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Introducción: El suicidio es la principal causa de muerte entre el personal militar veterano activo. Pese a ello, hay pocas terapias que acometan las tendencias suicidas, y el desarrollo de nuevos tratamientos es limitado. En los últimos años se ha propuesto el uso de la terapia cognitiva. Objetivo: Analizar la eficacia de la terapia cognitiva en la prevención del suicidio en militares veteranos. Desarrollo: Se realizó una revisión según la normativa PRISMA. Se consultaron las bases de datos de PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, y WOS. Se utilizó la herramienta Cochrane para valorar el riesgo de sesgo y la calidad de la evidencia se evaluó con GRADE. La terapia cognitiva es eficaz para prevenir el suicidio entre los militares veteranos. El número total de participantes en la revisión fue de 668 individuos. El número de sesiones totales osciló entre 6 y 10 y el seguimiento del programa varió entre 3 y 24 meses Conclusiones: La terapia cognitiva previene los intentos de suicidio entre los militares veteranos con ideas suicidas o un intento de suicidio reciente. También mejora la calidad de vida de los militares y sus familias, así como el patrón del sueño. Reduce la depresión, la desesperanza, el estrés postraumático, la gravedad de los síntomas, el número de suicidios y las hospitalizaciones psiquiátricas(AU)

Introduction: Suicide is the leading cause of death among active veteran military personnel. Despite this, there are few therapies that address suicidality, and the development of new treatments is limited. In recent years, the use of cognitive therapy has been proposed. Objective: Analyze the efficacy of cognitive therapy in preventing suicide in military veterans. Development: A review was carried out following the PRISMA regulations. The PubMed, Cinahl, PsycINFO, SPORTDiscus, Academic Search Complete, Lilacs, IBECS, CENTRAL, SciELO, and WOS databases were consulted. The Cochrane tool was used to assess the risk of bias and the quality of the evidence was assessed with GRADE. Cognitive therapy is effective in preventing suicide among military veterans. The total number of participants in the review was 668 individuals. The total number of sessions ranged from 6 to 10 and the follow-up of the program varied from 3 to 24 months. Conclusions: Cognitive therapy prevents suicide attempts among military veterans with suicidal ideation or a recent suicide attempt. It also improves the quality of life of service members and their families, as well as their sleep pattern. It reduces depression, hopelessness, post-traumatic stress, symptom severity, the number of suicides and psychiatric hospitalizations(AU)

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Background: Research in psychedelic medicine has focused primarily on civilian populations. Further study is needed to understand whether these treatments are effective for Veteran populations.Objectives: Here, we examine the effectiveness of psychedelic-assisted therapy among trauma-exposed Special Operations Forces Veterans (SOFV) seeking treatment for cognitive and mental health problems in Mexico.Methods: Data were collected from an ibogaine and 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) clinical treatment program for SOFV with a history of trauma exposure. This clinical program collects prospective clinical program evaluation data, such as background characteristics, symptom severity, functioning (e.g., satisfaction with life, posttraumatic stress disorder symptoms, depression symptoms, anxiety symptoms, sleep disturbance, psychological flexibility, disability in functioning, cognitive functioning, neurobehavioral symptoms, anger, suicidal ideation), and substance persisting/enduring effects through online surveys at four timepoints (baseline/pre-treatment, one-, three-, and six-months after treatment).Results: The majority of the sample (n = 86; Mean Age = 42.88, SD = 7.88) were Caucasian (87.2%), non-Hispanic (89.5%), and males (100%). There were significant and large improvements in self-reported PTSD symptoms (p < .001, d = .414), depression (p < .001, d = .275), anxiety (p < .001, d = .276), insomnia severity (p < .001, d = .351), and post-concussive symptoms (p < .001, d = .389) as well as self-reported satisfaction with life (p < .001, d = .371), psychological flexibility (p < .001, d = .313) and cognitive functioning (p < .001, d = .265) from baseline to one-month follow-up.Conclusions: Data suggest combined ibogaine and 5-MeO-DMT assisted therapy has potential to provide rapid and robust changes in mental health functioning with a signal of durable therapeutic effects up to 6-months. Future research in controlled settings is warranted.

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RESUMEN Introducción: La Leishmaniasis es una enfermedad infecciosa parasitaria zoonótica que afecta la piel, las mucosas y las vísceras. Es endémica en 98 países y hay más de 350 millones de personas en riesgo de transmisión. En Colombia, los campamentos de las antiguas Fuerzas Armadas Revolucionarias de Colombia, se ubicaban en zonas selváticas donde la enfermedad está presente. El objetivo del presente trabajo está dirigido a describir las prácticas y saberes de los excombatientes de las FARC-EP sobre la Leishmaniasis cutánea y su manejo en escenarios de combate al convivir con esta enfermedad. Métodos: El estudio es cualitativo/exploratorio, donde se abordaron los conocimientos sobre la enfermedad y su forma de transmisión, como también aquellas prácticas relacionadas con el uso de medicamentos para su tratamiento. Resultados: En el análisis de las entrevistas se encontró que los excombatientes conocen el ciclo de la enfermedad desde sus vivencias y por transmisión oral, como también de prácticas curativas propias adaptadas al contexto del conflicto armado, esta experiencia los llevó a desarrollar estrategias de gestión del conocimiento basado en la evidencia. Discusión: Las entrevistas dan cuenta del conocimiento empírico y clínico de los excombatientes sobre el ciclo de la enfermedad; no existe un registro documental, ni manuales de procedimientos realizados en la selva por las FARC-EP sobre tratamiento de enfermedades; los miembros de las FARC-EP a desarrollar estrategias de gestión del conocimiento basados en la evidencia; el contexto de conflicto afectó de manera importante el tiempo y los recursos técnicos para manejar la Leishmaniasis, esto posibilitó las respuestas alternativas a la enfermedad documentadas en este trabajo.

