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Male Veterans (male + veteran)
Selected AbstractsAre All Commonly Prescribed Antipsychotics Associated with Greater Mortality in Elderly Male Veterans with Dementia?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2010Rebecca C. Rossom MD OBJECTIVES: To estimate mortality risk associated with individual commonly prescribed antipsychotics. DESIGN: Five-year retrospective study. SETTING: Veterans national healthcare data. PARTICIPANTS: Predominantly male, aged 65 and older, with a diagnosis of dementia and no other indication for an antipsychotic. Subjects who received an antipsychotic were compared with randomly selected controls who did not. Exposed and control cohorts were matched according to their date of dementia diagnosis and time elapsed from diagnosis to the start of antipsychotic therapy. MEASUREMENTS: Mortality during incident antipsychotic use. RESULTS: Cohorts who were exposed to haloperidol (n=2,217), olanzapine (n=3,384), quetiapine (n=4,277), or risperidone (n=8,249) had more comorbidities than their control cohorts. During the first 30 days, there was a significant increase in mortality in subgroups prescribed a daily dose of haloperidol greater than 1 mg (hazard ratio (HR)=3.2, 95% confidence interval (CI)=2.2,4.5, P<.001), olanzapine greater than 2.5 mg (HR=1.5, 95% CI=1.1,2.0, P=.01), or risperidone greater than 1 mg (HR=1.6, 95% CI=1.1,2.2, P=.01) adjusted for demographic characteristics, comorbidities, and medication history using Cox regression analyses. Greater mortality was not seen when a daily dose of quetiapine greater than 50 mg (HR=1.2, 95% CI=0.7,1.8, P=.50) was prescribed, and there was no greater mortality associated with a dose less than 50 mg (HR=0.7, 95% CI=0.5,1.0, P=.03). No antipsychotic was associated with greater mortality after the first 30 days. CONCLUSION: Commonly prescribed doses of haloperidol, olanzapine, and risperidone, but not quetiapine, were associated with a short-term increase in mortality. Further investigations are warranted to identify patient characteristics and antipsychotic dosage regimens that are not associated with a greater risk of mortality in elderly patients with dementia. [source] The Relation Between Mitral Annular Calcification and Mortality in Patients Undergoing Diagnostic Coronary AngiographyECHOCARDIOGRAPHY, Issue 9 2006Howard J. Willens M.D. To determine whether the observed association between mitral annular calcification (MAC) and mortality is independent of the severity of coronary artery disease (CAD), we analyzed data from 134 male veterans (age 63 ± 10 years) followed for 5 years who had undergone diagnostic coronary angiography and transthoracic echocardiography within 6 months of each other. Echocardiograms were retrospectively reviewed for the presence of MAC. The relation of MAC to all-cause mortality was analyzed using logistic regression, and odds ratios (OR) were calculated. MAC was present in 49 (37%) subjects. Over the 5-year follow-up period, 38 (28%) patients expired. Five-year survival was 80% for subjects without MAC and 56% for subjects with MAC (P = 0.003). MAC (OR = 3.16, 95% confidence interval [CI]= 1.43,6.96, P = 0.003), ejection fraction (OR = 0.76, 95% CI = 0.59,0.97, P = 0.02), and left main CAD (OR = 2.70, 95% CI = 1.11,6.57, P = 0.02) were significantly associated with mortality in univariate analysis. After adjusting for left ventricular ejection fraction, number of obstructed coronary arteries and the presence of left main coronary artery stenosis, MAC significantly predicted death (OR = 2.48, 95% CI = 1.09,5.68, P = 0.03). Similarly, after adjusting for predictors of MAC, including ejection fraction, age, diabetes, peripheral vascular disease, and heart failure, MAC remained a significant predictor of death (OR = 2.38, 95% CI = 1.02,5.58, P = 0.04). MAC also predicted death independent of smoking status, hypertension, serum creatinine, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and C-reactive protein levels (OR = 3.98, 95% CI = 1.68,9.40, P = 0.001). MAC detected by two-dimensional echocardiography independently predicts mortality and may provide an easy-to-perform and inexpensive way to improve risk stratification. [source] Life Stories, War, and Veterans: On the Social Distribution of MemoriesETHOS, Issue 1 2004Edna Lomsky-Feder On the basis of examining life stories narrated by 63 Israeli male veterans of the 1973 Yom Kippur War, this article delves into the social construction of personal memory. Focusing on the remembering subject will allow us to study this process by highlighting the agent who creates his or her world, but at the same time it will disclose how society frames and channels the agent's choices. My contention is that personal memory (traumatic or normalizing, conforming or critical) is embedded within, designed by, and derives its meaning from, a memory field that offers different interpretations of war. Yet this memory field is not an open space, and the remembering subject is not free to choose any interpretation he wishes. Cultural criteria "distribute" accessibility to different collective memories according to social