Jan Dyer

The updated smoking policy goes into effect for employees, patients, visitors, volunteers, contractors, and vendors, whether they smoke cigarettes, cigars, pipes, or even electronic and vaping devices, and whenever they are on the grounds of VA health care facilities, including parking areas.

The new policy comes after the VA reviewed research on second- and thirdhand smoke and best practices in the health care industry. “There is no risk-free level of exposure to tobacco smoke,” the VA’s Smokefree website says. Overwhelming evidence shows exposure to secondhand smoke has significant medical risks. Moreover, a growing body of evidence shows exposure to thirdhand smoke (residual nicotine and other chemicals left on indoor surfaces) also is a health hazard. The residue is thought to react with indoor pollutants to create a toxic mix that clings long after smoking has stopped and cannot be eliminated by opening windows, or using fans, or other means of clearing rooms.

“We are not alone in recognizing the importance of creating a smoke-free campus,” said VA Secretary Robert Wilkie. He notes that as of 2014, 4000 health care facilities and 4 national health care systems in the US have implemented smoke-free grounds.

National Association of Government employees will begin implementing the policy as of October 1, and have until January 1, 2020, to fully comply. Smoking shelters will be closed, although each facility will independently determine the disposition of smoking areas and shelters.

The new policy does not mean anyone has to quit smoking but to encourage quitting, the VA offers resources, including www.publichealth.va.gov/smoking/quit/index.asp. More tips and tools are available at the Smokefree Veteran website: https://veterans.smokefree.gov. SmokefreeVET is a text-messaging program (https://veterans.smokefree.gov/tools-tips-vet/smokefreevet) that provides 24/7 support to help veterans quit for good. Employees can contact their facility for resources.

The policies are available at https://www.va.gov/health/smokefree.

The updated smoking policy goes into effect for employees, patients, visitors, volunteers, contractors, and vendors, whether they smoke cigarettes, cigars, pipes, or even electronic and vaping devices, and whenever they are on the grounds of VA health care facilities, including parking areas.

The new policy comes after the VA reviewed research on second- and thirdhand smoke and best practices in the health care industry. “There is no risk-free level of exposure to tobacco smoke,” the VA’s Smokefree website says. Overwhelming evidence shows exposure to secondhand smoke has significant medical risks. Moreover, a growing body of evidence shows exposure to thirdhand smoke (residual nicotine and other chemicals left on indoor surfaces) also is a health hazard. The residue is thought to react with indoor pollutants to create a toxic mix that clings long after smoking has stopped and cannot be eliminated by opening windows, or using fans, or other means of clearing rooms.

“We are not alone in recognizing the importance of creating a smoke-free campus,” said VA Secretary Robert Wilkie. He notes that as of 2014, 4000 health care facilities and 4 national health care systems in the US have implemented smoke-free grounds.

National Association of Government employees will begin implementing the policy as of October 1, and have until January 1, 2020, to fully comply. Smoking shelters will be closed, although each facility will independently determine the disposition of smoking areas and shelters.

The new policy does not mean anyone has to quit smoking but to encourage quitting, the VA offers resources, including www.publichealth.va.gov/smoking/quit/index.asp. More tips and tools are available at the Smokefree Veteran website: https://veterans.smokefree.gov. SmokefreeVET is a text-messaging program (https://veterans.smokefree.gov/tools-tips-vet/smokefreevet) that provides 24/7 support to help veterans quit for good. Employees can contact their facility for resources.

The policies are available at https://www.va.gov/health/smokefree.

The updated smoking policy goes into effect for employees, patients, visitors, volunteers, contractors, and vendors, whether they smoke cigarettes, cigars, pipes, or even electronic and vaping devices, and whenever they are on the grounds of VA health care facilities, including parking areas.

The new policy comes after the VA reviewed research on second- and thirdhand smoke and best practices in the health care industry. “There is no risk-free level of exposure to tobacco smoke,” the VA’s Smokefree website says. Overwhelming evidence shows exposure to secondhand smoke has significant medical risks. Moreover, a growing body of evidence shows exposure to thirdhand smoke (residual nicotine and other chemicals left on indoor surfaces) also is a health hazard. The residue is thought to react with indoor pollutants to create a toxic mix that clings long after smoking has stopped and cannot be eliminated by opening windows, or using fans, or other means of clearing rooms.

“We are not alone in recognizing the importance of creating a smoke-free campus,” said VA Secretary Robert Wilkie. He notes that as of 2014, 4000 health care facilities and 4 national health care systems in the US have implemented smoke-free grounds.

National Association of Government employees will begin implementing the policy as of October 1, and have until January 1, 2020, to fully comply. Smoking shelters will be closed, although each facility will independently determine the disposition of smoking areas and shelters.

The new policy does not mean anyone has to quit smoking but to encourage quitting, the VA offers resources, including www.publichealth.va.gov/smoking/quit/index.asp. More tips and tools are available at the Smokefree Veteran website: https://veterans.smokefree.gov. SmokefreeVET is a text-messaging program (https://veterans.smokefree.gov/tools-tips-vet/smokefreevet) that provides 24/7 support to help veterans quit for good. Employees can contact their facility for resources.

The policies are available at https://www.va.gov/health/smokefree.

When an emergency department (ED) closes, neighboring hospitals—“bystander hospitals”—feel the effects, especially if they are already near or at full capacity: The health outcomes for their patients worsen, according to findings from a study funded by the National Heart, Lung, and Blood Institute (NHLBI).

The researchers examined outcomes for more than 1 million patients at nearly 4,000 hospitals in both urban and rural areas who had been affected by the closure or opening of an ED. The primary measures were 30-day, 90-day, and 1-year mortality rates, and 30-day readmission rates for heart attack. The researchers chose heart attacks because of the known benefits of timely treatment.

The researchers used changes in driving time between an ED and the next-closest one as a proxy for a closure or opening. If driving time increased, it meant a nearby ED had closed.

They found that when it took an additional 30 minutes or more to get to another hospital, the 1-year mortality rate in those receiving hospitals increased by 8% and the 30-day readmission rate by 6%. The likelihood of patients receiving an angioplasty or stent dropped by 4%.

However, the researchers also found that when an ED opened, the patients in the bystander hospitals benefited, experiencing a reduction in 1-year mortality by 5%. And the likelihood of their receiving percutaneous coronary intervention improved by 12%.

The study is believed to be the first to evaluate the impact of ED openings and closures on other hospitals. The lead author of the study, Renee Hsia, MD, said, “We now have evidence that hospital closures affect other hospitals, and they do so in different ways. Hospitals that are already crowded will likely be unable to maintain the same quality when a nearby emergency department closes.”

Limited resources at high-occupancy hospitals make them “sensitive to changes” in neighboring communities, the researchers say. “Hospital closures stress the health care infrastructure,” says Nicole Redmond, MD, PhD, MPH, a medical officer at NHLBI, “especially if the hospital is already caring for a socially and medically complex patient population and working at full capacity. As a result, such closures may inadvertently increase the health disparities that we are trying to mitigate.”

When an emergency department (ED) closes, neighboring hospitals—“bystander hospitals”—feel the effects, especially if they are already near or at full capacity: The health outcomes for their patients worsen, according to findings from a study funded by the National Heart, Lung, and Blood Institute (NHLBI).

The researchers examined outcomes for more than 1 million patients at nearly 4,000 hospitals in both urban and rural areas who had been affected by the closure or opening of an ED. The primary measures were 30-day, 90-day, and 1-year mortality rates, and 30-day readmission rates for heart attack. The researchers chose heart attacks because of the known benefits of timely treatment.

The researchers used changes in driving time between an ED and the next-closest one as a proxy for a closure or opening. If driving time increased, it meant a nearby ED had closed.

They found that when it took an additional 30 minutes or more to get to another hospital, the 1-year mortality rate in those receiving hospitals increased by 8% and the 30-day readmission rate by 6%. The likelihood of patients receiving an angioplasty or stent dropped by 4%.

However, the researchers also found that when an ED opened, the patients in the bystander hospitals benefited, experiencing a reduction in 1-year mortality by 5%. And the likelihood of their receiving percutaneous coronary intervention improved by 12%.

The study is believed to be the first to evaluate the impact of ED openings and closures on other hospitals. The lead author of the study, Renee Hsia, MD, said, “We now have evidence that hospital closures affect other hospitals, and they do so in different ways. Hospitals that are already crowded will likely be unable to maintain the same quality when a nearby emergency department closes.”

