck, Susan E; Bogan, Richard K; Burch, James B

2016-07-01

A large proportion of individuals affected by sleep disorders are untreated and susceptible to accidents, injuries, long-term sequelae (e.g., risk of cardiovascular disease, cancer, psychiatric disorders), and increased mortality risk. Few studies have examined the scope and magnitude of sleep disorder diagnoses in the United States (US) or factors influencing them. Veterans are particularly vulnerable to factors that elicit or exacerbate sleep disorders. This serial cross-sectional study characterized secular trends in diagnosed sleep disorders among veterans seeking care in US Veterans Health Administration facilities over an eleven-year span (FY2000-2010, n = 9,786,778). Electronic medical records from the national Veterans Administration Informatics and Computing Infrastructure database were accessed. Cases were defined using diagnostic codes specified by the American Academy of Sleep Medicine. Age-adjusted annual prevalence was summarized by sex, race, combat exposure, body mass index, and comorbid diagnoses (cardiovascular disease, cancer, mental disorders). Sleep apnea (47%) and insomnia (26%) were the most common diagnoses among patients with any sleep disorder. There was a six-fold relative increase in total sleep disorder prevalence over the study period. Posttraumatic stress disorder, which tripled over the same time period, was associated with the highest prevalence of sleep disorders (16%) among the comorbid conditions evaluated. The results indicate a growing need for integration of sleep disorder management with patient care and health care planning among US veterans. A commentary on this article appears in this issue on page 1331. © 2016 Associated Professional Sleep Societies, LLC.

The Zarit Caregiver Burden Interview Short Form (ZBI-12) in spouses of Veterans with Chronic Spinal Cord Injury, Validity and Reliability of the Persian Version.

PubMed

Rajabi-Mashhadi, Mohammad T; Mashhadinejad, Hosein; Ebrahimzadeh, Mohammad H; Golhasani-Keshtan, Farideh; Ebrahimi, Hanieh; Zarei, Zahra

2015-01-01

To test the psychometric properties of the Persian version of Zarit Burden Interview (ZBI-12) in the Iranian population. After translating and cultural adaptation of the questionnaire into Persian, 100 caregiver spouses of Iran- Iraq war (1980-88) veterans with chronic spinal cord injury who live in the city of Mashhad, Iran, invited to participate in the study. The Persian version of ZBI-12 accompanied with the Persian SF-36 was completed by the caregivers to test validity of the Persian ZBI-12.A Pearson`s correlation coefficient was calculated for validity testing. In order to assess reliability of the Persian ZBI-12, we administered the ZBI-12 randomly in 48 caregiver spouses again 3 days later. Generally, the internal consistency of the questionnaire was found to be strong (Cronbach's alpha 0.77). Intercorrelation matrix between the different domains of ZBI-12 at test-retest was 0.78. The results revealed that majority of questions the Persian ZBI_12 have a significant correlation to each other. In terms of validity, our results showed that there is significant correlations between some domains of the Persian version the Short Form Health Survey -36 with the Persian Zarit Burden Interview such as Q1 with Role Physical (P=0.03),General Health (P=0.034),Social Functional (0.037), Mental Health (0.023) and Q3 with Physical Function (P=0.001),Viltality (0.002), Socil Function (0.001). Our findings suggest that the Zarit Burden Interview Persian version is both a valid and reliable instrument for measuring the burden of caregivers of individuals with chronic spinal cord injury.

Complex Factors in the Etiology of Gulf War Illness: Wartime Exposures and Risk Factors in Veteran Subgroups

PubMed Central

Sastre, Antonio; Gerkovich, Mary M.; Cook, Mary R.

2011-01-01

Background: At least one-fourth of U.S. veterans who served in the 1990–1991 Gulf War are affected by the chronic symptomatic illness known as Gulf War illness (GWI). Clear determination of the causes of GWI has been hindered by many factors, including limitations in how epidemiologic studies have assessed the impact of the complex deployment environment on veterans’ health. Objective: We sought to address GWI etiologic questions by evaluating the association of symptomatic illness with characteristics of veterans’ deployment. Methods: We compared veteran-reported wartime experiences in a population-based sample of 304 Gulf War veterans: 144 cases who met preestablished criteria for GWI and 160 controls. Veteran subgroups and confounding among deployment variables were considered in the analyses. Results: Deployment experiences and the prevalence of GWI differed significantly by veterans’ location in theater. Among personnel who were in Iraq or Kuwait, where all battles took place, GWI was most strongly associated with using pyridostigmine bromide pills [odds ratio (OR) = 3.5; 95% confidence interval (CI): 1.7, 7.4] and being within 1 mile of an exploding SCUD missile (OR = 3.1; 95% CI: 1.5, 6.1). For veterans who remained in support areas, GWI was significantly associated only with personal pesticide use, with increased prevalence (OR = 12.7; 95% CI: 2.6, 61.5) in the relatively small subgroup that wore pesticide-treated uniforms, nearly all of whom also used skin pesticides. Combat service was not significantly associated with GWI. Conclusions: Findings support a role for a limited number of wartime exposures in the etiology of GWI, which differed in importance with the deployment milieu in which veterans served. PMID:21930452

Interdisciplinary Transgender Veteran Care: Development of a Core Curriculum for VHA Providers.

PubMed

Shipherd, Jillian C; Kauth, Michael R; Firek, Anthony F; Garcia, Ranya; Mejia, Susan; Laski, Sandra; Walden, Brent; Perez-Padilla, Sonia; Lindsay, Jan A; Brown, George; Roybal, Lisa; Keo-Meier, Colton L; Knapp, Herschel; Johnson, Laura; Reese, Rebecca L; Byne, William

2016-01-01

Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network-Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge.

Interdisciplinary Transgender Veteran Care: Development of a Core Curriculum for VHA Providers

PubMed Central

Shipherd, Jillian C.; Kauth, Michael R.; Firek, Anthony F.; Garcia, Ranya; Mejia, Susan; Laski, Sandra; Walden, Brent; Perez-Padilla, Sonia; Lindsay, Jan A.; Brown, George; Roybal, Lisa; Keo-Meier, Colton L.; Knapp, Herschel; Johnson, Laura; Reese, Rebecca L.; Byne, William

2016-01-01

Abstract Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network–Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge. PMID:29159298

Telephone-Delivered Cognitive-Behavioral Therapy for Older, Rural Veterans with Depression and Anxiety in Home-Based Primary Care.

PubMed

Barrera, Terri L; Cummings, Jeremy P; Armento, Maria; Cully, Jeffrey A; Bush Amspoker, Amber; Wilson, Nancy L; Mallen, Michael J; Shrestha, Srijana; Kunik, Mark E; Stanley, Melinda A

2017-01-01

Rural, homebound older adults are at increased risk for anxiety and depression and have limited access to mental health services. These individuals face many barriers to receiving evidence-based mental health treatment and would benefit from interventions that increase access to and efficiency of care. The aim of this study was to evaluate use of a telephone-delivered, modular, cognitive behavioral therapy (CBT) intervention for both late-life depression and anxiety delivered to rural, homebound Veterans. Three cases are presented to illustrate the flexible adaptation of the intervention for use among older Veterans enrolled in home-based primary care, with varying symptom presentations and functional limitations. The Veterans received 7 to 9 sessions of the CBT intervention, with ordering of skill modules based on symptom presentation and determined collaboratively between patient and therapist. The three Veterans showed improvement in depression and/or anxiety symptoms following treatment and provided positive feedback regarding their experiences in this program. These results suggest that telephone-delivered CBT is acceptable to older adults and can be tailored to individual patient needs. Clinicians should consider telephone-delivered CBT as an alternate mode of therapy to increase access to mental health care for rural, homebound individuals with depression and anxiety.

38 CFR 1.942 - Termination of collection activity.

Code of Federal Regulations, 2010 CFR

2010-07-01

... may be terminated on cases previously suspended. The Department of Veterans Affairs may terminate... witnesses only in cases where efforts to induce voluntary payment are unsuccessful. (g) Discharge in...'s status or a new collection tool becomes available; (3) Offsetting against future income or assets...

Coalmining and the National Scheme for Disabled Ex-Servicemen after the First World War.

PubMed

Mantin, Mike

2016-04-02

After the First World War, disabled British veterans returned home to an uncertain future of work. In addition to voluntary efforts, the government's response to the national employment crisis - the National Scheme for Disabled Ex-Servicemen (commonly known as the King's Roll) - was established in 1919 to encourage employers to hire a five per cent quota of disabled ex-servicemen. Historians have recently revisited the scheme, noting that in many cases the process was slow and fraught, with many disabled veterans facing the prospect of unemployment, yet few have paid attention to soldiers' pre-war working backgrounds and the specific requests of British industries. This article focuses on British coalminers returning from war. What role was there in this national situation for an industry known for its own high rate of accident and injury? Although the King's Roll made some attempt to find veterans specifically targeted jobs above and below ground according to their impairments, it proved unable to incorporate coalmining. Instead, many disabled ex-servicemen returned to the workplace and utilized their existing identities as miners to navigate the process. With the industry beginning to decline, many faced potential regression in job status, exploitation or unemployment. By shifting to an industry-specific focus, this case study explores the contested nature of work for disabled people after the First World War, and highlights the interrelation and importance of workplace identity for the returning disabled veteran.

Coalmining and the National Scheme for Disabled Ex-Servicemen after the First World War

PubMed Central

Mantin, Mike

2016-01-01

Abstract After the First World War, disabled British veterans returned home to an uncertain future of work. In addition to voluntary efforts, the government’s response to the national employment crisis – the National Scheme for Disabled Ex-Servicemen (commonly known as the King’s Roll) – was established in 1919 to encourage employers to hire a five per cent quota of disabled ex-servicemen. Historians have recently revisited the scheme, noting that in many cases the process was slow and fraught, with many disabled veterans facing the prospect of unemployment, yet few have paid attention to soldiers’ pre-war working backgrounds and the specific requests of British industries. This article focuses on British coalminers returning from war. What role was there in this national situation for an industry known for its own high rate of accident and injury? Although the King’s Roll made some attempt to find veterans specifically targeted jobs above and below ground according to their impairments, it proved unable to incorporate coalmining. Instead, many disabled ex-servicemen returned to the workplace and utilized their existing identities as miners to navigate the process. With the industry beginning to decline, many faced potential regression in job status, exploitation or unemployment. By shifting to an industry-specific focus, this case study explores the contested nature of work for disabled people after the First World War, and highlights the interrelation and importance of workplace identity for the returning disabled veteran. PMID:27134339

Applying Lean Six Sigma to improve medication management.

PubMed

Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

2016-01-01

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health care managers who plan to apply Lean Six Sigma techniques in their organizations to improve the quality of care for their patients.

Military experience helps setting reasonable personality characteristics but does not alter the criminal behavior-related impression of negative parental experience and alcoholism in a Chinese population.

PubMed

Xu, Hongyu; Ye, Yuqin; Zhang, Xuesi; Hao, Yelu; Shi, Fei; Yuan, Guohao; Wu, Yan; Fei, Zhou; He, Xiaosheng

2016-10-30

Personalities are determined by convergent factors, including physical environment, culture, special experience, and heredity. It has been shown that abuse of substance and alcohol among individuals with personality disorders predict criminality (Glenn and Raine, 2014; Hernandez-Avila et al., 2000). Thus, it is important to clarify the relationship between psychological characteristics and valence of criminal practice, even in the population without substance abuse. Here, we focused on a population with military experience in Shaanxi province of China to screen the psychological characteristics and correlate these characteristics to criminal behaviors. The study population included incarcerated veterans, incarcerated civilians, and three groups of military troops with different lengths of active duty history (<1 month, 1 year, and 2 years). We used the MAST (Michigan Alcoholism Screening Test), EMBU (Egna Minnen av Barndoms Uppfostran), and 16PF (Sixteen Personality Factor Questionnaire) for the screening purpose. Eight hundred seventy-five valid packets of questionnaires were collected during November 2014-January 2015. Comparison of the mean scores was used to evaluate the difference among the five groups. Incarcerated veterans and incarcerated civilians shared the alcohol abuse-relevant characteristics, including negative parental attitudes during their childhood and decreased emotional stability. Compared to the incarcerated civilians, incarcerated veterans scored higher in emotional stability, self-reliance, and perfectionism, but a lower score in apprehension. Personality characteristics associated with criminal behavior of incarcerated veterans seem to be unrelated to their military service per se as evidenced by the control groups. Conversely, military service may benefit the personnel characteristics even in the incarcerated veteran population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Personality Assessment Inventory profiles of veterans: Differential effects of mild traumatic brain injury and psychopathology.

PubMed

Miskey, Holly M; Shura, Robert D; Yoash-Gantz, Ruth E; Rowland, Jared A

2015-09-01

Neuropsychiatric complaints often accompany mild traumatic brain injury (mTBI), a common condition in post-deployed Veterans. Self-report, multi-scale personality inventories may elucidate the pattern of psychiatric distress in this cohort. This study investigated valid Personality Assessment Inventory (PAI) profiles in post-deployed Veterans. Measures of psychopathology and mTBI were examined in a sample of 144 post-deployed Veterans divided into groups: healthy controls (n = 40), mTBI only (n = 31), any mental health diagnosis only (MH; n = 25), comorbid mTBI and Posttraumatic Stress Disorder (mTBI/PTSD; n = 23), and comorbid mTBI, PTSD, and other psychological diagnoses (mTBI/PTSD/MDD+; n = 25). There were no significant differences between the mTBI and the control group on mean PAI subscale elevation, or number of subscale elevations above 60T or 70T. The other three groups had significantly higher overall mean scores, and more elevations above 60 and 70T compared to both controls and mTBI only. The mTBI/PTSD/MDD+ group showed the highest and most elevations. After entering demographics, PTSD, and number of other psychological diagnoses into hierarchical regressions using the entire sample, mTBI history did not predict mean PAI subscale score or number of elevations above 60T or 70T. PTSD was the only significant predictor. There were no interaction effects between mTBI and presence of PTSD, or between mTBI and total number of diagnoses. This study suggests that mTBI alone is not uniquely related to psychiatric distress in Veterans, but that PTSD accounts for self-reported symptom distress.

Testosterone is related to deviance in male army veterans, but relationships are not moderated by cortisol.

PubMed

Mazur, Allan; Booth, Alan

2014-02-01

The Vietnam Experience Study (VES) of 4462 male U.S. Army veterans is the first large dataset used to demonstrate that testosterone (but not cortisol) is correlated with diverse measures of antisocial, aggressive or dominant behavior. Many subsequent studies have sustained these relationships while also pointing to important caveats. Some researchers suggest that testosterone is correlated to dominance and aggression only (or mostly) in people with low cortisol, not in those with high cortisol. Here we look back to the VES to test this "dual hormone" hypothesis. We find no testosterone-cortisol interaction for seven measures of antisocial deviance. We consider scope conditions under which the dual hormone hypothesis may be valid. Copyright © 2013 Elsevier B.V. All rights reserved.

Re-evaluating disability assessment in war veterans with posttraumatic stress disorder.

PubMed

Samardžić, Radomir M; Živić, Bratislav; Krstić, Dragan; Joković, Danilo; Dolić, Mirko; Stojanović, Zvezdana; Eror, Aleksandar; Đokić, Milan; Milojević, Slavoljub; Mandić-Gajić, Gordana

2016-10-01

Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability. The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans’ military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale – CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation. There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment. The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.

Feasibility of implementing a recovery education center in a Veterans Affairs medical center.

PubMed

Peer, Jason E; Gardner, Mary; Autrey, Sophia; Calmes, Christine; Goldberg, Richard W

2018-04-30

The purpose of this study was to determine the feasibility of implementing a recovery education program in a Veterans Affairs medical center. This case study describes development and implementation of a mental health and wellness curriculum offered through a centralized location. Referral and utilization data (n = 781) from the first 18 months of implementation were used to evaluate feasibility. Access to programming with zero exclusion was prioritized and average time from referral to enrollment was 9.6 days. Fifty-six percent of veterans admitted to mental health services during the 18-month evaluation period were referred to the program, and this level of utilization continued to be sustained. A broad range of classes was available. Opportunities to change classes as recovery goals evolved was encouraged and data indicate veterans actively tailored their individual recovery curriculum. Educational recovery programming was easily incorporated into a large integrated health facility, was well received, and offered greater opportunity for choice and individualization of recovery curriculum. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans.

