CABG Procedure Death Rates Lower at VA Hospitals Than Non-VA Hospitals

Outcomes of coronary surgery at a Veterans Affairs hospital versus other hospitals. 09/12/09. 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

Trauma History and Combat Exposure Vary by Branch of Service

Trauma exposure, branch of service, and physical injury in relation to mental health among U.S. veterans returning from Iraq and Afghanistan. 09/12/09. Significant mental health symptoms are reported in troops deployed to Iraq and Afghanistan (OEF/OIF). Symptomatic troops are more likely to be discharged and become eligible for Department of Veterans Affairs (DVA) care. Prevalence and predictors of mental health symptoms were assessed in 339 OEF/OIF veterans and reservists registering at the San Diego DVA. Participants completed self-report questionnaires assessing combat exposure, posttraumatic stress disorder (PTSD) symptom frequency and severity, depression, and substance and alcohol abuse. A minority of participants (36%) did not screen positive for mental health symptoms; the remainder met threshold for caseness of PTSD, depression, or substance and alcohol abuse. Using a hierarchical logistic regression model, gender, age, race, and rank were not significantly related to PTSD caseness, whereas most recent branch of service and report of injury during combat were. Follow-up analyses revealed that trauma history and combat exposure varied by branch of service. Knowledge of base rates and vulnerability factors can aid in rapid detection of "at risk" individuals. Military Medicine via PubMed

Mental Health and Functional Impairment in Kosovo Peacekeepers

PTSD subclusters and functional impairment in Kosovo peacekeepers. 09/12/09. Peacekeepers deployed to Kosovo (N = 203) were evaluated prospectively, before the mission (August 2000) and at postdeployment, on a number of mental health and functional impairment variables. We examined the association between PTSD symptom subclusters and three indicators of functional impairment using hierarchical regression analyses, controlling for PTSD symptoms before the mission, and history of prior trauma. In the first model, avoidance and hyperarousal symptoms uniquely predicted a conglomerate of functional impact outcomes (e.g., employment, family relationships, social functioning). In the second model, emotional numbing was the only significant predictor of violent behaviors. In the third model, re-experiencing symptoms were the only significant predictor of alcohol abuse problems. Overall, the four PTSD subclusters are differentially associated with varying functional impairment outcomes, which is important to note for evaluation and treatment purposes for veterans returning from overseas deployments. Military Medicine via PubMed

Applying the Chronic Care Model (CCM) to Improve Inpatient Smoking Cessation

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans. 09/12/09. Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. (Free full text) Implementation Science via PubMed

PTSD and Life Quality in Veterans Returning From Operation Enduring Freedom and Operation Iraqi Freedom

Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan. 09/12/09. The wars in Iraq and Afghanistan-Operation Iraqi Freedom and Operation Enduring Freedom, or OEF/OIF-have created unique conditions for promoting the development of psychological difficulties such as posttraumatic stress disorder (PTSD). PTSD is an important outcome because it can affect quality of life, impairing psychosocial and occupational functioning and overall well-being. The literature on PTSD and quality of life in OEF/OIF Veterans is at an early stage, but the consistency of the evidence is striking. Our review indicates that the findings on PTSD and quality of life in OEF/OIF veterans are comparable to findings obtained from other war cohorts and from nonveterans as well. Even though the duration of PTSD in OEF/OIF Veterans is much shorter than in Vietnam Veterans, for example, those with PTSD in both cohorts are likely to experience poorer functioning and lower objective living conditions and satisfaction. The review ends with discussion of the implications of the evidence for research and clinical practice.  Clinical Psychology Review via PubMed

Mild TBI and PTSD in Veterans Returning From Operation Enduring Freedom and Operation Iraqi Freedom

Mild traumatic brain injury and posttraumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience. 09/12/09. A significant proportion of military personnel deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has been exposed to war-zone events potentially associated with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). There has been significant controversy regarding healthcare policy for those service members and military veterans who returned from OEF/OIF deployments with both mild TBI and PTSD. There is currently little empirical evidence available to address these controversies. This review uses a cognitive neuroscience framework to address the potential impact of mild TBI on the development, course, and clinical management of PTSD. The field would benefit from research efforts that take into consideration the potential differential impact of mild TBI with versus without persistent cognitive deficits, longitudinal work examining the trajectory of PTSD symptoms when index trauma events involve TBI, randomized clinical trials designed to examine the impact of mild TBI on response to existing PTSD treatment interventions, and development and examination of potential treatment augmentation strategies. Clinical Psychology Review via PubMed

