Credit Newswise — If you think interior design is all about paint colors, fabric swatches and furniture styles, think again. Because students in an Iowa State University graduate studio have propelled interior design to a place it's never been before: the 21st century combat outpost. Students in the advanced experimental studio class created environments that support combat soldiers' mental health and help alleviate post-traumatic stress disorder. (PTSD). Their designs balance privacy and connection, relaxation and security, meditation and activity. The 1920s cots (yes, they're still used), standard-issue tents and hanging-poncho privacy dividers are replaced with individual spaces that soldiers can personalize and control. Communal spaces are strong and masculine; personal spaces are soft and soothing. Believed to be the only class of its kind, "In Harm's Way: Interior Design for Modern Combat" is the brainchild of Interior Design Professor and Chair Lee Cagley. "I've been working on this for several years, since watching a TV feature on PTSD. Soldiers returning from Iraq and Afghanistan spoke eloquently about the fact that they were never able to relax; the outpost tents never felt really safe. They couldn't talk about their fears or feelings and felt that their needs were not valued," he said. "It struck me that what they were talking about was fundamentally an interior design problem — the combat outpost environment wasn't supporting the troops emotionally," Cagley said. "The idea for the class was to rethink the outpost so the combat experience can be mitigated in some way by the environment." Tricky logisticsThe logistics — like getting site plans for a typical forward base in an active combat zone — have been tricky, Cagley said. But "once it happened," members of ISU's ROTC have "cooperated enthusiastically." Retired Air Force civil engineering technician Joseph Pasquantino, Hartford, Connecticut, helped move Cagley's idea forward. While in the military, Staff Sgt. Pasquantino was part of the engineering unit that designed and set up tent cities for bases in forward deployed locations, beginning with Desert Shield/Desert Storm. He provided the class with extensive information on combat-forward base requirements and design, which have not changed significantly since World War I, according to Cagley. Pasquantino has remained involved with the class, attending reviews throughout the semester. "Anyone who has been deployed knows there is no privacy, no escape from the job. And as hard as the military tries to provide some rest and relaxation, a few days here and there really doesn't help," Pasquantino said. "Being able to provide a customizable space for a soldier or airman to escape to daily would greatly improve their quality of life and possibly reduce the effects or occurrence of PTSD," Pasquantino said. Into the futureThe six interior design grad students in the class are Yongyeon Cho, Josh Kassing, Maricel Lloyd, Miranda Spears, Nathan Thiese and Zhenru Zhang. Alex Ausenhus, an industrial design grad student interested in the topic, is working on a separate, but compatible, device design (see sidebar below). The students researched and documented their design process while creating a combat outpost for 144 soldiers in about 2022. They were asked to design environments unlike anything else, using technologies and materials not yet widely available. Their designs had to include all operations of a typical base — from laundry, billeting and mess hall to armory, helipad and medical. The class visited Camp Dodge to see a practice outpost facility used for set-up and teardown training prior to the Iraq War. Master Sgt. Christopher Shaiko, Sgt. 1st Class Joey Bowman, and Human Resources Assistant Mike Tate (all with ISU ROTC) spoke to the class about what it's like to be in a combat-forward position and the inadequacy of current outposts. Diverse solutionsOne student designed an underground Zen Center with space for a chapel and private reflection; another used technology that enables soldiers to control their environment through light and sound. Another student conceived of acoustical seclusion for a soldier using headphones, but with a transparent fabric partition to prevent total isolation. One vernacular design used color and form to blend the base into its surroundings and another designed a camouflage city under one roof to protect the identity of base functions from overhead attack. Yet another student designed flexible structural elements that can be manipulated according to the interior space's function. Several students converted wasted vertical space into useable living space and specified modular components to simplify manufacturing, shipping and installation. Some called for blast-resistant materials to increase safety. Others proposed courtyards and gardens and moved bathrooms and showers closer to the billeting area. "All the solutions are remarkably different from one another," Cagley said. "They've been done with an eye for advanced experiential — they may not be the most practical but they're the most forward thinking." Student experienceAlthough grad student Lloyd is a veteran, she was not deployed into combat. Her husband was, however. And he lived in the combat outpost in Mosul, Iraq. "Interior design is about the experience [of an environment] so it's perfect for finding a solution to this problem," she said. "PTSD is something you can't see or fix for the person. But creating a space where they can feel safe — yet connected to battle buddies — is an important solution our studio can offer to mitigate PTSD." While Lloyd admits that her familiarity with the effects of war might be an advantage in the class, she said her knowledge of the