Announcements
Friday, December 1, 2017
Join VA Chief Health Equity Officer as She Discusses the Role of Dissemination & Implementation Research in Achieving Health Equity for Veterans
Bridge the gap between research, practice, and policy in health and health care by joining over 1,000 of your peers at the 10th Annual Conference on the Science of Dissemination and Implementation in Health, December 4-6, 2017, in Arlington, VA.VA Chief Health Officer Equity Uchenna S. Uchendu, MD and panel of esteemed speakers will discuss Achieving Health Equity: The Role of D&I Research on Tuesday, December 5 from 11:30 – 12:45 PM EST.
The Annual D&I conference addresses priorities in the field, grows the research base, and ensures that evidence is used to inform decisions that will improve health and health care.
This year, in an extended two and half day conference, organizers will be celebrating both the 10-year milestone of the conference series, and the contributions of all attendees in the field, working each day to improve the health of individuals and communities.
Register Today!
Register for December’s Focus on Health Equity and Action Cyberseminar -- Using Quality Improvement Projects to Demonstrate Health Equity in Action for Vulnerable Veterans
The VA Office of Health Equity (OHE) launched the VA Health Equity Themed Quality Improvement Projects Initiative during fiscal year 2014. This initiative was launched to support local and field-based efforts to implement quality improvement efforts that have been designed or identified through existing literature and that are expected to achieve health equity and/or reduce health disparities among vulnerable Veteran groups. The purpose of the current session is to describe quality improvement projects and findings for projects funded by OHE during fiscal year 2017 and discuss lessons learned and actionable steps that can be used by VA facilities, researchers, and stakeholders to inform local and national efforts that advance health equity for vulnerable Veterans. ** Please note, event will take place on a Monday.
Using Quality Improvement Projects to Demonstrate Health Equity in Action for Vulnerable Veterans
Monday, December 18, 2017
3:00 – 4:00 PM EST
Learning Objectives- Identify quality improvement strategies and other actions that can be used to advance health equity;
- Understand disparities in hysterectomy care in VA and how individual and system level determinants may contribute to disparities;
- Recognize differences in patient experience with surgical processes and outcomes; and
- Describe VISN-wide implementation of the MOVE! program as a quality improvement strategy to narrow the equity gap among Hispanic/Latino and Non-Hispanic/Latino Veterans with respect to uncontrolled HbA1c.
Wendell Jones, MD
Chief Medical Officer, VISN 17 Central Texas, Dallas, Texas
Jodie Katon, PhD
Scientist, VA Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
Sara Knight, PhD
Director, Health Services Research Program, Birmingham VA Medical Center, Birmingham, Alabama
Uchenna S. Uchendu, MD
Chief Officer, Office of Health Equity, VA Central Office, Washington, DC
Background Resources- Callegari, L. S., Gardella, C. M., Gray, K. E., Zephyrin, L., Uchendu, U. S., Katon, J. G. (2017, July). Unequal Treatment? Racial/Ethnic Differences in Receipt of Minimally Invasive Hysterectomy in the Veterans Health Administration. Presented at the 2017 HSR&D/QUERI National Conference, Crystal City, VA.
- Gray, K. E., CallegaDri, L. S., Fortney, J. C., Lynch, K. E., Zephyrin, L., Uchendu, U. S., Chen, J. A., Katon, J. G. (2017, July). Identifying and Classifying Health Disparities in VA: Application to Racial Disparities in Minimally Invasive Hysterectomy. Poster presented at the 2017 HSR&D/QUERI National Conference, Crystal City, VA.
- Romanova, M., Liang, L. J., Deng, M. L., Li, Z., & Heber, D. (2013). Peer Reviewed: Effectiveness of the MOVE! Multidisciplinary Weight Loss Program for Veterans in Los Angeles. Preventing Chronic Disease, 10, E112.
- Wahl, T. S., Goss, L. E., Morris, M. S., Gullick, A. A., Richman, J. S., Kennedy, G. D., Cannon, J. A., Vickers, S. M., Knight, S. J., Simmons, J. W. and Chu, D. I. (2017). Enhanced Recovery After Surgery (ERAS) Eliminates Racial Disparities in Postoperative Length of Stay After Colorectal Surgery. Annals of Surgery.
