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Banks CA, Slay L, Williams BR, Sargent E, Alabi O, Jackson EA, Spangler E. Exploring how military culture shapes veterans' perception of aortic aneurysm repair: A qualitative study. Vascular 2024:17085381241262130. [PMID: 38877806 DOI: 10.1177/17085381241262130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Veterans represent a distinct cultural group whose perceptions of illness and treatment are influenced by military culture. The study explores how prior military service shapes Veterans' assumptions and behaviors in the setting of aneurysm repair surgery. STUDY DESIGN We conducted content and thematic analysis of a case series of 10 transcripts from telephone interviews with older (76.7 ± 4.3 years) African American and White male Veterans now residing in the Southern U.S. who underwent open or endovascular aneurysm surgery at Veterans Affairs Medical Centers or university affiliates between 2004 and2019. RESULTS Throughout the continuum of care, Veterans described deferring to authority and not questioning provider's decisions ["I just can't make a judgment on that, because I'm not a doctor"]. Veterans valued commitment and articulated pride in keeping logistically challenging surveillance appointments [I always took them very seriously. . . If I'm scheduled for something by the doctor, I always make it."]. The routine structure of VA care aligned with Veterans military experiences, facilitating compliance with doctor's orders. However, procedural deviations in VA care were disconcerting for patients ["They haven't reached out to me in at least three years, since my surgery; I was being seen once a year and then all of a sudden, they just quit."]. While Veterans praised VA care, they exhibited sensitivity to signs of untoward treatment from clinical and support staff "…my surgeon, he never talked to me before, nor after, no anytime…I thought that maybe that wasn't right". CONCLUSIONS Military culture embodies rank, order, and respect, and remains a source of strength and stability for Veterans in their medical care late in life. Cultural competency about how military service has shaped Veterans' expectations can enhance providers' awareness of patients' military mindsets and inform surgeons' efforts to engage Veterans in shared decision making.
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Affiliation(s)
- C Adam Banks
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Laurie Slay
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Beverly R Williams
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
- Geriatrics, and Palliative Care, University of Alabama Division of Gerontology, Birmingham, AL, USA
| | - Emily Sargent
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Olamide Alabi
- School of Medicine Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, GA, USA
- Atlanta VA Healthcare System, Atlanta, GA, USA
| | - Elizabeth A Jackson
- Cardiovascular Quality and Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily Spangler
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Ditzel RM, Nield LS, Nease EK, Wamsley LM, Eisenhart W, Fisher AD, Vallejo MC. Factors Associated With the Acceptance of Military Applicants to a U.S. Allopathic Medical School. Mil Med 2023; 188:e3652-e3656. [PMID: 37192213 DOI: 10.1093/milmed/usad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/12/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Service members and veterans applying to medical schools can be a challenging experience. Often, the applicants have difficulty providing descriptions of their experiences. Additionally, their pathway to medical school is significantly different compared to traditional applicants. We sought to determine if there were statistically significant factors within a cohort of U.S. military medical school applications to a U.S.-based allopathic medical school to provide recommendations on how to best advise military applicants. METHODS Data about social, academic, and military factors were collected and analyzed from the American College Application Service (AMCAS) applications to the West Virginia University School of Medicine (WVU SoM) from the 2017 to 2021 cycles. Eligibility criteria included the applications that indicated that the applicant listed any type of military experience. RESULTS In the 5-year study period, there were 25,514 applicants to the WVU SoM, and 1.6% (n = 414) self-identified as military applicants. Of the military applicants, 28 (7%) were accepted to the WVU SoM. Statistically significant differences were found in several factors, including but not limited to academic performance, number of total experiences (14.5 vs. 12, P = .01), and number of military experiences (4 vs. 2, P = .003) listed on the AMCAS applications. In the accepted group, 88% of the applications included information about military experiences, which was understandable to the nonmilitary researchers compared to 79% in the nonaccepted group (P = .24). CONCLUSIONS Premedical advisors can share statistically significant findings with military applicants, so they are informed about the academic and experiential factors associated with medical school acceptance. Applicants should also be advised to provide clear explanations of any military lexicon used in their applications. Although not statistically significant, there were a higher percentage of applications that contained descriptions of military language that was understandable to the civilian researchers in the accepted group vs. the nonaccepted group.
