Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: comorbid conditions and self-rated health status

OBJECTIVES: Assess the prevalence of posttraumatic stress disorder (PTSD) symptomatology and its association with health characteristics in a geriatric primary care population. DESIGN: Cross‐sectional screening assessments during a multisite trial for the treatment of depression, anxiety, and at‐risk drinking. SETTING: Department of Veterans Affairs (VA)‐based primary care clinics across the United States. PARTICIPANTS: Seventeen thousand two hundred five veterans aged 65 and older. MEASUREMENTS: Sociodemographic information, the General Health Questionnaire (GHQ‐12), questions about death wishes and suicidal ideation, quantity and frequency of alcohol use, smoking, exposure to traumatic events, and PTSD symptom clusters. RESULTS: Twelve percent (2,041/17,205) of participants screened endorsed PTSD symptoms. Veterans with PTSD symptoms from some (partial PTSD) or each (PTSD all clusters) of the symptom clusters were significantly more likely to report poor general health, currently smoke, be divorced, report little or no social support, and have a higher prevalence of mental distress, death wishes, and suicidal ideation than those with no trauma history or those with trauma but no symptoms. Group differences were most pronounced for mental distress and least for at‐risk drinking. Presence of PTSD all clusters was associated with poorer outcomes on all of the above‐mentioned health characteristics than partial PTSD. CONCLUSION: PTSD symptoms are common in a substantial minority of older veterans in primary care, and careful inquiry about these symptoms is important for comprehensive assessment in geriatric populations.     

Substance use comorbidity among veterans with posttraumatic stress disorder and other psychiatric illness

There is considerable concern about the emergence of significant substance abuse among younger veterans of war in the Middle East, especially among those with Posttraumatic Stress Disorder (PTSD), but little information exists on the magnitude of this problem. Using national administrative data from the Department of Veterans Affairs (VA) (n = 1,001,996), we examined rates of diagnosed substance use disorders in Veterans who served in Iraq and Afghanistan diagnosed with PTSD compared to other psychiatric disorders; and compared rates among veterans of other service eras. Of VA patients with a selected mental disorder, 21.0% had a comorbid substance diagnosis. Veterans who served in the post-Vietnam era (VET) (1973-1991) had the highest rates of comorbidity. Logistic regression models indicated that veterans with each selected psychiatric diagnosis were significantly more likely to be dually diagnosed in comparison to veterans with PTSD; post-Vietnam veterans were significantly more likely to be dually diagnosed than veterans from other eras. Bipolar disorder and schizophrenia are most strongly associated with dual diagnosis in OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. There are high rates of substance use disorders among veterans with mental illness. The highest rates of comorbidity occur among those with bipolar disorder and schizophrenia; and in post-VET veterans.     

Patterns of cytomegalovirus infection in simultaneous kidney–pancreas transplant recipients receiving tacrolimus, mycophenolate mofetil, and prednisone with ganciclovir prophylaxis

Abstract: Background: The impact of tacrolimus (TAC), mycophenolate mofetil (MMF) and steroid immunosuppression on cytomegalovirus (CMV) infection in combination with ganciclovir prophylaxis in simultaneous kidney–pancreas transplantation (SKPT) has not been well studied. Methods: A retrospective analysis was made of 75 SKPTs performed between 1 January 1996 and 7 January 1999. All patients received ganciclovir for 3 months, but CMV donor (D)+/ recipient (R)? patients received ganciclovir for 6 months. Results: 16/74 (22%) were CMV D+/R?, 25 (33%) D+/R+, 16 (22%) D?/R+, and 17 (23%) D?/R? (1 patient with unknown donor serology was excluded). The mean time to CMV infection was 198 days post‐transplant. The incidence of either CMV infection or tissue invasive CMV disease was 16/74 (22%), including 9 (12%) with CMV infection and 7 (10%) CMV disease. The one‐year patient, kidney, and pancreas graft survival rates were 91%, 89%, and 83%, respectively. The mean follow‐up was 29 months (minimum of 12 months). CMV infection was not associated with an increased incidence of graft failure or mortality. The D+/R? group had the highest incidence of CMV infection (44%) compared with the other serologic groups (17%, P=0.02). Concurrent CMV and rejection occurred more frequently in the D+/R? than the other serologic groups (25% vs. 7%, P=0.03). The D?/R? group had the best outcomes, with no CMV infection, improved kidney graft survival at the end of follow‐up (82% vs. 72%, P=0.04) and the highest event‐free survival (no CMV infection, rejection, or graft loss) when compared to the other groups (76% vs. 33%, P<0.01). Conclusions: Compared to previous studies, ganciclovir prophylaxis delayed the onset and reduced the severity of CMV infection in patients receiving TAC, MMF, and steroids. Despite ganciclovir prophylaxis, CMV seronegative patients receiving CMV D+ organs had worse outcomes than seronegative recipients receiving CMV D? organs.     

