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Veterans
Kinds of Veterans Terms modified by Veterans Selected AbstractsINCIDENCE 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] Skin Cancer in an Atomic Veteran: Cause or Coincidence?DERMATOLOGIC SURGERY, Issue 11 2003Kevin L. Nelson PhD Background. Some military personnel who were exposed to ionizing radiation during atomic weapons tests subsequently developed skin cancer, but the cause,effect relationship is unclear. Objective. To explore the possible relationship between exposure to atomic tests and the development of skin cancer. Methods. We reviewed available literature regarding the effects of radiation on the skin and the case history of a patient in whom more than 300 basal cell carcinomas developed over a 30-year period after exposure to radiation during atomic testing. Results and Conclusions. Ionizing radiation can cause skin cancer, usually basal cell carcinoma. In some veterans of atomic testing, skin cancer may have been initiated by ionizing radiation and promoted by ultraviolet radiation. We conclude that exposure to ionizing radiation during atomic weapons testing contributed to the excessive number and location of basal cell carcinomas in our patient. [source] Co-morbidity and the utilization of health care for Australian veterans with diabetesDIABETIC MEDICINE, Issue 1 2010Y. Zhang Diabet. Med. 27, 65,71 (2010) Abstract Objective, To examine the impact of co-morbidity on health service utilization by Australian veterans with diabetes. Methods, A retrospective cohort study was undertaken including veterans aged , 65 years dispensed medicines for diabetes in 2006. Data were sourced from the Australian Department of Veterans' Affairs health claims database. Utilization of preventive health services for diabetes was assessed, including claims for glycated haemoglobin (HbA1c) test, microabuminuria, podiatry services, diabetes care plans, medication reviews, case conferences, general practitioner (GP) management plans and ophthalmology/optometry services. Results, Among the 17 095 veterans dispensed medicines for diabetes, more than 80% had four or more co-morbid conditions. Those with a higher number of co-morbidities were more likely to have had claims for optometry/ophthalmology services and podiatry services, but not for other services. Veterans with at least one diabetes-related hospital admission had no more claims for diabetes health services than those who had no diabetics-related hospital admission, except for endocrinology services (relative risk = 1.26, 95% confidence intervals 1.15,1.37). Veterans with dementia were less likely to have had claims for diabetes health services while patients with renal failure were more likely to have had claims for the services. Conclusions, Low utilization of preventive diabetes care services is apparent in all co-morbidity groups. Patients with renal failure or dementia used more and less health services resources, respectively. Given the high mean age of this population, there may be valid reasons for the low use, such as competing health demands and patients' preferences. [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] Measurement in Veterans Affairs Health Services Research: Veterans as a Special PopulationHEALTH SERVICES RESEARCH, Issue 5p2 2005Robert O. Morgan Objective. To introduce this supplemental issue on measurement within health services research by using the population of U.S. veterans as an illustrative example of population and system influences on measurement quality. Principal Findings. Measurement quality may be affected by differences in demographic characteristics, illness burden, psychological health, cultural identity, or health care setting. The U.S. veteran population and the VA health system represent a microcosm in which a broad range of measurement issues can be assessed. Conclusions. Measurement is the foundation on which health decisions are made. Poor measurement quality can affect both the quality of health care decisions and decisions about health care policy. The accompanying articles in this issue highlight a subset of measurement issues that have applicability to the broad community of health services research. It is our hope that they stimulate a broad discussion of the measurement challenges posed by conducting "state-of-the-art" health services research. [source] Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress DisorderJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2010[See editorial comments by Dr. Soo Borson, pp 1797-1798] OBJECTIVES: To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. SETTING: Veterans Integrated Service Network 16. PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH,, n=3,660), those with PH and no PTSD (PTSD,/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD,/PH,, n=5,165). MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. RESULTS: The PTSD+/PH, group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH, group as in the PTSD,/PH+ or PTSD,/PH, group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care. [source] Are 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] 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] Do Palliative Consultations Improve Patient Outcomes?