Associations of Accelerometer-Measured and Self-Reported Sedentary Time With Leukocyte Telomere Length in Older Women.

Few studies have assessed the association of sedentary time with leukocyte telomere length (LTL). In a cross-sectional study conducted in 2012-2013, we examined associations of accelerometer-measured and self-reported sedentary time with LTL in a sample of 1,481 older white and African-American women from the Women's Health Initiative and determined whether associations varied by level of moderate- to vigorous-intensity physical activity (MVPA). The association between sedentary time and LTL was evaluated using multiple linear regression models. Women were aged 79.2 (standard deviation, 6.7) years, on average. Self-reported sedentary time was not associated with LTL. In a model adjusting for demographic characteristics, lifestyle behaviors, and health-related factors, among women at or below the median level of accelerometer-measured MVPA, those in the highest quartile of accelerometer-measured sedentary time had significantly shorter LTL than those in the lowest quartile, with an average difference of 170 base pairs (95% confidence interval: 4, 340). Accelerometer-measured sedentary time was not associated with LTL in women above the median level of MVPA. Findings suggest that, on the basis of accelerometer measurements, higher sedentary time may be associated with shorter LTL among less physically active women.

Maternal Age at Childbirth and Parity as Predictors of Longevity Among Women in the United States: The Women's Health Initiative.

OBJECTIVES: To examine associations of maternal age at childbirth and parity with survival to age 90 years (longevity). METHODS: We performed a prospective study among a multiethnic cohort of postmenopausal US women in the Women's Health Initiative recruited from 1993 to 1998 and followed through August 29, 2014. We adjusted associations with longevity for demographic, lifestyle, reproductive, and health-related characteristics. RESULTS: Among 20 248 women (mean age at baseline, 74.6 years), 10 909 (54%) survived to age 90 years. The odds of longevity were significantly higher in women with later age at first childbirth (adjusted odds ratio = 1.11; 95% confidence interval = 1.02, 1.21 for age 25 years or older vs younger than 25 years; P for trend = .04). Among parous women, the relationship between parity and longevity was significant among White but not Black women. White women with 2 to 4 term pregnancies compared with 1 term pregnancy had higher odds of longevity. CONCLUSIONS: Reproductive events were associated with longevity among women. Future studies are needed to determine whether factors such as socioeconomic status explain associations between reproductive events and longevity.

An intervention study examining the effects of condom wrapper graphics and scent on condom use in the Botswana Defence Force.

Free condoms provided by the government are often not used by Botswana Defence Force (BDF) personnel due to a perceived unpleasant scent and unattractive wrapper. Formative work with the BDF found that scented condoms and military-inspired (camouflage) wrapper graphics were appealing to personnel. A non-randomized intervention study was implemented to determine whether condom wrapper graphics and scent improved condom use in the BDF. Four military sites were selected for participation. Two sites in the south received the intervention condom wrapped in a generic wrapper and two sites in the north received the intervention condom wrapped in a military-inspired wrapper; intervention condoms were either scented or unscented. Two hundred and eleven male soldiers who ever had sex, aged 18-30 years, and stationed at one of the selected sites consented to participate. Sexual activity and condom use were measured pre- and post-intervention using sexual behavior diaries. A condom use rate (CUR; frequency of protected sex divided by the total frequency of sex) was computed for each participant. Mean CURs significantly increased over time (85.7% baseline vs. 94.5% post-intervention). Adjusted odds of condom use over time were higher among participants who received the intervention condom packaged in the military wrapper compared with the generic wrapper. Adjusted odds of condom use were also higher for participants who reported using scented vs. unscented condoms. Providing scented condoms and condoms packaged in a military-inspired wrapper may help increase condom use and reduce HIV infection among military personnel.

The impact of pre-operative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty.

This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008-12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery. 10,718 TKAs and 4066 THAs were identified. During the one year pre-TKA 7.6% of patients gained weight, 12.4% lost weight, and 79.9% remained the same. In the one year pre-THA, 6.3% of patients gained weight, 18.0% lost weight, and 75.7% remained the same. In TKAs and THAs, after adjusting for covariates, the risk of SSI and readmission was not significantly different in the patients who gained or lost weight pre-operatively compared to those who remained the same.

Effects of genetically predicted posttraumatic stress disorder on autoimmune phenotypes.