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Affiliation(s)
- Ricky M Ditzel
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV 26506, USA
- Special Operations Medical Association, Chicago, IL 60604, USA
| | - Linda S Nield
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Emily K Nease
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Lauren M Wamsley
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - William Eisenhart
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV 26506, USA
- Special Operations Medical Association, Chicago, IL 60604, USA
| | - Andrew D Fisher
- Special Operations Medical Association, Chicago, IL 60604, USA
- Medical Command, Texas Army National Guard, Austin, TX 78763, USA
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA
| | - Manuel C Vallejo
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, WV 26506, USA
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Treichler EBH, Reznik SJ, Oakes D, Girard V, Zisman-Ilani Y. Military culture and collaborative decision-making in mental healthcare: cultural, communication and policy considerations. BJPsych Open 2023; 9:e154. [PMID: 37578050 PMCID: PMC10486237 DOI: 10.1192/bjo.2023.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023] Open
Abstract
Military culture relies on hierarchy and obedience, which contradict the implementation and use of collaborative care models. In this commentary, a team of lived experience, clinical and research experts discuss, for the first time, cultural, communication and policy considerations for implementing collaborative care models in military mental healthcare settings.
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Affiliation(s)
- Emily B. H. Treichler
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA; and Department of Psychiatry, University of California, San Diego, California, USA
| | - Samantha J. Reznik
- VA San Diego Psychosocial Rehabilitation and Recovery Center, San Diego, California, USA; and Texas Institute for Excellence in Mental Health, University of Texas at Austin, Austin, Texas, USA
| | - David Oakes
- VA San Diego Mental Illness Research, Education and Clinical Center, San Diego, California, USA
| | - Vanessa Girard
- VA San Diego Psychosocial Rehabilitation and Recovery Center, VA San Diego, San Diego, California, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA; and Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
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Women Veterans' Descriptions of Interactions With Civilian Health Care Providers: A Qualitative Inquiry. ANS Adv Nurs Sci 2023:00012272-990000000-00061. [PMID: 36928280 DOI: 10.1097/ans.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Women veterans often obtain care for unique gender- and military-related health issues from civilian health care settings. There is a gap in the literature surrounding woman veterans' perspectives about the care they receive. The purpose of this study was to apply the Interaction Model of Client Health Behavior framework to study the patient-provider interaction described by women veterans. A qualitative descriptive methodology, using directed content analysis, was employed. Six themes were identified. Consistent screening, provider knowledge about service roles and experiences of women veterans, and familiarity with military-related health conditions support holistic care. Further research in this area is warranted.
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Ingram PB, Morris CS, Golden B, Youngren WA, Fulton JA, Sharpnack J. The Influence of Service Era: Comparing Personality Assessment Inventory (PAI) Scale Scores Within a Posttraumatic Stress Disorder Treatment Clinic (PCT). J Clin Psychol Med Settings 2022; 29:624-635. [PMID: 34427816 DOI: 10.1007/s10880-021-09812-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Research is mixed on the role of service era in symptom endorsement among Veterans, with differences emerging depending on the instrument evaluated. This study compares Personality Assessment Inventory (PAI) scale scores of VA test-takers who served during the Vietnam, Desert Storm, or Post-9/11 service eras. The sample was collected at a VA Posttraumatic Stress Disorder Clinical Team. Associations between gender and combat exposure were also examined as covariates. Results suggest that Veterans' self-report on the PAI is influenced by service era, even after accounting for gender and combat exposure during deployment. The largest differences were between Vietnam or Post-9/11 Veterans and those from the Gulf War era. Symptom differences typically varied across scales commonly associated with symptoms of trauma exposure/posttraumatic stress disorder. Implications for the clinical use of, and research with, the PAI and other broadband personality assessments within the VA healthcare system and trauma treatment settings are discussed.
