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PubMed1999

The health status of Gulf War veterans: lessons learned from the Department of Veterans Affairs Health Registry.

OBJECTIVE: To describe the demographic characteristics and postwar health status of U.S. Gulf War veterans who participated in the Department of Veterans Affairs health examination registry program. DESIGN: Case records of 52,835 veterans who participated in a standardized health examination program were reviewed. SETTING: Participants volunteered for physical examinations at a Department of Veterans Affairs medical treatment facility from August 1992 to September 1996. SUBJECTS: U.S. Gulf War veterans deployed to southwest Asia between August 1990 and 1996. MAIN OUTCOME MEASURE: Demographic, military, symptom, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic categories. RESULTS: A wide variety of symptoms and diagnoses were reported without apparent internal variation by military characteristics (branch and service component). The frequency of symptoms (fatigue, skin rash, headache, muscle and joint pain, and memory loss) reported increased over time, whereas the proportion of individuals with physician-diagnosed illnesses remained fairly constant. No single category of disease increased or decreased substantially over time. CONCLUSIONS: Veterans have experienced a wide variety of health problems since their Gulf War service. These problems, in aggregate, are different from what has been seen in other armed conflicts. The Department of Veterans Affairs registry is a very large case series and has failed to identify a single, unique syndrome or new illness after Gulf War service. An epidemiologic study would better define the prevalence of specific symptoms and medical conditions among Gulf War veterans and to what extent any of the conditions identified are associated with Gulf War military service. The knowledge provided by such studies would be important to development of preventive measures and future deployment medical surveillance planning.

Adult↗
PubMed1998

Female veterans' use of Department of Veterans Affairs health care services.

OBJECTIVES: As access of women to mental health services has become increasingly important, empirical research has begun to examine the determinants of mental health care utilization across gender. This article examines the effect of being an extreme minority on utilization of Department of Veterans Affairs (VA) health services by female veterans. METHODS: Data were collected on a representative national sample of veterans in 1992 as part of the National Survey of Veterans. These data included information on sociodemographic variables, military service variables, physical health and disability, and health services utilization. The authors examined whether women who used health services in 1992, and who were eligible for VA care, differed from men on the likelihood of using any VA health services and on the likelihood of use of VA outpatient and inpatient health services. In addition, we compared VA health care utilization among subgroups of veterans with physical and mental disorders, and compared self-reported reasons for choice of health care provider, across gender. RESULTS: Results indicated that female veterans were less likely than male veterans to use VA health services. This difference was explained by lower utilization by women of VA outpatient services, since inpatient admission rates were the same across gender. The lower outpatient utilization was specific to women with self-reported mental disorders. Women with physical conditions did not differ from men with similar conditions in their VA outpatient utilization. Finally, men and women did not differ on their reasons for choosing VA or non-VA care. CONCLUSIONS: The authors conclude that extreme gender minority status appears to affect outpatient utilization rates at the VA among women with mental disorders, perhaps because of the more personal or sensitive nature of the services involved. Further research is needed to understand why certain women may be underutilizing VA outpatient services and on the consequences of minority gender status for health service utilization, more generally.

Adult↗
PubMed1984

Veterans Administration and ambulatory care: the "low-priority" veteran.

We describe several consequences of an effort to reduce patient volume in a general medical clinic (GMC) by releasing "low-priority" veterans. With a before-after descriptive study, we determined what sources of medical care these veterans used and assessed changes in their medical status using hypertension as a tracer condition. Private providers were used exclusively by 35% of veterans, 33% continued to use VA medical services, 11% used a combination of VA and private care, and 16% used other miscellaneous sources of care. While most veterans (74%) paid cash for their care, 35% also used Medicare or Medicaid supplementally. In veterans with hypertension, the diastolic blood pressure distributions were ostensibly unchanged after release. These results suggest that a reduction in services provided to "low-priority" veterans is feasible without deleteriously affecting their medical status. With regard to blood pressure control, those veterans who obtained private sources of care did as well as those who remained in the GMC.

Adult↗
PubMed2005

Treatment patterns of multiple sclerosis patients: a comparison of veterans and non-veterans using the NARCOMS registry.