The impact of posttraumatic stress disorder on upper gastrointestinal investigations in Australian Defence Force veterans: a retrospective review

Veterans with posttraumatic stress disorder (PTSD) commonly exhibit associated gastrointestinal (GI) symptoms. We compared upper GI endoscopy and abdominal ultrasound rates in veterans with and without PTSD. Veterans with PTSD were 77–81% more likely to undergo these procedures than those without PTSD. PTSD symptomatology influences GI investigation rate and more emphasis on clinician and patient education is recommended regarding stress-related gut symptoms.     

Comparison of attitudes towards the service connection claims process among veterans filing for PTSD and veterans filing for musculoskeletal disorders

Many veterans have negative views about the service connection claims process for posttraumatic stress disorder (PTSD), which likely impacts willingness to file service connection claims, re-file claims, and use Veterans Healthcare Administration care. Nevertheless, veterans have reported that PTSD claims are important to them for the financial benefits, validation of prior experience and harm, and self-other issues such as pleasing a significant other. It is unknown if reported attitudes are specific to PTSD claimants or if they would be similar to those submitting claims for other disorders, such as musculoskeletal disorders. Therefore, the purpose of this study was to compare attitudes and beliefs about service connection processes between veterans submitting service connection claims for PTSD and musculoskeletal disorders.Participants were Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans filing service connection claims for PTSD (n = 218) or musculoskeletal disorder (n = 257) who completed a modified Disability Application Appraisal Inventory. This secondary data analysis using multiple regression models tested the effect of demographics, clinical characteristics, and claim type on 5 Disability Application Appraisal Inventory subscales: Knowledge about service connection claims, Negative Expectations about the process, and importance of Financial Benefits, importance of Validation of veteran''s experience/condition, and importance of Self-Other attitudes.The PTSD group assigned significantly less importance to financial benefits than the musculoskeletal disorder group. In addition, the subset of the PTSD group without depression had significantly more Negative Expectations than musculoskeletal disorder claimants without depression. Negative Expectations did not differ between the PTSD and musculoskeletal disorder groups with depression. Depression was significantly positively associated with Negative Expectations, importance of Financial Benefits, and importance of Validation.Most perceptions around seeking service connection are not specific to PTSD claimants. Depression is associated with having negative expectations about service connection claims and motivations to file claims. Addressing depression and negative expectations during the compensation and pension process might help veterans at this important point of contact with Veterans Healthcare Administration services.     

Chronic kidney disease: a risk factor for dementia onset: a population-based study. The Osaki-Tajiri Project

OBJECTIVES: To examine the relationship between the incidence of dementia and chronic kidney disease (CKD). DESIGN: Longitudinal data analyses. SETTING: Baseline data and follow‐up data from the Osaki‐Tajiri Project. PARTICIPANTS: The Tajiri Project dementia prevalence study in 1998 involved 497 community‐dwelling, older men and women (346 with Clinical Dementia Rating score (CDR) of 0 (healthy), 119 with a CDR of 0.5 (questionable dementia), and 32 with a CDR of 1 or greater (dementia)). Two hundred fifty‐four participants with CDR of 0 and 0.5 who were reclassified as converters (n=28) or nonconverters (n=230) to dementia in the incidence study in 2003 were followed. MEASUREMENTS: The prevalence of CKD and the onset of dementia were retrospectively analyzed, and the effects of other vascular risk factors on converters and CKD were analyzed. RESULTS: Weighted logistic regression showed CKD to be significantly associated with incident dementia after adjustment for age, sex, education, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, and anemia. The odds ratio for conversion to dementia for those with CKD compared to those without was 5.3 (95% confidence interval=1.7, 16.2). Apart from dyslipidemia, there were no associations between dementia and the other vascular risk factors. CONCLUSION: CKD was strongly associated with the incidence of dementia independent of age, sex, education, and other vascular risk factors.     

