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Abstract
OBJECTIVES Hearing-aid use may reduce risk of dementia, but cognitive impairment makes use more challenging. An observed association between reduced hearing-aid use and incident dementia could reflect either or both of these causal paths. The objective was to examine the effects of each path while minimising contamination between paths. METHODS Health records data from 380,794 Veterans who obtained hearing aids from the US Veterans Affairs healthcare system were analysed. Analysis 1 (n = 72,180) used multivariable logistic regression to model the likelihood of incident dementia 3.5-5 years post hearing-aid fitting for patients free of dementia and mild cognitive impairment (MCI). Analysis 2 (n = 272,748) modelled the likelihood of being a persistent hearing-aid user at 3 years 2 months after fitting, contrasting subgroups by level of cognitive function at the time of fitting. Analysis time windows were optimized relative to dataset constraints. Models were controlled for available relevant predictors. RESULTS The adjusted OR for incident dementia was 0.73 (95% CI 0.66-0.81) for persistent (versus non-persistent) hearing-aid users. The adjusted OR for hearing-aid use persistence was 0.46 (95% CI 0.43-0.48) in those with pre-existing dementia (versus those remaining free of MCI and dementia). CONCLUSION Substantial independent associations are observed in both directions, suggesting that hearing-aid use decreases risk of dementia and that better cognitive function predisposes towards persistent use. Research studying protective effects of hearing-aid use against dementia needs to account for cognitive status. Clinically, hearing devices and hearing care processes must be accessible and usable for all, regardless of their cognitive status.
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Affiliation(s)
- Graham Naylor
- Address correspondence to: Graham Naylor, Hearing Sciences–Scottish Section, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, UK.
| | - Lauren Dillard
- Department of Otolaryngology- Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA,VA Rehabilitation R&D, National Center for Rehabilitative Auditory Research, Portland, OR, USA
| | - Martin Orrell
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Oliver Zobay
- School of Medicine, University of Nottingham, Nottingham, UK,VA Rehabilitation R&D, National Center for Rehabilitative Auditory Research, Portland, OR, USA
| | - Gabrielle H Saunders
- VA Rehabilitation R&D, National Center for Rehabilitative Auditory Research, Portland, OR, USA,Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
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Wood L, Flatau P, Seivwright A, Wood N. Out of the trenches; prevalence of Australian veterans among the homeless population and the implications for public health. Aust N Z J Public Health 2021; 46:134-141. [PMID: 34709717 DOI: 10.1111/1753-6405.13175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/01/2021] [Accepted: 09/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To examine the prevalence of Australian Defence Force veterans among people sleeping rough and explore their health and social needs relative to non-veteran rough sleepers. METHOD Analysis of responses to the Vulnerability Index - Service Prioritisation Decision Assistance Tool (VI-SPDAT) collected from 8,027 rough sleepers across five Australian States from 2010-2017. RESULTS Veterans were found to comprise 5.6% of people sleeping rough in Australia, with veterans reporting having spent an average of 6.3 years on the street or in emergency accommodation (compared with an average of five years for their non-veterans counterparts). Veterans had a higher prevalence of self-reported physical health, mental health and social issues compared with non-veteran rough sleepers. CONCLUSIONS This is the first study of its kind to elucidate the presence of Australian veterans among people sleeping rough. That they are likely to have spent more years on the street, and have a higher prevalence of health and social issues, highlights the imperative for earlier intervention and prevention of veteran homelessness itself, and its health impacts. Implications for public health: Veteran homelessness has been comparatively hidden in Australia compared to other countries, and consequently the myriad of health, psychosocial and adjustment issues faced by homeless veterans has also been hidden. With heightened attention on veteran suicide and self-harm, earlier intervention to prevent veterans becoming homeless constitutes sound public health prevention and mental health policy.
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Affiliation(s)
- Lisa Wood
- School of Population and Global Health, University of Western Australia
| | - Paul Flatau
- Centre for Social Impact, Business School, University of Western Australia
| | - Ami Seivwright
- Centre for Social Impact, Business School, University of Western Australia
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Meffert BN, Morabito DM, Sawicki DA, Hausman C, Southwick SM, Pietrzak RH, Heinz AJ. US Veterans Who Do and Do Not Utilize Veterans Affairs Health Care Services: Demographic, Military, Medical, and Psychosocial Characteristics. Prim Care Companion CNS Disord 2019; 21. [PMID: 30677266 DOI: 10.4088/pcc.18m02350] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/05/2018] [Indexed: 10/27/2022] Open
Abstract
Objective To examine sociodemographic and military characteristics of US veterans who do and do not utilize Veterans Affairs (VA) health care services as their primary source of health care and examine the relationship between VA utilization and medical and psychosocial characteristics. Methods Participants were a nationally representative sample of 3,152 military veterans (89.8% male, 83.5% white, 6.0% black, mean age = 62.0 [SD = 13.1] years) who completed a survey in 2011 assessing health care utilization, sociodemographic, military service, medical, and psychosocial characteristics. Receiver operator characteristic analyses and logistic and linear regressions were conducted to provide a comprehensive and multivariate examination of factors associated with VA utilization. Results Veterans who used VA services were more likely to be black, younger, female, unmarried, and less educated and to have lower household incomes. They were also more likely to have served longer in the military and in combat. VA users were more likely to screen positive for lifetime psychopathology, endorse current suicidality, and report enduring more traumas. VA users were also more likely to report more medical conditions, endorse a disability, and score lower on measures of functioning. The primary factor differentiating VA users from those that did not use VA services was presence of lifetime psychopathology. Conclusions Results provide a comprehensive profile of veterans who do and do not utilize VA services and suggest that veterans who use VA services have a substantially elevated health burden compared to other veterans. Results may help inform outreach and engagement initiatives targeting the unique health care needs of veterans who do and do not utilize VA services.