PubMed

Watkins, Katherine E; Smith, Brad; Akincigil, Ayse; Sorbero, Melony E; Paddock, Susan; Woodroffe, Abigail; Huang, Cecilia; Crystal, Stephen; Pincus, Harold Alan

2016-04-01

The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector. Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484). The authors computed VA and MarketScan national means for seven process-based quality measures related to medication evaluation and management and estimated national-level performance by age and gender. In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment. Findings demonstrate the significant advantages that accrue from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.

Validity of the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire.

PubMed

João, Thaís Moreira São; Rodrigues, Roberta Cunha Matheus; Gallani, Maria Cecília Bueno Jayme; Miura, Cinthya Tamie Passos; Domingues, Gabriela de Barros Leite; Amireault, Steve; Godin, Gaston

2015-09-01

This study provides evidence of construct validity for the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), a 1-item instrument used among 236 participants referred for cardiopulmonary exercise testing. The Baecke Habitual Physical Activity Questionnaire (Baecke-HPA) was used to evaluate convergent and divergent validity. The self-reported measure of walking (QCAF) evaluated the convergent validity. Cardiorespiratory fitness assessed convergent validity by the Veterans Specific Activity Questionnaire (VSAQ), peak measured (VO2peak) and maximum predicted (VO2pred) oxygen uptake. Partial adjusted correlation coefficients between the GSLTPAQ, Baecke-HPA, QCAF, VO2pred and VSAQ provided evidence for convergent validity; while divergent validity was supported by the absence of correlations between the GSLTPAQ and the Occupational Physical Activity domain (Baecke-HPA). The GSLTPAQ presents level 3 of evidence of construct validity and may be useful to assess leisure-time physical activity among patients with cardiovascular disease and healthy individuals.

Mitochondrial dysfunction in Gulf War illness revealed by 31Phosphorus Magnetic Resonance Spectroscopy: a case-control study.

PubMed

Koslik, Hayley J; Hamilton, Gavin; Golomb, Beatrice A

2014-01-01

Approximately 1/3 of 1990-1 Gulf War veterans developed chronic multisymptom health problems. Implicated exposures bear mechanisms that adversely affect mitochondria. Symptoms emphasize fatigue, cognition and muscle (brain and muscle are aerobically demanding); with protean additional domains affected, compatible with mitochondrial impairment. Recent evidence supports treatments targeting cell bioenergetics (coenzyme10) to benefit Gulf War illness symptoms. However, no evidence has directly documented mitochondrial or bioenergetic impairment in Gulf War illness. We sought to objectively assess for mitochondrial dysfunction, examining post-exercise phosphocreatine-recovery time constant (PCr-R) using (31)Phosphorus Magnetic Resonance Spectroscopy ((31)P-MRS), in Gulf War veterans with Gulf War illness compared to matched healthy controls. PCr-R has been described as a "robust and practical" index of mitochondrial status. Case-control study from 2012-2013. Fourteen community-dwelling Gulf War veterans and matched controls from the San Diego area comprised 7 men meeting CDC and Kansas criteria for Gulf War illness, and 7 non-deployed healthy controls matched 1:1 to cases on age, sex, and ethnicity. Calf muscle phosphocreatine was evaluated by (31)P-MRS at rest, through 5 minutes of foot pedal depression exercise, and in recovery, to assess PCr-R. Paired t-tests compared cases to matched controls. PCr-R was significantly prolonged in Gulf War illness cases vs their matched controls: control values, mean ± SD, 29.0 ± 8.7 seconds; case values 46.1 ± 18.0 seconds; difference 17.1 ± 14.9 seconds; p = 0.023. PCr-R was longer for cases relative to their matched controls for all but one pair; moreover while values clustered under 31 seconds for all but one control, they exceeded 35 seconds (with a spread up to 70 seconds) for all but one case. These data provide the first direct evidence supporting mitochondrial dysfunction in Gulf War illness. Findings merit replication in a larger study and/or corroboration with additional mitochondrial assessment tools.

Is the Veterans Specific Activity Questionnaire Valid to Assess Older Adults Aerobic Fitness?

PubMed

de Carvalho Bastone, Alessandra; de Souza Moreira, Bruno; Teixeira, Claudine Patrícia; Dias, João Marcos Domingues; Dias, Rosângela Corrêa

2016-01-01

Aerobic fitness in older adults is related to health status, incident disability, nursing home admission, and all-cause mortality. The most accurate quantification of aerobic fitness, expressed as peak oxygen consumption in mL·kg·min, is the cardiorespiratory exercise test; however, it is not feasible in all settings and might offer risk to patients. The Veterans Specific Activity Questionnaire (VSAQ) is a 13-item self-administered symptom questionnaire that estimates aerobic fitness expressed in metabolic equivalents (METs) and has been validated to cardiovascular patients. The purpose of this study was to assess the validity and reliability of the VSAQ in older adults without specific health conditions. A methodological study with a cross-sectional design was conducted with 28 older adults (66-86 years). The VSAQ was administered on 3 occasions by 2 evaluators. Aerobic capacity in METs as measured by the VSAQ was compared with the METs found in an incremental shuttle walk test (ISWT) performed with a portable metabolic measurement system and with accelerometer data. The validity of the VSAQ was found to be moderate-to-good when compared with the METs and distance measured by the ISWT and with the moderate activity per day and steps per day obtained by accelerometry. The Bland-Altman graph analysis showed no values outside the limits of agreement, suggesting good precision between the METs estimated by questionnaire and the METs measured by the ISWT. Also, the intrarater and interrater reliabilities of the instrument were good. The results showed that the VSAQ is a valuable tool to assess the aerobic fitness of older adults.

Reliability and validity of a combat exposure index for Vietnam era veterans.

PubMed

Janes, G R; Goldberg, J; Eisen, S A; True, W R

1991-01-01

The reliability and validity of a self-report measure of combat exposure are examined in a cohort of male-male twin pairs who served in the military during the Vietnam era. Test-retest reliability for a five-level ordinal index of combat exposure is assessed by use of 192 duplicate sets of responses. The chance-corrected proportion in agreement (as measured by the kappa coefficient) is .84. As a measure of criterion-related validity, the combat index is correlated with the award of combat-related military medals ascertained from the military records. The probability of receiving a Purple Heart, Bronze Star, Commendation Medal and Combat Infantry Badge is associated strongly with the combat exposure index. These results show that this simple index is a reliable and valid measure of combat exposure.

More than Just a Game? Combat-Themed Gaming Among Recent Veterans with Posttraumatic Stress Disorder

PubMed Central

Golub, Andrew; Price, Matthew; Bennett, Alexander

2015-01-01

Abstract This article examines recent combat veterans' experiences of “first-person shooter” (FPS) gaming and its relationship to posttraumatic stress disorder (PTSD). Current PTSD treatment approaches increasingly use virtual reality (VR) technologies, which have many similarities with FPS games. To explore these similarities, this article presents six case studies from recently separated veterans in New York City who reported both current PTSD symptoms and regular use of combat-themed FPS games. In open-ended interviews, participants discussed a range of benefits as well as the importance of regulating use and avoiding particular contextual dimensions of gaming to maintain healthy gaming habits. Findings demonstrate the need for more comprehensive study and dissemination of best-practices information about FPS gaming in the context of combat-related PTSD symptomatology. PMID:26182214

Hypnotically facilitated exposure response prevention therapy for an OIF veteran with OCD.

PubMed

Proescher, Eric J

2010-07-01

The highly stressful conditions of a war zone may exacerbate or trigger a wide variety of symptoms including Obsessive Compulsive Disorder (OCD) once a service member returns home. Service members and new veterans of the Iraq and Afghanistan wars present to treatment with multiple psychosocial concerns and co-morbid psychiatric conditions. Evidence-based treatments including exposure based therapies are commonly recommended for use with returning veterans. Although studies support the efficacy of Exposure Response Prevention (ERP) therapy for treating OCD, eligibility for these studies limits participation to subjects who self-report a well-defined, circumscribed complaint. This approach is not typical of clinic clients who, more often than not, report multiple psychological issues. The following individual case study demonstrates how integrating hypnosis facilitated the cognitive-behavioral ERP therapy and treatment for a patient suffering from OCD.

Distress and patient-centered communication among veterans with incidental (not screen-detected) pulmonary nodules. A cohort study.

PubMed

Slatore, Christopher G; Golden, Sara E; Ganzini, Linda; Wiener, Renda Soylemez; Au, David H

2015-02-01

Incidental pulmonary nodule detection is postulated to cause distress, but the frequency and magnitude of that distress have not been reported. The quality of patient-clinician communication and the perceived risk of lung cancer may influence distress Objectives: To evaluate the association of communication processes with distress and the perceived risk of lung cancer using validated instruments. We conducted a prospective cohort study of patients with incidentally detected nodules who received care at one Department of Veterans Affairs Medical Center. We measured distress with the Impact of Event Scale and patient-centered communication with the Consultation Care Measure, both validated instruments. Risk of lung cancer was self-reported by participants. We used multivariable adjusted logistic regression to measure the association of communication quality with distress. Among 122 Veterans with incidental nodules, 23%, 12%, and 4% reported experiencing mild, moderate, and severe distress, respectively, at the time they were informed of the pulmonary nodule. Participant-reported risk of lung cancer was not associated with distress. In the adjusted model, high-quality communication was associated with decreased distress (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.08-1.00, P = 0.05). Among participants who reported a risk of malignancy of 30% or less, high-quality communication was associated with decreased distress (OR = 0.15, 95% CI = 0.02-0.92, P = 0.04), but was not associated with distress for those who reported a risk greater than 30% (OR = 0.12 (95% CI = 0.00-3.97, P = 0.24), although the P value for interaction was not significant. Veterans with incidental pulmonary nodules frequently reported inadequate information exchange regarding their nodule. Many patients experience distress after they are informed that they have a pulmonary nodule, and high-quality patient-clinician communication is associated with decreased distress. Communication strategies that only target improved knowledge of the risk of malignancy may not be sufficient to reduce the distress associated with nodule detection.

38 CFR 21.92 - Preparation of the plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... rehabilitation specialist, and the veteran. (c) Implementation of the plan. The vocational rehabilitation specialist or counseling psychologist designated as case manager has the primary role in carrying out...

Anger and Postcombat Mental Health: Validation of a Brief Anger Measure with U.S. Soldiers Postdeployed from Iraq and Afghanistan

ERIC Educational Resources Information Center

Novaco, Raymond W.; Swanson, Rob D.; Gonzalez, Oscar I.; Gahm, Gregory A.; Reger, Mark D.

2012-01-01

The involvement of anger in the psychological adjustment of current war veterans, particularly in conjunction with combat-related posttraumatic stress disorder (PTSD), warrants greater research focus than it has received. The present study concerns a brief anger measure, Dimensions of Anger Reactions (DAR), intended for use in large sample studies…

An Exploratory Assessment of the Validity of the Community College Survey of Men (CCSM): Implications for Serving Veteran Men

ERIC Educational Resources Information Center

De La Garza, Thomas; Wood, J. Luke; Harris, Frank, III

2015-01-01

The Community College Survey of Men (CCSM) assesses predictors of student success for historically underrepresented and underserved men in community colleges. The instrument is designed to inform programming and service-delivery for male students (Wood & Harris, 2013). While the instrument was designed for community college men in general,…

38 CFR 10.36 - Proof of marital cohabitation under section 602 or section 312 of the Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... amended, claimant shall be required to establish: (a) A valid marriage, such marriage to be shown by the... had been no annulment of the marriage. (2) Statement of claimant that he or she was not remarried at... knew the claimant and the veteran; that they personally knew of the marriage relationship between...

Physiological reactivity to nonideographic virtual reality stimuli in veterans with and without PTSD.

PubMed

Webb, Andrea K; Vincent, Ashley L; Jin, Alvin B; Pollack, Mark H

2015-02-01

Post-traumatic stress disorder (PTSD) currently is diagnosed via clinical interview in which subjective self reports of traumatic events and associated experiences are discussed with a mental health professional. The reliability and validity of diagnoses can be improved with the use of objective physiological measures. In this study, physiological activity was recorded from 58 male veterans (PTSD Diagnosis n = 16; Trauma Exposed/No PTSD Diagnosis: n = 23; No Trauma/No PTSD Diagnosis: n = 19) with and without PTSD and combat trauma exposure in response to emotionally evocative non-idiographic virtual reality stimuli. Statistically significant differences among the Control, Trauma, and PTSD groups were present during the viewing of two virtual reality videos. Skin conductance and interbeat interval features were extracted for each of ten video events (five events of increasing severity per video). These features were submitted to three stepwise discriminant function analyses to assess classification accuracy for Control versus Trauma, Control versus PTSD, and Trauma versus PTSD pairings of participant groups. Leave-one-out cross-validation classification accuracy was between 71 and 94%. These results are promising and suggest the utility of objective physiological measures in assisting with PTSD diagnosis.

Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs

PubMed Central

McCarthy, John F.; Katz, Ira R.; Thompson, Caitlin; Kemp, Janet; Hannemann, Claire M.; Nielson, Christopher; Schoenbaum, Michael

2015-01-01

Objectives. The Veterans Health Administration (VHA) evaluated the use of predictive modeling to identify patients at risk for suicide and to supplement ongoing care with risk-stratified interventions. Methods. Suicide data came from the National Death Index. Predictors were measures from VHA clinical records incorporating patient-months from October 1, 2008, to September 30, 2011, for all suicide decedents and 1% of living patients, divided randomly into development and validation samples. We used data on all patients alive on September 30, 2010, to evaluate predictions of suicide risk over 1 year. Results. Modeling demonstrated that suicide rates were 82 and 60 times greater than the rate in the overall sample in the highest 0.01% stratum for calculated risk for the development and validation samples, respectively; 39 and 30 times greater in the highest 0.10%; 14 and 12 times greater in the highest 1.00%; and 6.3 and 5.7 times greater in the highest 5.00%. Conclusions. Predictive modeling can identify high-risk patients who were not identified on clinical grounds. VHA is developing modeling to enhance clinical care and to guide the delivery of preventive interventions. PMID:26066914

Predictive Modeling and Concentration of the Risk of Suicide: Implications for Preventive Interventions in the US Department of Veterans Affairs.

PubMed

McCarthy, John F; Bossarte, Robert M; Katz, Ira R; Thompson, Caitlin; Kemp, Janet; Hannemann, Claire M; Nielson, Christopher; Schoenbaum, Michael

2015-09-01

The Veterans Health Administration (VHA) evaluated the use of predictive modeling to identify patients at risk for suicide and to supplement ongoing care with risk-stratified interventions. Suicide data came from the National Death Index. Predictors were measures from VHA clinical records incorporating patient-months from October 1, 2008, to September 30, 2011, for all suicide decedents and 1% of living patients, divided randomly into development and validation samples. We used data on all patients alive on September 30, 2010, to evaluate predictions of suicide risk over 1 year. Modeling demonstrated that suicide rates were 82 and 60 times greater than the rate in the overall sample in the highest 0.01% stratum for calculated risk for the development and validation samples, respectively; 39 and 30 times greater in the highest 0.10%; 14 and 12 times greater in the highest 1.00%; and 6.3 and 5.7 times greater in the highest 5.00%. Predictive modeling can identify high-risk patients who were not identified on clinical grounds. VHA is developing modeling to enhance clinical care and to guide the delivery of preventive interventions.

HIA 2016 DOE Zero Energy Ready Home Case Study: United Way of Long Island, United Veterans, Beacon House, Deer Park, NY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pacific Northwest National Laboratory

Case study of a DOE 2016 Housing Innovation Award winning affordable home in the mixed-humid climate that met the DOE Zero Energy Ready Home criteria and achieved a HERS 32 without PV or HERS 9 with PV.

National dissemination of supported housing in the VA: model adherence versus model modification.