military's conventional approach to problem solving is a hindrance. "A lot of the creative process that goes into design is fostered by the ability to see beyond conventional solutions. But dealing with the military's standard operating procedures left me with blinders of practicality. That's been my challenge in this class," Lloyd said. For Josh Kassing, the class has presented a different challenge. "I was completely illiterate about what a military operation looks like. I've never had to put myself in a tent in an active combat zone. What does it look like at night? Does it feel like a home or a safe place?" Kassing said. "I had to understand that before I could do the design. Putting myself into a situation that I would never normally be in has been interesting and really different from our other usually luxurious design projects. We're putting ourselves into an inherently difficult position and then designing for it. It's complex to negotiate," he said. And that was an intended lesson of the class. "They've learned that design isn't necessarily just a discretionary spend. Design can genuinely save life, and perhaps even prevent some of the needless suicides," Cagley said. "The students have taken an entirely different look at what interior design in particular is capable of, and how the profession can claim a significant stake in shaping the future of our country and the lives of its citizens. It's clear they've discovered how socially relevant and urgently needed their skills actually are," he said. Cagley and Industrial Design Assistant Professor Will Prindle will apply for a grant from the Department of Defense to design and construct some prototypes of the students' designs at Camp Dodge. If all goes well, a design-build studio will do the work in the spring of 2017.  (Sidebar)Healing the invisible woundAlex Ausenhus, an industrial design graduate student, is "in an orbit around us, working on a device design that is compatible with the concepts of this class," said Lee Cagley, interior design professor and chair. His design for an application that addresses post-traumatic stress disorder (PTSD) head on is "genius and thoughtful," Cagley said. As Ausenhus learned in his historical research, the mental health condition was called "nervous exhaustion of yellow bellies" in the Civil War; "battle fatigue" necessitating dishonorable discharge in World Wars I and II; and shell shock in the Vietnam era. In the 1980s, the condition became known as PTSD. Between 15 and 30 percent of soldiers returning from combat in recent years suffer from PTSD. Ausenhus created an app that allows soldiers to orally record a completely confidential account of daily events, including how they felt during and after a battle. It's designed to help soldiers get through a particularly challenging or stressful situation. The app has a lock code, is not connected to Wi-Fi and is inaccessible to the military. The app flags terrible days and alerts the soldier when those red flags add up to susceptibility to PTSD. Ausenhus designed the device as a small tablet, with a steel and Kevlar bulletproof covering. It can be worn suspended behind a bulletproof vest as a thin addition to body armor that can be used hands-free and privately. "At the end of a 30-day mission, the soldier can listen and hear the emotion experienced during events," Ausenhus said. "It's simply a way to record, 'This is what happened and this is how I felt.'" Ausenhus calls the device "Ruck up," which, in the military, means to get through a difficult situation. Cagley said it could also be useful for patients of grief counselors and other mental health practitioners.
Credit Newswise — An average of approximately 10,000 active component service members were diagnosed with erectile dysfunction each year during a 10-year surveillance period and the annual number of incident cases doubled between 2004 and 2013, according to a newly released health surveillance report. During the 10-year surveillance period, there were 100,248 incident cases of erectile dysfunction diagnosed in active component servicemen, according to the report released today and published in the September issue of the Medical Surveillance Monthly Report (MSMR) from theArmed Forces Health Surveillance Center (AFHSC). The overall crude incidence rate was 8.4 per 1,000 person-years (p-yrs). Erectile dysfunction cases classified as psychogenic – related predominantly or exclusively to psychological factors – comprised almost half of all erectile dysfunction cases (48 percent) during the surveillance period (Table 2). The report described the counts and rates of newly diagnosed erectile dysfunction diagnoses for all males who had served at least one day in the active component of the Army, Navy, Air Force, Marine Corps, or Coast Guard. During the surveillance period, crude incidence rates of erectile dysfunction more than doubled from 5.8 cases per 1,000 p-yrs in 2004 to 12.6 cases per 1,000 p-yrs in 2013. Incidence rates of psychogenic erectile dysfunction demonstrated a greater increase than rates of organic erectile dysfunction (Figure 1). Organic erectile dysfunction is attributable to underlying physical factors such as obesity, smoking, diabetes, cardiovascular disease or medication use. “Since the advent of effective oral therapy for erectile dysfunction, this condition has been better recognized as a common medical disorder and as the most common sexual complaint reported by men to healthcare providers,” said Navy Captain Kevin Russell, the director of AFHSC. “This report is unique in its ability to clarify the epidemiology of this condition in a large population of men, namely active component U.S. servicemen.” The study also reported that about