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1.
Int J Radiat Oncol Biol Phys ; 106(1): 157-166, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31580929

RESUMEN

PURPOSE: Previous studies have found that patients with head and neck cancer (HNC) with a higher relative hazard for recurrence versus competing mortality (ω+ ratio) are more likely to benefit from intensive therapy. Nomograms to predict this ratio (ω scores) can be useful to guide clinical management; however, comorbidity and other risk factors are frequently lacking from trial samples. METHODS AND MATERIALS: In this study of 7117 US veterans, we evaluated the ability of a ω score nomogram developed from clinical trial data to stratify patients with HNC treated with radiation therapy by their relative risk of cancer progression versus competing mortality. We then fit generalized competing event models to determine the effect of comorbidity and other covariates on the ω+ ratio. RESULTS: The ω score was effective in stratifying patients with HNC according to their risk for cancer recurrence relative to competing mortality, especially among patients aged >70 years. Patients with ω score ≥0.80 were more likely to receive intensive therapy compared with patients with a ω score <0.80 (66 vs. 54%; P < .001). On multivariable generalized competing event regression, T2-4 category (relative hazard ratio [RHR], 1.08; 95% confidence interval [CI], 1.01-1.16), N2-3 category (RHR, 1.07; 95% CI, 1.01-1.15), and being employed (RHR, 1.11; 95% CI, 1.03-1.20) were associated with increased ω+ ratio, and increasing age (RHR, 0.83; 95% CI, 0.78-0.89), Charlson comorbidity index ≥2 (RHR, 0.85; 95% CI, 0.79-0.91), being a current smoker (RHR, 0.90; 95% CI, 0.84-0.96), and lower body mass index (RHR, 0.89; 95% CI, 0.84-0.95) were associated with a decreased ω+ ratio. CONCLUSIONS: The ω scores are effective in stratifying patients with HNC and are correlated with the intensity of treatment given. The ω scores incorporating comorbidity and other risk factors could help identify patients with HNC most likely to benefit from intensive therapy.


Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Recurrencia Local de Neoplasia , Nomogramas , Selección de Paciente , Carcinoma de Células Escamosas de Cabeza y Cuello/radioterapia , Factores de Edad , Anciano , Comorbilidad , Intervalos de Confianza , Progresión de la Enfermedad , Empleo , Femenino , Neoplasias de Cabeza y Cuello/clasificación , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Radioterapia de Intensidad Modulada , Análisis de Regresión , Factores de Riesgo , Fumadores , Carcinoma de Células Escamosas de Cabeza y Cuello/clasificación , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Delgadez/complicaciones , Veteranos/estadística & datos numéricos
2.
Adv Gerontol ; 32(4): 492-501, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31800175

RESUMEN

The study involving 317 former combatants aged 24 to 69 years was conducted. The aim of the study was to determine the regularities of the age dynamics of stress-induced pathology of combatants to develop the concept of their accelerated aging as a final component of the consequences of combat stress. It turned out that in relation to the period of influence of factors of combat stress and age, first manifests the pathology of the musculoskeletal system, gastrointestinal tract and arterial hypertension, then-cardiovascular disease associated with atherosclerosis. The formation of post-traumatic stress disorder occurred in 289 (91,2%) cases, and the chronic pain syndromes of different localization and different origin - in 192 (60,6%) at different times of the post-war period. But it is post-traumatic stress disorder in combination with chronic pain were decisive in the overall severity of the state of combatants, changes in indicators of free radical oxidation and an increase in biological age. It is proposed to consider accelerated aging, which is formed on the basis of the consequences of severe stress effects, as an independent disease.


Asunto(s)
Envejecimiento , Enfermedad Crónica , Trastornos de Combate , Veteranos , Adulto , Anciano , Enfermedades Cardiovasculares/etiología , Dolor Crónico/etiología , Trastornos de Combate/complicaciones , Enfermedades Gastrointestinales/etiología , Humanos , Persona de Mediana Edad , Trastornos por Estrés Postraumático/etiología , Veteranos/estadística & datos numéricos
3.
NeuroRehabilitation ; 45(2): 163-185, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31707378