PubMed

O'Connell, Maria; Kasprow, Wesley; Rosenheck, Robert A

2010-01-01

The continuing development and dissemination of emerging evidence-based practices may be facilitated by the availability of descriptive information on the actual delivery of the service, and its variability, across sites. This paper presents data on the participation of 2,925 homeless veterans in the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program at 36 sites across the country, for up to five years. While most conceptual models emphasize rapid placement, sustained intensive case management, rehabilitation services, and "permanent" housing, no program has yet presented empirical data on the actual delivery of such services over an extended period of time. Using extensive longitudinal data from the VA's national homeless outreach program, the Health Care for Homeless Veterans (HCHV) program, a quantitative portrait presents what happens in supported housing in a large real-world dissemination effort. Program entry to HUD-VASH was generally slow with 108 days (sd = 92 days) on average passing between program entry and housing placement. Total program participation lasted 2.6 years on average (sd = 1.6 years)-just half of the possible 5 years. Service delivery became substantially less intensive over time by several measures, and three-fourths of the veterans terminated within five years, although the vast majority (82%) were housed at the time. Few veterans received rehabilitation services (6%) or employment assistance (17%) and most service delivery focused on obtaining housing. These data suggest that real-world supported housing programs may not adhere to the prevalent model descriptions either because of implementation failure or because veteran needs and preferences differ from those suggested by that model.

HIV Care Continuum Applied to the US Department of Veterans Affairs: HIV Virologic Outcomes in an Integrated Health Care System.

PubMed

Backus, Lisa; Czarnogorski, Maggie; Yip, Gale; Thomas, Brittani P; Torres, Marisa; Bell, Tierney; Ross, David

2015-08-01

The Department of Veterans Affairs (VA), the largest integrated HIV care provider in the United States (US), used the HIV Care Continuum to compare clinical care within the VA HIV population with the general US HIV population and to identify areas for improvement. National data from the VA's HIV Clinical Case Registry were used to construct measures along the Continuum for Veterans in VA care diagnosed with HIV by June 2013 and alive by December 31, 2013. Comparisons were made to recent estimates for the same measures for the US HIV population. Additional comparisons were performed for demographic subgroups of sex, race/ethnicity, and age. Of 25,480 Veterans diagnosed with HIV, 77.4% were engaged in care compared with 46.3% in the US population diagnosed with HIV (P < 0.001). Seventy-three percent of Veterans diagnosed with HIV received antiretroviral therapy compared with 43% of the US population diagnosed with HIV (P < 0.001). Nearly two-thirds (65.3%) of HIV-diagnosed Veterans had suppressed HIV viral loads compared with 35.0% of the US population diagnosed with HIV (P < 0.001). The VA health care system performed better at every stage of the HIV Care Continuum compared with the general US estimates. Comparable high rates with some variation were noted among the demographic groups in the VA cohort. The high viral suppression rate in VA, which was almost double the estimate for the HIV-diagnosed US population, demonstrates that improved outcomes along the HIV Care Continuum can be achieved in a comprehensive integrated health care system.

Prospective post-traumatic stress disorder symptom trajectories in active duty and separated military personnel.

PubMed

Porter, Ben; Bonanno, George A; Frasco, Melissa A; Dursa, Erin K; Boyko, Edward J

2017-06-01

Post-traumatic stress disorder (PTSD) is a serious mental illness that affects current and former military service members at a disproportionately higher rate than the civilian population. Prior studies have shown that PTSD symptoms follow multiple trajectories in civilians and military personnel. The current study examines whether the trajectories of PTSD symptoms of veterans separated from the military are similar to continuously serving military personnel. The Millennium Cohort Study is a population-based study of military service members that commenced in 2001 with follow-up assessments occurring approximately every 3 years thereafter. PTSD symptoms were assessed at each time point using the PTSD Checklist. Latent growth mixture modeling was used to compare PTSD symptom trajectories between personnel who separated (veterans; n = 5292) and personnel who remained in military service (active duty; n = 16,788). Four distinct classes (resilient, delayed-onset, improving, and elevated-recovering) described PTSD symptoms trajectories in both veterans and active duty personnel. Trajectory shapes were qualitatively similar between active duty and veterans. However, within the resilient, improving, and elevated recovering classes, the shapes were statistically different. Although the low-symptom class was the most common in both groups (veterans: 82%; active duty: 87%), veterans were more likely to be classified in the other three classes (in all cases, p < 0.01). The shape of each trajectory was highly similar between the two groups despite differences in military and civilian life. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Developing Valid Measures of Emergency Management Capabilities within US Department of Veterans Affairs Hospitals.

PubMed

Dobalian, Aram; Stein, Judith A; Radcliff, Tiffany A; Riopelle, Deborah; Brewster, Pete; Hagigi, Farhad; Der-Martirosian, Claudia

2016-10-01

Introduction Hospitals play a critical role in providing health care in the aftermath of disasters and emergencies. Nonetheless, while multiple tools exist to assess hospital disaster preparedness, existing instruments have not been tested adequately for validity. Hypothesis/Problem This study reports on the development of a preparedness assessment tool for hospitals that are part of the US Department of Veterans Affairs (VA; Washington, DC USA). The authors evaluated hospital preparedness in six "Mission Areas" (MAs: Program Management; Incident Management; Safety and Security; Resiliency and Continuity; Medical Surge; and Support to External Requirements), each composed of various observable hospital preparedness capabilities, among 140 VA Medical Centers (VAMCs). This paper reports on two successive assessments (Phase I and Phase II) to assess the MAs' construct validity, or the degree to which component capabilities relate to one another to represent the associated domain successfully. This report describes a two-stage confirmatory factor analysis (CFA) of candidate items for a comprehensive survey implemented to assess emergency preparedness in a hospital setting. The individual CFAs by MA received acceptable fit statistics with some exceptions. Some individual items did not have adequate factor loadings within their hypothesized factor (or MA) and were dropped from the analyses in order to obtain acceptable fit statistics. The Phase II modified tool was better able to assess the pre-determined MAs. For each MA, except for Resiliency and Continuity (MA 4), the CFA confirmed one latent variable. In Phase I, two sub-scales (seven and nine items in each respective sub-scale) and in Phase II, three sub-scales (eight, four, and eight items in each respective sub-scale) were confirmed for MA 4. The MA 4 capabilities comprise multiple sub-domains, and future assessment protocols should consider re-classifying MA 4 into three distinct MAs. The assessments provide a comprehensive and consistent, but flexible, approach for ascertaining health system preparedness. This approach can provide an organization with a clear understanding of areas for improvement and could be adapted into a standard for hospital readiness. Dobalian A , Stein JA , Radcliff TA , Riopelle D , Brewster P , Hagigi F , Der-Martirosian C . Developing valid measures of emergency management capabilities within US Department of Veterans Affairs hospitals. Prehosp Disaster Med. 2016;31(5):475-484.

Evaluating User Experiences of the Secure Messaging Tool on the Veterans Affairs’ Patient Portal System

PubMed Central

Lind, Jason D; Shimada, Stephanie L; Martin, Tracey L; Gosline, Robert M; Antinori, Nicole; Stewart, Max; Simon, Steven R

2014-01-01

Background The United States Department of Veterans Affairs has implemented an electronic asynchronous “Secure Messaging” tool within a Web-based patient portal (ie, My HealtheVet) to support patient-provider communication. This electronic resource promotes continuous and coordinated patient-centered care, but to date little research has evaluated patients’ experiences and preferences for using Secure Messaging. Objective The objectives of this mixed-methods study were to (1) characterize veterans’ experiences using Secure Messaging in the My HealtheVet portal over a 3-month period, including system usability, (2) identify barriers to and facilitators of use, and (3) describe strategies to support veterans’ use of Secure Messaging. Methods We recruited 33 veterans who had access to and had previously used the portal’s Secure Messaging tool. We used a combination of in-depth interviews, face-to-face user-testing, review of transmitted secure messages between veterans and staff, and telephone interviews three months following initial contact. We assessed participants’ computer and health literacy during initial and follow-up interviews. We used a content-analysis approach to identify dominant themes in the qualitative data. We compared inferences from each of the data sources (interviews, user-testing, and message review) to identify convergent and divergent data trends. Results The majority of veterans (27/33, 82%) reported being satisfied with Secure Messaging at initial interview; satisfaction ratings increased to 97% (31/32, 1 missing) during follow-up interviews. Veterans noted Secure Messaging to be useful for communicating with their primary care team to manage health care needs (eg, health-related questions, test requests and results, medication refills and questions, managing appointments). Four domains emerged from interviews: (1) perceived benefits of using Secure Messaging, (2) barriers to using Secure Messaging, (3) facilitators for using Secure Messaging, and (4) suggestions for improving Secure Messaging. Veterans identified and demonstrated impediments to successful system usage that can be addressed with education, skill building, and system modifications. Analysis of secure message content data provided insights to reasons for use that were not disclosed by participants during interviews, specifically sensitive health topics such as erectile dysfunction and sexually transmitted disease inquiries. Conclusions Veterans perceive Secure Messaging in the My HealtheVet patient portal as a useful tool for communicating with health care teams. However, to maximize sustained utilization of Secure Messaging, marketing, education, skill building, and system modifications are needed. Data from this study can inform a large-scale quantitative assessment of Secure Messaging users’ experiences in a representative sample to validate qualitative findings. PMID:24610454

Utility of biochemical verification of tobacco cessation in the Department of Veterans Affairs.

PubMed

Noonan, Devon; Jiang, Yunyun; Duffy, Sonia A

2013-03-01

Research on the validity of self-report tobacco use has varied by the population studied and has yet to be examined among smokers serviced by the Department of Veterans Affairs (VA). The purpose of this study was to determine the predictors of returning a biochemical urine test and the specificity and sensitivity of self-reported tobacco use status compared to biochemical verification. This was a sub-analysis of the larger Tobacco Tactics research study, a pre-/post-non-randomized control design study to implement and evaluate a smoking cessation intervention in three large VA hospitals. Inpatient smokers completed baseline demographic, health history and tobacco use measures. Patients were sent a follow-up survey at six-months to assess tobacco use and urine cotinine levels. A total of 645 patients returned six-month surveys of which 578 also returned a urinary cotinine strip at six-months. Multivariate analysis of the predictors of return rate revealed those more likely to return biochemical verification of their smoking status were younger, more likely to be thinking about quitting smoking, have arthritis, and less likely to have heart disease. The sensitivity and specificity of self-report tobacco use were 97% (95% confidence interval=0.95-0.98) and 93% (95% confidence interval=0.84-0.98) respectively. The misclassification rate among self-reported quitters was 21%. The misclassification rate among self-reported tobacco users was 1%. The sensitivity and specificity of self-report tobacco use were high among veteran smokers, yet among self-report quitters that misclassification rate was high at 21% suggesting that validating self-report tobacco measures is warranted in future studies especially in populations that are prone to misclassification. Copyright © 2012 Elsevier Ltd. All rights reserved.

Performance of a Natural Language Processing (NLP) Tool to Extract Pulmonary Function Test (PFT) Reports from Structured and Semistructured Veteran Affairs (VA) Data.

PubMed

Sauer, Brian C; Jones, Barbara E; Globe, Gary; Leng, Jianwei; Lu, Chao-Chin; He, Tao; Teng, Chia-Chen; Sullivan, Patrick; Zeng, Qing

2016-01-01

Pulmonary function tests (PFTs) are objective estimates of lung function, but are not reliably stored within the Veteran Health Affairs data systems as structured data. The aim of this study was to validate the natural language processing (NLP) tool we developed-which extracts spirometric values and responses to bronchodilator administration-against expert review, and to estimate the number of additional spirometric tests identified beyond the structured data. All patients at seven Veteran Affairs Medical Centers with a diagnostic code for asthma Jan 1, 2006-Dec 31, 2012 were included. Evidence of spirometry with a bronchodilator challenge (BDC) was extracted from structured data as well as clinical documents. NLP's performance was compared against a human reference standard using a random sample of 1,001 documents. In the validation set NLP demonstrated a precision of 98.9 percent (95 percent confidence intervals (CI): 93.9 percent, 99.7 percent), recall of 97.8 percent (95 percent CI: 92.2 percent, 99.7 percent), and an F-measure of 98.3 percent for the forced vital capacity pre- and post pairs and precision of 100 percent (95 percent CI: 96.6 percent, 100 percent), recall of 100 percent (95 percent CI: 96.6 percent, 100 percent), and an F-measure of 100 percent for the forced expiratory volume in one second pre- and post pairs for bronchodilator administration. Application of the NLP increased the proportion identified with complete bronchodilator challenge by 25 percent. This technology can improve identification of PFTs for epidemiologic research. Caution must be taken in assuming that a single domain of clinical data can completely capture the scope of a disease, treatment, or clinical test.

Performance of a Natural Language Processing (NLP) Tool to Extract Pulmonary Function Test (PFT) Reports from Structured and Semistructured Veteran Affairs (VA) Data

PubMed Central

Sauer, Brian C.; Jones, Barbara E.; Globe, Gary; Leng, Jianwei; Lu, Chao-Chin; He, Tao; Teng, Chia-Chen; Sullivan, Patrick; Zeng, Qing

2016-01-01

Introduction/Objective: Pulmonary function tests (PFTs) are objective estimates of lung function, but are not reliably stored within the Veteran Health Affairs data systems as structured data. The aim of this study was to validate the natural language processing (NLP) tool we developed—which extracts spirometric values and responses to bronchodilator administration—against expert review, and to estimate the number of additional spirometric tests identified beyond the structured data. Methods: All patients at seven Veteran Affairs Medical Centers with a diagnostic code for asthma Jan 1, 2006–Dec 31, 2012 were included. Evidence of spirometry with a bronchodilator challenge (BDC) was extracted from structured data as well as clinical documents. NLP’s performance was compared against a human reference standard using a random sample of 1,001 documents. Results: In the validation set NLP demonstrated a precision of 98.9 percent (95 percent confidence intervals (CI): 93.9 percent, 99.7 percent), recall of 97.8 percent (95 percent CI: 92.2 percent, 99.7 percent), and an F-measure of 98.3 percent for the forced vital capacity pre- and post pairs and precision of 100 percent (95 percent CI: 96.6 percent, 100 percent), recall of 100 percent (95 percent CI: 96.6 percent, 100 percent), and an F-measure of 100 percent for the forced expiratory volume in one second pre- and post pairs for bronchodilator administration. Application of the NLP increased the proportion identified with complete bronchodilator challenge by 25 percent. Discussion/Conclusion: This technology can improve identification of PFTs for epidemiologic research. Caution must be taken in assuming that a single domain of clinical data can completely capture the scope of a disease, treatment, or clinical test. PMID:27376095

Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

PubMed

Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

2016-03-01

To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pain research using Veterans Health Administration electronic and administrative data sources.

PubMed

Abel, Erica A; Brandt, Cynthia A; Czlapinski, Rebecca; Goulet, Joseph L

2016-01-01

Health services researchers are using Veterans Health Administration (VHA) electronic health record (EHR) data sources to examine the prevalence, treatment, and outcomes of pain among Veterans in VHA care. Little guidance currently exists on using these data; thus, findings may vary depending on the methods, data sources, and definitions used. We sought to identify current practices in order to provide guidance to future pain researchers. We conducted an anonymous survey of VHA-affiliated researchers participating in a monthly national pain research teleconference. Thirty-two researchers (89%) responded: 75% conducted pain-focused research, 78% used pain intensity numeric rating screening scale (NRS) scores to identify pain, 41% used International Classification of Diseases-9th Revision codes, and 57% distinguished between chronic and acute pain using either NRS scores or pharmacy data. The NRS and pharmacy data were rated as the most valid pain data sources. Of respondents, 48% reported the EHR data sources were adequate for pain research, while 45% had published peer-reviewed articles based on the data. Despite limitations, VHA researchers are increasingly using EHR data for pain research, and several common methods were identified. More information on the performance characteristics of these data sources and definitions is needed.

Sexual health and quality of life among male veterans with intestinal ostomies.