Immigration as a Social Determinant of Health
On November 28, 2017, the National Academy of Medicine Roundtable on the Promotion of Health Equity hosted a workshop in Oakland, California, entitled Immigration as a Social Determinant of Health. This public workshop featured invited speaker presentations and discussions that considered the history of immigration laws and policies and how these laws and policies affect not only immigrant health, but population health more broadly.VA Chief Health Equity Officer Uchenna S. Uchendu, MD, a member of the Roundtable and served on the planning committee, recommended a panel to incorporate the voices of immigrants, including Veterans and Military Service Members. Dr. Uchendu moderated the panel, which featured voices, faces, and stories of military service members represented by Veterans for New Americans.
Service Members and Veterans of the U.S. Armed Forces and their dependents may be eligible for citizenship under special provisions of the Immigration and Nationality Act.
Resource
U.S. Department of Veterans Affairs
US Department of Veteran Affairs
Veterans Health Administration
Office of Health Equity
---Military Health System in Washington, D.C., United States for Friday, 1 December 2017 "DoD's international HIV/AIDS prevention program saves lives, builds lasting relationships"
DoD's international HIV/AIDS prevention program saves lives, builds lasting relationships
Air Force Capt. Crystal Karahan, U.S. Air Forces in Europe, Air Forces Africa international health specialist, talks to Cameroonian nursing students during a clean site delivery workshop in Douala, Cameroon. (Courtesy photo) by: Military Health System Communications Office
Navy Capt. Gregg Montalto remembers the first time he met the young Ugandan teenager a couple of years ago sitting across the table. The boy was HIV positive with AIDS.
“He’s a pretty shy kid,” said Montalto, a pediatrician now stationed at Naval Medical Center San Diego. He met the boy through DHAPP, the Department of Defense HIV/AIDS Prevention Program. DHAPP is the DoD’s implementing arm of the President’s Emergency Plan for AIDS Relief, also known as PEPFAR, which is the largest commitment by any nation in history to combat a single disease.
“We talked a little bit, and I learned he was severely underweight at just 38 kilograms [about 83 pounds] and orphaned,” said Montalto. He recalled that the boy’s CD4 count, the amount of HIV virus-killing cells in the body, read just four. Anything below 200 means the AIDS virus is allowing other infections to attack the body.
The Department of Defense recognizes World AIDS Day Dec. 1 as a time to commemorate not just this Ugandan teenager but the millions of lives that have been impacted by HIV/AIDS in the last 35 years. It is an epidemic that continues to infect more than 37,000 people globally every week, and threatens the health and prosperity of families and communities.
According to the Centers for Disease Control and Prevention, an estimated 35 million people worldwide live with HIV/AIDS; more than two-thirds are in Sub-Saharan Africa. Nearly 75 percent of the 2.1 million new HIV infections in 2013 occurred in this area. The Navy was previously the Department of Defense executive agent for DHAPP, which includes Army, Navy, and Air Force medical assets. Recently, DHAPP transitioned to the Defense Health Agency for oversight.
“We identify partner militaries and approach their medical folks,” said Richard Shaffer, DHAPP’s division chief and an epidemiologist. “We ask if there’s anything the U.S. military can help with when it comes to their medical programs that support their military members and family members with HIV.”
DHAPP collaborates with partner militaries to plan activities and implement programs to combat HIV/AIDS in their military services. Through direct military-to-military cooperation, its goal is to maximize program impact by focusing on the HIV epidemic specific to the partner military. DHAPP’s support includes training health care workers to provide HIV clinical services and implementing testing strategies, such as the use of mobile testing units, to reach individuals most at-risk. It also helps equip laboratories and clinics for testing and diagnostics, links HIV-positive individuals into treatment, promotes health education, and provides training against stigma and discrimination.
Fifteen years after its inception, DHAPP’s partnership with 57 other countries’ militaries, mostly in Africa, works to help lower the incidence of HIV and AIDS in those countries. Shaffer said not only does the program make a difference for the people living in those countries; it benefits American troops who may one day operate in those areas.
“Any time we can develop capable partners, it takes a health care burden off our U.S. military,” he said, adding that medical aid is a great foot in the door to help develop deeper relationships with other militaries and the larger civilian population.
In addition, American military doctors get to see other diseases firsthand they might have only read about. “We’ve got people who have learned about yellow fever in the United States through medical school, but never saw a case until they went with us to southern Africa to work on an HIV program,” said Shaffer. “Our medical departments are getting more experience than what they did before DHAPP.”