Hyperbaric Oxygen Therapy for Tinnitus

Tinnitus, a military epidemic: is hyperbaric oxygen therapy the answer? 09/12/09. Tinnitus is the phantom perception of sound in the absence of overt acoustic stimulation. Its impact on the military population is alarming. Annually, tinnitus is the most prevalent disability among new cases added to the Veterans Affairs numbers. Also, it is currently the most common disability from the War on Terror. Conventional medical treatments for tinnitus are well documented, but prove to be unsatisfying. Hyperbaric oxygen (HBO2) therapy may improve tinnitus, but the significance of the level of improvement is not clear. There is a case for large randomized trials of high methodological rigor in order to define the true extent of the benefit with the administration of HBO2 therapy for tinnitus. Journal of Special Operations Medicine via PubMed

Aluminum Hydroxide Adjuvant Possible Culprit in Gulf War Syndrome

Aluminum hydroxide injections lead to motor deficits and motor neuron degeneration. 09/12/09. Gulf War Syndrome is a multi-system disorder afflicting many veterans of Western armies in the 1990-1991 Gulf War. A number of those afflicted may show neurological deficits including various cognitive dysfunctions and motor neuron disease, the latter expression virtually indistinguishable from classical amyotrophic lateral sclerosis (ALS) except for the age of onset. This ALS "cluster" represents the second such ALS cluster described in the literature to date. Possible causes of GWS include several of the adjuvants in the anthrax vaccine and others. The most likely culprit appears to be aluminum hydroxide. Journal of Inorganic Biochemistry via PubMed

Injury to Caregiver May Result in Nursing Home Placement of Post-stroke Veteran

The prevalence of injury for stroke caregivers and associated risk factors. 09/12/09. Conclusion: This suggests that injury on the part of the family caregiver may lead to the veteran's placement in a skilled nursing facility and lead to increased costs for the Department of Veteran's Affairs. Topics in Stroke Rehabilitation via PubMed

Neuropsychological Assessment of Gulf War Veterans

Neuropsychologic assessment of a population-based sample of Gulf War veterans. 09/12/09. 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. Cognitive and Behavioral Neurology via PubMed

Firearm Suicide Rates in the Veteran and NonVeteran Populations

Firearm suicide among veterans in the general population: findings from the national violent death reporting system. 09/12/09. Although violent death and the use of firearms are generally associated with men, the results reported here suggest that firearms among female veterans deserve particular attention among health professionals within and outside the veterans affairs system. In addition, the focus should not be exclusively on the Operation Enduring Freedom/Operation Iraqi Freedom military cohort but also on men and women who served in earlier combat theaters, including the Gulf war, Vietnam Era, Korean Conflict, and World War II. Journal of Trauma via PubMed

Acute Renal Failure in U.S. Veterans

Outcomes following diagnosis of acute renal failure in U.S. veterans: focus on acute tubular necrosis. 09/12/09. When patients develop acute kidney injury, a small fraction of them will develop end-stage renal disease later. The severity of renal impairment in the remaining patients is uncertain because studies have not carefully examined renal function over time or the precise timing of entry into a late stage of chronic kidney disease. To determine these factors, we used a United States Department of Veterans Affairs database to ascertain long-term renal function in 113,272 patients. Kidney International via PubMed

New Brain Injury Therapy?

Brain Injury Therapy 09/12/09. The Department of Defense has estimated the number of Operation Enduring Freedom/Operation Iraqi Freedom veterans with combat-related traumatic brain injury (TBI) could reach 360,000. While more than $1 billion has been committed to fund academic research, almost eight years after the start of the war on terrorism, neither the Department of Veterans Affairs nor the Department of Defense has discovered, much less fielded, a treatment regimen or protocol that provides timely, assured relief for the disabling effects of this "signature injury."