Hyperthyroidism and pulmonary hypertension

In recent years, many authors have described several cases revealing an association between hyperthyroidism and pulmonary hypertension (PH). This observational study was designed to evaluate the incidence of PH in hyperthyroidism and was set in a department of internal medicine and pulmonary diseases with an out-patients department of endocrinology. Thirty-four patients, 25 women and nine men, with a mean age of 38 +/- 15 SD years participated. Twenty had Graves' disease and 14 had a nodular goitre. The patients were divided into two equally matched groups: those with a recently diagnosed hyperthyroidism, taking no drugs (group 1; n = 17) and those in a euthyroid state taking methimazole (group 2; n= 17). Transthoracic Doppler echocardiography was performed and systolic pulmonary artery pressurements of (PAPs) was determined by the tricuspid regurgitation method using the Bernoulli equation. Measurements of triiodothyronine, tetraiodothyronine, free thyroxine (Ft4), thyroid-stimulating hormone (TSH) and antithyroglobulin and antimicrosomal antibodies were also taken. We found a mild PH in seven patients of group 1 and in none of group 2.The mean +/- SD systolic pulmonaryartery pressurewas 28.88 +/- 6.41 in group 1 and 22.53 +/- 1.84 ingroup 2 (P<0.0001). A correlation was found between the TSH value and PAPs (r = -082;P < 0.001) and Ft4 and PAPs (r = 0 85; P < 0.001) in group 1. These findings indicate the presence of a frequent association between PH and hyperthyroidism. We suggest that hyperthyroidism be included in the differential diagnosis of PH.     

Different polysomnographic patterns in military veterans with obstructive sleep apnea in those with and without post-traumatic stress disorder

Introduction and objectives

Obstructive sleep apnea (OSA) is a prevalent disorder among military veterans. The goal of this study is to compare the polysomnographic patterns of OSA in military veterans who have a history of post-traumatic stress disorder (PTSD) with those of veterans who have not PTSD.

Materials and methods

Seventy-two Iranian military male veterans were classified into two groups: those with PTSD (40 cases) and those without PTSD (32 cases). Each participant was diagnosed with OSA using an overnight polysomnography, during which sleep-related parameters such as sleep efficiency (SE) and apnea-related events were detected. The body mass index (BMI) and Epworth Sleepiness Scale (ESS) were also assessed.

Results

For the PTSD group, mean age was 53.83?±?7.3 years, elapsed time since they participated in war was 28.3?±?3.4 years, apnea-hypopnea index (AHI) was 41.2?±?27, SE was 77.7?±?17.55%, ESS was 7.93?±?2.04, BMI was 26.5?±?5.7, and PLM index was 12.725?±?8.64. The above respective parameters for the non-PTSD group were 51.33?±?5.9 years, 28.3?±?3.4 years, 30.33?±?14.7, 82.4?±?15.65%, 10.08?±?3.02, 31.5?±?6.7, and 8.8?±?3.54. The relationships of AHI with ESS and BMI were not significant in PTSD group.

Conclusion

OSA in military veterans suffering from PTSD presents more often with insomnia than obesity or increased daytime sleepiness. These findings are different from those typically seen in non-PTSD veterans with OSA.

     

Post-traumatic stress disorder is associated with a higher rate of polypectomy independent of an increased frequency of colonoscopy in Australian veterans: a retrospective review

Background

Post-traumatic stress disorder (PTSD) is associated with extensive physical comorbidities, including lower gastrointestinal symptoms. Diagnostic uncertainty and poor therapeutic responses may result in more frequent colonoscopies than clinically necessary. Polypectomy is standard practice when polyps are identified, and if PTSD is a risk factor for polyp formation, one would expect a higher rate of polyp detection and removal in veterans with PTSD than those without PTSD.

