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Beck B. Embodied Practice: Reflections of a Physically Disabled Art Therapist in Social and Medical Disability Spaces. ART THERAPY 2020. [DOI: 10.1080/07421656.2020.1756137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Redd AM, Gundlapalli AV, Suo Y, Pettey WBP, Brignone E, Chin DL, Walker LE, Poltavskiy EA, Janak JC, Howard JT, Sosnov JA, Stewart IJ. Exploring Disparities in Awarding VA Service-Connected Disability for Post-Traumatic Stress Disorder for Active Duty Military Service Members from Recent Conflicts in Iraq and Afghanistan. Mil Med 2020; 185:296-302. [PMID: 32074380 DOI: 10.1093/milmed/usz208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We explore disparities in awarding post-traumatic stress disorder (PTSD) service-connected disability benefits (SCDB) to veterans based on gender, race/ethnicity, and misconduct separation. METHODS Department of Defense data on service members who separated from October 1, 2001 to May 2017 were linked to Veterans Administration (VA) administrative data. Using adjusted logistic regression models, we determined the odds of receiving a PTSD SCDB conditional on a VA diagnosis of PTSD. RESULTS A total of 1,558,449 (79% of separating service members) had at least one encounter in VA during the study period (12% female, 4.5% misconduct separations). Females (OR 0.72) and Blacks (OR 0.93) were less likely to receive a PTSD award and were nearly equally likely to receive a PTSD diagnosis (OR 0.97, 1.01). Other racial/ethnic minorities were more likely to receive an award and diagnosis, as were those with misconduct separations (award OR 1.3, diagnosis 2.17). CONCLUSIONS Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards. Other racial/ethnic minorities and those with misconduct separations were more likely to receive PTSD diagnoses and awards. Further study is merited to explore variation in awarding SCDB.
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Affiliation(s)
- Andrew M Redd
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Ying Suo
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Warren B P Pettey
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148.,Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Emily Brignone
- VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240
| | - David L Chin
- Department of Health Promotion and Policy, School of Public Health, University of Massachusetts Amherst, 715 N Pleasant St, Amherst, MA 01003
| | - Lauren E Walker
- David Grant USAF Medical Center, Clinical Investigation Facility, 101 Bodin Circle, Travis AFB, CA 94535
| | - Eduard A Poltavskiy
- David Grant USAF Medical Center, Clinical Investigation Facility, 101 Bodin Circle, Travis AFB, CA 94535
| | - Jud C Janak
- Department of Defense Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, 3698 Chambers Pass, San Antonio, TX 78234
| | - Jeffrey T Howard
- Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249
| | - Jonathan A Sosnov
- 375th Medical Group, Scott AFB, IL 62225.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Ian J Stewart
- David Grant USAF Medical Center, Clinical Investigation Facility, 101 Bodin Circle, Travis AFB, CA 94535.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
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Gundlapalli AV, Redd AM, Suo Y, Pettey WBP, Brignone E, Chin DL, Walker LE, Poltavskiy EA, Janak JC, Howard JT, Sosnov JA, Stewart IJ. Predicting and Planning for Musculoskeletal Service-Connected Disabilities in VA Using Disability for Active Duty OEF/OIF Military Service Members. Mil Med 2020; 185:413-419. [PMID: 32074349 PMCID: PMC10416188 DOI: 10.1093/milmed/usz223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Musculoskeletal (MSK) conditions are commonly seen among military service members (SM) and Veterans. We explored correlates of award of MSK-related service-connected disability benefits (SCDB) among SM seeking care in Veterans Affairs (VA) hospitals. MATERIALS AND METHODS Department of Defense data on SM who separated from October 1, 2001 to May 2017 were linked to VA administrative data. Using adjusted logistic regression models, we determined the odds of receiving MSK SCDB. RESULTS A total of 1,558,449 (79% of separating SM) had at least one encounter in VA during the study period (7.8% disability separations). Overall, 51% of this cohort had at least one MSK SCDB (88% among disability separations, 48% among normal). Those with disability separations (as compared to normal separations) were significantly more likely to receive MSK SCDB (odds ratio 2.37) as were females (compared to males, odds ratio 1.15). CONCLUSIONS Although active duty SM with disability separations were more likely to receive MSK-related service-connected disability ratings in the VA, those with normal separations also received such awards. Identifying those at highest risk for MSK-related disability could lead to improved surveillance and prevention strategies in the Department of Defense and VA health care systems to prevent further damage and disability.
