Canandaigua VA Medical Center

ABSTRACT Objectives This study aimed to investigate relationships between lucid dreaming and sleep and mental health outcomes within a representative sample of the general population. We also sought to examine how nightmares interact with the relationship between lucid dreaming, sleep, and mental health outcomes. Methods Participants (N = 1332) completed measures of lucid dream frequency, nightmare frequency, anxiety and depressive symptoms, stress, and sleep quality. Hierarchical regression models were conducted, where step-1 examined the direct effect of lucid dreaming on all outcome variables, and step-2 added nightmares into the equation (to examine direct effects of lucid dreaming frequency and nightmares, and the indirect effect of nightmares). Results Step-1 results demonstrated that lucid dreaming positively predicted poor sleep quality, stress, anxiety, and depressive symptoms. Step-2 results revealed that nightmares were the only significant predictor of poor sleep quality, stress, and anxiety symptoms, accounting for all of the variance of lucid dreaming. Nightmares and the interaction of nightmares and lucid dreaming positively predicted depressive symptoms. Conclusions Our results suggest that nightmares alone explain associations between lucid dreaming and poor sleep quality, anxiety symptoms, and stress. However, both nightmares and the combination of nightmares and lucid dreaming are associated with increased depressive symptoms.

Appendiceal mucinous neoplasms (AMNs) are tumors with dysplastic mucinous epithelium, a pushing growth pattern but no infiltrative invasion to the appendiceal wall. Some AMNs are associated with pseudomyxoma peritonei, characterized by intraperitoneal mucinous involvement. Recent studies have demonstrated that LAMNs confined to the appendix have low or no risk for disease recurrence, progression, and peritoneal involvement during follow up. Here, we present two extremely rare cases with confined low grade appendiceal mucinous neoplasm (pTis and pT3) and simultaneous extraperitoneal subcutaneous or ovary involvement at the time of diagnosis. Our cases demonstrate that although the primary tumor is limited to the appendix, coexisting distant metastasis may occur on very rare occasions.

Intimate partner violence (IPV) is a prominent public health problem in the United States, with significant health impacts that are often severe and persistent. Healthcare systems have been called upon to improve both the systematic identification and treatment of IPV largely by adopting secondary and tertiary prevention efforts. Research to date demonstrates both benefits and challenges with the current strategies employed. In this paper, we summarize current knowledge about the healthcare system’s response to IPV and evaluate the strengths, limitations, and opportunities. We offer recommendations to broaden the continuum of healthcare resources to address IPV, which include a population health approach to primary prevention.

Abstract Frailty increases risk of adverse outcomes in the presence of stressors such as COVID-19 infection. We examined the association between different levels of frailty and outcomes following COVID-19 infection. This is a retrospective cohort study of US Veterans aged ≥50 years, active Veterans Health Administration (VHA) care users, and tested positive for COVID-19 between 02/15/2020 and 09/30/2021. VHA frailty index (VA-FI) was calculated from one year prior to the COVID-19 testing and divided into three groups: robust (≤0.1), prefrail (0.1-0.2), and frail (>0.2). The risk of hospitalization, ICU admission, ventilator use, and in-hospital mortality were calculated using logistic regression adjusted by age, sex, body-mass-index, and race. The performance of VA-FI in predicting outcomes was compared to age or Charlson comorbidity index (CCI) using area under the curve (AUC). Of 204,426 COVID-19 positive Veterans, 32,965 were hospitalized (age: 71.4±10.4 years, BMI: 29.5±7.1 kg/m2). We observed higher odds of hospitalization (frail, adjusted odds ratio (aOR)=8.64; prefrail, aOR=2.57), ICU admission (frail, aOR=1.58; prefrail, aOR=1.32), ventilator use (frail, aOR=1.97; prefrail, aOR=1.57), and mortality (frail aOR=2.15; prefrail, aOR=1.55) in frail and prefrail compared to robust Veterans. We observed that VA-FI had higher AUC in predicting hospitalization (AUC 0.75) independent of age (0.59) and CCI (0.63). Veterans with COVID-19 who were frail and prefrail had a higher risk of hospitalization, ICU admission, ventilator use, mortality compared to robust. VA-FI may be a useful tool at the time of COVID-19 diagnosis to triage patients at risk for adverse outcomes.

Using predictive analytic modeling, the Veterans Affairs (VA) Geriatrics and Extended Care Data Analysis Center (GECDAC) identified vulnerable “High-Need High-Risk” (HNHR) Veterans, as requiring more support and services. We sought to identify variables linked with utilization of our outpatient HNHR C4 clinic offering Comprehensive Geriatric Assessment, Care Planning, Care Coordination, and Co-management". Of 724 HNHR Veterans contacted, 531 were reached and invited to participate; 193 were not reached, 326 were reached but declined the C4 clinic, 205 attended the clinic. We compared these groups. Independent variables were organized using Anderson’s behavioral model into predisposing (age, gender, race, ethnicity), enabling (drive time, service eligibility, Area Deprivation Index, marital status), and need factors (mental health cognitive condition, ambulatory care sensitive conditions, NOSOS, JFI, CAN, etc.). C4 enrollment acceptance was the outcome. Results showed that compared to patients who declined, HNHR veterans who attended C4 clinic had more chronic health conditions(p<0.01), more service eligibility(p=0.01), more driving time to the closest VA clinic(p=0.01), and more were married (p=0.01). Patients who declined C4 clinic might have greater barriers to care access. Accessing needed healthcare among HNHR older adults maybe impacted more by enabling factors that allow the individual to seek care if needed and are the resources that may facilitate access to services, rather than need factors, which include individuals' perceptions of their health and functional state, and healthcare needs assessed by professionals. More social and intermediary determinants of health should be incorporated as enabling factors into models striving to understand drivers of healthcare use.

Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.

Abstract Ninety years ago, the Federation of Polish Jews in America hosted their national convention and world congress in the New York City area. In this article, we will discuss some of what transpired at these events. Set at a tumultuous crossroads in world history, the Federation rallied Jewish groups throughout the United States and the world in humanitarian support for a war-torn Polish nation. The national convention and world congress were also set to have their own respective satellite sessions at the New York World’s Fair of 1939 and 1940. These satellite sessions are noteworthy in that they mark a Jewish presence at the Fair which extended beyond the Jewish Palestine Pavilion. They also mark a uniquely Polish presence, extending beyond Poland’s own Pavilion at the Fair.

Whether presenting as a symptom or disorder, providers should act upon insomnia symptomatology observed in their patients. Insomnia presents in a myriad of medical and psychiatric conditions, and the alleviation of insomnia symptoms can have profound effects on the onset and course of co-occurring pathology. Findings are presented regarding the treatment of a 62-year-old veteran experiencing suicidal ideation, who was diagnosed with major depressive disorder, insomnia disorder, and back pain. The treatment regimen consisted of brief cognitive behavioral therapy for insomnia (bCBT-I; four sessions) with a concurrent melatonin taper. The case is illustrative of (1) the importance of assessing patients’ utilization of over-the-counter medications and substances that may influence sleep, (2) the delivery of adjunctive bCBT-I in a patient with co-occurring disorders, and (3) the utility of bCBT-I in the reduction of co-occurring depressive symptomatology.