UAB clinical psychologist Dr. Josh Klapow says hurricane-weary residents of the Caribbean and Southeastern United States are in an emotional marathon to get back safely to home and now have to gear up emotionally for potentially another storm. People do have emotional bandwidth and thresholds, at some point the body and the mind gives up and give in. The emotional fatigue for victims, first responders, and the general public effects how we respond, how intensely we respond, how we are able to survive. Klapow says there are coping techniques that can help shore up the emotional and physiological reserves needed to handle a potential second strike. In the long run- however, a small number of people may permanently see an alteration of their psychological state. PTSD, depression, anxiety disorders are likely. UAB's broadcast studio is available for live or taped interviews.
A new study finds that patients with cancer, especially those aged 75 or older, are more likely to be admitted to the hospital – and less likely to be observed and released home – than patients without cancer. That’s despite the fact that inpatient admission is not always the best treatment option available. Observation status is often preferable because it minimizes patients' exposure to the inconvenience and risk of a hospital admission, while also reserving hospital resources for those who need it most. The research was led by Allison Lipitz-Snyderman, PhD, Assistant Attending Outcomes Research Scientist, Memorial Sloan Kettering Cancer Center, along with Adam Klotz, MD; Renee L. Gennarelli, MS; and Jeffrey Groeger, MD. The findings were published in the October issue of JNCCN – Journal of the National Comprehensive Cancer Network. “Observation status allows for additional time to be certain that a patient's clinical status is stabilized and that the correct diagnosis has been made, providing the treating staff, patient, and caregiver with a greater feeling of security upon discharge,” explained Dr. Groeger. “Not all acutely ill patients in the emergency department will ultimately require inpatient admission prior to safe discharge. Patients in observation status should be suitable for rapid discharge once symptoms resolve or diagnoses are confirmed.” After adjusting for patient characteristics, the researchers determined that there were only 43 observation status visits per 1,000 inpatient admissions among patients with cancer, versus 69 per 1,000 among the cancer-free group. In fact, cancer-free patients with prior inpatient admission were still more likely to be placed on observation status than those with cancer but without prior hospitalizations. The research focused on Medicare beneficiaries aged 66 and older. Dr. Lipitz-Snyderman and her team analyzed SEER-Medicare data for a total of 151,193 patients with cancer, matched to a demographically similar control group. Those with cancer had been diagnosed with breast, colon, lung, or prostate cancer between 2006 and 2008. Dr. Lipitz-Snyderman recommends more research to determine where there are opportunities to develop standards for emergency department staff to treat older patients with cancer in the most optimal way. “By implementing a set of standards and treatment protocols for addressing specific clinical conditions, we can increase the systematic use of observation status for patients with cancer,” said Dr. Groeger. “Some examples include the management of pain, nausea, vomiting, diarrhea, constipation, cellulitis, hypercalcemia, and steroid related hyperglycemia. Additionally, partnering with medical and surgical consultants can offer significant relief to patients with pleural effusions, ascites, as well as those with malfunction around the placement of catheters and drains.” “This study raises important questions about how to provide medical care for older adults with cancer who present to the emergency department,” said Dr. Louise C. Walter, MD, Professor of Medicine, Chief, Division of Geriatrics, UCSF Helen Diller Family Comprehensive Cancer Center. Dr. Walter is a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Older Adult Oncology. “As a geriatrician, I would go beyond advocating for developing standards for emergency department staff to manage more patients with cancer in observation status. We need to think broadly about the best location to provide medical care for this population. This should include implementing more Hospital at Home models and Housecalls programs to provide the same level of acute care for certain conditions in a patient's home, in order to avoid the hazards of long emergency department stays and unnecessary hospitalizations.” Complimentary access to the study, “A Population-Based Assessment of Emergency Department Observation Status for Older Adults with Cancer,” is available until December 11, 2017 on   ###  About JNCCN—Journal of the National Comprehensive Cancer Network More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit To inquire if you are eligible for a FREE subscription to JNCCN, visit Follow JNCCN on Twitter @JNCCN.  About the National Comprehensive Cancer Network The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT. Clinicians, visit Patients and caregivers, visit Media, visit Follow NCCN on Twitter @NCCNnews and Facebook @National.Comprehensive.Cancer.Network.