PubMed

Symms, Michelle R; Rawl, Susan M; Grant, Marcia; Wendel, Christopher S; Coons, Stephen Joel; Hickey, Sara; Baldwin, Carol M; Krouse, Robert S

2008-01-01

This secondary analysis was conducted to expand our understanding of the challenges men with ostomies face regarding intimate relationships and sexual functioning. We examined quantitative and qualitative data to examine sexual functioning, intimate relationships, and health-related quality of life (HR-QOL) among military veterans who are living with an intestinal stoma. Three Veterans Health Administration sites. Four hundred eighty-one male veterans. Case-control, mixed-methods design; cases were those who had ostomies for at least 2 months, and controls had a similar major intestinal surgical procedure that did not result in an ostomy. Quantitative and qualitative data on sexual functioning, relationships, and other dimensions of HR-QOL were collected using the modified City of Hope Quality of Life-Ostomy questionnaire. The overall response rate was 49%. Prevalence of erectile dysfunction was significantly higher among ostomates compared with controls (P < .001). Although a greater proportion of veterans with ostomies reported being sexually active before surgery compared with controls (P < .001), the proportion of men who had resumed sexual activity after surgery is significantly lower among the ostomy group (P = .015). Compared with veterans with ostomies who did not resume sexual activity after surgery, those who were sexually active reported a higher total HR-QOL score and higher scores on all 4 modified City of Hope Quality of Life-Ostomy dimensions (psychological, social, physical, and spiritual well-being). Veterans with ostomies who had resumed sexual activity after their ostomy also reported that their ostomy had caused significantly less interference with social activities, less isolation, less interference with their personal relationships, and less interference with their ability to be intimate. These men also reported less difficulty adjusting to the ostomy. Results of qualitative analyses showed that problems with intimacy and sexual function are among the greatest challenges faced by ostomates. Presence of an ostomy was associated with lower rates of sexual activity and higher erectile dysfunction. The lower rates of sexual activity and sexual satisfaction were related to the social and psychological dimensions of HR-QOL among men with ostomies. Interventions to address sexual concerns of male ostomates and their partners may prevent decrements to HR-QOL for these patients. Results of the study have implications for the clinical nurse specialist role in supporting and educating patients with ostomies to minimize the negative impact of an intestinal ostomy on sexual health and HR-QOL. Implications also relate to the need to educate current and future nurses about the importance of assessing sexual health.

Risk factors for oropharynx cancer in a cohort of HIV-infected veterans.

PubMed

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.

38 CFR 4.42 - Complete medical examination of injury cases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... possible, this should include complete neurological and psychiatric examination, and other special... and psychiatric fields, and frequently leaves the Department of Veterans Affairs in doubt as to the...

Managing the human side of change in VA's transformation.

PubMed

Backer, T E

1997-01-01

Transformational change interventions often fail or short fall of their intended impact on organizations and systems. One main reason is that these interventions frequently do not strategically address the complex human dynamics of change. This happens despite awareness of and commitment to intervening at this level by top management and change leaders. The wisdom that "systems don't change; people change" is widely acknowledged but inadequately applied. These are exactly the conditions the U.S. Department of Veterans Affairs (VA) faces in deploying its new Veterans Integrated Services Networks (VISNs). Applying validated behavioral science strategies that address the human side of change will help VA implement VISNs effectively. Six strategies derived from many years of study and practice in the public and private sectors are discussed, along with suggestions for VISN managers about how to implement them.

Who pays for providing spiritual care in healthcare settings? The ethical dilemma of taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.

PubMed

Warnock, Carla Jean Pease

2009-12-01

All US governmental, public, and private healthcare facilities and their staff fall under some form of regulatory requirement to provide opportunities for spiritual health assessment and care as a component of holistic healthcare. As often the case with regulations, these facilities face the predicament of funding un-reimbursable care. However, chaplains and nurses who provide most patient spiritual care are paid using funds the facility obtains from patients, private, and public sources. Furthermore, Veteran healthcare services, under the United States Department of Veterans Affairs (VA), are provided with taxpayer funds from local, state, and federal governments. With the recent legal action by the Freedom From Religion Foundation, Inc. (FFRF) against the Veterans Administration, the ethical dilemma surfaces between taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.

The influence of perception and peer support on STI prevention behavior (syphilis case study) in group of MSM at veterans STI-VCT clinic in Medan year 2016

NASA Astrophysics Data System (ADS)

Sukatendel, K.; Napitupulu, T. E.; Rusmalawati; Andayani, L. S.; Yustina, I.

2018-03-01

According to Behavioral and Biological Integrated Surveillance (BBIS) in Indonesia, 2011, there was an increase in syphilis surveillance in men who like to commit sexual intercourse with other men (MSM). It was 13% of the 3% in BBIS 2007 in bad STI prevention behavior. There were 478 MSM have visited STI-VCT clinic in Medan throughout 2015, and syphilis-infected 59 men. This study aims to analyze the influence of perception and peer support on prevention of STI in MSM at Veteran STI-VCT Clinic in Medan, 2016. It was a mixed method quantitative and qualitative study with the cross-sectional approach, enrolled 50 respondents. Data were collected and analyzed with SPSS 19. There was the influence of perception and peer support on STI prevention behavior of MSM group at STI-VCT Veteran Clinic in Medan.

20 CFR 408.1060 - What happens if a Federal Court remands your case to the Commissioner?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What happens if a Federal Court remands your case to the Commissioner? 408.1060 Section 408.1060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Determinations and the Administrative Review Process...

20 CFR 408.1060 - What happens if a Federal Court remands your case to the Commissioner?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What happens if a Federal Court remands your case to the Commissioner? 408.1060 Section 408.1060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Determinations and the Administrative Review Process...

20 CFR 408.1060 - What happens if a Federal Court remands your case to the Commissioner?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What happens if a Federal Court remands your case to the Commissioner? 408.1060 Section 408.1060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Determinations and the Administrative Review Process...

20 CFR 408.1060 - What happens if a Federal Court remands your case to the Commissioner?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What happens if a Federal Court remands your case to the Commissioner? 408.1060 Section 408.1060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Determinations and the Administrative Review Process...

20 CFR 408.1060 - What happens if a Federal Court remands your case to the Commissioner?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What happens if a Federal Court remands your case to the Commissioner? 408.1060 Section 408.1060 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Determinations and the Administrative Review Process...

Incidental Learning: A Brief, Valid Measure of Memory Based on the WAIS-IV Vocabulary and Similarities Subtests.

PubMed

Spencer, Robert J; Reckow, Jaclyn; Drag, Lauren L; Bieliauskas, Linas A

2016-12-01

We assessed the validity of a brief incidental learning measure based on the Similarities and Vocabulary subtests of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Most neuropsychological assessments for memory require intentional learning, but incidental learning occurs without explicit instruction. Incidental memory tests such as the WAIS-III Symbol Digit Coding subtest have existed for many years, but few memory studies have used a semantically processed incidental learning model. We conducted a retrospective analysis of 37 veterans with traumatic brain injury, referred for outpatient neuropsychological testing at a Veterans Affairs hospital. As part of their evaluation, the participants completed the incidental learning tasks. We compared their incidental learning performance to their performance on traditional memory measures. Incidental learning scores correlated strongly with scores on the California Verbal Learning Test-Second Edition (CVLT-II) and Brief Visuospatial Memory Test-Revised (BVMT-R). After we conducted a partial correlation that controlled for the effects of age, incidental learning correlated significantly with the CVLT-II Immediate Free Recall, CVLT-II Short-Delay Recall, CVLT-II Long-Delay Recall, and CVLT-II Yes/No Recognition Hits, and with the BVMT-R Delayed Recall and BVMT-R Recognition Discrimination Index. Our incidental learning procedures derived from subtests of the WAIS-IV Edition are an efficient and valid way of measuring memory. These tasks add minimally to testing time and capitalize on the semantic encoding that is inherent in completing the Similarities and Vocabulary subtests.

The Process of Adjustment Among Caregivers of Individuals with Spinal Cord Injury: A Qualitative Study

DTIC Science & Technology

2016-10-01

adults with spinal cord injuries, quality of life, mixed methods, dyads, veterans, civilians, ecological intervention development 16. SECURITY...existing literature in order to provide a foundation for the development of ecologically valid interventions to bolster support and quality of life...civilians, ecological intervention development 3. ACCOMPLISHMENTS Major Goals For year two, we articulated six major tasks, with associated sub-tasks

Effectiveness of Telerehabilitation for OIF/OEF returnees with Combat Related Trauma

DTIC Science & Technology

2018-04-01

validated health outcome instruments that capture physical function, cognition, mental health status and integration into society. We have enrolled a total...community integration over time. 2) The presence of comorbid Post Traumatic Stress Disorders was a significant predictor in reported patient health 3...Individualized treatment pathways may be needed for rehabilitation and ultimate integration into society and 4) Veterans have expressed appreciation for

Occupational risk factors for ill health in Gulf veterans of the United Kingdom

PubMed Central

Ismail, K.; Blatchley, N.; Hotopf, M.; Hull, L.; Palmer, I.; Unwin, C.; David, A.; Wessely, S.

2000-01-01

OBJECTIVES—To study the association between occupational factors specific to the Armed Forces (rank, functional roles, Service, regular or reservist status and deployment factors) and symptomatic health problems in Gulf veterans, after sociodemographic and lifestyle factors have been accounted for.
DESIGN—A postal cross sectional survey of randomly selected UK Gulf veterans was conducted six to seven years after the Gulf conflict. Physical ill health was measured using the Fatigue Questionnaire and a measure of the Centers for Disease Control and Prevention (CDC) multi-symptom syndrome. Psychological ill health was measured using the General Health Questionnaire and a post-traumatic stress measure.
SETTING—Population of servicemen who were serving in the UK Armed Forces during the Gulf conflict between 1 September 1990 and 30 June 1991.
PARTICIPANTS—3297 Gulf veterans.
MAIN RESULTS—In multivariate logistic regression, there was an inverse relation between higher rank and psychological and physical ill health (test of trend: General Health Questionnaire, p=0.004 ; post-traumatic stress, p=0.002; fatigue, p=0.015; CDC case, p=0.002). Having left the Armed Forces was associated with a two to three times increase in reporting ill health. Of the deployment factors, there was a weak association between being deployed as an individual reinforcement in a combat role and post-traumatic stress but there was no association between receiving pre-deployment training or post-deployment leave and ill health. Marital status and smoking were associated with psychological and physical ill health.
CONCLUSIONS—Rank was the main occupational factor associated with both psychological and physical ill health in Gulf veterans. This may parallel the associations between socioeconomic status and morbidity in civilian populations. Ill health seems to be greater in those who return to civilian life. Sociodemographic factors also seem to be important in ill health in Gulf veterans.


Keywords: military; Gulf veterans; rank PMID:11027197

Statin Utilization and Recommendations Among HIV- and HCV-infected Veterans: A Cohort Study

PubMed Central

Clement, Meredith E.; Park, Lawrence P.; Navar, Ann Marie; Okeke, Nwora Lance; Pencina, Michael J.; Douglas, Pamela S.; Naggie, Susanna

2016-01-01

Background. Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are associated with increased risk of cardiovascular disease (CVD). The potential impact of recently updated cholesterol guidelines on treatment of HIV- and HCV-infected veterans is unknown. Methods. We performed a retrospective cohort study to assess statin use and recommendations among 13 579 HIV-infected, 169 767 HCV-infected, and 6628 HIV/HCV-coinfected male veterans aged 40–75 years. Prior 2004 Adult Treatment Panel (ATP-III) guidelines were compared with current 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines and 2014 US Department of Veterans Affairs (VA)/US Department of Defense (DoD) joint clinical practice guidelines using laboratory, medication, and comorbidity data from the VA Clinical Case Registry from 2008 through 2010. Results. Using risk criteria delineated by the ATP-III guidelines, 50.6% of HIV-infected, 45.9% of HCV-infected, and 33.8% of HIV/HCV-coinfected veterans had an indication for statin therapy. However, among those eligible, 22.7%, 30.5%, and 31.5%, respectively, were not receiving ATP-III recommended statin therapy. When current cholesterol guidelines were applied by VA/DoD and ACC/AHA criteria, increases in recommendations for statins were found in all groups (57.3% and 66.1% of HIV-infected, 64.4% and 73.7% of HCV-infected, 49.1% and 58.5% of HIV/HCV-coinfected veterans recommended). Conclusions. Statins were underutilized among veterans infected with HIV, HCV, and HIV/HCV according to previous ATP-III guidelines. Current VA/DoD and ACC/AHA guidelines substantially expand statin recommendations and widen the gap of statin underutilization in all groups. These gaps in care present an opportunity to improve CVD prevention efforts in these at-risk populations. PMID:27143663

Statin Utilization and Recommendations Among HIV- and HCV-infected Veterans: A Cohort Study.

PubMed

Clement, Meredith E; Park, Lawrence P; Navar, Ann Marie; Okeke, Nwora Lance; Pencina, Michael J; Douglas, Pamela S; Naggie, Susanna

2016-08-01

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are associated with increased risk of cardiovascular disease (CVD). The potential impact of recently updated cholesterol guidelines on treatment of HIV- and HCV-infected veterans is unknown. We performed a retrospective cohort study to assess statin use and recommendations among 13 579 HIV-infected, 169 767 HCV-infected, and 6628 HIV/HCV-coinfected male veterans aged 40-75 years. Prior 2004 Adult Treatment Panel (ATP-III) guidelines were compared with current 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines and 2014 US Department of Veterans Affairs (VA)/US Department of Defense (DoD) joint clinical practice guidelines using laboratory, medication, and comorbidity data from the VA Clinical Case Registry from 2008 through 2010. Using risk criteria delineated by the ATP-III guidelines, 50.6% of HIV-infected, 45.9% of HCV-infected, and 33.8% of HIV/HCV-coinfected veterans had an indication for statin therapy. However, among those eligible, 22.7%, 30.5%, and 31.5%, respectively, were not receiving ATP-III recommended statin therapy. When current cholesterol guidelines were applied by VA/DoD and ACC/AHA criteria, increases in recommendations for statins were found in all groups (57.3% and 66.1% of HIV-infected, 64.4% and 73.7% of HCV-infected, 49.1% and 58.5% of HIV/HCV-coinfected veterans recommended). Statins were underutilized among veterans infected with HIV, HCV, and HIV/HCV according to previous ATP-III guidelines. Current VA/DoD and ACC/AHA guidelines substantially expand statin recommendations and widen the gap of statin underutilization in all groups. These gaps in care present an opportunity to improve CVD prevention efforts in these at-risk populations. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

The VA Ostomy Health-Related Quality of Life Study: objectives, methods, and patient sample.

PubMed

Krouse, Robert S; Mohler, M Jane; Wendel, Christopher S; Grant, Marcia; Baldwin, Carol M; Rawl, Susan M; McCorkle, Ruth; Rosenfeld, Kenneth E; Ko, Clifford Y; Schmidt, C Max; Coons, Stephen Joel

2006-04-01

To present the design and methods of a multisite study of health-related quality of life (HR-QOL) in veterans living with ostomies. Veterans from Tucson, Indianapolis, and Los Angeles VA Medical Centers were surveyed using the validated City of Hope ostomy-specific tool (mCOH-QOL-Ostomy) and the SF-36V. Cases (ostomates) had a major gastrointestinal procedure that required an intestinal stoma, while controls had similar procedures for which an ostomy was not required. Ostomy subjects were recruited for four focus groups in each of two sites divided by ostomy type (colostomy versus ileostomy) and overall mCOH-QOL-Ostomy HR-QOL score (highest versus lowest quartile). The focus groups further evaluated barriers, concerns, and adaptation methods and skills. This report presents recruitment results, reliability of survey instruments, and demographic characteristics of the sample. The overall response (i.e., recruitment) rate across all sites was 48% and by site was 53%, 57%, and 37%, respectively (p < 0.001). Internal consistency reliability estimates indicated that both instruments remain reliable in this population (Cronbach's alpha for HR-QOL domains/scales: 0.71-0.96). Cases and controls were similar in demographic characteristics. Proportions of minority subjects matched projections from the site patient populations. Subjects with ostomies had significantly longer time since surgery than controls (p < 0.001). Focus groups were comprised of two to six subjects per group and demonstrated racial diversity at the Los Angeles site. The unique design of our study of VA patients with ostomies is an illustration of a successful mixed methods approach to HR-QOL research. We collected meaningful quantitative and qualitative data that will be used in the development of new approaches to care that will lead to improved functioning and well-being in persons living with ostomies. Subsequent reports will provide the results of this research project.

Electronic Medical Record Documentation of Driving Safety for Veterans with Diagnosed Dementia.