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Affiliation(s)
- Paul B Ingram
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA.
- Eastern Kansas Veteran Healthcare System, Topeka, KS, USA.
| | - Cole S Morris
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA
| | - Brittney Golden
- Department of Psychological Sciences, Texas Tech University, 2810 18th Street, Lubbock, TX, 79424, USA
| | | | - Joe A Fulton
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 103:1222-1232. [PMID: 34516996 DOI: 10.1016/j.apmr.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where "psychoeducation" was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation-the Rehabilitation Treatment Specification System-can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.
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Comartin E, Dunnigan M, Nelson V. Lost in Transition: The Behavioral Health Needs of Veterans in Eight County Jails. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:104-115. [PMID: 34272640 DOI: 10.1007/s10488-021-01151-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
The behavioral health needs, service utilization, and discharge planning provision of veterans in jails have been understudied, yet practitioners must understand each component to ensure veterans' behavioral health needs are met through linkage to culturally-appropriate services. Thus, this study asked: How do veterans differ from non-veterans regarding behavioral health needs, jail-based service engagement, and discharge planning within jails? How do jails identify veterans and are they referred to culturally-appropriate services? In a booking sample across eight jails, this evaluative, cross-sectional study compared veterans to non-veterans by demographics, criminal/legal outcomes, behavioral health needs, and receipt of jail-based behavioral health and discharge planning services. Additionally, the process by which booking officers and jail-based clinicians identify veterans was assessed. Veterans were more likely to be male, older, to have received mental health services prior to their jail stay, and to misuse alcohol. They are less likely to have insecure housing and misuse drugs. No differences existed for length of stay in jail nor recidivism. Veterans were equally likely to receive jail-based behavioral health services, but less likely to receive discharge planning services. While many veterans identified their military status at booking, just over one-third who received services from clinicians were identified as veterans. Of those identified by clinicians, few were referred to culturally-appropriate services as part of their discharge planning. Practitioners in the criminal/legal and mental health systems need to collaborate and develop processes that successfully identify and link veterans to culturally-appropriate services.
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Affiliation(s)
- Erin Comartin
- School of Social Work, Center of Behavioral Health & Justice, Wayne State University, 5447 Woodward Ave, RM 029, Detroit, MI, 48202, USA
| | - Megan Dunnigan
- School of Social Work, Center of Behavioral Health & Justice, Wayne State University, 5447 Woodward Ave, RM 029, Detroit, MI, 48202, USA.
| | - Victoria Nelson
- School of Social Work, Center of Behavioral Health & Justice, Wayne State University, 5447 Woodward Ave, RM 029, Detroit, MI, 48202, USA
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Dondanville KA, Fina BA, Straud CL, Finley EP, Tyler H, Jacoby V, Blount TH, Moring JC, Pruiksma KE, Blankenship AE, Evans WR, Zaturenskaya M. Launching a Competency-Based Training Program in Evidence-Based Treatments for PTSD: Supporting Veteran-Serving Mental Health Providers in Texas. Community Ment Health J 2021; 57:910-919. [PMID: 32666417 DOI: 10.1007/s10597-020-00676-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Community mental health providers play an essential role in delivering services to veterans who either have limited access to U.S. Department of Veterans Affairs (VA) facilities or who prefer to seek care outside of the VA. However, there are limited training opportunities in evidence-based treatments for posttraumatic stress disorder (PTSD) outside of the VA. In 2017, the STRONG STAR Training Initiative was established to develop competency-based training in two evidence-based therapies for PTSD and to provide that training for mental health providers serving veterans and their families in community settings in Texas. This article describes the program's development and implementation, baseline characteristics of participating clinicians, and lessons learned toward the scale-up and extension of this competency-based training effort to include other interventions and locations.