  About a quarter of adults whose marijuana use is problematic in early adulthood have anxiety disorders in childhood and late adolescence, according to new data from Duke Health researchers. The findings, publishing this week in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry, also shed light on an estimated 4 percent of adults who endured childhood maltreatment and peer bullying without resorting to chronic marijuana abuse, only to develop problems with the drug between the ages of 26 and 30. “Given that more states may be moving towards legalization of cannabis for medicinal and recreational purposes, this study raises attention about what we anticipate will be the fastest growing demographic of users -- adults,” said lead author Sherika Hill, Ph.D., an adjunct faculty associate at the Duke University School of Medicine. “A lot of current interventions and policies in the U.S. are aimed at early adolescent users. We have to start thinking about how we are going to address problematic use that may arise in a growing population of older users.” The findings are based on data from 1,229 participants in the Great Smoky Mountains Study, a long-term study of residents in 11 counties near the Appalachian Mountains in western North Carolina, where Hispanics and Latinos are underrepresented and Native Americans are overrepresented compared to the rest of the U.S. A cohort of children in the study were enrolled as young as age 9 and have now reached their 30s. From 1993 to 2015, researchers tracked data in numerous areas of interest, including mental health, education, work attainment, and use of drugs and alcohol. The researchers defined problematic cannabis or marijuana use as daily consumption or a habit that meets diagnostic guidelines for addiction. They tracked participants’ patterns of use from the college years (ages 19-21) into adulthood (ages 26-30). They found more than three-fourths (76.3 percent) of participants didn’t use or develop a problem with marijuana during this period. The remaining quarter developed problems that researchers grouped into three profiles -- those with limited problems, persistent problems and delayed problems. Limited users (13 percent) Limited problematic users had trouble with marijuana either while in school before age 16 or in their late teens and early 20s, but their habits dropped off as they aged.  Researchers were somewhat surprised that this group reported the highest levels of family conflict and instability during childhood as compared to others in the study; these factors are often associated with more drug use.  “When this group of children left home, they seemed to do better,” Hill said. “They didn’t have as many children at a young age, and they went further in their education when they were 19 to 21 compared to those with persistent and delayed profiles.”  Persistent users (7 percent)  This group had trouble with marijuana beginning as young as 9 years old and their chronic use continued into their late 20s and early 30s, the data showed.  Large portions of this group had anxiety disorders in both childhood (27 percent) and at ages 19-21 (23 percent).  They had the highest rates of psychiatric disorders and involvement in the criminal justice system, and most said the majority of their friends were drug users, too.  “This suggests that a focus on mental health and well-being could go a long way to prevent the most problematic use,” Hill said.  Delayed users (4 percent)  This was a small but unique group that made it through adolescence and early adulthood without problematic marijuana use, only to become habitual users between ages 26 and 30.  Blacks were five times as likely as whites to be delayed problematic users in the late 20s and early 30s after not having trouble with the between the ages 19-21 -- a peak time for most marijuana users.  More than half of delayed users were both bullied by peers and mistreated by caregivers as children, yet also had lower rates of anxiety, alcohol use, and other hard drug use compared to persistent users.  “What we don't yet understand is how childhood maltreatment didn’t prompt earlier problematic use of cannabis between ages 19 and 21 -- how individuals could be resilient to that kind of adverse experience for so long,” Hill said. “One theory is that they were somewhat protected by having fewer peers in late adolescence who were substance users, but this is one of the questions we will continue to seek answers for.” In addition to Hill, study authors include E. Jane Costello, Ph.D., and William Copeland, Ph.D., of Duke and Lilly Shanahan Ph.D., of the Jacobs Center for Productive Youth Development, University of Zurich. The research was supported by the National Institutes of Health (NIDA: R01DA036523, R01DA11301, P30DA23026; NIMH: MH094605, MH63970, MH63671, MH48085; NICHD: HD07376) and the William T. Grant Foundation. Full author disclosures are listed in the manuscript.