PubMed

Vair, Christina L; King, Paul R; Gass, Julie; Eaker, April; Kusche, Anna; Wray, Laura O

2018-01-01

Many older adults continue to drive following dementia diagnosis, with medical providers increasingly likely to be involved in addressing such safety concerns. This study examined electronic medical record (EMR) documentation of driving safety for veterans with dementia (N = 118) seen in Veterans Affairs primary care and interdisciplinary geriatrics clinics in one geographic region over a 10-year period. Qualitative directed content analysis of retrospective EMR data. Assessment of known risk factors or subjective concerns for unsafe driving were documented in fewer than half of observed cases; specific recommendations for driving safety were evident for a minority of patients, with formal driving evaluation the most frequently documented recommendation by providers. Utilizing data from actual clinical encounters provides a unique snapshot of how driving risk and safety concerns are addressed for veterans with dementia. This information provides a meaningful frame of reference for understanding potential strengths and possible gaps in how this important topic area is being addressed in the course of clinical care. The EMR is an important forum for interprofessional communication, with documentation of driving risk and safety concerns an essential element for continuity of care and ensuring consistency of information delivered to patients and caregivers.

38 CFR 20.1506 - Rule 1506. Board review of cases.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AFFAIRS (CONTINUED) BOARD OF VETERANS' APPEALS: RULES OF PRACTICE Expedited Claims Adjudication Initiative... certified and transferred to the Board under the Initiative to determine whether the record is adequate for...

Implementation of a novel occupational and environmental medicine specialty teleconsultation service: the VHA experience.

PubMed

Eaton, Jennifer L; Mohr, David C; Mohammad, Amir; Kirkhorn, Steven; Gerstel-Santucci, Christina; McPhaul, Kathleen; Hodgson, Michael J

2015-02-01

Occupational and environmental medicine (OEM) physician specialty practices continue to grow in scope and intensity across the Veterans Health Administration. This study characterizes the implementation of a novel, nationwide telemedicine program that provides OEM specialty consultation to providers across the Veterans Health Administration. We examined provider requests and specialist responses for a 6-month pilot from May to October 2013. Characteristics of consult users, determinants of case complexity, and specific applications of OEM specialty expertise were identified. Over a 6-month period, employee occupational health providers consulted the OEM telemedicine pilot a total of 65 times. Employee occupational health providers without formal training repeatedly identified complex cases related to work and disability. The program has created a new system management solution to deliver expert, in-depth consultation and real-time provider education in OEM.

Health information technology and implementation science: partners in progress in the VHA.

PubMed

Hynes, Denise M; Whittier, Erika R; Owens, Arika

2013-03-01

The Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has demonstrated how implementation science can enhance the quality of health care. During this time an increasing number of implementation research projects have developed or utilized health information technology (HIT) innovations to leverage the VA's electronic health record and information systems. To describe the HIT approaches used and to characterize the facilitators and barriers to progress within implementation research projects in the VA QUERI program. Nine case studies were selected from among 88 projects and represented 8 of 14 HIT categories identified. Each case study included key informants whose roles on the project were principal investigator, implementation science and informatics development. We conducted documentation analysis and semistructured in-person interviews with key informants for each of the 9 case studies. We used qualitative analysis software to identify and thematically code information and interview responses. : Thematic analyses revealed 3 domains or pathways critical to progression through the QUERI steps. These pathways addressed: (1) compliance and collaboration with information technology policies and procedures; (2) operating within organizational policies and building collaborations with end users, clinicians, and administrators; and (3) obtaining and maintaining research resources and approvals. Sustained efforts in HIT innovation and in implementation science in the Veterans Health Administration demonstrates the interdependencies of these initiatives and the critical pathways that can contribute to progress. Other health care quality improvement efforts that rely on HIT can learn from the Veterans Health Administration experience.

Alert Hypnotic Inductions: Use in Treating Combat Post-Traumatic Stress Disorder.

PubMed

Eads, Bruce; Wark, David M

2015-10-01

Alert hypnosis can be a valuable part of the treatment protocol for the resolution of post-traumatic stress disorder (PTSD). Research indicates that combat veterans with PTSD are more hypnotically susceptible than the general population. For that reason, it is hypothesized that they should be better able to use hypnosis in treatment. As opposed to the traditional modality, eyes-open alert hypnosis allows the patient to take advantage of hypnotic phenomena while participating responsibly in work, social life, and recreation. Three case studies are reported on combat veterans with PTSD who learned to overcome their symptoms using alert hypnosis.

To amend titles 5 and 38, United States Code, to ensure that certain employees of the Department of Veterans Affairs are subject to the same removal, demotion, and suspension policies as other employees of the Federal Government, and for other purposes.

THOMAS, 111th Congress

Rep. Fitzpatrick, Brian K. [R-PA-8

2018-06-14

House - 06/14/2018 Referred to the Committee on Veterans' Affairs, and in addition to the Committee on Oversight and Government Reform, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Complex contribution of combat-related post-traumatic stress disorder to veteran suicide: facing an increasing challenge.

PubMed

Lee, Elizabeth A D

2012-04-01

The purpose of this case study is to present the complex contribution of combat-related post-traumatic stress disorder (PTSD) to suicide and international standards of treatment among veterans deployed to the Middle East. PTSD carries increased physical and psychological health risk in combat soldiers. Internationally, guidelines for PTSD promote cognitive behavior therapies, specifically exposure therapy, as first line treatment; however, implementation varies among countries. Evidence supports the benefit of exposure-based psychotherapy for combat-related PTSD. Commonly prescribed antidepressants and other psychotherapy treatments may not be as beneficial. © 2011 Wiley Periodicals, Inc.

To direct the Secretary of Veterans Affairs to establish a registry to ensure that members of the Armed Forces who may have been exposed to per- and polyfluoroalkyl substances on military installations receive information regarding such exposure, and for other purposes.

THOMAS, 113th Congress

Rep. Shea-Porter, Carol [D-NH-1

2018-05-22

House - 05/22/2018 Referred to the Committee on Veterans' Affairs, and in addition to the Committee on Armed Services, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

A cluster randomized Hybrid Type III trial testing an implementation support strategy to facilitate the use of an evidence-based practice in VA homeless programs.

PubMed

Smelson, David A; Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Sawh, Leon; Glickman, Mark

2015-05-28

The Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program is one of the largest initiatives to end Veteran homelessness. However, mental health and substance use disorders continue to reduce client stability and impede program success. HUD-VASH programs do not consistently employ evidence-based practices that address co-occurring mental health and substance use disorders. This paper presents a study protocol to evaluate the implementation of an evidence-based, co-occurring disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) in HUD-VASH using an implementation strategy called Getting To Outcomes (GTO). In three large VA Medical Centers, this Hybrid Type III trial will randomize case managers and their clients by HUD-VASH sub-teams to receive either MISSION-Vet Implementation as Usual (IU-standard training and access to the MISSION-Vet treatment manuals) or MISSION-Vet implementation augmented by GTO. In addition to testing GTO, effectiveness of the treatment (MISSION-Vet) will be assessed using existing Veteran-level data from the HUD-VASH data monitoring system. This project will compare GTO and IU case managers and their clients on the following variables: (1) fidelity to the MISSION-Vet intervention; (2) proportion of time the Veteran is housed; (3) mental health, substance use, and functional outcomes among Veterans; and (4) factors key to the successful deployment of a new treatment as specified by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. This project is an important step for developing an implementation strategy to increase adoption of evidence-based practice use in VA homeless programs, and to further examine efficacy of MISSION-Vet in HUD-VASH. This project has important implications for program managers, policy makers, and researchers within the homelessness field. VA Central IRB approval for this study was granted in October 2011. The three sites were trained on MISSION-Vet and GTO in the first half of 2013. The first GTO planning meetings began after training occurred, between January 2013 and November 2013, across the three sites. The data collection-via a fidelity measure embedded into the VA Computerized Patient Record System-began as each site initiated MISSION-Vet, between April 2013 and January 2014. ClinicalTrials.gov: NCT01430741.

Pain Intensity and Opioid Utilization in Response to CPAP Therapy in Veterans with Obstructive Sleep Apnea on Chronic Opioid Treatment.

PubMed

Jaoude, Philippe; Lal, Ashima; Vermont, Leah; Porhomayon, Jahan; El-Solh, Ali A

2016-08-15

Sleep fragmentation has been linked to poor pain tolerance and lowered pain threshold. Little evidence exists on whether continuous positive airway pressure (CPAP) adherence in veterans with obstructive sleep apnea (OSA) who are taking opioids for non-malignant pain would ameliorate pain and reduce consumption of opioids. A retrospective case-control study was performed at a VA sleep center. Pain intensity was assessed using the Numerical Categorical Scale prior to CPAP treatment and 12-mo follow-up. Opioids intake was assessed using the morphine equivalent daily dose (MEDD). Adherence to CPAP was evaluated with the built-in meter. We reviewed 113 patients with OSA (apnea-hypopnea index [AHI] 35.9 ± 29.5) using a MEDD of 61.6 mg (range 5-980 mg) and a control group of 113 veterans with OSA (AHI 33.4 ± 27.3) on no opioids treatment. CPAP adherence was significantly lower at 12 mo in opioid-treated patients compared to controls (37% versus 55%; p = 0.01). Greater pain intensity was the only independent variable associated with CPAP non-adherence at 12-mo follow-up (p = 0.03). Compared to baseline, no significant difference was observed in pain intensity or consumption of opioids in CPAP adherent patients. CPAP treatment did not reduce pain intensity or consumption of opioids in veterans with chronic pain who have coexisting OSA. CPAP adherence was lower in opioid-treated veterans with OSA compared to opioid-free veterans with OSA. Pain intensity was the only determinant of CPAP adherence. Future studies are needed to evaluate pain management program on adherence to CPAP. © 2016 American Academy of Sleep Medicine.

Case-mix groups for VA hospital-based home care.

PubMed

Smith, M E; Baker, C R; Branch, L G; Walls, R C; Grimes, R M; Karklins, J M; Kashner, M; Burrage, R; Parks, A; Rogers, P

1992-01-01

The purpose of this study is to group hospital-based home care (HBHC) patients homogeneously by their characteristics with respect to cost of care to develop alternative case mix methods for management and reimbursement (allocation) purposes. Six Veterans Affairs (VA) HBHC programs in Fiscal Year (FY) 1986 that maximized patient, program, and regional variation were selected, all of which agreed to participate. All HBHC patients active in each program on October 1, 1987, in addition to all new admissions through September 30, 1988 (FY88), comprised the sample of 874 unique patients. Statistical methods include the use of classification and regression trees (CART software: Statistical Software; Lafayette, CA), analysis of variance, and multiple linear regression techniques. The resulting algorithm is a three-factor model that explains 20% of the cost variance (R2 = 20%, with a cross validation R2 of 12%). Similar classifications such as the RUG-II, which is utilized for VA nursing home and intermediate care, the VA outpatient resource allocation model, and the RUG-HHC, utilized in some states for reimbursing home health care in the private sector, explained less of the cost variance and, therefore, are less adequate for VA home care resource allocation.

Considerations for Residency Programs Regarding Accepting Undocumented Students Who Are DACA Recipients.

PubMed

Nakae, Sunny; Rojas Marquez, Denisse; Di Bartolo, Isha Marina; Rodriguez, Raquel

2017-11-01

The Deferred Action for Childhood Arrivals (DACA) initiative provides for the temporary deferral of enforcement of immigration laws for certain undocumented individuals brought to the United States before age 16. More than 50 medical schools now consider applicants who are DACA recipients, and medical school graduates with DACA are eligible to continue their training in graduate medical education. In this article, the authors summarize current policy and provide data on DACA recipients in medical school. They then review the implications for considering DACA recipients in graduate medical education, including employment guidelines, employer responsibilities, training at Veterans Affairs facilities, research funding, and professional licensure. They conclude by discussing the future of the DACA program and best practices for supporting students who are DACA recipients.First, there are no employment restrictions for DACA recipients with valid work authorization documents as long as their employers use Form I-9 Employment Eligibility Verification. Second, unlike H-1B or J-1 visa holders, DACA recipients do not generate additional immigration-related costs for their residency programs. Next, provisions in the Civil Rights Act prohibit employers from discriminating against applicants based on national origin or, in some cases, citizenship status. Furthermore, trainees with DACA are eligible to rotate through Veterans Affairs facilities. Finally, some states, like California and New York, have adopted policies and regulations allowing trainees with DACA who meet all professional requirements to receive a medical license. Given this state of affairs, DACA recipients should have equal standing to their peers when being evaluated for residency positions.

38 CFR 12.6 - Cases of living veterans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... administrator or executor or as directed in writing by such owner, or his or her executor or administrator. (2... or executor, or as directed in writing by such guardian, executor or administrator. (3) To the...

32 CFR 881.8 - Disposition of documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... documents. (a) File a copy of the application, supporting evidence, and DD Form 214 in the Master Personnel... cases. Send copies of DD Form 214 to: (1) The applicant. (2) The Veterans' Administration. (3) HQ AFPC...

38 CFR 36.4526 - Issuance of fund reservation commitments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... for the making of loans to eligible veterans for the purchase or construction of such dwellings. Such... case in which it determines that the experience or technical qualifications of the builder in respect...

“Do You Expect Me to Receive PTSD Care in a Setting Where Most of the Other Patients Remind Me of the Perpetrator?”: Home-Based Telemedicine to Address Barriers to Care Unique to Military Sexual Trauma and Veterans Affairs Hospitals

PubMed Central

Gilmore, Amanda K.; Davis, Margaret T.; Grubaugh, Anouk; Resnick, Heidi; Birks, Anna; Denier, Carol; Muzzy, Wendy; Tuerk, Peter; Acierno, Ron

2016-01-01

Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because ‘dose received’, that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed. PMID:26992740

"Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?": Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals.

PubMed

Gilmore, Amanda K; Davis, Margaret T; Grubaugh, Anouk; Resnick, Heidi; Birks, Anna; Denier, Carol; Muzzy, Wendy; Tuerk, Peter; Acierno, Ron

2016-05-01

Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because 'dose received', that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Is military sexual trauma associated with trading sex among women veterans seeking outpatient mental health care?

PubMed

Strauss, Jennifer L; Marx, Christine E; Weitlauf, Julie C; Stechuchak, Karen M; Straits-Troster, Kristy; Worjoloh, Ayaba W; Sherrod, Christina B; Olsen, Maren K; Butterfield, Marian I; Calhoun, Patrick S

2011-01-01

A robust association between sexual trauma and trading sex has been documented in civilian samples but has not been examined in veterans. Women veterans experience high rates of sexual victimization across the lifespan, including during military service (military sexual trauma [MST]). Associations between MST and trading sex were examined in 200 women enrolled in a crosssectional study of HIV risks and seroprevalence among women receiving outpatient mental health care at a Veterans Affairs (VA) medical center. Each woman completed an assessment interview composed of validated measures that queried childhood sexual trauma; substance use; and risk behaviors, including trading sex for money, drugs, shelter, food, or other things. History of MST was derived from mandated VA screening results and chart notes. Overall, 19.7% reported a history of trading sex. Those who reported trading sex had a higher rate of MST than those who did not report trading sex (87.2% vs. 62.9%, respectively). A multivariable logistic regression model examined the relationship between trading sex and MST, controlling a priori for substance abuse and childhood sexual trauma (both associated with trading sex in civilian samples) and education, which was associated with trading sex in our sample. In this adjusted model, MST was associated with trading sex: odds ratio = 3.26, p = .025, 95% confidence interval = [1.16, 9.18]. To our knowledge, this is the 1st report of an association between MST and trading sex. Results extend previously observed associations between sexual trauma and trading sex in civilian cohorts and underscore the pernicious influence of sexual victimization across the lifespan.

VA's expansion of supportive housing: successes and challenges on the path toward Housing First.

PubMed

Austin, Erika Laine; Pollio, David E; Holmes, Sally; Schumacher, Joseph; White, Bert; Lukas, Carol Vandeusen; Kertesz, Stefan

2014-05-01

The U.S. Department of Veterans Affairs (VA) is transitioning to a Housing First approach to placement of veterans in permanent supportive housing through the use of rental vouchers, an ambitious organizational transformation. This qualitative study examined the experiences of eight VA facilities undertaking this endeavor in 2012. A multidisciplinary team interviewed facility leadership, midlevel managers, and frontline staff (N=95 individuals) at eight VA facilities representing four U.S. regions. The team used a semistructured interview protocol and the constant comparative method to explore how individuals throughout the organizations experienced and responded to the challenges of transitioning to a Housing First approach. Frontline staff faced challenges in rapidly housing homeless veterans because of difficult rental markets, the need to coordinate with local public housing authorities, and a lack of available funds for move-in costs. Staff sought to balance their time spent on housing activities with intensive case management of highly vulnerable veterans. Finding low-demand sheltering options (that is, no expectations regarding sobriety or treatment participation, as in the Housing First model) for veterans waiting for housing presented a significant challenge to implementation of Housing First. Facility leadership supported Housing First implementation through resource allocation, performance monitoring, and reliance on midlevel managers to understand and meet the challenges of implementation. The findings highlight the considerable practical challenges and innovative solutions arising from a large-scale effort to implement Housing First, with particular attention to the experiences of individuals at all levels within an organization.

Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans

PubMed Central

Murphy, Dominic; Ross, Jana; Ashwick, Rachel; Armour, Cherie; Busuttil, Walter

2017-01-01

ABSTRACT Background: Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations. Objective: This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD. Methods: Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems. Results: The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD. Conclusions: Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment. PMID:29435200

Exploring optimum cut-off scores to screen for probable posttraumatic stress disorder within a sample of UK treatment-seeking veterans.

PubMed

Murphy, Dominic; Ross, Jana; Ashwick, Rachel; Armour, Cherie; Busuttil, Walter

2017-01-01

Background : Previous research exploring the psychometric properties of the scores of measures of posttraumatic stress disorder (PTSD) suggests there is variation in their functioning depending on the target population. To date, there has been little study of these properties within UK veteran populations. Objective : This study aimed to determine optimally efficient cut-off values for the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist for DSM-5 (PCL-5) that can be used to assess for differential diagnosis of presumptive PTSD. Methods : Data from a sample of 242 UK veterans assessed for mental health difficulties were analysed. The criterion-related validity of the PCL-5 and IES-R were evaluated against the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Kappa statistics were used to assess the level of agreement between the DSM-IV and DSM-5 classification systems. Results : The optimal cut-off scores observed within this sample were 34 or above on the PCL-5 and 46 or above on the IES-R. The PCL-5 cut-off is similar to the previously reported values, but the IES-R cut-off identified in this study is higher than has previously been recommended. Overall, a moderate level of agreement was found between participants screened positive using the DSM-IV and DSM-5 classification systems of PTSD. Conclusions : Our findings suggest that the PCL-5 and IES-R can be used as brief measures within veteran populations presenting at secondary care to assess for PTSD. The use of a higher cut-off for the IES-R may be helpful for differentiating between veterans who present with PTSD and those who may have some sy`mptoms of PTSD but are sub-threshold for meeting a diagnosis. Further, the use of more accurate optimal cut-offs may aid clinicians to better monitor changes in PTSD symptoms during and after treatment.

Opening a window of opportunity through technology and coordination: a multisite case study.

PubMed

Cherry, Julie Cheitlin; Dryden, Kirsten; Kobb, Rita; Hilsen, Patricia; Nedd, Nicole

2003-01-01

The Community Care Coordination Service (CCCS) program was implemented in April, 2000, at the Veterans Integrated Service Network (VISN 8). The goals of the CCCS were to improve the coordination of care for clinically complex patients, referred to as veterans, and to increase their access to care while reducing complications, hospital admissions, and emergency room (ER) visits. This program used a coordinated care approach, a process whereby veterans were followed throughout the continuum of care. The information presented in this case study is specific to three medical centers that implemented the CCCS: Ft. Myers, Lake City, and Miami. Analysis of utilization and clinical impact were conducted after 18 months. Inpatient admissions were reduced by 46% at Ft. Myers, 68% at Lake City, and 13% at Miami. ER encounters were reduced by 19% at Ft. Myers, 70% at Lake City, and 15% at Miami. Reductions in bed days were demonstrated at Ft. Myers (29%) and Lake City (71%). In Miami, there was a 13% increase in the number of bed days of care for the patients after 1 year in the program. In addition to these changes in health-care utilization, quality of life was significantly improved as evidenced by increases in the four of the eight components scores of the Medical Outcomes Study 36-item Short Form health survey for veterans (SF36V) at Lake City and Ft. Myers. In the CCCS model of care using home telehealth technology, the Care Coordinators bridged the gap between office visits by providing a daily connection between the coordinators and the patients. This daily communication made it possible for problems to be identified early and interventions implemented before problems escalated.

Validity of the MCMI Drug Abuse Scale varies as a function of drug choice, race, and axis II subtypes.

PubMed

Calsyn, D A; Saxon, A J; Daisy, F

1991-06-01

The validity of the Drug Abuse Scale (T) from the Million Clinical Multiaxial Inventory (MCMI) was studied by administering the MCMI to 110 male veterans seeking treatment for opioid or cocaine dependence. Only 26 and 23% of the sample obtained base rate (BR) scores above the clinical relevant cutoffs of 84 and 74, respectively. Covariables associated with elevated scores on the T Scale were Black race, presence of narcissistic/antisocial personality features, and more severe psychopathology in general. The authors urge caution in using the Drug Abuse Scale for the purpose of identifying drug abusers.

Religion and motion pictures' effects on reversing suicidal intentions: two case studies.

PubMed

Khouzam, Hani Raoul; Williams, Leonard; Manzano, Nestor

2003-02-01

Case studies of two veterans contemplating suicide are described. Their suicidal intentions subsided as a result of a rekindling of their Christian faith. Although their Christian beliefs were awakened following their attendance at a motion picture, they both attributed the remission of their suicidal intentions to the practices of their Christian faith in their lives. Despite the favorable outcome, these findings are not generalizable to other cases.

78 FR 37278 - Proposed Information Collection (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-20

... (Veterans Benefits Administration (VBA) Voice of the Veteran (VOV) Pilot Surveys) Activity: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of Veterans Affairs (VA), is announcing an opportunity...

Utility of home sleep apnea testing in high-risk veterans.

PubMed

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 observed between groups with regard to rates of positive studies, study integrity indicators, or predictors of OSA. Veterans, on average, had 30 min less recording time compared to those in the general clinic sample (p < .01). However, these differences did not impact the amount of the record that was deemed valid nor were veterans more likely to have wakefulness after sleep onset. Predictors of OSA for both groups included advancing age, and increased measures of adiposity (neck circumference and BMI). Mean AHI and respiratory disturbance index (RDI) were statistically similar for both groups and were similar for sleep stage and position. Home sleep apnea testing for the diagnosis of OSA appears to yield similar results for VAMC patients deemed at high risk for OSA as it does with general sleep clinic patients.

Molecular Profiles for Lung Cancer Pathogenesis and Detection in U.S. Veterans

DTIC Science & Technology

2013-10-01

All small RNA sequencing and microarray data has been deposited in GEO under the accession number GSE48798. References 1. Hwang HW, Mendell JT (2006...searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send...histologically normal airway epithelium and tumor. We have validated this approach and the data will allow us to identify novel pathways for lung

Biomarker Discovery in Gulf War Veterans: Development of a War Illness Diagnostic Panel

DTIC Science & Technology

2015-10-01

reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of...subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO...a relatively low cost. This interdisciplinary research study is led by a team of experienced GWI investigators and statisticians at Baylor

Improving Diagnostics and Treatments for GWI Females by Accounting for the Effects of PTSD

DTIC Science & Technology

2017-10-01

As there is no widely accepted biomarker for Gulf War Illness (GWI) afflicted veterans are commonly diagnosed based on psychological or... psychological profiles. Estimated completion: 40% Specific AIM 2. Identify and validate bio-behavioral patterns that confirm diagnosis. • Major Task 1...What was accomplished under these goals? Recruitment: • Recruited Mary Jeffrey (M.A. in Clinical Psychology , 2015, University of Colorado

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

ERIC Educational Resources Information Center

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…

MMPI-2 Symptom Validity (FBS) Scale: psychometric characteristics and limitations in a Veterans Affairs neuropsychological setting.

PubMed

Gass, Carlton S; Odland, Anthony P

2014-01-01

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

Physiological reactivity to nonideographic virtual reality stimuli in veterans with and without PTSD

PubMed Central

Webb, Andrea K; Vincent, Ashley L; Jin, Alvin B; Pollack, Mark H

2015-01-01

Background Post-traumatic stress disorder (PTSD) currently is diagnosed via clinical interview in which subjective self reports of traumatic events and associated experiences are discussed with a mental health professional. The reliability and validity of diagnoses can be improved with the use of objective physiological measures. Methods In this study, physiological activity was recorded from 58 male veterans (PTSD Diagnosis n = 16; Trauma Exposed/No PTSD Diagnosis: n = 23; No Trauma/No PTSD Diagnosis: n = 19) with and without PTSD and combat trauma exposure in response to emotionally evocative non-idiographic virtual reality stimuli. Results Statistically significant differences among the Control, Trauma, and PTSD groups were present during the viewing of two virtual reality videos. Skin conductance and interbeat interval features were extracted for each of ten video events (five events of increasing severity per video). These features were submitted to three stepwise discriminant function analyses to assess classification accuracy for Control versus Trauma, Control versus PTSD, and Trauma versus PTSD pairings of participant groups. Leave-one-out cross-validation classification accuracy was between 71 and 94%. Conclusions These results are promising and suggest the utility of objective physiological measures in assisting with PTSD diagnosis. PMID:25642387

Predictive ability of positive clinical culture results and International Classification of Diseases, Ninth Revision, to identify and classify noninvasive Staphylococcus aureus infections: a validation study.

PubMed

Tracy, LaRee A; Furuno, Jon P; Harris, Anthony D; Singer, Mary; Langenberg, Patricia; Roghmann, Mary-Claire

2010-07-01

To develop and validate an algorithm to identify and classify noninvasive infections due to Staphylococcus aureus by using positive clinical culture results and administrative data. Retrospective cohort study. Veterans Affairs Maryland Health Care System. Data were collected retrospectively on all S. aureus clinical culture results from samples obtained from nonsterile body sites during October 1998 through September 2008 and associated administrative claims records. An algorithm was developed to identify noninvasive infections on the basis of a unique S. aureus-positive culture result from a nonsterile site sample with a matching International Classification of Diseases, Ninth Revision (ICD-9-CM), code for infection at time of sampling. Medical records of a subset of cases were reviewed to find the proportion of true noninvasive infections (cases that met the Centers for Disease Control and Prevention National Healthcare Safety Network [NHSN] definition of infection). Positive predictive value (PPV) and negative predictive value (NPV) were calculated for all infections and according to body site of infection. We identified 4,621 unique S. aureus-positive culture results, of which 2,816 (60.9%) results met our algorithm definition of noninvasive S. aureus infection and 1,805 (39.1%) results lacked a matching ICD-9-CM code. Among 96 cases that met our algorithm criteria for noninvasive S. aureus infection, 76 also met the NHSN criteria (PPV, 79.2% [95% confidence interval, 70.0%-86.1%]). Among 98 cases that failed to meet the algorithm criteria, 80 did not meet the NHSN criteria (NPV, 81.6% [95% confidence interval, 72.8%-88.0%]). The PPV of all culture results was 55.4%. The algorithm was most predictive for skin and soft-tissue infections and bone and joint infections. When culture-based surveillance methods are used, the addition of administrative ICD-9-CM codes for infection can increase the PPV of true noninvasive S. aureus infection over the use of positive culture results alone.

RBANS Validity Indices: a Systematic Review and Meta-Analysis.

PubMed

Shura, Robert D; Brearly, Timothy W; Rowland, Jared A; Martindale, Sarah L; Miskey, Holly M; Duff, Kevin

2018-05-16

Neuropsychology practice organizations have highlighted the need for thorough evaluation of performance validity as part of the neuropsychological assessment process. Embedded validity indices are derived from existing measures and expand the scope of validity assessment. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief instrument that quickly allows a clinician to assess a variety of cognitive domains. The RBANS also contains multiple embedded validity indicators. The purpose of this study was to synthesize the utility of those indicators to assess performance validity. A systematic search was completed, resulting in 11 studies for synthesis and 10 for meta-analysis. Data were synthesized on four indices and three subtests across samples of civilians, service members, and veterans. Sufficient data for meta-analysis were only available for the Effort Index, and related analyses indicated optimal cutoff scores of ≥1 (AUC = .86) and ≥ 3 (AUC = .85). However, outliers and heterogeneity were present indicating the importance of age and evaluation context. Overall, embedded validity indicators have shown adequate diagnostic accuracy across a variety of populations. Recommendations for interpreting these measures and future studies are provided.

Comparing the smoking behavior of veterans and nonveterans.

PubMed Central

McKinney, W P; McIntire, D D; Carmody, T J; Joseph, A

1997-01-01

OBJECTIVES: The authors analyzed self-reported questionnaire data from the 1987 National Medical Expenditure Survey (NMES) to determine the smoking patterns of veterans. METHODS: Using NMES data, the authors compared veterans versus nonveterans overall, women veterans versus women nonveterans, Vietnam-era veterans versus other veterans, and veterans whose usual source of medical care was the Department of Veterans Affairs (VA) system versus veterans who received care elsewhere. RESULTS: The likelihood of ever having smoked cigarettes was higher for veterans than for nonveterans and for women veterans than for women nonveterans. The prevalence of current smoking was higher for veterans than for nonveterans and higher for those seeking care within the VA system than for other veterans. CONCLUSIONS: Given the enormous health care costs associated with smoking, health promotion efforts should be developed to reduce the high rate of smoking among veterans--especially those who are consumers of VA health care. Images p213-a PMID:9160055

An assessment of survey measures used across key epidemiologic studies of United States Gulf War I Era Veterans

PubMed Central

2013-01-01

Over the past two decades, 12 large epidemiologic studies and 2 registries have focused on U.S. veterans of the 1990–1991 Gulf War Era. We conducted a review of these studies’ research tools to identify existing gaps and overlaps of efforts to date, and to advance development of the next generation of Gulf War Era survey tools. Overall, we found that many of the studies used similar instruments. Questions regarding exposures were more similar across studies than other domains, while neurocognitive and psychological tools were the most variable. Many studies focused on self-reported survey results, with a range of validation practices. However, physical exams, biomedical assessments, and specimen storage were not common. This review suggests that while research may be able to pool data from past surveys, future surveys need to consider how their design can yield data comparable with previous surveys. Additionally, data that incorporate recent technologies in specimen and genetic analyses would greatly enhance such survey data. When combined with existing data on deployment-related exposures and post-deployment health conditions, longitudinal follow-up of existing studies within this collaborative framework could represent an important step toward improving the health of veterans. PMID:23302181

Combat and herbicide exposures in Vietnam among a sample of American Legionnaires

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stellman, S.D.; Stellman, J.M.; Sommer, J.F. Jr.

A cross-sectional survey of 6,810 randomly selected members of The American Legion in six states who served in the US Armed Forces during the Vietnam Era was conducted by a mailed questionnaire. Combat stress was evaluated by a previously validated eight-item scale. Exposure to Agent Orange and other herbicides was estimated via exposure probability index previously developed by the authors which uses an algorithm based on the combined Air Force and Joint Services HERBS files of spray data. Two-fifths of the men had served in Southeast Asia, generally at the same time during which the major proportion of herbicides weremore » used; the remaining subjects served elsewhere. Both combat and Agent Orange exposure exhibited distinct, meaningful distributions among Vietnam veterans with service in Southeast Asia and were also correlated with each other. Our analysis demonstrates conclusively that mere presence in Vietnam cannot be used as a proxy for exposure to Agent Orange. Categorization of Vietnam veterans according to herbicide exposure can be successfully accomplished, based on an existing detailed herbicide application data base. This analysis, together with the consistent dose-related results obtained in this series of papers on health and behavioral effects, demonstrates the utility of questionnaire-derived herbicide and combat exposure measures for epidemiologic study of Vietnam veterans.« less

Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression.

PubMed

Vable, Anusha M; Canning, David; Glymour, M Maria; Kawachi, Ichiro; Jimenez, Marcia P; Subramanian, Subu V

2016-02-01

The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities. Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents ≥ 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups. Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95% CI = (-8.2, -22.6), P = .035]. Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers. Copyright © 2016 Elsevier Inc. All rights reserved.

Predictors of cognitive and physical fatigue in post-acute mild-moderate traumatic brain injury.