Limited resources at high-occupancy hospitals make them “sensitive to changes” in neighboring communities, the researchers say. “Hospital closures stress the health care infrastructure,” says Nicole Redmond, MD, PhD, MPH, a medical officer at NHLBI, “especially if the hospital is already caring for a socially and medically complex patient population and working at full capacity. As a result, such closures may inadvertently increase the health disparities that we are trying to mitigate.”

When an emergency department (ED) closes, neighboring hospitals—“bystander hospitals”—feel the effects, especially if they are already near or at full capacity: The health outcomes for their patients worsen, according to findings from a study funded by the National Heart, Lung, and Blood Institute (NHLBI).

The researchers examined outcomes for more than 1 million patients at nearly 4,000 hospitals in both urban and rural areas who had been affected by the closure or opening of an ED. The primary measures were 30-day, 90-day, and 1-year mortality rates, and 30-day readmission rates for heart attack. The researchers chose heart attacks because of the known benefits of timely treatment.

The researchers used changes in driving time between an ED and the next-closest one as a proxy for a closure or opening. If driving time increased, it meant a nearby ED had closed.

They found that when it took an additional 30 minutes or more to get to another hospital, the 1-year mortality rate in those receiving hospitals increased by 8% and the 30-day readmission rate by 6%. The likelihood of patients receiving an angioplasty or stent dropped by 4%.

However, the researchers also found that when an ED opened, the patients in the bystander hospitals benefited, experiencing a reduction in 1-year mortality by 5%. And the likelihood of their receiving percutaneous coronary intervention improved by 12%.

The study is believed to be the first to evaluate the impact of ED openings and closures on other hospitals. The lead author of the study, Renee Hsia, MD, said, “We now have evidence that hospital closures affect other hospitals, and they do so in different ways. Hospitals that are already crowded will likely be unable to maintain the same quality when a nearby emergency department closes.”

Limited resources at high-occupancy hospitals make them “sensitive to changes” in neighboring communities, the researchers say. “Hospital closures stress the health care infrastructure,” says Nicole Redmond, MD, PhD, MPH, a medical officer at NHLBI, “especially if the hospital is already caring for a socially and medically complex patient population and working at full capacity. As a result, such closures may inadvertently increase the health disparities that we are trying to mitigate.”

Antibiotics given to preterm infants can set them up for health problems later in life; research has shown, including allergies, psoriasis, diabetes, and inflammatory bowel disease. Researchers who conducted a National Institutes of Health (NIH)-funded study have added to that body of knowledge with their finding that treating preterm infants with long-term antibiotics could have lasting effects by promoting multidrug-resistant gut bacteria.

They used high-speed DNA sequencing and advanced computational analysis to study stool samples from 32 infants born very preterm who received antibiotic treatment for 21 months in the hospital and after discharge, then compared those with results from 9 very preterm infants treated with antibiotics for > 1 week and 17 healthy term and late-term infants who had not received antibiotics.

The infants on long-term antibiotics had less diverse bacterial populations in their gut, and those bacteria contained more antibiotic-resistant genes.

Strikingly, the genomes of the high-antibiotic-use samples contained genes for resistance to antibiotics typically not given to newborns, such as ciprofloxacin and chloramphenicol. The researchers say this may mean that the genes originate in multidrug-resistant bacteria. Using a particular antibiotic may trigger resistance to other antibiotics even if they were not used.

“The collateral damage of early-life antibiotic treatment and hospitalization in preterm infants is long lasting,” the researchers say. They urge development of strategies to protect these highly vulnerable patients.

Antibiotics given to preterm infants can set them up for health problems later in life; research has shown, including allergies, psoriasis, diabetes, and inflammatory bowel disease. Researchers who conducted a National Institutes of Health (NIH)-funded study have added to that body of knowledge with their finding that treating preterm infants with long-term antibiotics could have lasting effects by promoting multidrug-resistant gut bacteria.

They used high-speed DNA sequencing and advanced computational analysis to study stool samples from 32 infants born very preterm who received antibiotic treatment for 21 months in the hospital and after discharge, then compared those with results from 9 very preterm infants treated with antibiotics for > 1 week and 17 healthy term and late-term infants who had not received antibiotics.

The infants on long-term antibiotics had less diverse bacterial populations in their gut, and those bacteria contained more antibiotic-resistant genes.

Strikingly, the genomes of the high-antibiotic-use samples contained genes for resistance to antibiotics typically not given to newborns, such as ciprofloxacin and chloramphenicol. The researchers say this may mean that the genes originate in multidrug-resistant bacteria. Using a particular antibiotic may trigger resistance to other antibiotics even if they were not used.

“The collateral damage of early-life antibiotic treatment and hospitalization in preterm infants is long lasting,” the researchers say. They urge development of strategies to protect these highly vulnerable patients.

Antibiotics given to preterm infants can set them up for health problems later in life; research has shown, including allergies, psoriasis, diabetes, and inflammatory bowel disease. Researchers who conducted a National Institutes of Health (NIH)-funded study have added to that body of knowledge with their finding that treating preterm infants with long-term antibiotics could have lasting effects by promoting multidrug-resistant gut bacteria.

They used high-speed DNA sequencing and advanced computational analysis to study stool samples from 32 infants born very preterm who received antibiotic treatment for 21 months in the hospital and after discharge, then compared those with results from 9 very preterm infants treated with antibiotics for > 1 week and 17 healthy term and late-term infants who had not received antibiotics.

The infants on long-term antibiotics had less diverse bacterial populations in their gut, and those bacteria contained more antibiotic-resistant genes.

Strikingly, the genomes of the high-antibiotic-use samples contained genes for resistance to antibiotics typically not given to newborns, such as ciprofloxacin and chloramphenicol. The researchers say this may mean that the genes originate in multidrug-resistant bacteria. Using a particular antibiotic may trigger resistance to other antibiotics even if they were not used.

“The collateral damage of early-life antibiotic treatment and hospitalization in preterm infants is long lasting,” the researchers say. They urge development of strategies to protect these highly vulnerable patients.

On September 7, 2017, Hurricane Irma was bearing down on Florida. The Orlando Veterans Administration Medical Center Home-Based Primary Care program (OVAMC-HBPC) had 364 veterans enrolled. Some were oxygen dependent. Some were ventilator dependent. All were complex-care cases. The nurse manager and HBPC program director needed to make some critical decisions, fast, about how best to help their patients.

The VHA-HBPC program was designed to serve veterans with complex chronic disease; the average patient has > 8 chronic conditions. Currently, about 140 VHA-HBPC programs nationwide serve almost 38,000 veterans, according to the researchers reporting in the CDC’s Preventing Chronic Disease.

Luckily, 2 years before Irma, OVAMC-HBPC had joined an innovative project using geographic information system (GIS) maps for emergency planning and response.

The mapping project has trained staff members at 30 VHA-HBPC programs to use VHA’s Portal for ArcGIS mapping software. The project was designed so that any member of the VHA-HBPC staff, including staff providing direct care, could make maps tailored to their local program’s needs. The maps are layered, incorporating patient data, location of emergency services, and environmental threats, such as storm surges. At OVAMC-HBPC , a nurse care manager (RNCM) trained as the mapmaker.

As Irma approached, the RNCM/mapmaker created maps showing the locations of vulnerable patients, such as those near the coast, synthesizing information from the GIS maps and other sources about the storm’s path, wind force, patient location and level of vulnerability, and areas with high likelihood of power outages.

The map of the oncoming storm was a powerful tool. The RNCM said, “The map made me realize that it was real and it was going to come.”

Armed with information, the care team set to work on the emergency response. For instance, the RNCM/mapmaker facilitated the sheltering-in-place of a patient with brittle diabetes mellitus by educating the patient’s daughter on the impending risk. The daughter bought a generator to run the air conditioning and a small refrigerator to keep the patient’s insulin cool. The mapmaker also convinced the family of a patient with chronic obstructive pulmonary disease and congestive heart failure that they needed to evacuate to the OVAMC hospital.

OVAMC also facilitated the transport of VHA-HBPC patients to its hospital, including 2 who were admitted to the intensive care unit. Because of the team’s advanced planning and the use of GIS, only 23 of the 364 patients needed to be sheltered at the hospital. No patient deaths or injuries were attributed to the hurricane.

The mapping project was funded by the Veterans Administration Geriatrics and Extended Care Strategic and Transformational Initiatives.