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Affiliation(s)
- Brienna N Meffert
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California, USA
| | - Danielle M Morabito
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California, USA
| | - Danielle A Sawicki
- Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California, USA
| | - Catherine Hausman
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Steven M Southwick
- Clinical Neurosciences Division, National Center for PTSD, US Department of Veterans Affairs Connecticut Healthcare System and Department of Psychiatry, Yale School of Medicine, West Haven, Connecticut, USA
| | - Robert H Pietrzak
- Clinical Neurosciences Division, National Center for PTSD, US Department of Veterans Affairs Connecticut Healthcare System and Department of Psychiatry, Yale School of Medicine, West Haven, Connecticut, USA
| | - Adrienne J Heinz
- 795 Willow Rd (152-MPD), Menlo Park, CA 94025. .,Dissemination and Training Division, National Center for PTSD, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California, USA.,Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California, USA
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Cook WA, Melvin KC, Doorenbos AZ. US Military Service Members' Reasons for Deciding to Participate in Health Research. Res Nurs Health 2017; 40:263-272. [PMID: 28185285 DOI: 10.1002/nur.21785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2016] [Indexed: 11/07/2022]
Abstract
Researchers have reported challenges in recruiting US military service members as research participants. We explored their reasons for participating. Eighteen US military service members who had participated in at least one health-related research study within the previous 3 years completed semi-structured individual interviews in person or by telephone, focused on the service members' past decisions regarding research participation. Service members described participation decisions for 34 individual research experiences in 27 separate studies. Service members' reasons for participation in research clustered in three themes: others-, self-, and fit-focused. Each decision included reasons characterized by at least two themes. Reasons from all three themes were apparent in two-thirds of individual participation decisions. Reasons described by at least half of the service members included a desire to make things better for others, to improve an organization, to help researchers, and to improve one's health; understanding how they fit in studies; and convenience of participation. Findings may help researchers, study sponsors, ethicists, military leaders, and military decision-makers better understand service members' reasons for participating in research and improve future recruitment of service members in health research. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Wendy A Cook
- Commander, US Navy Nurse Corps, Nurse Scientist, Clinical Investigations Department, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA 92134
| | - Kristal C Melvin
- Lieutenant Colonel, US Army Nurse Corps, Chief, Center for Nursing Science & Clinical Inquiry, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Ardith Z Doorenbos
- Professor, Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA
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Fryar CD, Herrick K, Afful J, Ogden CL. Cardiovascular Disease Risk Factors Among Male Veterans, U.S., 2009-2012. Am J Prev Med 2016; 50:101-105. [PMID: 26232905 PMCID: PMC7339966 DOI: 10.1016/j.amepre.2015.06.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/12/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cardiovascular disease remains an important cause of death in the U.S. where veterans of the U.S. Armed Forces represent a significant segment of the population. Limited national estimates of cardiovascular disease risk factors using physical measurements and reported veteran status in the U.S. civilian population have been reported. The purpose of this study was to compare the prevalence of cardiovascular disease risk factors among veteran and non-veteran men in the U.S. civilian population. METHODS Using data from the 2009-2012 National Health and Nutrition Examination Surveys, 1,107 veteran and 3,972 non-veteran men were identified for this study (analyzed in 2014-2015). Differences in hypertension, dsylipidemia, diabetes, obesity, and smoking between veterans and non-veterans were compared using chi-square and t-tests. Predicted prevalence from multivariable logistic regression models adjusted for age, race/Hispanic origin, and poverty level were used to assess whether previous military service was associated with having a cardiovascular disease risk factor. RESULTS Veteran men were older than non-veteran men (59.9 years vs 43.4 years) and were more likely to be non-Hispanic white (79.9% vs 65.7%). Adjusted predicted prevalence estimates show that veterans were more likely than non-veterans to be obese (42.6% vs 33.7%, p<0.01). After adjustment for obesity, there was no difference in hypertension, dyslipidemia, diagnosed diabetes, or smoking between veteran and non-veteran men. CONCLUSIONS This study identified a segment of the U.S. civilian population-veteran men-who have a higher prevalence for obesity, a risk factor associated with increased risk for other cardiovascular disease risk factors.
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Affiliation(s)
- Cheryl D Fryar
- National Center for Health Statistics, CDC, Hyattsville, Maryland.
| | - Kirsten Herrick
- National Center for Health Statistics, CDC, Hyattsville, Maryland
| | - Joseph Afful
- Harris IT Services Corporation, Herndon, Virginia
| | - Cynthia L Ogden
- National Center for Health Statistics, CDC, Hyattsville, Maryland
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