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Affiliation(s)
- Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Brooke A Fina
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Erin P Finley
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, USA
| | - Hannah Tyler
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Vanessa Jacoby
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Tabatha H Blount
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - John C Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Abby E Blankenship
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Wyatt R Evans
- VA North Texas Health Care System, 4500 S Lancaster Rd, Dallas, TX, USA
| | - Mariya Zaturenskaya
- James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL, USA
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Disaster Behavioral Health Research Involving Military Facilities and Populations after Mass Violence: Insights from the 2013 Washington Navy Yard Shooting. Disaster Med Public Health Prep 2021; 16:1215-1220. [PMID: 33966690 DOI: 10.1017/dmp.2021.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Research on disaster behavioral health presents significant methodological challenges. Challenges are even more complex for research on mass violence events that involve military members, families, and communities, due to the cultural and logistical considerations of working with this population. The current article aims to inform and educate on this specialized area of research, by presenting a case study on the experience of designing and conducting disaster behavioral health research after a mass violence event in a military setting: the 2013 mass shooting at the Washington Navy Yard, in Washington, D.C. Using the case example, the authors explore methodological challenges and lessons learned from conducting research in this context, and provide guidance for future researchers.
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10
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Hoffman M. Between Order and Execution: A Phenomenological Approach to the Role of Relationships in Military Culture. JOURNAL OF VETERANS STUDIES 2020. [DOI: 10.21061/jvs.v6i3.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Cowlishaw S, Metcalf O, Lawrence-Wood E, Little J, Sbisa A, Deans C, O'Donnell M, Sadler N, Van Hooff M, Crozier M, Battersby M, Forbes D, McFarlane AC. Gambling problems among military personnel after deployment. J Psychiatr Res 2020; 131:47-53. [PMID: 32920277 DOI: 10.1016/j.jpsychires.2020.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/01/2022]
Abstract
Military and veteran populations may exhibit heightened vulnerability to gambling problems; however, there is scant relevant evidence outside the US, and few studies of transition periods, including return from operational deployment. The aim of this study was thus to highlight the extent, risk-factors, and implications of gambling problems among current members of the Australian Defence Force (ADF) following deployment to the Middle East Area of Operations (MEAO). It involved analyses of data from n = 1324 ADF personnel who deployed between 2010 and 2012, and completed surveys within four months of returning to Australia. The Problem Gambling Severity Index (PGSI) identified Problem Gambling (PG: PGSI ≥5) and At-Risk Gambling (ARG: PGSI 1-4), alongside measures of Depression (PHQ-9), Posttraumatic Stress Disorder (PCL-C), alcohol use problems (AUDIT), distress (K10), and post-deployment stressors. Analyses indicated that 7.7% of personnel reported at least some gambling problems post-deployment, including 2.0% that were distinguished by PG, and 5.7% indicating ARG. These figures were comparable to conditions including probable depression and alcohol dependence, while levels of any gambling problems were high relative to harmful drinking. Higher levels were observed among personnel who were aged 18-24, reported 0-4 years of military service, served in the Army, and comprised Non-Commissioned Officers/Other Ranks. There were strong associations with gambling problems and various indicators of mental health and wellbeing, and self-reported post-deployment difficulties. The findings indicate that gambling problems are salient concerns for some Australian military personnel post-deployment, and highlight the need for increased recognition and responses to these problems.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Jonathon Little
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Alyssa Sbisa
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Carolyn Deans
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Nicole Sadler
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Miranda Van Hooff
- Australian Centre for Excellence in Posttraumatic Stress, The Road Home, The Hospital Research Foundation, Australia
| | - Matilda Crozier
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - Alexander C McFarlane
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia; University of Adelaide, Adelaide, Australia
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Re-engaging Dropouts of Prolonged Exposure for PTSD Delivered via Home-Based Telemedicine or In Person: Satisfaction with Veteran-to-Veteran Support. J Behav Health Serv Res 2020; 48:171-182. [PMID: 33034019 DOI: 10.1007/s11414-020-09734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
This paper describes feasibility of and patient and peer satisfaction with a Veteran-to-Veteran peer support program purposefully integrated into prolonged exposure (PE) for post-traumatic stress disorder (PTSD) to address barriers contributing to dropout from both in person and telemedicine delivered PE. Specifically, patients who had dropped out of PE were offered the opportunity to return to treatment, this time with a peer who themselves had completed PE, who would join them during a limited number of PE in vivo exposure homework trials. About half of the Veterans who dropped out indicated willingness to return to treatment, noting the peer as central to this decision, and about a third actually returned to treatment. Participants reported high satisfaction with the program, as did peers. Peers reported that their own symptoms were not exacerbated by engaging in exposure homework with the patients. While in the military, service members are trained to leverage the power of the group toward mission-specific tasks; and this training appears relevant to PTSD treatment in the present context.