On September 7, 2017, Hurricane Irma was bearing down on Florida. The Orlando Veterans Administration Medical Center Home-Based Primary Care program (OVAMC-HBPC) had 364 veterans enrolled. Some were oxygen dependent. Some were ventilator dependent. All were complex-care cases. The nurse manager and HBPC program director needed to make some critical decisions, fast, about how best to help their patients.

The VHA-HBPC program was designed to serve veterans with complex chronic disease; the average patient has > 8 chronic conditions. Currently, about 140 VHA-HBPC programs nationwide serve almost 38,000 veterans, according to the researchers reporting in the CDC’s Preventing Chronic Disease.

Luckily, 2 years before Irma, OVAMC-HBPC had joined an innovative project using geographic information system (GIS) maps for emergency planning and response.

The mapping project has trained staff members at 30 VHA-HBPC programs to use VHA’s Portal for ArcGIS mapping software. The project was designed so that any member of the VHA-HBPC staff, including staff providing direct care, could make maps tailored to their local program’s needs. The maps are layered, incorporating patient data, location of emergency services, and environmental threats, such as storm surges. At OVAMC-HBPC , a nurse care manager (RNCM) trained as the mapmaker.

As Irma approached, the RNCM/mapmaker created maps showing the locations of vulnerable patients, such as those near the coast, synthesizing information from the GIS maps and other sources about the storm’s path, wind force, patient location and level of vulnerability, and areas with high likelihood of power outages.

The map of the oncoming storm was a powerful tool. The RNCM said, “The map made me realize that it was real and it was going to come.”

Armed with information, the care team set to work on the emergency response. For instance, the RNCM/mapmaker facilitated the sheltering-in-place of a patient with brittle diabetes mellitus by educating the patient’s daughter on the impending risk. The daughter bought a generator to run the air conditioning and a small refrigerator to keep the patient’s insulin cool. The mapmaker also convinced the family of a patient with chronic obstructive pulmonary disease and congestive heart failure that they needed to evacuate to the OVAMC hospital.

OVAMC also facilitated the transport of VHA-HBPC patients to its hospital, including 2 who were admitted to the intensive care unit. Because of the team’s advanced planning and the use of GIS, only 23 of the 364 patients needed to be sheltered at the hospital. No patient deaths or injuries were attributed to the hurricane.

The mapping project was funded by the Veterans Administration Geriatrics and Extended Care Strategic and Transformational Initiatives.

On September 7, 2017, Hurricane Irma was bearing down on Florida. The Orlando Veterans Administration Medical Center Home-Based Primary Care program (OVAMC-HBPC) had 364 veterans enrolled. Some were oxygen dependent. Some were ventilator dependent. All were complex-care cases. The nurse manager and HBPC program director needed to make some critical decisions, fast, about how best to help their patients.

The VHA-HBPC program was designed to serve veterans with complex chronic disease; the average patient has > 8 chronic conditions. Currently, about 140 VHA-HBPC programs nationwide serve almost 38,000 veterans, according to the researchers reporting in the CDC’s Preventing Chronic Disease.

Luckily, 2 years before Irma, OVAMC-HBPC had joined an innovative project using geographic information system (GIS) maps for emergency planning and response.

The mapping project has trained staff members at 30 VHA-HBPC programs to use VHA’s Portal for ArcGIS mapping software. The project was designed so that any member of the VHA-HBPC staff, including staff providing direct care, could make maps tailored to their local program’s needs. The maps are layered, incorporating patient data, location of emergency services, and environmental threats, such as storm surges. At OVAMC-HBPC , a nurse care manager (RNCM) trained as the mapmaker.

As Irma approached, the RNCM/mapmaker created maps showing the locations of vulnerable patients, such as those near the coast, synthesizing information from the GIS maps and other sources about the storm’s path, wind force, patient location and level of vulnerability, and areas with high likelihood of power outages.

The map of the oncoming storm was a powerful tool. The RNCM said, “The map made me realize that it was real and it was going to come.”

Armed with information, the care team set to work on the emergency response. For instance, the RNCM/mapmaker facilitated the sheltering-in-place of a patient with brittle diabetes mellitus by educating the patient’s daughter on the impending risk. The daughter bought a generator to run the air conditioning and a small refrigerator to keep the patient’s insulin cool. The mapmaker also convinced the family of a patient with chronic obstructive pulmonary disease and congestive heart failure that they needed to evacuate to the OVAMC hospital.

OVAMC also facilitated the transport of VHA-HBPC patients to its hospital, including 2 who were admitted to the intensive care unit. Because of the team’s advanced planning and the use of GIS, only 23 of the 364 patients needed to be sheltered at the hospital. No patient deaths or injuries were attributed to the hurricane.

The mapping project was funded by the Veterans Administration Geriatrics and Extended Care Strategic and Transformational Initiatives.

Researchers from University College London in the United Kingdom and University of Amsterdam in the Netherlands who conducted a systematic review of available research found a “striking” lack of evidence, considering the vast interest in the potential of the treatment and the “overwhelming demand by veterans.”

The researchers wanted to conduct a “fine-grained evaluation” of cannabinoid effectiveness in posttraumatic stress disorder (PTSD). They identified 10 studies investigating medicinal cannabinoids for patients with PTSD who were experiencing symptoms that were measured by a clinical psychometric, such as the Clinician-Administered PTSD Scale. Only 1 was a randomized, double-blind, placebo-controlled crossover clinical trial. Three studies used nabilone, a synthetic delta9-tetrahydrocannabinol (THC) analog; 1 used oral THC; 2 used cannabidiol (CBD) oil, and 4 used smoked herbal preparations of cannabis.

In line with previous reviews, the researchers found insufficient evidence to support the use of cannabinoids as a psychopharmacologic treatment for PTSD. In fact, they suggest that the lack of evidence poses a public health risk. However, the researchers say, this is mainly because the available support so far has been limited to small, “low-quality” studies, anecdotal reports, and some experimental evidence. There are reasons to keep investigating the possibilities, they conclude.

For instance, there is concurrence among studies that medicinal cannabinoids can help with sleep disturbances, and thus may be more effective, with less risk of addiction than benzodiazepines or opiate-based medications. Self-reports, anecdotal accounts, and case reports suggest that medical cannabis can dramatically reduce not only sleep symptoms, such as insomnia and nightmares, but may help with traumatic intrusions, hyperarousal, stress, anxiety, and depression.

The researchers also cite a study that found veterans who use cannabis believe it to be more effective and less complicated by adverse effects (AEs) than are alcohol and other psychopharmaceuticals. The AEs are generally mild to moderate, such as dry mouth and feeling “stoned,” but compared with the AEs of currently prescribed drugs are considered less burdensome.

Safety concerns are particularly critical in this population, though. Some research has shown that rates of cannabis use disorder are greater among patients who have PTSD compared with those who do not. A study of veterans admitted to US Department of Veterans Affairs treatment programs found recreational cannabis users with PTSD had poorer outcomes on severity of symptoms, violent behavior, and other drug use. Cannabinoids have also been associated with severe AEs in people with a history of psychosis—a consideration in combat veterans who have hallucinations or delusions.

Although they used strict inclusion criteria, the researchers say the studies they used still had “significant” limitations. Future well-controlled, randomized, double-blind clinical trials are highly warranted, they add, to address the “large unmet need” for effective PTSD treatments.

Researchers from University College London in the United Kingdom and University of Amsterdam in the Netherlands who conducted a systematic review of available research found a “striking” lack of evidence, considering the vast interest in the potential of the treatment and the “overwhelming demand by veterans.”

The researchers wanted to conduct a “fine-grained evaluation” of cannabinoid effectiveness in posttraumatic stress disorder (PTSD). They identified 10 studies investigating medicinal cannabinoids for patients with PTSD who were experiencing symptoms that were measured by a clinical psychometric, such as the Clinician-Administered PTSD Scale. Only 1 was a randomized, double-blind, placebo-controlled crossover clinical trial. Three studies used nabilone, a synthetic delta9-tetrahydrocannabinol (THC) analog; 1 used oral THC; 2 used cannabidiol (CBD) oil, and 4 used smoked herbal preparations of cannabis.

In line with previous reviews, the researchers found insufficient evidence to support the use of cannabinoids as a psychopharmacologic treatment for PTSD. In fact, they suggest that the lack of evidence poses a public health risk. However, the researchers say, this is mainly because the available support so far has been limited to small, “low-quality” studies, anecdotal reports, and some experimental evidence. There are reasons to keep investigating the possibilities, they conclude.