A few months into his second deployment in Afghanistan in 2015 — which interrupted his studies at the University of Virginia Darden School of Business — U.S. Army Staff Sgt. Michael Sargent found himself trapped by Taliban insurgents in a dark, muddy compound in the country’s tumultuous Helmand province. Sargent’s Special Forces team — an elite Army special operations unit nicknamed the “Green Berets” — led commando operations with Afghan counterparts, typically serving as guides and consultants as the U.S. military scaled down its operations in the country. The events of this particular evening, however, compelled Sargent and the rest of his team to take a very active role. The commando assault team Sargent was tasked with advising had entered the compound, but was forced to retreat under heavy enemy fire. Several commandos were wounded and two were missing. Sargent and a few other teammates returned to find them and again encountered stiff resistance. Ultimately, Sargent and one other soldier were stuck in the compound, trying to retrieve the body of a fallen commando while Taliban fighters fired on them and blocked their only exit. Sargent recalled quickly running through his dwindling options. “There was no way to get out without one of us having to expose our backs, and the gunfire exchanges were not as effective as we wanted,” he said. “So, my teammate twice provided suppressing fire while I advanced to deploy hand grenades into the enemy position. The second grenade started a fire near the insurgents.” The flames forced the Taliban fighters to stage one final assault before fleeing the growing fire, giving Sargent and his teammate the window of opportunity they needed. “At that point, we were able to neutralize the threat, retrieve the fallen commando and get out,” Sargent said. Sargent’s quick thinking that night saved his and his teammates’ lives, allowed them to return the commando’s body to his family and protected the commandos wounded earlier. They also earned him one of the military’s highest honors. In May 2016, Sargent received the Silver Star Medal, the U.S. military’s third-highest personal decoration for valor in combat. Later that year, in December, the United Service Organizations, or USO, presented him with the George Van Cleave Military Leadership Award. One soldier from each branch of the military is nominated for the annual award, which recognizes selfless leaders who inspire and uplift others. “It’s been an incredible, very humbling experience,” said Sargent, who returned to Darden in August 2016. A second deployment to Afghanistan was not part of Sargent’s original plan. After six years of active duty service as a Green Beret – including his first deployment to Afghanistan in 2011 – the Union College graduate had transitioned to the National Guard to pursue his MBA. His friend and mentor, fellow Union alumnus and Green Beret Kevin Flike, had attended business school after being wounded in combat and convinced Sargent it would give him the skills he needed to transition into civilian life. He knew several Darden alumni and was interested in the format of Darden’s Global Executive MBA program, which includes residencies in South America, Asia and Europe. “I had been given the opportunity to experience a lot of what the world had to offer through a military and government lens, but this gave me an opportunity to build on that from a business standpoint,” Sargent said. “It seemed perfect.” Indeed, Sargent loved his first year in the program. However, it was interrupted when, in May 2015, he learned that his Green Beret unit was scheduled to return to southern Afghanistan and the Helmand province, where Taliban insurgents were regaining strength. That information raised a tough question: Should he interrupt his education to redeploy with that team? The answer would put him on the path toward that dark Taliban compound. “On my first deployment, one of my teammates was killed and one of my closest friends [Flike] was shot and wounded,” Sargent said. “Leaving Afghanistan was bittersweet, because it felt a bit unfinished.” That feeling nagged him even as he switched gears at Darden and ultimately compelled him to return. “I knew I was putting a lot on the line, with all I had started to learn at Darden and the momentum I had developed there,” he said. “But I also knew I could not stand by and watch as my teammates went over there. I wanted to go and felt like I needed to. It just seemed right.” He worked with Darden administrators to determine the best way for him to leave and eventually return to the program. Ultimately, it meant leaving Sargent’s original class — the Class of 2016 — and later joining the Class of 2017 in its final year of the 21-month program. Sargent would have to pause his job search process, leave classmates he had already spent a year with and quickly relearn class concepts after a year off. “It is a challenge, because students who take time off and then return are stepping into a brand-new class that has already spent a year together in intensive residencies and grown very close,” said Larry Mueller, an assistant dean of global advising and former dean of the Global Executive MBA program. “Still, this was not the first time we had a student change classes to complete military service. There were many class members who were either in service or military veterans, so our students are certainly very welcoming and understanding.” When Sargent returned to the U.S. in February 2016, Mueller and other faculty members worked with him to make up missed classes and assignments and placed him on a learning team – small teams that students are assigned to for much of the program – that included a fellow veteran. Advisers in Darden’s Career Development Center helped him restart his search for a post-graduation job. “Coming back was a bit of a difficult transition, but my cohort was incredibly open and the professors were very willing to help me get back where I needed to be,” Sargent said. And, Mueller pointed out, the lessons Sargent learned in Afghanistan were also instructive for his classmates. “Michael had a really firm and real grasp on making leadership decisions that affect other people’s lives,” Mueller said. “Hearing from veterans like Michael gives students a great recognition of what it means to make sacrifices, honor commitments and be willing to be called upon for one’s specialized abilities. That is an education unto itself.” By June 2016, Sargent had accepted a job offer from Morgan Stanley, which he started immediately after graduating 11 months later. He is currently a year into a three-year training program with the firm’s wealth management division in Seattle, working as a wealth adviser associate. Though he loved his time in the military, Sargent said, the change has been a welcome one. “Morgan Stanley is a fantastic firm, and I am enjoying knowing where I will be in three weeks, six months or a year,” he said. “That sort of stability has allowed me to reconnect with family and friends, to go to all of those weddings and reunions and celebrations that I sometimes had to miss.” This story originally appeared on UVA Today.   About the University of Virginia Darden School of Business The University of Virginia Darden School of Business delivers the world’s best business education experience to prepare entrepreneurial, global and responsible leaders through its MBA, Ph.D. and Executive Education programs. Darden’s top-ranked faculty is renowned for teaching excellence and advances practical business knowledge through research. Darden was established in 1955 at the University of Virginia, a top public university founded by Thomas Jefferson in 1819 in Charlottesville, Virginia.
