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PubMed1996

The Australian Vietnam Veterans Health Study: II. self-reported health of veterans compared with the Australian population.

BACKGROUND: Self-reported physical health status of Australian Vietnam veterans was determined 20-25 years after the war and its relation to combat was investigated. METHOD: An epidemiological cohort study of a simple random sample of Army veterans posted to Vietnam between 1964 and 1972 was conducted with personal interviews using the Australian Bureau of Statistics Health Interview Survey questionnaire to compare veterans with the Australian population and a 21-item combat exposure index used to measure the relationship of combat to physical health. RESULTS: Veterans reported greater health service usage and more recent health actions than population expectations. They also reported excess health problems in almost all recent illness disease categories except endocrine conditions and cardiovascular conditions; only 6 of 37 chronic disease groups were not elevated compared to the population. Adjustment for non-response changed estimates only slightly. Combat exposure was significantly related to reports of recent and chronic mental disorders, recent hernia and chronic ulcer, recent eczema and chronic rash, deafness, chronic infective and parasitic disease, chronic back disorders and symptoms, signs and ill-defined conditions. CONCLUSION: Combat exposure may have significantly increased reports of only some health problems. A general position to complain as a result of psychological conditions due to combat is not consistent with the lack of relationship between combat and reports of physical conditions.

Adult↗
PubMed2004

The Veterans Short Form 36 questionnaire is predictive of mortality and health-care utilization in a population of veterans with a self-reported diagnosis of asthma or COPD.

STUDY OBJECTIVE: Measures of health-related quality of life (HRQL) correlate with disease stage in persons with COPD. However, as their predictive capacity for mortality or medical utilization is less well defined, we sought to examine the relationship of a general measure of HRQL and outcomes in persons with obstructive lung disease. DESIGN: Prospective cohort study. SETTING: Upper Midwest Veterans Integrated Service Network (VISN)-13. PARTICIPANTS: All veterans in VISN-13 (n = 70,017) were surveyed with the Veterans Short Form 36 (SF-36V). Persons with reported asthma or COPD who completed the SF-36V formed the study cohort (n = 8,354). MEASUREMENTS AND RESULTS: For purposes of analysis, individuals were divided into quartiles of HRQL according to their physical component summary (PCS) and mental component summary (MCS), values derived from the SF-36V. Outcomes of mortality, hospitalization, and outpatient visits were recorded for 12 months after the survey. Outpatient utilization was dichotomized into high vs low use, with high use being defined as the upper quartile of visits in the 12 months prior to survey mailing. The study cohort had a mean age of 65 years and was largely male (95%), both consistent with a veteran population. After correcting for potential confounding factors through multivariable regression, the PCS was independently predictive of death, hospitalization, and high outpatient utilization. When using the first quartile of PCS as the reference population, those in the fourth quartile of PCS had a hazard ratio for death of 5.47 (95% confidence interval [CI], 3.63 to 8.26). Similarly, the odds ratios for hospitalization, high primary care visits, and high specialty medicine visits in the fourth quartile of PCS were 1.82 (95% CI, 1.51 to 2.19), 1.54 (95% CI, 1.26 to 1.87), and 1.46 (95% CI, 1.21 to 1.78), respectively. The MCS, through multivariable regression, was predictive of death but unassociated with subsequent hospitalization or high outpatient utilization. CONCLUSION: HRQL, as assessed by the SF-36V, is an independent predictor of mortality, hospitalization, and outpatient utilization in persons with self-reported obstructive lung disease.

Aged↗
PubMed1991

Occupational therapy in the Department of Veterans Affairs: focus on health care of the elderly veteran.

The Department of Veteran Affairs (VA) operates the largest integrated health care system in the world (VA, 1989), with designated departments and programs designed to meet the long-term care needs of the aging veteran. Occupational therapy is an important intervention to maximize the quality of life of older persons. Because of the increasing number of aging veterans and the national shortage of occupational therapists, the VA has been devising programs to recruit and retain occupational therapists in VA medical centers. The combination of long-term care programs and the VA's commitment to ongoing research, education, and occupational therapy services points to a promising outlook for care of our aging veterans.

Aged↗
PubMed1980

Veterans Administration--Medical benefits; readjustment counseling for Vietnam era veterans. Final regulations.

The VA [Veterans Administration] has added regulations to comply with the Veterans Health Care Amendments of 1979. This law mandates that the VA provide readjustment counseling and related mental health services to Vietnam era veterans. The law allows for the providing for these services through contract sources. Contractors will be required to meet quality and effectiveness standards established by the Veterans Administration before they can be authorized to provide services.