For instance, there is concurrence among studies that medicinal cannabinoids can help with sleep disturbances, and thus may be more effective, with less risk of addiction than benzodiazepines or opiate-based medications. Self-reports, anecdotal accounts, and case reports suggest that medical cannabis can dramatically reduce not only sleep symptoms, such as insomnia and nightmares, but may help with traumatic intrusions, hyperarousal, stress, anxiety, and depression.

The researchers also cite a study that found veterans who use cannabis believe it to be more effective and less complicated by adverse effects (AEs) than are alcohol and other psychopharmaceuticals. The AEs are generally mild to moderate, such as dry mouth and feeling “stoned,” but compared with the AEs of currently prescribed drugs are considered less burdensome.

Safety concerns are particularly critical in this population, though. Some research has shown that rates of cannabis use disorder are greater among patients who have PTSD compared with those who do not. A study of veterans admitted to US Department of Veterans Affairs treatment programs found recreational cannabis users with PTSD had poorer outcomes on severity of symptoms, violent behavior, and other drug use. Cannabinoids have also been associated with severe AEs in people with a history of psychosis—a consideration in combat veterans who have hallucinations or delusions.

Although they used strict inclusion criteria, the researchers say the studies they used still had “significant” limitations. Future well-controlled, randomized, double-blind clinical trials are highly warranted, they add, to address the “large unmet need” for effective PTSD treatments.

Researchers from University College London in the United Kingdom and University of Amsterdam in the Netherlands who conducted a systematic review of available research found a “striking” lack of evidence, considering the vast interest in the potential of the treatment and the “overwhelming demand by veterans.”

The researchers wanted to conduct a “fine-grained evaluation” of cannabinoid effectiveness in posttraumatic stress disorder (PTSD). They identified 10 studies investigating medicinal cannabinoids for patients with PTSD who were experiencing symptoms that were measured by a clinical psychometric, such as the Clinician-Administered PTSD Scale. Only 1 was a randomized, double-blind, placebo-controlled crossover clinical trial. Three studies used nabilone, a synthetic delta9-tetrahydrocannabinol (THC) analog; 1 used oral THC; 2 used cannabidiol (CBD) oil, and 4 used smoked herbal preparations of cannabis.

In line with previous reviews, the researchers found insufficient evidence to support the use of cannabinoids as a psychopharmacologic treatment for PTSD. In fact, they suggest that the lack of evidence poses a public health risk. However, the researchers say, this is mainly because the available support so far has been limited to small, “low-quality” studies, anecdotal reports, and some experimental evidence. There are reasons to keep investigating the possibilities, they conclude.

For instance, there is concurrence among studies that medicinal cannabinoids can help with sleep disturbances, and thus may be more effective, with less risk of addiction than benzodiazepines or opiate-based medications. Self-reports, anecdotal accounts, and case reports suggest that medical cannabis can dramatically reduce not only sleep symptoms, such as insomnia and nightmares, but may help with traumatic intrusions, hyperarousal, stress, anxiety, and depression.

The researchers also cite a study that found veterans who use cannabis believe it to be more effective and less complicated by adverse effects (AEs) than are alcohol and other psychopharmaceuticals. The AEs are generally mild to moderate, such as dry mouth and feeling “stoned,” but compared with the AEs of currently prescribed drugs are considered less burdensome.

Safety concerns are particularly critical in this population, though. Some research has shown that rates of cannabis use disorder are greater among patients who have PTSD compared with those who do not. A study of veterans admitted to US Department of Veterans Affairs treatment programs found recreational cannabis users with PTSD had poorer outcomes on severity of symptoms, violent behavior, and other drug use. Cannabinoids have also been associated with severe AEs in people with a history of psychosis—a consideration in combat veterans who have hallucinations or delusions.

Although they used strict inclusion criteria, the researchers say the studies they used still had “significant” limitations. Future well-controlled, randomized, double-blind clinical trials are highly warranted, they add, to address the “large unmet need” for effective PTSD treatments.

Levy was chief pathologist at Veterans Health Care System of the Ozarks in Fayetteville, Arkansas. During his 12-year tenure at the US Department of Veterans Affairs (VA), he read almost 34,000 pathology slides. However, at the same time, he was working under the influence of alcohol and 2-methyl-2-butanol (2M2B)—a substance that intoxicates but cannot be detected in routine tests.

The VA fired Levy last year, and the VA Office of the Inspector General (OIG) began an investigation of his actions and of agency lapses in overseeing him. The 18-month review found that 8.9% of Levy’s diagnoses involved clinical errors—the normal misdiagnosis rate for pathologists is 0.7%. Hundreds of Levy’s misdiagnoses were not serious, but ≥ 15 may have led to deaths and harmful illness in 15 other patients. Some patients were not diagnosed when they should have been. Some were told they were sick when they were not and suffered unnecessary invasive treatment.

Levy knowingly falsified diagnoses for  3 veterans. One patient was diagnosed with diffuse large B-cell lymphoma—a type of cancer he did not have. He received the wrong treatment and died. Levy diagnosed another patient, also wrongly, with small cell carcinoma; that patient died of squamous cell carcinoma that spread. The third patient was given a benign test result for prostate cancer. Untreated, he died after the cancer spread.

One patient was given antibiotics instead of treatment for what was later diagnosed as late-stage neck and throat cancer. In an interview with the Washington Post he said, “I went from ‘Your earache isn’t anything’ to stage 4.”

How was Levy able to wreak such havoc? One reason was that despite concerns and complaints from colleagues, he looked good on paper. He falsified records to indicate that his deputy concurred with his diagnoses in mandated peer reviews. He also appeared “clean” in inspections through using 2M2B.

Levy was fired not for his work performance but for being arrested for driving while intoxicated. He had been a “star hire” with an medical degree from the University of Chicago, who had completed a pathology residency at the University of California at San Francisco and a fellowship at Duke University focusing on disease of the blood. But he also had a 1996 arrest for a driving under the influence (DUI) on his record when he joined the VA in 2005.

He was suspended again in 2017 for being under the influence but allowed to continue with nonclinical work until he was again arrested for DUI in 2018, when the police toxicology test detected 2M2B. He was finally dismissed in April 2018. Nonetheless, even after he had arrived impaired at the laboratory twice, the VA had awarded him 2 performance bonuses, based on the supposedly low clinical error rate and 42 urine and blood samples that turned up negative for alcohol and drugs.

In addition to 3 counts of involuntary manslaughter, the indictment charges that Levy devised a scheme to defraud the VA and to obtain money and property from the VA in the form of salary, benefits, and performance awards. He is charged with 12 counts of wire fraud, 12 counts of mail fraud, and 4 counts of making false statements related to 12 occasions between 2017 and 2018, when Levy was reportedly buying 2M2B over the Internet while he was contractually obligated to submit to random drug and alcohol screens.

After being fired, Levy moved to a small island in the Dutch Caribbean and found a position teaching pathology at a local medical school. At the time of his VA hiring, Levy held a medical license issued by Mississippi. His active medical licenses in California and Florida were revoked only this spring. The VA did not notify the3 states where Levy was licensed that he could no longer practice until June 2018.

The Office of Inspector General (OIG) has identified other VA physicians who continued to practice even after they were found to have compromised patient care, and the Government Accountability Office found “weak systems” for ensuring that problems are addressed in a timely fashion. A VA spokesperson, however, quoted in The Washington Post, said the Levy case was “an isolated incident,” and that the agency has “strengthened internal controls” to ensure that errors are more quickly identified and addressed. The Fayetteville Medical Center also has increased monitoring of its clinical laboratory, according to a Washington Post report. VA officials also said they have added oversight of small specialty staffs across the system to ensure “independent and objective oversight.”

The VA has contacted the families in the 30 most serious cases to advise them of their legal and treatment options, according to the Washington Post.

“The arrest of Dr. Levy was accomplished as a result of the strong leadership of the US Attorney’s Office and the extensive work of special agents of the VA OIG, supported by the medical expertise of the OIG’s health care inspection professionals,” said Michael Missal, the VA’s inspector general, in a press release issued by the US Attorney’s Office in the Western District of Arkansas. “These charges send a clear signal that anyone entrusted with the care of veterans will be held accountable for placing them at risk by working while impaired or through other misconduct.”

Levy is in jail in Fayetteville. The trial date for his case is set for October 7.

