15 research outputs found

    Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis etiology

    Get PDF
    Factors underlying a possible excess of amyotrophic lateral sclerosis (ALS) among military veterans remain unidentified. Limitations of previous studies on this topic include reliance on ALS mortality as a surrogate for ALS incidence, low statistical power, and sparse information on military-related factors

    Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival

    Get PDF
    Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases

    Pain coping skills training for African Americans with osteoarthritis (STAART): study protocol of a randomized controlled trial

    Get PDF
    Background: African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA. Methods/Design: This is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System. Discussion: This culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities.Funded by Patient-Centered Outcomes Research Institute (PCORI) Award (AD-1408-19519)

    Military service, deployments, and exposures in relation to amyotrophic lateral sclerosis survival

    Get PDF
    <div><p>Background</p><p>Military veterans may have higher rates of amyotrophic lateral sclerosis (ALS) mortality than non-veterans. Few studies, with sparse exposure information and mixed results, have studied relationships between military-related factors and ALS survival. We evaluated associations between military-related factors and ALS survival among U.S. military veteran cases.</p><p>Methods</p><p>We followed 616 medical record-confirmed cases from enrollment (2005–2010) in the Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study until death or July 25, 2013, whichever came first. We ascertained vital status information from several sources within the Department of Veterans Affairs. We obtained information regarding military service, deployments, and 39 related exposures via standardized telephone interviews. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals. We adjusted for potential confounding and missing covariate data biases via inverse probability weights. We also used inverse probability weights to adjust for potential selection bias among a case group that included a disproportionate number of long-term survivors at enrollment.</p><p>Results</p><p>We observed 446 deaths during 24,267 person-months of follow-up (median follow-up: 28 months). Survival was shorter for cases who served before 1950, were deployed to World War II, or mixed and applied burning agents, with HRs between 1.58 and 2.57. Longer survival was associated with exposure to: paint, solvents, or petrochemical substances; local food not provided by the Armed Forces; or burning agents or Agent Orange in the field with HRs between 0.56 and 0.73.</p><p>Conclusions</p><p>Although most military-related factors were not associated with survival, associations we observed with shorter survival are potentially important because of the large number of military veterans.</p></div

    Flow chart showing the ascertainment of GENEVA cases, United States of America, 2005–2010.

    No full text
    <p>Solid boxes or lines depict cases who progressed past each step shown. Small-dashed boxes or lines depict cases who did not progress past each step shown, but who were incorporated into the analysis indirectly via inverse probability weights (see Statistical Analyses and Section C in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185751#pone.0185751.s001" target="_blank">S1 File</a> for more details). Among the 27 cases ineligible for GENEVA, reasons included dementia (n = 9), diagnosis change (n = 4), withdrawal from the Registry DNA bank (n = 3), or interview infeasibility (n = 11). Abbreviations: ALS, amyotrophic lateral sclerosis; GENEVA, Genes and Environmental Exposures in Veterans with Amyotrophic Lateral Sclerosis study; PLS, primary lateral sclerosis.</p

    Military deployments or danger pay and amyotrophic lateral sclerosis survival in GENEVA<sup>a</sup>, United States of America, 2005–2013.

    No full text
    <p>Military deployments or danger pay and amyotrophic lateral sclerosis survival in GENEVA<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185751#t004fn002" target="_blank"><sup>a</sup></a>, United States of America, 2005–2013.</p

    Military service and amyotrophic lateral sclerosis survival in GENEVA<sup>a</sup>, United States of America, 2005–2013.

    No full text
    <p>Military service and amyotrophic lateral sclerosis survival in GENEVA<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185751#t003fn002" target="_blank"><sup>a</sup></a>, United States of America, 2005–2013.</p

    Military exposures and amyotrophic lateral sclerosis survival in GENEVA<sup>a</sup>, United States of America, 2005–2013.

    No full text
    <p>Military exposures and amyotrophic lateral sclerosis survival in GENEVA<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185751#t005fn002" target="_blank"><sup>a</sup></a>, United States of America, 2005–2013.</p
    corecore