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Eckart AC, Ghimire PS, Stavitz J. Predictive Validity of Multifactorial Injury Risk Models and Associated Clinical Measures in the U.S. Population. Sports (Basel) 2024; 12:123. [PMID: 38786992 PMCID: PMC11125903 DOI: 10.3390/sports12050123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Popular movement-based injury risk screens were shown to lack predictive precision, leading to interest in multifactorial models. Furthermore, there is a lack of research regarding injury risk assessment for those currently or planning to be recreationally active. This study aims to provide injury risk insights by analyzing multifactorial injury risk models and associated clinical measures in the U.S. population. Methods: Data related to injury, inflammatory markers, physical functioning, body composition, physical activity, and other variables from 21,033 respondents were extracted from NHANES. Odds ratios for self-reported injury were calculated for single predictors and risk models. Case-control and principal component analyses (PCA) were conducted to elucidate confounders and identify risk factor clusters, respectively. Receiver operating characteristic analysis was used to test the precision of a risk factor cluster to identify pain points and functional difficulties. Results: Sociodemographic, individual, and lifestyle factors were strongly associated with higher odds of injury. Increases in fibrinogen and C-reactive protein were significantly associated with all risk groups. Membership to the high-risk group (age over 40, obesity, no muscle-strengthening activities, sedentary lifestyle, and low back pain) predicted at least one functional difficulty with 67.4% sensitivity and 87.2% specificity. In the injury group, bone turnover markers were higher, yet confounded by age, and there was a significantly higher prevalence of self-reported osteoporosis compared to the control. In males, low testosterone was associated with injury, and high estradiol was associated with pain and functional difficulties. In females, high follicle-stimulating hormone was associated with functional difficulties. PCA revealed four high-risk profiles, with markers and activities showing distinct loadings. Conclusions: A comprehensive approach to injury risk assessment should consider the nexus of aging, lifestyle, and chronic disease to enhance tailored injury prevention strategies, fostering safe and effective physical activity participation and reducing the burden of musculoskeletal disorders.
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Affiliation(s)
- Adam C. Eckart
- Department of Health and Human Performance, College of Health Professions and Human Services, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA;
| | - Pragya Sharma Ghimire
- Department of Health and Human Performance, College of Health Professions and Human Services, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA;
| | - James Stavitz
- Department of Athletic Training, College of Health Professions and Human Services, Kean University, 1000 Morris Avenue, Union, NJ 07083, USA;
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2
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Cypel YS, Vogt D, Maguen S, Bernhard P, Lowery E, Culpepper WJ, Armand-Gibbs I, Schneiderman AI. Physical health of Post-9/11 U.S. Military veterans in the context of Healthy People 2020 targeted topic areas: Results from the Comparative Health Assessment Interview Research Study. Prev Med Rep 2023; 32:102122. [PMID: 36922958 PMCID: PMC10009290 DOI: 10.1016/j.pmedr.2023.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Large-scale epidemiological studies suggest that veterans may have poorer physical health than nonveterans, but this has been largely unexamined in post-9/11 veterans despite research indicating their high levels of disability and healthcare utilization. Additionally, little investigation has been conducted on sex-based differences and interactions by veteran status. Notably, few studies have explored veteran physical health in relation to national health guidelines. Self-reported, weighted data were analyzed on post-9/11 U.S. veterans and nonveterans (n = 19,693; 6,992 women, 12,701 men; 15,160 veterans, 4,533 nonveterans). Prevalence was estimated for 24 physical health conditions classified by Healthy People 2020 targeted topic areas. Associations between physical health outcomes and veteran status were evaluated using bivariable and multivariable analyses. Back/neck pain was most reported by veterans (49.3 %), twice that of nonveterans (22.8 %)(p < 0.001). Adjusted odds ratios (AORs) for musculoskeletal and hearing disorders, traumatic brain injury, and chronic fatigue syndrome (CFS) were 3-6 times higher in veterans versus nonveterans (p < 0.001). Women versus men had the greatest adjusted odds for bladder infections (males:females, AOR = 0.08, 95 % CI:0.04-0.18)(p < 0.001), and greater odds than men for multiple sclerosis, CFS, cancer, irritable bowel syndrome/colitis, respiratory disease, some musculoskeletal disorders, and vision loss (p < 0.05). Cardiovascular-related conditions were most prominent for men (p < 0.001). Veteran status by sex interactions were found for obesity (p < 0.03; greater for male veterans) and migraine (p < 0.01; greater for females). Healthy People 2020 targeted topic areas exclude some important physical health conditions that are associated with being a veteran. National health guidelines for Americans should provide greater consideration of veterans in their design.
