Suicide Among US Veterans

Suicide Among US Veterans: A Prospective Study of 500,000 Middle-aged and Elderly Men. 07/11/09. Expert opinion is divided about whether US military veterans, the vast majority of whom are middle-aged or older, are at increased risk of suicide. To assess the risk of suicide associated with veteran status, the authors conducted a prospective cohort study of 499,356 male participants in the Cancer Prevention Study II. Participants reported their veteran status and other characteristics in 1982 and were followed for mortality through 2004. The relative risk of mortality from suicide according to veteran status at baseline was estimated by using Cox proportional hazards models. During follow-up, 1,248 veterans and 614 nonveterans died by suicide. In age-adjusted analyses, the risk of suicide did not differ by veteran status. Additional adjustment for several sociodemographic, behavioral, and clinical factors had little effect on hazard ratios. The authors concluded that the risk of death from suicide among middle-aged and older US males is independent of veteran status and suggest that policies to prevent veteran suicide should focus on factors that may heighten suicide risk rather than on veteran status per se. American Journal of Epidemiology via PubMed

Medication Adherance of Veterans in PTSD Treatment Program

Medication Adherence and Its Effect on Relapse Among Patients Discharged from a Veterans Affairs Posttraumatic Stress Disorder Treatment Program(July/August). 07/11/09. The majority of patients who were discharged from a residential PTSD treatment program were nonadherent to antidepressant drug therapy. One in 5 veterans with PTSD was rehospitalized within 1 year; however, medication adherence did not affect this outcome. Annals of Pharmacotherapy via PubMed

Mirtazapine for PTSD

An Open-Label Study of Mirtazapine as Treatment for Combat-Related PTSD(July/August). 07/11/09. Although small and with methodological limitations, this study suggests that mirtazapine is an effective treatment for combat-related PTSD. Additional research incorporating an appropriately powered, double-blind, placebo-controlled study design is required. Annals of Pharmacotherapy via PubMed

Neurological-related Deaths Among Persian Gulf War Veterans

Neurological mortality among U.S. veterans of the Persian Gulf War: 13-year follow-up. 07/11/09. BACKGROUND: This study focuses on long-term mortality, specifically brain cancer, amyotrophic lateral sclerosis (ALS), Parkinson's disease, and multiple sclerosis (MS) of 621,902 veterans who served in the 1990-1991 Persian Gulf War (GW), and 746,248 non-GW veterans. American Journal of Industrial Medicine via PubMed

Results of Chiropratic Care in Veterans With PTSD

A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder. 07/11/09. This study was a cross-sectional analysis of clinical outcomes for 130 veteran patients with neck or low back complaints completing a course of care within the chiropractic clinic at the VA of Western New York in 2006. Multivariate analysis of variance (MANOVA) was utilized, comparing baseline and discharge scores for both the neck and low back regions and for those patients with and without post-traumatic stress disorder (PTSD). Patients with PTSD (n = 21) experienced significantly lower levels of score improvement than those without PTSD (n = 119) on self-reported outcome measures of neck and low back disability. These findings, coupled with the theorized relationships between PTSD and chronic pain, suggest that the success of conservative forms of management for veteran patients with musculoskeletal disorders may be limited by the presence of PTSD. Further research is warranted to examine the potential contributions of PTSD on chiropractic clinical outcomes with this unique patient population. Military Medicine via PubMed

Veteran's Adherance to Cardiovascular Medication

Assessing overall duration of cardiovascular medicines in veterans with established cardiovascular disease. 07/11/09. Problems with medication adherence can relate to either persistence or compliance during treatment. This novel method provides a way to determine which of these factors is most problematic when considering chronic therapies. We found that Australian veterans with established cardiovascular disease are persistent with their cardiovascular therapy, with only small gaps in therapy. European Journal of Cardiovascular Prevention & Rehabilitation via PubMed