RESUMEN

OBJECTIVE: To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI). METHODS: An electronic literature search first identified abstracts published from 2008-2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn, and Persian Gulf veterans. Selection criteria eliminated studies on non-combat TBI, open or penetrating injuries, and articles where the relationship between sleep and TBI was not directly examined. Articles on all military branches and components, those currently serving and veterans-ranging from medical chart reviews to clinical trials, were included. Forty-one articles were selected for full text-review. RESULTS: Twenty-four papers estimated the prevalence of sleep disturbances in TBI. Eight studies demonstrated the contribution of common co-occurring conditions, most notably posttraumatic stress disorder, to the relationship between disrupted sleep and TBI. Ten studies differentiated sleep profiles between military SMs and veterans with and without acute TBI and detected significant differences in sleep disturbances across the course of injury. Longitudinal studies were scarce but helped to establish the temporal relationship between sleep disturbances and TBI and isolate sleep-related mechanisms influencing TBI prognosis. Only three studies reported on interventions for improving sleep quality and TBI symptoms. Systematic research testing assessments and interventions that target sleep disturbances for improving sleep, TBI symptoms, and long-term functional outcomes were identified as critical knowledge gaps. CONCLUSION: Findings unequivocally establish that sleep disturbances are highly prevalent in SMs and veterans with TBI. However, studies testing the effectiveness of treatments for improving sleep in military groups with TBI have been limited and their results inconsistent. This review highlights a critical opportunity for advancing military medicine through future research aimed at identifying and testing sleep-focused treatments in SMs and veterans with combat-related TBI.


Asunto(s)
Lesiones Traumáticas del Encéfalo/epidemiología , Personal Militar/estadística & datos numéricos , Trastornos del Sueño-Vigilia/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Veteranos/estadística & datos numéricos , Adulto , Campaña Afgana 2001- , Femenino , Humanos , Guerra de Irak 2003-2011 , Masculino
4.
J Frailty Aging ; 8(4): 205-209, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31637407

RESUMEN

BACKGROUND: Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. OBJECTIVES: The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. DESIGN: This was a clinical demonstration project/quality improvement project. SETTING: Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). PARTICIPANTS: Older Veterans, aged ≥60 years. INTERVENTION: A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. MEASUREMENTS: Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. RESULTS: One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01). CONCLUSIONS: Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.


Asunto(s)
Terapia por Ejercicio/métodos , Fragilidad/prevención & control , Veteranos/estadística & datos numéricos , Caminata/fisiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Velocidad al Caminar/fisiología
6.
Sleep Health ; 5(5): 495-500, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31416799

RESUMEN

OBJECTIVES: Sleep complaints, such as insomnia and sleep disturbances caused by posttraumatic stress disorder (PTSD), are more common among women veterans than nonveteran women. Alcohol use among some women may be partially motivated by the desire to improve sleep. This study evaluated rates of alcohol use as a sleep aid among women veterans and explored the relationship between alcohol use to aid sleep and drinking frequency and sleeping pill use. DESIGN AND SETTING: National cross-sectional population-based residential mail survey on sleep and other symptoms. PARTICIPANTS: Random sample of women veteran VA users who completed a postal survey (N = 1533). INTERVENTIONS: None. MEASUREMENTS: The survey included demographics, Insomnia Severity Index, Primary Care PTSD screen, and items on alcohol use frequency (days/week), use of prescription or over-the-counter sleep medications, and use of alcohol as a sleep aid (yes/no for each item) over the past month. RESULTS: A total of 14.3% of respondents endorsed using alcohol to aid sleep. Logistic regression models showed more severe insomnia (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.01-1.06) and PTSD (OR = 2.11; 95% CI: 1.49-2.97) were associated with increased odds of using alcohol to aid sleep. Alcohol use to aid sleep was associated with increased odds of daily drinking (OR = 8.46; 95% CI: 4.00-17.87) and prescription (OR = 1.79; 95% CI: 1.34-2.38) and over-the-counter sleep aid use (OR = 1.54; 95% CI: 1.12-2.11). CONCLUSIONS: Insomnia and PTSD may increase risk for using alcohol as a sleep aid, which may increase risk for unhealthy drinking and for mixing alcohol with sleep medications. Findings highlight the need for alcohol use screening in the context of insomnia and for delivery of cognitive-behavioral therapy for insomnia to women veterans with insomnia.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Fármacos Inductores del Sueño/uso terapéutico , Veteranos/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Asunción de Riesgos , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios , Veteranos/estadística & datos numéricos
7.
Behav Ther ; 50(5): 910-923, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31422847