eterans with traumatic brain injury (TBI) differ from civilians with TBI in some key ways—with potentially important implications for long-term care and support of injured service members and their families. New research from the Veterans Administration TBI Model System is assembled in the July/August special issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America, JHTR is published by Wolters Kluwer. “The VA TBI Model System is uniquely positioned to inform policy about the health, mental health, socioeconomic, rehabilitation, and caregiver needs following TBI,” write Guest Editors Risa Nakase-Richardson, PhD, of James A. Haley Veterans’ Hospital, Tampa, Fla., and Lillian Stevens, PhD, of Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va. The special issue presents initial reports from a Department of Veterans Affairs (VA)-specific database of patients representing all traumatic brain injury (TBI) severity levels. The findings will play a critical role in VA’s efforts to meet the long-term needs of veterans with TBI. VA TBI Model System Will Guide Care for Veterans and Families Affected by TBI The initial TBI Model System was developed by the National Institute on Disability and Rehabilitation Research— now the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR)–in 1987. Over the years, 16 civilian hospitals have contributed data on the course of recovery and outcomes for more than 16,000 patients who received inpatient rehabilitation after TBI. The VA TBI Model System, created in response to a Congressional mandate, collects similar data on rehabilitation outcomes of military TBI. Since 2010, over 1,000 patients with TBI hospitalized at five regional VA Polytrauma Rehabilitation Centers have been added to the database. The five premiere VA Polytrauma Rehabilitation Centers offer inpatient rehabilitation with specialized capacity to treat the more severely injured veterans and active duty service members. Dr. Nakase-Richardson is the lead author of a study comparing the characteristics of 550 patients from the VA TBI Model System versus 5,270 patients from the original NIDILRR system. The results suggested that military and civilian cases of TBI differ in most characteristics/outcomes compared. For example, the data showed that violent causes of TBI were more common in the VA group, while falls were more common in civilian cases. Most violence-related TBI cases in veterans were related to deployment. At least 13 percent of the civilian TBI patients had previously served in the military. Dr. Nakase-Richardson and co-authors highlight the need for a complementary sample to broaden research findings to veterans and service members who seek primarily civilian health care. The differences between databases make it difficult to directly compare outcomes between the military and civilian TBI groups. The researchers emphasize the need for further studies to clarify the differences and their implications for treatment and outcomes. Other topics in the special issue include the critical long-term impact on families and caregivers; and new insights for promoting health, quality of life, and community re-entry (i.e., employment) for veterans and service members with TBI. These and future studies will have a major impact on VA's efforts to plan for ongoing care and support for the large numbers of veterans and families affected by TBI, according to Joel Scholten, MD, Director of Physical Medicine and Rehabilitation at the Veterans Health Administration. "Participation in the TBI Model System allows VA to continue to define the unique needs of Veterans following TBI and translate these findings into policy, essentially creating a model of continuous quality improvement for TBI rehabilitation within VA," said Scholten. Click here to read “Comparison of the VA and NIDILRR TBI Model System Cohorts.” Article: “Comparison of the VA and NIDILRR TBI Model System Cohorts” (doi: 10.1097/HTR.0000000000000334) ### About The Journal of Head Trauma Rehabilitation The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America. About the Brain Injury Association of America The Brain Injury Association of America is the country’s oldest and largest nationwide brain injury advocacy organization. Our mission is to advance awareness, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, we bring help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them.  About Wolters Kluwer Wolters Kluwer N.V. (AEX: WKL) is a global leader in information services and solutions for professionals in the health, tax and accounting, risk and compliance, finance and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services. Wolters Kluwer reported 2016 annual revenues of €4.3 billion. The company, headquartered in Alphen aan den Rijn, the Netherlands, serves customers in over 180 countries, maintains operations in over 40 countries and employs 19,000 people worldwide. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). For more information about our solutions and organization, visit, follow us on Twitter, Facebook, LinkedIn, and YouTube.