ABSTRACT Introduction: Leishmaniasis is a zoonotic parasitic infectious disease that affects the skin, mucous membranes and viscera. It is endemic in 98 countries and there are more than 350 million people at risk of transmission. In Colombia, the camps of the former Revolutionary Armed Forces of Colombia were located in jungle areas where the disease is present. The objective of this work is aimed at describing the practices and knowledge of ex-combatants of the FARC-EP about cutaneous Leishmaniasis and its management in combat scenarios when living with this disease. Methods: The study is qualitative/exploratory, where knowledge about the disease and its form of transmission were addressed, as well as those practices related to the use of medications for its treatment. Results: In the analysis of the interviews it was found that the ex-combatants know the cycle of the disease from their experiences and by oral transmission, as well as their own healing practices adapted to the context of the armed conflict, this experience led them to develop knowledge management strategies based on the evidence. Discussion: The interviews give an account of the empirical and clinical knowledge of the ex-combatants about the cycle of the disease; There is no documentary record, nor manuals of procedures carried out in the jungle by the FARC-EP on the treatment of diseases; the members of the FARC-EP to develop evidence-based knowledge management strategies; the context of conflict significantly affected the time and technical resources to manage Leishmaniasis, this made possible the alternative responses to the disease documented in this work.

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INTRODUCTION: It has been reported in different parts of the world that war veterans are more exposed to cardiovascular risk factors. The objective of this study was to establish the risk factors, the cardiometabolic profile and the prevalence of cardiovascular disease in a group of ex-combatants of the Malvinas War (HdeM). METHODS: In a case-control design, data from 799 HdeM were analyzed and compared with 799 controls matched by age. The sample was selected from the participants of the Cardiovascular Health Prevention Program of the Favaloro Foundation, between January 2017 and December 2019. RESULTS: The average age was 56.9 ± 3.9 years. An increase in weight was observed among the HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). A higher frequency of arterial hypertension (42% vs. 34%; p < 0.001) and diabetes mellitus (15.1% vs. 10.4%; p < 0.005) was observed in HdeM. Metabolic syndrome was also more prevalent in HdeM (49.2% vs. 39.7%; p = 0.0001). It was observed that the history of acute myocardial infarction was more frequent among the HdeM (3.6% vs. 2%; p < 0.05), with a similar prevalence of stroke (1.2% vs. 1%; p = ns), coronary angioplasty (3.2% vs. 2.1%; p = ns) or myocardial revascularization surgery (0.8% vs. 0.4%; p = ns). DISCUSSION: The HdeM showed an increase in the frequency of risk factors, metabolic syndrome and acute myocardial infarction. It is important to take this increased risk into account in order to maximize cardiovascular prevention strategies in ex-combatants.

Introducción: Se ha informado que los veteranos de guerra están más expuestos a factores de riesgo cardiovascular. El objetivo del presente trabajo fue establecer los factores de riesgo, el perfil cardiometabólico y la prevalencia de enfermedad cardiovascular de un grupo de excombatientes de la Guerra de Malvinas (HdeM). Métodos: En un diseño caso-control se analizaron los datos de 799 HdeM y se compararon 799 controles de misma edad. La muestra se seleccionó de los participantes del Programa de Prevención de Salud Cardiovascular de la Fundación Favaloro, entre enero de 2017 y diciembre de 2019. Resultados: La edad promedio fue 56.9 ± 3.9 años. Se observó un aumento del peso entre los HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). Se observó mayor frecuencia de hipertensión arterial en HdeM (42% vs. 34%; p < 0.001) y diabetes mellitus (15.1% vs. 10.4%; p < 0.005). El síndrome metabólico fue más prevalente en HdeM (49.2% vs. 39.7%; p = 0.0001). Se observó que el antecedente de infarto agudo de miocardio fue más frecuente entre los HdeM (3.6% vs. 2%; p < 0.05), con similar prevalencia de ACV (1.2% vs. 1%; p = ns), angioplastia coronaria (3.2% vs. 2.1%; p = ns) o cirugía de revascularización miocárdica (0.8% vs. 0.4%; p = ns). Discusión: Los HdeM mostraron mayor prevalencia de factores de riesgo, síndrome metabólico e infarto agudo de miocardio. Es importante tener en cuenta este aumento de riesgo para maximizar las estrategias de prevención cardiovascular en los excombatientes.