PubMed

Schiehser, Dawn M; Delano-Wood, Lisa; Jak, Amy J; Hanson, Karen L; Sorg, Scott F; Orff, Henry; Clark, Alexandra L

2017-10-01

Post-traumatic fatigue (PTF) is a common, disabling, and often chronic symptom following traumatic brain injury (TBI). Yet, the impact of chronic cognitive and physical fatigue and their associations with psychiatric, sleep, cognitive, and psychosocial sequelae in mild-moderate TBI remain poorly understood. Sixty Veterans with a history of mild-moderate TBI and 40 Veteran controls (VC) were administered the Modified Fatigue Impact Scale, a validated measure of TBI-related cognitive and physical fatigue as well as measures of neuropsychiatric, psychosocial, sleep, and objective cognitive functioning. Compared to VC, TBI Veterans endorsed significantly greater levels of cognitive and physical fatigue. In TBI, psychiatric symptoms, sleep disturbance, and post-traumatic amnesia (PTA) were associated with both cognitive and physical fatigue, while loss of consciousness (LOC) and poor attention/processing speed were related to elevations in cognitive fatigue only. In regression analyses, anxiety, sleep disturbance, and LOC significantly predicted cognitive fatigue, while only post-traumatic stress symptoms and PTA contributed to physical fatigue. Cognitive and physical fatigue are problematic symptoms following mild-moderate TBI that are differentially associated with specific injury and psychiatric sequelae. Findings provide potential symptom targets for interventions aimed at ameliorating fatigue, and further underscore the importance of assessing and treating fatigue as a multi-dimensional symptom following TBI.

38 CFR 21.8012 - Vocational training program for certain children of Vietnam veterans and veterans with covered...

Code of Federal Regulations, 2014 CFR

2014-07-01

... program for certain children of Vietnam veterans and veterans with covered service in Korea-spina bifida... Rehabilitation for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... Vietnam veterans and veterans with covered service in Korea—spina bifida and covered birth defects. VA...

38 CFR 21.8012 - Vocational training program for certain children of Vietnam veterans and veterans with covered...

Code of Federal Regulations, 2013 CFR

2013-07-01

... program for certain children of Vietnam veterans and veterans with covered service in Korea-spina bifida... Rehabilitation for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... Vietnam veterans and veterans with covered service in Korea—spina bifida and covered birth defects. VA...

38 CFR 21.8012 - Vocational training program for certain children of Vietnam veterans and veterans with covered...

Code of Federal Regulations, 2012 CFR

2012-07-01

... program for certain children of Vietnam veterans and veterans with covered service in Korea-spina bifida... Rehabilitation for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... Vietnam veterans and veterans with covered service in Korea—spina bifida and covered birth defects. VA...

38 CFR 21.8012 - Vocational training program for certain children of Vietnam veterans and veterans with covered...

Code of Federal Regulations, 2011 CFR

2011-07-01

... program for certain children of Vietnam veterans and veterans with covered service in Korea-spina bifida... Rehabilitation for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida... Vietnam veterans and veterans with covered service in Korea—spina bifida and covered birth defects. VA...

A comparison of four embedded validity indices for the RBANS in a memory disorders clinic.

PubMed

Paulson, Daniel; Horner, Michael David; Bachman, David

2015-05-01

This examination of four embedded validity indices for the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) explores the potential utility of integrating cognitive and self-reported depressive measures. Examined indices include the proposed RBANS Performance Validity Index (RBANS PVI) and the Charleston Revised Index of Effort for the RBANS (CRIER). The CRIER represented the novel integration of cognitive test performance and depression self-report information. The sample included 234 patients without dementia who could be identified as having demonstrated either valid or invalid responding, based on standardized criteria. Sensitivity and specificity for invalid responding varied widely, with the CRIER emerging as the best all-around index (sensitivity = 0.84, specificity = 0.90, AUC = 0.94). Findings support the use of embedded response validity indices, and suggest that the integration of cognitive and self-report depression data may optimize detection of invalid responding among older Veterans. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Supporting veterans' transitions from permanent supportive housing.

PubMed

Montgomery, Ann Elizabeth; Cusack, Meagan C; Gabrielian, Sonya

2017-12-01

Little research has assessed the nature of veterans' departures from permanent supportive housing (PSH), which may be of positive valence (e.g., moving into more independent housing). This study aimed to identify participants appropriate for "graduation" from PSH and how to support their transitions. This mixed methods study used qualitative data from PSH program staff, 445 PSH participants' responses to a survey assessing their experiences and administrative records, and qualitative data from a subsample of 10 participants who graduated from the program. Participants were classified as "stayers" (retained in PSH for at least 600 days); "graduates" (exited with improvement in community integration); or "involuntary leavers" (exited for reasons of negative valence). Template analysis of qualitative data from PSH staff described graduation processes; qualitative data from participants were analyzed using a thematic analysis approach. The study compared veterans' characteristics using chi-square and analysis of variance (ANOVA) tests; a multinomial logistic regression assessed correlates of graduates' and involuntary leavers' exits from PSH. Approximately one half of participants who exited the program were graduates. Processes used by program staff to identify potential graduates varied. Participants' self-report of substance use and mental health problems was associated with involuntary leaver status. Frequency of case management, a trusting relationship between participant and case manager, and participants' receipt of compensation related to disability incurred during military service were associated with graduation. To support successful transitions from PSH, programs should focus on providing high-quality case management that may respond flexibly to participants' varying recovery needs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The relationship between employment and veteran status, disability and gender from 2004-2011 Behavioral Risk Factor Surveillance System (BRFSS).

PubMed

Smith, Diane L

2014-01-01

In 2011, about 1.8 million or 8 percent of the 22.2 million veterans were women in the US. The unemployment rate for female veterans of the wars in Iraq and Afghanistan rose to 13.5%, above the 8.4% for non-veteran adult women. To examine data from the Behavioral Risk Factor Surveillance System (BRFSS), from 2004-2011 to determine the relationship between employment and veteran status, disability and gender. Chi square analysis was used to determine if significant differences existed between the employment rate of female veterans with disabilities and female veterans without disabilities, female non-veterans with disabilities and male veterans with disabilities. Binomial logistic regression analysis was used to determine how veteran status, disability and gender affected the likelihood of not being employed. Significant differences were found in employment rate between female veterans with disabilities and female veterans without disabilities, but not when compared to female non-veterans with disabilities or male veterans with disabilities. Disability was the strongest factor increasing the likelihood of not being employed, though veteran status and female gender were also predictive. Female veterans with disabilities experience low levels of employment. Policies and programs are needed to address the unique needs of these veterans.

Dissemination and implementation of an educational tool for veterans on complementary and alternative medicine: a case study.

PubMed

Held, Rachel Forster; Santos, Susan; Marki, Michelle; Helmer, Drew

2016-09-02

We developed and disseminated an educational DVD to introduce U.S. Veterans to independently-practiced complementary and alternative medicine (CAM) techniques and encourage CAM experimentation. The project's goal was to determine optimal dissemination methods to facilitate implementation within the Veteran's Health Administration. In the first phase, the DVD was disseminated using four methods: passive, provider-mediated, active, and peer-mediated. In the second, implementation phase, "champion" providers who supported CAM integrated dissemination into clinical practice. Qualitative data came from Veteran focus groups and semi-structured provider interviews. Data from both phases was triangulated to identify common themes. Effective dissemination requires engaging patients. Providers who most successfully integrated the DVD into practice already had CAM knowledge, and worked in settings where CAM was accepted clinical practice, or with leadership or infrastructure that supported a culture of CAM use. Institutional buy-in allowed for provider networking and effective implementation of the tool. Providers were given autonomy to determine the most appropriate dissemination strategies, which increased enthusiasm and use. Many of the lessons learned from this project can be applied to dissemination of any new educational tool within a healthcare setting. Results reiterate the importance of utilizing best practices for introducing educational tools within the healthcare context and the need for thoughtful, multi-faceted dissemination strategies.

Factors Associated with Performance-based Physical Function of Older Veterans of the PLAAF: A Pilot Study

PubMed Central

Chen, Da-Wei; Jin, Yan-Bin; Liu, Wei; Du, Wen-Jin; Li, Hua-Jun; Chen, Jin-Wen; Xu, Wei

2014-01-01

[Purpose] This study investigated the factors associated with performance-based physical function of older veterans of the People’s Liberation Army Air Force of China (PLAAF). [Subjects and Methods] A cross-sectional survey of 146 older veterans of the PLAAF was carried out. Their physical function was measured using the Chinese Mini-Physical Performance Testing (CM-PPT). The demographics and health status (including physical measures, blood chemical tests, chronic diseases, and number of morbidities) were collected from health examination reports and computer records of case history. Cognition was measured using the Mini-Mental Status Examination (MMSE). [Results] In multiple linear regressions, age, MMSE, Parkinsonism, and chronic obstructive pulmonary disease were independently associated with CM-PPT, while previous stroke and albumin level reached borderline statistical significance. The association between the number of morbidities and CM-PPT was significant after adjustment for MMSE and demographics. The CM-PPT of low (0 or 1), medium (2 to 4) and high count (5 or more) morbidities were 11.3±3.9, 10.2±4.1, 6.1±3.8 respectively, and the difference among these three groups was significant. [Conclusion] Some modified conditions and the number of chronic diseases might be associated with the physical function of older veterans of the PLAAF. PMID:24648625

Gender, race & the veteran wage gap.

PubMed

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.

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

PubMed

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.

Critical concerns in Iraq/Afghanistan war veteran-forensic interface: combat-related postdeployment criminal violence.

PubMed

Sreenivasan, Shoba; Garrick, Thomas; McGuire, James; Smee, Daniel E; Dow, Daniel; Woehl, Daniel

2013-01-01

Identifying whether there is a nexus between Iraq and Afghanistan combat injuries and civilian violence on return from deployment is complicated by differences in reactions of individuals to combat exposure, the overlapping effects of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), and the low base rate of civilian violence after combat exposure. Moreover, the overall prevalence of violence among returning Iraq and Afghanistan combat war veterans has not been well documented. Malingered symptoms and either exaggeration or outright fabrication of war zone exposure are challenges to rendering forensic opinions, with the risk reduced by accessing military documents that corroborate war zone duties and exposure. This article serves as a first step toward understanding what may potentiate violence among returning Iraq and Afghanistan veterans. We offer a systematic approach toward the purpose of forensic case formulation that addresses whether combat duty/war zone exposure and associated clinical conditions are linked to criminal violence on return to civilian life.

Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map

PubMed Central

Anderson, Johanna; Boundy, Erin; Ferguson, Lauren; McCleery, Ellen; Waldrip, Kallie

2018-01-01

Background. Continued racial/ethnic health disparities were recently described as “the most serious and shameful health care issue of our time.” Although the 2014 US Affordable Care Act–mandated national insurance coverage expansion has led to significant improvements in health care coverage and access, its effects on life expectancy are not yet known. The Veterans Health Administration (VHA), the largest US integrated health care system, has a sustained commitment to health equity that addresses all 3 stages of health disparities research: detection, understanding determinants, and reduction or elimination. Despite this, racial disparities still exist in the VHA across a wide range of clinical areas and service types. Objectives. To inform the health equity research agenda, we synthesized evidence on racial/ethnic mortality disparities in the VHA. Search Methods. Our research librarian searched MEDLINE and Cochrane Central Registry of Controlled Trials from October 2006 through February 2017 using terms for racial groups and disparities. Selection Criteria. We included studies if they compared mortality between any racial/ethnic minority and nonminority veteran groups or between different minority groups in the VHA (PROSPERO# CRD42015015974). We made study selection decisions on the basis of prespecified eligibility criteria. They were first made by 1 reviewer and checked by a second and disagreements were resolved by consensus (sequential review). Data Collection and Analysis. Two reviewers sequentially abstracted data on prespecified population, outcome, setting, and study design characteristics. Two reviewers sequentially graded the strength of evidence using prespecified criteria on the basis of 5 key domains: study limitations (study design and internal validity), consistency, directness, precision of the evidence, and reporting biases. We synthesized the evidence qualitatively by grouping studies first by racial/ethnic minority group and then by clinical area. For areas with multiple studies in the same population and outcome, we pooled their reported hazard ratios (HRs) using random effects models (StatsDirect version 2.8.0; StatsDirect Ltd., Altrincham, England). We created an evidence map using a bubble plot format to represent the evidence base in 5 dimensions: odds ratio or HR of mortality for racial/ethnic minority group versus Whites, clinical area, strength of evidence, statistical significance, and racial group. Main Results. From 2840 citations, we included 25 studies. Studies were large (n ≥ 10 000) and involved nationally representative cohorts, and the majority were of fair quality. Most studies compared mortality between Black and White veterans and found similar or lower mortality for Black veterans. However, we found modest mortality disparities (HR or OR = 1.07, 1.52) for Black veterans with stage 4 chronic kidney disease, colon cancer, diabetes, HIV, rectal cancer, or stroke; for American Indian and Alaska Native veterans undergoing noncardiac major surgery; and for Hispanic veterans with HIV or traumatic brain injury (most low strength). Author’s Conclusions. Although the VHA’s equal access health care system has reduced many racial/ethnic mortality disparities present in the private sector, our review identified mortality disparities that have persisted mainly for Black veterans in several clinical areas. However, because most mortality disparities were supported by single studies with imprecise findings, we could not draw strong conclusions about this evidence. More disparities research is needed for American Indian and Alaska Native, Asian, and Hispanic veterans overall and for more of the largest life expectancy gaps. Public Health Implications. Because of the relatively high prevalence of diabetes in Black veterans, further research to better understand and reduce this mortality disparity may be prioritized as having the greatest potential impact. However, other mortality disparities affect thousands of veterans and cannot be ignored. PMID:29412713

More than Just Test Scores: Leading for Improvement with an Alternative Community-Driven Accountability Metric

ERIC Educational Resources Information Center

Spain, Angeline; McMahon, Kelly

2016-01-01

In this case, Sharon Rowley, a veteran principal, volunteers to participate in a new community-driven accountability initiative and encounters dilemmas about what it means to be a "data-driven" instructional leader. This case provides an opportunity for aspiring school leaders to explore and apply data-use theory to the work of leading…

A Case Study of Teacher Retention in Three Title I Hawai'i Schools

ERIC Educational Resources Information Center

Furuta, Stephanie H.

2015-01-01

Teacher retention in Hawai'i is a challenge, particularly in high needs Title I schools. This qualitative case study explores the question "What factors influence teacher retention in Title I schools in Hawai'i?" The participants were 10 early career and veteran teachers from three Title I schools within one O'ahu public school complex.…

Optometric Grand Rounds.

ERIC Educational Resources Information Center

Townsend, John C.; Selvin, Gerald J.

1988-01-01

A clinical program developed for Veterans Administration optometry residents and rotating Southern California College of Optometry interns consisted of clinical patient examination followed by case discussion, a formal lecture corresponding to the ocular and systemic diseases presented in the examination, and student testing. (MSE)

Development of an opioid-related Overdose Risk Behavior Scale (ORBS).

PubMed

Pouget, Enrique R; Bennett, Alex S; Elliott, Luther; Wolfson-Stofko, Brett; Almeñana, Ramona; Britton, Peter C; Rosenblum, Andrew

2017-01-01

Drug overdose has emerged as the leading cause of injury-related death in the United States, driven by prescription opioid (PO) misuse, polysubstance use, and use of heroin. To better understand opioid-related overdose risks that may change over time and across populations, there is a need for a more comprehensive assessment of related risk behaviors. Drawing on existing research, formative interviews, and discussions with community and scientific advisors an opioid-related Overdose Risk Behavior Scale (ORBS) was developed. Military veterans reporting any use of heroin or POs in the past month were enrolled using venue-based and chain referral recruitment. The final scale consisted of 25 items grouped into 5 subscales eliciting the number of days in the past 30 during which the participant engaged in each behavior. Internal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectivelyInternal reliability, test-retest reliability and criterion validity were assessed using Cronbach's alpha, intraclass correlations (ICC) and Pearson's correlations with indicators of having overdosed during the past 30 days, respectively. Data for 220 veterans were analyzed. The 5 subscales-(A) Adherence to Opioid Dosage and Therapeutic Purposes; (B) Alternative Methods of Opioid Administration; (C) Solitary Opioid Use; (D) Use of Nonprescribed Overdose-associated Drugs; and (E) Concurrent Use of POs, Other Psychoactive Drugs and Alcohol-generally showed good internal reliability (alpha range = 0.61 to 0.88), test-retest reliability (ICC range = 0.81 to 0.90), and criterion validity (r range = 0.22 to 0.66). The subscales were internally consistent with each other (alpha = 0.84). The scale mean had an ICC value of 0.99, and correlations with validators ranged from 0.44 to 0.56. These results constitute preliminary evidence for the reliability and validity of the new scale. If further validated, it could help improve overdose prevention and response research and could help improve the precision of overdose education and prevention efforts.