The American Society of Anesthesiologists (ASA) will host the Run For The Warriors® 5K Run/Walk at 7 a.m. on Saturday, Oct. 21, beginning at the historic Boston Common. The race coincides with the ANESTHESIOLOGY® 2017 annual meeting and marks ASA’s eighth consecutive year of sponsorship. All proceeds from the Boston race will benefit Hope For The Warriors®, a national nonprofit organization that aims to enhance the quality of life for post 9/11 veterans, service members and military families. “ASA has a rich history of supporting the safety and welfare of our nation’s veterans and their families,” said ASA President Jeffrey Plagenhoef, M.D. “Run For The Warriors has become an ongoing part of the ANESTHESIOLOGY annual meeting, and we are grateful for the opportunity to continue providing veterans and service members with the support they have earned and deserve.” The Run For The Warriors race series gives wounded service members encouragement and the opportunity to pursue running or walking to assist in their physical and emotional rehabilitation. Registration is $40 with special pricing for service members. The event will end with an awards ceremony to honor local wounded heroes and families of the fallen, and provide a time to remember those who have served our country in the line of duty. “Hope For The Warriors is proud of our many long-standing successful partnerships that allow us to restore a sense of self, family, and hope to military families nationwide,” said Robin Kelleher, co-founder and president of Hope For The Warriors. “We are grateful to the American Society of Anesthesiologists for their involvement in our national Run For The Warriors series.” To register for the Boston Run For The Warriors, please visit THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.   For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at To learn more about the role physician anesthesiologists play in ensuring patient safety, visit Join the ANESTHESIOLOGY® 2017 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES17. HOPE FOR THE WARRIORS Founded in 2006, Hope For The Warriors is a national nonprofit dedicated to restoring a sense of self, family and hope for post 9/11 veterans, service members and military families. Since its inception, Hope For The Warriors has served more than 13,000 through a variety of support programs focused on transition, health and wellness, peer engagement and connections to community resources. The nonprofit’s first program, A Warrior’s Wish, has granted 165 wishes to fulfill a desire for a better quality of life or support a quest for gratifying endeavors. In addition, Run For The Warriors has captured the hearts of more than 22,000 since 2010. For more information, visit, Facebook or Twitter. # # # CONTACT: American Society of Anesthesiologists   Theresa Hill Public Relations Director O: (847) 268-9246 C: (773) 330-5273 LaSandra Cooper Senior Public Relations ManagerO: (847) 268-9106 l.cooper@asahq.orgAshley Pekic Public Relations AssociateO: (847) 268-9222 Hope For The Warriors® Erin McCloskey (336) 207-5222
A new study presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – found that daily aspirin therapy was significantly associated with a reduced risk in hepatitis  B virus‐related liver cancer. Hepatitis B is a viral infection that attacks the liver. HBV can be contracted through contact with an infected person’s blood or other bodily fluid, and the infection can either be acute or chronic. According to AASLD’s Guidelines for Treatment of Chronic Hepatitis B, an estimated 240 million people worldwide have chronic HBV, and the highest prevalence of the virus is in Africa and Asia. Death from HBV is commonly due to the development of cirrhosis (scaring of healthy liver tissue) or hepatocellular carcinoma (liver cancer). Past research suggests that daily aspirin therapy — which is often prescribed to prevent cardiovascular disease — may also prevent the development of cancer. However, clinical evidence is lacking for the effectiveness of aspirin therapy in preventing HBV‐related liver cancer. Researchers at Taichung Veterans General Hospital in Taichung, Taiwan; E‐Da Hospital in Kaohsiung, Taiwan; Fu Jen Catholic University in New Taipei City, Taiwan; and National Taiwan University Hospital in Taipei conducted a nationwide cohort study to determine if aspirin therapy could, indeed, reduce liver cancer risk. “Liver cancer is the second leading cause of cancer death worldwide, and HBV is the most prevalent risk factor in our region, says Teng‐Yu Lee, MD, PhD, a researcher in the Department of Gastroenterology at Taichung Veterans General Hospital and lead investigator in the study. “HBV‐related liver cancer is therefore a major public health issue with a severe socioeconomic impact.” Although current antiviral medicines such as nucleos(t)ide analogue therapy could significantly reduce liver cancer risk, Dr. Lee notes these therapies do not completely eliminate the risk. Additionally, Dr. Lee says most HBV carriers are not indicated for antiviral therapy, so another effective way of reducing liver cancer risk needs to be developed. “Aspirin has been investigated to explore its chemopreventive effect