TRAUMA INDUCES MORE ALCOHOL CRAVING THAN STRESS AMONG VETERANS WITH PTSD AND CO-OCCURRING ALCOHOL DEPENDENCE
Newswise — Post-traumatic stress disorder (PTSD) and alcohol dependence (AD) are two of the most common and debilitating disorders diagnosed among American military veterans. AD and PTSD often occur together, and this co-occurrence has a worse prognosis than either disorder alone. Alcohol craving is related to relapse, but the relationship between PTSD symptoms, craving, and relapse is not well understood. This study is the first to explore the effects of trauma-induced and stress-induced imagery on alcohol craving, affect, and cardiovascular and cortisol responses in a laboratory setting. Researchers examined 25 veterans who had been diagnosed with AD and PTSD and were participating in a randomized treatment trial. At baseline, participants’ PTSD symptoms and drinking quantity and frequency during the three-month pretreatment period were assessed. During the session, the participants were exposed to neutral, stressful, and traumatic imagery in random order. The main outcomes included craving, anxiety, mood states, salivary cortisol, and cardiovascular responses. Both stress and trauma cues produced greater increases in craving, negative affect (anxiety, fear, anger), and cardiovascular reactivity when compared to neutral cues. Traumatic images produced significantly stronger craving for alcohol and greater cardiovascular reactivity than stressful images. Also, trauma-induced but not stress-induced craving was positively correlated with baseline levels of drinking. These findings are consistent with prior observations of a relationship between PTSD symptoms and alcohol relapse.
Less than 8 percent of veterans expelled from the military under the "don't ask, don't tell" policy have applied to upgrade their discharges to honorable or strip references to their sexual orientation from their record. In the nearly five years since the repeal of the policy that banned gays and lesbians from serving openly in the military, fewer than 1,000 people - out of the more than 13,000 people who were expelled - have sought corrections, according to data the military provided to The Associated Press. Many veterans simply don't know it's an option, said Scott Thompson, executive director of the Board for Correction of Naval Records. The boards have always existed without a lot of internal or external advertisement, he said. Veterans and the veterans' advocates agreed there's a lack of awareness but cited reasons why veterans wouldn't correct their record. They may be in jobs where they aren't affected by what the record says. Going to the board could open up old wounds. Or they may feel it's not worth the effort, or don't know where to start. For Danny Ingram, the reference to his sexual orientation on the form is a badge of honor. Ingram was given an honorable discharge from the Army in 1994 as one of the first to be expelled under "don't ask, don't tell." "I was victimized by that policy," said Ingram, of Atlanta, who is now 56. "I want that to remain so people in the future can see what was done to people, and that it was unjust." "Don't ask, don't tell" didn't require that people be dishonorably discharged. It varied case by case, but if their commanders weren't pushing for a lower category and there were no mitigating factors, such as misconduct, the service member could be given an other-than-honorable or honorable discharge. Honorably discharged veterans are entitled to benefits, such as medical care and a military burial, and can re-enlist if they meet eligibility requirements. Jeremy Brooks was given an honorable discharge from the Navy in 2007 under the policy. He re-enlisted in 2011 after the full repeal. Currently serving in the Navy Reserve, Brooks said he considered trying to change the narrative that states "homosexual admission" because of the risk of bias anytime anyone sees it. "You're handing it to them and telling them something about yourself without being able to choose when you're telling them," said Brooks, who is 39 and works in Washington, D.C. Brooks said the idea of tackling it was overwhelming. Like Ingram, he didn't want that part of history erased from his record, as if his service under "don't ask, don't tell" didn't happen, so he didn't pursue a correction. He thinks many veterans know about the process but were deeply wounded by their discharge and may be trying to forget that part of their lives. Since the 2011 repeal, the Navy has reviewed about 430 cases, including from the Marines, and upgraded slightly more than 300 of the discharges. The Army has received nearly 300 applications from soldiers discharged under "don't ask, don't tell" or its predecessor policies and granted about 200 requests. The Air Force reviewed about 150 similar cases and approved about 130 of the applications. The Coast Guard, which falls under the Department of Homeland Security, reviews far fewer cases, only eight since the repeal. Some applications were denied because there were "aggravating factors," such as misconduct. Some were incomplete. About 65 cases are pending among the boards. The Defense Department barred gays and lesbians from serving before "don't ask, don't tell." President Bill Clinton promised to lift the ban but compromised and authorized the policy in 1993. After that, they could serve but not be open about their sexual orientation, and personnel couldn't ask about it. The policy was widely criticized because thousands of people were discharged under it, and many others were forced into secrecy. A bill in Congress would streamline the paperwork for applying for a correction and codify the Defense Department policy in statute. It would require the historians of each military service to review the circumstances of the estimated 100,000 service members discharged for their sexual orientation prior to "don't ask, don't tell" to improve the historical record. Melvin Dwork was expelled from the Navy during World War II for being gay. He spent decades fighting what he called a "terrible insult" that had to be righted - a discharge characterized as "undesirable." In 2011, the Navy agreed to change it to honorable. It was believed to be the first time the Pentagon had taken such a step on behalf of a WWII since the repeal of "don't ask, don't tell." Dwork died last week at age 94.
