The effects of sustained virological response to direct-acting anti-viral therapy on the risk of extrahepatic manifestations of hepatitis C infection.

Background: Direct-acting anti-viral (DAA) therapy may have a beneficial role in extrahepatic manifestations of hepatitis C virus (HCV) infection. However, the available data are limited.

Aim: To examine the effects of DAA treatment on the risk of several extrahepatic manifestations of HCV.

Composite measures of physical activity and pain associate better with functional assessments than pain alone in knee osteoarthritis.

Introduction: Recent research showed that physical activity (PA)-adjusted pain measures were more strongly associated with radiographic osteoarthritis (OA) severity than an unadjusted pain measure. This exploratory study examined whether PA-adjusted pain measures were more closely associated with other key OA-related measures, compared to unadjusted pain scores.

Method: Participants were 122 Veterans (mean age = 61.

Using implementation facilitation to implement primary care mental health integration via clinical video telehealth in rural clinics: protocol for a hybrid type 2 cluster randomized stepped-wedge design.

Background: Integrating mental health providers into primary care clinics improves access to and outcomes of mental health care. In the Veterans Health Administration (VA) Primary Care Mental Health Integration (PCMHI) program, mental health providers are co-located in primary care clinics, but the implementation of this model is challenging outside large VA medical centers, especially for rural clinics without full mental health staffing. Long wait times for mental health care, little collaboration between mental health and primary care providers, and sub-optimal outcomes for rural veterans could result.

Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Case Study of a Veteran With Violent Intrusive Thoughts.

Exposure and Response Prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD); however, few studies have evaluated the use of ERP with veterans. This case study describes ERP and medication treatment of a veteran who experienced violent sexual thoughts, countered by compulsions of focusing on the distressing thought to ensure a negative emotion or reversing the thought to a nonviolent thought or image. The veteran had previously received supportive psychotherapy and medication for depression, anxiety, and sleep difficulties, with poor treatment adherence.

Co-Occurrence of Obsessive-Compulsive Disorder and Substance Use Disorders Among U.S. Veterans: Prevalence and Mental Health Utilization.

Obsessive-compulsive disorder (OCD) and substance-use disorders (SUDs) co-occur at high rates, which is related to poorer psychosocial outcomes. Prior work suggests that, among veterans in the Veterans Health Administration (VHA), OCD is underdiagnosed and undertreated, which can compound negative effects of OCD and SUD co-occurrence. This study identified patterns of OCD and specific SUD co-occurrence and their effect on mental health and substance-use screening measures and mental healthcare utilization.

Prevalence and Treatment of Obsessive-Compulsive Disorder in Veterans and Active-Duty Service Members: A Systematic Review.

The prevalence and treatment of obsessive-compulsive disorder (OCD) in veterans and active-duty military remains unclear. We systematically reviewed literature on OCD diagnosis and treatment in U.S.

Validation of a new symptom outcome for knee osteoarthritis: the Ambulation Adjusted Score for Knee pain.

Objective: Validation of a symptom measure for early knee OA may help identify new treatments and modifiable risk factors. Symptom measures that consider pain in the context of activity level may provide better discrimination than pain alone. Therefore, we aimed to compare sensitivity to change for radiographic progression between Ambulation Adjusted Score for Knee pain (AASK), which accounts for self-reported ambulation, and Western Ontario McMaster Osteoarthritis (WOMAC) knee pain score.

Positive and negative religious coping as predictors of distress among minority older adults.

Objectives: The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults.

Methods: Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods.

Instrumented Trail-Making Task: Application of Wearable Sensor to Determine Physical Frailty Phenotypes.

Background: The physical frailty assessment tools that are currently available are often time consuming to use with limited feasibility.

Objective: To address these limitations, an instrumented trail-making task (iTMT) platform was developed using wearable technology to automate quantification of frailty phenotypes without the need of a frailty walking test.

Methods: Sixty-one older adults (age = 72.

A Randomized Trial to Compare a Tailored Web-Based Intervention and Tailored Phone Counseling to Usual Care for Increasing Colorectal Cancer Screening.

Background: Colorectal cancer mortality could be decreased with risk-appropriate cancer screening. We examined the efficacy of three tailored interventions compared with usual care for increasing screening adherence.

Methods: Women ( = 1,196) ages 51 to 74, from primary care networks and nonadherent to colorectal cancer guidelines, were randomized to (1) usual care, (2) tailored Web intervention, (3) tailored phone intervention, or (4) tailored Web + phone intervention.

Benefits of an on-line migraine education video for patients with co-occurring migraine and depression.

Objective: To evaluate effects of an online, hour-long migraine education and management education program on health outcomes in people with migraine experiencing significant depressive symptoms.

Methods: Eligible individuals in the community with comorbid migraine and depressive symptoms (n = 95) participated in the 12-week study. Participants completed self-report questionnaires examining general functioning, headache-specific disability, migraine frequency, pain, and depressive symptoms, before, and at 2, 6, and 12 weeks following the migraine education and management program.

Impact of the Treating Hospital on Care Outcomes for Hepatocellular Carcinoma.

Multidisciplinary hepatocellular carcinoma (HCC) treatment is associated with optimal outcomes. There are few data analyzing the impact of treating hospitals' therapeutic offerings on survival. We performed a retrospective cohort study of patients aged 18-70 years with HCC in the National Cancer Database (2004-2012).