Moving responsibility of DHAPP to the Defense Health Agency gives the program a more defined DoD-wide role, said Shaffer. “There are so many organizational benefits I see coming out of this. We already had a good relationship with the combatant commands, and being part of the Defense Health Agency will help to improve that relationship. This transition gives us the ability to engage more at the military Joint Staff and interagency levels.”
Montalto recently saw the Ugandan boy again. He had gained about 45 pounds in two years, and his CD4 count was at about 300-400, meaning his immune system was far better equipped to keep him healthy. The captain said the youth had improved in part because he was taking better care of himself, when many in that condition might have just given up.
“I asked him what motivated him to take care of himself,” said Montalto. “He said, ‘I looked around and saw a lot of other kids who were having problems, and I wanted to help other people. The only way to do that is by helping myself.’”
Helping people who help themselves and improving HIV outcomes is what DHAPP is all about. Montalto waved off any credit he may have had in the process, crediting the local doctors for making DHAPP a success, especially in parts of Africa where it’s still a big issue despite gains made since HIV/AIDS was at extreme epidemic levels in the 1990s.
“The members of the team in the HIV treatment clinic in Uganda are the ones doing the heavy lifting,” said Montalto. “They sit down with these kids and talk. The team we send from San Diego brings a concept of adolescent health to the clinicians already on the ground there.”
Montalto encouraged other military doctors and other health care providers to get involved in DHAPP by contacting the program. Then DHAPP can assess skills and match the provider to a program area or country where the skill set can be best utilized.
“You never want to go somewhere, take a few pictures, feel good about yourself, and never show up again,” said Montalto, who wants the program to continue until AIDS is eradicated.
“The reason programs such as DHAPP work is not because the people in it come and go,” he said. “They bring hope and stay.”Read More ...
Eating disorders, disordered eating: A look into the personal struggle for balance
Eating disorders, which are a mix of psychological, physiological, and behavioral factors, can affect every system in the body. (U.S. Air Force illustration by Staff Sgt. Keith Ballard) by: Military Health System Communications Office
For almost two decades, the spouse of an active duty service member kept a secret from loved ones. No one knew of her guilt after she binged on a bag of cookies or snuck candy when she was alone. She was overweight, and yet remained determined to cut out sugar and treats. Her struggle with food continued for years, but she never expected to hear a psychiatrist diagnose a binge eating disorder.
“Not even my husband knew,” said the spouse, who preferred to remain anonymous. Food was constantly on her mind. She learned she had a disorder after starting the process for gastric bypass, which required an appointment with a psychiatrist before surgery.
“I was in total denial,” said the spouse, who underwent about eight months of treatment. “But when I started going through therapy, I thought, ‘Yeah, you know what, I do have that.’ Therapy has changed my life.”
While most people would have been surprised to learn of her disorder, being overweight had a big impact on her life and her health, she said. In therapy, she talked about why and when she binged, which helped her become more aware of her habits. In just nine weeks, she lost 44 pounds. While it hasn’t been easy, she’s healthier, happier, and able to think of food differently than before treatment.
Despite the name, eating disorders are about more than nutrition. These disorders involve psychological, physiological, and behavioral characteristics. According to the National Institute of Mental Health, eating disorders include anorexia nervosa, bulimia nervosa, and binge eating, and can often coexist with depression, anxiety disorders, and substance abuse.
Anorexia nervosa, the most deadly of the disorders, is characterized by extreme thinness and food restriction. People with anorexia have a distorted body view, usually seeing themselves as overweight rather than severely underweight. Bulimia nervosa involves frequent episodes of eating unusually large amounts of food, followed by purging, excessive exercise, or strict food restriction. Binge eating, the most common eating disorder in the United States, occurs when someone loses control over his or her eating and consumes an unusually large amount of food in a single sitting. Unlike bulimia, binge eating isn’t followed by excessive exercise, purging, or food restrictions.
Angela Gray, a licensed clinical psychologist for the Psychological Health Center of Excellence, said eating disorders can affect people of any age and any weight. Both women and men are impacted by eating disorders, but women are more likely to show symptoms and seek treatment, she added.
While no specific causes have been found, risk factors include a mix of biological, environmental, and psychological factors, according to information provided by NIMH. Factors such as trauma, major life changes, or family history can contribute to an individual’s risk for developing an eating disorder.