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Resumen Introducción: Se ha informado que los veteranos de guerra están más expuestos a factores de riesgo cardiovascular. El objetivo del presente trabajo fue establecer los factores de riesgo, el perfil cardiometabólico y la prevalencia de enfermedad cardiovascular de un grupo de excombatientes de la Guerra de Malvinas (HdeM). Métodos: En un diseño caso-control se analizaron los datos de 799 HdeM y se compararon 799 controles de misma edad. La muestra se seleccionó de los participantes del Programa de Prevención de Salud Cardiovascular de la Fundación Favaloro, entre enero de 2017 y diciembre de 2019. Resultados: La edad promedio fue 56.9 ± 3.9 años. Se observó un aumento del peso entre los HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). Se observó mayor frecuencia de hipertensión arterial en HdeM (42% vs. 34%; p < 0.001) y diabetes mellitus (15.1% vs. 10.4%; p < 0.005). El síndrome metabólico fue más prevalente en HdeM (49.2% vs. 39.7%; p = 0.0001). Se observó que el antecedente de infarto agudo de miocardio fue más frecuente entre los HdeM (3.6% vs. 2%; p < 0.05), con similar prevalencia de ACV (1.2% vs. 1%; p = ns), angioplastia corona ria (3.2% vs. 2.1%; p = ns) o cirugía de revascularización miocárdica (0.8% vs. 0.4%; p = ns). Discusión: Los HdeM mostraron mayor prevalencia de factores de riesgo, síndrome metabólico e infarto agudo de miocardio. Es importante tener en cuenta este aumento de riesgo para maximizar las estrategias de prevención cardiovascular en los excombatientes.

Abstract Introduction: It has been reported in different parts of the world that war veterans are more exposed to cardio vascular risk factors. The objective of this study was to establish the risk factors, the cardiometabolic profile and the prevalence of cardiovascular disease in a group of ex-combatants of the Malvinas War (HdeM). Methods: In a case-control design, data from 799 HdeM were analyzed and compared with 799 controls matched by age. The sample was selected from the participants of the Cardiovascular Health Prevention Program of the Favaloro Foundation, between January 2017 and December 2019. Results: The average age was 56.9 ± 3.9 years. An increase in weight was observed among the HdeM (91.3 ± 16.6 kg vs. 88.2 ± 14.7 kg; p = 0.0001). A higher frequency of arterial hypertension (42% vs. 34%; p < 0.001) and diabetes mellitus (15.1% vs. 10.4%; p < 0.005) was observed in HdeM. Metabolic syndrome was also more prevalent in HdeM (49.2% vs. 39.7%; p = 0.0001). It was observed that the history of acute myocardial infarction was more frequent among the HdeM (3.6% vs. 2%; p < 0.05), with a similar prevalence of stroke (1.2% vs. 1%; p = ns), coronary angioplasty (3.2% vs. 2.1%; p = ns) or myocardial revascularization surgery (0.8% vs. 0.4%; p = ns). Discussion: The HdeM showed an increase in the frequency of risk factors, metabolic syndrome and acute myocardial infarction. It is important to take this increased risk into account in order to maximize cardiovascular prevention strategies in ex-combatants.

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Purpose: We examined whether an educational, shared-decision-making tool designed to empower patients, individualize pain management, and maximize use of nonopioid, over-the-counter analgesics reduces opioid use and waste while maintaining adequate pain relief. Methods: We developed an educational, shared-decision-making tool regarding postoperative pain medication for outpatient hand surgery. Patients randomized to groups with and without the tool were surveyed for 4 weeks after surgery. Survey variables included Patient-Reported Outcomes Measurement Information System pain intensity and pain interference scores, as well as the number of oxycodone or over-the-counter pills taken. Results were compared using chi-squared, Wilcoxon rank-sum, and Welch's t tests. Results: Fifty-three patients participated: 25 in the shared-tool group and 28 in the no-tool group. The mean age was 60 years, with more women in the no-tool group than the shared-tool group (n =17 versus 11, respectively). The shared-tool group averaged 6.4 prescribed oxycodone pills, versus 10 for the no-tool group (P < .01). The median numbers of oxycodone pills taken the first week after surgery were 2 (interquartile range, 6) for the shared-tool group and 3 (interquartile range, 6) for the no-tool group (P = .97). Patient-reported outcome measures for pain intensity and pain interference were not significantly different for weeks 1, 3, and 4 after surgery. Pain interference was significantly lower in week 2 in the shared-tool group (difference, -4.4; 95% confidence interval, -8.57 to -0.30; P = .04). Conclusions: The shared-tool group had equivalent or better pain control and were prescribed a lower number of opioid pain pills than the no-tool group. Both groups used nonopioid medications, with no difference in the types of over-the-counter medications used. Shared decision-making strategies could be applied to other outpatient orthopedic surgical settings, and may reduce the amount of opioids prescribed without compromising pain control. Type of study/level of evidence: Therapeutic II.