Multiple sclerosis (MS) is a chronic illness of the central nervous system, with a highly variable clinical course. Available therapies are only partially effective and as a consequence treatment patterns between patients can be varied. Longitudinal databases consisting of large cohorts where successive and sequential data is collected may reveal disease and treatment characteristics not apparent when data is gathered during clinical trials that consist usually of relatively homogeneous patients followed for short durations. We analysed data from the North American Research Committee on Multiple Sclerosis registry, a self-reported database, to assess MS patient characteristics and treatment patterns, with a focus on veterans. We show that the Veteran Healthcare Administration (VHA) system of medical centres care for a greater number of patients with higher average disability but not necessarily patients who report primary progressive or actively worsening disease. We also show that the VHA medical centres appear to better provide multidisciplinary care, particularly in the areas of social work, physical therapy and urology. In general, treatment patterns for symptomatic therapies follow similar patterns across veterans and non-veterans groups. Treatment patterns for immunomodulatory agents suggest that VHA veterans use IMA less frequently than either non-VHA veterans or non-veterans.

Adjuvants, Immunologic↗
PubMed1999

Enrollment--provision of hospital and outpatient care to veterans. Department of Veterans Affairs. Final rule.

This document amends VA's medical regulations. The Veterans' Health Care Eligibility Reform Act of 1996 mandates that VA implement a national enrollment system to manage the delivery of healthcare services. Accordingly, the medical regulations are amended to establish provisions consistent with this mandate. Starting October 1, 1998, most veterans were required to be enrolled in the VA healthcare system as a condition of receiving VA hospital and outpatient care. Veterans will be allowed to apply to be enrolled at any time. They will be eligible to be enrolled based on funding availability and their priority status. In accordance with statutory provisions, the final rule also states that some categories of veterans are eligible for VA hospital and outpatient care even if not enrolled. This document further establishes a "medical benefits package" setting forth, with certain exceptions, the hospital and outpatient care that will be provided to enrolled veterans and certain other veterans. Moreover, this document announces that VA will enroll all 7 priority categories of veterans for the period October 1, 1999 through September 30, 2000, unless it is necessary to change this determination by a subsequent rulemaking document.

Ambulatory Care↗
PubMed2006

Barriers to Veterans Health Administration care in a nationally representative sample of women veterans.

BACKGROUND: Women veterans are generally less healthy than their nonveteran female counterparts or male veterans. Accumulating evidence suggests there may be barriers to women veterans' access to and use of Veterans Health Administration (VHA) care. OBJECTIVE: To document perceived and/or actual barriers to care in a nationally representative sample of women veterans and examine associations with VHA use. DESIGN: Cross-sectional telephone survey. PARTICIPANTS: Women who are current and former users of VHA from VA's National Registry of Women Veterans. MEASUREMENTS: Assessments of perceptions of VHA care, background characteristics, and health service use. RESULTS: Perceptions of VHA care were most positive regarding facility/physical environment characteristics and physician skill and sensitivity and least positive regarding the availability of needed services and logistics of receiving VHA care (M=0.05 and M=-0.10; M=-0.23 and M=-0.25, respectively). The most salient barrier to the use of VHA care was problems related to ease of use. Moreover, each of the barriers constructs contributed unique variance in VHA health care use above and beyond background characteristics known to differentiate current users from former VHA users (Odds ratio [OR]=4.03 for availability of services; OR=2.63 for physician sensitivity and skill: OR=2.70 for logistics of care; OR=2.30 for facility/physical environment). Few differences in barriers to care and their association with VHA health care use emerged for women with and without service-connected disabilities. CONCLUSIONS: Findings highlight several domains in which VHA decisionmakers can intervene to enhance the care available to women veterans and point to a number of areas for further investigation.

Adult↗
PubMedDate not supplied

Mortality and morbidity of members of the British Nuclear Tests Veterans Association and the New Zealand Nuclear Tests Veterans Association and their families.