The good news is that some members of Congress, particularly Reps. Walter B. Jones, North Carolina Republican; Pete Sessions, Texas Republican; and Chet Edwards, Texas Democrat, have found and are championing a treatment that works: hyperbaric oxygen therapy (HBOT 1.5) as pioneered by Dr. Paul G. Harch, a clinician and faculty member at the Louisiana State University School of Medicine in New Orleans. Sgt. Shaft via Military.com

Smoking Session Program for Veterans With PTSD

Public health clinical demonstration project for smoking cessation in veterans with posttraumatic stress disorder. 09/10/09. Veterans with posttraumatic stress disorder are at high risk for smoking and experience difficulty with smoking cessation. We designed this clinical demonstration project to provide a low-cost, feasibly implemented smoking cessation intervention that would maximize the number of smokers who accessed the intervention. Addictive Behaviors via PubMed

Cumulative Lead Exposure Contributes to Higher Death Rates

A Prospective Study of Bone Lead Concentration and Death From All Causes, Cardiovascular Diseases, and Cancer in the Department of Veterans Affairs Normative Aging Study. 09/10/09. We found bone lead to be associated with all-cause and cardiovascular mortality in an environmentally exposed population with low blood lead levels. This study suggests that cumulative lead exposure from prior decades of high environmental exposures continues to significantly affect risk of death despite recent declines in environmental lead exposure. Circulation via PubMed

Long-term PTSD Symptoms May Result in Attention Difficulties

Study sheds light on post-combat mental problems 09/10/09. Symptoms of posttraumatic stress disorder (PTSD) are typical after deployment to a war zone, and may even represent a healthy reaction to stress, but can lead to problems with mental functioning if they persist, new research in Iraq vets suggests. Past research has demonstrated that people exposed to life-threatening situations will show changes in their nervous and hormonal systems, Dr. Jennifer J. Vasterling of the VA Boston Healthcare System and her colleagues note, but it's not clear how long such symptoms last after exposure ends, and if they do last, what the consequences might be. Reuters

Extreme Traumatic Experiences May Result in Greater Personal Strength

Ground Zero-scale trauma can prompt psychological growth, says UB researcher. 09/10/09. People who live through an extreme traumatic experience such as the 9/11 terrorist attacks or an airplane crash often have the capacity to bounce back or even grow to a higher level of functioning and personal strength, according to a University at Buffalo researcher and expert in the effects of horrifying trauma. University at Buffalo via Eurekalert!

Intense Wheelchair Propulsion May Increase Risk of Carpal Tunnel Syndrome

Ultrasonographic median nerve changes after a wheelchair sporting event. 09/09/09. OBJECTIVES: To investigate the acute median nerve response to intense wheelchair propulsion by using ultrasonography and to examine the relationship between carpal tunnel syndrome (CTS) signs and symptoms and the acute median nerve response.  CONCLUSIONS: Manual wheelchair propulsion induces acute changes in median nerve characteristics that can be visualized by using ultrasound. Studying the acute median nerve response may be useful for optimizing various interventions, such as wheelchair set up or propulsion training, to decrease both acute and chronic median nerve damage and the likelihood of developing CTS. Archives of Physical Medicine & Rehabilitation via PubMed

Blood Changes 20 Years After Sulfur Mustard Exposure

Serum levels of GM-CSF 20 years after sulfur mustard exposure: Sardasht-Iran Cohort Study. 09/08/09. Sulfur Mustard (SM) is highly toxic for various organs. The eyes, skin, respiratory tract, as well hematopoietic and immune systems are the main organs affected by SM. Granulocyte-macrophage colony stimulating factor (GM-CSF) is a potent cytokine that plays an important role in the hematopoietic and immune system. The aim of this study was to determine the serum levels of GM-CSF and its relation to blood cell count and other inflammatory cytokines 20 years after SM exposure. The association of GM-CSF with the clinical severity of pulmonary, ophthalmic and dermatologic complications has also been studied. In this historical cohort study named as Sardasht-Iran Cohort Study (SICS), 369 SM exposed male participants and 125 unexposed volunteers were studied. International Immunopharmacology

Neuroevolutionary Time-depth Principle and PTSD

Posttraumatic stress disorder in war veterans: A discussion of the Neuroevolutionary Time-depth Principle. 09/08/09. Trauma is a universal phenomenon. Violence is a type of trauma and war is one of the ways in which violence is expressed. The "Neuroevolutionary Time-depth Principle" of innate fears, based on prevalence data, suggests that high rates of posttraumatic stress disorder (PTSD) after combat exposure can be due to the fact that this fear-stress response appeared as a reaction to inter-group male-to-male and intra-group killings after the rising of population densities in the Neolithic period. Journal of Affective Disorders

Canine Program for Disabled Vets

VA Canine Program on Track After Delays 09/08/09. Finally, about eight years after the program began, many hope it will start finding homes for the four-legged companions that can help disabled veterans be more independent, better deal with post traumatic stress syndrome and to just be a friend. The VA is now working on improving the program and in Washington, increasing funding for such programs is getting bipartisan support. Military.com