RESUMEN

While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment nonresponse. More specifically, predicting effects of residual insomnia and nightmares on postintervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veterans (N = 232) to evaluate whether residual insomnia and nightmare symptoms remained after treatment completion and, if so, whether these residual insomnia and nightmare symptoms were associated with higher levels of comorbid PTSD and depression at the end of treatment. Participants (ages 21 to 77 years old; 47.0% Black; 61.6% married) completed demographic questions, symptom assessments, and engagement-related surveys. Hierarchical multiple linear regression models demonstrated that residual insomnia was a significant predictor of PTSD and depression symptom reduction above and beyond the influence of demographic and engagement factors (e.g., therapy satisfaction). Consistent with previous research, greater residual insomnia symptoms were predictive of smaller treatment gains. Findings illustrate the potential significance of insomnia during the course of transdiagnostic treatment (e.g., PTSD and depression), leading to several important clinical assessment and treatment implications.


Asunto(s)
Depresión/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Sueño-Vigilia/complicaciones , Trastornos por Estrés Postraumático/complicaciones , Veteranos/psicología , Adulto , Anciano , Depresión/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos del Sueño-Vigilia/psicología , Trastornos por Estrés Postraumático/terapia , Veteranos/estadística & datos numéricos , Adulto Joven
8.
J Surg Res ; 243: 539-552, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31377495

RESUMEN

BACKGROUND: Frailty predicts poor outcome after vascular surgery. We determined the predictive utility of the modified frailty index (mFI) after first-time revascularization and identified biomarkers of frailty predictive of outcome in veterans with peripheral arterial disease. METHODS: A retrospective study was performed of first-time revascularizations (open surgery [OS] and endovascular surgery [ES]) in male veterans (2003-2016). Preoperative mFI scores were calculated, and serum and nonserum biomarkers of frailty were recorded. The primary endpoint was 2-y incidence of reintervention, amputation, and mortality. Secondary endpoints included 30-day morbidity and readmissions. RESULTS: Four hundred and thirty one patients (OS, n = 188; ES, n = 243), mean age of 66 ± 9 y, and 16 mo of median follow-up were studied. Mean mFI was 0.39 ± 0.16 for OS and 0.38 ± 0.15 for ES (P = 0.43). 30-day complications (adjusted odds ratio, 4.89; 95% confidence interval [CI]: 1.67-14.33) and readmissions (adjusted hazard ratio [aHR] 3.32; 95% CI: 1.16-9.55) were increased in the OS versus ES group when stratified by mFI. Survival analysis showed a correlation between risk of amputation, death, and composite outcome with increasing mFI (P < 0.005) in both groups. Frailty independently predicted major amputation (aHR 2.16; 1.06-4.39), mortality (aHR 2.62; 95% CI: 1.17-5.88), and composite outcome (aHR 1.97; 95% CI: 1.06-3.68) when the groups are combined. Except for absolute neutrophil count, all preoperative lab values correlated with mFI (P < 0.5). Higher albumin was independently associated with lower risk of amputation (aHR: 0.58 [0.36-0.94]) and mortality (aHR: 0.45 [0.25-0.83]); higher hemoglobin predicted limb salvage (aHR 0.7 [0.62-0.84]). CONCLUSIONS: Frailty predicts short- and long-term outcomes after first-time revascularization in veterans. Hypoalbuminemia and anemia are associated with higher mFI and independently predict poor outcome, suggesting albumin and hemoglobin are viable biomarkers of frailty in veterans.


Asunto(s)
Procedimientos Endovasculares/mortalidad , Fragilidad/complicaciones , Enfermedad Arterial Periférica/cirugía , Complicaciones Posoperatorias/epidemiología , Anciano , Biomarcadores/sangre , Fragilidad/sangre , Humanos , Masculino , Persona de Mediana Edad , New York/epidemiología , Enfermedad Arterial Periférica/complicaciones , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Veteranos/estadística & datos numéricos
9.
Health Serv Res ; 54(6): 1346-1356, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31328798