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008David Casarett MD OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care. DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics. PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey. MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items). RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62,66) versus 54 (95% CI=51,56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (,=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support. CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit. [source] Potentially Inappropriate Prescribing in Elderly Veterans: Are We Using the Wrong Drug, Wrong Dose, or Wrong Duration?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2005Mary Jo V. Pugh PhD Objectives: To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose-limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people. Design: Retrospective national Veterans Health Administration (VA) administrative database analysis. Setting: VA outpatient facilities during fiscal year 2000 (FY00). Participants: Veterans aged 65 and older having at least one VA outpatient visit in FY00 (N=1,265,434). Measurements: Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inappropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose-limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described. Results: After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose-limited drugs Conclusion: For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes. [source] Integrative outpatient treatment for returning service membersJOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2008Sonja V. Batten Abstract Veterans returning from Operations Enduring and Iraqi Freedom (OEF/OIF) frequently present with multiple psychological and physical symptoms. The authors propose an innovative approach in which primary care providers, polytrauma specialists, vocational rehabilitation specialists, and mental health clinicians work together to provide care that is not simply concurrent, but truly integrated. All members of this interdisciplinary team must provide a consistent message that supports treatment engagement and progress. The authors illustrate this approach with a case report of a soldier deployed to both OEF and OIF, requiring subsequent treatment for joint pain, headaches, mild traumatic brain injury, posttraumatic stress disorder, depression, and substance abuse. Despite the emphasis on early intervention, treatment engagement and retention remain challenges in this population. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64:1,12;, 2008. [source] Overall self-rated health: a new quality indicator for primary careJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007James E. Rohrer PhD Abstract Rationale, aims and objectives, Patient ,empowerment' gives patients choices about their own care and about the outcomes they would most prefer. Many patients can be presumed to regard overall self-rated health as an important outcome. Therefore, overall self-rated health can be considered a relevant and important outcome measure for a patient-centred medical clinic. The purpose of this study was to use this new outcome measure as a dependent variable and to test the hypothesis that patients who are confident about their ability to manage their health will have better health, in comparison to more dependent patients. Methods, We conducted a randomized cross-sectional postal survey of 500 veteran patients from the Panhandle of Texas and the surrounding areas; and 302 participated in the study. Multiple logistic regression analysis was used to test the hypothesis that health confidence is positively related to self-rated health, controlling for obesity, cigarette smoking and participation in recreational activities. Results, Veterans who strongly disagreed with the statement that they usually could overcome illnesses on their own were less likely to report good, very good or excellent self-rated health (adjusted odds ratio = 0.25). Conclusions, Overall self-rated health as measured by a single question proved to be significantly related to behavioural risk factors in this sample of primary care patients, attesting to its validity as an outcome indicator. Furthermore, health confidence was associated with better health. Most primary providers believe that they can, through good communication and providing self-care tools, increase healthy behaviours in their patients. If we are indeed able to increase health confidence in our patients, this study would suggest that self-rated health would improve. [source] Attaining organizational commitment across different generations of nursesJOURNAL OF NURSING MANAGEMENT, Issue 8 2008LARA CARVER PhD Aim, To inform nurse managers about the generational differences that exist among nurses, how it affects the work environment and how this information can be used to encourage organizational commitment. Background, Every person is born into a generational cohort of peers who experience similar life experiences that go on to shape distinct generational characteristics. Thanks to delayed retirements, mid-life career changes, job re-entry and a small but significant group of younger graduates, the nursing profession is now experiencing four generations in the workforce: Veterans, Baby Boomers, Generation X and the Millennial Generation. At the same time, the literature on organizational commitment is expanding and can provide a compelling context through which to view generational differences among nurses. Implications for nursing management, As part of an overall strategy to increase organizational commitment, consideration of generational differences in nurses can be helpful in leading to increased job satisfaction, increased productivity and decreased turnover among staff. In