Aim

To determine the association between PTSD and the rate of colonoscopy and polypectomy in Australian veterans.

Methods

Diagnostic and therapeutic colonoscopy rates in Australian male Veterans aged ≥50 years were examined by reviewing case records of veterans who accessed Department of Veterans' Affairs funded health services between 1 January 2013 and 31 December 2018.

Results

A total of 138 471 veterans was included, of whom 28 018 had a diagnosis of PTSD; 56.4% were aged ≥65 years. Twenty-one percent of the entire cohort underwent at least one colonoscopy during the study period. Increased rates of diagnostic colonoscopy and polypectomy were associated with the presence of PTSD across all age brackets. The effect was empirically large as veterans with PTSD experience colonoscopy rates 76–81% greater than those without PTSD. Similarly, veterans with PTSD experienced polypectomy rates 76–81% greater than veterans without PTSD, and this increase persisted when controlling for the increased number of diagnostic colonoscopies they undergo.

Conclusion

The presence of PTSD has a marked impact on colonoscopy rates in Australian veterans. The increased polypectomy rate independent of increased colonoscopy rate suggests that PTSD is a risk factor for colonic polyp formation.     

Burden of medical illness in women with depression and posttraumatic stress disorder

BACKGROUND: Depression and posttraumatic stress disorder (PTSD) are important women's health issues. Depression is known to be associated with poor physical health; however, associations between physical health and PTSD, a common comorbidity of depression, have received less attention. OBJECTIVES: To examine number of medical symptoms and physical health status in women with PTSD across age strata and benchmark them against those of women with depression alone or with neither depression nor PTSD. METHODS: A random sample of Veterans Health Administration enrollees received a mailed survey in 1999-2000 (response rate, 63%). The 30 865 women respondents were categorized according to whether a health care provider had ever told them that they had PTSD, depression (without PTSD), or neither. Outcomes were self-reported medical conditions and physical health status measured with the Veterans SF-36 instrument, a version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) modified for use in veteran populations. RESULTS: Across age strata, women with PTSD (n = 4348) had more medical conditions and worse physical health status (physical functioning, role limitations due to physical problems, bodily pain, and energy/vitality scales from the Veterans SF-36) than women with depression alone (n = 7580) or neither (n = 18 937). In age-adjusted analyses, the Physical Component Summary score was on average 3.4 points lower in women with depression alone and 6.3 points lower in women with PTSD than in women with neither (P<.001). CONCLUSIONS: Posttraumatic stress disorder is associated with a greater burden of medical illness than is seen with depression alone. The presence of PTSD may account for an important component of the excess medical morbidity and functional status limitations seen in women with depression.     

Prevalence and fate of severe pulmonary hypertension in 559 consecutive patients with severe rheumatic mitral stenosis undergoing mitral balloon valvotomy

BACKGROUND AND AIM OF THE STUDY: The prevalence of severe pulmonary hypertension (PH) in patients with severe mitral stenosis (MS) remains unknown, and the long-term effect of mitral balloon valvotomy (MBV) in large numbers of these patients is not well characterized. METHODS: Details from the prospective MBV database at the authors' institution relating to 559 consecutive patients who had successful MBV were analyzed. Patients were allocated to three groups on the basis of their pulmonary artery systolic pressure (PASP) at cardiac catheterization immediately before MBV: group A (n = 345) had PASP <50 mmHg; group B (n = 183) had PASP 50-79 mmHg; and group C (n = 31) had PASP > or =80 mmHg. Patients were evaluated clinically and echocardiographically at six months after MBV, and annually thereafter for up to 13 years. RESULTS: No mortality was encountered after MBV. Immediately after MBV, the mean PASP was 38.5+/-6.8 mmHg in group A (mild PH), 59.0+/-7.7 mmHg in group B (moderately severe PH), and 97.8+/-17.0 mmHg in group C (severe PH). At follow up (ca. 4 years), Doppler-monitored PASP fell to normal, and was similar in groups A, B and C (29+/-8, 31+/-9, and 29+/-5 mmHg, respectively; p = NS). CONCLUSION: MBV was shown to be safe and effective in treating patients with MS and severe PH. The latter condition regressed to normal levels over 6-12 months after successful MBV.     