Adaptation, Psychological↗
PubMed1990

Use of Veterans Administration outpatient facilities by older, rural veterans.

A mail survey was conducted in rural northeastern Missouri to study the factors affecting use of Veterans Administration (VA) outpatient medical services by older veterans. During the year preceding the survey, 39.6% of the 169 responding veterans had used VA outpatient facilities. Travel time, long waiting time at the clinic, and travel expense were the most common perceived barriers to use. However, these factors were generally poor predictors of use. The reported percentage of each perceived geographic or administrative barrier to use was consistently greater for previous users than for nonusers of these facilities. Multiple regression analysis revealed private medical insurance coverage to be the only significant predictor of use. Veterans with private medical insurance were more likely to receive ambulatory medical care from local providers than from the VA. The potential impact of removing perceived barriers to use in this population remains unclear.

Aged↗
PubMed1988

Serum 2,3,7,8-tetrachlorodibenzo-p-dioxin levels in US Army Vietnam-era veterans. The Centers for Disease Control Veterans Health Studies.

This study investigates whether military records can be used to identify US Army Vietnam veterans who were likely to be exposed to the herbicide Agent Orange. Serum levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a toxic contaminant in Agent Orange, were obtained for 646 ground combat troops who served in heavily sprayed areas of Vietnam and for 97 veterans who did not serve in Vietnam. The distributions of current TCDD levels in Vietnam and non-Vietnam veterans were nearly identical (mean in each group, approximately equal to 4 parts per trillion [ppt]). Only two men (both Vietnam veterans) had clearly elevated levels (greater than 20 ppt). Levels of TCDD did not tend to increase with greater likelihood of exposure to Agent Orange, as estimated from either military records or self-reported exposure. This study is consistent with other studies and suggests that most US Army ground troops who served in Vietnam were not heavily exposed to TCDD, except perhaps men whose jobs involved handling herbicides.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1997

Suicide risk factors among veterans: risk management in the changing culture of the Department of Veterans Affairs.

Suicide risk management in the Department of Veterans Affairs (VA) health care system is particularly challenging because of both patient characteristics and aspects of the delivery system. The prototypical suicide-prone person is an older white male with alcoholism, depression, physical problems, and poor psychosocial support. This describes a large portion of the veteran patient population. Suicide risk factors that are common in VA patients include male gender, older age, diminished social environment support (exemplified by homelessness and unmarried status), availability and knowledge of firearms, and the prevalence of medical and psychiatric conditions associated with suicide. A variety of characteristics of the VA system complicate suicide management. Efforts under way to emphasize ambulatory care and decrease the VA culture of reliance on inpatient treatment heighten the importance of accurate suicide assessment. The authors recommend several strategies that VA administrators can consider for improving the assessment and management of veterans with long-term suicide risk factors.

Adult↗
PubMed1989

The veteran athlete: an echocardiographic comparison of veteran cyclists, former cyclists and non-athletic subjects.

To determine the effects of prolonged endurance training on the heart, a comparison was made of veteran cyclists aged 41-51 years, former cyclists, and non-athletic subjects, including echocardiography, ECG, systolic and diastolic time intervals, and maximal oxygen uptake. The veterans had significantly larger diastolic diameter, systolic diameter, thickness of septum, posterior wall, and left ventricular mass. The enlargement of the left ventricle was found to be proportionate, as the ratio of diastolic diameter to wall thickness showed no change. In contrast to earlier reports, no indication of reduced cardiac function was found in the veterans, as echocardiographically measured function parameters, systolic, and diastolic time intervals were similar in the three groups. In the former athletes, whose previous training experience was similar to that of the veterans, no significant variation in cardiac structure and function was found in relation to the control group. This indicates that the physiological hypertrophy caused by physical training can be reversible.

Adaptation, Physiological↗
PubMedDate not supplied

Inadequate follow-up care for depression and its impact on antidepressant treatment duration among veterans with and without diabetes mellitus in the Veterans Health Administration.