DETROIT (AP) -- Dozens of military veterans have come to Detroit to rebuild neglected areas of the financially distressed city. It marks the latest - and largest - effort undertaken by St. Louis, Missouri-based The Mission Continues, a nonprofit that encourages and aids volunteerism by veterans to ease the post-military transition. Teams of volunteers fanned out Monday to three locations in a neighborhood on the northeast side of Detroit. At a park, Iraq and Afghanistan veteran Ben Eichel, 33, and others picked up trash and built benches. "When you're not part of something that's bigger than yourself, you lose that identity. You become isolated, and a lot of us tend to go to dark places," said Eichel, of Denver, taking a break from trying to remove a rusted-out fence. "So, The Mission Continues was there and got me involved in the community. It helped me reintegrate in civilian society effectively, because I learned that I'm not just a veteran." The Detroit deployment, which is known as Operation Motown Muster, got underway Saturday and will end Wednesday. In addition to park beautification, the volunteers will also convert a school classroom into an art gallery and clean vacant lots. "We believe very strongly that military veterans are really uniquely poised to help try to solve some of these community challenges all over the country," according to group official Mary Beth Bruggeman, who should know. She was a combat engineer with the U.S. Marines and was part of the force that invaded Iraq in 2003.
NURSING COALITION AND VETERANS GROUPS JOIN FORCES IN UNPRECEDENTED RESPONSE TO VA PROPOSED RULE TO INCREASE VETERANS’ ACCESS TO CARE
Newswise — WASHINGTON D.C. – At the midpoint of the public comment period, professional nursing and veterans’ organizations held a press conference today to demonstrate support and highlight the need for a proposed rule by the Veterans Administration(VA) to provide veterans with direct access to Advanced Practice Registered Nurses (APRNs) practicing to the top of their education and training in VA facilities. As of June 28 at 9 a.m., more than 44,000 people had submitted comments on the proposed rule, which is by far the highest number of comments for a VA rule since online comment submission was instituted in 2006 – more than six times the total number of comments previously submitted. Over the last ten years, a combined total of 6,030 comments have been posted during more than 150 VA comment opportunities. The news conference, which was held at the National Press Club in Washington D.C., provided in-depth analysis of the proposed rule and included first-hand accounts of how it will benefit veterans and the Veterans Healthcare Administration (VHA) by increasing veterans’ access to health care provided by APRNs. The organizations that participated in the news conference included the American Association of Nurse Anesthetists (AANA), American Association of Nurse Practitioners (AANP), American Nurses Association (ANA) and the American Association of Colleges of Nursing (AACN), along with the Air Force Sergeants Association (AFSA) and the Military Officers Association of America (MOAA). “It’s time for evidence to trump politics when it comes to the health of our veterans. And there’s no evidence for the arguments of the groups opposing the rule – all baseless rhetoric,” said Juan Quintana, DNP, MHS, CRNA, president, American Association of Nurse Anesthetists, who also served in the Air Force Reserves. “Our initial review of the comments submitted thus far indicates wide-reaching support for the rule from veterans and health care providers alike - roughly two-thirds of the comments submitted - and we want to encourage others to submit comments and let their voices be heard.” “Throughout my career, I have been honored to care for this extraordinary population,” said AANP President Cindy Cooke, DNP, FNP-C, FAANP, on behalf of the 222,000 nurse practitioners in the U.S. today. “Our veterans have given so much to our nation and deserve to have us stand with them. The proposed rule is zero risk. Zero delay. And