half of servicemen who are newly diagnosed with erectile dysfunction do not seek medical care for the condition more than once during a two-year period; this may indicate that many servicemen are successfully treated in a single visit although it could also indicate that subsequent care for erectile dysfunction is sought outside the military health system. As expected, incidence rates were higher in the older age groups, and the highest rates were observed in those aged 60 years or older. The incidence rates were sharply higher in service members aged 40 years or older (Table 2). Except for servicemen aged 20 years or younger, incidence rates in all age groups showed a slight increasing trend over the course of the surveillance period (Figure 2). For the entire surveillance period, the crude incidence rate of erectile dysfunction was higher among black, non-Hispanic servicemen compared to servicemen of other race/ethnicity groups. Separated, divorced, and widowed servicemen had an almost four-fold higher crude incidence rate of erectile dysfunction than servicemen who had never married. The crude incidence rate of erectile dysfunction was lowest in servicemen with an education level of high school or lower (Table 2). Over the entire surveillance period, servicemen who had never deployed had the highest crude incidence rate of erectile dysfunction (10.1 per 1,000 p-yrs). A cross-sectional study examining prevalence rates by race and ethnicity in U.S. civilian men aged 40 years or older reported the highest prevalence rates in blacks.7 Additionally, black, non-Hispanic service members have higher incidence rates of several conditions known to be risk factors for erectile dysfunction (i.e., hypertension, obesity, and diabetes).8,9 Some findings differed from those seen in the civilian literature. For example, Selvin et al. reported that lower levels of education were associated with higher prevalence of erectile dysfunction, whereas the report published in the September MSMR indicated that those with higher levels of education were more likely to be diagnosed with erectile dysfunction.4 These study findings suggest several avenues for additional analyses. For example, further studies could examine the comorbid and co-occurring medical conditions to look for possible reasons for erectile dysfunction in servicemen, and might provide insight into the reasons that the incidence rates of this condition are increasing. Several studies in veterans have examined the association between mental health diagnoses, especially post-traumatic stress disorder, and the occurrence of erectile dysfunction.
Credit Newswise — The University of Alabama at Birmingham is launching a research project that will provide therapy to wounded veterans and active-duty personnel at no cost through a $2.7 million grant from the U.S. Department of Defense. The Brave Initiative will enable 80 veterans and active-duty personnel with traumatic brain injuries, or TBI, to receive free, intensive therapy to improve arm function and physical fitness through the study. “We are eager to make the services provided by this grant available to as many of Alabama’s brave veterans and active-duty personnel with TBI as possible,” said Edward Taub, Ph.D., UAB psychology professor and director of this project. “We believe that our treatments can have a major impact on the quality of their lives, and we are grateful to be able to do something for veterans after all they have done for our country.” The Lakeshore Foundation, along with Veterans Affairs hospitals from across the country, will be partnering with UAB to help make the study possible.TBI is a highly prevalent condition that often results in the loss of independence and quality of life for many individuals; it is seen frequently in military personnel who have sustained a blast injury. The traditional view in the rehabilitation field was that there was a limited period of time after this type of damage to the central nervous system during which the rehabilitation of motor deficits could take place. However, research conducted in Taub’s laboratory has shown that stroke and also TBI survivors can regain use of their limbs even years after the brain injury occurred through the use of a novel family of therapies. The study funded through the DOD grant consists of two different types of treatments, which will be randomly assigned to participants. One treatment is called Constraint-induced Movement Therapy, or CI Therapy. Taub developed CI Therapy and has treated hundreds of patients with this treatment, showing its effectiveness in improving the rehabilitation of movement after stroke and other neurological injuries. The therapy centers around teaching the brain to “rewire” itself following a major injury using motor-training techniques. It enhances the brain’s ability to heal itself by retraining regions of the brain that still function well after the brain injury, a process called brain reorganization or neuroplasticity. The CI Therapy participants will practice exercises and skilled movements that increase the use of their weaker, injured limb in daily life. The stronger limb is constrained to encourage use of the weaker limb. A second group of participants will benefit from an alternative therapy developed in collaboration with the laboratory of James Rimmer, Ph.D., UAB professor of occupational therapy, and will focus on physical and mental fitness training. The physical and mental fitness therapy combines gentle to moderate holistic exercise, breathing techniques, muscle and mind relaxation, and massage therapy. An MRI will be given before and after each treatment to assess the effects of both therapies on the brain. “With more than 400,000 veterans living in