Observational studies suggest that posttraumatic stress disorder (PTSD) increases risk for various autoimmune diseases. Insights into shared biology and causal relationships between these diseases may inform intervention approaches to PTSD and co-morbid autoimmune conditions. We investigated the shared genetic contributions and causal relationships between PTSD, 18 autoimmune diseases, and 3 immune/inflammatory biomarkers. Univariate MiXeR was used to contrast the genetic architectures of phenotypes. Genetic correlations were estimated using linkage disequilibrium score regression. Bi-directional, two-sample Mendelian randomization (MR) was performed using independent, genome-wide significant single nucleotide polymorphisms; inverse variance weighted and weighted median MR estimates were evaluated. Sensitivity analyses for uncorrelated (MR PRESSO) and correlated horizontal pleiotropy (CAUSE) were also performed. PTSD was considerably more polygenic (10,863 influential variants) than autoimmune diseases (median 255 influential variants). However, PTSD evidenced significant genetic correlation with nine autoimmune diseases and three inflammatory biomarkers. PTSD had putative causal effects on autoimmune thyroid disease (p = 0.00009) and C-reactive protein (CRP) (p = 4.3 × 10-7). Inferences were not substantially altered by sensitivity analyses. Additionally, the PTSD-autoimmune thyroid disease association remained significant in multivariable MR analysis adjusted for genetically predicted inflammatory biomarkers as potential mechanistic pathway variables. No autoimmune disease had a significant causal effect on PTSD (all p values > 0.05). Although causal effect models were supported for associations of PTSD with CRP, shared pleiotropy was adequate to explain a putative causal effect of CRP on PTSD (p = 0.18). In summary, our results suggest a significant genetic overlap between PTSD, autoimmune diseases, and biomarkers of inflammation. PTSD has a putative causal effect on autoimmune thyroid disease, consistent with existing epidemiologic evidence. A previously reported causal effect of CRP on PTSD is potentially confounded by shared genetics. Together, results highlight the nuanced links between PTSD, autoimmune disorders, and associated inflammatory signatures, and suggest the importance of targeting related pathways to protect against disease and disability.

Association of phosphodiesterase 4 polymorphism (rs702553) with blood pressure in the African American Study of Kidney Disease and Hypertension Genomics Study.

Hypertension is a risk factor for diseases such as stroke, heart and kidney disease. Phosphodiesterase (PDE) enzymes play a significant role in regulating inflammation and there is some association between increased inflammatory cell mediators and development of hypertension. Previous research has shown the single nucleotide polymorphism (rs702553) on the PDE4D gene to be associated with stroke and carotid atherosclerosis. This research analyzed the association of rs702553 with baseline mean arterial blood pressure (MAP) in a subset of the African American Study of Kidney Disease and Hypertension Cohort. Data analysis identified baseline diuretic use as an interaction term in the association between this polymorphism and MAP. Compared with participants with AA/AT genotypes, those with a TT genotype at rs702553 had significantly lower baseline MAP among study participants on a diuretic (P=0.02). To our knowledge, the influence of rs702553 on final PDE4D gene expression has not yet been studied. Additional clinical and in-vitro studies are needed to better understand the biological mechanisms from gene expression to enzyme translation that affect blood pressure.

Prevalence of PTSD and depression, and associated sexual risk factors, among male Rwanda Defense Forces military personnel.

OBJECTIVES: To assess depression and PTSD prevalence among the Rwanda Defense Forces (RDF) and evaluate whether sexual risk behaviour, STIs, HIV and alcohol use were significantly higher among those who screened positive. METHODS: Consenting active-duty male RDF personnel, aged ≥21 years, completed an anonymous sexual risk survey linked to HIV rapid testing that included standardised assessments for PTSD (PCL-M), depression (CES-D) and alcohol use (AUDIT). PTSD and depression prevalence were calculated (data available for 1238 and 1120 participants, respectively), and multivariable regression analyses were conducted. RESULTS: 22.5% screened positive for depression, 4.2% for PTSD and 3.4% for both. In adjusted analyses, odds of either depression or PTSD were significantly higher in participants reporting STI symptoms (OR = 2.27, 2.78, respectively) and harmful alcohol use (OR = 3.13, 3.21, respectively). Sex with a high-risk sex partner, lower rank and never deploying were also significantly associated with depression in adjusted analyses. CONCLUSIONS: Nearly one-fourth of RDF participants screened positive for PTSD or depression, which impacts sexual risk behaviour, HIV acquisition risk and military readiness. Findings may extend to other deploying militaries and provide additional evidence of an association between mental health status and sexual risk behaviour. Effective mental health treatment interventions that also include alcohol use assessments, STI identification/treatment and sexual risk behaviour reduction are needed.