a zero cost solution to ensuring veterans have access to needed health care. We applaud the VA for taking this important action, which will immediately improve veterans’ access to care. And we are doing everything we can to support its proposal.” Dr. Cooke has provided primary care to patients for 18 years, more than 12 of those exclusively to active duty and retired military members and their families. The Department of Defense (DoD) already provides active duty personnel direct access to APRNs. Nurse anesthetists first provided healthcare to wounded soldiers on the battlefields of the American Civil War, and have been the main providers of anesthesia care on the front lines of every U.S. military conflict since World War I. CAPT (Ret) Kathryn Beasley, USN, PhD, FACHE, served alongside nurse practitioners, nurse anesthetists and other APRNs as a Navy Nurse for 30 years. She supports the proposed rule on behalf of the 390,000 members of the Military Officers Association of America. Said CAPT Beasley: “In the Navy we would never train a sailor ten skills, then limit them to using only three. It makes no sense. No one would do that. But that’s what illogical and wasteful practice limitations on highly skilled advanced practice nurses do. Our Veterans need all the skills Advanced Practice Registered Nurses can provide them.” “Health care is one of the things our veterans were promised when they raised their right hands to serve their country,” said CMSGT Robert L. Frank, USAF (ret.), chief executive officer of the Air Force Sergeants Association. “More than 80 percent of those who served in the military were enlisted, and many rely on VA healthcare to take care of them. The waiting is unacceptable. We’re excited about this rule to allow the 6,000 APRNs currently employed by the VHA to be used to their full potential. Let them serve our veterans.” Prior to becoming the CEO of the American Nurses Association, Marla J. Weston, PhD, RN, FAAN, worked at the VHA as deputy chief officer. “I personally know the value and contribution that APRNs can make to serve our country’s veterans,” said Weston. “Our veterans deserve the best care that this country can provide and that requires having APRNs practicing to the full extent of their education and training. We know that when there are not enough nurses, patient mortality goes up.” The proposed rule impacts future care of our veterans as well. Many APRNs complete clinical rotations in the VA, gaining additional exposure to the unique needs of the veteran population. “When the more than 70,000 APRN students enrolled in AACN member nursing schools enter the workforce, allowing them to practice to the full extent of their education and training will serve as a strong incentive for these highly skilled providers to seek employment at VA facilities,” said Jane M. Kirschling, PhD, RN, FAAN, dean and professor, University of Maryland School of Nursing, and director of interprofessional education, University of Maryland. More than 60 organizations support this policy change, including veterans’ groups such as the Military Officers Association of America and the Air Force Sergeants Association. The policy is also supported by AARP (whose membership includes 3.7 million veteran households), and 80 Democratic and Republican members of Congress. The public comment period on the proposed rule is currently underway and expires July 25. Comments can be submitted tohttps://www.regulations.gov/document?D=VA-2016-VHA-0011-0001. About the Veterans Access to Quality Healthcare AllianceThe Veterans Access to Quality Healthcare Alliance is an initiative of advanced practice registered nurse (APRN) organizations and others dedicated to providing and promoting the access to care Veterans need and deserve. These groups are joined in their goal of ensuring Veterans’ access to APRN services by other nursing groups, veterans’ organizations, individual veterans, patient advocacy groups, congressional leaders, and others that together represent millions of individuals and healthcare providers across the country.