Alabama and more than 30,000 active military and active reservists who are Alabama residents, this therapy has the long-term potential to make a positive impact on our state, our veterans and beyond,” said Gitendra Uswatte, Ph.D., UAB professor of psychology and another leader of this project. “We have seen our therapies work for veterans and for others who have suffered from TBI, so we’re excited about the promise of a very successful outcome.” Participants in the treatment, along with a companion, will have all travel and living expenses covered by the grant. The treatment will take place during a three-week period, with participants living at the Lakeshore Foundation and receiving treatment at UAB and at Lakeshore. Potential participants should meet the following criteria: • Be active-duty or veteran military personnel• Be at least 19 years old• Be at least three months post-TBI• Have movement problems or weakness in one or both arms If you or someone you know meets the criteria for this treatment, please call the TBI rehabilitation research team at (205) 934-9768 or visit
Credit Newswise — Military families face unique challenges – frequent moves, long separations and parents returning from active duty injured or suffering from post-traumatic stress disorder. It can be an anxiety-filled lifestyle for both the deployed parent and the one who remains to manage the household alone – and even more difficult if the family includes children with special needs. To help ease the mental health burden of New Jersey families affected by military service, the National Call Center at Rutgers University Behavioral Health Care (UBHC) has launched Military Mom2Mom (844-645-6261), a 24/7 confidential peer support helpline staffed by military parents and behavioral specialists. It joins three similar helplines operated by the call center: and Vets4Warriors, which serve veterans and active duty, National Guard and Reserve military personnel, and Mom2Mom, which provides support for caregivers of children with special needs.  UBHC recognized a need for Military Mom2Mom to offer support for the families as they navigate many challenges, to suggest professional counseling if the indicators present themselves, and offer guidance on resources available. The helpline is sponsored by a grant from the Health Care Foundation of New Jersey, which launched its Veterans Mental Health Initiative last spring after almost a year of networking with providers within the VA system and the healthcare community. “We discovered that unattended mental health needs rose to the top of identified gaps in service due to the scarcity of appropriate services available, the wait list for services that do exist and the stigma that often prevents veterans from seeking the help they need,” says Marsha Atkind, CEO of the foundation.  Although the number of military families with special needs children is not quantified, more than 15 percent of children in the United States have disabilities. “We were seeing a lot of military families calling the Mom2Mom line, and callers on the military lines requesting resources for their special needs children,” says Dawn Dreyer Valovcin, a supervising mental health specialist at the UBHC National Call Center. “There was a demand to have a dedicated helpline to address these families’ unique issues.” Military Mom2Mom peer support counselor Melissa Tippett, an Army combat veteran who also answers calls to Vets4Warriors, understands the importance of speaking to someone who has been there. When Tippett was medically discharged in 2006, she faced more than recuperation from an injury that caused permanent nerve damage in her right arm: She had to learn how to reconnect with her two young special needs sons after deployments in Afghanistan and Iraq. “Mothers are the traditional primary caregivers, and it was challenging to reintroduce myself to these small children who didn’t know me,” says the Dunellen mother. “There are no words I can use to describe how tough that time was.” Her son, Nasir, 11, suffered from meconium aspiration syndrome, a condition that places him at risk for serious breathing problems. Rahim, 9, is on the autism spectrum. “It’s complicated when you’re in the military and have a child with health issues,” she says. “I had to take extra leave when Nasir went into cardiac arrest and had to have a blood transfusion. I thought we would lose him.” Although Tippett had supportive family and friends, they couldn’t relate to her situation – none had ever been deployed parents or injured in service. She recalls the support she received from a Vietnam veteran who befriended her while she was undergoing treatment at a VA hospital. “I was as miserable as I could be, and he helped me so much just by listening,” she says. “We had an instant bond; I didn’t need to explain anything since he had walked in my boots.” Tippett says callers to the helpline receive the same support. “They don’t have to explain to me what it’s like to move four times in three years or how you deal with your child when you are in the field for two weeks,” she says. “I get it.” Military Mom2Mom answers calls from anyone – parents, spouses, children – who is affected by military service. The callers range from parents concerned about their children in the service and military families grappling with reuniting with a parent, to spouses seeking resources for special needs children or helping a loved one who is struggling with a service-related disability. Peer counselors provide ongoing, personalized support, resource referrals and call families back to check their progress. “We stay in contact with them until their issue is resolved,” Tippett says. “We want them to know that they are not alone.”  