OBJECTIVE: Our objective was to describe the adequacy of follow-up care for depression and its association with antidepressant treatment duration among veterans with and without diabetes mellitus (DM). METHOD: This was a retrospective study (1997-2005) of 2178 veterans (33% with DM) in a Midwestern Veterans Health Administration facility who had a new episode of unipolar depression. Adequate follow-up care was defined by a health care visit within 7 and 14 days, and >/=3 visits following antidepressant treatment initiation. Adequate treatment duration was defined by a medication possession ratio of >/=80%. Multivariate logistic regression was used to calculate odds ratios (ORs) adjusted for demographic, clinical and health care utilization characteristics. RESULTS: Only 27% received >/=3 follow-up visits within 12 weeks, and <23% received follow-up within 2 weeks of antidepressant initiation. Subjects with DM were 1.36-fold more likely [95% confidence interval (95% CI)=1.05-1.75] to have received >/=3 visits but were similarly likely to have received follow-up within 7 days (OR=1.02; 95% CI=0.74-1.41) or 14 days (OR=1.08; 95% CI=0.83-1.40) of antidepressant initiation. Adequate follow-up care was the most important predictor of adequate treatment duration (OR=2.10; 95% CI=1.54-2.88). CONCLUSION: DM had little influence on the adequacy of follow-up care for depression, with few exceptions. Follow-up care for depression is underutilized and has a significant impact on antidepressant treatment duration. Strategies to more effectively manage depression treatment are required.

Adult↗
PubMed1999

Using Department of Veterans Affairs Administrative databases to examine long-term care utilization for men and women veterans.

We examined long-term care (LTC) utilization by male and female veterans using administrative databases maintained by VA. Research questions included: (1) Which LTC services are utilized? (2) Do utilization patterns of older veterans differ from those of elderly persons in the general U.S. population? (3) Do LTC needs of veterans vary by gender? We were unable to track LTC utilization of individuals across administrative databases. Some databases could only provide information at the national level, or alternatively, were available only at local facilities, or only at the patient or program-level data--making it impossible to get a clear picture of all the services received by an individual. Those planning to use administrative databases to conduct research must: (1) take more time than expected; (2) be flexible/willing to compromise, (3) "ferret out" information, and (4) recognize that because of dynamism inherent in information systems, results may change over time.

Age Factors↗
PubMed2006

Female veterans seeking medical care at Veterans Affairs primary care clinics: psychiatric and medical illness burden and service use.

OBJECTIVE: To examine rates of medical and psychiatric disorders among 187 female veterans recruited at four Veterans Affairs Medical Centers (VAMCs), the recognition of such disorders by VAMC care providers, and the use of relevant medical and mental health services by women both within and outside of the VA setting. METHODS: We used a cross-sectional, epidemiological design incorporating self-report measures, structured interviews, and chart reviews to obtain relevant information for analyses. RESULTS: Forty-four percent (43.9%) of women met criteria for at least one psychiatric disorder; 34.0% of these women met criteria for two or more additional psychiatric diagnoses, and concordance rates between interview and chart diagnoses were low. Ninety-five percent (95.2%) of women had a medical condition noted in their charts; 86.6% had two or more additional medical conditions, and a significant number of women had both medical and psychiatric diagnoses. Forty-four percent (43.9%) of women with an identified mental health condition received specialized mental health care by the VA in the past year. CONCLUSIONS: Findings from this study suggest that female veterans treated in VAMCs had significant medical and psychiatric problems, and these women might not be getting their health care needs adequately met through the VA health care system. In light of our findings, we discuss relevant implications and future directions for research.

Adult↗
PubMed2005

Organization and management of care for military veterans with human immunodeficiency virus/acquired immunodeficiency syndrome in Department of Veterans Affairs Medical Centers.

OBJECTIVE: As the largest provider of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome health care services, the Department of Veterans Affairs (VA) has launched a national quality improvement program. As a first step, an assessment of how care for veterans with HIV/acquired immunodeficiency syndrome was organized was conducted. METHODS: Structured surveys were administered to senior HIV clinicians in 118 VA facilities, about local approaches to structuring, staffing, and delivering HIV health services. RESULTS: HIV care was chiefly delivered in special VA-based HIV clinics. HIV-related services were widely available on site, with non-VA referrals being more commonly needed to meet long-term care needs. Urban VA facilities had greater HIV caseloads, were more likely to have separate HIV clinics, and had greater access to HIV expertise, whereas rural practices focused on primary care-based models and tended to rely on off-site VA HIV experts. CONCLUSIONS: Understanding the organization and management of VA-based HIV services will help design systematic quality improvement efforts and meet the treatment needs of HIV-infected veterans.

Data Collection↗
PubMed1996

The prevalence of physical and sexual abuse in women veterans seeking care at a Veterans Affairs Medical Center.