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Affiliation(s)
- Yasmin S. Cypel
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
- Corresponding author at: Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420, USA.
| | - Dawne Vogt
- National Center for PTSD, VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA
- University of California-San Francisco, San Francisco, CA, USA
| | - Paul Bernhard
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Elizabeth Lowery
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - William J. Culpepper
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Irvine Armand-Gibbs
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Aaron I. Schneiderman
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
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3
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Miles SR, Martindale SL, Flanagan JC, Troyanskaya M, Reljic T, Gilmore AK, Wyant H, Nakase-Richardson R. Putting the pieces together to understand anger in combat veterans and service members: Psychological and physical contributors. J Psychiatr Res 2023; 159:57-65. [PMID: 36657315 DOI: 10.1016/j.jpsychires.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for the association between PTSD and anger, in addition to the association between pain interference and anger. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Additionally, treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference.
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Affiliation(s)
- Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Sarah L Martindale
- W.G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | - Maya Troyanskaya
- Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Tea Reljic
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
| | - Hannah Wyant
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA; Traumatic Brain Injury Center of Excellence, Defense Health Agency, James A. Haley Veterans' Hospital, Tampa, FL, USA; Pulmonary and Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
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4
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Walsh C, Sullivan C, Bosworth HB, Wilson S, Gierisch JM, Goodwin KB, Mccant F, Hoenig H, Heyworth L, Zulman DM, Turvey C, Moy E, Lewinski AA. Incorporating TechQuity in Virtual Care Within the Veterans Health Administration: Identifying Future Research and Operations Priorities. J Gen Intern Med 2023:10.1007/s11606-023-08029-2. [PMID: 36650326 PMCID: PMC9845020 DOI: 10.1007/s11606-023-08029-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The Covid-19 pandemic dramatically changed healthcare delivery, driving rapid expansion of synchronous (i.e., real-time) audio-only and video telehealth, otherwise known as virtual care. Yet evidence describes significant inequities in virtual care utilization, with certain populations more dependent on audio-only virtual care than video-based care. Research is needed to inform virtual care policies and processes to counteract current inequities in access and health outcomes. OBJECTIVE Given the importance of incorporating equity into virtual care within the Veterans Health Administration (VHA), we convened a Think Tank to identify priorities for future research and virtual care operations focused on achieving equitable implementation of virtual care within the VHA. METHODS We used participatory activities to engage clinicians, researchers, and operational partners from across the VHA to develop priorities for equitable implementation of virtual care. We refined priorities through group discussion and force-ranked prioritization and outlined next steps for selected priorities. KEY RESULTS Think Tank participants included 43 individuals from the VHA who represented diverse geographical regions, offices, and backgrounds. Attendees self-identified their associations primarily as operations (n = 9), research (n = 28), or both (n = 6). We identified an initial list of 63 potential priorities for future research and virtual care operations. Following discussion, we narrowed the list to four priority areas: (1) measure inequities in virtual care, (2) address emerging inequities in virtual care, (3) deploy virtual care equitably to accommodate differently abled veterans, and (4) measure and address potential adverse consequences of expanded virtual care. We discuss related information, data, key partners, and outline potential next steps. CONCLUSIONS This Think Tank of research and operational partners from across the VHA identified promising opportunities to incorporate equity into the design and implementation of virtual care. Although much work remains, the priorities identified represent important steps toward achieving this vital goal.
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Affiliation(s)
- Conor Walsh
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA. .,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Caitlin Sullivan
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Hayden B Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Wilson
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kaitlyn B Goodwin
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Felicia Mccant
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Helen Hoenig
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Physical Medicine & Rehabilitation Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Leonie Heyworth
- Office of Connected Care/Telehealth, Department of Veterans Affairs Central Office, Washington, DC, USA.,Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Carolyn Turvey
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Office of Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA
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5
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Hall AL, Batchelor T, Bogaert L, Buckland R, Cowieson AB, Drew M, Harrison K, McBride DI, Schneiderman A, Taylor K. International perspective on military exposure data sources, applications, and opportunities for collaboration. Front Public Health 2023; 11:1154595. [PMID: 37213639 PMCID: PMC10198376 DOI: 10.3389/fpubh.2023.1154595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/07/2023] [Indexed: 05/23/2023] Open
Abstract
Military personnel may be exposed to a range of hazards. The assessment, documentation and reporting of military exposure information are important steps to guide health protection, services, and research to support actively serving members and veterans. In 2021, a Working Group of researchers from veteran and defense administrations across the Five Eyes countries (Australia, Canada, New Zealand, the United Kingdom, and the United States) was established to examine large military exposure data sources available in each country, their applications, and opportunities to leverage information across administrations and internationally. We provide a brief summary of this work here to highlight some successful examples of data applications and to elicit interest in this evolving area of exposure science.