HIV seroprevalence, associated risk behavior, and alcohol use among male Rwanda Defense Forces military personnel.

A cross-sectional study was conducted among active-duty male soldiers, aged ≥21 years, in the Rwanda Defense Forces (RDF) and included an anonymous behavioral survey and HIV rapid testing to determine risk factors associated with HIV seroprevalence. Overall prevalence was 2.6 % (95 % CI: 1.84-3.66); personnel who were divorced, separated or widowed, served ≥6 years, never deployed, uncircumcised, reported STI symptoms, had ≥6 lifetime sex partners, or screened positive for harmful alcohol use (via Alcohol Use Disorders Identification Test) had higher HIV prevalence. Ever being divorced, separated or widowed (OR = 29.8; 95 % CI: 5.5-159.9), and STI symptoms (OR = 3.4; 95 % CI: 1.5-7.6) were significantly associated with infection, after multivariable adjustment, while circumcision was protective (OR = 0.4; 95 % CI: 0.2-0.9). Despite mobility and other factors that uniquely influence HIV transmission in militaries, RDF prevalence was similar to the general population. A reason for this finding may be conservative sexual behavior combined with effective leadership-supported prevention programs. Data suggest a concentrated rather than generalized epidemic, with targets identified for intervention.

The association of self-reported measures with poor training outcomes among male and female U.S. Navy recruits.

This prospective study evaluated the association of self-reported health habits and behaviors in 2,930 Navy recruits with poor training outcomes, defined as graduating late or separating from training. Although 17% of the men and 21% of the women had a poor training outcome, results suggest that some self-reported measures were associated with poor training outcomes. Men who did not run or jog at least 1 month before basic training or had a previous lower limb injury without complete recovery and women reporting the same or less physical activity compared with their same-age counterparts were more likely to have a poor training outcome. An important first step in decreasing poor training outcomes is encouraging incoming recruits to participate in physical activity and taking steps to identify and rehabilitate recruits who are not completely healed from a lower limb musculoskeletal injury before reporting to basic training.

A radiotherapy planning study of RapidArc, intensity modulated radiotherapy, three-dimensional conformal radiotherapy, and parallel opposed beams in the treatment of pediatric retroperitoneal tumors.

BACKGROUND: This planning study compared RapidArc, fixed-field IMRT (cIMRT), 3D conformal radiotherapy (3D-CRT), and a parallel-opposed pair (POP) for children with retroperitoneal tumors. PROCEDURE: Plans were generated in eight patients to treat the PTV (dose range 19.8-45 Gy) while limiting kidney and liver doses. In selected patients, vertebral body (VB) dose heterogeneity was minimized. Cumulative DVH parameters, monitor units (MU), and treatment times were compared for the four techniques using the Wilcoxon matched pairs test. RESULTS: RapidArc and cIMRT covered target volumes more conformally than 3D-CRT and POP (P = 0.012). There was no difference in the ability to meet kidney dose constraints. A significantly lower volume of the liver received 12 Gy with cIMRT or RapidArc compared with 3D-CRT (P = 0.028). Where VB was included in PTV, VB dose homogeneity was generally within 94-104% of the prescription dose. Time to deliver a single fraction with RapidArc, POP, 3D-CRT, and cIMRT was 1.25 ± 0.01, 1.38 ± 0.10, 2.6 ± 0.45, and 4.02 ± 1.12 min, respectively (P = 0.012). Monitor units for a single fraction with POP, 3D-CRT, RapidArc, and cIMRT were 203 ± 26, 235 ± 32, 325 ± 71, and 665 ± 215, respectively (P < 0.05). CONCLUSIONS: POP resulted in favorable MU, treatment time and dosimetry but had poor conformality. 3D-CRT was more conformal but had higher MU and treatment time. RapidArc and cIMRT were generally no better dosimetrically than conformal techniques. RapidArc was dosimetrically very similar to cIMRT, but resulted in a major reduction in time and MU used to deliver the radiation.

International College of Dentists-USA Section: a brief history, 1934-2011.