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13
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Mathewson-Chapman M, Chapman HJ. One Health and veterans' post-deployment health. CLINICAL TEACHER 2020; 18:24-31. [PMID: 32909399 DOI: 10.1111/tct.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Since 2001, more than 3.3 million US service members have been deployed to operations Iraqi Freedom, Enduring Freedom, New Dawn, Inherent Resolve and Freedom's Sentinel. Visible and invisible war wounds from direct combat experiences, coupled with environmental exposures to harmful substances, can complicate veterans' health throughout their lifespan. While promoting a holistic view of health, health professionals should be attentive for potential risks associated with environmental or animal exposures (One Health concept). During deployment, infectious and non-infectious environmental exposures and harmful substances in the air, on the land and in the water may result in immediate- or long-term health effects. Veterans can also face psychosocial health risks when home that may impact their concentration, emotional responses and social interactions. To strengthen health professions education, the authors recommend that curricula incorporate a comprehensive overview of veterans' physical and psychosocial health risks as a result of their deployment. They describe four specific curriculum topics, competencies and didactic methods that can reinforce veteran-specific content for clinical education and training. By applying the One Health concept, health professionals can document harmful environmental exposures during deployment, report gaps in clinical practice, and provide support for veterans' physical and psychosocial health needs when returning to civilian life.
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Affiliation(s)
| | - Helena J Chapman
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Lane J, Wallace D. Australian military and veteran's mental health care part 1: an introduction to cultural essentials for clinicians. Australas Psychiatry 2020; 28:267-269. [PMID: 32019355 DOI: 10.1177/1039856220901470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This article aims to define the cultural specificity of Australian military and veterans, and introduce some of the essential clinician knowledge, skills and attitudes required for effective cultural competence in the management of mental health (MH) conditions in this population. CONCLUSION Military culture has the defining characteristics of the military as an organisation with a formal structure, as a cultural group governed by norms and shared values, and as a social group that provides people with identities. Key requirements for cultural competence introduced here are basic knowledge of the military structure, norms and identity; clinical skills including basic assessment and awareness of the commonly occurring MH disorders; and an exploration of attitudes of both the clinician and the military or veteran patient. Further research is needed, particularly in terms of assessing clinician's cultural competence.