SOMERSET – They were heroes for our country, and they are heroes again for New Jersey’s former service members; the seven NJHA veteran health navigators were honored Tuesday morning as winners of the Education Hero- Organization award by NJBIZ at the 10th annual Healthcare Heroes awards program. New Jersey is home to more than 428,000 veterans. For many, accessing primary and mental health care can be a great challenge. To address this, the New Jersey Hospital Association (NJHA) and several other organizations have called upon members of our veteran community to assist those who are not receiving the care they need. They served in war zones and in peacetime. They include Purple Heart recipients and PhDs. The navigators assist fellow veterans in getting the appropriate care as well as social supports, and have spent the spring touring South Jersey providing outreach at clinical screening events. In addition to linking former service members and their families to care, the navigators are also working with clinicians around the state to better inform them about the military culture and the unique challenges veterans face when seeking healthcare. “These veterans are not only educating other veterans about opportunities for better health, but they are educating our state’s healthcare systems on how to better serve those who have served us,” said NJHA President and CEO Betsy Ryan. The navigators are: * Francis “Bud” Funk, of Edgewater Park, Marine Corps; * Norman F. “Norm” Glover, Jr., of East Windsor, Army; * Vernon Hall, PhD, of Asbury Park, Army; * Michael Mimms, EdD, of Sicklerville, Marine Corps; * Edward “Ed” Sadowski, of Winslow Township, Army; * Don Sanford, of Pennsauken, Air Force; and * Jaye Silver, PhD, of Pennsauken, Air Force. Their work is funded by grants from the New Jersey Department of Health, United Health Foundation and the Centers for Medicare and Medicaid Services’ Hospital Engagement Network. NJHA first engaged with the veteran community through the Affordable Care Act; unemployed veterans were hired to help screen and enroll uninsured persons for the Health Insurance Marketplace or Medicaid. The success of the collaboration led to the three additional grant programs using veteran navigators to improve access to appropriate care. More information on the veteran navigators program is available on Facebook, at www.Facebook.com/ServingThoseWhoServed.
DENVER (AP) -- Fort Logan National Cemetery honored 30 veterans whose remains have gone unclaimed with a funeral ceremony Saturday in Denver, including veterans' whose cremated remains were left at funeral homes and others who had no next of kin. Maj. Gen. H. Michael Edwards, the service's guest speaker, said remains also may go unclaimed because families forgot about them, or don't know their relatives are eligible for a military burial. "In my mind, (they're) almost MIA, because they just sat there," Edwards said. "Each of them has a story. I only wish we knew their full story." A crowd of about 80 people showed up. The names of the dead were read, followed by the rank, branch and war in which they served, going back as far as World War II. Service members located the veterans' urns on a table and declare them "present," and a bell would ring, the Denver Post reported (http://tinyurl.com/zjq9fws ). The remains were marked with engraved marble plates. Stan Paprocki, president of Chapter 1071 of the Vietnam Veterans Association, said it took the chapter more than a year to assemble the remains for the service. He said the U.S. Department of Veterans Affairs helped identify the remains. Paprocki said another 36 veterans would be honored at another service in two months. The ceremony was part of the Missing In America Project, a national nonprofit that works with veterans groups to inter unclaimed veterans' remains. Jose Gonzales, a 67-year-old Vietnam veteran, said it took him a long time to heal after he returned home. After several decades, Gonzales started to go to memorial services for veterans. "I (hadn't) attended before because it took some 40 years to break out of that shell and honor the vets," Gonzales said. "It's healing to the soul, you know."