the face of the global nursing shortage, managers should increase their knowledge of generational diversity just as they have with ethnic and cultural diversity in the past. Understanding how to relate to the different generations and tap into their individual strengths can lead to improved nursing work environments. [source] Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSDJOURNAL OF TRAUMATIC STRESS, Issue 6 2007Matthew Jakupcak Iraq and Afghanistan War veterans were grouped by level of posttraumatic stress disorder (PTSD) symptomatology and compared on self-report measures of trait anger, hostility, and aggression. Veterans who screened positive for PTSD reported significantly greater anger and hostility than those in the subthreshold-PTSD and non-PTSD groups. Veterans in the subthreshold-PTSD group reported significantly greater anger and hostility than those in the non-PTSD group. The PTSD and subthreshold-PTSD groups did not differ with respect to aggression, though both groups were significantly more likely to have endorsed aggression than the non-PTSD group. These findings suggest that providers should screen for anger and aggression among Iraq and Afghanistan War veterans who exhibit symptoms of PTSD and incorporate relevant anger treatments into early intervention strategies. [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] Anger and combat-related posttraumatic stress disorderJOURNAL OF TRAUMATIC STRESS, Issue 2 2002Raymond W. Novaco Abstract We examined whether combat-related PTSD was differentially associated with particular dimensions of anger on two multi-index, psychometric instruments and whether the proportion of variation in PTSD scores explained by anger was significantly greater than that by demographic and exposure variables. We also examined the reliability and validity of a subset of Mississippi Scale items as an anger measure. Participants were 143 Vietnam combat veterans. Anger accounted for over 40% of the variance in Mississippi PTSD scores (minus the anger items) above that associated with age, education, and combat exposure. Veterans with structured-interview,diagnosed PTSD were significantly differentiated from those without PTSD on all anger indices. The results point to anger treatment as a high priority for combat-related PTSD. [source] Urinary incontinence among institutionalized oldest old Chinese men in Taiwan,NEUROUROLOGY AND URODYNAMICS, Issue 4 2009Yi-Ming Chen Abstract Aims To explore prevalence and related factors for urinary incontinence (UI) among the oldest old institutionalized Chinese men in Taiwan. Methods All residents living in Banciao Veterans Care Home were invited for study. UI was defined as urinary leakage at least once weekly. Additional data items from the Minimum Data Set (MDS Nursing Home Chinese Version 2.1) were used to explore impact associated with physical function, cognitive status and quality of life (social engagement, SocE). Depressive symptoms were screened by the Short Form Geriatric Depression Scale. Results Data from 594 male residents (mean age: 80.9,±,5.3 years) were analyzed. Among all study subjects, 92.8% were functionally independent, 20.4% had certain cognitive impairment and 8.2% had depressive symptoms. The prevalence of UI in the Banciao Veterans Care Home was 10.1%. Compared with residents without UI, subjects with UI had poorer physical function, cognitive status, and more depressive symptoms. The mean SocE score was 1.5,±,1.3, and was similar between UI (+) and UI (,) subjects (1.4,±,1.2 vs. 1.6,±,1.3, P,=,0.411). By multivariate logistic regression, poorer physical functional status, cognitive impairment and depressive symptoms were independent risk factors for UI (P,<,0.05). Conclusions Poorer physical function, poorer cognitive status and depressive symptoms were all statistically significant independent risk factors for UI. However, SocE score (proxy indicator of quality of life) did not differ between subjects with and without UI. Further investigations are needed to evaluate the impact of UI on quality of life among oldest old institutionalized Chinese men in Taiwan. Neurourol. Urodynam. 28:335,338, 2009. © 2008 Wiley-Liss, Inc. [source] Use of Nutritional Scores to Predict Clinical Outcomes in Chronic DiseasesNUTRITION REVIEWS, Issue 2 2000Stephane M. Schneider M.D. Many hospitalized patients are malnourished, and the relationship between malnutrition and patient outcome is well established. To determine which patients are at nutritional risks, clinical scores are probably more accurate than using a single nutritional parameter. Among the numerous scores published, both the Prognostic Nutritional Index and the Subjective Global Assessment were prospectively validated. One is based on objective measurements, whereas the second is based on medical history and physical examination. The Nutritional Risk lndex has been used in many studies including the "Veterans Study'. The Mini Nutritional Assessment is a promising score for evaluating malnutrition in the elderly. The development of nutritional scores for use by nurses may facilitate screening of a large number of hospitalized patients. [source] Risk Exposure in Early Life and Mortality at Older Ages: Evidence from Union Army VeteransPOPULATION AND DEVELOPMENT REVIEW, Issue 2 2009Dejun Su This study examines the relation between risk exposures in early life and hazard of mortality among 11,978 Union Army veterans aged 50 and over in 1900. Veterans' risk exposures prior to enlistment,as approximated by birth season, country of