RESUMEN
AIMS: To evaluate temporal trends in racial/ethnic groups in rates of serious hypoglycemia among higher risk patients dually enrolled in Veterans Health Administration and Medicare fee-for-service and assess the relationship(s) between hypoglycemia rates, insulin/secretagogues and comorbid conditions. METHODS: Retrospective observational serial cross-sectional design. Patients were ≥65â¯years receiving insulin and/or secretagogues. The primary outcome was the annual (period prevalence) rates (2004-2015), per 1000 patient years, of serious hypoglycemic events, defined as hypoglycemic-related emergency department visits or hospitalizations. RESULTS: Subjects were 77-83% White, 7-10% Black, 4-5% Hispanic, <2% women; 38-58% were ≥75â¯years old; 72-75% had ≥1 comorbidity. In 2004-2015, rates declined from 63.2 to 33.6(-46.9%) in Blacks; 29.7 to 20.3 (-31.6%) in Whites; and 41.8 to 29.6 (-29.3%) in Hispanics. The Black-White rate differences narrowed regardless of insulin use, hemoglobin A1c level, and frequency and various combinations of comorbid conditions. Among insulin users, the Black-White contrast decreased from 34.7 (98.5 vs. 63.8) in 2004 to 13.2 (43.6 vs. 30.4) in 2015; in non-insulin users, the contrast was 25.7 (44.1 vs. 18.4) in 2004 and 10.1 (18.9 vs. 8.8) in 2015. CONCLUSION: Marked declines in serious hypoglycemia events occurred across race, medications, and comorbidities, suggesting significant changes in clinical practice.
Asunto(s)
Diabetes Mellitus Tipo 2/etnología , Disparidades en el Estado de Salud , Hipoglucemia/etnología , Grupos Raciales/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Etnicidad/estadística & datos numéricos , Femenino , Hemoglobina Glucada/efectos de los fármacos , Hemoglobina Glucada/metabolismo , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Hipoglucemia/patología , Insulina/uso terapéutico , Masculino , Medicare/historia , Medicare/estadística & datos numéricos , Medicare/tendencias , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , United States Department of Veterans Affairs/historia , United States Department of Veterans Affairs/estadística & datos numéricos , United States Department of Veterans Affairs/tendencias , Salud de los Veteranos/etnología , Salud de los Veteranos/estadística & datos numéricosRESUMEN
The United States' entry into the First World War prompted progressives to reform veterans' entitlements in the hopes of creating a system insulated from corruption and capable of rehabilitating disabled veterans into productive members of society. The replacement of pensions with medical care for wounded and disabled soldiers through the Reconstruction Hospital System was originally intended as a temporary measure but resulted in establishing the foundations of the modern veterans' health care system. Yet, these reforms would not have been possible without the support from the community of war veterans to which these reforms applied. By examining the communal values expressed in publications produced by and for soldiers, this paper explores the ways in which the Great War's veteran community expressed agency in the process of reforming the US veteran entitlements.
Asunto(s)
Personas con Discapacidad/historia , Medicina Militar/historia , Personal Militar/historia , Veteranos/historia , Primera Guerra Mundial , Historia del Siglo XX , Humanos , Estados Unidos , United States Department of Veterans Affairs/historiaAsunto(s)
Medicina Militar/historia , Medicina Militar/organización & administración , Política , Cambio Social/historia , United States Department of Veterans Affairs/historia , United States Department of Veterans Affairs/organización & administración , Historia del Siglo XX , Humanos , Estados UnidosRESUMEN
OBJECTIVE: The Section of Urology at the Minneapolis Veteran's Affairs (VA) Medical Center has a long history of contributions to Urology including the Gleason Score, Fuhrman Grading system, testicular tumor marker development and the birth of Endourology. The objective of this manuscript is to compile and present the Urologic history of the Minneapolis VA. METHODS: The Urologic literature and institutional records originating from the Minneapolis VA Medical Center from 1946-2017 were reviewed and presented herein. RESULTS: The Minneapolis VA Health Care System originated in 1921 and currently employs 5 Urologist who serve over 16,000 veterans per year. Historic achievements from the Minneapolis VA Section of Urology include the development of the Veteran's Affairs Cooperative Research Group (VACURG) which was instrumental to development of the Gleason grading system for prostate cancer in 1965. Additional urologic oncology achievements originating from the Minneapolis VA Section of Urology included the development of the diagnostic utility of tumor markers in testis cancer in 1976 and The Fuhrman Grading System in 1982. Perhaps the greatest contribution to the field of Urology was the birth of Endourology at the Minneapolis VA in the late 1970s under the direction of Dr. Paul Lange. Currently the Minneapolis VA is a premier center for Evidence Based Urology by housing Cochrane Urology and the U.S. Grading of Recommendations Assessment, Development and Evaluation network (US GRADE). CONCLUSION: Since 1946, the section of Urology at the Minneapolis VA has contributed basic science, clinical technique and evidence based medicine to the field of Urology while providing care to the nation's veterans.