Levy was chief pathologist at Veterans Health Care System of the Ozarks in Fayetteville, Arkansas. During his 12-year tenure at the US Department of Veterans Affairs (VA), he read almost 34,000 pathology slides. However, at the same time, he was working under the influence of alcohol and 2-methyl-2-butanol (2M2B)—a substance that intoxicates but cannot be detected in routine tests.

The VA fired Levy last year, and the VA Office of the Inspector General (OIG) began an investigation of his actions and of agency lapses in overseeing him. The 18-month review found that 8.9% of Levy’s diagnoses involved clinical errors—the normal misdiagnosis rate for pathologists is 0.7%. Hundreds of Levy’s misdiagnoses were not serious, but ≥ 15 may have led to deaths and harmful illness in 15 other patients. Some patients were not diagnosed when they should have been. Some were told they were sick when they were not and suffered unnecessary invasive treatment.

Levy knowingly falsified diagnoses for  3 veterans. One patient was diagnosed with diffuse large B-cell lymphoma—a type of cancer he did not have. He received the wrong treatment and died. Levy diagnosed another patient, also wrongly, with small cell carcinoma; that patient died of squamous cell carcinoma that spread. The third patient was given a benign test result for prostate cancer. Untreated, he died after the cancer spread.

One patient was given antibiotics instead of treatment for what was later diagnosed as late-stage neck and throat cancer. In an interview with the Washington Post he said, “I went from ‘Your earache isn’t anything’ to stage 4.”

How was Levy able to wreak such havoc? One reason was that despite concerns and complaints from colleagues, he looked good on paper. He falsified records to indicate that his deputy concurred with his diagnoses in mandated peer reviews. He also appeared “clean” in inspections through using 2M2B.

Levy was fired not for his work performance but for being arrested for driving while intoxicated. He had been a “star hire” with an medical degree from the University of Chicago, who had completed a pathology residency at the University of California at San Francisco and a fellowship at Duke University focusing on disease of the blood. But he also had a 1996 arrest for a driving under the influence (DUI) on his record when he joined the VA in 2005.

He was suspended again in 2017 for being under the influence but allowed to continue with nonclinical work until he was again arrested for DUI in 2018, when the police toxicology test detected 2M2B. He was finally dismissed in April 2018. Nonetheless, even after he had arrived impaired at the laboratory twice, the VA had awarded him 2 performance bonuses, based on the supposedly low clinical error rate and 42 urine and blood samples that turned up negative for alcohol and drugs.

In addition to 3 counts of involuntary manslaughter, the indictment charges that Levy devised a scheme to defraud the VA and to obtain money and property from the VA in the form of salary, benefits, and performance awards. He is charged with 12 counts of wire fraud, 12 counts of mail fraud, and 4 counts of making false statements related to 12 occasions between 2017 and 2018, when Levy was reportedly buying 2M2B over the Internet while he was contractually obligated to submit to random drug and alcohol screens.

After being fired, Levy moved to a small island in the Dutch Caribbean and found a position teaching pathology at a local medical school. At the time of his VA hiring, Levy held a medical license issued by Mississippi. His active medical licenses in California and Florida were revoked only this spring. The VA did not notify the3 states where Levy was licensed that he could no longer practice until June 2018.

The Office of Inspector General (OIG) has identified other VA physicians who continued to practice even after they were found to have compromised patient care, and the Government Accountability Office found “weak systems” for ensuring that problems are addressed in a timely fashion. A VA spokesperson, however, quoted in The Washington Post, said the Levy case was “an isolated incident,” and that the agency has “strengthened internal controls” to ensure that errors are more quickly identified and addressed. The Fayetteville Medical Center also has increased monitoring of its clinical laboratory, according to a Washington Post report. VA officials also said they have added oversight of small specialty staffs across the system to ensure “independent and objective oversight.”

The VA has contacted the families in the 30 most serious cases to advise them of their legal and treatment options, according to the Washington Post.

“The arrest of Dr. Levy was accomplished as a result of the strong leadership of the US Attorney’s Office and the extensive work of special agents of the VA OIG, supported by the medical expertise of the OIG’s health care inspection professionals,” said Michael Missal, the VA’s inspector general, in a press release issued by the US Attorney’s Office in the Western District of Arkansas. “These charges send a clear signal that anyone entrusted with the care of veterans will be held accountable for placing them at risk by working while impaired or through other misconduct.”

Levy is in jail in Fayetteville. The trial date for his case is set for October 7.

Levy was chief pathologist at Veterans Health Care System of the Ozarks in Fayetteville, Arkansas. During his 12-year tenure at the US Department of Veterans Affairs (VA), he read almost 34,000 pathology slides. However, at the same time, he was working under the influence of alcohol and 2-methyl-2-butanol (2M2B)—a substance that intoxicates but cannot be detected in routine tests.

The VA fired Levy last year, and the VA Office of the Inspector General (OIG) began an investigation of his actions and of agency lapses in overseeing him. The 18-month review found that 8.9% of Levy’s diagnoses involved clinical errors—the normal misdiagnosis rate for pathologists is 0.7%. Hundreds of Levy’s misdiagnoses were not serious, but ≥ 15 may have led to deaths and harmful illness in 15 other patients. Some patients were not diagnosed when they should have been. Some were told they were sick when they were not and suffered unnecessary invasive treatment.

Levy knowingly falsified diagnoses for  3 veterans. One patient was diagnosed with diffuse large B-cell lymphoma—a type of cancer he did not have. He received the wrong treatment and died. Levy diagnosed another patient, also wrongly, with small cell carcinoma; that patient died of squamous cell carcinoma that spread. The third patient was given a benign test result for prostate cancer. Untreated, he died after the cancer spread.

One patient was given antibiotics instead of treatment for what was later diagnosed as late-stage neck and throat cancer. In an interview with the Washington Post he said, “I went from ‘Your earache isn’t anything’ to stage 4.”

How was Levy able to wreak such havoc? One reason was that despite concerns and complaints from colleagues, he looked good on paper. He falsified records to indicate that his deputy concurred with his diagnoses in mandated peer reviews. He also appeared “clean” in inspections through using 2M2B.

Levy was fired not for his work performance but for being arrested for driving while intoxicated. He had been a “star hire” with an medical degree from the University of Chicago, who had completed a pathology residency at the University of California at San Francisco and a fellowship at Duke University focusing on disease of the blood. But he also had a 1996 arrest for a driving under the influence (DUI) on his record when he joined the VA in 2005.

He was suspended again in 2017 for being under the influence but allowed to continue with nonclinical work until he was again arrested for DUI in 2018, when the police toxicology test detected 2M2B. He was finally dismissed in April 2018. Nonetheless, even after he had arrived impaired at the laboratory twice, the VA had awarded him 2 performance bonuses, based on the supposedly low clinical error rate and 42 urine and blood samples that turned up negative for alcohol and drugs.

In addition to 3 counts of involuntary manslaughter, the indictment charges that Levy devised a scheme to defraud the VA and to obtain money and property from the VA in the form of salary, benefits, and performance awards. He is charged with 12 counts of wire fraud, 12 counts of mail fraud, and 4 counts of making false statements related to 12 occasions between 2017 and 2018, when Levy was reportedly buying 2M2B over the Internet while he was contractually obligated to submit to random drug and alcohol screens.

After being fired, Levy moved to a small island in the Dutch Caribbean and found a position teaching pathology at a local medical school. At the time of his VA hiring, Levy held a medical license issued by Mississippi. His active medical licenses in California and Florida were revoked only this spring. The VA did not notify the3 states where Levy was licensed that he could no longer practice until June 2018.

The Office of Inspector General (OIG) has identified other VA physicians who continued to practice even after they were found to have compromised patient care, and the Government Accountability Office found “weak systems” for ensuring that problems are addressed in a timely fashion. A VA spokesperson, however, quoted in The Washington Post, said the Levy case was “an isolated incident,” and that the agency has “strengthened internal controls” to ensure that errors are more quickly identified and addressed. The Fayetteville Medical Center also has increased monitoring of its clinical laboratory, according to a Washington Post report. VA officials also said they have added oversight of small specialty staffs across the system to ensure “independent and objective oversight.”

The VA has contacted the families in the 30 most serious cases to advise them of their legal and treatment options, according to the Washington Post.

“The arrest of Dr. Levy was accomplished as a result of the strong leadership of the US Attorney’s Office and the extensive work of special agents of the VA OIG, supported by the medical expertise of the OIG’s health care inspection professionals,” said Michael Missal, the VA’s inspector general, in a press release issued by the US Attorney’s Office in the Western District of Arkansas. “These charges send a clear signal that anyone entrusted with the care of veterans will be held accountable for placing them at risk by working while impaired or through other misconduct.”