Hepatitis C tested prevalence and comorbidities among veterans in the US Northwest

GOALS: (1) Investigate the epidemiology of hepatitis C virus infection among patients seen in the Veterans Administration Northwest Network; (2) examine time trends in testing practices and results; and (3) estimate the prevalence of hepatitis C virus infection among active patients. BACKGROUND: Hepatitis C virus infection causes chronic hepatitis and cirrhosis and is a leading cause of end-stage liver disease. Hepatitis C virus antibodies are estimated to be present in 1.8% of the US population, but reports of its prevalence among US veterans range from 1.7 to 35%. STUDY: Retrospective review of computerized medical records of veterans tested for hepatitis C from October 1994 through December 2000 (n = 37,938) at 8 Northwest Veterans Administration Medical Centers. RESULTS: Among tested veterans, 8230 (21.7%) had evidence of hepatitis C virus infection. The number of patients tested increased annually from 2335 to 18,191, while the proportion with first-time positive hepatitis C test results decreased from 35 to 10%. This drop in tested prevalence was associated with a shift away from testing individuals at highest risk--those with positive hepatitis B serostatus, repeatedly elevated alanine transaminase levels, and drug use disorder diagnoses. We estimate that 11.4% of the Northwest Network veteran users are hepatitis C virus seropositive, with a lower bound of 4.0% and upper bound of 19.5%. CONCLUSIONS: Although estimates of hepatitis C virus infection rates among veteran users of the Veterans Administration system remain higher than those for the general population, changes in testing practice make generalizations from earlier studies hazardous.     

Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial

Background/Objectives

Dementia‐related behavioral symptoms and functional dependence result in poor quality of life for persons with dementia and their caregivers. The goal was to determine whether a home‐based activity program (Tailored Activity Program; TAP ‐VA ) would reduce behavioral symptoms and functional dependence of veterans with dementia and caregiver burden.

Design

Single‐blind (interviewer), parallel, randomized, controlled trial (Clinicaltrials.gov: NCT 01357564).

Setting

Veteran's homes.

Participants

Veterans with dementia and their family caregivers (N = 160 dyads).

Intervention

Dyads in TAP ‐VA underwent 8 sessions with occupational therapists to customize activities to the interests and abilities of the veterans and educate their caregivers about dementia and use of customized activity. Caregivers assigned to attention control received up to 8 telephone‐based dementia education sessions with a research team member.

Measurements

Primary outcomes included number of behaviors and frequency of their occurrence multiplied by severity of occurrence; secondary outcomes were functional dependence, pain, emotional well‐being, caregiver burden (time spent caregiving, upset with behaviors) and affect at 4 (primary endpoint) and 8 months.

Results

Of 160 dyads (n = 76 TAP ‐VA ; n = 84 control), 111 completed 4‐month interviews (n = 51 TAP ‐VA ; n = 60 control), and 103 completed 8‐month interviews (n = 50 TAP ‐VA ; n = 53 control). At 4 months, compared to controls, the TAP ‐VA group showed reductions in number (difference in mean change from baseline = ?0.68, 95% CI = ?1.23 to ?0.13) and frequency by severity (?24.3, 95% CI = ?45.6 to ?3.1) of behavioral symptoms, number of activities needing assistance with (?0.80, 95% CI = ?1.41 to ?0.20), functional dependence level (4.09, 95% CI = 1.06, 7.13), and pain (?1.18, 95% CI = ?2.10 to ?0.26). Caregivers of veterans in TAP ‐VA reported less behavior‐related distress. Benefits did not extend to 8 months.

Conclusion

TAP ‐VA had positive immediate effects and no adverse events. Because TAP ‐VA reduces behavioral symptoms, slows functional dependence, and alleviates pain and caregiver distress, it is a viable treatment option for families.

