Massachusetts Veterans Epidemiology Research and Information Center

Boston, MA, United States

Massachusetts Veterans Epidemiology Research and Information Center

Boston, MA, United States
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Farwell W.R.,Massachusetts Veterans Epidemiology Research and Information Center | Farwell W.R.,VA Boston Healthcare System | D'Avolio L.W.,Massachusetts Veterans Epidemiology Research and Information Center | Lawler E.V.,Massachusetts Veterans Epidemiology Research and Information Center | And 3 more authors.
Journal of the National Cancer Institute | Year: 2011

Background Although prostate cancer is commonly diagnosed, few risk factors for high-grade prostate cancer are known and few prevention strategies exist. Statins have been proposed as a possible treatment to prevent prostate cancer.MethodsUsing electronic and administrative files from the Veterans Affairs New England Healthcare System, we identified 55875 men taking either a statin or antihypertensive medication. We used age- and multivariable-adjusted Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for prostate cancer incidence among patients taking statins (n = 41078) compared with patients taking antihypertensive medications (n = 14797). We performed similar analyses for all lipid parameters including total cholesterol examining each lipid parameter as a continuous variable and by quartiles. All statistical tests were two-sided.ResultsCompared with men taking an antihypertensive medication, statin users were 31% less likely (HR = 0.69, 95% CI = 0.52 to 0.90) to be diagnosed with prostate cancer. Furthermore, statin users were 14% less likely (HR = 0.86, 95% CI = 0.62 to 1.20) to be diagnosed with low-grade prostate cancer and 60% less likely (HR = 0.40, 95% CI = 0.24 to 0.65) to be diagnosed with high-grade prostate cancer compared with antihypertensive medication users. Increased levels of total cholesterol were also associated with both total (HR = 1.02, 95% CI = 1.00 to 1.05) and high-grade (HR = 1.06, 95% CI = 1.02 to 1.10) prostate cancer incidence but not with low-grade prostate cancer incidence (HR = 1.01, 95% CI = 0.98 to 1.04).ConclusionsStatin use is associated with statistically significantly reduced risk for total and high-grade prostate cancer, and increased levels of serum cholesterol are associated with higher risk for total and high-grade prostate cancer. These findings indicate that clinical trials of statins for prostate cancer prevention are warranted. © 2011 The Author.