Inspiration for the International College of Dentists can be traced to a Tokyo dinner in 1920, with the College being founded in 1927 and the USA Section following in 1934. The College has always held a focus on international relations and service. The USA Section has also developed a firm commitment to leadership. The origins of the College are traced in this article, and the organizational structure and a sampling of its many programs are also presented.

In Vitro Evaluation of Notch Inhibition to Enhance Efficacy of Radiation Therapy in Melanoma.

PURPOSE: The scope of radiation therapy is limited in melanoma. Using in vitro melanoma models, we investigated a Notch signaling inhibitor as a radiosensitizer to explore its potential to improve the efficacy of radiation therapy to widen the clinical application of radiation therapy in melanoma. METHODS AND MATERIALS: Melanoma cell lines A375, SKMEL28, and G361 were grown using standard tissue culture methods. Radiation was delivered with a clinical x-ray unit, and a gamma secretase inhibitor RO4929097 was used to inhibit Notch signaling. Cell viability signal was used to calculate Loewe's combination index to assess the interaction between radiation and RO4929097 and also the effect of scheduling of radiation and RO4929097 on synergy. Clonogenic assays were used to assess the clonogenic potential. An in vitro 3-dimensional culture model, γ-H2AX, and notch intracellular domain assays were used to interrogate potential underlying biological mechanisms of this approach. Scratch and transwell migration assays were used to assess cell migration. RESULTS: A375 and SKMEL28 cell lines showed consistent synergy for most single radiation doses examined, with a tendency for better synergy with the radiation-first schedule (irradiation performed 24 hours before RO4929097 exposure). Clonogenic assays showed dose-dependent reduction in colony numbers. Both radiation and RO4929097 reduced the size of melanospheres grown in 3-dimensional culture in vitro, where RO4929097 demonstrated a significant effect on the size of A375 and SKMEL28 melanospheres, indicating potential modulation of stem cell phenotype. Radiation induced γ-H2AX foci signal levels were reduced after exposure to RO4929097 with a tendency toward reduction in notch intracellular domain levels for all 3 cell lines. RO4929097 impaired both de novo and radiation-enhanced cell migration. CONCLUSIONS: We demonstrate Notch signaling inhibition with RO4929097 as a promising strategy to potentially improve the efficacy of radiation therapy in melanoma. This strategy warrants further validation in vivo.

Reconfirming HIV serostatus in three West African Military ART clinics.

BACKGROUND: HIV rapid diagnostic test (RDT) algorithms have been successfully employed worldwide to accelerate critically important HIV testing. Deviations from the algorithm and processing errors have been associated with inaccurate algorithm results. Positive RDT algorithm results should be confirmed prior to HIV clinic enrollment, but compliance varies. We sought to retest HIV status of patients in three West African military HIV clinics. SETTING: Military HIV clinics in Lome, Togo; Freetown, Sierra Leone; and Monrovia, Liberia METHODS: Patients coming for routine HIV clinic visits were approached for enrollment. Consenting participants completed a 15-minute questionnaire and provided blood samples for both national and WHO-recommended HIV RDT algorithms, and HIV ELISA (plus HIV PCR if HIV ELISA negative). RESULTS: In total, 817 participants provided data: 374 in Togo, 360 in Sierra Leone, and 83 in Liberia. One participant from Liberia was HIV-negative (although follow-up testing was positive). Two of 807 participants on antiretroviral treatment (ART) had inconclusive algorithms, while 2 of 10 participants not on ART had algorithms, for 4 total based on the WHO-approved algorithm. Using the national algorithms, only 3 were inconclusive. A substantial proportion of the cohort had taken ART for over 6 years (25-46%, depending on the site). CONCLUSION: HIV RDT retesting in three military HIV clinics did not uncover significant numbers of misclassified HIV patients. There was no significant difference between national and WHO-recommended RDT algorithms, although the study was underpowered to detect a difference. Antiretroviral treatment was not associated with increased rates of inconclusive RDT algorithm results.

Prevalence and psychological correlates of traumatic brain injury in operation iraqi freedom.

