Study: Obese, Highly Fit Vets With Lowest Mortality Risk

Fitness and fatness as mortality predictors in healthy older men: the veterans exercise testing study. 05/29/09. In this cohort of elderly male veterans, we observed independent and joint inverse relations of BMI and CRF to mortality. This warrants further investigation of fitness, fatness, and mortality interactions in older persons. Free full text. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences via PubMed

Agent Orange & Aggressive Prostate Cancer

Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy. 05/29/09.Patients with AO exposure and treated with RP were more likely to be black, present with lower risk features, have an increased risk of biochemical progression, and shorter PSADT after recurrence. When stratified by race, the association between AO exposure and poor outcomes was present in both races. These findings suggest that among selected men who choose RP, AO exposure might be associated with more aggressive prostate cancer. BJU International via PubMed

VAOIG Audit of Consolidated Mail Outpatient Pharmacies

Audit of VA Consolidated Mail Outpatient Pharmacy Inventory Accountability 05/28/09. The Office of Inspector General conducted an audit to determine whether VA CMOPs effectively and efficiently accounted for non controlled pharmaceutical inventories and to determine whether the CMOPs managed and safeguarded non controlled pharmaceutical inventories at risk for diversion. The Charleston and Dallas CMOPs established physical security controls to prevent the unauthorized physical removal of pharmaceuticals from CMOPs. However, inventory management controls used to account for and prevent diversion of non controlled pharmaceuticals could be further improved. Specifically, the Charleston and Dallas CMOPs did not: (1) conduct physical counts of their entire wall to wall inventory, as required; (2) consistently estimated inventory quantities of open products during their annual wall to wall physical inventory; (3) effectively control and monitor adjustments made to their pharmaceutical inventory; (4) secure, track and monitor non controlled pharmaceuticals held for return credit, as required; (5) ensure segregation of critical system functions; (6) control and monitor the prime vendor’s (Econolink) system access. In addition, QMSI software, which controls the majority of the CMOPs production system, does not always adequately track the dispensing of pharmaceuticals. The Under Secretary for Health concurred with all six of our recommendations and has already implemented two of the six recommendations. The Under Secretary’s planned actions for the remaining four recommendations are acceptable. Finally, we consider all review issues to be resolved and will follow up on the implementation of planned improvement actions. VAOIG

General Anxiety Disorder, Major Depressive Episode & Mortality in Vietnam Veterans

Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study. 05/28/09. OBJECTIVE: To examine whether the 1-year prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and their comorbidity were associated with subsequent all-cause and cardiovascular disease (CVD) mortality during 15 years in Vietnam veterans. Psychosom Med. via PubMed

PTSD Affects Interoceptive Responses

Initial Evidence of a Failure to Activate Right Anterior Insula During Affective Set Shifting in Posttraumatic Stress Disorder 05/28/09. These findings may suggest that although individuals with PTSD are cognitively aware of the impending shift in interoceptive state, they fail to appropriately activate neural circuitry involved in modulating interoceptive responses. Psychosom Med. via PubMed

Personality Traits & Longevity: Vietnam Experience Study Cohort

Emotionally stable, intelligent men live longer: the Vietnam experience study cohort 05/28/09. The effects of high neuroticism, low cognitive ability, and their interaction predict mortality. Cognitive ability effects are mediated by health, income, and education. Psychosom Med. via PubMed

Combat Exposure & PTSD

PTSD prevalence, associated exposures, and functional health outcomes in a large, population-based military cohort. 05/27/09. Posttraumatic stress disorder (PTSD) results from experiencing or witnessing traumatic, life-threatening events including combat-related experiences. The purpose of this study was to investigate the prevalence of PTSD symptoms and diagnosis, self-reported exposures, and functional health in a large cross-section of the U.S. military. Public Health Rep.

Psychological Risks Associated With Combat Exposure

Combat Exposure Raises PTSD, Smoking, Alcohol Abuse Risks 05/27/09. The latest research results from a large randomized study on the long-term health effects of thousands of service members show that while deployers generally are very healthy, there are increased risks for smoking, heavy drinking, and PTSD symptoms among subgroups exposed to combat during deployment. Military Health System

Counseling Veteran Students Website

Web Site Helps College Counselors Aid Vets 05/27/09. The Department of Veterans Affairs has launched a new Web site to strengthen the connection between college and university mental health professionals and veterans of the Iraq and Afghanistan conflicts studying on their campuses. The Web site, http://www.mentalhealth.va.gov/College, features recommended training for college and university counselors, with online modules including “Operation SAVE” for suicide prevention, “PTSD 101” and “Helping Students Who Drink Too Much.” It also will feature a resource list that will be updated regularly. DefenseLink