entitlement. These "distributive criteria" dictate who is entitled to remember and what is to be remembered, thereby controlling the extent of trauma and criticism of personal memory. [source] Use of Medicare and Department of Veterans Affairs Health Care by Veterans with Dementia: A Longitudinal AnalysisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Carolyn W. Zhu PhD The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA),only use, dual VA and Medicare use, and Medicare-only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998,2001) for 2,137 male veterans who, in 1997, used some VA services, had a formal diagnosis of Alzheimer's disease or vascular dementia in the VA, and were aged 65 and older. Generalized ordered logit models were used to estimate the effects of patient characteristics on use group over time. In 1998, 41.7% of the sample were VA-only users, 55.4% were dual users, and 2.9% were Medicare-only users. By 2001, 30.4% were VA-only users, 51.5% were dual users, and 18.1% were Medicare-only users. Multivariate results show that greater likelihood of Medicare use was associated with older age, being white, being married, having higher education, having private insurance or Medicaid, having low VA priority level, and living in a nursing home or dying during the year. Higher comorbidities were associated with greater likelihood of dual use as opposed to any single system use. Alternatively, number of functional limitations was associated with greater likelihood of Medicare-only use and less likelihood of VA-only use. These results imply that different aspects of veterans' needs have differential effects on where they seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure that patients receive high-quality care, especially patients with multiple comorbidities. [source] Domains of quality of life and symptoms in male veterans treated for posttraumatic stress disorder,JOURNAL OF TRAUMATIC STRESS, Issue 6 2007Carole A. Lunney This study examined the relationship between domains of quality of life and posttraumatic stress disorder (PTSD) symptoms in 319 male veterans in a randomized trial of group psychotherapy. Confirmatory factor analyses suggested a 4-factor model of quality of life (achievement, self-expression, relationships, and surroundings) fit better than a unidimensional model. Clinically meaningful symptom change was associated with greater change in all quality of life domains. At pretreatment, numbing symptoms uniquely predicted all quality of life domains. Change in avoidance and hyperarousal uniquely predicted change in achievement. Change in reexperiencing uniquely predicted change in self-expression. Change in numbing uniquely predicted change in relationships. Examining change in PTSD symptoms and quality of life domains may provide important information for treatment planning and evaluation. [source] Juvenile conduct disorder as a risk factor for trauma exposure and posttraumatic stress disorderJOURNAL OF TRAUMATIC STRESS, Issue 1 2005Karestan C. Koenen Juvenile conduct disorder (CD) is a well-documented risk factor for posttraumatic stress disorder (PTSD). This study examines the mechanisms underlying this relationship by using data from 3,315 twin pairs in the Vietnam Era Twin Registry. Results indicate the number of conduct disorder symptoms increased risk of trauma exposure and PTSD in a dose,response fashion. This increased risk was mediated in part by the positive association between CD and lifestyle factors and was not due to confounding by shared genetic or familial vulnerability. The findings suggest CD increases risk for trauma exposure and PTSD among male veterans through direct and indirect mechanisms. Veterans who have a history of CD are at high risk for trauma exposure and development of PTSD. [source] An investigation of the impact of posttraumatic stress disorder on physical healthJOURNAL OF TRAUMATIC STRESS, Issue 1 2000Amy W. Wagner Abstract In a large sample of Gulf War veterans (N = 2301) we examined the relations between PTSD symptoms assessed immediately upon returning from the Gulf War and self-reported health problems assessed 18,24 months later. PTSD symptomatology was predictive of self-reported health problems over time for both men and women veterans, even after the effects of combat exposure were removed from the analysis. Female veterans reported significantly more health problems than male veterans, however, there was no interactive effect of gender and PTSD on health problems. These findings provide further support for the theory that psychological response to stressors impacts health outcome. [source] Assaultive Behavior Intervention in the Veterans Administration: Psychodynamic Group Psychotherapy Compared to Cognitive Behavior TherapyPERSPECTIVES IN PSYCHIATRIC CARE, Issue 3 2002Marilyn L. Lanza DNSc PURPOSE. To compare the efficacy of a psychodynamic psychotherapy group (PPG) and a cognitive-behavior group (CBG) for male veterans with a history of assault. METHODS. Data collected included the Addiction Severity Index, the Overt Aggression Scale, and the State-Trait Anger Expression Inventory. Subjects (N = 27) were assigned randomly