Development and validation of PSPSQ 2.0 measuring patient satisfaction with pharmacist services.

PubMed

Sakharkar, Prashant; Bounthavong, Mark; Hirsch, Jan D; Morello, Candis M; Chen, Timothy C; Law, Anandi V

2015-01-01

The extant literature reveals a lack of psychometrically validated tools measuring patient satisfaction with pharmacist clinical services. The Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0) was developed to address this need using a mixed methods approach. To assess the psychometric properties of the PSPSQ 2.0, an instrument developed to measure patient satisfaction with clinical services provided by pharmacists. Validation studies were conducted in two Veterans Affairs (VA)-based and two community-based (diabetes and psychiatric care) disease management/medication therapy management clinics. The PSPSQ 2.0 consisted of 22-items related to three domains identified as quality of care, patient-pharmacist relationship and overall satisfaction using a 4-point, Likert-type scale. It was administered to participants following their session with a pharmacist at the clinics. Collected data were analyzed for descriptive statistics, internal consistency, and validity using exploratory factor analysis. A total of 149 patients completed the survey. Patients from VA clinics were on average 61 years old, mostly white (63%), and predominantly male (95%). Patients from non-VA clinics were on average 47 years old, mostly White (47%) and male (53%). Non-VA patients mostly had Medicaid (42%) and commercial health insurance (31%), whereas VA patients retained benefits with the US Department of Veterans Affairs. Reliability of the scale using internal consistency metrics revealed a Cronbach's alpha of 0.98, 0.98 and 0.95 for VA, diabetes, and psychiatric care clinics, respectively, whereas the Cronbach's alpha for the pooled sample was 0.96. Factor analyses resulted in a three-factor solution accounting for 91% and 69% variance for diabetes and psychiatric care clinics, respectively; however, VA clinics and pooled sample yielded only 2-factor solution with 80% and 66% variance, respectively, with more items loading on patient-pharmacist relationship domain. The results suggest that the PSPSQ 2.0 can serve as a reliable and valid tool for measuring patient satisfaction with pharmacists providing clinical services in VA- and non-VA settings upon further validation. Copyright © 2015 Elsevier Inc. All rights reserved.

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

Code of Federal Regulations, 2010 CFR

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...

38 CFR 51.50 - Eligible veterans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.50 Eligible veterans. A veteran is an eligible veteran under this part if VA determines that the veteran needs nursing home care... receive disability compensation under 38 U.S.C. 1151; (e) Veterans whose entitlement to disability...

38 CFR 51.50 - Eligible veterans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.50 Eligible veterans. A veteran is an eligible veteran under this part if VA determines that the veteran needs nursing home care... receive disability compensation under 38 U.S.C. 1151; (e) Veterans whose entitlement to disability...

38 CFR 51.50 - Eligible veterans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.50 Eligible veterans. A veteran is an eligible veteran under this part if VA determines that the veteran needs nursing home care... receive disability compensation under 38 U.S.C. 1151; (e) Veterans whose entitlement to disability...

38 CFR 51.50 - Eligible veterans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Per Diem Payments § 51.50 Eligible veterans. A veteran is an eligible veteran under this part if VA determines that the veteran needs nursing home care... receive disability compensation under 38 U.S.C. 1151; (e) Veterans whose entitlement to disability...

Mental Health and Comorbidities in U.S. Military Members.

PubMed

Crum-Cianflone, Nancy F; Powell, Teresa M; LeardMann, Cynthia A; Russell, Dale W; Boyko, Edward J

2016-06-01

Using data from a prospective cohort study of U.S. service members who joined after September 11, 2001 to determine incidence rates and comorbidities of mental and behavioral disorders. Calculated age and sex adjusted incidence rates of mental and behavioral conditions determined by validated instruments and electronic medical records. Of 10,671 service members, 3,379 (32%) deployed between baseline and follow-up, of whom 49% reported combat experience. Combat deployers had highest incidence rates of post-traumatic stress disorder (PTSD) (25 cases/1,000 person-years [PY]), panic/anxiety (21/1,000 PY), and any mental disorder (34/1,000 PY). Nondeployers had substantial rates of mental conditions (11, 13, and 18 cases/1,000 PY). Among combat deployers, 12% screened positive for mental disorder, 59% binge drinking, 16% alcohol problem, 19% cigarette smoking, and 20% smokeless tobacco at follow-up. Of those with recent PTSD, 73% concurrently developed >1 incident mental or behavioral conditions. Of those screening positive for PTSD, 11% had electronic medical record diagnosis. U.S. service members joining during recent conflicts experienced high rates of mental and behavioral disorders. Highest rates were among combat deployers. Most cases were not represented in medical codes, suggesting targeted interventions are needed to address the burden of mental disorders among service members and Veterans. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

48 CFR 222.1310 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ACQUISITIONS Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans 222.1310... Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans, with its paragraph (c...

48 CFR 222.1310 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ACQUISITIONS Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans 222.1310... Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans, with its paragraph (c...

48 CFR 222.1310 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ACQUISITIONS Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans 222.1310... Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans, with its paragraph (c...

48 CFR 222.1310 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ACQUISITIONS Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans 222.1310... Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans, with its paragraph (c...

Will Veterans Answer Sexual Orientation and Gender Identity Questions?

PubMed

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.

Whole-Genome DNA Methylation Status Associated with Clinical PTSD Measures of OIF/OEF Veterans

DTIC Science & Technology

Emerging knowledge suggests that post -traumatic stress disorder (PTSD) pathophysiology is linked to the patients epigenetic changes, but...promoter-bound CpGIs to identify networks related to PTSD. The identified networks were further validated by an independent test set comprising 31 PTSD /29...set. To improve the statistical power and mitigate the assay bias and batch effects, a union set combining both training and test set was assayed

Beck PRIDE Center - An Effective Solution for Combat Injured Student Veterans

DTIC Science & Technology

2016-09-01

DOCUMENTATION PAGE Form Approved OMB No . 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response...law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB...initial sessions that included hippotherapy (Treatment A), however scores plateaued and slightly increased at times after hippotherapy was no longer

38 CFR 3.42 - Compensation at the full-dollar rate for certain Filipino veterans residing in the United States.

Code of Federal Regulations, 2010 CFR

2010-07-01

... through birth in the territorial U.S., birth abroad as provided under title 8, United States Code, or... is a natural born citizen of the U.S.: (i) A valid U.S. passport; (ii) A birth certificate showing that he or she was born in the U.S.; or (iii) A Report of Birth Abroad of a Citizen of the U.S. issued...

38 CFR 3.42 - Compensation at the full-dollar rate for certain Filipino veterans residing in the United States.

Code of Federal Regulations, 2011 CFR

2011-07-01

... through birth in the territorial U.S., birth abroad as provided under title 8, United States Code, or... is a natural born citizen of the U.S.: (i) A valid U.S. passport; (ii) A birth certificate showing that he or she was born in the U.S.; or (iii) A Report of Birth Abroad of a Citizen of the U.S. issued...

Fetal alcohol effects in alcoholic veteran patients.

PubMed

Tishler, P V; Henschel, C E; Ngo, T A; Walters, E E; Worobec, T G

1998-11-01

Fetal alcohol syndrome is often associated with severe physical and neuropsychiatric maldevelopment. On the other hand, some offspring of women who drank during pregnancy appear to be affected in minimal ways and function relatively well within society. We questioned whether this effect of prenatal alcohol in the adult is generally minimal. To bear on this, we determined whether we could distinguish alcohol-exposed from nonexposed individuals in a population of male veterans, selected because of both their accepted level of function within society (e.g., honorable discharge from the military) and their admission to an alcohol treatment unit (thus, a greater likelihood of parental alcoholism, because of its familial aggregation). Consecutively admitted alcoholics (cases; n = 77) with likely maternal alcohol ingestion during their pregnancy or the first 10 years of life were matched with alcoholics with no maternal alcohol exposure during these periods (controls; n = 161). Each subject completed questionnaires regarding personal birthweight, alcohol, drug, educational and work histories, and family (including parental) alcohol and drug histories. We measured height, weight, and head circumference; checked for facial and hand anomalies; and took a frontal facial photograph, from which measurements of features were made. Data were analyzed by univariate statistics and stepwise logistic regression. No case had bona fide fetal alcohol syndrome. With univariate statistical analyses, the cases differed from the controls in 10 variables, including duration of drinking, width of alae nasae, being hyperactive or having a short attention span, and being small at birth. By stepwise logistic regression, the variables marital status, small size at birth, duration of drinking, and the presence of a smooth philtrum were marginally (the first two) or definitely (the last two) significant predictors of case status. Analysis of only the 37 cases in whom maternal prenatal drinking was the most likely yielded a marginal association for small size at birth (odds ratio = 3.1, p = 0.08) and a significant association for the presence of a smooth philtrum (odds ratio = 11.9, p = 0.005). Predictability was poor in all regression models. Based on the presence of this single physical finding (smooth philtrum), we estimate that the prevalence of manifestations of fetal alcohol exposure (fetal alcohol effects) is 6 to 13% in adult male veteran children (not necessarily nonveteran offspring) of women who drank alcohol during pregnancy. Thus, in our study of adult veterans, most individuals who were born to women who drank during pregnancy could not be differentiated from normal individuals, and those who were affected were distinguished by a single, nonspecific physical finding.

Role of mitochondrial DNA damage and dysfunction in veterans with Gulf War Illness.

PubMed

Chen, Yang; Meyer, Joel N; Hill, Helene Z; Lange, Gudrun; Condon, Michael R; Klein, Jacquelyn C; Ndirangu, Duncan; Falvo, Michael J

2017-01-01

Gulf War Illness (GWI) is a chronic multi-symptom illness not currently diagnosed by standard medical or laboratory test that affects 30% of veterans who served during the 1990-1991 Gulf War. The clinical presentation of GWI is comparable to that of patients with certain mitochondrial disorders-i.e., clinically heterogeneous multisystem symptoms. Therefore, we hypothesized that mitochondrial dysfunction may contribute to both the symptoms of GWI as well as its persistence over time. We recruited 21 cases of GWI (CDC and Kansas criteria) and 7 controls to participate in this study. Peripheral blood samples were obtained in all participants and a quantitative polymerase chain reaction (QPCR) based assay was performed to quantify mitochondrial and nuclear DNA lesion frequency and mitochondrial DNA (mtDNA) copy number (mtDNAcn) from peripheral blood mononuclear cells. Samples were also used to analyze nuclear DNA lesion frequency and enzyme activity for mitochondrial complexes I and IV. Both mtDNA lesion frequency (p = 0.015, d = 1.13) and mtDNAcn (p = 0.001; d = 1.69) were elevated in veterans with GWI relative to controls. Nuclear DNA lesion frequency was also elevated in veterans with GWI (p = 0.344; d = 1.41), but did not reach statistical significance. Complex I and IV activity (p > 0.05) were similar between groups and greater mtDNA lesion frequency was associated with reduced complex I (r2 = -0.35, p = 0.007) and IV (r2 = -0.28, p < 0.01) enzyme activity. In conclusion, veterans with GWI exhibit greater mtDNA damage which is consistent with mitochondrial dysfunction.

Delirium tremens and alcohol withdrawal nationally in the Veterans Health Administration.

PubMed

Moore, David Thomas; Fuehrlein, Brian Scott; Rosenheck, Robert Alan

2017-10-01

Alcohol withdrawal-especially delirium tremens (DT)-is a potentially life-threatening condition. While short-term treatment regimens and factors that predispose to more severe symptomatology have been extensively studied, little attention has been paid to the clinical epidemiology and long-term care of the chronic medical, addictive, psychiatric, and psychosocial problems faced by these patients. National Veterans Health Administration data from fiscal year 2012 were examined to identify veterans diagnosed with DT; with withdrawal but not DT (WNDT); and with Alcohol Use Disorder (AUD) but neither DT nor WNDT. They were compared on sociodemographic characteristics, psychiatric and medical co-morbidities, and health service and psychotropic medication use, first with bivariate analyses and then multiple logistic regression. Among the 345,297 veterans diagnosed with AUD, 2,341 (0.7%) were diagnosed with DT and 6,738 (2.0%) with WNDT. Veterans diagnosed with either WNDT or DT were more likely to have been homeless, had more comorbid medical and psychiatric disorders, were more likely to be diagnosed with drug use disorders, utilized more health services, received more psychotropic medications, and were more likely to receive naltrexone. They were more likely to receive specialized legal, housing, vocational, and psychosocial rehabilitation services, as well as intensive case management. Adults with WNDT and DT suffer from multiple chronic conditions and long-term service models are needed to coordinate the work of multiple specialists and to assure continuity of care. This national study identifies sociodemographic characteristics, comorbidities, and service utilization patterns associated with WNDT and DT.(Am J Addict 2017;26:722-730). © 2017 American Academy of Addiction Psychiatry.

Longitudinal study of objective and subjective cognitive performance and psychological distress in OEF/OIF Veterans with and without traumatic brain injury.

PubMed

Donnelly, Kerry; Donnelly, James P; Warner, Gary C; Kittleson, C James; King, Paul R

2018-04-01

To describe changes in post-deployment objective and subjective cognitive performance in combat Veterans over 18 months, relative to traumatic brain injury (TBI) status and psychological distress. This prospective cohort study examined 500 Veterans from Upstate New York at four time points, six months apart. TBI status was determined by a structured clinical interview. Neuropsychological instruments focused on attention, memory, and executive functions. Subjective cognitive complaints were assessed with the Neurobehavioral Symptom Inventory (NSI). A psychological distress composite included measures of post-traumatic stress disorder (PTSD), depression, and generalized anxiety. Forty-four percent of the sample was found to have sustained military-related TBI, 97% of which were classified as mild (mTBI), with a mean time since injury of 41 months. Veterans with TBI endorsed moderate cognitive symptoms on the NSI. In contrast to these subjective complaints, mean cognitive test performance was within normal limits at each time point in all domains, regardless of TBI status. Multilevel models examined effects of TBI status, time, and psychological distress. Psychological distress was a strong predictor of all cognitive domains, especially the subjective domain. Substantial proportions of both TBI+ and TBI- groups remained in the clinically significant range at the initial and final assessment for all three distress measures, but the TBI+ group had higher proportions of clinically significant cases. Objective cognitive performance was generally within normal limits for Veterans with mTBI across all assessments. Psychological distress was elevated and significantly related to both objective and subjective cognitive performance.

The Mediating Roles of Coping, Sleep, and Anxiety Motives in Cannabis Use and Problems among Returning Veterans with PTSD and MDD

PubMed Central

Metrik, Jane; Jackson, Kristina; Bassett, Shayna S.; Zvolensky, Michael J.; Seal, Karen; Borsari, Brian

2016-01-01

Veterans with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), the two most prevalent mental health disorders in the Iraq and Afghanistan veterans, are at increased risk for cannabis use and problems including cannabis use disorder (CUD). The present study examined the relationship of PTSD and MDD with cannabis use frequency, cannabis problems, and CUD as well as the role of three coping-oriented cannabis use motives (coping with negative affect, situational anxiety, and sleep) that might underlie this relationship. Participants were veterans (N = 301) deployed post 9/11/2001 recruited from Veterans Health Administration facility in the Northeast US based on self-reported lifetime cannabis use. There were strong unique associations between PTSD and MDD and cannabis use frequency, cannabis problems, and CUD. Mediation analyses revealed the three motives accounted, in part, for the relationship between PTSD and MDD with three outcomes in all cases but for PTSD with cannabis problems. When modeled concurrently, sleep motives, but not situational anxiety or coping with negative affect motives, significantly mediated the association between PTSD and MDD with use. Together with coping motives, sleep motives also fully mediated the effects of PTSD and MDD on CUD and in part the effect of MDD on cannabis problems. Findings indicate the important role of certain motives for better understanding the relation between PTSD and MDD with cannabis use and misuse. Future work is needed to explore the clinical utility in targeting specific cannabis use motives in the context of clinical care for mental health and CUD. PMID:27786514

Diagnosis of retinal detachments by a tele-ophthalmology screening program.

PubMed

McCord, Sarah A; Lynch, Mary G; Maa, April Y

2018-01-01

In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.