More than 20,000 British servicemen--many of them on their National Service, few of them volunteering for the tests, and most in their early twenties, some still boy soldiers in their teens--were required to 'participate' in the United Kingdom nuclear tests in Australia and Christmas Island in the 1950s and 1960s. 528 members of the New Zealand Navy were also present for one series of tests. There was also a Fijian Army contingent, which has been variously numbered between 100 and 500 men. An estimated 16,000 Australian servicemen and civilians were also involved in the tests at Maralinga and other sites. The men performed a wide range of duties, from highly technical preparations for the detonations to catering and clerical jobs. But whatever their role, they were all required to witness the detonations as part of their 'indoctrination' for the possibility of nuclear war. Most of them were required to line up on the beach, with their backs to the detonations and their hands over their eyes for the first minute or so. They were then allowed to turn around and look at the awesome sight as the mushroom cloud plumed thousands of feet into the air. Very few wore more than shorts and sandals during their time at the tests; only those who were thought to be at risk from radiation injury were issued with protective clothing and radiation dose badges. The UK government was sure that the troops, most of whom were standing within 20 km of the detonations and some of whom were present for 25 nuclear bomb blasts in as many weeks on Christmas Island, were not irradiated. The Ministry of Defence still routinely issues a document to nuclear veterans who feel that their illnesses were caused by the radiation they encountered when they were young men which states: The background [radiation] dose received by civilians and members of HM Forces serving at or off Christmas Island in the years 1956 to 1964 was only about 35% of that which they would have received on average had they remained, for that period of their lives, in the United Kingdom--that is, some 100 microsieverts per calendar month less at Christmas Island than in the United Kingdom. This sanguine view of the health burden borne by nuclear veterans and their families is not borne out by the data reported in this study of the health outcomes of the 2,500 men (2,200 UK, 238 New Zealand and 62 Fijian) on whom data are available to the present researcher. Thirty per cent of the men in this sample have already died, mostly in their fifties. Two-thirds of them died from cancers that are pensionable in the United States as presumptively radiogenic among nuclear veterans. About one in seven of the men in the sample of 1,014 who responded to the questionnaire circulated in late 1997 did not father any children after they returned from the weapons tests. Among the nearly 5,000 children and grandchildren of this group of more than a thousand veterans, there are 26 cases of spina bifida alone--more than five times the usual rate for live births in the UK. Nearly half the health problems among the offspring of the nuclear weapons tests veterans reported in this study consist of the same dermatological, musculoskeletal and gastrointestinal conditions from which many of the men have also suffered. Among the 2,261 children of 1,041 veterans, more than 200 skeletal abnormalities were reported, including more than 30 cases of short stature and 18 spinal problems, mostly curvature and scoliosis. More than 100 skin conditions were reported, mostly eczema and dermatitis, in many cases described as congenital. Over 50 of the children are already suffering from arthritis and similar conditions, although they are only now entering their thirties. Hip deformities were reported for 19 children and kneecap deformities for 14. More than 100 of the veterans' children reported reproductive difficulties; 24 women reported problems with their ovaries. This pattern of morbidity was repeated in the grandchildren, tho

Adolescent↗
PubMed2004

Does membership in veterans' service organizations influence use of the Department of Veterans Affairs as the usual source of care?

Veterans' service organizations (VSOs) provide outreach regarding veterans' benefits. Medical care provided by the Department of Veterans Affairs (VA) is one such benefit that has improved health and quality of life. This study evaluates the characteristics of veterans who report VSO membership and who use the VA as their usual source of care, and it determines whether VSO membership influences the choice of a VA or non-VA facility as the usual source of care. The findings reveal that VSO members, compared with nonmembers, are Caucasian, older, retired, of lower income, and more functionally impaired. Veterans who use the VA, compared with non-VA users, are African American, of lower income, unemployed, and more functionally impaired. VSO members are more likely to use the VA as the usual source of care than are VSO non-members, with the effects varying according to race/ethnicity. Policy recommendations include increasing the diversity of VSO membership, because VSOs play an important outreach and informational role for veterans.

Adult↗
PubMed2005

Predicting costs of Veterans Affairs health care in Gulf War veterans with medically unexplained physical symptoms.

