Long-term health and quality of life experiences of Vietnam veterans with combat-related limb loss.

PURPOSE: This paper describes the long-term health and quality of life (QOL) outcomes of Vietnam veterans with combat-related limb loss. METHODS: This mixed-method, cross-sectional study analyzes survey data of 247 Vietnam veterans with combat-related limb loss measuring several comorbidities [measured as ever diagnosed], PTSD using the PTSD Checklist Military (PCL-M), depression using the Patient Health Questionnaire (PHQ-8), and QOL using the SF-12. In-depth interviews with 20 such veterans about their health and QOL experiences were conducted. RESULTS: Of 247 Vietnam veterans, most report good to excellent health (79.7 %) and several comorbidities: arthritis (61.1 %), cardiovascular disease (18.2 %), diabetes (22.7 %), obesity (17.4 %), phantom-limb pain (76.1 %), back pain (76.5 %), PTSD (15.8 %), and depression (17.8 %). Those with depression fared worse on the SF-12 physical component summary score (PCS), whereas those with arthritis, depression, and PTSD fared worse on the SF-12 mental component summary score. Interview data describe these comorbidities and QOL from the veterans' perspective and illustrate how such comorbidities may be directly related to the veterans' combat and/or limb loss experiences. CONCLUSION: The prevalence of these health issues and the adverse effects of some of these on QOL underscore the importance of effective rehabilitation over the life course, especially including better mental health care and pain management.

Development of a Yemeni AIDS Stigma Scale.

Research on the social and behavioral aspects of AIDS in the Arab world is relatively scarce despite the efforts of a few scholars over the last quarter century. AIDS-related stigma and discrimination are especially important areas that have received little attention. One critical barrier to undertaking such research has been the absence of an Arabic instrument to employ this work. The current study addressed this gap by developing and implementing an Arabic AIDS Stigma Scale that consisted of 10 items. The data were collected from college students at a public university in Yemen. Principle axis factor analysis identified two factors with five items each that explained 35% of the variance. The availability of the Yemeni AIDS Stigma Scale (YASS) should be a valuable resource for scholars interested in AIDS-related research in Yemen and the rest of the Arab world.

Reduction of Injection-Related Risk Behaviors After Emergency Implementation of a Syringe Services Program During an HIV Outbreak.

OBJECTIVE: To describe injection-related HIV risk behaviors preimplementation and postimplementation of an emergency syringe services program (SSP) in Scott County, Indiana, after an HIV outbreak among persons who inject drugs (PWID). DESIGN: Mixed methods retrospective pre-post intervention analysis. METHODS: We analyzed routine SSP program data collected at first and most recent visit among clients with ≥2 visits, ≥7 days apart from April 4 to August 30, 2015, to quantify changes in injection-related risk behaviors. We also analyzed qualitative data collected from 56 PWID recruited in Scott County to understand factors contributing to these behaviors. RESULTS: SSP clients included in our analysis (n = 148, 62% of all SSP clients) reported significant (P < 0.001) reductions over a median 10 weeks (range 1-23) in syringe sharing to inject (18%-2%) and divide drugs (19%-4%), sharing other injection equipment (eg, cookers) (24%-5%), and number of uses of the same syringe [2 (interquartile range: 1-4) to 1 (interquartile range: 1-1)]. Qualitative study participants described access to sterile syringes and safer injection education through the SSP, as explanatory factors for these reductions. Injection frequency findings were mixed, but overall suggested no change. The number of syringes returned by SSP clients increased from 0 at first visit to median 57. All qualitative study participants reported using sharps containers provided by the SSP. CONCLUSIONS: Analyses of an SSP program and in-depth qualitative interview data showed rapid reduction of injection-related HIV risk behaviors among PWID post-SSP implementation. Sterile syringe access as part of comprehensive HIV prevention is an important tool to control and prevent HIV outbreaks.

Multiple injections per injection episode: High-risk injection practice among people who injected pills during the 2015 HIV outbreak in Indiana.

BACKGROUND: Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. METHODS: Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. RESULTS: All 25 participants were non-Hispanic white and the median age was 33 years (range: 19-57). All had ever injected extended-release oxymorphone (Opana® ER) and most (n=20) described preparing Opana® ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2-4 injections during an injection episode resulting from needing >1mL water to prepare Opana® ER solution using 1mL syringes and the frequent use of "rinse shots." MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. CONCLUSIONS: We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment.

Dealing with death: medical students' experiences with patient loss.

This article explores medical students' experiences and coping strategies when confronting patient loss in their 3rd and 4th years of their programs. Much of the literature on the impact of patient losses focuses on physicians. This article joins a handful of works aimed at how medical students experience and cope with patient loss. In-depth interviews with 20 medical students provided rich descriptions of their varying experiences coping with death. Consistent with previous work, students experience substantial emotional stress coping with patient deaths, though some were more difficult to bear than others, such as when the dying patient was a child or when treatment errors could have contributed to deaths. Common coping mechanisms included talking through their emotions, thrusting themselves into continuing their rounds, crying, participating in infant death rituals, and turning to religion. When deaths occurred, senior personnel who exhibited empathy toward the deceased and tolerance toward the students' emotional responses were lauded and made the process easier. Also emotionally daunting, in many instances, was dealing with the families of dying patients. Most of the students did not view death as a failure, contrary to much earlier literature, except in instances in which human error or decision making may have played a part in causing the death of a patient.

High prevalence of stump dermatoses 38 years or more after amputation.

OBJECTIVE: To highlight the prevalence and impact of skin disease at the stump site in patients who have undergone amputation. DESIGN: A cross-sectional health questionnaire of Vietnam War veterans with stump dermatoses at least 38 years after major limb amputation. SETTING: A research registry of veterans with combat-related amputations who agreed to participate. PARTICIPANTS: Recruitment began January 1, 2006, and ended December 31, 2009, with a registry of 416 veterans. MAIN OUTCOME MEASURES: Results of a self-reported 35-item questionnaire. Participants were later contacted by telephone or asked to complete a Web survey. RESULTS: Of the 247 veterans, 119 (48.2%) reported at least 1 skin problem within the preceding year. The most common were skin breakdown (25.2%), rash (21.8%), and abrasion (21.0%). In addition, 25.2% experienced skin problems more than 50% of the time, and 37.1% had to alter or replace their prosthesis. Stump dermatoses limited or prevented prosthesis use in the preceding year for 55.6% and caused pain or discomfort at the stump site in 61.5%. CONCLUSIONS: More than 38 years after major limb amputation, skin complications at the stump site continue to cause significant morbidities and contribute to prosthesis abandonment. The high prevalence of stump dermatoses stresses the importance of disease prevention, early management, and advanced treatment of skin disease.