OBJECTIVE: To describe the prevalence and psychological correlates of traumatic brain injury (TBI) among injured male combatants in the Iraq conflict. PARTICIPANTS: A total of 781 men injured during military combat between September 2004 and February 2005. MAIN OUTCOME MEASURES: Mental health diagnosis (ICD-9 290-319), particularly posttraumatic stress disorder and mood/anxiety disorders, assigned through November 2006. RESULTS: 15.8% met criteria for TBI (13.4% mild, 2.4% moderate-severe TBI), 35.0% other head injury, and 49.2% non-head injury. Multivariate logistic regression suggested lower rates of posttraumatic stress disorder and mood/anxiety disorders among those with mild and moderate-severe TBI. CONCLUSIONS: These findings could reflect a problem with differential diagnosis or, conversely, a low rate of self-presentation for symptoms. Further research is needed to elucidate the psychological consequences, clinical implications, and overall impact of TBI among military combat veterans.

Selected static anatomic measures predict overuse injuries in female recruits.

This prospective study determined whether selected anatomic measures identified women at increased risk of patellofemoral pain syndrome (PFPS) and shin splints (SS). Ten anatomic measures were performed on 748 women before basic training at the Marine Corps Recruit Depot (MCRD), Parris Island, South Carolina. Recruits were then followed throughout basic training for occurrence of injuries. Logistic regression modeling indicated that a left hip internal rotation range of motion (ROM) < or =25 degrees and > or =46 degrees, a right Q angle > or =20 degrees, and left knee hyperextension ROM > or =6 degrees were positively associated with PFPS. Whereas left dorsiflexion ROM > or =21 degrees was associated with SS, right Q angle > or =20 degrees was inversely associated with SS. These findings suggest that multiple anatomic measures can be used to identify women entering MCRD basic training at risk for PFPS and SS injuries.

Association of Race and Major Adverse Cardiac Events (MACE): The Atherosclerosis Risk in Communities (ARIC) Cohort.

BACKGROUND AND AIMS: To evaluate the association of self-reported race with major adverse cardiac events (MACE) and modification of this association by paraoxonase gene (PON1, PON2, and PON3) single nucleotide polymorphisms (SNPs). METHODS: Included in this longitudinal study were 12,770 black or white participants from the Atherosclerosis Risk in Communities (ARIC) cohort who completed a baseline visit (1987-1989) with PON genotyping. Demographic, behavioral, and health information was obtained at baseline. MACE was defined as first occurrence of myocardial infarction, stroke, or CHD-related death through 2004. Cox proportional hazards regression was used to evaluate the association between race and MACE after adjustment for age, gender, and other demographic and cardiovascular risk factors such as diabetes and hypertension. Modification of the association between PON SNPs and MACE was also assessed. RESULTS: Blacks comprised 24.6% of the ARIC cohort; overall, 14.0% of participants developed MACE. Compared with whites, blacks had 1.24 times greater hazard of MACE (OR = 1.24,95%CI = 1.10,1.39) than whites after adjusting for age, gender, BMI, cigarette and alcohol use, educational and marital status, and aspirin use. This association became nonsignificant after further adjustment for high cholesterol, diabetes, and hypertension. None of the evaluated SNPs met the significance level (p < 0.001) after Bonferroni correction for multiple comparisons. CONCLUSIONS: No association between race and MACE was identified after adjusting for high cholesterol, diabetes, and hypertension, suggesting that comorbidities are major determinants of MACE; medical intervention with focus on lifestyle and health management could ameliorate the development of MACE. Further studies are needed to confirm this observation.

Hydroxychloroquine and short-course radiotherapy in elderly patients with newly diagnosed high-grade glioma: a randomized phase II trial.

BACKGROUND: Effective treatment for patients at least 70 years with newly diagnosed glioblastoma remains challenging and alternatives to conventional cytotoxics are appealing. Autophagy inhibition has shown promising efficacy and safety in small studies of glioblastoma and other cancers. METHODS: We conducted a randomized phase II trial to compare radiotherapy with or without hydroxychloroquine (2:1 allocation). Patients aged at least 70 years with newly diagnosed high-grade glioma deemed suitable for short-course radiotherapy with an ECOG performance status of 0-1 were included. Radiotherapy treatment consisted of 30 Gy, delivered as 6 fractions given over 2 weeks (5 Gy per fraction). Hydroxychloroquine was given as 200 mg orally b.d. from 7 days prior to radiotherapy until disease progression. The primary endpoint was 1-year overall survival (OS). Secondary endpoints included progression-free survival (PFS), quality of life, and toxicity. RESULTS: Fifty-four patients with a median age of 75 were randomized between May 2013 and October 2016. The trial was stopped early in 2016. One-year OS was 20.3% (95% confidence interval [CI] 8.2-36.0) hydroxychloroquine group, and 41.2% (95% CI 18.6-62.6) radiotherapy alone, with a median survival of 7.9 and 11.5 months, respectively. The corresponding 6-month PFS was 35.3% (95% CI 19.3-51.7) and 29.4% (95% CI 10.7-51.1). The outcome in the control arm was better than expected and the excess of deaths in the hydroxychloroquine group appeared unrelated to cancer. There were more grade 3-5 events in the hydroxychloroquine group (60.0%) versus radiotherapy alone (38.9%) without any clear common causation. CONCLUSIONS: Hydroxychloroquine with short-course radiotherapy did not improve survival compared to radiotherapy alone in elderly patients with glioblastoma.