News Article | February 15, 2017

February 13, 2017 -- A study just released by Columbia University's Mailman School of Public Health reports on the health of American women who were deployed to Vietnam for either military or civilian service. The results show that 48 percent of career military women were very happy compared to 38 percent of women in the general population, and of better than average physical and mental health. The study is the first study to describe the experiences of civilian women deployed to a warzone, compare them to those of military women and match the patterns of general health and happiness for women deployed to Vietnam with a representative sample of their peers. Findings are published online in the journal Social Science & Medicine--Population Health. In addition to positive aspects of service, adverse effects were also noted. Women who served less than 10 years in the military were more likely to report their Vietnam experience as "highly stressful" (28 percent) compared to career military women who served more than 20 years (12 percent) and civilian women (13 percent). They cited such stressors as poor living and working conditions, exposure to the consequences of war, physical threat, negative interpersonal experiences (including rape and sexual harassment), and drug and alcohol problems. About 265,000 women served in the U.S. military during the Vietnam Era, with as many as 11,000 deployed to Vietnam but not formally assigned combat roles. Nonetheless, they were deployed to combat zones where they experienced warzone stressors and hostile fire. "Our results suggest that a military career--which by military rules in force during the Vietnam era, precluded a woman from typical wife and mother roles--afforded women a meaningful experience that continued to positively impact their emotional well-being, even decades after the war," said Jeanne Mager Stellman, PhD, professor emerita of Health Policy and Management and senior author. Career military women who never had children also reported being happier than the average American woman. "Women who volunteered and went to Vietnam in the 1960s may have done so as a way of breaking away from the traditional roles assigned to women in the United States during that time, and they seem to have continued on a different trajectory in post-war years," said Dr. Stellman. Collaborating with the Vietnam Women's Memorial Project, Dr. Stellman and colleagues at the VA National Center for PTSD, VA Boston Healthcare System and Boston University School of Medicine also compared civilian women, primarily American Red Cross workers, to military women and studied how warzone experiences, exposure to casualties and sexual harassment, affected their current health. They also compared the deployed women to women of comparable age in the General Social Survey, a widely used representative study of Americans. Both military and civilian women who served in Vietnam, regardless of whether they continued to make the military their career, were less likely to have married or have had children than women from the general population. Deployment to Vietnam for both military and civilian women had other positive aspects. Many women reported satisfaction from their work with the wounded troops and civilians in Vietnam. Those who served as nurses, in particular, commented that they were given much more responsibility in their positions while in Vietnam than they would have had in a similar civilian job in the U. S. An earlier paper by Dr. Stellman and the Boston-VA based group evaluated the psychological well-being of approximately 1,300 female military personnel, Red Cross workers, and others deployed to Vietnam. "Our new study underscores the benefits of a military career for those women who chose it," noted Dr. Stellman. "Entering military service or volunteering for civilian activities in a warzone offered an opportunity for talented women to establish careers, and rise to high ranks and achieve positions that would be impossible in the civilian world. In addition, career military women in general, lived in a supportive community that was knowledgeable and sympathetic to their work. What we learned from this study can help to improve the experiences and well-being of current and future generations of female military personnel," noted Dr. Stellman. Co-authors include Anica Pless Kaiser and Eve H. Davison, Veteran Affairs A National Center for PTSD, Veteran Affairs Boston Healthcare System and Boston University School of Medicine; Avron Spiro III, Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System and Boston University Schools of Public Health and Medicine; Daniel H. Kabat, Mailman School of Public Health, now Gold Health Strategies, Inc. The study was supported by the National Academy of Sciences (NAS-VA-5124-98-001), National Institute on Aging (R24-AG039343), and U.S. Department of Veterans Affairs (IK2 RX001832-01A2. Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit http://www. .

Litz B.T.,National Center for PTSD | Litz B.T.,Massachusetts Veterans Epidemiology Research and Information Center | Litz B.T.,Boston University | Salters-Pedneault K.,Eastern Connecticut State University | And 6 more authors.
Journal of Psychiatric Research | Year: 2012

d-Cycloserine (DCS) is a partial NMDA receptor agonist that has been shown to enhance therapeutic response to exposure-based treatments for anxiety disorders, but has not been tested in the treatment of combat-related posttraumatic stress disorder (PTSD). The aim of this randomized, double-blind, placebo-controlled trial was to determine whether DCS augments exposure therapy for PTSD in veterans returning from Iraq and Afghanistan and to test whether a brief six-session course of exposure therapy could effectively reduce PTSD symptoms in returning veterans. In contrast to previous trials using DCS to enhance exposure therapy, results indicated that veterans in the exposure therapy plus DCS condition experienced significantly less symptom reduction than those in the exposure therapy plus placebo condition over the course of the treatment. Possible reasons for why DCS was associated with poorer outcome are Registry #: NCT00371176; A Placebo-Controlled Trail of d-Cycloserine and Exposure Therapy for Combat-PTSD; © 2012.

Miller M.,Northeastern University | Barber C.W.,Boston University | Leatherman S.,Massachusetts Veterans Epidemiology Research and Information Center | Leatherman S.,Boston University | And 8 more authors.
JAMA Internal Medicine | Year: 2015