     

Positive Psychological Factors are Linked to Successful Cognitive Aging Among Older Persons Living with HIV/AIDS

We aimed to characterize successful cognitive aging (SCA) among older HIV-infected (HIV+) and HIV-uninfected (HIV?) adults, and to determine associations with positive psychological factors and health-related quality of life (HRQoL). Ninety-nine HIV+ and 46 HIV? older adults (≥ 50 years) completed measures of neurocognition, positive psychological factors, and HRQoL. Using study-defined SCA criteria (i.e., no cognitive or everyday impairment or major depressive disorder), we compared positive psychological factors and HRQoL across four groups: HIV+/SCA+, HIV+/SCA?, HIV?/SCA+, HIV?/SCA?. SCA was identified in 29% of the HIV+ sample compared to 61% of the HIV? sample (p < 0.01). HIV+/SCA+ participants had higher scores on 8 of 10 measures of positive psychological factors as well as better HRQoL (ps < 0.05) as compared to the HIV+/SCA? group. Furthermore, the HIV+/SCA+ participants had comparable scores on these factors as HIV? adults. Fewer HIV+ than HIV? participants met SCA criteria; however, the level of positive psychological factors among the HIV+/SCA+ group was comparable to the HIV? sample. Our findings present opportunities for interventions to optimize positive psychological factors and potentially improve SCA among older HIV+ adults.     

Prevalence of dyspepsia, heartburn, and peptic ulcer disease in veterans

OBJECTIVE: Medications used to treat gastrointestinal symptoms account for a substantial share of pharmacy expenses for veterans affairs medical centers. Prior studies have shown that the prevalence of peptic ulcer disease is higher in veterans than in nonveterans. Our aim was to determine the prevalence of upper gastrointestinal symptoms among patients seeking health care in the Department of Veterans Affairs outpatient clinics. METHODS: A total of 1582 veterans completed a previously validated bowel symptom questionnaire in the following clinics: gastroenterology (n = 693), walk-in (n = 403), general medicine (n = 379), and women's health (n = 107). RESULTS: Overall response was 78%. Dyspepsia was reported in 30%, 37%, 44%, and 53% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Heartburn, at least weekly, was reported in 21%, 21%, 28%, and 40% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Prior peptic ulcer disease (PUD) was reported in 29%, 26%, 22%, and 44% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Dyspepsia, heartburn, and PUD were significantly associated with increased physician visits and lower general health. CONCLUSIONS: Dyspepsia and heartburn are common symptoms among veterans. Lifetime prevalence of PUD is high among veterans. Gastrointestinal symptoms have a significant impact on health care utilization and general health. These prevalence estimates provide a basis for studies of resource utilization and for cost-effectiveness analyses of the treatment of gastrointestinal disorders in the veteran population. Moreover, the high prevalence of symptoms helps to explain the high utilization of gastrointestinal medications.     

Pulmonary hypertension in patients with chronic renal failure: role of parathyroid hormone and pulmonary artery calcifications

RATIONALE: The aim of this work was to study the association of pulmonary hypertension (PH) with pulmonary artery calcifications (PACs) and hyperparathyroidism in patients with chronic renal failure (CRF) receiving regular hemodialysis. BACKGROUND: Scarce data are available regarding the prevalence and the predictors of PH in patients with CRF. Abnormal (99m)Tc diphosphonate lung uptake was reported in these patients, suggesting a role of PACs. METHODS: We studied 51 patients (28 men and 23 women) with end-stage renal disease, who were receiving regular hemodialysis. Patients underwent two-dimensional, Doppler echocardiographic imaging. Laboratory investigations included BUN, serum creatinine, calcium, phosphorus, alkaline phosphatase, and intact molecule parathormone. PH was defined as pulmonary artery systolic pressure > 35 mm Hg as determined by Doppler echocardiographic evaluation. RESULTS: PH was detected in 15 patients (29%). Women had a higher prevalence of PH (48% vs 14%, p = 0.01). There was no significant differences between patients with PH and those without PH with regards to age, duration of dialysis, serum calcium (9.6 +/- 2 mg/dL vs 10 +/- 2 mg/dL), phosphorus (6 +/- 1.4 mg/L vs 6.2 +/- 1.9 mg/L), alkaline phosphatase (609 +/- 768 U/L vs 473 +/- 574 U/L), parathyroid hormone (PTH) [420 +/- 512 pg/mL vs 354 +/- 519 pg/mL] or the prevalence of an abnormal (99m)Tc diphosphate lung scan result (60% vs 73%, respectively [+/- SD]). CONCLUSIONS: This study demonstrated that 29% of patients with CRF receiving regular hemodialysis have PH. The presence of PH was not related to the level of PTH or the severity of other metabolic abnormalities. There was no relation between PH and the presence or the severity of PAC. PH is detected more frequently in women. This study does not support a role of secondary hyperparathyroidism and subsequent PAC as the etiology of PH in patients with CRF.     

