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The Numu Pukutsinuu, or Pukutsi, were nineteenth-century Comanche (Namun-uu) warriors who followed ritual contrary roles in combat and everyday life. Following the end of traditional Plains Indian warfare and their cessation, Comanches soon began regaining veteran status through service in the US Armed Forces. While several Southern Plains tribes later revived traditional men's warrior societies and created veteran's organizations, none have formally associated a contrary status with newer forms of military service. In 2010 members of the Comanche Indian Veterans Association decided to reclaim this ancestral warrior status, bestowing it upon select contemporary veterans. In doing so, the Comanche continue a tradition of reviving important martial cultural symbols, blending them with US Armed Forces service, insignia, and rituals, and demonstrating how the importance of Comanche military service and recognizing veterans continues in modern contexts and on their own terms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Care for people with human immunodeficiency virus (HIV) increasingly focuses on comorbidities, including hypertension. Evidence indicates that antiretroviral therapy and opportunistic infections are best managed by providers experienced in HIV medicine, but it is unclear how to structure comorbidity care. Approaches include providing comorbidity care in HIV clinics (consolidated care) or combining HIV care with comorbidity management in primary care clinics (shared care). We compared blood pressure (BP) control in HIV clinics practicing consolidated care versus shared care. METHODS: We created a national cohort of Veterans with HIV and hypertension receiving care in HIV clinics in Veterans Administration facilities and merged these data with a survey asking HIV providers how they delivered hypertension care (5794 Veterans in 73 clinics). We defined BP control as BP ≤140/90 mmHg on the most recent measure. We compared patients likelihood of experiencing BP control in clinics offering consolidated versus shared care, adjusting for patient and clinic characteristics. RESULTS: Forty-two of 73 clinics (57.5%) practiced consolidated care for hypertension. These clinics were larger and more likely to use multidisciplinary teams. The unadjusted frequency of BP control was 65.6% in consolidated care clinics vs 59.4% in shared care clinics (P < .01). The likelihood of BP control remained higher for patients in consolidated care clinics after adjusting for patient and clinic characteristics (odds ratio, 1.32; 95% confidence interval, 1.04-1.68). CONCLUSIONS: Patients were more likely to experience BP control in clinics reporting consolidated care compared with clinics reporting shared care. For shared-care clinics, improving care coordination between HIV and primary care clinics may improve outcomes.

Background: Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms. Methods: PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning. Results: The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample. Conclusions: Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems. [ABSTRACT FROM AUTHOR]

This article explores the governance of post-traumatic stress disorder among soldiers-turned-contractors in the private military labour market. Using original data relating to the UK case, it argues that this governance regime is best understood as a political economic process which transcends the public–private divide. On one side, post-traumatic stress disorder is managed as an economic issue—a calculation to be factored into the pursuit of profit maximization. On the other side, it is managed as a political or social issue—a component of the civil–military relationship in which state and society have a duty to care for all those who have served and sacrificed in defense of the nation. In other words, this process is shaped by—and gives shape to—the complex professional identity of the individuals under examination: they are private military contractors and, at the same time, armed forces veterans. [ABSTRACT FROM AUTHOR]

Objectives. The effectiveness of cognitive behavioral therapy for depression (CBT-D) among older adults in routine clinical settings has received limited attention. The current article examines and compares outcomes of older versus younger veterans receiving CBT-D nationally. Method. Patient outcomes were assessed using the Beck Depression Inventory–II and World Health Organization Quality of Life-BREF. Therapeutic alliance was assessed using the Working Alliance Inventory-Short Revised. Results. A total of 764 veterans aged 18–64 and 100 veterans aged 65+ received CBT-D; 68.0% of older and 68.3% of younger patients completed all sessions or finished early due to symptom relief, and mean depression scores declined from 27.0 (standard deviation [SD] = 10.7) to 16.2 (SD = 12.4) in the older group and from 29.1 (SD = 11.2) to 17.8 (SD = 13.5) in the younger group. Within-group effect sizes were d = 1.01 for both groups. Significant increases in quality of life and therapeutic alliance were observed for both groups. Discussion. CBT-D resulted in significant improvements in depression and quality of life among older patients. Outcomes and rate of attrition were equivalent to younger patients. Findings indicate that CBT-D is an effective and acceptable treatment for older veterans in real-world settings with often high levels of depression. [ABSTRACT FROM PUBLISHER]