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OBJECTIVES: Patients with end stage kidney disease (ESKD) are at higher risk for increased mortality and morbidity due to disaster-related disruptions to care. We examine effects of Hurricanes Irma and Maria on access to dialysis care for US Department of Veterans Affairs (VA) ESKD patients in Puerto Rico. METHODS: A retrospective, longitudinal cohort study was conducted among VA patients with at least 1 dialysis-related encounter between September 6, 2016, and September 5, 2018. The annual number of dialysis encounters, visits to an emergency department (ED), and the number of deaths pre- and post-hurricanes were compared. A random effects logistic regression model for correlated binary outcomes was fitted for predictors of mortality. Chi-square tests were for differences between pre- and post-hurricane visits. RESULTS: The number of ED visits increased in post-hurricane period (1172 [5.7%] to 1195 [6.6%]; P < 0.001). ESKD-related ED visits increased from 200 (0.9%) to 227 (1.3%) (P < 0.05). Increase in mortality was associated with age (OR = 1.66; CI: 1.23-2.17), heart failure (OR = 2.07; CI: 1.26-3.40), chronic pulmonary disease (OR = 3.26; CI: 1.28-8.28), and sepsis (OR = 3.16; CI: 1.89-5.29). CONCLUSIONS: There was an increase in dialysis services at the San Juan VA Medical Center post-Irma/Maria, and access to dialysis care at the non-VA clinics was limited. The role of VA dialysis centers in providing care during disasters warrants further investigation.

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OBJECTIVES: To describe the generational differences and similarities existing among nursing professionals of the 20th and 21st centuries and how these have influenced on the evolution of the profession. METHODS: Integrative review according to the methodology by Whittemore and Knafl. The key words used for the search were: nurses, intergenerational relations, Veterans, Baby Boom, X generation, and Millennials. RESULTS: The electronic search process yielded 10 documents (eight articles and two theses), all within the Anglo-Saxon environment (4 in Canada, 5 in the United States, and 1 in Australia). The documents recovered determined three principal themes: the intergenerational nursing workforce (n = 7), recruiting and retention within an intergenerational workforce (n = 2), and tutoring within an intergenerational nursing workforce (n = 1). The four generations of nursing professionals (X, Y, Baby Boomers, and Veterans) have different aptitudes, social and cultural setting, that coexist within the same work staff. CONCLUSIONS: This study establishes the legitimacy of the intergenerational differences as an important variable of social categorization. The findings have the potential to improve generational comprehension and promote a more cohesive culture in clinical practice settings, besides conserving the legacy of the four generations of nursing professionals contributing to outline the identity of the nurses through the conservation of social, cultural, and professional experiences.

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Objective. To describe the generational differences and similarities existing among nursing professionals of the 20th and 21st centuries and how these have influenced on the evolution of the profession. Methods. Integrative review according to the methodology by Whittemore and Knafl. The key words used for the search were: nurses, intergenerational relations, Veterans, Baby Boom, X generation, and Millennials. Results. The electronic search process yielded 10 documents (eight articles and two theses), all within the Anglo-Saxon environment (4 in Canada, 5 in the United States, and 1 in Australia). The documents recovered determined three principal themes: the intergenerational nursing workforce (n = 7), recruiting and retention within an intergenerational workforce (n = 2), and tutoring within an intergenerational nursing workforce (n = 1). The four generations of nursing professionals (X, Y, Baby Boomers, and Veterans) have different aptitudes, social and cultural setting, that coexist within the same work staff. Conclusion. This study establishes the legitimacy of the intergenerational differences as an important variable of social categorization. The findings have the potential to improve generational comprehension and promote a more cohesive culture in clinical practice settings, besides conserving the legacy of the four generations of nursing professionals contributing to outline the identity of the nurses through the conservation of social, cultural, and professional experiences.

Objetivo. Describir las diferencias y similitudes generacionales existentes entre los profesionales de enfermería del siglo XX y XXI y cómo han influido en la evolución de la profesión. Métodos. Revisión integradora según la metodología de Whittemore y Knafl. Las palabras clave utilizadas para la búsqueda fueron: enfermeras, relaciones intergeneracionales, Veteranos, Baby Boom, generación X y Millennials. Resultados. El proceso de búsqueda electrónica dio como resultado un total de 10 documentos (8 artículos y dos tesis), todos ellos en el ámbito anglosajón (4 en Canadá, 5 en Estados Unidos y 1 en Australia). En los documentos recuperados se determinaron tres temas principales: la fuerza de trabajo de enfermería intergeneracional (n = 7), el reclutamiento y la retención dentro de una fuerza de trabajo intergeneracional (n = 2) y la tutoría dentro de una fuerza laboral de enfermería intergeneracional (n = 1). Las cuatro generaciones de profesionales de enfermería (X, Y, Baby Boomers y Veteranos) tienen diferentes aptitudes, entorno social y cultural, que conviven dentro de un mismo equipo de trabajo. Conclusión. Este estudio establece la legitimidad de las diferencias intergeneracionales como una importante variable de categorización social. Los hallazgos tienen el potencial de mejorar la comprensión generacional y fomentar una cultura más cohesiva en entornos de práctica clínica, además de conservar el legado de las cuatro generaciones de profesionales de enfermería lo que contribuye a perfilar las señas de identidad de las enfermeras mediante la conservación de experiencias sociales, culturales y profesionales.