birth, residential region, city size, and height at enlistment,significantly influenced their chance of survival after 1900. These effects are robust irrespective of whether socioeconomic well-being in 1900 has been taken into account; however, they are sensitive to the particular age periods selected for survival analysis. Whereas some of the effects such as being born in Ireland and coming from large cities became apparent in the first decade after 1900 and then dissipated over time, the effects of birth season, being born in Germany, residential region in the United States, and height at enlistment were more salient in the post-1910 periods. Height at enlistment shows a positive association with risk of mortality in the post-1910 periods. Compared to corresponding findings from more recent cohorts, the exceptional robustness of the effects of risk exposures prior to enlistment on old-age mortality among the veterans highlights the harshness of living conditions early in their lives. [source] Vietnam Veterans Three Years after Vietnam: How Our Study Changed Our View of HeroinTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2010Lee N. Robins PhD First page of article [source] Integrating Tobacco Cessation Treatment into Mental Health Care for Patients with Posttraumatic Stress DisorderTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 5 2006Miles McFall PhD The integration of tobacco cessation treatment into mental health care for posttraumatic stress disorder (PTSD), known as Integrated Care (IC), was evaluated in an uncontrolled feasibility and effectiveness study. Veterans (N = 107) in PTSD treatment at two outpatient clinics received IC delivered by mental health practitioners. Outcomes were seven-day point prevalence abstinence measured at two, four, six, and nine months post-enrollment and repeated seven-day point prevalence abstinence (RPPA) obtained across three consecutive assessment intervals (four, six, and nine months). Abstinence rates at the four assessment intervals were 28%, 23%, 25%, and 18%, respectively, and RPPA was 15%. The number of IC sessions and a previous quit history greater than six months predicted RPPA. Stopping smoking was not associated with worsening PTSD or depression. [source] "Enabled Courage": Race, Disability, and Black World War II Veterans in Postwar AmericaTHE HISTORIAN, Issue 5 2003Robert F. Jefferson First page of article [source] Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural VeteransTHE JOURNAL OF RURAL HEALTH, Issue 4 2010Thad E. Abrams MD Abstract Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified by either Rural-Urban Commuting Area (RUCA) codes or the VA Urban/Rural/Highly Rural (URH) system. Endpoints of mortality and coronary revascularization were adjusted using administrative laboratory and clinical variables. Results: URH codes identified 184 (1%) veterans as highly rural, 6,046 (39%) as rural, and 9,378 (60%) as urban; RUCA codes identified 1,350 (9%) veterans from an isolated town, 3,505 (22%) from a small or large town, and 10,345 (65%) from urban areas. Adjusted mortality analyses demonstrated similar risk of mortality for rural veterans using either URH or RUCA systems. Hazards of revascularization using the URH classification demonstrated no difference for rural (HR, 0.96; 95% CI, 0.94-1.00) and highly rural veterans (HR, 1.13; 0.96-1.31) relative to urban veterans. In contrast, rural (relative to urban) veterans designated by the RUCA system had lower rates of revascularization; this was true for veterans from small or large towns (HR, 0.89; 0.83-0.95) as well as veterans from isolated towns (HR, 0.86; 0.78-0.93). Conclusion: Rural veterans admitted for AMI care have a similar risk of 30-day mortality but the adjusted hazard for receipt of revascularization for rural veterans was dependent upon the rural classification system utilized. These findings suggest potentially lower rates of revascularization for rural veterans. [source] Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?THE JOURNAL OF RURAL HEALTH, Issue 1 2009William B. Weeks MD ABSTRACT:,Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004. We calculated 30-day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30-day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity. Findings: Overall, rural veterans had slightly higher 30-day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural- and urban-dwelling veterans, readmission after using a VA hospital was more common than after using a non-VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital. Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non-VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non-VA hospitals. [source] Research on Rural Veterans: An Analysis of the LiteratureTHE JOURNAL OF RURAL HEALTH, Issue 4 2008William B. Weeks MD ABSTRACT:,Context: The Veterans Health Administration (VA) provides comprehensive health care services to veterans across the United States. Recently, the VA established an Office of Rural Health to address the health care needs of rural veterans. Purpose: To review the literature on rural veterans' health care needs in order to identify areas for future research. Methods: We conducted a literature review of articles listed in the Medline, CINAHL, and BIOSIS datasets since 1950. We reviewed and summarized the findings of 50 articles that specifically examined rural veterans. Findings: The literature on rural veterans included 4 articles examining access to care, 7 evaluating distance technology, 4 examining new models of care