RESUMEN

OBJECTIVE: To compare the costs of Community Nursing Homes (CNHs) to Medical Foster Homes (MFHs) at Veteran Health Administration (VHA) Medical Centers that established MFH programs. DATA SOURCES: Episode and costs data were derived from VA and Medicare files (inpatient, outpatient, emergency room, skilled nursing facility, dialysis, and hospice). STUDY DESIGN: Propensity scores matched 354 MFH to 1693 CNH Veterans on demographics, clinical characteristics, health care utilization, and costs. DATA EXTRACTION METHODS: Data were retrieved for years 2010-2011 from the VA Corporate Data Warehouse, VA Health Data Repository, and the VA MFH Program through the VA Informatics and Computing Infrastructure (VINCI). PRINCIPAL FINDINGS: After matching on unique characteristics of MFH Veterans, costs were $71.28 less per day alive compared to CNH care. Home-based and mental health care costs increased with savings largely attributable to avoiding CNH residential care. When average out-of-pocket payments by Veterans of $74/day are considered, MFH is at least cost neutral. Mortality was 12 percent higher among matched Veterans in CNHs. CONCLUSIONS: MFHs may serve as alternatives to traditional CNH care that do not increase total costs with mortality benefits. Future work should examine the differences for functional disability subgroups.


Asunto(s)
Cuidados en el Hogar de Adopción/economía , Cuidados en el Hogar de Adopción/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Medicare/economía , Medicare/estadística & datos numéricos , Casas de Salud/economía , Casas de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , United States Department of Veterans Affairs/economía , United States Department of Veterans Affairs/estadística & datos numéricos , Veteranos/estadística & datos numéricos
10.
J Altern Complement Med ; 25(9): 902-909, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31328956

RESUMEN

Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders. Design: Retrospective chart review. Settings: Veterans Administration Medical Center (VAMC). Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%). Intervention: Eight-week MBCT class. Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations. Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535). Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.


Asunto(s)
Terapia Cognitivo-Conductual , Trastornos Mentales/terapia , Atención Plena , Aceptación de la Atención de Salud/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Adulto , Terapia Cognitivo-Conductual/métodos , Terapia Cognitivo-Conductual/estadística & datos numéricos , Femenino , Humanos , Masculino , Meditación , Persona de Mediana Edad , Atención Plena/métodos , Atención Plena/estadística & datos numéricos , Estudios Retrospectivos , Trastornos por Estrés Postraumático/terapia , Resultado del Tratamiento , Adulto Joven
11.
J Opioid Manag ; 15(3): 183-191, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31343720

RESUMEN

OBJECTIVE: To characterize primary care physicians' (PCPs') perceptions of the reasons patients receive opioid medications from both VA and non-VA healthcare systems. DESIGN: Qualitative. SETTING: Department of Veterans Affairs (VA). PARTICIPANTS: Forty-two VA PCPs who prescribed opioids to at least 15 patients and who practiced in Massachusetts, Illinois, or Pennsylvania. METHODS: Thirty-minute, semistructured telephone interviews were conducted in 2016, addressing topics regarding PCPs' experiences and perspectives on patients who use both VA and non-VA healthcare systems to obtain prescription opioids. The analysis focused on two questions: attributes that PCPs believe characterize dual-use patients and reasons that PCPs believe patients obtain opioids from both VA and non-VA sources. RESULTS: PCPs identified multiple attributes of, and reasons for, patients obtaining opioid medications from both VA and non-VA healthcare systems, including pain issues, opioid misuse, having healthcare managed through multiple healthcare systems, and transferring care between systems. More than half of the PCPs identified addiction and diversion as key attributes and reasons why patients obtain prescription opioids from multiple sources. PCPs also identified several behavioral and psychological factors as attributes of these patients. CONCLUSIONS: PCPs within the VA have varying perceptions of patients obtaining opioid medications from multiple healthcare systems, with pain complaints and opioid misuse as the primary themes. This knowledge about PCPs' perceptions can be incorporated into interventions to better manage pain and prescription opioid use by VA patients.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Trastornos Relacionados con Opioides , Médicos de Atención Primaria/psicología , Veteranos , Humanos , Massachusetts , Trastornos Relacionados con Opioides/prevención & control , Percepción , Veteranos/estadística & datos numéricos
12.
Am J Public Health ; 109(9): 1233-1235, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31318586