Objetivo. Descreva as diferenças e semelhanças geracionais entre os profissionais de enfermagem dos séculos XX e XXI e como elas influenciaram a evolução da profissão. Métodos. Revisão integrativa segundo a metodologia Whittemore e Knafl. As palavras-chave utilizadas para a busca foram: Enfermeiros, relações intergeracionais, Veteranos, Baby Boom, Geração X e Millennials. Resultados. O processo de busca eletrônica resultou em um total de 10 documentos (8 artigos e duas teses), todos da área anglo-saxônica (4 no Canadá, 5 nos Estados Unidos e 1 na Austrália). Três temas principais foram identificados nos documentos recuperados: a força de trabalho de enfermagem intergeracional (n = 7), recrutamento e retenção dentro de uma força de trabalho intergeracional (n = 2) e tutoria dentro de uma força de trabalho de enfermagem intergeracional (n = 1). As quatro gerações de profissionais de enfermagem (X, Y, Baby Boomers e Veteranos) possuem diferentes aptidões, meio social e cultural, que convivem dentro de uma mesma equipe de trabalho. Conclusão. Este estudo estabelece a legitimidade das diferenças intergeracionais como uma importante variável de categorização social. Os resultados têm potencial para melhorar a compreensão geracional e fomentar uma cultura mais coesa no cenário da prática clínica, além de preservar o legado das quatro gerações de profissionais de enfermagem, ajudando a moldar a identidade do enfermeiro por meio da preservação de experiências sociais, culturais e profissional.

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OBJECTIVE: Inflammatory bowel disease (IBD) comprises a group of related conditions characterized by idiopathic inflammation of the gastrointestinal (GI) tract. Several studies have described the epidemiology of IBD in Puerto Rico (PR) but none have included the US military and Veteran population. The goal of this study was to describe the prevalence of IBD in this population as well as to describe patients' characteristics. METHODS: We conducted a retrospective analysis of 163 patients using data gathered from electronic medical records of Veterans who received care at the VA Caribbean Healthcare System (VACHS) and the diagnosis of IBD between October 1, 2010 and September 30, 2015. The prevalence out of 100,000 in our study was calculated for each Fiscal Year. RESULTS: Overall, the prevalence of IBD markedly increased among VA patients. Among 163 patients who met inclusion criteria, 7 (4.3%) patients had a diagnosis of undetermined IBD, 45 (27.6%) had Crohn's disease (CD) and 111 (68.0%) had ulcerative colitis (UC). This information was used to compare the epidemiologic data of IBD in the population receiving care at the VACHS with the epidemiologic data of IBD in the general population in PR. CONCLUSION: This is the first study to describe the prevalence of IBD and to describe additional characteristics of patients with IBD receiving care at the VACHS.

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Women Veterans are one of the fastest growing groups among homeless people. Previous studies on race, ethnicity and homelessness have emphasized the important differences on predictors, health risks, behaviors, and service outcomes between different groups. These differences are crucial to inform policy makers and program developers in order to solve this social issue. This research assesses sociodemographic, psychosocial and military characteristics and their role in service-connected disabilities to provide a profile of the Caribbean Homeless Women Veteran of the U.S. military. We evaluated 46 healthcare records of women Veterans who requested services at the Homeless Program of the VA Caribbean Healthcare System (VACHS) from 2005 to 2014. Statistical analyses consisted of Chi square, Fisher's exact test, Wilcoxon-Rank Sum tests, and Logistic Regression. Extreme poverty, unemployment, unaffordable housing, psychological disorders and low social support were the most prevalent characteristics. Women with psychological disorders had eight times higher the odds of having a service-connected disability than women without psychological conditions. Implications of study results are discussed for VACHS and future research with this population.

Las mujeres Veteranas son uno de los grupos de mayor crecimiento entre las personas sin hogar. Estudios previos sobre raza, etnia y falta de vivienda han enfatizado en las diferencias en torno a los predictores, los riesgos de salud, los comportamientos y la utilización de servicios entre los diferentes grupos. Estas diferencias son cruciales para la creación de políticas publicas y programas que ayuden a resolver este problema social. Esta investigación evalúa las características sociodemográficas, psicosociales y militares y su papel en las discapacidades relacionadas al servicio militar para proporcionar un perfil de las mujeres caribeñas Veteranas sin hogar de las fuerzas armadas de los EE. UU. Evaluamos 46 registros de salud de mujeres Veteranas que solicitaron servicios en el Programa para Veteranos sin Hogar del Sistema de Salud de Veteranos del Caribe (VACHS por sus siglas en inglés) desde 2005 hasta 2014. Los análisis estadísticos incluyeron Chi cuadrado, prueba exacta de Fisher, pruebas de suma de rango de Wilcoxon y regresión logística. La pobreza extrema, el desempleo, la vivienda inasequible, los trastornos psicológicos y el poco apoyo social fueron las características más prevalentes. Las mujeres con trastornos psicológicos tenían ocho veces más probabilidades de tener una discapacidad relacionada con el servicio militar que las mujeres sin condiciones psicológicas. Se discuten implicaciones de los resultados del estudio tanto para VACHS como para futuras investigaciones con esta población.