IMPORTANCE: The unprecedented increase in unintentional overdose events that has occurred in tandem with escalating sales of prescription opioids over the past 2 decades has raised concerns about whether the therapeutic use of opioids has contributed to increases in overdose injury. Few controlled studies have examined the extent to which ecologic measures of increases in opioid prescribing and overdose injuries reflect risk among patients prescribed opioids, let alone whether some opioid regimens are safer than others. OBJECTIVE: To examine whether the risk of unintentional overdose injury is associated with the duration of opioid action (ie, long-acting vs short-acting formulations). DESIGN, SETTING, AND PARTICIPANTS: A propensity score-adjusted cohort study was conducted using population-based health care utilization data from the Veterans Administration Healthcare System. The patients were veterans with chronic painful conditions who began therapy with opioid analgesics between January 1, 2000, and December 31, 2009. MAIN OUTCOMES AND MEASURES: Unintentional overdoses that are explicitly coded using International Classification of Disease, Ninth Revision codes as drug or medication poisonings of accidental intent (E850.x-860.x) or undetermined intent (E980.x or drug poisoning [960.x-980.x] without an accompanying external cause of injury code). RESULTS: A total of 319 unintentional overdose events were observed. Patients initiating therapy with long-acting opioids were more than twice as likely to overdose compared with persons initiating therapy with short-acting opioids. After adjustment for age, sex, opioid dose, and other clinical characteristics, patients receiving long-acting opioids had a significantly higher rate of overdose injury than did those receiving short-acting opioids (hazard ratio [HR], 2.33; 95% CI, 1.26-4.32). The risk associated with long-acting agents was particularly marked during the first 2 weeks after initiation of treatment (HR, 5.25; 1.88-14.72). CONCLUSIONS AND RELEVANCE: To our knowledge, the findings of the present study provide the first evidence that the risk of unintentional overdose injury is related to the prescribed opioid's duration of action. If replicated in other cohorts, our findings suggest that clinicians weighing the benefits and risks of initiating different opioid regimens should consider not only the daily dose prescribed but also the duration of opioid action, favoring short-acting agents whenever possible, especially during the first 2 weeks of therapy. Copyright 2015 American Medical Association. All rights reserved.

Spiro 3rd. A.,Massachusetts Veterans Epidemiology Research and Information Center
The journals of gerontology. Series B, Psychological sciences and social sciences | Year: 2011

We argue that age is a descriptive, and not explanatory, variable and consequently cannot account for the cognitive changes that often occur with aging. Once age is removed from consideration, other truly causal explanations for "cognitive aging" must be identified. We argue that health and disease represent an important class of explanatory variables for age-related cognitive changes. We make this argument first by reviewing the prevalence of risk factors, disability, and subclinical and frank disease in the elderly population. We emphasize that the complexity of health effects rivals that of age on cognition while noting that most studies of cognitive aging rarely consider this complexity fully. We then consider in more detail the "vascular hypothesis," which proposes that vascular diseases (e.g., stroke, heart disease) and their risk factors (e.g., hypertension) can explain aspects of cognitive decline in aging through their impact on circulatory and brain functions. Clinical implications of this hypothesis suggest that treatment of vascular risk factors might well reduce the incidence or severity of dementia syndromes. We conclude with a brief summary of approaches to further integrate aspects of health and disease into the study of "cognitive aging."

D'Avolio L.W.,Massachusetts Veterans Epidemiology Research and Information Center | D'Avolio L.W.,Brigham and Women's Hospital | D'Avolio L.W.,Harvard University | Nguyen T.M.,Massachusetts Veterans Epidemiology Research and Information Center | And 3 more authors.
Journal of the American Medical Informatics Association | Year: 2011

Objective: Despite at least 40 years of promising empirical performance, very few clinical natural language processing (NLP) or information extraction systems currently contribute to medical science or care. The authors address this gap by reducing the need for custom software and rules development with a graphical user interface-driven, highly generalizable approach to concept-level retrieval. Materials and methods: A 'learn by example' approach combines features derived from open-source NLP pipelines with open-source machine learning classifiers to automatically and iteratively evaluate top-performing configurations. The Fourth i2b2/VA Shared Task Challenge's concept extraction task provided the data sets and metrics used to evaluate performance. Results: Top F-measure scores for each of the tasks were medical problems (0.83), treatments (0.82), and tests (0.83). Recall lagged precision in all experiments. Precision was near or above 0.90 in all tasks. Discussion: With no customization for the tasks and less than 5 min of end-user time to configure and launch each experiment, the average F-measure was 0.83, one point behind the mean F-measure of the 22 entrants in the competition. Strong precision scores indicate the potential of applying the approach for more specific clinical information extraction tasks. There was not one best configuration, supporting an iterative approach to model creation. Conclusion Acceptable levels of performance can be achieved using fully automated and generalizable approaches to concept-level information extraction. The described implementation and related documentation is available for download.