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Affiliation(s)
- Adi V Gundlapalli
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148
- Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Andrew M Redd
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148
- Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Ying Suo
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148
- Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Warren B P Pettey
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148
- Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Emily Brignone
- VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA 15240
| | - David L Chin
- Department of Health Promotion and Policy, School of Public Health, University of Massachusetts Amherst, 715 N Pleasant St., Amherst, MA 01003
| | - Lauren E Walker
- Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis AFB, CA 94535
| | - Eduard A Poltavskiy
- Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis AFB, CA 94535
| | - Jud C Janak
- Department of Defense Joint Trauma System, Defense Health Agency, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX 78234
| | - Jeffrey T Howard
- Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249
| | - Jonathan A Sosnov
- 375th Medical Group, 375 MDG, Scott AFB, IL 62225
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814
| | - Ian J Stewart
- Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis AFB, CA 94535
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814
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Kelley AT, Tipirneni R, Levy H. Changes in Veterans' Coverage and Access to Care Following the Affordable Care Act, 2011-2017. Am J Public Health 2019; 109:1233-1235. [PMID: 31318586 DOI: 10.2105/ajph.2019.305160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To evaluate the effect of the Affordable Care Act (ACA) on US veterans' access to care.Methods. We used US Behavioral Risk Factor Surveillance System data to compare measures of veterans' coverage and access to care, including primary care, for 3-year periods before (2011-2013) and after (2015-2017) ACA coverage provisions went into effect. We used difference-in-differences analyses to compare changes in Medicaid expansion states with those in nonexpansion states.Results. Coverage increased and fewer delays in care were reported in both expansion and nonexpansion states after 2014, with larger effects among low socioeconomic status (SES) and poor health subgroups. Coverage increases were significantly larger in expansion states than in nonexpansion states. Reports of cost-related delays, no usual source of care, and no checkup within 12 months generally improved in expansion states relative to nonexpansion states, but improvements were small; changes were mixed among veterans with low SES or poor health.Conclusions. Increases in insurance coverage among nonelderly veterans after ACA coverage expansions did not consistently translate into improved access to care. Additional study is needed to understand persisting challenges in veterans' access to care.
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Affiliation(s)
- A Taylor Kelley
- A. Taylor Kelley is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; and the VA Ann Arbor Healthcare System, Ann Arbor. Renuka Tipirneni is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan. Helen Levy is with the Institute for Social Research, Institute for Healthcare Policy and Innovation, School of Public Health, and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
| | - Renuka Tipirneni
- A. Taylor Kelley is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; and the VA Ann Arbor Healthcare System, Ann Arbor. Renuka Tipirneni is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan. Helen Levy is with the Institute for Social Research, Institute for Healthcare Policy and Innovation, School of Public Health, and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
| | - Helen Levy
- A. Taylor Kelley is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; and the VA Ann Arbor Healthcare System, Ann Arbor. Renuka Tipirneni is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan. Helen Levy is with the Institute for Social Research, Institute for Healthcare Policy and Innovation, School of Public Health, and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
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Wright BN, MacDermid Wadsworth S, Wellnitz A, Eicher-Miller HA. Reaching rural veterans: a new mechanism to connect rural, low-income US Veterans with resources and improve food security. J Public Health (Oxf) 2018; 41:714-723. [PMID: 30452669 DOI: 10.1093/pubmed/fdy203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/15/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Rural, low-income US veterans face additional barriers to accessing food and resources compared to urban veterans. Based on both social-ecological and cultural competence approaches, the Reaching Rural Veterans (RRV) pilot intervention built on the existing infrastructure of food pantries to improve food security and connect rural, low-income veterans with resources. This article describes the process of implementing and evaluating RRV.
Methods
Five rural food pantries within each of two states, Indiana and Kentucky, received training in cultural competence and held monthly outreach events where food and services were offered to veterans. Veteran adult participants completed an assessment at baseline and 3-month follow-up that measured food security using the US Household Food Security Survey Module and self-reported resource enrollment. Repeated measures logistic regression models evaluated the odds of improving food security and resource enrollment from baseline to follow-up (significance P < 0.05).
Results
RRV recruited 234 participants; 53% completed the follow-up assessment. At follow-up, the odds of household (P = 0.009) and adult (P = 0.01) food security increased, as did enrollment in one or more of the following resources: Temporary Assistance for Needy Families, Supplemental Security Income, General Assistance or Assistance from the Township Trustee (P = 0.005).
Conclusions
RRV yielded promising preliminary results of improved food security and resource use.
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Affiliation(s)
- B N Wright
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | - A Wellnitz
- Military Family Research Institute, Purdue University, West Lafayette, IN, USA
| | - H A Eicher-Miller
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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