Levy is in jail in Fayetteville. The trial date for his case is set for October 7.

Colorectal cancer (CRC) survivor rates are improving, which means people are living long enough after the cancer to have other chronic conditions. CRC is the third most commonly diagnosed cancer among users of the US Department of Veterans Affairs (VA) health care system, according to VA researchers, and there is a high prevalence of cardiovascular disease (CVD). The researchers also say emerging evidence suggests that survivors of CRC may be more likely to develop diabetes mellitus (DM) in the 5 years following their cancer diagnosis. But they add that there is a paucity of research about control of CVD-related chronic conditions among survivors of CRC.

In a retrospective study, the researchers compared 9,758 nonmetastatic patients with CRC with 29,066 people who had not had cancer. At baseline, 69% of the survivors of CRC and the matched controls were diagnosed with hypertension, 52% with hyperlipidemia, and 37% with DM.

But somewhat contrary to expectations, the researchers found no significant differences between the 2 groups for DM in the year following the baseline assessment. The researchers point to the VA’s “strong history” of DM risk reduction research and 2 national programs targeting DM, although they do not know whether the people in their study participated in those.

The survivors of CRC also had half the odds of being diagnosed with hyperlipidemia. However, they did have 57% higher odds of being diagnosed with hypertension.

Although the researchers acknowledge that hypertension is a transient adverse effect of certain chemotherapy regimens, they found only 7 survivors of CRC and 11 controls were treated with bevacizumab during their first year postanchor date.

The relationship between nonmetastatic CRC and CVD risk-related chronic conditions is complex, the researchers say. But they share risk factors, including obesity, physical inactivity, and diet.

The researchers call behavioral change interventions that improve survivors of CRC physical activity, dietary habits, and body mass index a “promising beginning” but call for other similar interventions, particularly those targeting blood pressure management and adherence to antihypertensive medications (which was significantly lower among the survivors).

While the magnitude of the effect regarding hypertension seems relatively small, the researchers say, they believe it is still an important difference when considered from a population health perspective—and one that should be addressed. The researchers also note that nonmetastatic survivors of CRC and controls had very similar rates of primary care visits in the 3 years postanchor date and as a result similar opportunities to receive a hypertension diagnosis.

Colorectal cancer (CRC) survivor rates are improving, which means people are living long enough after the cancer to have other chronic conditions. CRC is the third most commonly diagnosed cancer among users of the US Department of Veterans Affairs (VA) health care system, according to VA researchers, and there is a high prevalence of cardiovascular disease (CVD). The researchers also say emerging evidence suggests that survivors of CRC may be more likely to develop diabetes mellitus (DM) in the 5 years following their cancer diagnosis. But they add that there is a paucity of research about control of CVD-related chronic conditions among survivors of CRC.

In a retrospective study, the researchers compared 9,758 nonmetastatic patients with CRC with 29,066 people who had not had cancer. At baseline, 69% of the survivors of CRC and the matched controls were diagnosed with hypertension, 52% with hyperlipidemia, and 37% with DM.

But somewhat contrary to expectations, the researchers found no significant differences between the 2 groups for DM in the year following the baseline assessment. The researchers point to the VA’s “strong history” of DM risk reduction research and 2 national programs targeting DM, although they do not know whether the people in their study participated in those.

The survivors of CRC also had half the odds of being diagnosed with hyperlipidemia. However, they did have 57% higher odds of being diagnosed with hypertension.

Although the researchers acknowledge that hypertension is a transient adverse effect of certain chemotherapy regimens, they found only 7 survivors of CRC and 11 controls were treated with bevacizumab during their first year postanchor date.

The relationship between nonmetastatic CRC and CVD risk-related chronic conditions is complex, the researchers say. But they share risk factors, including obesity, physical inactivity, and diet.

The researchers call behavioral change interventions that improve survivors of CRC physical activity, dietary habits, and body mass index a “promising beginning” but call for other similar interventions, particularly those targeting blood pressure management and adherence to antihypertensive medications (which was significantly lower among the survivors).

While the magnitude of the effect regarding hypertension seems relatively small, the researchers say, they believe it is still an important difference when considered from a population health perspective—and one that should be addressed. The researchers also note that nonmetastatic survivors of CRC and controls had very similar rates of primary care visits in the 3 years postanchor date and as a result similar opportunities to receive a hypertension diagnosis.

Colorectal cancer (CRC) survivor rates are improving, which means people are living long enough after the cancer to have other chronic conditions. CRC is the third most commonly diagnosed cancer among users of the US Department of Veterans Affairs (VA) health care system, according to VA researchers, and there is a high prevalence of cardiovascular disease (CVD). The researchers also say emerging evidence suggests that survivors of CRC may be more likely to develop diabetes mellitus (DM) in the 5 years following their cancer diagnosis. But they add that there is a paucity of research about control of CVD-related chronic conditions among survivors of CRC.

In a retrospective study, the researchers compared 9,758 nonmetastatic patients with CRC with 29,066 people who had not had cancer. At baseline, 69% of the survivors of CRC and the matched controls were diagnosed with hypertension, 52% with hyperlipidemia, and 37% with DM.

But somewhat contrary to expectations, the researchers found no significant differences between the 2 groups for DM in the year following the baseline assessment. The researchers point to the VA’s “strong history” of DM risk reduction research and 2 national programs targeting DM, although they do not know whether the people in their study participated in those.

The survivors of CRC also had half the odds of being diagnosed with hyperlipidemia. However, they did have 57% higher odds of being diagnosed with hypertension.

Although the researchers acknowledge that hypertension is a transient adverse effect of certain chemotherapy regimens, they found only 7 survivors of CRC and 11 controls were treated with bevacizumab during their first year postanchor date.

The relationship between nonmetastatic CRC and CVD risk-related chronic conditions is complex, the researchers say. But they share risk factors, including obesity, physical inactivity, and diet.

The researchers call behavioral change interventions that improve survivors of CRC physical activity, dietary habits, and body mass index a “promising beginning” but call for other similar interventions, particularly those targeting blood pressure management and adherence to antihypertensive medications (which was significantly lower among the survivors).

While the magnitude of the effect regarding hypertension seems relatively small, the researchers say, they believe it is still an important difference when considered from a population health perspective—and one that should be addressed. The researchers also note that nonmetastatic survivors of CRC and controls had very similar rates of primary care visits in the 3 years postanchor date and as a result similar opportunities to receive a hypertension diagnosis.

American Indians and Alaska Natives (AI/AN) are often misidentified as other races in public health administrative records. In the Northwest, for instance, the Northwest Tribal Epidemiology Center (NTEC) has found that about 10% of AI/AN birth and death records and up to 60% of hospitalization records are misclassified.

Racial misclassification makes it difficult to accurately assess the health of Native people: The numbers affected by a disease may appear lower or higher than they actually are. It can muddle and misrepresent information in birth certificates, cancer registries, death certificates, emergency department records, hospitalization records, injury reports. Without accurate health data, says Lisa Neel, director of the Indian Health Service (IHS) Tribal Epidemiology Center Program, tribes cannot make informed decisions about how best to serve their people.

That is why the IHS and the Center recently signed an agreement supporting a new information-sharing project. The agreement will allow the IHS to provide the NTEC with a list of people who have received health services at IHS, tribal, and urban Indian health programs in the Portland Area. The list will include no information about patients’ medical histories and will not be shared outside the NTEC. The center will then compare the list with outside information sources, such as state cancer registries, to check for racial misclassification.

The NTEC is 1 of 13 national “EpiCenters” charged with collecting tribal health status data, evaluating data monitoring and delivery systems, and helping tribes identify local priorities for health care delivery and health education. NTEC serves the 43 federally recognized tribes in Idaho, Oregon, and Washington. The center is housed in the Northwest Portland Area Indian Health Board (NPAIHB), whose delegates, representing the member tribes, direct and oversee activities, including health promotion, disease prevention, training and technical assistance.

The IHS plans for this to be a pilot project, possibly pointing the way for other tribal EpiCenters to launch similar projects.

American Indians and Alaska Natives (AI/AN) are often misidentified as other races in public health administrative records. In the Northwest, for instance, the Northwest Tribal Epidemiology Center (NTEC) has found that about 10% of AI/AN birth and death records and up to 60% of hospitalization records are misclassified.