in cancers that are related to chronic inflammation, particularly in the prevention of colorectal cancer. However, clinical evidence supporting the chemopreventive effect of aspirin therapy on liver cancer remains limited. Therefore, we conducted a large‐scale cohort study to evaluate the association of aspirin therapy with HBV‐related liver cancer.” The researchers retrieved medical records from the National Health Insurance Research Database between 1998 and 2012 for their study. They screened records of 204,507 patients with chronic hepatitis B, and excluded patients with other forms of infectious hepatitis. After excluding patients with liver cancer before the follow‐up index dates, 1,553 patients who had continuously received daily aspirin for at least 90 days were randomly matched 1:4 with 6,212 patients who had never received anti‐ platelet therapy by means of propensity scores consisting of baseline characteristics, the index date and nucleos(t)ide analogue (NA) use during follow‐up. The researchers analyzed both cumulative incidences of and hazard ratios for HCC development after adjusting for competing mortality. Cumulative incidence of liver cancer in the group treated with aspirin therapy was significantly lower than that in the untreated group in five years. In their multivariate regression analysis, the researchers found aspirin therapy was independently associated with reduced liver cancer risk. Sensitivity subgroup analyses also verified this association. Older age, male gender, cirrhosis and diabetes also were independently associated with an increased risk, but nucleos(t)ide analogue or statin use was associated with a decreased risk. “For effectively preventing HBV‐related liver cancer, the findings of this study may help hepatologists treat patients with chronic HBV infection in the future, particularly for those who are not indicated for antiviral therapy. We are pursuing prospective investigations for further confirming the findings,” says Dr. Lee. Dr. Lee will present “Association of Aspirin Therapy with Reduced Risk of Hepatocellular Carcinoma in Patients with Chronic Hepatitis B” at the Walter E. Washington Convention Center in Washington, D.C., on Monday, October 23 at 4:45 pm in Room 145. The corresponding abstract (223) can be found in the journal, HEPATOLOGY. About the AASLD AASLD is a medical subspecialty society representing clinicians and researchers in liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts. AASLD is the leading organization of scientists and healthcare professionals committed to preventing and curing liver disease. AASLD was founded in 1950 by a small group of leading liver specialists and has grown to an international society responsible for all aspects of hepatology. Press releases and additional information about AASLD are available online at
A test called the lung clearance index (LCI) is superior to standard tests in identifying patients with lung disease related to military deployment, suggests a study in the August Journal of Occupational and Environmental Medicine. Silpa Dhoma Krefft, MD, MPH, of National Jewish Health, Denver, and colleagues evaluated the LCI as a test for deployment-related lung disease. An "unknown number" of military personnel deployed to Iraq and Afghanistan have developed respiratory symptoms unexplained by traditional lung function tests and chest CT scans. This condition may be linked to burn pit emissions, desert dust, and other exposures during deployment. The LCI detects abnormalities of the small airways; it is most often used to assess early lung damage in children with cystic fibrosis (CF). The researchers evaluated its use in 28 patients with definite (17 cases) or probable (11 cases) deployment-related lung disease. Currently, a surgical sample of lung tissue (biopsy) is needed to confirm the diagnosis. The average LCI score was were higher for patients with symptoms of deployment-related lung disease, compared to a non-deployed control group. The difference narrowed and become nonsignificant on adjustment for age, body mass index, and smoking. An abnormal LCI score was more sensitive in identifying patients with deployment-related lung disease, compared to standard lung function tests or CT scans. An elevated LCI score was also a better indicator of abnormal results on lung biopsy. A noninvasive test such as the LCI could be a major advantage in detecting underlying lung disease in veterans with respiratory symptoms. Dr. Krefft and coauthors note the lack of "normative data" on LCI results in healthy adults—most previous studies of this test have focused on younger patients with CF. With further research, the LCI might prove useful in monitoring for stability or progression of deployment-related lung disease. It might also aid in assessing small airway abnormalities in larger groups of patients at risk of other occupational lung diseases. About the Author Dr. Krefft may be contacted for interviews at KrefftS(at) About ACOEM ACOEM (, an international society of 4,500 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments. About the Journal of Occupational and Environmental Medicine The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.