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OBJECTIVES: To evaluate the psychometric properties of the Transfer Assessment Instrument Questionnaire (TAI-Q), a self-assessment measure to evaluate transfer quality compared with clinician-reported measures. DESIGN: Participants self-assessed transfers from their wheelchair to a mat table using the TAI-Q. For session 1, participants self-assessed their transfer both before and after reviewing a video of themselves completing the transfer (session 1). Self-assessment was completed for another transfer after a 10-minute delay (session 2, intrarater reliability) and after a 1- to 2-day delay (session 3, test-retest reliability). Self-assessment was compared with a criterion standard of an experienced clinician scoring the same transfers with the Transfer Assessment Instrument (TAI) version 4.0 (concurrent validity). SETTING: 2017 National Veterans Wheelchair Games. PARTICIPANTS: Convenience sample of full-time wheelchair users (N=44). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: TAI-Q and TAI. RESULTS: After video review of their transfer, acceptable levels of reliability were demonstrated for total TAI-Q score for intrarater (intraclass correlation [ICC], 0.627) and test-retest reliability (ICC, 0.705). Moderate to acceptable concurrent validity was demonstrated with the TAI (ICC, 0.554-0.740). Participants tended to underestimate the quality of their transfer (reported more deficient items) compared with the TAI. However, this deficit decreased and reliability improved from pre-video review to post-video review and from session 1 to session 2. The minimum detectable change indicated that a change of 1.63 to 2.21 in the TAI-Q total score is needed to detect a significant difference in transfer skills. CONCLUSIONS: When paired with video review, the TAI-Q demonstrates moderate to acceptable levels of reliability and validity for the total score. Self-assessment was completed quickly (<5min) and could help to potentially screen for deficiencies in transfer quality and opportunities for intervention.

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O objetivo do presente estudo foi analisar o processo de construção e manutenção de uma representação social positiva sobre os jogadores veteranos, presentes no campo futebolístico amador existente na cidade de Ponta Grossa (PR). Para tanto, optou-se pelos direcionamentos metodológicos da etnografia, pois eles guiam os pesquisadores no processo interpretativo da "visão sobre o mundo" dos indivíduos pertencentes ao grupo social investigado, através das interpretações de suas práticas simbólicas. As representações revelaram que mesmo no campo esportivo em que, tradicionalmente, o rendimento técnico-físico é o que determina a visão sobre os diferentes agentes; na análise em questão descobriu-se que através de ancoragens compensatórias, tais como não se tem vigor físico mas tem sabedoria/experiência, somado ao capital simbólico adquirido historicamente os idosos foram representados como figuras centrais deste espaço social. Conclui-se que em Ponta Grossa o futebol amador veterano apresenta-se como uma manifestação sociocultural, que tensiona o olhar negativo que comumente é estabelecido para o processo de envelhecimento e para a velhice. (AU)

The objective of the present study was to analyze the process of building and maintaining a positive social representation about the veteran players of the amateur football field in the city of Ponta Grossa, PR. In order to do so, we chose the methodological orientations of ethnography, since they guide the researchers in the interpretative process of the "world view" of the individuals belonging to the social group investigated, through the interpretations of their symbolic practices. It is concluded that in Ponta Grossa football presents itself as a sociocultural manifestation, which makes it possible to hold the negative eye on the process of aging and old age. The social representations revealed that even in the sports field, where it is aprioristically imagined that the performance is what determines the vision on the different agents, in the analysis in question it was discovered that through compensatory anchorages (there is no physical force, but has intelligence) and the acquired symbolic capital, legitimize the elderly as nuclear figures of the field. (AU)