The Interactive Influence of Social Anxiety and Experimentally Induced Postevent Processing on Cannabis Use.

Cannabis use is a major public health concern, and identification of factors that increase risk of negative consequences of cannabis use may aid in the prevention and treatment of such disorders. Social anxiety has been shown to be robustly linked to negative consequences of cannabis use and cannabis use disorder. However, mechanisms that underlie these co-occurring conditions are not well understood.

Recent Advances in Delivering Mental Health Treatment via Video to Home.

Purpose Of Review: Telemental health has rapidly evolved as technology and policy advances have allowed new and innovative approaches, including the remote delivery of services directly to patients' homes. This review examined the literature on video to home (VTH) delivery of mental health services to synthesize information regarding (1) the comparative clinical effectiveness of VTH to in-person mental health treatment, (2) impact of VTH on treatment adherence, (3) patient and provider satisfaction with VTH, (4) cost effectiveness of VTH, and (5) clinical considerations for VTH use.

Recent Findings: Clinical effectiveness, treatment adherence, and patient satisfaction outcomes are comparable for VTH and in-person delivery of psychotherapy and psychiatric consultation services.

Acid suppression medications reduce risk of oesophageal adenocarcinoma in Barrett's oesophagus: a nested case-control study in US male veterans.

Background: Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) may reduce the risk of oesophageal adenocarcinoma (OAC) in Barrett's oesophagus; however, current epidemiologic studies are inconclusive.

Aim: To evaluate the independent effects of PPIs and H2RAs on risk of OAC in patients with Barrett's oesophagus.

Methods: We conducted a nested case-control study of male veterans diagnosed with Barrett's oesophagus.

Development of a web-based toolkit to support improvement of care coordination in primary care.

Promising practices for the coordination of chronic care exist, but how to select and share these practices to support quality improvement within a healthcare system is uncertain. This study describes an approach for selecting high-quality tools for an online care coordination toolkit to be used in Veterans Health Administration (VA) primary care practices. We evaluated tools in three steps: (1) an initial screening to identify tools relevant to care coordination in VA primary care, (2) a two-clinician expert review process assessing tool characteristics (e.

Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative.

Higher levels of moderate to vigorous physical activity improve all-cause mortality and cardiovascular events. However, the effect of running, a moderate to vigorous activity, in those with knee osteoarthritis (OA), a common arthritis that occurs with aging, a high-risk group for mortality and cardiovascular events, is unclear. Therefore, we aimed to evaluate the association of self-selected running on OA symptom and structure progression in people with knee OA.

Potential Impact of "Take the Volume Pledge" on Access and Outcomes for Gastrointestinal Cancer Surgery.

Objective: To quantify the number of US hospitals that would meet "Take the Volume Pledge" (TVP) volume thresholds and compare outcomes at hospitals meeting and not meeting TVP thresholds.

Summary Background Data: TVP aims to regionalize complex cancer resections to hospitals meeting established annual average volume thresholds. There is little data describing the potential impact on patient access if this initiative were broadly implemented or the relationship between these volume thresholds and quality of oncologic care.

Using clinician text notes in electronic medical record data to validate transgender-related diagnosis codes.

Objective: Transgender individuals are vulnerable to negative health risks and outcomes, but research remains limited because data sources, such as electronic medical records (EMRs), lack standardized collection of gender identity information. Most EMR do not include the gold standard of self-identified gender identity, but International Classification of Diseases (ICDs) includes diagnostic codes indicating transgender-related clinical services. However, it is unclear if these codes can indicate transgender status.

Market Competition and Health Outcomes in Hemodialysis.

Objective: To examine whether market competition is associated with improved health outcomes in hemodialysis.

Data Sources: Secondary analysis of data from a national dialysis registry between 2001 and 2011.

Study Design: We conducted one- and two-part linear regression models, using each hospital service area (HSA) as its own control, to examine the independent associations among market concentration and health outcomes.

One-Day Behavioral Intervention for Distressed Veterans with Migraine: Results of a Multimethod Pilot Study.

Introduction: Migraine, a chronic neurological disorder characterized by episodic severe headache pain and functional impairment, affects approximately 12% of the general US population. Veterans returning from Iraq or Afghanistan have two to four times the incidence of migraine of the general population. Veterans with migraines are more than twice as likely to have comorbid psychiatric conditions as veterans without migraines, with depression and post-traumatic stress disorder being most prevalent.

Qualitative findings on building a partnered approach to implementation of a group-based diabetes intervention in VA primary care.

Objective: Conduct a formative evaluation to inform the implementation of 'Empowering Patients in Chronic Care' (EPIC), an evidence-based interdisciplinary group medical appointment intervention to improve collaborative goal-setting in patients with treated but uncontrolled diabetes.

Design: The formative evaluation involved qualitative, in-depth interviews with clinicians, structured according to the Promoting Action on Research in Health Services framework. Interviews elicited (1) participants' knowledge regarding interdisciplinary group self-management and goal-setting programmes and how well clinicians embrace these interventions (evidence), (2) physical and social climate at each target facility and how the intervention can best be embedded into routine primary care (context) and (3) site-specific needs to be addressed by our implementation team and clinicians' preparedness and intentions to participate in the intervention (facilitation).