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Affiliation(s)
- Jonathan Lane
- University of Adelaide Centre for Traumatic Stress Studies, Australia; and School of Medicine, University of Tasmania, Australia
| | - Duncan Wallace
- Australian Defence Force Centre for Mental Health, HMAS Penguin, Australia; and School of Psychiatry, University of NSW, Australia
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15
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Ammerman BA, Reger MA. Evaluation of Prevention Efforts and Risk Factors Among Veteran Suicide Decedents Who Died by Firearm. Suicide Life Threat Behav 2020; 50:679-687. [PMID: 32017233 DOI: 10.1111/sltb.12618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Veterans die by suicide at a higher rate than the U.S. population, and veterans more frequently use a firearm as the suicide method. Consequently, firearm accessibility and storage represent important prevention considerations. This project aimed to explore the implementation of suicide prevention efforts among veterans who went on to die by suicide, with and without the use of a firearm, and to identify factors that differentiated veteran suicide decedents to help inform suicide prevention efforts. METHODS Data from the Veteran Health Administration Behavior Health Autopsy Program was analyzed for 97 veteran suicide decedents. RESULTS Results demonstrated that veterans who used a firearm for suicide were less likely to have engaged in suicide prevention efforts overall and were less likely to have received lethal means safety counseling / safety planning. Veterans who died by firearm had lower levels of notable risk factors (e.g., prior suicide attempt, no-shows for appointments), however were more likely to have a documented unsecured firearm in their home. CONCLUSION These findings support the benefit of broadening the reach of suicide prevention efforts, especially for high-risk veterans with access to firearms.
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Affiliation(s)
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Morse C. Training for a new environment: Using military operational concepts in counseling veterans. J Clin Psychol 2020; 76:841-851. [PMID: 31909837 DOI: 10.1002/jclp.22919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since September 11, 2001, the United States has engaged in an extended period of military conflict, resulting in 4.1 million men and women serving in support of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Whereas not all servicemembers experience mental health issues, many have experienced difficulties with readjusting to the civilian world, often requiring mental health services both inside and outside of the Department of Veterans Affairs. Issues related to stigma and military culture contribute to barriers not only for veterans seeking treatment but for clinicians providing services who may lack experience with military culture. This article provides a framework to use military concepts in clinical sessions to further therapeutic engagement with the military/veteran client.
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Messerschmitt-Coen S. Considerations for Counseling Student Veterans. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2019. [DOI: 10.1080/87568225.2019.1660292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND The principles of the Armed Forces Covenant state that Armed Forces Veterans should be at no disadvantage resulting from their service compared with a general adult population. However, despite being at increased risk of experiencing common mental health difficulties, evidence indicates that 82% of Armed Forces Veterans receive no treatment, compared with 63% of the general adult population. AIM To gain a better appreciation of factors that inform the type of adaptations to cognitive behavioural therapy (CBT) interventions for depression and mainstream service promotion materials to enhance acceptability for Armed Forces Veterans. METHOD This is a qualitative study employing a focus group of 12 participants to examine the main impacts of depression on Armed Forces Veterans alongside attitudes towards terminology and visual imagery. Thematic analysis was used to identify themes and sub-themes with rigour established through two researchers independently developing thematic maps to inform a final agreed thematic map. RESULTS A behavioural activation intervention supporting re-engagement with activities to overcome depression had good levels of acceptability when adapted to reflect an Armed Forces culture. Preferences regarding terminology commonly used within CBT adapted for Armed Forces Veterans were identified. Concerns were expressed with respect to using imagery that emphasized physical rather than mental health difficulties. CONCLUSIONS There is the need to consider the Armed Forces community as a specific institutional culture when developing CBT approaches with potential to enhance engagement, completion and recovery rates. Results have potential to inform the practice of CBT with Armed Forces Veterans and future research.