Male to Female Aggression Among Veterans

Male-to-female sexual aggression among Iraq, Afghanistan, and Vietnam veterans: Co-occurring substance abuse and intimate partner aggression. 07/11/09. The current study examined the frequency and correlates of coercive sexual behaviors by male Iraq, Afghanistan, and/or Vietnam veterans recruited from a Veterans Affairs trauma recovery clinic (n = 92) toward their female partners. Men who reported sexual aggression in the past year (n = 37) compared to men who did not report sexual aggression in the past year (n = 55) more frequently reported impulsive aggression, dominating/isolating, and physically assaulting their partner, and were more likely to have a substance abuse diagnosis. Sexually aggressive men were significantly less likely than nonsexually aggressive men to have a diagnosis of depression. Posttraumatic stress disorder, an established risk factor for nonsexual partner aggression among veterans, was not associated with sexual aggression. Journal of Traumatic Stress via PubMed

Inflammatory Bowel Disease in Veterans

Hospitalizations for inflammatory bowel disease among US military veterans 1975-2006. 07/11/09. BACKGROUND: The Department of Veterans Affairs (VA) is the largest healthcare system in the United States. The VA database was used to analyze patterns of hospitalization for inflammatory bowel disease (IBD) among US military veterans. METHODS: The study used the VA Patient Treatment File (PTF) between 1975 and 2006. Each hospital record extracted from the PTF included diagnosis, patient age, and ethnicity. Patient age was analyzed in three age groups: 0-44, 45-64, and 65+. Patient ethnicity was analyzed by two broad categories as white and nonwhite. RESULTS: Among veterans, Crohn's disease was more common than ulcerative colitis and both diseases were more common in whites than in nonwhites. During the past 30 years, the age distributions of both diseases have shifted towards older patients who have come to represent an increasingly larger fraction of patients with Crohn's disease, as well as ulcerative colitis. Hospitalization rates for inflammatory bowel disease among whites recently declined, while most rates among nonwhites continued to rise throughout the observation period. CONCLUSION: The present study revealed a time-dependent shift towards older ages in the age distribution of IBD among hospitalized veterans. These changes, which have been observed similarly in other US statistics, may reflect a birth-cohort phenomenon underlying the long-term time trends of IBD. Digestive Diseases and Science via PubMed

Veterans Exposue to Depleted Uranium

Biological monitoring for depleted uranium exposure in U.S. Veterans. 07/11/09. BACKGROUND: As part of an ongoing medical surveillance program for U.S. veterans exposed to depleted uranium (DU), biological monitoring of urine uranium (U) concentrations is offered to any veteran of the Gulf War and those serving in more recent conflicts (post-Gulf War veterans). OBJECTIVES: Since a previous report of surveillance findings in 2004, an improved methodology for determination of the isotopic ratio of U in urine ((235)U:(238)U) has been developed and allows for more definitive evaluation of DU exposure. This report updates previous findings. METHODS: Veterans provide a 24-hr urine specimen and complete a DU exposure questionnaire. Specimens are sent to the Baltimore Veterans Affairs Medical Center for processing. Uranium concentration and isotopic ratio are measured using ICP-MS at the Armed Forces Institute of Pathology. RESULTS: Between January 2003 and June 2008, we received 1,769 urine specimens for U analysis. The mean urine U measure was 0.009 microg U/g creatinine. Mean urine U concentrations for Gulf War and post-Gulf War veterans were 0.008 and 0.009 microg U/g creatinine, respectively. Only 3 of the 1,700 (0.01%) specimens for which we completed isotopic determination showed evidence of DU. Exposure histories confirmed that these three individuals had been involved in "friendly fire" incidents involving DU munitions or armored vehicles. CONCLUSIONS: No urine U measure with a "depleted" isotopic signature has been detected in U.S. veterans without a history of retained DU embedded fragments from previous injury. These findings suggest that future DU-related health harm is unlikely in veterans without DU fragments. Environmental Health Perspectives