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Affiliation(s)
- Amy L. Hall
- Research Directorate, Veterans Affairs Canada, Charlottetown, PE, Canada
- *Correspondence: Amy L. Hall,
| | - Trish Batchelor
- Department of Veterans’ Affairs, Canberra City, ACT, Australia
| | - Laura Bogaert
- Directorate of Force Health Protection, Department of National Defence, Ottawa, ON, Canada
| | - Robert Buckland
- Defence Health Directorate, New Zealand Defence Force, Wellington, New Zealand
| | - Ali B. Cowieson
- Research Directorate, Veterans Affairs Canada, Charlottetown, PE, Canada
| | - Michael Drew
- Department of Defence, Canberra City, ACT, Australia
| | | | - David I. McBride
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Aaron Schneiderman
- Epidemiology Program, US Department of Veterans Affairs, Washington, DC, United States
| | - Kathryn Taylor
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States
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6
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McDonald MLN, Lakshman Kumar P, Srinivasasainagendra V, Nair A, Rocco AP, Wilson AC, Chiles JW, Richman JS, Pinson SA, Dennis RA, Jagadale V, Brown CJ, Pyarajan S, Tiwari HK, Bamman MM, Singh JA. Novel genetic loci associated with osteoarthritis in multi-ancestry analyses in the Million Veteran Program and UK Biobank. Nat Genet 2022; 54:1816-1826. [PMID: 36411363 DOI: 10.1038/s41588-022-01221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/05/2022] [Indexed: 11/22/2022]
Abstract
Osteoarthritis is a common progressive joint disease. As no effective medical interventions are available, osteoarthritis often progresses to the end stage, in which only surgical options such as total joint replacement are available. A more thorough understanding of genetic influences of osteoarthritis is essential to develop targeted personalized approaches to treatment, ideally long before the end stage is reached. To date, there have been no large multiancestry genetic studies of osteoarthritis. Here, we leveraged the unique resources of 484,374 participants in the Million Veteran Program and UK Biobank to address this gap. Analyses included participants of European, African, Asian and Hispanic descent. We discovered osteoarthritis-associated genetic variation at 10 loci and replicated findings from previous osteoarthritis studies. We also present evidence that some osteoarthritis-associated regions are robust to population ancestry. Drug repurposing analyses revealed enrichment of targets of several medication classes and provide potential insight into the etiology of beneficial effects of antiepileptics on osteoarthritis pain.
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Affiliation(s)
- Merry-Lynn N McDonald
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA.
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Genetics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Preeti Lakshman Kumar
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Vinodh Srinivasasainagendra
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashwathy Nair
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Alison P Rocco
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Ava C Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joe W Chiles
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Joshua S Richman
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA
- Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah A Pinson
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Richard A Dennis
- Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA
| | - Vivek Jagadale
- Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, AR, USA
| | - Cynthia J Brown
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Saiju Pyarajan
- Center for Data and Computational Sciences (C-DACS), Veterans Affairs Boston Healthcare System (VABHS), Boston, MA, USA
| | - Hemant K Tiwari
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marcas M Bamman
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA
- Department of Cell, Developmental, and Integrative Biology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Florida Institute for Human & Machine Cognition, Pensacola, FL, USA
| | - Jasvinder A Singh
- Birmingham Veterans Affairs Health Care System (BVAHCS), Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Rheumatology and Clinical Immunology, Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Bergman BP, Mackay DF, Pell JP. Hip and knee replacement as a proxy measure for lower limb osteoarthritis in Scottish military veterans. BMJ Mil Health 2021:bmjmilitary-2021-001913. [PMID: 34373348 DOI: 10.1136/bmjmilitary-2021-001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/22/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Physical activity is an important component of military training. Although injuries and musculoskeletal disorders are the most common cause of medical retirement from the Armed Forces, the long-term risk of lower limb osteoarthritis in veterans is unknown. We used data on hip and knee replacement in Scottish military veterans as a proxy measure. METHODS Retrospective cohort study of 78 000 veterans born between 1945 and 1995 and a comparison group of 253 000 non-veterans, matched for age, sex and area of residence, followed up for up to 37 years, using survival analysis to examine the risk of hip and knee replacement. RESULTS Veterans were significantly less likely to undergo hip replacement than non-veterans, Cox proportional HR 0.87, 95% CI 0.80 to 0.95, p<0.001. There was no significant difference between veterans and non-veterans in respect of knee replacement, HR 1.02, 95% CI 0.94 to 1.11, p=0.643, and there was no difference in the ages at which veterans and non-veterans underwent joint replacement. People who had served for longest in the military had similar risk to those with the shortest service. CONCLUSIONS Based on the likelihood of undergoing joint replacement surgery in later life, we found no evidence of a positive association between military service and an increased risk of lower limb osteoarthritis.