Credit Newswise — Improvements in military trauma care procedures related to hemorrhage and resuscitation on the combat zone front lines may lead to improvements in civilian trauma care as well, according to an article in the latest issue of the AANA Journal. Titled, “Far Forward Anesthesia and Massive Blood Transfusion: Two Cases Revealing the Challenge of Damage Control Resuscitation in an Austere Environment,” the article states that although “hemorrhage is a less common cause of death than a central nervous system injury, it is the most common cause of preventable death in both civilian and military casualties.” The article, by David Gaskin, CRNA, MHS; Nicholas A. Kroll, CRNA; Alyson A. Ochs, RN; Martin A. Schreiber, MD; and Prakash K. Pandalai, MD; examines two unique cases involving military casualties. In the military, while providing care in a forward combat zone, the transfusion of packed red blood cells (PRBC) and fresh frozen plasma (FFP) is performed in a 1:1 ratio. While some facilities in the civilian sector follow this example, the approach is not universally accepted. In the forward combat zone, due to packaging and thawing techniques of the plasma, delays can happen in being able to administer enough blood in time to a trauma patient. The severe loss of blood and the inability to replenish it in a timely manner can create new problems for the patient that may be life threatening. In a far forward military environment, the situation is even more dire. Thawing the thinly packaged FFP, which is stored at -20C, can cause ruptures in the plastic, creating delays in thawing other blood component units in the warmer. “Approximately 25 percent will experience a break in the bag as thawing occurs, rending them unavailable for use,” according to the article. A second issue in a military environment is the challenge of effectively communicating with live donors on site, which also can cause delays in obtaining fresh blood supplies. Following the surgery performed in one of the cases, protocols were identified and implemented to keep four FFP units thawed and ready for immediate use at all times. Also, “additional donors were identified and prescreened, and a phone roster and base-wide overhead system were implemented to aid in rapid notification of these critical human resources.” The results “suggest that efforts to incorporate this resuscitation strategy into civilian practice may improve outcomes, and warrant continued study,” assert the authors. Since World War I, CRNAs have predominately been the only anesthesia providers deployed in Forward Operating Bases in combat areas. The article states that in these challenging settings CRNAs are responsible for the entire anesthetic process, critically analyzing information and rapidly developing a plan of care, often with little or no medical history of the patient, and safely delivering lifesaving anesthetic care to wounded soldiers and civilians. CRNAs do this with limited resources in the most austere environments. 
Newswise — You don't have to watch the latest news to see the devastating impact that the conflicts in Iraq and Afghanistan are having on American soldiers. You can just look on the streets of many American cities. Hundreds, perhaps thousands, of veterans of Iraq and Afghanistan are already homeless, and each year their numbers grow larger. That's why Project Homeless Connect has teamed up with the City of San Francisco, the VA Medical Center, Swords to Plowshares and a coalition of businesses and non-profit organizations to help homeless veterans. "The idea of Veterans Connect is to bring the VA, Project Homeless Connect, City of San Francisco and local non-profit organizations together to give America's homeless veterans the help and hope that they need and deserve," says Judith Klain, Director of Project Homeless Connect. "About one-third of the adult homeless population has served their country" says Roberta Rosenthal, Network Homeless Coordinator for the Department of Veterans Affairs. "Veterans Connect is an excellent opportunity for us to partner with the City of San Francisco and other organizations to ensure homeless veterans have access to health care and other services." These current conflicts seem to be different than earlier ones. After Vietnam veterans usually took between five and 10 years trying to readjust to civilian life before ending up on the streets. Veterans of the fighting in Iraq and Afghanistan are often winding up homeless after just 18 months. It is estimated that there are up to 2,000 military veterans who are currently homeless in San Francisco. Aids groups and the Veterans Affairs Department have already said they expect to see an even bigger surge in homeless vets in the years ahead. "We all owe a tremendous debt of gratitude to everyone who has served in uniform," says Paul Markovich, Senior Vice President & Chief Executive, Large Group Business Units with Blue Shield of California, which is sponsoring Veterans Connect. "As an organization dedicated to improving the health of Californians, we feel privileged to help those who have served their country with honor, and to thank them for their sacrifice."  