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The U.S. government has affirmed commitments to improving health and well-being for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) veterans, who may have distinct needs and challenges when accessing timely and appropriate health care. To date, there are limited data about potential health disparities among LGBTQ+ veterans that examine differences by both sexual identity and gender identity. Understanding the nature and magnitude of disparities among LGBTQ+ veterans is critical for targeted efforts to improve their health and well-being. The authors of this study use nationally representative data from 2015-2021 from the Behavioral Risk Factor Surveillance System to compare the age-adjusted prevalence of health-related outcomes across multiple domains (health care access and affordability, general health, substance use, and chronic conditions) for sexual and gender minority veterans with that of their heterosexual and cisgender veteran peers. LGBTQ+ veterans showed poorer health-related outcomes in multiple domains than their heterosexual and cisgender peers, including in terms of healthcare affordability, mental health, chronic cardiovascular conditions, and chronic respiratory conditions. The authors also examine associations between state LGBTQ+ policy climates and health-related outcomes among LGBTQ+ veterans. Among LGBTQ+ veterans, living in a state with a more favorable (versus negative) LGBTQ+ policy climate was associated with several health indicators (e.g., having health insurance, lower smoking rates). The authors then discuss implications for ongoing efforts to improve health and well-being for LGBTQ+ veterans, including sustained actions to ensure that all LGBTQ+ veterans are able to access necessary care and use the full scope of benefits for which they are eligible., (Copyright © 2024 RAND Corporation.)

Purpose: Bladder exstrophy (BE) poses challenges both during the surgical repair and throughout follow-up. In 2013, a multi-institutional BE consortium was initiated, which included utilization of unified surgical principles for the complete primary repair of exstrophy (CPRE), real-time coaching, ongoing video capture and review of video footage, prospective data collection, and routine patient data analysis, with the goal of optimizing the surgical procedure to minimize devastating complications such as glans ischemia and bladder dehiscence while maximizing the rate of volitional voiding with continence and long-term protection of the upper tracts. This study reports on our short-term complications and intermediate-term continence outcomes., Materials and Methods: A single prospective database for all patients undergoing surgery with a BE epispadias complex diagnosis at 3 institutions since February 2013 was used. For this study, data for children with a diagnosis of classic BE who underwent primary CPRE from February 2013 to February 2021 were collected. Data recorded included sex, age at CPRE, adjunct surgeries including ureteral reimplantations and hernia repairs at the time of CPRE, osteotomies, and immobilization techniques, and subsequent surgeries. Data on short-term postoperative outcomes, defined as those occurring within the first 90 days after surgery, were abstracted. In addition, intermediate-term outcomes were obtained for patients operated on between February 2013 and February 2017 to maintain a minimum follow-up of 4 years. Outcomes included upper tract dilation on renal and bladder ultrasound, presence of vesicoureteral reflux, cortical defects on nuclear scintigraphy, and continence status. Bladder emptying was assessed with respect to spontaneous voiding ability, need for clean intermittent catheterization, and duration of dry intervals. All operating room encounters that occurred subsequent to initial CPRE were recorded., Results: CPRE was performed in 92 classic BE patients in the first 8 years of the collaboration (62 boys), including 46 (29 boys) during the first 4 years. In the complete cohort, the median (interquartile range) age at CPRE was 79 (50.3) days. Bilateral iliac osteotomies were performed in 89 (97%) patients (42 anterior and 47 posterior). Of those undergoing osteotomies 84 were immobilized in a spica cast (including the 3 patients who did not have an osteotomy), 6 in modified Bryant's traction, and 2 in external fixation with Buck's traction. Sixteen (17%) patients underwent bilateral ureteral reimplantations at the time of CPRE. Nineteen (21%) underwent hernia repair at the time of CPRE, 6 of which were associated with orchiopexy. Short-term complications within 90 days occurred in 31 (34%), and there were 13 subsequent surgeries within the first 90 days. Intermediate-term outcomes were available for 40 of the 46 patients, who have between 4 and 8 years of follow-up, at a median of 5.7 year old. Thirty-three patients void volitionally, with variable dry intervals., Conclusions: Cumulative efforts of prospective data collection have provided granular data for evaluation. Short-term outcomes demonstrate no devastating complications, that is, penile injury or bladder dehiscence, but there were other significant complications requiring further surgeries. Intermediate-term data show that boys in particular show encouraging spontaneous voiding and continence status post CPRE, while girls have required modification of the surgical technique over time to address concerns with urinary retention. Overall, 40% of children with at least 4 years of follow-up are voiding with dry intervals of > 1 hour.