Measures of post-traumatic stress disorder (PTSD) and depression were used to predict Veterans Affairs outpatient treatment costs among Persian Gulf War veterans with medically unexplained physical symptoms. Patients (N = 206) enrolled in a Veterans Affairs primary care clinic for Persian Gulf War veterans completed study assessments at the initial appointment or at a proximal follow-up visit. Costs of care for mental health, medical, and pharmacy services for these veterans were computed for the subsequent 6-month period. Depression and PTSD symptoms explained a significant share of variance in costs of mental health care and pharmacy services, after adjustment for covariates. None of the mental status measures was significantly related to costs of medical care. Models using global measures of mental health status were as robust as models using disorder-specific measures of PTSD and depression in predicting mental health care and pharmacy costs. The implications of these findings for anticipating costs of care for Persian Gulf War veterans are discussed.

Adult↗
PubMed2005

Obesity prevalence among veterans at Veterans Affairs medical facilities.

BACKGROUND: Obesity is a significant public health problem in the United States. Comprehensive obesity prevalence data among veterans have not been previously reported. METHODS: This is a cross-sectional analysis of 1,803,323 veterans receiving outpatient care at 136 Veterans Affairs (VA) medical facilities in 2000. Measured weight, height, and demographic data were used to obtain age-adjusted prevalences of body mass index (BMI) categories, which were stratified by gender and examined by age and race/ethnicity. RESULTS: Of 93,290 women American veterans receiving care at VA medical facilities during 2000, 68.4% were at least overweight (body mass index [BMI]> or =25 kg/m(2)), with 37.4% classified as obese (BMI> or =30 kg/m(2)), and 6.0% as class-III obese (BMI> or =40 kg/m(2)). Of 1,710,032 men, 73.0% were at least overweight, 32.9% were obese, and 3.3% were class-III obese. Among women, obesity prevalence increased into the sixth and seventh decade of life before prevalence began to decline. Among men, prevalence was lowest for those aged <30 and >70. By race/ethnicity, Native American women (40.7%) and men (35.1%) had the highest prevalence of obesity, while Asian-American women (12.8%) and men (20.6%) had the lowest. CONCLUSIONS: There is a substantial burden of obesity among veterans using VA medical facilities. A comprehensive approach for weight management by the Veterans Health Administration is needed.

Adult↗
PubMed1988

Utilization, attitudes, and experiences of Vietnam Era veterans with Veterans Administration health facilities: the American Legion experience.

A random sample of American Legion members in six states who had served in the Armed Forces during the Vietnam Era was conducted through a mailed questionnaire, in order to determine patterns of usage of Veterans Administration health facilities, as well as attitudes toward the VA and experiences at these facilities. Of the 6810 male respondents, 42.0% had served in Southeast Asia. These subjects were categorized according to their level of combat in South Vietnam. Thirty-six percent of those who had served in Southeast Asia had used VA health facilities, compared to only 18% of men who served elsewhere. Among Southeast Asia veterans, combat level was an important predictor of extent of usage of VA facilities for problems of both physical and mental health. Combat level was also associated with lack of basic and major medical insurance. While men with lower incomes tended to make greater use of VA mental health facilities, nearly one-fourth of mental health users had family incomes above $30,000. Despite their greater usage of the VA, men with higher combat levels expressed lower feelings of security about this agency, and rated its staff less helpful and of lower quality than did men who experienced lower levels of combat. On the other hand, higher combat veterans thought themselves better informed about VA services. Men who had gone to the VA for mental health assistance reported a disturbingly low frequency of having been asked basic questions that relate to possible diagnosis of post-traumatic stress disorder (PTSD), questions related to combat, which may be one of its etiologic factors, or other questions relating to their military history. Because combat level in Vietnam veterans is a major determinant of both attitudes toward and utilization of VA health facilities, the VA as well as other health agencies which deal with Vietnam veterans should be especially sensitive to this factor, and should take it into consideration when evaluating veterans' physical and mental health.

Attitude↗
PubMed2002

Characteristics of veterans using Veterans Affairs community-based outpatient clinics.

In the late 1990s, the Department of Veterans Affairs (VA) initiated a system of community-based outpatient clinics to enhance access to care. The purpose of this study was to explore factors that may be related to veterans' desire to transfer care from VA-based to community clinics. Among 1,452 veterans who were currently receiving VA clinic care and were eligible for care in two community-based clinics in rural Minnesota, 85 percent responded to a survey. Fifty-four percent of respondents requested community-based outpatient clinic care. Multivariate analysis revealed that veterans less satisfied with VA care were more likely to request a transfer to a community clinic, whereas Veterans SF-36 scale scores were not strongly associated with request for community-based outpatient clinic care. Veterans who had more VA clinic visits were less likely to request community-based outpatient clinic care. The likelihood of requesting also varied across the VA facilities and by VA eligibility level.