Edwards S.T.,Veterans Affairs VA Boston Healthcare System | Edwards S.T.,Massachusetts Veterans Epidemiology Research and Information Center | Edwards S.T.,Harvard University | Mafi J.N.,Harvard University | And 3 more authors.
Journal of General Internal Medicine | Year: 2014

BACKGROUND: Although many specialists serve as primary care physicians (PCPs), the type of patients they serve, the range of services they provide, and the quality of care they deliver is uncertain. OBJECTIVE: To describe trends in patient, physician, and visit characteristics, and compare visit-based quality for visits to generalists and specialists self-identified as PCPs. DESIGN: Cross-sectional study and time trend analysis. DATA: Nationally representative sample of visits to office-based physicians from the National Ambulatory Medical Care Survey, 1997-2010. MAIN MEASURES: Proportions of primary care visits to generalist and specialists, patient characteristics, principal diagnoses, and quality. KEY RESULTS: Among 84,041 visits to self-identified PCPs representing an estimated 4.0 billion visits, 91.5 % were to generalists, 5.9 % were to medical specialists and 2.6 % were to obstetrician/gynecologists. The proportion of PCP visits to generalists increased from 88.4 % in 1997 to 92.4 % in 2010, but decreased for medical specialists from 8.0 % to 4.8 %, p = 0.04). The proportion of medical specialist visits in which the physician self-identified as the patient's PCP decreased from 30.6 % in 1997 to 9.8 % in 2010 (p < 0.01). Medical specialist PCPs take care of older patients (mean age 61 years), and dedicate most of their visits to chronic disease management (51.0 %), while generalist PCPs see younger patients (mean age 55.4 years) most commonly for new problems (40.5 %). Obstetrician/gynecologists self-identified as PCPs see younger patients (mean age 38.3 p < 0.01), primarily for preventive care (54.0 %, p < 0.01). Quality of care for cardiovascular disease was better in visits to cardiologists than in visits to generalists, but was similar or better in visits to generalists compared to visits to other medical specialists. CONCLUSIONS: Medical specialists are less frequently serving as PCPs for their patients over time. Generalist, medical specialist, and obstetrician/ gynecologist PCPs serve different primary care roles for different populations. Delivery redesign efforts must account for the evolving role of generalist and specialist PCPs in the delivery of primary care. © 2014 Society of General Internal Medicine.

Dhingra R.,Dartmouth Hitchcock Medical Center | Dhingra R.,Harvard University | Gaziano J.M.,Harvard University | Gaziano J.M.,Massachusetts Veterans Epidemiology Research and Information Center | And 2 more authors.
Circulation: Heart Failure | Year: 2011

Background-The relations between chronic kidney disease (CKD) and incident heart failure remain unclear. Methods and Results-We related CKD to incident nonfatal heart failure and cardiovascular (CVD) death (as separate and combined end points) in 10 181 male participants (mean age, 67 years). Kidney function was assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation in clinically relevant categories of <60 and ≥60 mL·min-1 · 1.73 m-2 (referent) and <45, 45 to 60, 60 to 90, and ≥90 mL · min -1 · 1.73 m-2 (referent). During follow-up (mean, 10.1 years; range, 0.03 to 12.2), 439 developed heart failure and 832 had CVD death/heart failure. In multivariable models, men with eGFR <60 mL · min-1 · 1.73 m-2 had a 2-fold risk of heart failure (95% confidence interval, 1.62 to 2.56, P<0.0001) compared with referent category. The hazard ratio (with corresponding 95% confidence interval) for development of heart failure according to eGFR categories of 60 to 90, 45 to 60, and <45 mL · min-1 · 1.73 m-2 compared with referent category were 1.24 (0.98 to 1.56), 2.58 (1.91 to 3.49), and 1.52 (0.92 to 2.76), respectively. In the analyses restricted to subgroup of nondiabetic individuals and normotensive individuals at baseline (n=7545), men with eGFR <60 mL · min-1 · 1.73 m-2 had a 2.2-fold risk of heart failure (95% confidence interval, 1.66 to 2.95), compared with men with eGFR ≥60 mL · min-1 · 1.73 m-2. Additionally, risk of heart failure or CVD death was >2.5-fold higher among individuals with eGFR 45 to 60 and <45 mL · min-1 · 1.73 m-2, compared with referent category. Conclusions-Moderate level of CKD, even in absence of diabetes and hypertension at baseline, is associated with a higher risk of development of heart failure and CVD death/heart failure in men. (Circ Heart Fail. 2011;4:138-144.). © 2011 American Heart Association, Inc.