delivery, 11 studying rural veterans' patient characteristics, 10 evaluating programs provided in a rural setting, 6 examining rural health care settings, and 8 exploring rural veterans' health services utilization patterns. Most studies were small, based on data obtained before 2000, and consisted of uncontrolled, retrospective, descriptive studies of health care provided in rural VA settings. Definitions of rural were inconsistent, and in 20% of the articles examined the rural aspect of the setting was incidental to the study. Conclusions: The literature on rural veterans' health care needs warrants expansion and investment so that policy makers can make informed decisions in an environment of limited resources and competing interests. [source] Hearing Loss in Union Army Veterans from 1862 to 1920,THE LARYNGOSCOPE, Issue 12 2004Ryan K. Sewell MD Abstract Objectives: To examine the prevalence of hearing loss (HL) in Union Army (UA) veterans by year, birth cohort, and occupation, and to compare Civil War pension and contemporary disability programs by examining monthly dollar awards. Study Design: A retrospective review of medical records for 17,722 UA veteran pension applicants, a subset of some 35,000 soldiers retrieved randomly from the Military Archives. Methods: The diagnosis of HL was based on review of medical records, which used gross measurements because of the unavailability of audiometric testing. Results: One third (5,891 or 33%) of pensioners sampled received compensation for HL. The veterans with HL suffered predominantly from left-sided HL (4,091 or 70%), which is consistent with noise-induced HL in a right-handed individual firing a rifle. Comparison of civilian occupations reveals minimal variation in prevalence of HL. Civil War pensions for unilateral HL averaged $134.04 per year, representing nearly one third of the average annual income in 1890. Bilateral HL received nearly twice that amount. Today, military veterans receive $1,248 annually for unilateral loss and $27,288 annually for bilateral loss. Social Security disability benefits are granted only for bilateral HL, with an average 60-year-old individual receiving $11,400 per year. Conclusion: HL was a common disability among UA Civil War veterans, with noise exposure a likely etiology for the HL. The differing levels of compensation for HL may reflect differing perceptions on the incapacitating effects of HL. [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] Longitudinal study of the Home Falls and Accidents Screening Tool in identifying older people at increased risk of fallsAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2009Lynette Mackenzie Aim:, To evaluate the predictive validity and responsiveness of the Home Falls and Accidents Screening Tool (HOME FAST). Methods:, A prospective study of 727 community dwelling Veterans and war widows aged 70 years and over. The outcome was 6-month recall of any fall at 3-year follow-up. Baseline measurements were taken of common falls risk factors, and home hazards (using the HOME FAST). Changes in the prevalence of HOME FAST items were calculated and a logistic regression model was computed to determine predictors of falls at follow-up. Results:, Prevalence of 14 HOME FAST items was significantly reduced from baseline to follow-up (P , 0.05). Falls were significantly related to the baseline HOME FAST score (odds ratio (OR) 1.016, 95% confidence interval (CI) 1.004,1.098, P = 0.006), and a reduction in home hazards at follow-up (OR 0.984, 95% CI 0.973,0.996, P = 0.02). Conclusion:, The HOME FAST can predict falls in older people and is responsive to change. [source] Treatment choices in life threatening illness: Attitudes and preferences of elderly Australian Veterans and War WidowsAUSTRALASIAN JOURNAL ON AGEING, Issue 4 2002Felicity Barr Objectives: The study investigated whether older Australians would choose invasive or active treatment or palliative treatment were they to have a life threatening illness. Reasons for choice of treatment were also investigated. Methods: 109 older veterans and war widows were offered four case studies of patients with a life threatening illness. For each patient there were four treatment options with likely outcomes described. Participants were asked to put themselves in the position of the patient and to select one or more treatment option and to give reasons for their choice. Results: There was considerable diversity in choice of treatment and reasons for choice. Overall, participants were more likely to choose palliative than invasive treatments. Men, especially older men, were more likely than women to choose invasive treatments. Discussion: The study indicated that participants want to exercise choice in their treatment but that they want this to be an informed choice. [source] Immunisation Rates in Older Veterans and War WidowsAUSTRALASIAN JOURNAL ON AGEING, Issue 3 2000Balakrishnan Nair Aim: To study the immunisation rates of veterans and war widows aged 70 years and above in New South Wales and Queensland, as part of the Preventive Care Trial. Method: A trained health care worker assessed subjects at home regarding health, illness and immunisation status. Results: Suboptimal immunisation rate for influenza (72%) and poor rates for pneumococcus (14%) and tetanus (43%) were detected. Conclusion: Subjects in this study were not immunised according to recommended guidelines. Further education campaigns are warranted to improve immunisation rates in older people. [source] | |||||||||||||||||||||||||||||||||||||||||||