Aged↗
PubMed2005

Exploring veteran identity and health services use among Native American veterans.

The objectives of this study were to describe the military experiences of Native American veterans and to explore how factors related to veteran identity influence their use of health services. Study participants completed a demographic and health questionnaire, followed by participation in a focus group session. The findings revealed that, despite their negative experiences during military service, most participants had a positive veteran identity. Almost 46% of participants reported having a service-related illness or injury. Almost one-third (28.2%) used the Indian Health Service (IHS) exclusively for their health care, followed by those who used both IHS and Veterans Affairs (VA) services (23.5%), followed by VA-only users (21.2%). We conclude that Native American veterans highly identify with their military service but may turn to IHS for their medical care. The data support the current VA policy of strengthening coordination with the IHS to ensure that the medical needs of Native American veterans are addressed.

Aged↗
PubMed2002

Innovation in veterans' health care and assistance: the Department of Veterans Affairs 10 years after the Gulf War.

The Department of Veterans Affairs (VA) has responded to significant challenges in treating and compensating Persian Gulf War veterans by adapting existing programs and developing new ones. The VA established a Gulf War health examination registry and expanded existing "Vet Centers" to provide assistance to Gulf War veterans. Health care eligibility income limitations were eliminated. Outreach efforts included a national newsletter, veterans' organization briefings, and other products. The VA is developing targeted training programs and continuing medical education for health care providers. Numerous major research initiatives have begun. Innovations include the establishment of environmental hazards research centers, clinical demonstration projects, and centers for the study of war-related illness. These efforts required increased coordination among federal agencies and collaboration with other countries. In a precedent-setting development, Congress gave the VA authority to compensate certain veterans with undiagnosed illnesses. Veterans from future conflicts and peacekeeping missions can expect improved services from the VA as a result of these initiatives.

Humans↗
PubMed1997

Where do elderly veterans obtain care for acute myocardial infarction: Department of Veterans Affairs or Medicare?

OBJECTIVE: To examine Department of Veterans Affairs (VA) and Medicare hospitalizations for elderly veterans with acute myocardial infarction (AMI), their use of cardiac procedures in both systems, and patient mortality. DATA SOURCES: Merging of inpatient discharge abstracts obtained from VA Patient Treatment Files (PTF) and Medicare MedPAR Part A files. STUDY DESIGN: A retrospective cohort study of male veterans 65 years or older who were prior users of the VA medical system (veteran-users) and who were initially admitted to a VA or Medicare hospital with a primary diagnosis of AMI at some time from January 1, 1988 through December 31, 1990 (N = 25,312). We examined the use of cardiac catheterization, coronary bypass surgery, and percutaneous transluminal coronary angioplasty in the 90 days after initial admission for AMI in both VA and Medicare systems, and survival at 30 days, 90 days, and one year. Other key measures included patient age, race, marital status, comorbidities, cardiac complications, prior utilization, and the availability of cardiac technology at the admitting hospital. PRINCIPAL FINDINGS: More than half of veteran-users (54 percent) were initially hospitalized in a Medicare hospital when they suffered an AMI. These Medicare index patients were more likely to receive cardiac catheterization (OR 1.24, 95% C.I. 1.17-1.32), coronary bypass surgery (OR 2.01, 95% C.I. 1.83-2.20), and percutaneous transluminal coronary angioplasty (OR 2.56, 95% C.I. 2.30-2.85) than VA index patients. Small proportions of patients crossed over between systems of care for catheterization procedures (VA to Medicare = 3.3%, and Medicare to VA = 5.1%). Many VA index patients crossed over to Medicare hospitals to obtain bypass surgery (27.6 percent) or coronary angioplasty (12.1 percent). Mortality was not significantly different between veteran-users who were initially admitted to VA versus Medicare hospitals. CONCLUSIONS: Dual-system utilization highlights the need to look at both systems of care when evaluating access, costs, and quality either in VA or in Medicare systems. Policy changes that affect access to and utilization of one system may lead to unpredictable results in the other.