Vascular remodeling in experimentally induced subacute canine pulmonary hypertension

We quantified in vivo pulmonary vascular remodeling in a large animal model of pulmonary hypertension (PH). In group PH (n = 6), 3 mg/kg dehydromonocrotaline (DHMC) was administered to 12-week-old beagles via a right atrial injection. Eight weeks after DHMC in group PH, pulmonary artery pressure increased significantly (P < .05) from 18 +/- 2 mm Hg at baseline to 30 +/- 4 mm Hg. Medial wall thickness and medial wall area as a percentage of total vessel diameter or area was significantly higher (P < .05) in group PH (29 +/- 9% and 48 +/- 12%) than in a control group (n = 5) (7 +/- 1% and 14 +/- 1%). Neointimal proliferation was observed in 42% of pulmonary arterioles in the PH group but never in the control group. We conclude that a single injection of DHMC in young beagles, in addition to the development of moderate degrees of PH after 8 weeks, causes significant pulmonary vascular remodeling, with features similar to those observed in patients with primary PH.     

Atypical antipsychotic medication and substance use-related outcomes in the treatment of schizophrenia

Using national administrative data from the Department of Veterans Affairs (VA), clinical change in veterans with schizophrenia and comorbid substance abuse and dependence (n = 249) was assessed with the Addiction Severity Index. Outcomes among those switched or maintained on an atypical antipsychotic were compared with those treated with conventionals. For the entire sample and those on an atypical during the last assessment, paired t-tests showed significant decreases in the alcohol and psychological ASI scores. However, multivariate analysis showed no greater improvement in alcohol, drug, or psychological scores in individuals who were switched to (n = 33) or maintained on (n = 161) an atypical antipsychotic as compared to those who were treated with conventional at the final assessment (n = 55). Patients treated with atypical antipsychotics achieved no greater improvement in substance-related outcomes that patients who were not.     

The impact of the use of statins on the prevalence of dementia and the progression of cognitive impairment

BACKGROUND: Previous evidence suggests that treatment with 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors (statins) has a positive impact on dementia. We decided to investigate the association between the use of statins and the prevalence of dementia and statins' impact on the progression of cognitive impairment. METHODS: This is a case-control and a retrospective cohort study of a community-based ambulatory primary care geriatric practice. We included a convenience sample of all patients (N = 655, mean age 78.7 +/- 0.3 years, 85% Caucasian, 74% women) with hypercholesterolemia or dementia, or using statins. We compared those using statins with those who do not with respect to the clinical diagnosis of dementia and its subtypes and the progression of cognitive impairment. RESULTS: At the initial visit, 35% had dementia, and 17% were using statins. After covariate adjustments, patients on statins were less likely to have dementia (odds ratio [OR] for dementia based on composite definition = 0.23; 95% confidence interval [CI] [0.1-0.56], p =.001, OR Alzheimer's disease = 0.37; 95% CI [0.19-0.74], p =.005, OR vascular dementia = 0.25; 95% CI [0.08-0.85], p =.027). At follow-up, patients on statins showed an improvement on their Mini-Mental Status Examination score by 0.7 +/- 0.4 compared to a decline by 0.5 +/- 0.3 in controls, p =.025 (OR for no change or improvement on statins = 2.81; 95% CI [1.02-8.43], p =.045) and scored higher on the Clock Drawing Test (difference of 1.5 +/- 0.1, p =.036). CONCLUSIONS: The use of statins is associated with a lower prevalence of dementia and has a positive impact on the progression of cognitive impairment.