Effects of Military Trauma Exposure on Women Veterans’ Use and Perceptions of Veterans Health Administration Care

Background  Few studies have addressed how military trauma exposure, particularly sexual assault and combat exposure, affects women veterans’ use and perceptions of Veterans Health Administration (VHA) care. Objective  The aim of the present study was to evaluate the effects of military sexual assault and combat exposure on women veterans’ use and perceptions of different aspects of VHA care. Design  Cross-sectional telephone survey of a national sample of women veterans. Participants  Women from the VA’s National Registry of Women Veterans. Measurements  Sociodemographic characteristics, VHA care utilization, perceptions of care. Results  Women veterans with histories of military sexual assault reported more use of VHA services, but less satisfaction, poorer perceptions of VHA facilities and staff, and more problems with VHA services compared to women veterans without histories of sexual assault. Combat exposure was related to more problems with VHA staff, although few other differences were observed for women with and without histories of combat exposure. Conclusions  Findings provide information on areas that can be targeted with respect to caring for women veterans exposed to military sexual trauma and combat exposure, including improving interactions with VHA staff and the ease of using VHA services.     

Women Veterans’ Healthcare Delivery Preferences and Use by Military Service Era: Findings from the National Survey of Women Veterans

BACKGROUND

The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis.

OBJECTIVE

To identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness.

DESIGN AND PARTICIPANTS

Cross-sectional 2008–2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population.

MAIN MEASURES

Healthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era.

KEY RESULTS

Military service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women’s health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras.

CONCLUSIONS

Our findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs’ higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.

     

Protecting the delivery of heart failure: Regenerative Medicine/Stem Cell Therapeutics: Potential protections afforded by the Department of Health and Human Services and Health Resources Service Administration‘s Bureau of Special Programs

Abbreviations CBER Center for Biologics Evaluation and Research DOJ Department of Justice DoT Division of Transplantation (in HRSA) FDA Food and Drug Administration FTCA Federal Tort Claims Act GMP Good Manufacturing Processes GTP Good Tissue Processes HCT/P Human Cells, Tissues and Cell/Tissue Products HHS Department of Health and Human Services HIPAA Health Information Portability and Accountability Act HRSA Health Resources Service Administration HRSA/SPB …     

What Do We Mean by Older Adult and Physical Activity? Reviewing the Use of These Terms in Recent Research

As our global population ages, physical activity has been found to be an important dimension of healthy aging. Many research fields use the terms “older adult” and “physical activity,” but differences in how these terms are defined and conceptualized can impair interpretation and comparison. As such, the purpose of this review was to determine how recent peer-reviewed articles defined, conceptualized, and operationalized the terms “older adult” and “physical activity.” Gaps in the literature resulting from considerable variation in term use and operationalization are discussed. Measures such as functional ability may be useful in addition to chronological age when describing a sample of “older adults,” while a number of age-specific considerations for physical activity measurement are presented. By illustrating the variability in how these two terms are used in the literature and outlining considerations for conceptualization and assessment, this article provides guidance for future study in the field of aging and physical activity.     

Alcohol Dependence,Other Psychiatric Disorders,and Health‐Related Quality of Life: A Replication Study in a Large Random Sample of Enrollees in the Veterans Health Administration

The purpose of this study was to investigate the relationship between alcohol dependence and health‐related quality of life (HRQoL) in people with and without other selected psychiatric disorders. A sample of 127,308 Veterans Health Administration enrollees completed a survey that included questions about alcohol use and the Veterans SF‐36, a well‐validated measure of HRQoL. In addition, a Veterans Administration database was used to obtain respondents' past‐year history of alcohol dependence and other psychiatric disorders. Comorbid psychiatric disorders significantly moderated or attenuated the relationship between alcohol dependence and HRQoL. Respondents with a history of alcohol dependence plus one or more other psychiatric disorders had significantly lower HRQoL in domains pertaining to psychological and social functioning than respondents with alcohol dependence only. Effect size differences (mean differences of clinical groups/pooled standard deviation) were large (greater than 0.80 of one standard deviation). Respondents with a history of alcohol dependence only vs. no history of alcohol dependence had poorer HRQoL. Effect size differences were small to moderate (between 0.20 and 0.50 of one standard deviation). Findings highlight the important moderating influence of comorbid psychiatric disorders in the relationship between alcohol dependence and HRQoL. As comorbid psychiatric disorders are often associated with poorer treatment outcome, findings also provide strong corroboration for the importance of treating other psychiatric disorders concurrently with alcohol dependence.     

Do the Effects of Pentoxifylline on the Inflammatory Process and Pancreatic Infection Justify Its Use in Acute Pancreatitis?

Severe acute pancreatitis is associated with high morbidity and mortality rates. At the present time, no specific therapy has been shown to be uniformly effective in reducing morbidity and mortality in this disease. The aim of this study was to determine the effects of pentoxifylline on the pancreatic and systemic inflammatory process, pancreatic infection, and mortality rate in severe acute pancreatitis in rats. Methods: One hundred and twenty male Wistar rats were divided into 3 groups: sham, pancreatitis, and pentoxifylline (acute pancreatitis induction plus administration of 25 mg/kg pentoxifylline). Inflammatory response was measured by histological studies, inflammatory cytokine production (IL-6, IL-10, and TNF-α), and mortality rate. Pancreatic infection was evaluated by bacterial cultures expressed in colony-forming units per gram. Results: Pentoxifylline-treated animals had a statistically significant reduction of inflammatory cytokine levels, pancreatic histological damage, occurrence of bacterial translocation and pancreatic infection (p< 0.05), associated with a significant reduction in mortality rate. Conclusions: Pentoxifylline administration in this experimental model of acute pancreatitis reduces local and systemic inflammatory responses and decreases the pancreatic infection and the mortality rate.     

Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses' Health Study

OBJECTIVE: To explore the contribution of female hormonal factors occurring prior to the onset of rheumatoid arthritis (RA), such as age at menarche, parity, age at first birth, breast-feeding, use of oral contraceptives (OCs), irregular menstrual cycles, and postmenopausal hormone (PMH) use, to the subsequent development of RA in a large female cohort. METHODS: We studied female reproductive and hormonal risk factors for RA in a cohort of 121,700 women enrolled in the longitudinal Nurses' Health Study. The diagnosis of incident RA (between 1976 and 2002) in 674 women was confirmed by a connective tissue disease screening questionnaire and blinded medical record review for American College of Rheumatology criteria. Sixty percent of the patients with RA were rheumatoid factor positive. The relationship between potential risk factors, including age, age at menarche, parity, age at first birth, total lifetime history of breast-feeding, use of OCs, and irregular menstrual cycles and the multivariate-adjusted risk of RA was estimated using Cox proportional hazards models. RESULTS: Using a multivariate model that adjusted for age, body mass index, smoking, parity, and other hormonal factors, we observed a strong trend for decreasing risk of RA with increasing duration of breast-feeding (P for trend = 0.001). For women who breast-fed (compared with parous women who did not breast-feed), the risk ratios (RRs) and 95% confidence intervals (95% CIs) were as follows: breast-feeding for < or =3 total months, RR 1.0 (95% confidence interval [95% CI] 0.8-1.2); for 4-11 total months, RR 0.9 (95% CI 0.7-1.1); for 12-23 total months, RR 0.8 (95% CI 0.6-1.0); and for > or =24 total months, RR 0.5 (95% CI 0.3-0.8). Very irregular menstrual cycles were associated with an increased risk of RA (RR 1.4, 95% CI 1.0-2.0). Age at menarche < or =10 years was associated with an increased risk of seropositive RA (RR 1.6, 95% CI 1.1-2.4) but not significantly associated with risk of RA. Parity, total number of children, age at first birth, and OC use were not associated with an increased risk of RA in this cohort. CONCLUSION: In this large cohort, breast-feeding for >12 months was inversely related to the development of RA. This apparent effect was dose-dependent, with a significant trend toward lower risk with longer duration of breast-feeding. Irregular menstrual cycles and earlier age at menarche increased the risk of RA. Other reproductive hormonal factors were not associated with RA risk.     

Do Changes in Sex Steroid Hormones Precede or Follow Increases in Body Weight during the Menopause Transition? Results from The Study of Women's Health Across the Nation

Context: Whether menopause-related changes in sex steroids account for midlife weight gain in women or whether weight drives changes in sex steroids remains unanswered. Objective: The objective of the study was to characterize the potential reciprocal nature of the associations between sex hormones and their binding protein with waist circumference in midlife women. Design, Setting, and Participants: The study included 1528 women (mean age 46 yr) with 9 yr of follow-up across the menopause transition from the observational Study of Women's Health Across the Nation. Main Outcome Measures: Waist circumference, SHBG, testosterone, FSH, and estradiol were measured. Results: Current waist circumference predicted future SHBG, testosterone, and FSH but not vice versa. For each sd higher current waist circumference, at the subsequent visit SHBG was lower by 0.04-0.15 sd, testosterone was higher by 0.08-0.13 sd, and log(2) FSH was lower by 0.15-0.26 sd. Estradiol results were distinct from those above, changing direction across the menopause transition. Estradiol and waist circumference were negatively associated in early menopausal transition stages and positively associated in later transition stages (for each sd higher current waist circumference, future estradiol was lower by 0.15 sd in pre- and early perimenopause and higher by 0.38 sd in late peri- and postmenopause; P for interaction <0.001). In addition, they appeared to be reciprocal, with current waist circumference associated with future estradiol and current estradiol associated with future waist circumference. However, associations in the direction of current waist circumference predicting future estradiol levels were of considerably larger magnitude than the reverse. Conclusions: These Study of Women's Health Across the Nation data suggest that the predominant temporal sequence is that weight gain leads to changes in sex steroids rather than vice versa.     

Guidelines for management of osteoarthritis published by the American College of Rheumatology and the European League Against Rheumatism: why are they so different?

Because of different methodology the ACR and EULAR guidelines differ significantly in their recommendations despite an identical evidence base. Guidelines that use a strictly evidence-based approach are less likely to incur bias than those that rely more on expert consensus. Although expert consensus is useful in areas in which there are little trial data, clear delineation should be made between evidence-based statements and expert opinion. Following the dissemination of guidelines for the management of OA, emphasis should now be placed on discussion and implementation of the recommendations and subsequent revision of guidelines as new evidence comes to light.