The validity of neuropsychological testing is reliant on examinees putting forth adequate effort, yet it has been asserted that verbal subtests from the Wechsler Adult Intelligence Scales (WAIS) are insensitive to suboptimal effort in comparison to other commonly used neuropsychological measures. The current study examined performance differences on the entire WAIS-IV and WRAT-4 Reading, as well as the CVLT-II and several WMS-IV subtests, in 207 Veterans classified into Credible Effort (n= 146) and Non-credible Effort (n= 61) groups. Analyses revealed that the Non-credible Effort group performed significantly lower on all examined measures including verbal tests, with moderate to large effect sizes observed for most tests. Current findings thus indicate that WAIS-IV verbal subtests and reading ability measures, such as on the WRAT-4, are not insensitive to effects of non-credible effort. Consequently it is recommended that these tests not generally be used to estimate baseline intellectual functioning when found in the presence of non-credible effort. While there was broad performance suppression across all measures examined, results also showed a distinct continuum of test susceptibility with some measures being more or less sensitive to inadequate effort. Recommendations for future performance validity test development are presented. [ABSTRACT FROM AUTHOR]

The psychometric properties of the PTSD Checklist (PCL) were investigated in a sample of treatment-seeking and community-dwelling male veterans. In conjunction with previous reports, results from the present study indicate that the PCL possesses strong, robust psychometric properties. The current investigation suggests a cutoff score of 60-higher than previous investigations-related to posttraumatic stress disorder (PTSD) diagnosis derived from the Clinician-Administered PTSD Scale. This research supports the use of the PCL as a brief self-report measure of PTSD symptomatology. [ABSTRACT FROM AUTHOR]

We examined the impact of patient-level factors on provider recognition of posttraumatic stress disorder (PTSD). Analyses were based on a random sample of 1,079 consenting patients who had an outpatient visit at any of four southeastern Department of Veterans Affairs hospitals in 1999. We collected data on PTSD symptoms, sociodemographics, functional status, medical record diagnoses, and independent PTSD diagnostic assessments for 888 patients. Complete and usable data were available for 819 patients. A total of 98 patients (12%) met criteria for PTSD, and of these, 42 (43%) were correctly classified as such by their provider. Results indicate that age (50-64), war-zone service, worse functioning on the 36-Item Short Form Health Survey role emotional subscale, a diagnosis of musculoskeletal pain, a greater percentage of persistent reexperiencing or avoidance/numbing symptoms, and a previously diagnosed substance use disorder were all independently related to provider recognition of PTSD. Knowledge of these factors may help inform providers and direct improved screening and case finding. [ABSTRACT FROM AUTHOR]

Significant gaps exist in our knowledge about gender differences in quality of life among individuals with posttraumatic stress disorder (PTSD). We addressed these gaps by using data from two randomized clinical trials of veterans treated in Department of Veterans Affairs settings: 358 male Vietnam veterans who received group therapy and 203 female veterans who received individual psychotherapy. Using confirmatory factor analysis, we found that a four-factor structure for the Quality of Life Inventory provided the best fit for both groups. Overall quality of life was poor in men and women, and in general, they did not differ in quality of life or in how PTSD was associated with quality of life; the few statistically significant differences were small and clinically insignificant. For both men and women, numbing was uniquely associated with reduced quality of life. We suggest that quality of life should receive increased attention in research and clinical efforts to help veterans with PTSD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the prevalence and correlates of comorbid diabetes and Post-Traumatic Stress disorder(PTSD)and potential relationships between PTSD and diabetes outcomes. Male patients enrolled in a VA primary care database (N = 73,270) were classified as having diabetes from pharmacy records (N = 14,438) and grouped into those with diagnoses of PTSD with depression (N = 649), PTSD-only (N = 480), Depression-only (N = 1696),Other psychiatric diagnosis (N = 736), or No psychiatric diagnosis (N = 10,877) based on the Purpose of Visit diagnoses in the medical record. Outcomes included glycemic control (HbA1c), cholesterol and tryglycerides. Correlates were age, substance use disorder, other psychiatric diagnosis, number of primary care encounters, and medications. The prevalence of comorbid diabetes and PTSD was 8% (n = 1129). Of these, 57% (n = 649) had comorbid depression. Patients with PTSD and depression had higher rates of substance use disorder and higher cholesterol and LDL. Patients with depression had poorer glycemic control. Patients with PTSD and depression weighed more and had higher BMI than patients with neither diagnosis. Thus, male diabetes patients with PTSD and depression may be vulnerable to substance use disorders and to weight/lipid problems that can affect health. Depression is a likely contributor to poor glycemic control. Careful screening for mental health comorbidities is needed for diabetes patients. [ABSTRACT FROM AUTHOR]