The Post-9/11 G.I. Bill, which covers educational costs for veterans beyond tuition, has boosted college enrollment rates among veterans by 3 percentage points compared with the earlier G.I. Bill, finds a new study by NYU’s Steinhardt School of Culture, Education, and Human Development. However, the increase in enrollment was much larger immediately after the bill’s adoption and has waned in recent years.   The study, published online in the journal Educational Evaluation and Policy Analysis, a journal of the American Educational Research Association, comes days after Congress passed a major expansion to the G.I. Bill, which – if signed into law – will provide additional educational benefits to veterans.  The Servicemen’s Readjustment Act of 1944, commonly known as the G.I. Bill, helped pay for college and other training for millions of World War II veterans. Since its inception, the G.I. Bill has been updated to continue providing educational benefits, with the most recent expansion being the Post-9/11 Veterans Educational Assistance Act of 2008, or Post-9/11 G.I. Bill.  “The original G.I. Bill not only significantly improved the human capital in the United States after World War II, but also democratized American higher education and created a robust middle class. Education benefits provided by the bill allowed veterans to go back to college and obtain necessary knowledge and skills, while also serving as an important entry point back to civilian life,” said Liang Zhang, the study’s author and a professor of higher education at NYU Steinhardt.  The Post-9/11 G.I. Bill, which took effect in August 2009, offers more generous educational benefits than the previous version of the bill. It covers full tuition and fees at in-state public schools (or up to a set amount for tuition and fees at private institutions), a monthly housing allowance, and up to $1,000 a year for books and supplies. All veterans who have served since September 2001 are eligible for the Post-9/11 G.I. Bill, meaning that those who did not take advantage of benefits under the previous bill were retroactively eligible.  In this study, Zhang examined the impact of the Post-9/11 G.I. Bill – including its monthly housing allowance and stipend to cover miscellaneous educational costs – on veterans’ college participation.  Zhang used 11 years of data (2005 to 2015) from the American Community Survey, which resulted in a sample of approximately 200,000 veterans who have served in the post-9/11 era. This sample enabled a comparison between data from before and after the 2009 adoption of the Post-9/11 G.I. Bill in order to determine how veterans might have reacted differently to the bill over time.  Zhang found that the Post-9/11 G.I. Bill increased overall college enrollment by about 3 percentage points when compared with enrollment prior to the bill’s adoption. However, the effect was much larger immediately after the bill’s adoption (approximately 4 percentage points) and has waned in recent years (to about 2 percentage points), suggesting that part of the initial enrollment burst was due to the retroactive nature of the bill.  Despite the increase in enrollment, Zhang noted that the effect of the Post-9/11 G.I. Bill is much smaller than the effects of typical financial aid programs, which have been shown to improve enrollment by about 3 to 6 percentage points for every $1,000 reduction in college costs.  In addition, Zhang examined how the bill affected college enrollment among veterans ranging from 20 to 60 years old, given that veterans typically follow a different educational trajectory than that of nonveterans. He found that the Post-9/11 G.I. Bill has had a consistent and positive impact on college enrollment among veterans of all ages, even among older veterans who are usually considered less likely to enroll in college.  “This suggests that older veterans may be more responsive to financial incentives, echoing previous research findings that older students are more responsive to financial aid than younger students,” Zhang said.  Finally, Zhang looked at the levels of existing educational attainment among veterans, since the Post-9/11 G.I. Bill can be used for a variety of educational and training programs, including both undergraduate and graduate education. He found consistent and positive enrollment effects across veterans with all levels of education, with those already holding master’s degrees taking the most advantage of the bill’s educational benefits.  Zhang concluded that it is both important to evaluate the effect of veterans’ programs on college enrollment, as well as to consider the social impact of the bill – which is broader and more profound than any college-related outcomes could possibly measure.  “While providing generous education benefits to veterans could ease the financial burden of going to college, research shows that veterans can face additional challenges associated with service-related injuries and disabilities, as well as being older students. Higher education institutions must continue to better understand and support this growing, yet potentially vulnerable student population, to best serve those who served the country,” said Zhang.  About the Steinhardt School of Culture, Education, and Human Development (@nyusteinhardt) Located in the heart of Greenwich Village, NYU’s Steinhardt School of Culture, Education, and Human Development prepares students for careers in the arts, education, health, media, and psychology. Since its founding in 1890, the Steinhardt School's mission has been to expand human capacity through public service, global collaboration, research, scholarship, and practice. To learn more about NYU Steinhardt, visit