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Tam-Seto L, Krupa T, Stuart H, Aiken AB, Lingley-Pottie P, Cramm H. Identifying military family cultural competencies: experiences of military and Veteran families in Canadian health care. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Military family life is characterized by mobility, separation, and increased risk for injury or death of the military member, which impacts the health and well-being of all family members. Additional stress is experienced when accessing and navigating a new health care system. Unknown to most Canadians is the reality that military and Veteran families (MVFs) access the civilian health care system; this indicates a need for military family cultural competency among health care providers. This current research identifies aspects of military family cultural competency to inform health care provision to MVFs. Method: A qualitative study using one-on-one interviews was completed with MVFs. Critical Incident Technique (CIT) was used to develop interview questions. Framework analysis was used for data analysis. Results: In total 17 interviews were completed including:1 family (female military spouse, male military member and child); 1 male Veteran; and 15 female military spouses (1 Veteran; 1 active member). Military family cultural competency domains such as cultural knowledge (characteristics of military families; impacts of mobility, separation, and risk) and cultural skills (building relationships; use of effective and appropriate assessments and interventions) were identified. The ecological context was also described as impacting the health care experience. Discussion: The reported experiences of MVFs in this study have highlighted the gaps in the military family cultural knowledge and military family cultural skills Canadian health care providers have when providing care. Results of this study can be used to develop continuing education for health professionals and inform future research.
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Affiliation(s)
- Linna Tam-Seto
- Health Services & Policy Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Terry Krupa
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Heather Stuart
- Health Services & Policy Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Alice B. Aiken
- Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
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Armistead-Jehle P, Soble JR, Cooper DB, Belanger HG. Unique Aspects of Traumatic Brain Injury in Military and Veteran Populations. Phys Med Rehabil Clin N Am 2018; 28:323-337. [PMID: 28390516 DOI: 10.1016/j.pmr.2016.12.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury (TBI), in particular mild TBI (mTBI), is a relatively common injury experienced by service members across both deployed and nondeployed environments. Although many of the principles and practices used by civilian health care providers for identifying and treating this injury apply to military settings, there are unique factors that impact mTBI-related care in service members and Veterans. This article reviews several of these factors, including the epidemiology of TBI in the military/Veteran population, the influence of military culture on this condition, and identification and treatment of mTBI in the war zone.
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Affiliation(s)
- Patrick Armistead-Jehle
- Concussion Clinic, Munson Army Health Center, 550 Pope Avenue, Fort Leavenworth, KS 66027, USA.
| | - Jason R Soble
- Psychology Service, South Texas Veterans Healthcare System, 7400 Merton Minter, San Antonio, TX 78229, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center, Department of Neurology, San Antonio Military Medical Center, Joint Base San Antonio, MCHE-ZDM-N, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234-4504, USA; Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Heather G Belanger
- HSR&D, Tampa VA TBI/Polytrauma Rehabilitation Center, Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Boulevard - 116A, Tampa, FL 33612, USA; Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33612, USA; Defense and Veterans Brain Injury Center, 13000 Bruce B Downs Boulevard (116B), Tampa, FL 33612, USA
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21
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Lancaster SL, Kintzle S, Castro CA. Validation of the Warrior Identity Scale in the Chicagoland Veterans Study. IDENTITY 2018. [DOI: 10.1080/15283488.2017.1410157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Sara Kintzle
- USC Center for Innovation and Research on Veterans & Military Families, University of Southern California, Los Angeles, California, USA
| | - Carl A. Castro
- USC Center for Innovation and Research on Veterans & Military Families, University of Southern California, Los Angeles, California, USA
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Talbot LA, Brede E, Price M, Metter EJ. Health-related quality of life in active duty military: A secondary data analysis of two randomized controlled trials. Nurs Outlook 2017; 65:S53-S60. [PMID: 28830632 DOI: 10.1016/j.outlook.2017.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Military service members with lower extremity injuries are at risk for compromised health-related quality of life during rehabilitation. PURPOSE The purpose of this secondary data analysis was to examine changes in self-perceived physical and mental health in two clinical trials of military service members during rehabilitation for a lower extremity injury. METHODS This study is a secondary analysis of existing data from two cohorts of active duty military service members with lower extremity injuries as they participated in separate randomized controlled trials. DISCUSSION A similar pattern for both physical and mental health was observed in both groups of participants. Perceptions of physical health improved significantly in both studies, whereas mental health perceptions may or may not have declined. CONCLUSION Increased attention to mental health may be important during rehabilitation after major and minor lower extremity injuries. Although perceptions of physical health improve, corresponding changes may not occur in mental health perceptions.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN.