PARIS (AP) -- The Latest from soccer's European Championship (all times local): --- 5:50 p.m. The match between Italy and Spain at the European Championship is one for the veterans. Six players in the starting lineups have made more than 100 international appearances. And on the Spain bench is goalkeeper Iker Casillas, whose 167 caps is the most of all. Gianluigi Buffon, making his 159th appearance in Italy's goal, is joined by midfielder Daniele De Rossi (106) in the centurion club. Spain has defender Sergio Ramos (135), midfielders Andres Iniesta (112) and Cesc Fabregas (110), and forward David Silva (103). --- 5:05 p.m. Spain coach Vicente Del Bosque will use the same starting lineup for the fourth straight time when his team faces Italy in the round of 16 at the European Championship. The coach didn't make any changes despite losing to Croatia 2-1 in Spain's final group game, a result that set up the early encounter with the Italians. Italy coach Antonio Conte is using his regular starters again after resting them in the final group game against Ireland. He won't be able to count on winger Antonio Candreva, who is being replaced by Mattia de Sciglio at Stade de France. --- 5 p.m. Here are the lineups for the match between Italy and Spain at Stade de France: Italy: Gianluigi Buffon, Andrea Barzagli, Leonardo Bonucci, Giorgio Chiellini, Alessandro Florenzi, Marco Parolo, Daniele De Rossi, Emanuele Giaccherini, Mattia de Sciglio, Graziano Pelle, Eder. Spain: David De Gea, Juanfran Torres, Sergio Ramos, Gerard Pique, Jordi Alba, Sergio Busquets, Andres Iniesta, Cesc Fabregas, David Silva, Manuel "Nolito" Agudo, Alvaro Morata. --- 2:45 p.m. UEFA will take no action against the Portuguese soccer federation for a fan running across the field to take a selfie with Cristiano Ronaldo. The man evaded security lines to run across half the field from behind one goal at Parc des Princes after Portugal drew 0-0 with Austria on June 18. He found Ronaldo near the halfway line, and the Portugal forward gestured to security officials to stay back until the picture was taken. UEFA says it "decided to close the proceedings" which had been opened against the Portuguese body for a "field invasion." UEFA rules make federations responsible for fans' behavior fans inside a stadium. --- 11 a.m. On any given Sunday, a rested France team will play at the European Championship. In tournament soccer where a team's matches typically come every four days, France's schedule is more like a club team. On Sunday, June 19, France drew 0-0 with Switzerland to ensure first place in its group. That earned France a match against Ireland in the round of 16 exactly one week later. The hosts won 2-1. Next Sunday, France will return to Stade de France for a quarterfinal match against either England or Iceland.
ONE IN FIVE FROM 2001 - 2008 U.S. MILITARY SAMPLE HAVE OBESITY; VETERANS AS LIKELY TO HAVE OBESITY AS CIVILIANS, STUDY SHOWS
Newswise — Despite being held to stringent weight and body fat standards, newly published research shows that one in five individuals from a sample of U.S. military personnel from 2001 – 2008 have obesity. Further, shortly after separating from active duty, U.S. military veterans are as likely to have obesity as civilians. Data from the research also showed an association between military personnel who have obesity – including both active duty and veterans – and mental health conditions like depression and posttraumatic stress disorder (PTSD). The research led by Toni Rush, MPH, is published in the July issue of Obesity, the scientific journal of The Obesity Society. The study comes at a time when the military is already presented with significant recruiting challenges and names obesity as one of the top reasons for military ineligibility among people ages 17 to 24. “These individuals are frequently put in harm’s way to protect our nation,” said Catherine Champagne, PhD, RD, member of The Obesity Society’s Advocacy Committee. “We count on our military to be in the best shape both physically and mentally, and these data show there is a need to improve efforts to maintain a healthy weight within our Armed Forces.” Researchers who conducted the study say the benefits of learning to maintain a healthy weight and proper nutrition go beyond time spent serving our country. “Establishing lifelong healthy behaviors for active duty and veteran military personnel could not only ensure a fit force, but also reduce post-service-related costs for the Department of Defense, Department of Veterans Affairs and the U.S. healthcare system,” said Toni Rush, MPH, lead author of the study. “More importantly, it could enhance the quality of life for thousands of veterans.” To conduct the study, Rush and colleagues examined data from 42,200 current and former military personnel from 2001 – 2008 as part of the Millennium Cohort Study. Of the 42,200 individuals, rates of obesity were significantly higher among veterans (32%) compared to service members (20%). Percentage of veterans with obesity did not change significantly between less than one year and more than three years after military separation, suggesting that the increase in obesity may occur shortly after separation. In a cross-sectional analysis of the data, the researchers found that military personnel who had obesity had higher rates of depression and PTSD