RESUMEN

Objectives. To evaluate the effect of the Affordable Care Act (ACA) on US veterans' access to care.Methods. We used US Behavioral Risk Factor Surveillance System data to compare measures of veterans' coverage and access to care, including primary care, for 3-year periods before (2011-2013) and after (2015-2017) ACA coverage provisions went into effect. We used difference-in-differences analyses to compare changes in Medicaid expansion states with those in nonexpansion states.Results. Coverage increased and fewer delays in care were reported in both expansion and nonexpansion states after 2014, with larger effects among low socioeconomic status (SES) and poor health subgroups. Coverage increases were significantly larger in expansion states than in nonexpansion states. Reports of cost-related delays, no usual source of care, and no checkup within 12 months generally improved in expansion states relative to nonexpansion states, but improvements were small; changes were mixed among veterans with low SES or poor health.Conclusions. Increases in insurance coverage among nonelderly veterans after ACA coverage expansions did not consistently translate into improved access to care. Additional study is needed to understand persisting challenges in veterans' access to care.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Patient Protection and Affordable Care Act/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Humanos , Persona de Mediana Edad , Factores Socioeconómicos , Estados Unidos/epidemiología , Adulto Joven
13.
Int J Occup Med Environ Health ; 32(4): 503­526, 2019 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-31309787

RESUMEN

Objectives: Veterans of the 1991 Gulf War (GW) were exposed to a myriad of potentially hazardous chemicals during deployment. Epidemiological data suggest a possible link between chemical exposures and Parkinson's disease (PD); however, there have been no reliable data on the incidence or prevalence of PD among GW veterans to date. This study included the following 2 questions: 1. Do deployed GW veterans display PD-like symptoms? and 2. Is there a relationship between the occurrence and quantity of PD-like symptoms, and the levels of deployment-related exposures in GW veterans? Material and Methods: Self-reports of symptoms and exposures to deployment-related chemicals were filled out by 293 GW veterans, 202 of whom had undergone 3 Tesla volumetric measurements of basal ganglia volumes. Correlation analyses were used to examine the relationship between the frequency of the veterans' self-reported exposures to deployment-related chemicals, motor and non-motor symptoms of PD, and the total basal ganglia volumes. Results: Healthy deployed GW veterans self-reported few PD-like non-motor symptoms and no motor symptoms. In contrast, GW veterans with Gulf War illness (GWI) self-reported more PD-like motor and non-motor symptoms, and more GW-related exposures. Compared to healthy deployed veterans, those with GWI also had lower total basal ganglia volumes. Conclusions: Although little is known about the long-term consequences of GWI, findings from this study suggest that veterans with GWI show more symptoms as those seen in PD/prodromal PD, compared to healthy deployed GW veterans. Int J Occup Med Environ Health. 2019;32(4):503­26


Asunto(s)
Guerra del Golfo , Exposición Profesional/efectos adversos , Enfermedad de Parkinson/epidemiología , Veteranos/estadística & datos numéricos , Ganglios Basales/diagnóstico por imagen , Disfunción Cognitiva/epidemiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/diagnóstico por imagen , Síndrome del Golfo Pérsico/inducido químicamente , Síndrome del Golfo Pérsico/epidemiología , Plaguicidas/efectos adversos , Prevalencia , Autoinforme , Temblor/epidemiología
15.
Womens Health Issues ; 29 Suppl 1: S15-S23, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253237

RESUMEN

INTRODUCTION: Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a proactive outreach intervention. METHODS: We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing proactive outreach with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to proactive outreach versus UC were compared using logistic regression. RESULTS: Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in proactive outreach as compared with UC. At the 1-year follow-up, men in proactive outreach were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28-2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48-3.99). CONCLUSIONS: Satisfaction with cessation care in VA remains low. Proactive outreach to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.


Asunto(s)
Consejo/métodos , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Fumar/psicología , Fumar/terapia , Veteranos/estadística & datos numéricos , Adulto , Femenino , Hospitales de Veteranos , Humanos , Masculino , Estudios Multicéntricos como Asunto/métodos , Médicos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicología
16.
Womens Health Issues ; 29 Suppl 1: S24-S31, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253239