Clients are able to access a wide range of services from mental health to dental health, immunizations and mammograms. Other services include things as simple as haircuts to employment information, legal assistance and housing resources. Services are geared towards all ages, from children and youth to adults and seniors. There is even a veterinary service to take care of people's pets. PHC has proven so effective a model for addressing the issue of homelessness that it is now being copied in more than 170 cities and counties in 26 states around the U.S. It is also being replicated internationally in Canada and Australia. About Project Homeless ConnectProject Homeless Connect makes a real difference in the lives of the City's homeless by bringing together almost 250 non-profit agencies, private businesses and volunteers to assist San Franciscans in need. Since the program's inception in October 2004 as a joint effort of San Francisco's health care, housing and human service systems, Project Homeless Connect has been supported by tens of thousands of volunteers, individuals and companies giving their time, cash, clothing, food and essential services. To date, this program has provided services to thousands of the City's most economically disadvantaged men, women and children with basic human needs and housing. Project Homeless Connect is a key component of Mayor Newsom's 10-year plan to abolish homelessness in San Francisco. This unprecedented approach to helping the homeless has been adopted as a national model in more than 170 jurisdictions in the U.S and has also been implemented in Canada and Australia. About Blue Shield of CaliforniaBlue Shield of California, an independent member of the Blue Shield Association, is a not-for-profit health plan dedicated to providing Californians with access to high quality care at a reasonable price. Founded in 1939, it now has 3.4 million members, 4,500 employees, one of the largest provider networks and more than 20 office locations, providing a wide range of commercial and government products throughout the state. The company has contributed more than $100 million during the past three years to the Blue Shield of California Foundation to fund nonprofit organizations that improve access to quality health care in California. Contact your local agent or broker for more information about Blue Shield products and services, or visit the Blue Shield web site at About SFVAMCThe San Francisco VA Medical Center (SFVAMC) is renowned for its state-of-the-art acute medical, neurological, surgical and psychiatric care. The Medical Center has 124 operating beds and a 120-bed Nursing Home Care Unit. Primary and mental health care is provided at community based outpatient clinics in: Santa Rosa, Eureka, Ukiah, and San Bruno. There is a specialized homeless veterans clinic in downtown San Francisco. SFVAMC has the largest funded research programs in the Veterans Health Administration with $78 million annual research budget. It is one of the few medical centers in the world equipped for studies using both whole-body magnetic resonance imaging (MRI) and spectroscopy, and is the site of VA's National Center for the Imaging of Neurological Diseases. The Medical Center has been affiliated with the University of California, San Francisco (UCSF), School of Medicine for nearly 40 years. All physicians are jointly recruited by SFVAMC and UCSF School of Medicine. SFVAMC has 153 residency and fellow positions and 40 allied health professionals. More than 700 UCSF trainees from 34 programs rotate through the Medical Center. About Swords to PlowsharesWar causes wounds and suffering that last beyond the battlefield. Swords to Plowshares' mission is to heal the wounds, to restore dignity, hope, and self-sufficiency to all veterans in need, and to significantly reduce homelessness and poverty among veterans. Founded in 1974, Swords to Plowshares is a community-based, not-for-profit organization that provides counseling and case management, employment and training, housing, and legal assistance to more than 1500 homeless and low-income veterans annually in the San Francisco Bay Area and beyond. We promote and protect the rights of veterans through advocacy, public education, and partnerships with local, state, and national entities.