Racial misclassification makes it difficult to accurately assess the health of Native people: The numbers affected by a disease may appear lower or higher than they actually are. It can muddle and misrepresent information in birth certificates, cancer registries, death certificates, emergency department records, hospitalization records, injury reports. Without accurate health data, says Lisa Neel, director of the Indian Health Service (IHS) Tribal Epidemiology Center Program, tribes cannot make informed decisions about how best to serve their people.

That is why the IHS and the Center recently signed an agreement supporting a new information-sharing project. The agreement will allow the IHS to provide the NTEC with a list of people who have received health services at IHS, tribal, and urban Indian health programs in the Portland Area. The list will include no information about patients’ medical histories and will not be shared outside the NTEC. The center will then compare the list with outside information sources, such as state cancer registries, to check for racial misclassification.

The NTEC is 1 of 13 national “EpiCenters” charged with collecting tribal health status data, evaluating data monitoring and delivery systems, and helping tribes identify local priorities for health care delivery and health education. NTEC serves the 43 federally recognized tribes in Idaho, Oregon, and Washington. The center is housed in the Northwest Portland Area Indian Health Board (NPAIHB), whose delegates, representing the member tribes, direct and oversee activities, including health promotion, disease prevention, training and technical assistance.

The IHS plans for this to be a pilot project, possibly pointing the way for other tribal EpiCenters to launch similar projects.

American Indians and Alaska Natives (AI/AN) are often misidentified as other races in public health administrative records. In the Northwest, for instance, the Northwest Tribal Epidemiology Center (NTEC) has found that about 10% of AI/AN birth and death records and up to 60% of hospitalization records are misclassified.

Racial misclassification makes it difficult to accurately assess the health of Native people: The numbers affected by a disease may appear lower or higher than they actually are. It can muddle and misrepresent information in birth certificates, cancer registries, death certificates, emergency department records, hospitalization records, injury reports. Without accurate health data, says Lisa Neel, director of the Indian Health Service (IHS) Tribal Epidemiology Center Program, tribes cannot make informed decisions about how best to serve their people.

That is why the IHS and the Center recently signed an agreement supporting a new information-sharing project. The agreement will allow the IHS to provide the NTEC with a list of people who have received health services at IHS, tribal, and urban Indian health programs in the Portland Area. The list will include no information about patients’ medical histories and will not be shared outside the NTEC. The center will then compare the list with outside information sources, such as state cancer registries, to check for racial misclassification.

The NTEC is 1 of 13 national “EpiCenters” charged with collecting tribal health status data, evaluating data monitoring and delivery systems, and helping tribes identify local priorities for health care delivery and health education. NTEC serves the 43 federally recognized tribes in Idaho, Oregon, and Washington. The center is housed in the Northwest Portland Area Indian Health Board (NPAIHB), whose delegates, representing the member tribes, direct and oversee activities, including health promotion, disease prevention, training and technical assistance.

The IHS plans for this to be a pilot project, possibly pointing the way for other tribal EpiCenters to launch similar projects.

Do parents pass along posttraumatic stress disorder (PTSD) to their children? Researchers from Universidade do Porto in Portugal, say although it seems a reasonable possibility, the “degree of controversy is high,” and studies have had conflicting results. For instance, some research has found that children of war veterans with PTSD have higher depression scores and higher rates of aggression and anxiety. While other research has shown no differences between veterans’ and nonveterans’ children.

The Universidade do Porto study involved 46 veterans of Portugal’s war with Angola, Mozambique, and Guinea from 1961 to 1974. The researchers studied the association of war veterans’ PTSD lifetime diagnosis and war exposure intensity with the self-reported psychopathology of their adult offspring, assessed 40 years after the end of the war. They also studied childhood adversities and attachment patterns, which have been implicated in intergenerational transmission of trauma and PTSD.

Both veterans and offspring were assessed via questionnaires, clinical interviews, and symptom scales, including the Brief Symptom Inventory (BSI). The veterans also answered the War Experiences Questionnaire. Offspring of fathers with PTSD were not different from offspring of fathers without PTSD, with respect to age, gender, socioeconomic status, and marital status.

The researchers found no association between the veterans’ lifetime PTSD and their children’s psychopathology, attachment dimensions, and self-reported overall childhood maltreatment. The fathers’ war experience carried more weight. It seemed, the researchers say, that the children were able to overcome living with a parent’s PTSD symptoms, but they were less resilient when it came to their fathers’ war experience.

Veterans’ war exposure was associated with BSI in the offspring with regard to somatization, phobic anxiety, Global Severity Index, and Positive Symptom Distress Index. It was also associated with offspring’s physical neglect as a childhood adversity.

These findings could have considerable social importance, the researchers say. They suggest that mental health support could benefit the children especially if provided early after highly traumatized veterans return from war, “not just later on—if and when they develop PTSD.”

Do parents pass along posttraumatic stress disorder (PTSD) to their children? Researchers from Universidade do Porto in Portugal, say although it seems a reasonable possibility, the “degree of controversy is high,” and studies have had conflicting results. For instance, some research has found that children of war veterans with PTSD have higher depression scores and higher rates of aggression and anxiety. While other research has shown no differences between veterans’ and nonveterans’ children.

The Universidade do Porto study involved 46 veterans of Portugal’s war with Angola, Mozambique, and Guinea from 1961 to 1974. The researchers studied the association of war veterans’ PTSD lifetime diagnosis and war exposure intensity with the self-reported psychopathology of their adult offspring, assessed 40 years after the end of the war. They also studied childhood adversities and attachment patterns, which have been implicated in intergenerational transmission of trauma and PTSD.

Both veterans and offspring were assessed via questionnaires, clinical interviews, and symptom scales, including the Brief Symptom Inventory (BSI). The veterans also answered the War Experiences Questionnaire. Offspring of fathers with PTSD were not different from offspring of fathers without PTSD, with respect to age, gender, socioeconomic status, and marital status.

The researchers found no association between the veterans’ lifetime PTSD and their children’s psychopathology, attachment dimensions, and self-reported overall childhood maltreatment. The fathers’ war experience carried more weight. It seemed, the researchers say, that the children were able to overcome living with a parent’s PTSD symptoms, but they were less resilient when it came to their fathers’ war experience.

Veterans’ war exposure was associated with BSI in the offspring with regard to somatization, phobic anxiety, Global Severity Index, and Positive Symptom Distress Index. It was also associated with offspring’s physical neglect as a childhood adversity.

These findings could have considerable social importance, the researchers say. They suggest that mental health support could benefit the children especially if provided early after highly traumatized veterans return from war, “not just later on—if and when they develop PTSD.”

Do parents pass along posttraumatic stress disorder (PTSD) to their children? Researchers from Universidade do Porto in Portugal, say although it seems a reasonable possibility, the “degree of controversy is high,” and studies have had conflicting results. For instance, some research has found that children of war veterans with PTSD have higher depression scores and higher rates of aggression and anxiety. While other research has shown no differences between veterans’ and nonveterans’ children.

The Universidade do Porto study involved 46 veterans of Portugal’s war with Angola, Mozambique, and Guinea from 1961 to 1974. The researchers studied the association of war veterans’ PTSD lifetime diagnosis and war exposure intensity with the self-reported psychopathology of their adult offspring, assessed 40 years after the end of the war. They also studied childhood adversities and attachment patterns, which have been implicated in intergenerational transmission of trauma and PTSD.

Both veterans and offspring were assessed via questionnaires, clinical interviews, and symptom scales, including the Brief Symptom Inventory (BSI). The veterans also answered the War Experiences Questionnaire. Offspring of fathers with PTSD were not different from offspring of fathers without PTSD, with respect to age, gender, socioeconomic status, and marital status.

The researchers found no association between the veterans’ lifetime PTSD and their children’s psychopathology, attachment dimensions, and self-reported overall childhood maltreatment. The fathers’ war experience carried more weight. It seemed, the researchers say, that the children were able to overcome living with a parent’s PTSD symptoms, but they were less resilient when it came to their fathers’ war experience.

Veterans’ war exposure was associated with BSI in the offspring with regard to somatization, phobic anxiety, Global Severity Index, and Positive Symptom Distress Index. It was also associated with offspring’s physical neglect as a childhood adversity.

These findings could have considerable social importance, the researchers say. They suggest that mental health support could benefit the children especially if provided early after highly traumatized veterans return from war, “not just later on—if and when they develop PTSD.”