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INTRODUCTION: Access to high-quality healthcare, including mental healthcare, is a high priority for the Department of Veterans Affairs (VA). Meaningful monitoring of progress will require patient-centered measures of access. To that end, we developed the Perceived Access Inventory focused on access to VA mental health services (PAI-VA). However, VA is purchasing increasing amounts of mental health services from community mental health providers. In this paper, we describe the development of a PAI for users of VA-funded community mental healthcare that incorporates access barriers unique to community care service use and compares the barriers most frequently reported by veterans using community mental health services to those most frequently reported by veterans using VA mental health services. MATERIALS AND METHODS: We conducted mixed qualitative and quantitative interviews with 25 veterans who had experience using community mental health services through the Veterans Choice Program (VCP). We used opt-out invitation letters to recruit veterans from three geographic regions. Data were collected on sociodemographics, rurality, symptom severity, and service satisfaction. Participants also completed two measures of perceived barriers to mental healthcare: the PAI-VA adapted to focus on access to mental healthcare in the community and Hoge's 13-item measure. This study was reviewed and approved by the VA Central Institutional Review Board. RESULTS: Analysis of qualitative interview data identified four topics that were not addressed in the PAI-VA: veterans being billed directly by a VCP mental health provider, lack of care coordination and communication between VCP and VA mental health providers, veterans needing to travel to a VA facility to have VCP provider prescriptions filled, and delays in VCP re-authorization. To develop a PAI for community-care users, we created items corresponding to each of the four community-care-specific topics and added them to the 43-item PAI-VA. When we compared the 10 most frequently endorsed barriers to mental healthcare in this study sample to the ten most frequently endorsed by a separate sample of current VA mental healthcare users, six items were common to both groups. The four items unique to community-care were: long waits for the first mental health appointment, lack of awareness of available mental health services, short appointments, and providers' lack of knowledge of military culture. CONCLUSIONS: Four new barriers specific to veteran access to community mental healthcare were identified. These barriers, which were largely administrative rather than arising from the clinical encounter itself, were included in the PAI for community care. Study strengths include capturing access barriers from the veteran experience across three geographic regions. Weaknesses include the relatively small number of participants and data collection from an early stage of Veteran Choice Program implementation. As VA expands its coverage of community-based mental healthcare, being able to assess the success of the initiative from the perspective of program users becomes increasingly important. The 47-item PAI for community care offers a useful tool to identify barriers experienced by veterans in accessing mental healthcare in the community, overall and in specific settings, as well as to track the impact of interventions to improve access to mental healthcare.

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The aim of this paper is to account for the modalities in which Malvinas veterans' health was constituted as a problem requiring state intervention between 1984 and 2000. In order to do so, we have focused on the concept of problematization as a way to analyze practices and political thought. The text consists of three sections: the first one presents the methodological basis of the analysis of public policies, whereas the second and third ones intend to analyze a series of laws, bills, decrees, reports and other documents produced by different state spheres about war veterans and their health situation. The hypothesis that we propose is that the Malvinas veterans were problematized as a marginal segment of the population, although the stabilization of a specific treatment took more than fifteen years to materialize.

El objetivo de este artículo es dar cuenta de las modalidades en que fue instituida la salud del veterano argentino de la guerra de Malvinas como un problema de intervención estatal entre 1984 y 2000. Para ello nos centramos en el concepto de problematización como un modo de análisis de las prácticas y el pensamiento político. El texto consta de tres apartados: en el primero se presentan las bases metodológicas para el análisis de las políticas públicas, mientras que el segundo y el tercero están destinados al análisis de una serie de leyes, proyectos de ley, decretos, informes, etc., producidos por diferentes esferas estatales en torno al veterano de guerra y su situación sanitaria. La hipótesis de lectura que proponemos es que el veterano o excombatiente de Malvinas fue problematizado como un segmento poblacional marginal, aunque la estabilización de un tratamiento específico tardó más de quince años en materializarse.

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RESUMEN El objetivo de este artículo es dar cuenta de las modalidades en que fue instituida la salud del veterano argentino de la guerra de Malvinas como un problema de intervención estatal entre 1984 y 2000. Para ello nos centramos en el concepto de problematización como un modo de análisis de las prácticas y el pensamiento político. El texto consta de tres apartados: en el primero se presentan las bases metodológicas para el análisis de las políticas públicas, mientras que el segundo y el tercero están destinados al análisis de una serie de leyes, proyectos de ley, decretos, informes, etc., producidos por diferentes esferas estatales en torno al veterano de guerra y su situación sanitaria. La hipótesis de lectura que proponemos es que el veterano o excombatiente de Malvinas fue problematizado como un segmento poblacional marginal, aunque la estabilización de un tratamiento específico tardó más de quince años en materializarse.

ABSTRACT The aim of this paper is to account for the modalities in which Malvinas veterans' health was constituted as a problem requiring state intervention between 1984 and 2000. In order to do so, we have focused on the concept of problematization as a way to analyze practices and political thought. The text consists of three sections: the first one presents the methodological basis of the analysis of public policies, whereas the second and third ones intend to analyze a series of laws, bills, decrees, reports and other documents produced by different state spheres about war veterans and their health situation. The hypothesis that we propose is that the Malvinas veterans were problematized as a marginal segment of the population, although the stabilization of a specific treatment took more than fifteen years to materialize

