Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus.

Background: Veterans with evidence of homelessness have high rates of mental health and substance abuse disorders, but chronic medical conditions such as diabetes are also prevalent.

Objective: We aimed to determine the impact of homelessness on glycemic control in patients with type 2 diabetes mellitus.

Design: Longitudinal analysis of a retrospective cohort.

Racial/Ethnic Differences in Combat- and Non-Combat-Associated Traumatic Brain Injury Severity in the Veterans Health Administration: 2004-2010.

Objectives: We examined the association between traumatic brain injury (TBI) severity and combat exposure by race/ethnicity.

Methods: We estimated logit models of the fully adjusted association of combat exposure with TBI severity in separate race/ethnicity models for a national cohort of 132 995 veterans with TBI between 2004 and 2010.

Results: Of veterans with TBI, 25.

Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care.

Objective: This randomized controlled trial examined the effectiveness of a nurse assisted online cognitive-behavioral self-management intervention for war-related posttraumatic stress disorder (PTSD), compared to optimized usual primary care PTSD Treatment (OUC) to reduce PTSD symptoms.

Method: Participants were 80 veterans of recent military conflicts with PTSD as assessed by the PTSD Checklist (PCL) seeking primary care treatment at one of three Veterans Affairs (VA) and four Army clinics. DESTRESS-PC consisted of logins to a secure website three times per week for 6 weeks with monitoring by a study nurse.

Levels of symptom severity and functioning in four different definitions of subthreshold posttraumatic stress disorder in primary care veterans.

Four definitions of subthreshold posttraumatic stress disorder (PTSD) were compared in 815 veterans seen in Veterans Affairs Medical Center primary care clinics. We compared PTSD Checklist (PCL) scores and Short Form 36 (SF-36) scores between participants meeting criteria for one of the subthreshold PTSD definitions (based on Schnurr, Marshall, Blanchard, or Stein) to those with and without PTSD. Using regression, those meeting subthreshold criteria by any of the four definitions had lower mental and physical health functioning and higher PCL scores relative to those without PTSD; they also had higher mental health functioning and lower PCL scores relative to those with PTSD.

PTSD checklist scoring rules for elderly Veterans Affairs outpatients.

Objective: To assess the diagnostic performance of the PTSD Checklist (PCL) for three age groups (<50, 50-64, and ≥65 years).

Methods: The PCL was compared with the Clinician Administered PTSD Scale, a gold standard for the diagnosis of post-traumatic stress disorder. Receiver operating characteristic curves and the corresponding area under the receiver operating characteristic curve (AUC) and measures of sensitivity and specificity were used to assess the performance of and to determine optimal cutscores for the PCL across the three groups.

Post-traumatic stress disorder screening test performance in civilian primary care.

Purpose: we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting.

Methods: this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit.

Preference-weighted health status of PTSD among veterans: an outcome for cost-effectiveness analysis using clinical data.

Objective: Posttraumatic stress disorder (PTSD) is a highly prevalent, chronic, disabling but treatable condition. Preference-based measures (for example, health utilities) are recommended for and useful in cost-effectiveness analyses and for policy decisions because they reflect a population's valuation of the desirability of disease states. However, no such measures exist for PTSD.

Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics.

Background: Only limited empirical data support the existence of delayed-onset post-traumatic stress disorder (PTSD).

Aims: To expand our understanding of delayed-onset PTSD prevalence and phenomenology.

Method: A cross-sectional, epidemiological design (n = 747) incorporating structured interviews to obtain relevant information for analyses in a multisite study of military veterans.

Patient factors relating to detection of posttraumatic stress disorder in Department of Veterans Affairs primary care settings.

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.

Performance characteristics of the posttraumatic stress disorder checklist and SPAN in Veterans Affairs primary care settings.

Background: Posttraumatic stress disorder (PTSD) is a treatable disorder, and individuals with this condition may benefit from early detection. Many people with PTSD are not aware of its symptoms and do not seek treatment, making a brief and targeted screening program a worthwhile endeavor. For this reason, research aimed at improving screening instruments could yield substantial benefits.

Group visits: promoting adherence to diabetes guidelines.

Background: Current diabetes management guidelines offer blueprints for providers, yet type 2 diabetes control is often poor in disadvantaged populations. The group visit is a new treatment modality originating in managed care for efficient service delivery to patients with chronic health problems. Group visits offer promise for delivering care to diabetic patients, as visits are lengthier and can be more frequent, more organized, and more educational.

Further evaluating the acceptability of group visits in an uninsured or inadequately insured patient population with uncontrolled type 2 diabetes.

Purpose: The purpose of the study was to evaluate perceptions of care delivered through group visits to disadvantaged patients with type 2 diabetes.

Methods: One hundred eighty-six patients with uncontrolled type 2 diabetes were randomly assigned to receive care in group visits or usual care for 12 months. Their perceptions of the care they received were measured at baseline and 6 and 12 months by the Primary Care Assessment Tool (PCAT), the Diabetes-Specific Locus of Control (DLC) survey, and the Trust in Physician Scale (TPS).

Amlodipine reduces blood pressure and headache frequency in cocaine-dependent outpatients.

Blood pressure and headache frequency were evaluated in normotensive male and female cocaine-dependent patients (N=43) participating in a placebo-controlled, double-blind trial of amlodipine for the treatment of cocaine dependence. Amlodipine produced a significant reduction in both systolic (p=0.04) and diastolic (p=0.