Physical and sexual abuse are increasingly recognized as common harmful experiences for women. We surveyed 828 women veterans seeking care at the Baltimore Veterans Affairs Medical Center to determine the prevalence of physical and sexual abuse experiences, both during and outside of military service. Data were collected through an anonymous, mailed questionnaire, with a response rate of 52%. Sixty-eight percent of respondents reported at least one form of abuse, and 27% reported all three. Sexual abuse was most common (55%), followed by physical abuse (48%), and rape (41%). Enlisted women, women younger than 50, and single, separated, or divorced women were significantly more likely to report abusive experiences. Over 40% of the women reporting abuse were never victimized while on active duty, and these women were less likely to receive counseling. Physical and sexual abuse experiences are disturbingly common among women veterans and demonstrate the need for additional services to assist these women.

Adult↗
PubMed2001

World war II veterans, social support, and veterans' associations.

People use many different coping strategies to deal with their traumatic recollections. Twenty-five British World War II veterans were interviewed regarding the ways they used social support both during the war and in the years afterwards. The findings demonstrate that social support is used in fundamentally different ways. During the war comradeship was particularly important and even fifty years after the war comrades are still a valuable resource for discussing war experiences, and dealing with the emotional content of traumatic recollections. Veterans rely on wives and families to help deal with the more physical and practical elements of coping, but tend not to discuss their traumatic memories with them. The findings show that social support is an important lifelong coping strategy for World War II veterans.

Adaptation, Psychological↗
PubMed1996

The Australian Vietnam Veterans Health Study: III. psychological health of Australian Vietnam veterans and its relationship to combat.

BACKGROUND: Self-reported psychiatric status of Australian Vietnam war veterans was determined 20-25 years after the war and its relation to combat was investigated. METHOD: A simple random sample of Australian Army Vietnam veterans was interviewed nationally using standardized interviews and self-completion tests to assess the prevalence of lifetime and current psychiatric illness and its relationship to combat. Army records were used to extract data on the cohort for use in regression-based adjustment for non-response. RESULTS: The conditions mainly affecting the Australian veterans were alcohol abuse or dependence, post-traumatic stress disorder, somatization disorder were significantly related to combat exposure but not with posting to a combat unit. Less than half of the current one-month diagnoses were related to combat, possibly because of low power conferred by the relative rarity of these conditions. CONCLUSIONS: The results confirm a range of psychological problems in former warriors may linger 20 or more years from their war exposure and may be directly affected by exposure to war trauma.

Australia↗
PubMedDate not supplied

Dissemination of methods and results from the veterans health study: final comments and implications for future monitoring strategies within and outside the veterans healthcare system.

The Veterans Health Study (VHS) followed a cohort of patients receiving ambulatory care in the Veterans Affairs healthcare system for up to 5 years. One of the principal aims of this study was to develop a library of methodologies including general and disease-specific health outcome questionnaires for use in monitoring the quality of healthcare and for research purposes. The cornerstone for this work is the Veterans RAND 36 and 12 Item Health Surveys (VR-36 and VR-12), a general measure developed in the VHS for measuring the physical and psychologic well-being of the patient. A comprehensive set of disease-specific assessments has also been developed as part of this study for the purposes of monitoring specific chronic conditions more commonly seen in routine ambulatory care settings. Since 1996, more than 2 million questionnaires have been administered in the VA for quality monitoring purposes, using the VR-36 and VR-12. Research studies that have used these batteries span randomized clinical trials in the VA cooperative studies program and clinical effectiveness research. Health assessments using VHS batteries are being disseminated for widespread use outside the VA. Chief among the assessments used is the VR-12, which has recently been included in the 2006 Health Plan Employer Data and Information Set (HEDIS) as part of the Medicare Health Outcomes Survey for monitoring the Medicare Advantage Program. The methods and batteries developed in the VHS are in the public domain and provide a framework for future patient monitoring using standard measures of health.

Cohort Studies↗
PubMed2006

Use of the veterans history project to assess World War II veterans' perceptions of military experiences and health.

OBJECTIVE: This qualitative research study evaluated the attitudes, perceptions, and opinions of World War II veterans regarding the health impact of their military service. METHODS: The study design involved adding relevant health questions to the interview format developed by the ongoing Veterans History Project, a military oral history depository directed and maintained by the U.S. Library of Congress. Audiotaped interviews conducted with individuals and a focus group were coded and evaluated. Key informants provided background information. RESULTS: Findings included a general consensus among participants that military service during World War II was beneficial to their health. Preventive health practices were instilled as lifelong habits, as were feelings of self-confidence and independence. The Veterans Administration was viewed positively by respondents but was not used to any great extent. CONCLUSIONS: Current good health and feelings of patriotism, duty, and selflessness may underlie expressed positive attitudes about the health impact of service during World War II.

Aged↗