“Smoldering” lesions—signaling chronic inflammation—may be a hallmark of more aggressive forms of multiple sclerosis (MS), according to researchers from the National Institute of Neurological Disorders and Stroke (NINDS). New technology that allows long-term in vivo monitoring could make it possible for the first time to predict who is at risk for progressive MS and potential treatments.

MS lesions appear as spots on brain scans. Some lesions heal. Others remain and may have characteristic dark rims, which is inflammatory demyelination at the edges. The dark-rimmed lesions appear to expand, or “smolder” for years. But until recently, researchers did not fully understand what role those chronic active lesions played in MS because it was difficult to find the ones that remain inflamed.

The researchers conducted 3 studies at the NIH Clinical Center. In the first, using a high-powered, 7-tesla MRI scanner and a 3D printer, they scanned the brains of 192 MS patients. Of those, 40% had no rimmed lesions; 32% had 1 to 3 rims; and 20% had ≥ 4 rims. Regardless of the treatment they were receiving, 56% of the patients had at < 1 rimmed lesion.  

The researchers compared the brain scans to the patients’ baseline neurologic examinations. Patients with ≥ 4 rimmed lesions were nearly twice as likely to be diagnosed with progressive MS than were those without rimmed lesions. Moreover, the patients with rimmed lesions developed motor and cognitive disabilities at a younger age than did patients without rimmed lesions. Patients with ≥ 4 rimmed lesions also had less white matter and smaller basal ganglia.

When they analyzed a subset of patients whose brains had been scanned once a year for ≥ 10 years, the researchers found that although the rimless lesions generally shrank, the rimmed lesions grew or stayed the same size and were “particularly damaged.”

The team also used a 3D printer to compare the spots they had seen on scans with lesions in brain tissue samples from a patient who died during the trial. All 10 expanding rimmed spots on the scans had the “telltale features” of chronic active lesions when examined under a microscope.

“Figuring out how to spot chronic active lesions was a big step,” said research team member Martina Absinta, MD, PhD. “We could not have done it without the high-powered MRI scanner.” Most MRI scanners used clinically have field strengths of 1.5 or 3 Tesla. The research team had previously published instructions for programming lower powered MRI scanners to detect rimmed chronic active lesions.

Chronic active lesions are common and exert ongoing tissue damage, said Daniel S. Reich, MD, PHD, senior investigator at NINDS, and senior author of the paper. The fact that these lesions are present in patients who are receiving anti-inflammatory drugs, he added, suggests that the field of MS research may want to focus on new treatments that target the brain’s unique immune system—especially a type of brain cell called microglia, which are instrumental in the immune response.

Their findings, the researchers say, should prompt MRI-based clinical trials aimed at treating perilesional chronic inflammation in MS. Dr. Reich said, “Our results point the way toward using specialized brain scans to predict who is at risk of developing progressive MS.”

“Smoldering” lesions—signaling chronic inflammation—may be a hallmark of more aggressive forms of multiple sclerosis (MS), according to researchers from the National Institute of Neurological Disorders and Stroke (NINDS). New technology that allows long-term in vivo monitoring could make it possible for the first time to predict who is at risk for progressive MS and potential treatments.

MS lesions appear as spots on brain scans. Some lesions heal. Others remain and may have characteristic dark rims, which is inflammatory demyelination at the edges. The dark-rimmed lesions appear to expand, or “smolder” for years. But until recently, researchers did not fully understand what role those chronic active lesions played in MS because it was difficult to find the ones that remain inflamed.

The researchers conducted 3 studies at the NIH Clinical Center. In the first, using a high-powered, 7-tesla MRI scanner and a 3D printer, they scanned the brains of 192 MS patients. Of those, 40% had no rimmed lesions; 32% had 1 to 3 rims; and 20% had ≥ 4 rims. Regardless of the treatment they were receiving, 56% of the patients had at < 1 rimmed lesion.  

The researchers compared the brain scans to the patients’ baseline neurologic examinations. Patients with ≥ 4 rimmed lesions were nearly twice as likely to be diagnosed with progressive MS than were those without rimmed lesions. Moreover, the patients with rimmed lesions developed motor and cognitive disabilities at a younger age than did patients without rimmed lesions. Patients with ≥ 4 rimmed lesions also had less white matter and smaller basal ganglia.

When they analyzed a subset of patients whose brains had been scanned once a year for ≥ 10 years, the researchers found that although the rimless lesions generally shrank, the rimmed lesions grew or stayed the same size and were “particularly damaged.”

The team also used a 3D printer to compare the spots they had seen on scans with lesions in brain tissue samples from a patient who died during the trial. All 10 expanding rimmed spots on the scans had the “telltale features” of chronic active lesions when examined under a microscope.

“Figuring out how to spot chronic active lesions was a big step,” said research team member Martina Absinta, MD, PhD. “We could not have done it without the high-powered MRI scanner.” Most MRI scanners used clinically have field strengths of 1.5 or 3 Tesla. The research team had previously published instructions for programming lower powered MRI scanners to detect rimmed chronic active lesions.

Chronic active lesions are common and exert ongoing tissue damage, said Daniel S. Reich, MD, PHD, senior investigator at NINDS, and senior author of the paper. The fact that these lesions are present in patients who are receiving anti-inflammatory drugs, he added, suggests that the field of MS research may want to focus on new treatments that target the brain’s unique immune system—especially a type of brain cell called microglia, which are instrumental in the immune response.

Their findings, the researchers say, should prompt MRI-based clinical trials aimed at treating perilesional chronic inflammation in MS. Dr. Reich said, “Our results point the way toward using specialized brain scans to predict who is at risk of developing progressive MS.”

“Smoldering” lesions—signaling chronic inflammation—may be a hallmark of more aggressive forms of multiple sclerosis (MS), according to researchers from the National Institute of Neurological Disorders and Stroke (NINDS). New technology that allows long-term in vivo monitoring could make it possible for the first time to predict who is at risk for progressive MS and potential treatments.

MS lesions appear as spots on brain scans. Some lesions heal. Others remain and may have characteristic dark rims, which is inflammatory demyelination at the edges. The dark-rimmed lesions appear to expand, or “smolder” for years. But until recently, researchers did not fully understand what role those chronic active lesions played in MS because it was difficult to find the ones that remain inflamed.

The researchers conducted 3 studies at the NIH Clinical Center. In the first, using a high-powered, 7-tesla MRI scanner and a 3D printer, they scanned the brains of 192 MS patients. Of those, 40% had no rimmed lesions; 32% had 1 to 3 rims; and 20% had ≥ 4 rims. Regardless of the treatment they were receiving, 56% of the patients had at < 1 rimmed lesion.  

The researchers compared the brain scans to the patients’ baseline neurologic examinations. Patients with ≥ 4 rimmed lesions were nearly twice as likely to be diagnosed with progressive MS than were those without rimmed lesions. Moreover, the patients with rimmed lesions developed motor and cognitive disabilities at a younger age than did patients without rimmed lesions. Patients with ≥ 4 rimmed lesions also had less white matter and smaller basal ganglia.

When they analyzed a subset of patients whose brains had been scanned once a year for ≥ 10 years, the researchers found that although the rimless lesions generally shrank, the rimmed lesions grew or stayed the same size and were “particularly damaged.”

The team also used a 3D printer to compare the spots they had seen on scans with lesions in brain tissue samples from a patient who died during the trial. All 10 expanding rimmed spots on the scans had the “telltale features” of chronic active lesions when examined under a microscope.

“Figuring out how to spot chronic active lesions was a big step,” said research team member Martina Absinta, MD, PhD. “We could not have done it without the high-powered MRI scanner.” Most MRI scanners used clinically have field strengths of 1.5 or 3 Tesla. The research team had previously published instructions for programming lower powered MRI scanners to detect rimmed chronic active lesions.

Chronic active lesions are common and exert ongoing tissue damage, said Daniel S. Reich, MD, PHD, senior investigator at NINDS, and senior author of the paper. The fact that these lesions are present in patients who are receiving anti-inflammatory drugs, he added, suggests that the field of MS research may want to focus on new treatments that target the brain’s unique immune system—especially a type of brain cell called microglia, which are instrumental in the immune response.

Their findings, the researchers say, should prompt MRI-based clinical trials aimed at treating perilesional chronic inflammation in MS. Dr. Reich said, “Our results point the way toward using specialized brain scans to predict who is at risk of developing progressive MS.”