Asunto(s)
Atención a la Salud/historia , United States Department of Veterans Affairs/historia , Urología/historia , Historia del Siglo XX , Minnesota , Estados UnidosRESUMEN
The US Department of Veterans Affairs (VA), the largest health care system in the US, has been confronted with the health care consequences of opioid disorder (OUD). Increasing access to quality OUD treatment, including pharmacotherapy, is a priority for the VA. We examine the history of medications (e.g., methadone, buprenorphine, injectable naltrexone) used in the treatment of OUD within VA, document early and ongoing efforts to increase access and build capacity, primarily through the use of buprenorphine, and summarize research examining barriers and facilitators to prescribing and medication receipt. We find that there has been a slow but steady increase in the use of medications for OUD and, despite system-wide mandates and directives, uneven uptake across VA facilities and within patient sub-populations, including some of those most vulnerable. We conclude with recommendations intended to support the greater use of medication for OUD in the future, both within VA as well as other large health care systems.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/tratamiento farmacológico , United States Department of Veterans Affairs/historia , United States Department of Veterans Affairs/tendencias , Creación de Capacidad , Predicción , Guías como Asunto , Política de Salud , Accesibilidad a los Servicios de Salud , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Tratamiento de Sustitución de Opiáceos/historia , Trastornos Relacionados con Opioides/historia , Estados UnidosRESUMEN
In the decade after World War II, psychologists, eager to bring the benefits of counseling to larger numbers, convinced hundreds of American colleges and universities to establish counseling centers. Inspired by the educational-vocational counseling center founded by psychologists at the University of Minnesota in 1932, Carl R. Rogers's "client-centered" methods of personal adjustment counseling, and the 400-plus college counseling centers created by the Veterans Administration to provide the educational-vocational counseling benefit promised to returning World War II servicemen under the 1944 GI Bill, these counseling psychologists created a new place to practice where important currents in psychology, higher education, and federal policy converged and where they attempted to integrate educational-vocational counseling with personal adjustment counseling based on techniques from psychotherapy. By the mid-1960s, half of America's colleges and universities had established counseling centers, and more than 90% offered students educational, vocational, and psychological counseling services, a great achievement of the first generation of counseling psychologists.
Asunto(s)
Aspiraciones Psicológicas , Consejo/historia , Psicoterapia Centrada en la Persona/historia , Servicios de Salud para Estudiantes/historia , United States Department of Veterans Affairs/historia , Veteranos/historia , Orientación Vocacional/historia , Segunda Guerra Mundial , Historia del Siglo XX , Humanos , Minnesota , Estados UnidosRESUMEN
The U.S. Department of Veterans Affairs compensates 13 percent of the nation's military veterans for servicerelated disabilities through the Disability Compensation (DC) program. In 2001, a legislative change made it easier for Vietnam veterans to receive benefits for diabetes associated with military service. In this paper, we investigate this policy's effect on DC enrollment and expenditures as well as the behavioral response of potential beneficiaries. Our findings demonstrate that the policy increased DC enrollment by 6 percentage points among Vietnam veterans and that an additional 1.7 percent experienced an increase in their DC benefits, which increased annual program expenditures by $2.85 billion in 2007. Using individual-level data from the Veterans Supplement to the Current Population Survey, we find that the induced increase in DC enrollment had little average impact on the labor supply or health status of Vietnam veterans but did reduce labor supply among their spouses.
Asunto(s)
Gastos en Salud , Medicina Militar , Política Pública , United States Department of Veterans Affairs , Ayuda a Lisiados de Guerra , Programas de Gobierno/economía , Programas de Gobierno/educación , Programas de Gobierno/historia , Programas de Gobierno/legislación & jurisprudencia , Gastos en Salud/historia , Gastos en Salud/legislación & jurisprudencia , Historia del Siglo XX , Historia del Siglo XXI , Medicina Militar/economía , Medicina Militar/educación , Medicina Militar/historia , Medicina Militar/legislación & jurisprudencia , Personal Militar/educación , Personal Militar/historia , Personal Militar/legislación & jurisprudencia , Personal Militar/psicología , Política Pública/economía , Política Pública/historia , Política Pública/legislación & jurisprudencia , Estados Unidos/etnología , United States Department of Veterans Affairs/economía , United States Department of Veterans Affairs/historia , United States Department of Veterans Affairs/legislación & jurisprudencia , Veteranos/educación , Veteranos/historia , Veteranos/legislación & jurisprudencia , Veteranos/psicología , Ayuda a Lisiados de Guerra/economía , Ayuda a Lisiados de Guerra/historia , Ayuda a Lisiados de Guerra/legislación & jurisprudenciaRESUMEN
OBJECTIVE: The authors review the more than 30-year history of the academic affiliation between the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas and the Mental Health Service at the Veterans Affairs North Texas Health Care System. METHODS: The authors interviewed individuals involved at various stages in developing this affiliation about decisions and challenges. RESULTS: The academic association has been very successful on the whole, though not consistently so. At this time, a flourishing educational and research program is in place and seems stable. CONCLUSION: It is not clear how generalizable the Dallas experience is. Both sides of this affiliation have overcome obstacles. Persistence and patience have been crucial, especially when one or the other side produced temporarily insurmountable obstacles. It appears that the decision to pursue the recruitment of both researchers and educators to the North Texas Veterans Health Care System from the beginning may have been crucial in developing a fuller academic collaboration.
Asunto(s)
Centros Médicos Académicos/historia , Conducta Cooperativa , Hospitales de Veteranos/historia , Psiquiatría Militar/historia , Facultades de Medicina/historia , United States Department of Veterans Affairs/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Texas , Estados UnidosRESUMEN
The U.S. Department of Veterans Affairs (VA) has been a leader in program development and service delivery in the areas of geriatrics, hospice and palliative care for decades. Zelda Foster, MSW, serving as the Chief of Social Work Services at the Brooklyn VA Hospital for almost 20 years, was a force in the early days of the palliative care and hospice movement in the United States, publishing a seminal article in 1965, and contributing through educational initiatives, program development, information dissemination and mentorship of countless social workers. With an early recognition of the demographic imperative of aging veterans, the VA established a number of innovative programs which have been widely replicated outside of the VA. Zelda Foster was a central figure in the evolution of these programs and a strong and effective advocate for the inclusion of social workers. She deserves much credit for the fact that social workers are now centrally involved in an array of leadership activities in palliative and end-of-life care both within and outside of VA.