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OBJECTIVE: To evaluate the effect of dual use of VA/Medicare Part D drug benefits on antihypertensive medication supply in older Veterans with dementia. DATA SOURCES/STUDY SETTING: National, linked 2007-2010 Veterans Affairs (VA) and Medicare utilization and prescription records for 50,763 dementia patients with hypertension. STUDY DESIGN: We used inverse probability of treatment (IPT)-weighted multinomial logistic regression to examine the association of dual prescription use with undersupply and oversupply of antihypertensives. DATA COLLECTION/EXTRACTION METHODS: Veterans Affairs and Part D prescription records were used to classify patients as VA-only, Part D-only, or dual VA/Part D users of antihypertensives and summarize their antihypertensive medication supply in 2010: (1) appropriate supply of all prescribed antihypertensive classes, (2) undersupply of ≥1 class with no oversupply of another class, (3) oversupply of ≥1 class with no undersupply, or (4) both undersupply and oversupply. PRINCIPAL FINDINGS: Dual prescription users were more likely than VA-only users to have undersupply only (aOR = 1.28; 95 percent CI = 1.18-1.39), oversupply only (aOR = 2.38; 95 percent CI = 2.15-2.64), and concurrent under- and oversupply (aOR = 2.89; 95 percent CI = 2.53-3.29), versus appropriate supply of all classes. CONCLUSIONS: Obtaining antihypertensives through both VA and Part D was associated with increased antihypertensive under- and oversupply. Efforts to understand how best to coordinate dual-system prescription use are critically needed.

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We use narrative inquiry to illustrate the complex lives and experiences of combat veterans who go surfing to deal with the traumatic aftermath of war. The stories we collected reveal the rich and varied qualities of veterans' surfing experiences. These stories are several things at once. They are personal, revealing the body in motion as it negotiates the natural environment. They are social and cultural, shaped as they are by dominant societal narratives about veterans and masculinity. And, importantly, they are also actors, shaping the ways in which veterans experience themselves, each other, and the world around them(AU)

Usamos a investigação narrativa para ilustrar as vidas complexas e experiências de veteranos de combate que vão surfar para lidar com as conseqüências traumáticas da guerra. As histórias que coletamos revelam as qualidades ricas e variadas das experiências de surf dos veteranos. Essas histórias são várias coisas ao mesmo tempo. Eles são pessoais, revelando o corpo em movimento como ele negocia o ambiente natural. Eles são sociais e culturais, moldados como eles são por narrativas societal dominantes sobre veteranos e masculinidade. E, o mais importante, eles também são atores, moldando as maneiras pelas quais os veteranos experimentam a si mesmos, uns aos outros e ao mundo à sua volta(AU)

Utilizamos la investigación narrativa para ilustrar las complejas vidas y experiencias de los veteranos de combate que van a surfear para tratar las consecuencias traumáticas de la guerra. Las historias que recopilamos revelan las cualidades ricas y variadas de las experiencias de surf de los veteranos. Estas historias son varias cosas a la vez. Son personales, revelando el cuerpo en movimiento mientras que negocia el ambiente natural. Son sociales y culturales, conformados por las narrativas dominantes de la sociedad sobre los veteranos y la masculinidad. Y, lo que es más importante, también son actores, moldeando las maneras en que los veteranos se experimentan a sí mismos, entre ellos, y el mundo que los rodea(AU)

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While it is recognized that veterans have increased rates of depression, post-traumatic stress disorder (PTSD), suicide, and substance use disorders, rates of homicide and unintentional injury deaths in veterans have been minimally investigated. We evaluated all non-natural deaths in New Mexico veterans between 2002 and 2011 in comparison with non-natural deaths among non-veterans. We reviewed all decedents in New Mexico with a history of military service and investigated by the medical examiner, excluding natural deaths and deaths due to fall from standing height. The most common manner of death was unintentional injury (62%), most of these deaths due to motor vehicle accidents (29%) followed by unintentional overdose (26%). Suicide rates among veterans were consistently higher than the general population. The most common mechanism of suicide in men was gunshot wound (72%), and intentional overdose in women (49%). Services are needed for veterans that are tailored to all ages and both sexes.

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OBJECTIVE: Helicobacter pylori is a bacterial pathogen associated with chronic gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa associated lymphoid tissue lymphoma. Current treatment guidelines support a 7- to 14-day, triple-drug protocol consisting of a proton-pump inhibitor (PPI), clarithromycin, and either amoxicillin or an imidazole. The initial eradication rates for this regimen were 80 to 90%. Nevertheless its effectiveness has declined as the antibiotic resistance to clarithromycin and metronidazole has emerged. In Puerto Rico the reported resistance of H. pylori to clarithromycin is 16% and to metronidazole, 3.7%. Sequential therapy for H. pylori eradication, 5 days of treatment with a PPI and amoxicillin followed by 5 days of treatment with the PPI and 2 other antibiotics (clarithromycin and an imidazole), was introduced as an effective alternate regimen. This is a prospective clinical trial intended to compare the efficacy of first-line, standard 10-day tripledrug therapy with those of both 10- and 14-day sequential therapy in eradicating H. pylori at the San Juan Veterans Affairs Hospital in a population that is naïve to previous treatment. METHODS: This was a prospective, open-label, randomized clinical trial. RESULTS: Based on the intention-to-treat analysis, the eradication rate was 83.7% (72 of 86 patients) in the standard triple-therapy group, 80.0% (68/85) in the 10- day sequential-therapy group, and 79.1% (68/86) in the 14-day sequential-therapy group. There were no significant statistical differences between the eradication rates among therapies. CONCLUSION: Sequential-therapy treatment regimens are not better than standard triple therapy for the eradication of H. pylori infection, regardless of the treatment duration.

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