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Affiliation(s)
- Beverly P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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8
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Barassi JP. What Would it Take to Put a Chiropractor in Khakis? Effecting Chiropractors as Commissioned Officers in the U.S. Military-A Historical Brief. Mil Med 2021; 187:23-28. [PMID: 34331452 DOI: 10.1093/milmed/usab324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 11/14/2022] Open
Abstract
The purpose of this article is to provide a historical perspective on the commissioning of chiropractors within the U.S. Military and to propose a pathway by which this can be accomplished. A comprehensive review of Congressional actions proposed and enacted, and historical documents to create a chronology of actions that influence and support a proposed pathway for commissioning. The authority to commission chiropractors within the U.S. Military has long been provided to the Secretary of Defense, but it has never been acted upon despite decades of legislation. Chiropractors currently serve within the DoD as contractors or government employees; however, the direct association with the military in terms of commissioning has remained elusive. Musculoskeletal injuries are statistically one of the most prevalent combat-related injury classifications within the active duty military and subsequent veteran population. Chiropractic physicians serving within military medicine and veteran health care facilities routinely manage common and complex neurological and musculoskeletal injuries sustained by combat and non-combat servicemen and women. Patient satisfaction with chiropractic services within both the active duty and veteran population is high and routinely sought after. Chiropractic inclusion in the medical corps or medical service corps within the DoD is long overdue.
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Affiliation(s)
- James P Barassi
- Department of Pain Management, Veterans Administration Medical Center, Manchester, NH 03104, USA
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9
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Coleman BC, Goulet JL, Higgins DM, Bathulapalli H, Kawecki T, Ruser CB, Bastian LA, Martino S, Piette JD, Edmond SN, Heapy AA. ICD-10 Coding of Musculoskeletal Conditions in the Veterans Health Administration. PAIN MEDICINE 2021; 22:2597-2603. [PMID: 33944953 DOI: 10.1093/pm/pnab161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE We describe the most frequently used musculoskeletal diagnoses in Veterans Health Administration (VHA) care. We report the number of visits and patients associated with common musculoskeletal ICD-10 codes and compare trends across primary and specialty care settings. DESIGN Secondary analysis of a longitudinal cohort study. SUBJECTS Veterans included in the Musculoskeletal Diagnosis Cohort with a musculoskeletal diagnosis from October 1, 2015 through September 30, 2017. METHODS We obtained counts and proportions of all musculoskeletal diagnosis codes used and the number of unique patients with each musculoskeletal diagnosis. Diagnosis use was compared between primary and specialty care settings. RESULTS Of over 6,400 possible ICD-10 M-codes describing "Diseases of the Musculoskeletal System and Connective Tissue", 5,723 codes were used at least once. The most frequently used ICD-10 M-code was "Low Back Pain" (18.3%) followed by "Cervicalgia" (3.6%). Collectively, the 100 most frequently used codes accounted for 80% of M-coded visit diagnoses, and 95% of patients had at least one of these diagnoses. The most common diagnoses (spinal pain, joint pain, osteoarthritis) were used similarly in primary and specialty care settings. CONCLUSION A diverse sample of all available musculoskeletal diagnosis codes were used; however, less than 2% of all possible codes accounted for 80% of the diagnoses used. This trend was consistent across primary and specialty care settings. The most frequently used diagnosis codes describe the types of musculoskeletal conditions, among a large pool of potential diagnoses, that prompt veterans to present to VHA for musculoskeletal care.