Credit Newswise — African-American veterans of the armed forces often struggle to get the health care they need, says a new report from Northeastern University's Institute on Urban Health Research (IUHR). The report, titled "Health Care Experiences and Health Status of African-American Veterans" was partially funded by the Boston Public Health Commission (BHPC) and the IUHR and was prepared in response to a request from the Tri Ad Veterans League, Inc., a Boston-based grassroots group of African-American veterans. Among the findings, Northeastern researchers reported that 78% of the respondents recalled having an experience of discrimination where they received health care services. Although on average, study participants were moderately satisfied with their health care, they indicated lack of confidence in the diagnosis given to them by their doctors. They also expressed dissatisfaction with access to medical specialists; the time their doctors spent with them; and getting medical care in a timely manner. "Our study uncovered significant relationships between perceived discrimination from health care providers and the satisfaction with care in general," says Nathaniel M. Rickles, Pharm.D., Ph.D., BCPP, assistant professor of pharmacy at Northeastern and lead author of the report. "We also found that there is a strong connection between perceived discrimination and the level of physical functioning of our respondents, which may be due to a delay in getting the services they need." Additional findings include:"¢ About two-thirds of the sample did not use VA as their sole provider, although only about 10% indicated a lack of willingness to use the VA in the future. The authors note that this indicates that the decision not to use VA services may have less to do with dissatisfaction with the VA system and more with their access to other sources of health care."¢ Many respondents expressed concern about their health care providers not asking them about their spiritual needs. The authors recommend future research to explore ways for VA providers to integrate chaplain services with medical care so African-American patients feel their spiritual needs are being met holistically by the medical team. The report concludes that further research needs to be done to assess discrimination in health care of veterans. Recommendations of Joseph D. Warren, Ph.D. of Northeastern University's Office of Public Affairs and one of the authors of the report, include: "¢ Health care systems serving veterans, especially the VA, should solicit the assistance of veteran's advocacy groups, like the Tri Ad Veterans, to monitor and assist the VA to address identifiable disparities with access, patient satisfaction and quality of care."¢ A comprehensive review and ongoing performance-based monitoring of policies and provider behavior is needed, as well as further education of administrators and service providers about health disparities, unconscious clinician bias and cultural competency."¢ Policy changes and provider-level interventions are needed to reduce discrimination in health care. "The effectiveness of our mission largely depends upon academic institutions, like Northeastern University, providing the intellectual and scientific background to our work," says Haywood Fennell, founder of the Tri Ad Veterans League, Inc. "We are committed to providing the leadership to mobilize the necessary resources to implement the recommendations for future study."
Credit Newswise — Did you know that symptoms of hepatitis C could take 20 to 30 years to appear? Hepatitis C is a disease that affects the liver and is spread through contact with infected blood or contaminated needles, tattoo tools, and other means. An estimated four million people in the U.S. are diagnosed with hepatitis C. In some cases, veterans seem to have higher rates of infection than others. While symptoms are often very mild or non-existent, hepatitis C can be a very serious illness and, over time, cause permanent liver problems including cirrhosis and liver cancer. The liver is one of the largest and most important organs in your body. During National Hepatitis Awareness Month, the Department of Veterans Affairs (VA) encourages those with one or more risk factors to consider getting tested. Talk with your doctor about being tested for hepatitis C if you: "¢ have ever used a needle to inject drugs, even if it was many years ago;"¢ had a blood transfusion or organ transplant before 1992;"¢ have been on long-term kidney dialysis;"¢ are a Vietnam veteran;"¢ have had exposure to blood on your skin;"¢ have had multiple sex partners;"¢ have tattoos or body piercings;"¢ have liver disease;"¢ have a history of drinking a lot of alcohol; or"¢ have had an abnormal liver function test"¢ wish to be tested The test for hepatitis C is simple and only requires a blood sample. VA is the largest single provider of medical care to people with hepatitis C infection in the U.S., and is the nation's leader in hepatitis C screening, testing and treatment. VA has a system-wide policy for screening all enrolled veterans for hepatitis C risk factors and has identified approximately 250,000 veterans in the past 10 years who have a diagnosis of or positive blood test for hepatitis C. VA spent more than $2.4 million on 16 research projects relating to hepatitis C. In addition, VA investigators received $4.1 million from non-VA sources for another 104 studies. VA funds four Hepatitis C Resource Centers to foster innovation and disseminate best practices in prevention, care and education. They are located in Minneapolis, Minn.; San Francisco, Calif.; West Haven, Conn.; and Seattle, Wash., in collaboration with Portland, Ore. VA research on hepatitis C includes clinical trials of treatments, epidemiological studies, investigations into the biological mechanisms of infection, and studies on improving quality of life for hepatitis C patients.