RESUMEN

BACKGROUND: Chronic pain conditions are common among both male and female Iraq/Afghanistan-era veterans and can have substantial negative impacts on quality of life and function. Although in general women tend to report higher levels of pain intensity than men, findings remain mixed on whether gender differences in pain exist in Iraq/Afghanistan-era veterans. Additionally, the relationships between functional impairment, pain intensity, and gender remain unknown. METHODS: This project examined gender differences in pain intensity and pain interference in 875 male and female Iraq/Afghanistan-era veterans. Nonparametric Wilcoxon rank-tests examined gender differences in pain scores. Multivariable generalized linear regression modeling was used to evaluate the magnitude of pain intensity and interference across levels of chronicity and gender, and to evaluate the role of chronicity in gender effects in measures of pain and function. RESULTS: Pain intensity and interference scores were significantly greater among both male and female veterans reporting chronic pain relative to acute pain. Women veterans endorsed higher levels of pain intensity and pain interference compared with men. Results derived from multivariable analyses implicated pain intensity as a factor underlying gender differences in functional impairment among chronic pain sufferers, indicating that gender differences in functional measures were eliminated after controlling statistically for pain intensity. CONCLUSIONS: Results demonstrate that the effects of functional impairment are impacted by pain intensity, and not by gender.


Asunto(s)
Dolor/epidemiología , Dolor/psicología , Calidad de Vida/psicología , Veteranos/psicología , Adulto , Campaña Afgana 2001- , Afganistán , Femenino , Humanos , Irak , Guerra de Irak 2003-2011 , Masculino , Distribución por Sexo , Factores Sexuales , Estados Unidos , Veteranos/estadística & datos numéricos
17.
Womens Health Issues ; 29 Suppl 1: S32-S38, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253240

RESUMEN

BACKGROUND: Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care. METHODS: Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n = 13,462 women, n = 268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics. RESULTS: The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women. CONCLUSIONS: It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.


Asunto(s)
Prestación de Atención de Salud , Obesidad/psicología , Satisfacción del Paciente , Calidad de la Atención de Salud , Estereotipo , Veteranos/psicología , Adulto , Anciano , Comunicación , Femenino , Hospitales de Veteranos/organización & administración , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Obesidad/terapia , Atención Primaria de Salud , Automanejo , Estados Unidos , United States Department of Veterans Affairs , Veteranos/estadística & datos numéricos , Salud de los Veteranos
18.
Womens Health Issues ; 29 Suppl 1: S39-S46, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253241

RESUMEN

BACKGROUND: The health of women Gulf War (deployed) and Gulf Era (nondeployed) veterans is understudied; although most studies examining the health effects of deployment to the Gulf War adjust for gender in multivariate analyses, gender-specific prevalence and effect measures are not routinely reported. The National Academy of Medicine recommended that the Department of Veterans Affairs assess gender-specific health conditions in large cohort studies of Gulf War veterans. METHODS: Data from this study come from the follow-up study of a national cohort of Gulf War and Gulf Era veterans. This study was conducted between 2012 and 2014, and was the second follow-up of a population-based cohort of Gulf War and Gulf Era veterans that began in 1995. Measures included self-reported medical conditions and frequency of doctor visits as well as validated screening instruments for mental health conditions. RESULTS: Overall, female veterans (both Gulf War and Era) reported poorer health than their male counterparts as measured by the prevalence of self-reported disease. The top five prevalent conditions in both Gulf War and Gulf Era veterans were migraine, hypertension, major depressive disorder, arthritis, and dermatitis. Female Gulf War veterans were found to have a higher prevalence of disease than male Gulf Era veterans. CONCLUSIONS: Women veterans, particularly deployed veterans, from this era have significant medical needs that may justify increased outreach from the Department of Veterans Affairs. Our findings highlight the importance of asking about military service, particularly for women veterans, in the clinical setting, both in the Department of Veterans Affairs and in the private sector.


Asunto(s)
Disparidades en el Estado de Salud , Estado de Salud , Vigilancia de la Población/métodos , Veteranos/estadística & datos numéricos , Adolescente , Adulto , Artritis/epidemiología , Estudios de Cohortes , Trastorno Depresivo Mayor/epidemiología , Dermatitis/epidemiología , Femenino , Estudios de Seguimiento , Guerra del Golfo , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Prevalencia , Autoinforme , Distribución por Sexo , Estados Unidos/epidemiología , Veteranos/psicología , Adulto Joven
19.
Womens Health Issues ; 29 Suppl 1: S47-S55, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253242