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Affiliation(s)
- Brian C Coleman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Joseph L Goulet
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA.,Boston University School of Medicine, Boston, MA
| | - Harini Bathulapalli
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Todd Kawecki
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Christopher B Ruser
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Steve Martino
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - John D Piette
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.,University of Michigan School of Public Health, Ann Arbor, MI
| | - Sara N Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
| | - Alicia A Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.,Yale School of Medicine, Yale University, New Haven, CT
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10
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Incident Musculoskeletal Conditions Among Men and Women Veterans Returning From Deployment. Med Care 2021; 58:1082-1090. [PMID: 32925458 DOI: 10.1097/mlr.0000000000001403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Military service confers an increased risk for musculoskeletal (MSK) injury among women and men Veterans. OBJECTIVE The objective of this study was to determine the prevalence of MSK conditions at first visit to Veterans Affairs (VA), and the incidence rates of new MSK conditions in women and men Veterans with and without a baseline MSK condition. DESIGN A cohort study including Veterans whose end of last deployment was between October 1, 2001 and October 1, 2015. SUBJECTS A total of 765,465 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans. MAIN OUTCOME MEASURES Prevalent and incident MSK conditions identified through the International Classification of Diseases, ninth Revision, Clinical Modification diagnostic codes. RESULTS Twenty-six percent of women and 29% of men present to the VA with a MSK condition. In those without an MSK diagnosis at baseline, the unadjusted rate of developing at least 1 MSK condition was 168 and 180 per 1000 person-year [hazard ratio (HR)=0.94; 95% confidence interval (CI)=0.92-0.95] in women and men. Women were more likely to develop newly diagnosed MSK conditions of the hip (HR=1.9; 95% CI=1.83-1.98) or the ankle/foot (HR=1.17; 95% CI=1.15-1.20) and less likely to develop MSK conditions of the upper extremity (HR=0.75; 95% CI=0.73-0.78), knee (HR=0.87; 95% CI=0.86-0.89), and spine (HR=0.94; 95% CI=0.93-0.96). In those with prevalent MSK conditions at baseline, the rate of developing a second MSK condition was higher in women than men (151 and 133/1000 person-year; HR=1.13; 95% CI=1.11-1.15). CONCLUSIONS A high proportion of Veterans present to the VA with MSK conditions. Women are less likely to develop conditions related to the upper extremities, spine or knee, and more likely to have conditions of the hip or ankle/foot.
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11
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Kneeman J, Battalio SL, Korpak A, Cherkin DC, Luo G, Rundell SD, Suri P. Predicting Persistent Disabling Low Back Pain in Veterans Affairs Primary Care Using the STarT Back Tool. PM R 2020; 13:241-249. [PMID: 32902134 DOI: 10.1002/pmrj.12488] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Subgrouping for Targeted Treatment (STarT Back) is a stratified care approach to low back pain (LBP) treatment. The predictive validity of STarT Back in Veterans Affairs (VA) primary care has not been demonstrated. OBJECTIVE To examine the validity of the STarT Back tool for predicting future persistent disabling LBP in VA primary care. DESIGN Cohort study. SETTING VA primary care in Washington State. PARTICIPANTS Veterans seeking care for LBP in VA primary care clinics. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The STarT Back tool was used to classify Veterans according to their baseline risk group (low vs medium vs high). The primary study outcome, persistent disabling LBP, was defined as a Roland-Morris Disability Questionnaire (RMDQ) score ≥ 7 at 6-month follow-up. Analyses examined discrimination and calibration of the baseline STarT Back risk groups for prediction of persistent disabling LBP at 6-month follow-up. RESULTS Of the study sample, 9% were female and 80% reported longstanding LBP (>5 year duration). Among 538 participants, the baseline STarT Back risk groups were associated with future persistent disabling LBP at 6-month follow-up. Within each baseline STarT Back risk group, the proportions with future persistent disabling LBP at 6-month follow-up were 54% (low risk), 88% (medium risk), and 97% (high risk). The baseline STarT Back risk groups had useful discrimination (area under the curve [AUC] 0.79) for predicting future persistent disabling LBP, but the proportion of Veterans with persistent disabling LBP at 6-month follow-up was substantially higher than that observed in non-VA primary care settings. CONCLUSIONS The STarT Back risk groups had useful discrimination (AUC = 0.79) for future persistent disabling LBP, but calibration was poor, underestimating the risk of persistent disabling LBP. The STarT Back tool may require updating for use in VA primary care.