Miller M.,Harvard University | Barber C.,Harvard University | Young M.,Massachusetts Veterans Epidemiology Research and Information Center | Azrael D.,Harvard University | And 2 more authors.
American Journal of Public Health | Year: 2012

Objectives: We assessed the risk of suicide among veterans compared with nonveterans. Methods: Cox proportional hazards models estimated the relative risk of suicide, by self-reported veteran status, among 500 822 adult male participants in the National Death Index (NDI)-linked National Health Interview Survey (NHIS), a nationally representative cohort study. Results. A total of 482 male veterans died by suicide during 1 837 886 personyears of follow-up (76% by firearm); 835 male nonveterans died by suicide during 4 438 515 person-years of follow-up (62% by firearm). Crude suicide rates for veterans and nonveterans were, respectively, 26.2 and 18.8 per 100 000 person-years. The risk of suicide was not significantly higher among veterans, compared with nonveterans, after adjustment for differences in age, race, and survey year (hazard ratio = 1.11; 95% confidence interval = 0.96, 1.29). Conclusions: Consistent with most studies of suicide risk among veterans of conflicts before Operation Iraqi Freedom/Operation Enduring Freedom, but in contrast to a previous study using the NDI-linked NHIS data, we found that male veterans responding to the NHIS were modestly, but not significantly, at higher risk for suicide compared with male nonveterans.

Wang L.,Harvard University | Sesso H.D.,Harvard University | Glynn R.J.,Harvard University | Christen W.G.,Harvard University | And 5 more authors.
American Journal of Clinical Nutrition | Year: 2014

Background: Recent posttrial analysis of a completed randomized trial found an increased risk of prostate cancer among healthy men taking high-dose vitamin E supplements. Trials that examined the effect of vitamin C supplements on cancer risk are few. Objective: We examined whether vitamin E or vitamin C supplementation affects the risk of cancer events during posttrial follow-up of the Physicians' Health Study II. Design: Beginning in 1997, a total of 14,641 US male physicians aged ≥50 y were randomly assigned to receive 400 IU of vitamin E every other day, 500 mg of vitamin C daily, or their respective placebos. The vitamin E and vitamin C treatment ended in 2007, and observational follow-up continued through June 2011. Results: This study included an additional 356 cases of incident prostate cancer and 771 total cancers that developed during a mean (maximum) of 2.8 (3.8) y of posttrial observation. During an overall mean of 10.3 (13.8) y, there were a total of 1373 incident prostate cancers and 2669 total cancers documented. In comparison with placebo, vitamin E supplementation had no effect on the incidence of prostate cancer (HR: 0.99; 95% CI: 0.89, 1.10) or total cancers (HR: 1.02; 95% CI: 0.95, 1.10). There was also no effect of vitamin C supplementation on total cancers (HR: 1.02; 95% CI: 0.94, 1.10) or incident prostate cancer (HR: 1.03; 95% CI: 0.93, 1.15). Neither vitamin E nor vitamin C supplementation had effects on other site-specific cancers overall. Stratification by known cancer risk factors, history of cancer, other randomized treatment, and follow-up time showed no significant interactions. Conclusion: In this large-scale randomized trial in men, vitamin E and C supplementation had no immediate or long-term effects on the risk of total cancers, prostate cancer, or other site-specific cancers. This trial was registered at as NCT00270647. © 2014 American Society for Nutrition.

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