| | - Emily Brede
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Marquita Price
- Office of the Surgeon General/Medical Force Development (SG1/8AN), Falls Church, VA
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
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Holliday RP, Holder ND, Williamson MLC, Surís A. Therapeutic response to Cognitive Processing Therapy in White and Black female veterans with military sexual trauma-related PTSD. Cogn Behav Ther 2017; 46:432-446. [PMID: 28485687 DOI: 10.1080/16506073.2017.1312511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive Processing Therapy (CPT) is an evidence-based treatment (EBT) for posttraumatic stress disorder (PTSD) which has been validated for female veterans with military-related PTSD. Existing trials have enrolled predominantly White veterans with some studies documenting higher rates of early termination from EBTs among Black females when compared to White females. Data from a previously published randomized clinical trial were used to evaluate the effectiveness of CPT for Black female veterans with military sexual trauma (MST)-related PTSD. Reductions in PTSD symptom severity, number of sessions attended, and early termination rates were compared between Black (n = 20) and White (n = 16) female veterans. A hierarchical linear modeling approach was used, with PTSD symptom severity over the course of treatment and follow-up entered as a level-1 variable and race (Black or White) entered as a level-2 predictor. Piecewise growth curves analyses revealed that both Black and White female veterans experienced significant reductions in PTSD symptom severity over the course of treatment and gains were maintained up to 6 months post-treatment. Race was not found to be a significant predictor of change in the slope of PTSD symptom severity over the course of CPT treatment. Additionally, number of sessions attended and rates of early termination did not significantly differ based on race. Results suggest that CPT was a well-tolerated and effective psychotherapeutic treatment for this sample regardless of racial self-identification.
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Affiliation(s)
- Ryan P Holliday
- a Veterans Affairs North Texas Health Care System , Dallas , TX 75216 , USA.,b University of Texas Southwestern Medical Center , Dallas , TX 75390 , USA
| | - Nicholas D Holder
- a Veterans Affairs North Texas Health Care System , Dallas , TX 75216 , USA.,b University of Texas Southwestern Medical Center , Dallas , TX 75390 , USA
| | | | - Alina Surís
- a Veterans Affairs North Texas Health Care System , Dallas , TX 75216 , USA.,b University of Texas Southwestern Medical Center , Dallas , TX 75390 , USA
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Tran LD, Grant D, Aydin M. California Veterans Receive Inadequate Treatment to Address their Mental Health Needs. ACTA ACUST UNITED AC 2016; 3:126-140. [PMID: 27570802 DOI: 10.22381/ajmr3220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data from the 2011 to 2013 California Health Interview Survey (CHIS) were pooled to estimate prevalence of mental health need (serious psychological distress and impairment in one or more life domains), minimally adequate treatment (having four or more visits with a health professional in the past 12 months and use of prescription medication for mental health problems in the past 12 months), and suicide ideation among veterans living in California. Numbers and percentages were weighted to the CA population using a large sample size (N=6,952), and for comparison purposes, veterans and nonveterans were standardized to the age and gender distribution of veterans in the sample. Although differences in mental health need were similar between veterans and nonveterans after adjustment, over three-quarters of veterans did not receive minimally adequate treatment needed to address their mental health needs. Suicide ideation was significantly higher among veterans than nonveterans. Male veterans at all ages were more vulnerable to thinking about suicide compared to their nonveteran counterparts.
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Affiliation(s)
- Linda Diem Tran
- UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024, (310) 794-0909
| | - David Grant
- UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Suite 1550, Los Angeles, CA 90024, (310) 794-0909,
| | - May Aydin
- National Science Foundation, National Center for Science and Engineering Statistics, 4201 Wilson Blvd, Suite 965, Arlington, VA 22230, (703) 292-4977,
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