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Affiliation(s)
- Jacob Kneeman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Anna Korpak
- Seattle Epidemiologic Research and Information Center (ERIC, VA Puget Sound Health Care System, Seattle, WA
| | | | - Gang Luo
- Department of Biomedical Informatics and Education, University of Washington, Seattle, WA.,Clinical Learning, Evidence, and Research Center (CLEAR), University of Washington, Seattle, WA
| | - Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Pradeep Suri
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.,Seattle Epidemiologic Research and Information Center (ERIC, VA Puget Sound Health Care System, Seattle, WA.,Clinical Learning, Evidence, and Research Center (CLEAR), University of Washington, Seattle, WA.,Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA
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12
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Hall AL, MacLean MB, VanTil L, McBride DI, Glass DC. Considering Exposure Assessment in Epidemiological Studies of Chronic Health in Military Populations. Front Public Health 2020; 8:577601. [PMID: 33123510 PMCID: PMC7573167 DOI: 10.3389/fpubh.2020.577601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/26/2020] [Indexed: 12/18/2022] Open
Abstract
Exposure assessment is an important factor in all epidemiological research seeking to identify, evaluate, and control health risks. In the military and veteran context, population health research to explore exposure-response links is complicated by the wide variety of environments and hazards encountered during active service, long latency periods, and a lack of information on exposures in potentially vulnerable subgroups. This paper summarizes some key considerations for exposure assessment in long-term health studies of military populations, including the identification of hazards related to military service, characterization of potentially exposed groups, exposure data collection, and assignment of exposures to estimate health risks. Opportunities and future directions for exposure assessment in this field are also discussed.
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Affiliation(s)
- Amy L Hall
- Research Directorate, Veterans Affairs Canada, Charlottetown, PE, Canada
| | - Mary Beth MacLean
- Research Directorate, Veterans Affairs Canada, Charlottetown, PE, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, PE, Canada
| | - David Iain McBride
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Deborah C Glass
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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13
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Hall AL, Sweet J, Tweel M, MacLean MB. Comparing negative health indicators in male and female veterans with the Canadian general population. BMJ Mil Health 2020; 168:82-87. [PMID: 32868291 PMCID: PMC8788043 DOI: 10.1136/bmjmilitary-2020-001526] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 11/22/2022]
Abstract
Introduction Sex-based information on differences between Canadian veterans and the general population is important to understand veterans’ unique health needs and identify areas requiring further research. This study compared various health indicators in male and female veterans with their Canadian counterparts. Methods Health indicators for recent-era Regular Force veterans (released between 1998 and 2015) were obtained from the 2016 Life After Service Survey and compared with the general population in the 2015–16 Canadian Community Health Survey using a cross-sectional approach. Age-adjusted rates and 95% CIs were calculated for males and females separately. Results Compared with Canadians, veterans (both sexes) reported higher prevalence of fair or poor health and mental health, needing help with one or more activity of daily living, lifetime suicidal ideation and being diagnosed with mood and anxiety disorders, post-traumatic stress disorder, migraines, back problems, chronic pain, arthritis, ever having cancer, hearing problems, chronic pain and gastrointestinal problems. A higher prevalence of cardiovascular disease (all types) and high blood pressure was observed in male veterans compared with their Canadian counterparts. Within veterans only, males reported a higher prevalence of diagnosed hearing problems and cardiovascular disease compared with females; conversely females reported a higher prevalence of diagnosed migraines, mood, anxiety and gastrointestinal disorders, and needing help with activities of daily living. These sex differences are similar to the Canadian general population. Some similarities in reporting prevalence between male and female veterans (eg, fair or poor mental health, lifetime suicidal ideation, arthritis, asthma, lifetime cancer incidence, chronic pain and diabetes) were not observed in other Canadians. Conclusion Male and female veterans differed from comparable Canadians, and from each other, in various areas of health. Further research is needed to explore these findings, and veteran-based policies and services should consider sex differences.