Racial differences in the interaction between family history and risk factors associated with diabetes in the National Health and Nutritional Examination Survey, 1999-2004.

PURPOSE: We sought to determine whether the association between family history, a surrogate for genetic predisposition, and diabetes was modified by any known diabetes risk factors and if these relationships were constant across different ethnic groups. METHODS: We examined 10,899 adults from the National Health and Nutrition Examination Survey (1999 -2004) to identify interactions between family history and clinical, demographic, and lifestyle variables for the outcome of diabetes using logistic regression analysis in racial/ethnic subgroups. RESULTS: There was significant heterogeneity by race/ethnicity in the interaction between covariates and family history in relation to diabetes. In black (P = 0.0001) and Hispanic (P = 0.013), but not white (P = 0.75) subgroups, high-familial risk was a strong risk factor for diabetes among lean individuals but less so among overweight or obese subjects.Among blacks, high-familial risk conferred a 20-fold increased odds of diabetes among lean subjects and only a sixfold increased odds among obese individuals. CONCLUSIONS: These findings suggest possible race/ethnic-specific differences in gene by environment interaction and identify body mass index as an important effect modifier of familial risk in diabetes in non-white populations. These findings may help guide future genetic studies and improve the utility of family history as a public health screening tool.

Acute cardiotoxicity with concurrent trastuzumab and radiotherapy including internal mammary chain nodes: a retrospective single-institution study.

PURPOSE: To examine the acute cardiotoxicity of internal mammary chain (IMC) irradiation with concurrent trastuzumab. MATERIALS AND METHODS: Clinical and cardiac function data were collected on 59 patients with early breast cancer who were treated with adjuvant trastuzumab and chemotherapy with or without radiotherapy (often including IMC) at BC Cancer Agency in 2005. RESULTS: Forty-four of fifty-nine patients received adjuvant radiotherapy (RT). Thirteen had left-sided IMC RT. For left-sided RT, IMC inclusion increased the mean percentage dose to 5% of the heart, but the mean doses to 50% and 90% of the heart were similar. Median baseline left ventricular ejection fraction (LVEF) was 62% and similar in all groups. Median absolute decrease in LVEF after RT was 4%, which was not significantly different according to side or inclusion of IMCs. Trastuzumab was stopped in 11 of 59 patients (18.6%) due to decrease in LVEF. After median follow up of 15 months, three patients developed clinical congestive heart failure, none of whom received left-sided IMC RT. CONCLUSIONS: There was no excess acute cardiotoxicity observed with the combination of left-sided IMC irradiation and concurrent trastuzumab.

Psychological correlates of battle and nonbattle injury among Operation Iraqi Freedom veterans.

Limited research exists on the relationship between physical injury and PTSD within military populations. The present study assessed postinjury rates of PTSD and other psychological correlates among battle and non-battle injuries. A total of 1,968 men (831 battle injuries and 1,137 nonbattle injuries) injured between September 2004 and February 2005 during Operation Iraqi Freedom (OIF) composed the study sample. Patients were followed through November 2006 for mental health diagnosis (ICD-9 290-319). Compared with nonbattle injuries, those with battle injuries had a greater risk of PTSD and other mental health diagnosis, and there was a positive association with injury severity. Self-reported mental health symptoms were significantly higher for both minor and moderate-severe battle injury in comparison to nonbattle injury and previous population estimates from an earlier OIF period. More research is needed to further define this relationship by examining potential mechanisms and addressing the possible contributing effect of combat exposure.