VAOIG Review of James H. Quillen VA Medical Center Mountain Home, Tennessee

Combined Assessment Program Review of the James H. Quillen VA Medical Center Mountain Home, Tennessee 07/11/09. The purpose of the review was to evaluate selected operations, focusing on patient care administration and quality management (QM). During the review, we also provided fraud and integrity awareness briefings to 120 employees. This review focused on seven operational activities. The medical center complied with selected standards in the following four activities: (1) coordination of care, (2) environment of care, (3) medication management, and (4) survey of healthcare experiences of patients. We identified discharge coordination and the time-out process as an organizational strength. We made recommendations for improvements in the following three activities: Emergency/urgent care operations. QM program. Suicide prevention program. VAOIG

New Spinal Cord Treatment Center for Milwaukee VA

Milwaukee VA Hospital Gains New Spinal Cord Treatment Center 07/11/09. The Department of Veterans Affairs has awarded a $26.9 million contract to design and build a free-standing spinal cord injury center at the Milwaukee VA Medical Center. VA

Two New AOIG Reviews

Healthcare Inspection Review of Veterans Health Administration Residential Mental Health Care Facilities 07/08/09. As directed in Public Law 110-387, the VA Office of Inspector General (OIG) conducted a review of residential mental health care facilities, including domiciliary facilities, of the Veterans Health Administration (VHA). The review employed three components for information gathering: a web based information request, onsite inspections, and medical record reviews. VAOIG

Oversight Review of Specialty Service Issues at the VA Montana Health Care System, Fort Harrison, Montana 07/08/09. This is a review of actions taken by the Veterans Health Administration (VHA) to address allegations that a physician at the VA Montana Health Care System was providing substandard care and engaging in improper medical record documentation practices. VAOIG

Treatment of PTSD via Video Teleconferencing

Issues in the design of a randomized noninferiority clinical trial of telemental health psychotherapy for rural combat veterans with PTSD. 07/08/09. This methodological article provides a description of the design, methods, and rationale of the first prospective, noninferiority designed randomized clinical trial evaluating the clinical and cost implications of delivering an evidence-based cognitive behavioral group intervention specifically treating posttraumatic stress disorder (PTSD) with a trauma-focused intervention via video teleconferencing (VTC). Contemporary Clinical Trials via PubMed

Mild TBI & PTSD

Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. 07/08/09. Mild traumatic brain injury (MTBI), even in the chronic phase years postinjury, is not a benign condition. It is associated with increased rates of headaches, sleep problems, and memory difficulties. Furthermore, it can complicate or prolong recovery from preexisting or comorbid conditions such as PTSD. Similarly, PTSD is a potent cocontributor to physical, cognitive, and emotional symptoms. Archives of Physical Medicine and Rehabilitation via PubMed

Coronary Surgery Outcomes at VA Hospitals

Outcomes of Coronary Surgery at a Veterans Affairs Hospital Versus Other Hospitals. 07/08/09. Despite the higher prevalence of comorbidities, patients who underwent CABG at a VA hospital had a significantly lower mortality rate than CABG patients in non-VA hospitals. Journal of Surgical Research via PubMed

PTSD Prevention?

Post-traumatic stress disorder: Psychological treatments may not prevent PTSD 07/07/09. Psychological interventions intended to prevent the development of post-traumatic stress disorder in the early stages after a traumatic experience have not been shown to be effective, Cochrane researchers have concluded. This systematic review focused on multiple-session treatments for everyone involved, irrespective of the presence of symptoms. Two previous reviews found single session interventions to be ineffective. Wiley-Blackwell via Eurekalert!