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Affiliation(s)
- Amy L Hall
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - J Sweet
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - M Tweel
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada
| | - M B MacLean
- Veterans Affairs Canada, Government of Canada, Charlottetown, Prince Edward Island, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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14
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Britt TW, Sipos ML, Klinefelter Z, Adler AB. Determinants of mental and physical health treatment-seeking among military personnel. Br J Psychiatry 2020; 217:420-426. [PMID: 31258095 DOI: 10.1192/bjp.2019.155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although research has documented factors influencing whether military personnel seek treatment for mental health problems, less research has focused on determinants of treatment-seeking for physical health problems. AIMS To explicitly compare the barriers and facilitators of treatment-seeking for mental and physical health problems. METHOD US soldiers (n = 2048) completed a survey with measures of barriers and facilitators of treatment-seeking for mental and physical health problems as well as measures of somatic symptoms and mental health. RESULTS The top barrier for both mental and physical health treatment-seeking was a preference for handling problems oneself. The top facilitators for both symptom types were related to treatment improving quality of life. Differential endorsement of barriers occurred for treatment of mental versus physical health symptoms. In contrast, facilitators were endorsed more for physical than for mental health treatment. While there were few gender differences, officers reported more barriers and facilitators than did enlisted personnel. Screening positive for mental or physical health problems was associated with greater endorsement of both barriers and facilitators for physical and mental health treatment, respectively. CONCLUSIONS The leading barriers and facilitators for seeking treatment for mental health and physical problems are relatively similar, suggesting that health education should consider decision-making in seeking both mental and physical healthcare. Interventions should be tailored to reduce barriers for officers and improve facilitators for junior enlisted personnel, and address barriers and facilitators for service members screening positive for a mental or physical health problem.
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Affiliation(s)
- Thomas W Britt
- Professor, Department of Psychology, Clemson University; and Research Psychologist, Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research, USA
| | | | - Zachary Klinefelter
- Graduate Research Assistant, Department of Psychology, Clemson University, USA
| | - Amy B Adler
- Clinical Research Psychologist, Center for Military Psychiatry and Neuroscience Research, Walter Reed Army Institute of Research, USA
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15
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Hinojosa R. Cardiovascular disease among United States military veterans: Evidence of a waning healthy soldier effect using the National Health Interview Survey. Chronic Illn 2020; 16:55-68. [PMID: 29940779 DOI: 10.1177/1742395318785237] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Cardiovascular disease is the most common chronic health condition affecting Americans. One important group of Americans that health researchers have noted as key to understanding general population health and wellbeing are veterans of the US military. The healthy soldier effect has been used to explain the health benefits of military service during and for a period of time after service. The purpose of this study is to examine the prevalence of cardiovascular disease in a national sample of veterans and non-veterans with specific attention paid to reported cardiovascular disease across ages. Methods A total of 150,067 veteran and non-veteran respondents from the National Health Interview Survey were examined for the likelihood of reporting the type and number of cardiovascular conditions. Results Veterans report higher rates of certain cardiovascular disease conditions and report a higher number of cardiovascular disease conditions compared to non-veterans. Veterans also reported higher numbers of cardiovascular disease conditions at younger ages (ages 25–65) compared to non-veteran counterparts. At older ages (ages 66 to 85+), non-veterans reported higher numbers of cardiovascular disease conditions compared to veterans. Discussion Our findings are consistent with research that indicates a waning healthy soldier effect for young veterans.
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Affiliation(s)
- Ramon Hinojosa
- Department of Sociology, University of Central Florida, Orlando, FL, USA
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16
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Physical Therapy as a Force Multiplier: Population Health Perspectives to Address Short-Term Readiness and Long-Term Health of Military Service Members. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000129] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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McCaskill GM, Clay OJ, Motl RW, Ball KK. Older Veterans EmpoweRed To Use Regular Exercise (OVERTURE) II: Design and methods of a randomized controlled trial among older veterans with chronic health conditions. Contemp Clin Trials Commun 2019; 15:100395. [PMID: 31338477 PMCID: PMC6626999 DOI: 10.1016/j.conctc.2019.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gina M McCaskill
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, 35294-2100, USA.,Birmingham/Atlanta GRECC, Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
| | - Olivio J Clay
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, 35294-2100, USA
| | - Robert W Motl
- University of Alabama at Birmingham, Department of Physical Therapy, SHPB 336, 1716 9th Ave South, Birmingham, AL, 35233, USA.,University of Alabama at Birmingham, Lakeshore Research Collaborative, 1716 9th Avenue South, Birmingham, AL, 35294, USA
| | - Karlene K Ball
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, 35294-2100, USA
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