Credit Newswise A study of 33,481 diabetic veterans suggests that many of these individuals carry an "extremely heavy burden" of other diseases, which may account for their frequent hospital and outpatient visits within the Veterans Affairs medical system. Seventy-three percent of the veterans had high blood pressure and 35 percent had a type of heart disease, according to Carol M. Ashton, M.D., MPH, of Baylor College of Medicine and colleagues. "We also documented a high prevalence of alcohol or drug abuse disorders [29.5 percent] and psychosis [23.3 percent] conditions that make it more difficult for patients to sustain diabetes self-management behaviors," Ashton says. Over the course of a year, the average patient in the study spent eight days in a hospital and 23 days in outpatient services, which could include medical tests, specialist consultations and general check-ups. Of the nearly 40 percent of those hospitalized one or more times during the year, three-fourths had multiple hospital stays. The patients also faced a significant possibility of dying within a given year, according to Ashton and colleagues. They calculated that approximately 6 percent, or one in 20, of the patients were at risk of dying. These numbers may paint a more serious picture of hospitalization and health care visits than would be typical among the entire diabetic population, since almost half of the patients were 65 or older and eligible for the study only if they were initially hospitalized for an acute diabetes-related condition. But the findings are comparable to two other similar studies, according to the researchers. "Payers are concerned with the monetary costs of heavy utilization, but the indirect costs and opportunity costs associated with so many contacts must be an enormous burden on the patient and family," Ashton says. Diabetes is the seventh-leading cause of death in the United States, and diabetes-related death rates have increased among women and men of all racial and ethnic groups since 1980.
Credit Newswise - An innovative Veteran's Affair's home health care model provides patients and their caregivers with higher health-related quality of life and satisfaction with care than does private-sector home care, according to a study jointly conducted by researchers from the UIC, the VA and Northwestern University. The Journal of the American Medical Association will report the findings as the lead story. Susan Hughes, UIC School of Public Health professor and codirector of the Center for Research on Health and Aging in UIC's Health Research and Policy Centers, is the lead author. An early single-site study of the VA primary-care home care model, conducted by Hughes and colleagues at the Hines VA Hospital, found significant benefits and led the VA to fund this 16-site randomized trial of nearly 2,000 patients and 2,000 caregivers, most of whom were patients' spouses. The VA home-based primary care model is unique in that it enables physicians to designate a portion of their time as salaried staff to the home care program. In this model, there is close cooperation among nurses, social workers and other team members, and the physician is free to work with the patient directly or with the team on behalf of the patient. Medicare home care physicians, in contrast, are constrained by significant paperwork requirements and limited reimbursement for the management of home care patients, Hughes said. The study targeted hospitalized patients with severe disabilities or terminal illnesses and patients who were homebound with a primary diagnosis of congestive heart failure or chronic obstructive pulmonary disease. It examined the impact of the VA home care model on functional status, patient and caregiver health-related quality of life and satisfaction with care, caregiver burden, hospital readmissions and health care costs. Testing was conducted at the first, sixth and 12th months. The control group received customary VA and private sector care, with about half opting for Medicare home care services. As expected, the researchers found no difference in patient functional status. Terminally ill treatment patients scored significantly higher than control group patients on six of eight health-related quality of life measures, including emotional role function, social function, bodily pain, mental health, vitality and general health. The researchers found no health-related quality of life differences among non-terminally ill patients other than a significant decrease in bodily pain in the control group. There was no difference in satisfaction with care among terminal patients over 12 months, but nonterminal patients reported significant increases in satisfaction while the control group's satisfaction scores remained the same or declined slightly. "When the physician and home care team jointly manage patient care, you can get much better, consistent quality-of-life and satisfaction. I think it would be great if the VA model were replicated in a managed-care setting," Hughes said. Treatment group caregivers of both terminally ill and non-terminally ill patients also scored significantly higher than the control group in all but two of eight quality of life measures and showed consistent and significant gains in satisfaction with patient care. Treatment group caregivers of nonterminal patients reported a significant decline in burden compared to the control group. This finding is particularly relevant in light of a recent JAMA article showing that spousal caregivers who experience stress are at 60 percent higher risk of mortality over a four-year period than caregivers who do not experience stress, Hughes said. The VA home care study is among the first of its kind to consider the burden on family members and their emotional well-being. Researchers found decreases in hospital readmissions among the treatment group at six months, but not at 12 months. The cost of care was 12.1 percent higher in the treatment group at 12 months. Though half of the sites experienced higher costs, the remaining half either saved money or broke even, Hughes said. "We still need to do more to examine the impact on costs. A secondary analysis of the use and cost data is needed to determine how and why some sites improved outcomes at lower costs."