to a central group, PPG, or CBG. Analyses included an overall comparison of the groups as well as repeated-measures analyses and adjustments for covariates. FINDINGS. The PPG showed a trend toward improvement of overt aggression and significant improvement of trait aggression compared with CBG. There were no differences in state aggression or efforts to control aggression. CONCLUSIONS. Both the PPG and CBG are effective treatments for aggression. [source] Impact of Rural Residence on Survival of Male Veterans Affairs Patients After Age 65THE JOURNAL OF RURAL HEALTH, Issue 4 2010Todd A. MacKenzie PhD Abstract Objectives: More than 1 in 5 Veterans Affairs (VA) users lives in a rural setting. Rural veterans face different barriers to health care than their urban counterparts, but their risk of death relative to their urban counterparts is unknown. The objective of our study was to compare survival between rural and urban VA users. Methods: We linked the Large Health Survey of Veteran Enrollees conducted in 1999 to the Veterans Administration vital status registry. We used time-to-event regression models controlling for patient race, education, ZIP-code median income, and marital and smoking status. Findings: Of the 372,463 male veterans of age 65 or greater, 80,931 lived in rural settings. Age-adjusted mortality was 5.9% higher (95% CI, 4.5%-7.2%) in rural residents compared to urban residents. After adjusting for age, education, and ZIP-code median income, rural residents had 3.0% lower mortality (95% CI, 1.5%-4.4%). Compared to urban and suburban VA users, rural VA users' mortality at age 65 was 12% lower, but this advantage gradually diminished by age 75. Conclusion: Mortality after the age of 65 for male VA users is higher in rural dwellers than in urban dwellers. However, among veterans of the same socioeconomic characteristics, rural-dwelling veterans have up to 15% better mortality than urban-dwelling veterans until the age of 75. [source] INCIDENCE AND OUTCOMES OF KNEE AND HIP JOINT REPLACEMENT IN VETERANS AND CIVILIANSANZ JOURNAL OF SURGERY, Issue 5 2006Vanessa Wells Background: This article describes the incidence of total knee and hip replacement, and compares post-surgery health status outcomes in veterans and civilians. Methods: The numbers of male veterans and civilians who had a knee and/or a hip replacement in South Australia (1994,2002) were obtained. Standardized morbidity ratios, and odds ratios for age group by veteran/civilian interactions, were calculated. Presurgery and 1-year post-surgery Medical Outcomes Short Form (36) Health Survey, Knee Society and Harris hip scores were completed. Independent samples t -tests were used to compare presurgery scores. ancova models were used to determine any differences between veterans and civilians post-surgery. Results: For veterans, standardized morbidity ratios were 0.987 and 0.715 for knee and hip replacements, respectively (P < 0.0001). Veterans' odds ratios for knee and hip replacements were significantly lower in the 65- to 74-year age group (P < 0.001), similar in the 75- to 84-year and above 85-year age groups for hip replacement, but significantly higher in the above 85-year age group for knee replacement (P < 0.001). Presurgery, veterans reported significantly lower scores (P < 0.003) for knee function. After knee replacement, veterans reported significantly lower Medical Outcomes Short Form (36) Health Survey scores for bodily pain, physical functioning, role , physical, role , emotional, social functioning and physical component summary (P < 0.033). Significantly lower physical functioning, role , physical and physical component summary scores (P < 0.02) were reported by veterans post-surgery for hip replacement. Conclusion: Veterans are delaying joint replacement. Presurgical knee function is worse in veterans. Post-surgery, the veterans are worse off in a number of health status outcomes. [source] End-of-life care for older cancer patients in the Veterans Health Administration versus the private sector,,§¶CANCER, Issue 15 2010Nancy L. Keating MD Abstract BACKGROUND: Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under fee-for-service Medicare arrangements. METHODS: Using propensity score methods, we matched 2913 male veterans who were diagnosed with stage IV lung or colorectal cancer in 2001-2002 and died before 2006 with 2913 similar men enrolled in fee-for-service Medicare living in Surveillance, Epidemiology, and End Result (SEER) areas. We assessed chemotherapy within 14 days of death, intensive care unit (ICU) admissions within 30 days of death, and >1 emergency room visit within 30 days of death. RESULTS: Among matched cohorts, men treated in the VHA were less likely than men in the private sector to receive chemotherapy within 14 days of death (4.6% vs 7.5%, P < .001), be admitted to an ICU within 30 days of death (12.5% vs 19.7%, P < .001), or have >1 emergency room visit within 30 days of death (13.1 vs 14.7, P = .09). CONCLUSIONS: Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in fee-for-service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes. Cancer 2010. © 2010 American Cancer Society. [source] | ||||||||||