Advanced Prostheitc Arm

VA Announces Study of Advanced Prosthetic Arm 05/27/09. The Department of Veterans Affairs has announced a three-year study of an advanced artificial arm that easily allows those with severe limb loss to pick up a key or hold a pencil. “This arm is a high-tech example of how VA researchers are continually modernizing the materials, design and clinical use of artificial limbs to meet veterans’ lifestyle and medical needs,” said Dr. Joel Kupersmith, VA’s physician and chief research and development officer. DefenseLink

$215 Million for Rural Veterans' Projects

Secretary Shinseki Announces $215 Million in Projects for Rural Veterans 05/23/09. The Department of Veterans Affairs (VA) has provided $215 million in competitive funding to improve services specifically designed for Veterans in rural and highly rural areas. VA

Two year VA Funding Possible

Two-year funding for VA appears likely 05/23/09. Momentum has gathered behind the idea of advanced appropriations for the Veterans Affairs Department to the point that a chief supporter of says he would be stunned if anything derails what has become the top priority for veterans groups.

The Senate Veterans’ Affairs Committee unanimously approved an advanced appropriations bill Thursday. Sen. Daniel Akaka, D-Hawaii, the committee chairman, said the proposal “has the potential to strengthen every aspect of VA’s national health care system.” Federal Times

Nicotine Dependence& Psychiatric Issues in Sample of American Indian Veterans

Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans. 05/23/09. American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. METHODS: This study analyzes the co-occurrence of current and lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a community sample of 480 American Indian male veterans. RESULTS: Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, affective and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% of the sample and significantly associated with current affective and gambling disorder. CONCLUSIONS: Substantial co-morbidity exists between nicotine dependence and other substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended. Drug and Alcohol Dependence via PubMed

PTSD in Substance Abusing Veterans

Posttraumatic stress disorder and other psychopathology in substance abusing patients. 05/23/09Studies demonstrating greater problem severity in substance abuse patients with posttraumatic stress disorder (PTSD) versus those without have rarely considered other co-occurring psychiatric disorders. This study of 466 male veterans recently admitted to outpatient substance abuse treatment attempts to identify problems associated with PTSD versus those associated with other nonsubstance use Axis I disorders. Problem severity, particularly psychiatric, was examined across four groups of patients with substance use disorders (SUDs). Those with: 1, SUDs only (SU-Only); 2, PTSD, but no other Axis I disorders (SU+PTSD); 3, PTSD and other Axis I disorders (SU+PTSD+Axis I); and 4, no PTSD, but other Axis I disorders (SU+other Axis I). Results suggested a hierarchy of psychiatric, and to a lesser extent, other life problem severities associated with these diagnostic groupings. The most severe group was SU+PTSD+Axis I, followed in decreasing severity by the SU+other Axis I, SU+PTSD, and SU-Only groups. Additional analyses comparing the SU+PTSD+Axis I patients with a subgroup of Axis I patients with more than one Axis I disorder (SU+multiple Axis I) revealed few group differences except for more lifetime suicide attempts and psychiatric hospitalizations in the SU+PTSD+Axis I group. The findings suggest that it is not PTSD per se, but the frequent co-occurrence of PTSD and other psychopathology that largely accounts for previously reported greater problem severity of SUD patients with PTSD. Drug and Alcohol Dependence via PubMed
.

PTSD Assessment via Videoconferencing Compared with Face to Face

Assessment of post-traumatic stress disorder in veterans by videoconferencing and by face-to-face methods. 05/23/09. We compared videoconferencing and face-to-face (FTF) assessments for veterans seeking a mental health evaluation for post-traumatic stress disorder (PTSD). The Clinician-Administered PTSD Scale (CAPS) interview was used in 20 male veterans. There were significant correlations (ranging from 0.74 to 0.92) between the CAPS administered FTF and by videoconferencing on all three subscales, as well as on the total severity score. The confidence intervals for the CAPS scores indicated statistical equivalence between administration FTF and by videoconferencing. The sensitivity of videoconferencing was 0.94 and the specificity was 0.33, compared with FTF assessment. The total and subscale scores suggested that there was a moderate working alliance with both methods. The patients indicated general satisfaction with the videoconferencing method. Most of them indicated that they would prefer to see a clinician FTF, but would utilize videoconferencing if there were distance barriers to services. Overall, the results of the present study support the use of videoconferencing in the assessment of PTSD. Journal of Telemedicine and Telecare via PubMed