Innovative Industrial Engineering Solutions That May Improve VA Processes

Northeastern Leads Partnership to Improve VA Health Care Processes 07/06/09. Northeastern University has partnered with the New England Veterans Affairs (VA) health care system, establishing a new systems engineering center to significantly improve quality and performance throughout VA hospitals. The partnership will design innovative industrial engineering solutions that improve VA processes, and that may ultimately extend to the U.S. private health care system. Northeastern University via Newswise

Compulsive Behaviors in Veterans With PTSD

Diagnosis and treatment of PTSD-related compulsive checking behaviors in veterans of the Iraq war: the influence of military context on the expression of PTSD symptoms. 07/05/09. This case study presents an overview of the conceptualization and treatment of two veterans of the Iraq War who presented for combat-related treatment at a Veterans Administration Medical Center. In addition to posttraumatic stress disorder (PTSD) symptoms of reexperiencing, arousal, and avoidance, the veterans exhibited compulsive checking behaviors that appear to be influenced by theater-specific combat duties and traumatic events. These cases represent what the authors believe to be an increasingly common expression of PTSD in veterans of the Iraq and Afghanistan wars. Both veterans were treated with prolonged exposure therapy, which includes imaginal and in vivo exposure to anxiety-provoking stimuli, processing of traumatic events, and self-assessment of anxiety. Treatment also included in vivo exposure with response prevention techniques borrowed from the literature on obsessive-compulsive disorder to address compulsive checking behaviors within the ecological context of each patient's symptom presentation. Measures related to PTSD and depression were obtained before, during, and after treatment. Treatment was associated with significant declines in symptom severity and improved functioning for both veterans. The unique nature of the conflict in the Middle East represents role challenges for soldiers that affect symptom presentation. Variations in symptom presentation can in turn complicate efforts to identify and appropriately address PTSD-related health concerns in this population. Thus, clinicians and researchers must remain cognizant of how theater-specific duties influence the manifestation and treatment of PTSD in order to provide optimal care to a new generation of veterans. American Journal of Psychiatry via PubMed

Sulphur Mustard Poisoning

Delayed head and neck complications of sulphur mustard poisoning in Iranian veterans. 07/05/09. Objective:Sulphur mustard is a chemical warfare agent which was used against Iranian combatants and civilians between 1983 and 1988. The purpose of this study was to document the delayed toxic effects of sulphur mustard in Iranian veterans, focussing on head and neck complications.Patients and methods:This was a two-year, prospective, descriptive study of 43 male Iranian veterans aged 34 to 48 years (mean 41.8 years) who were moderately disabled or worse due to sulphur mustard poisoning. Investigations were performed with consent, including haematological, biochemical and immunological tests, spirometry, chest X-ray, high resolution computed tomography of the lungs, and skin biopsies. Further investigations and interventions were performed as clinically indicated.Results:The most affected sites were the lungs (95 per cent), peripheral nerves (77 per cent), skin (73 per cent), eyes (68 per cent), and head and neck (16.2 per cent). Of seven patients with mostly head and neck complications, four had a skin disorder (hyperpigmentation in all four, an erythematous, papular rash in two, and dry skin in one). Two patients had thyroid cancer (undifferentiated thyroid carcinoma in one and papillary carcinoma of a thyroglossal cyst in the other, 12 and 14 years after sulphur mustard exposure, respectively). One patient had nasopharyngeal carcinoma, 12 years after sulphur mustard exposure.Conclusion:Carcinomas of the thyroid and nasopharynx in three patients with sulphur mustard exposure are reported for the first time. Journal of Laryngology and Otology via PubMed

PTSD Not a Monolithic Disorder

The longitudinal course of posttraumatic stress disorder symptom clusters among war veterans. 07/05/09. The findings of this study suggest that PTSD is not a monolithic disorder, as symptom clusters differ in several important aspects. Also, the course and severity of symptoms differ between clinical and nonclinical groups. Finally, practitioners are encouraged to focus on the identification and treatment of early hyperarousal due to its prominent role in the development of other PTSD symptoms. Journal of Clinical Psychiatry via PubMed