In recent years, the Veterans Administration (VA) Healthcare System has expanded its efforts to target groups of veterans facing disparities in healthcare access and outcomes. An update on research toward advancing equitable healthcare for all veterans is presented in a September supplement to Medical Care, published by Wolters Kluwer. The special issue papers "add incrementally to the state of the science surrounding the equity of health and healthcare for potentially vulnerable veterans who are managed in the VA Healthcare System," according to a guest editorial by Drs. Said A. Ibrahim, Leonard E. Egede, and Michael J. Fine. Drs. Ibrahim and Fine are Directors of the VA's Center for Health Equity Research and Promotion (CHERP). Dr. Egede was previously Director of the Health Equity and Rural Outreach Innovation Center (HEROIC) New Studies on Reducing Health Disparities among Veterans The supplement presents original research and perspectives informing VA's efforts to ensure high-quality patient-centered care for all veterans. It grows out of a recent VA-sponsored "state of the science" conference, hosted by CHERP and HEROIC. The special issue was posted today on the Medical Care website. The supplement includes 12 original research papers, focusing on advancing health equity for three groups of vulnerable veterans: Racial and ethnic minorities. One study found lower rates of recommended psychotherapy or medications for African American and Latino veterans with posttraumatic stress disorder (PTSD). Another paper reported that veterans with multiple substance use disorders were more likely to be African American; they also had higher rates of homelessness and increased physical and mental health problems. Veterans from the lesbian, gay, bisexual, and transgender (LGBT) community. One study found that transgender veterans are generally satisfied with VA healthcare, although satisfaction with mental care was lower for transgender men. A survey of more than 5,000 transgender veterans suggested higher rates of PTSD and tobacco use disorder among those living in smaller towns. Studies of other sex/gender issues highlighted the impact of military sexual trauma and intimate partner violence among male and female veterans. Homeless veterans. One study evaluated a successful effort to reduce high use of emergency department care by homeless veterans. Another reported a high burden of physical and mental health problems in homeless women veterans. The supplement includes a review article showing a "dearth of interventions" to reduce disparities in recently recognized groups of vulnerable veterans, including the LGBT population. Another article paper highlights the role of implementation science in efforts to improve equity throughout the VA Healthcare System. Ensuring health equity takes on new importance with the passage of the Veterans Choice Act of 2014, under which some veterans are eligible to receive care from non-VA community providers, based on waiting times and travel distance to VA facilities. VA's health equity efforts have expanded to include a wide range of vulnerable veterans—not just racial/ethnic minorities, but also populations characterized by gender/gender identity, age, geographic location, religion, socioeconomic status, sexual orientation, mental illness, and disability. Drs. Ibrahim, Egede, and Fine hope the "first and second generation health equity studies" presented in the special issue will create a broader foundation of knowledge for future research—particularly as more veterans receive care outside the VA Healthcare System. A pair of editorials by VA leadership highlight VA's commitment to continued research and leadership in promoting health equity—including through the Veterans Choice Act and other new programs. Deputy Under Secretary for Health for Community Care Dr. Baligh R. Yehia and coauthors write, "As the largest integrated health care system in the nation, VA has an opportunity to lead the rest of the country in reducing health and health care disparities." Click here to read the September supplement issue. ### About Medical Care Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association About Wolters Kluwer Wolters Kluwer N.V. (AEX: WKL) is a global leader in information services and solutions for professionals in the health, tax and accounting, risk and compliance, finance and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services. Wolters Kluwer reported 2016 annual revenues of €4.3 billion. 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