VA Eastern Kansas Health Care System

See related article by Mor et al. in this issue.

With almost 90% of Americans expressing a desire to age in place in their home, many health systems and communities are challenged to provide the right resources, at the right time, to support What Matters to older adults. In the Department of Veterans Affairs (VA), approximately 50% of Veterans enrolled in VA health care are aged 65 and older, driving an imperative to provide timely, Age-Friendly care through a broad continuum of services. VA has taken a multifaceted approach to shift Long-Term Services and Supports to promote aging in place through innovation pilots, expansion of Home and Community Based Services (HCBS) and adoption of Age-Friendly Health Systems (AFHS) practices [or "framework"]. VA is spreading geriatrics knowledge throughout the clinician and trainee workforce, improving skills and practices across all disciplines and care settings. The framework of AFHS creates a shared language to support transitions across ambulatory, hospital, emergency department, home care, and nursing home settings. Through these efforts, VA is reimagining geriatrics, providing an example of the type of care all older adults want and deserve. Since March 2020, 375 care settings across 132/139 (95%) VA parent facilities have earned AFHS recognition. By incorporating AFHS into the infrastructure of the healthcare system, clinicians are prepared to address What Matters across clinical settings and address common geriatric syndromes. Leaders in a variety of health systems can learn from VA efforts to provide a continuum of Age-Friendly programs and services that promote independence, function, well-being and aging in place.

Disordered eating is a major health epidemic that occurs at disproportionate rates among young adults and for which gender plays a major role in symptom presentation. Broadband psychological instruments have historically not included disordered eating as a core scale construct. The recent release of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) offers an opportunity to address this shortcoming through the newly developed Eating Concerns Scale (EAT) for which the existing literature is promising but limited. This study expands research on EAT by investigating its validity and comparing findings across gender. In 345 college students (102 men, 243 women), we examined gender differences between men and women in the EAT scale’s structure, item endorsement rates, mean scores, and correlations with measures of body image and eating pathology. Differences emerged in item endorsement rate, scale score elevation rate, and correlation magnitudes. Broadly, findings further support EAT’s use in detecting eating pathology and highlight ways in which the EAT scale may not effectively capture masculine expressions of eating pathology, namely binging and purging behaviors. To assess eating pathology more comprehensively, clinicians and researchers should consider including assessments of eating pathology inclusive of masculine eating patterns. Limitations and future research directions are also discussed.

Military service members must maintain a certain body mass index and body fat percentage. Due to weight-loss pressures, some service members may resort to unhealthy behaviors that place them at risk for the development of an eating disorder (ED). To understand the scope and impact of EDs in military service members and veterans, we formed the Longitudinal Eating Disorders Assessment Project (LEAP) Consortium. LEAP aims to develop novel screening, assessment, classification, and treatment tools for veterans and military members with a focus on EDs and internalizing psychopathology. We recruited two independent nationally representative samples of post-9/11 veterans who were separated from service within the past year. Study 1 was a four-wave longitudinal survey and Study 2 was a mixed-methods study that included surveys, structured-clinical interviews, and qualitative interviews. Recruitment samples were representative of the full population of recently separated veterans. Sample weights were created to adjust for sources of non-response bias to the baseline survey. Attrition was low relative to past studies of this population, with only (younger) age predicting attrition at 1-week follow-up. We expect that the LEAP Consortium data will contribute to improved information about EDs in veterans, a serious and understudied problem.

Research is mixed on the role of service era in symptom endorsement among Veterans, with differences emerging depending on the instrument evaluated. This study compares Personality Assessment Inventory (PAI) scale scores of VA test-takers who served during the Vietnam, Desert Storm, or Post-9/11 service eras. The sample was collected at a VA Posttraumatic Stress Disorder Clinical Team. Associations between gender and combat exposure were also examined as covariates. Results suggest that Veterans' self-report on the PAI is influenced by service era, even after accounting for gender and combat exposure during deployment. The largest differences were between Vietnam or Post-9/11 Veterans and those from the Gulf War era. Symptom differences typically varied across scales commonly associated with symptoms of trauma exposure/posttraumatic stress disorder. Implications for the clinical use of, and research with, the PAI and other broadband personality assessments within the VA healthcare system and trauma treatment settings are discussed.

Cadaveric prosections are effective learning tools in anatomy education. They range from a fully dissected, sometimes plastinated, complete cadaver (in situ prosections), to a single, carefully dissected structure detached from a cadaver (ex situ prosections). While most research has focused on the advantages and disadvantages of dissection versus prosection, limited information is available on the instructional efficacy of different prosection types. This contribution explored potential differences between in situ and ex situ prosections regarding the ability of undergraduate students to identify anatomical structures. To determine if students were able to recognize the same anatomical structure on both in situ and ex situ prosections, or on either one individually, six structures were tagged on both prosection types as part of three course summative examinations. The majority of students (61%-68%) fell into one of the two categories: those that recognized or failed to recognize the same structure on both in situ and ex situ prosections. The percentage of students who recognized a selected structure on only one type of prosection was small (1.6%-31.6%), but skewed in favor of ex situ prosections (P≤0.01). These results suggest that overall students' identification ability was due to knowledge differences, not the spatial or contextual challenges posed by each type of prosection. They also suggest that the relative difficulty of either prosection type depends on the nature of the anatomical structure. Thus, one type of prosection might be more appropriate for teaching some structures, and therefore the use of both types is recommended.

This study examines the convergent validity of the substantive scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in the Veteran Affairs (VA) population. The sample includes test protocols drawn from all administrations of the MMPI-2-RF or MMPI-2 entered into the electronic medical record system between January 1, 2008 and May 31, 2015 at any VA across the United States. After excluding invalid protocols, substantive scale scores were correlated with external measures of depression, anxiety, and posttraumatic stress disorder if they were administered within |14| days of the MMPI-2/-RF. Results supported the convergent validity of the MMPI-2-RF emotional dysfunction domain scores. Discriminant validity for the remaining MMPI-2-RF substantive scale scores was also adequate. Limitations and implications of these findings are discussed.

Background: Suicide rates are on the rise globally. Many suicide completers are previous attempters. Risk identification of attempters will provide an opportunity for prompt and targeted intervention towards suicide prevention. The aim of this study was to determine the incidence of suicide attempt and self-inflicted injury (SASI), and its associations with deployment-related PTSD and/or TBI and attempted suicide among a large national cohort of Veterans deployed pre and post-9/11 2001 who received care from the Veterans Health Administration (VHA) between 1998 - 2014. Methods: Clinical data from over 1,400 VHA establishments provided by the Veterans Administrations Informatics and Computing Infrastructure (VINCI) were used for descriptive and Cox regression analyses. Results: There were 1,327,604 patients in the study - PTSD only (1,121,818), TBI only (100,033), both PTSD and TBI (105,753). The incidence of SASI in the entire cohort was 351 per 100,000 person years; PTSD only (323), TBI only (181), both PTSD and TBI (835). Compared to TBI only group, the adjusted risk for SASI was higher in the PTSD only group (HR=1.129; 95% CI =1.063 - 1.200) and much higher in those with both PTSD and TBI (HR=2.283; 95% CI =2.136 - 2.441). The risk of SASI was higher if they were younger than 50 years, divorced or separated, non-Hispanic females, homeless, suffered adult abuse and neglect, had substance use, generalized anxiety and antisocial personality disorders, and if they were in the Pre-9/11 service period. Proportion of people attempting suicide increased every year post-diagnosis of PTSD and/or TBI. Conclusion: We recommend prioritizing resources to prevent suicide among at risk groups.