The mission of the Multiple Sclerosis Centers of Excellence (MSCoEs) is to optimize the services veterans with multiple sclerosis (MS) receive across the U.S. Veterans Health Administration. To accomplish this mission, the MSCoE West has adopted a collaborative chronic-disease management strategy along the lines of the model described by Wagner and colleagues. This model describes an organized, integrated, proactive, and population-based approach to patient care that includes healthcare delivery system change and patient-based self-management. While Wagner's model is described independent of information technology, the majority of actions called for in that model benefit tremendously from the application of a powerful and well-integrated informatics infrastructure designed to serve and support populations with chronic disease. Key elements such as goals and actions encourage high-quality care for those with chronic illnesses. [ABSTRACT FROM AUTHOR]

The article presents information on the disease multiple sclerosis (MS) and informs about the articles discussed in this issue of the journal. Approximately 24,000 veterans with MS receive care through the U.S. Veterans Health Administration (VHA). According to a 1993 study, the total cost to the VHA for providing care and disability benefits to veterans, including the U.S. Department of Veterans Affairs (VA) benefits and home healthcare, is $35,000 per patient each year. This articles in this issue of the journal address issues related to the care of veterans with MS and give information on the initiatives promoted by the two Multiple Sclerosis Centers of Excellence established by the VA.

Severe urinary retention is not a common condition, but may occur following some pelvic surgeries or other medical conditions. Electrical stimulation of the bladder has been examined as a means of managing this difficult problem. We conducted preliminary investigations in cats to prove the hypothesis that pelvic-plexus (bladder-neck) stimulation would produce greater micturition response with reduced side effects, such as animal movement or discomfort, than bladder-wall stimulation with electrodes implanted higher on the bladder wall. We used model microstimulators that mimic the look and function of commercial microstimulators, but that we constructed. We instrumented four female cats during a survival surgery. Animals recovered well and studies were conducted over a 1-month period in the conscious animal and under anesthesia. We performed a variety of studies with different stimulation parameters and electrode locations to evaluate our hypothesis. In the active animal, we supplied only low currents, but two animals responded to stimulation with bladder contractions and voiding. Following anesthesia, higher stimulating currents resulted in greater bladder contractions during stimulation in two of the three animals. In two cases, pelvic-plexus (bladder-neck) stimulation induced greater micturition responses than direct bladderwall stimulation. In conclusion, we learned from these preliminary observations that stimulation at the pelvic plexus (bladder neck) may induce a better micturition response than stimulation higher on the bladder-wall. Newly available commercial microstimulators should be further studied for the treatment of urinary retention. [ABSTRACT FROM AUTHOR]

The insulated environment of the lower-limb pros- thesis can result in elevated residual-limb skin temperatures that may contribute to skin irritation, blistering, and a reduced quality of life. The design and materials of the prosthetic socket, suspension system, and liner can potentially alleviate these conditions, but the thermal load may vary with activity and location within the socket. To characterize the thermal environment at the skin-prosthesis interface, we made temperature measurements on five transtibial amputees at 14 locations on the residual limbs. After the participants donned their prosthesis and rested in the seated position for 15 mm, the mean skin temperatures of their residual limbs increased by 0.8 degrees Celcius. Subsequent walking for 10 mm resulted in a 1.7 degrees Celsius total increase in mean skin temperature. Thermal contour maps revealed the skin was coolest at the anterior proximal location and warmest across the posterior section, correlating with areas of low and high perfusion. From the results, we determined that residual-limb skin temperature depends on activity and locality. This information may aid in understanding where and why skin problems develop on lower-limb residual limbs and may provide design requirements for new prosthetic socket systems intended to alleviate temperature-related discomfort. [ABSTRACT FROM AUTHOR]