RESUMEN

OBJECTIVE: The 1990-1991 Gulf War employed more women servicemembers than any prior conflict. Gender-based differences among veterans of this era have yet to be explored. This study is among the first and most recent to stratify Gulf War veteran demographics, lifestyle factors, and self-reported diagnoses by gender. METHODS: Data from the cross-sectional Gulf War Era Cohort and Biorepository pilot study (n = 1,318; collected between 2014 and 2016), including users and nonusers of the Veterans Health Administration, were used to calculate demographics and adjusted odds ratios. RESULTS: Women veterans were oversampled and comprised approximately 23% of the sample. Women reported similar rates of Veterans Health Administration use (44%) and deployment (67%) as men (46% and 72%, respectively). Women were less likely than men to report frequent alcohol use (adjusted odds ratio [aOR], 0.59; 95% confidence interval [CI], 0.43-0.81; p = .0009) or have a history of smoking (aOR, 0.65; 95% CI, 0.49-0.84; p = .0014). Among common health conditions, women were more likely than men to report a diagnosis of osteoporosis (aOR, 4.24; 95% CI, 2.39-7.51; p < .0001), bipolar disorder (aOR, 2.15; 95% CI, 1.15-4.04; p = .0167), depression (aOR, 2.39; 95% CI, 1.81-3.16; p < .0001), irritable bowel syndrome (aOR, 2.10; 95% CI, 1.43-3.09; p = .0002), migraines (aOR, 2.96; 95% CI, 2.18-4.01; p < .0001), asthma (aOR, 1.86; 95% CI, 1.29-2.67; p = .0008), and thyroid problems (aOR, 4.60; 95% CI, 3.14-6.73; p < .0001). Women were less likely than men to report hypertension (aOR, 0.55; 95% CI, 0.41-0.72; p < .0001), tinnitus (aOR, 0.46; 95% CI, 0.33-0.63; p < .0001), and diabetes (aOR, 0.44; 95% CI, 0.28-0.69; p = .0003). CONCLUSIONS: Health differences exist between female and male veterans from the 1990-1991 Gulf War. Gender-specific analyses are needed to better understand the unique health care needs of Gulf War Era veterans and direct future research.


Asunto(s)
Depresión/epidemiología , Conductas Relacionadas con la Salud , Disparidades en el Estado de Salud , Estilo de Vida , Veteranos/psicología , Adulto , Anciano , Estudios de Cohortes , Estudios Transversales , Depresión/psicología , Femenino , Guerra del Golfo , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prevalencia , Autoinforme , Distribución por Sexo , Estrés Psicológico/complicaciones , Encuestas y Cuestionarios , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Veteranos/estadística & datos numéricos
20.
Womens Health Issues ; 29 Suppl 1: S67-S73, 2019 06 25.
Artículo en Inglés | MEDLINE | ID: mdl-31253245

RESUMEN

OBJECTIVES: Military sexual trauma (MST) is a pervasive problem among veterans, and is associated with a host of deleterious outcomes. It is, therefore, imperative to identify individuals who have experienced MST so that they can be offered appropriate treatment. To determine how to best identify MST survivors, the current study examined how different assessment modalities might affect MST endorsement, and whether endorsement varied as a product of demographic group membership. METHODS: Data from 697 male and female veterans participating in the Veterans' After-Discharge Longitudinal Registry (Project VALOR) were used to examine how three different MST assessment modalities-the Veterans Health Administration screen, a study interview, and a study questionnaire measure-might affect MST endorsement across five different demographic variables (gender, ethnicity, sexual orientation, race, and age). Each participant was evaluated for MST exposure using each of the three assessment modalities. RESULTS: Both assessment modality and demographic membership influenced MST endorsement. MST endorsement on the study measures was consistently twice as large as on the Veterans Health Administration screen, across demographic groups. For men, MST endorsement varied by a factor of 11 across measures, with endorsement being lowest on the Veterans Health Administration screen and highest on the study questionnaire. Although differences were also detected for sexual minority and Black participants, these findings may have been better explained by gender differences. CONCLUSIONS: Both assessment modality and demographic membership substantially influenced MST endorsement. Providing a clear rationale for screening and increasing privacy around screening results, particularly for male veterans, may help to facilitate MST disclosure.


Asunto(s)
Tamizaje Masivo/métodos , Personal Militar , Delitos Sexuales/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Adulto , Revelación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Delitos Sexuales/psicología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Veteranos/psicología , Salud de los Veteranos
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