than individuals with normal weight (all p < 0.05). Hypertension, diabetes and sleep apnea were also significantly more common among individuals with obesity (all p < 0.05). The study authors said they hope their study can be used to inform programs and policies that address obesity and overall health among U.S. service members and veterans. “Because military personnel – and especially veterans – make up a sizable portion of the U.S. population, this research is important to the overall health of the country,” continued Dr. Champagne, of The Obesity Society. “The findings show that even when equipped with the knowledge of how to implement healthy behaviors, it can be difficult to maintain a healthy weight when motivational drivers change. Given the associations of obesity and its complications, this should be seen as a national priority both for the American people and its military.” Study limitations include that the analysis relies on self-reported data and that data was based on a random sample of Service members serving in 2000 (individuals who are now likely in their 30s and 40s), which may not be entirely representative of today’s military profile. Additionally, in a commentary accompanying the paper, Van Hubbard, PhD, MD and Karl Friedl, PhD, mention that greater muscle mass in fitness-oriented service members, which is so prevalent in the military, may have affected some of the data related to individuals, especially the individuals classified as overweight. “This Millennium Cohort Study dataset, with its longitudinal and prospective design, offers many opportunities for further analyses,” concluded Dr. Hubbard. Read the paper and the accompanying commentary in Obesity, the scientific journal of The Obesity Society. ###
JOHANNESBURG (AP) -- A group of American military veterans with experience in Iraq and Afghanistan plans to train rangers at some private wildlife areas in South Africa, where poachers have killed large numbers of rhinos for their horns. The small conservation group called Vetpaw previously operated in Tanzania, which ordered the group to leave last year, partly because of a video in which a member talked about killing poachers. Ryan Tate, a former U.S. Marine and head of Vetpaw, said Tuesday that the member didn't speak for Vetpaw and that he has sought to "rebrand" the organization. Tate and Shea Peaton, a U.S. Navy veteran, have spent about a month in South Africa, assessing security needs in several wildlife parks. Training will include marksmanship, field medicine and maneuvering at night, Tate said. "People are desperate and want to try anything and everything that they can," he said, referring to operators of private wildlife areas that lack the resources that some state-run parks receive. On Friday, suspected poachers fatally shot a ranger and killed a rhino at a private reserve in Bela-Bela, north of Johannesburg, South African media reported. Separately, the national parks service said Monday that two rangers at the state-run Kruger National Park were arrested for alleged involvement in rhino poaching. Tate and Peaton are both 31 and from Tampa, Florida. Peaton said he has suffered post-traumatic stress disorder and that working with Vetpaw provides a sense of purpose. "A lot of guys don't find that" after returning to the United States from deployments, he said. BY CHRISTOPHER TORCHIA
HOUSTON (AP) -- Staff at Houston-area Veterans Affairs facilities improperly manipulated wait times for Texas veterans wishing to make a medical appointment, according to a federal report released Monday. The Department of Veterans Affairs' Office of Inspector General said more than 200 appointments were incorrectly recorded for the year that ended in June 2015. Two former scheduling supervisors and a current director of two VA clinics instructed staff to incorrectly record cancellations as being canceled by the patient, the report shows. Veterans in many instances then encountered average wait times of nearly three months when the appointments were rescheduled. "These issues have continued despite the Veterans Health Administration ... having identified similar issues during a May and June 2014 system-wide review of access," according to the report. "These conditions persisted because of a lack of effective training and oversight." Federal inspectors also determined that wait times for other veterans were understated by more than two months. As a result, wait times "did not reflect the actual wait experienced by the veterans and the wait time remained unreliable and understated." VA officials in the Houston area were directed to provide additional training for staff, improve scheduling audit procedures and take other steps to correct the lingering issue. Similar problems have been found in other states. Scandal erupted in Phoenix nearly two years ago, following complaints that as many as 40 patients died while awaiting care at the city's VA hospital. VA employees in Texas have previously reported to investigators that they sometimes engaged in misleading scheduling at the behest of their supervisors. But supervisors and administrators at many facilities denied there was a systematic effort to manipulate wait time data. Some told investigators that schedulers may have misunderstood directives, while others said employees had since been retrained to correct the practice.