Aged↗
PubMed1995

Unexplained illnesses among Desert Storm veterans. A search for causes, treatment, and cooperation. Persian Gulf Veterans Coordinating Board.

Between August 1990 and March 1991, the United States deployed 697,000 troops to the Persian Gulf to liberate Kuwait from Iraqi occupation. Since the Gulf War, most veterans seeking medical care at Departments of Veterans Affairs and Defense medical facilities have had diagnosable conditions, but the symptoms of several thousand veterans have not been readily explained. The most commonly reported, unexplained complaints have been chronic fatigue, rash, headache, arthralgias/myalgias, difficulty concentrating, forgetfulness, and irritability. These symptoms have not been localized to any one organ system, and there has been no consistent physical sign or laboratory abnormality that indicates a single specific disease. Because of the unexplained illnesses being experienced by some Gulf War troops, a comprehensive clinical and research effort has been organized by the Departments of Veterans Affairs, Defense, and Health and Human Services to provide care for veterans and to evaluate their medical problems. To determine the causes and most effective treatments of illnesses among Gulf War veterans, a thorough understanding of all potential health risks associated with service in the Persian Gulf is necessary. These risks are reviewed in this article and include possible reactions to prophylactic drugs and vaccines, infectious diseases, and exposures to chemicals, radiation, and smoke from oil fires.

Disease↗
PubMed2003

Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans.

The authors estimated the prevalence of post-traumatic stress disorder (PTSD) and illness resembling chronic fatigue syndrome (CFS) in the entire population of Gulf War and non-Gulf-War veterans. They also evaluated the relation between the extent of deployment-related stress and the risk of either PTSD or CFS. In 1995-1997, the authors conducted a health survey in which these two symptom-based medical diagnoses in a population-based sample of 15,000 Gulf War veterans representing four military branches and three unit components (active, reserve, and National Guard) were compared with those of 15,000 non-Gulf veteran controls. Gulf War veterans, compared with non-Gulf veteran controls, reported significantly higher rates of PTSD (adjusted odds ratio = 3.1, 95% confidence interval: 2.7, 3.4) and CFS (adjusted odds ratio = 4.8, 95% confidence interval: 3.9, 5.9). The prevalence of PTSD increased monotonically across six levels of deployment-related stress intensity (test for trend: p < 0.01), while the prevalence of CFS rose only at the low end of the stress spectrum. While deployment-related stress could account for the higher risks of both PTSD and CFS, additional factor(s) unique to the Gulf environment may have contributed to the risk of CFS among Gulf War veterans.

Adult↗
PubMedDate not supplied

Elevations of serum T3 levels and their association with symptoms in World War II veterans with combat-related posttraumatic stress disorder: replication of findings in Vietnam combat veterans.

OBJECTIVE: In previous serum thyroid studies, we reported an unusual thyroid profile, including elevated levels of total and free triiodothyronine (T3), total thyroxine (T4), and thyroxine-binding globulin (TBG) with no elevations in free T4 and thyrotropin (TSH) in Vietnam veterans with combat-related posttraumatic stress disorder (PTSD) compared to control subjects. In a subsample of Vietnam veterans, we found a significant positive correlation between total T3, free T3, and PTSD symptoms, specifically hyperarousal symptoms. In the present study, we explored the generalizability of our findings to World War II (WWII) veterans with PTSD. METHOD: Clinical symptoms were assessed in and serum thyroid measures were obtained from 12 WWII veterans with PTSD and 18 WWII veterans without PTSD. RESULTS: WWII veterans with combat-related PTSD showed elevations of serum total and free T3 with no elevations of free T4 and TSH compared to control subjects, replicating the results of our previous studies. A significant positive relationship between total and free T3 and PTSD symptoms, specifically hyperarousal symptoms, was also replicated in the total WWII group. Elevations of total T4 and TBG were not replicated in the WWII group with PTSD, which may indicate a shift with age in the free/bound dynamics of the thyroid alterations observed. CONCLUSIONS: This study supports the observation that the thyroid system is altered in chronic combat-related PTSD. The observed alterations of thyroid function along with PTSD symptoms appear to be chronic, detectable 50 years after the war.

Chronic Disease↗