“Any time you’re looking at large life shifts, that can be a time period where somebody feels a loss of control, and sometimes that loss of control and not being sure how to cope with those emotions will channel into focusing on food,” said Army Maj. Susan Stankorb, a dietitian at Blanchfield Army Community Hospital at Fort Campbell, Kentucky.
Symptoms include difficulty concentrating, being withdrawn, and looking distressed during group meals, said Gray. Other signs include preoccupation with thoughts of food or meal preparation, over exercising (such as spending three or four hours at a time in the gym), skipping meals, and losing weight, she added.
Treatment for eating disorders is usually geared to meeting individual needs. According to information from NIMH, the goal of treatment is to restore nutrition, maintain a healthy weight, and reduce harmful behaviors, such as excessive exercise and purging. The first line of treatment is psychotherapy, such as cognitive behavioral health therapy; however, treatment can also include nutritional counseling, medications, and group or family psychotherapy.
“Ultimately, we want to make sure that everyone is operating at their optimal psychological and physical health,” said Gray.Read More ...
Navy bells, Army colors mark NCR change of leadership
From left, Navy Rear Adm. David Lane, Navy Vice Adm. Raquel Bono, and Army Maj. Gen. Ronald Place during the change of authority ceremony for the National Capital Region Medical Directorate. (Courtesy photo) by: Military Health System Communications Office
In a ceremony combining time-honored traditions from the Army and the Navy, Rear Adm. David Lane relinquished his position as director of the National Capital Region Medical Directorate (NCR-MD) to Army Maj. Gen. Ronald Place.
The ceremony was held on Wednesday, Nov. 29, at the Gaylord National Resort and Conference Center in Oxon Hill, Maryland, during the 126th annual meeting of AMSUS, the Society of Federal Health Professionals.
“Bringing together two different traditions pays greater homage and respect to each,” said Vice Adm. Raquel Bono, director of the Defense Health Agency. Bono officiated the change of authority ceremony, which also included elements from the Air Force, Marine Corps, and Public Health Service.
The ceremony combined the sea service’s tradition of bells to mark arrivals – six for Lane and Place, and eight for Bono, corresponding to their ranks – and the land force’s tradition of “passing colors,” to ensure the continuation of leadership. Bono said the melding was particularly appropriate, given the joint nature of NCR-MD.
The directorate was established in October 2013 to exercise authority, direction, and control over Walter Reed National Military Medical Center in Bethesda, Maryland; Fort Belvoir Community Hospital in Virginia; and their subordinate clinics.
“We serve the largest concentration of DoD beneficiaries in the world,” said Lane, the outgoing director. Earlier, he noted the directorate extends as far east as Annapolis, as far north as Fort Meade, in Maryland; and as far south as Quantico, Virginia, “with patients that live far beyond those named places.”
During the ceremony, Bono thanked Lane for his superb leadership. “We all need to recognize the potential of what we can do collectively,” Bono said. “Dedication, focus, and innovation have allowed NCR-MD to thrive.”
To continue the success, Bono said, “you need to have the right kind of leader.” That leader, she said, is Place. He began his career as a staff general surgeon at Martin Army Community Hospital at Fort Benning, Georgia.
Board-certified in both general and colorectal surgery, Place deployed to Afghanistan with the 250th Forward Surgical Team (Airborne) in October 2001. For most of last year, Place has been a focal point in managing and coordinating the historic MHS reforms included in the 2017National Defense Authorization Act.
In his remarks, Place said change is never easy and that Lane is “a tough act to follow.”
“But readiness is our central mission, and that’s not going to change,” Place said. “We need to continue focusing on the health readiness of the force – fit to fight, ready to win – and a ready medical force that can perform the mission anytime, anywhere, at a moment’s notice.”
“Practice may never make perfect,” Place said, “but it’s our obligation to continuously learn.”Read More ...
Questions for MHS?
---VA Office of Economic Opportunity in Washington, D.C., United States for Thursday, 30 November 2017 "Forever GI Bill Update"
Dear Fellow Veterans and Colleagues,
In this 99th year of commemorating Veterans Day on November 11, VA has broadened that observance and appreciation to designate the entire month of November as National Veterans and Military Families Month. At VA, we like to say that every day is Veterans Day, but this month and year it has been especially evident as we begin implementing several new provisions enacted by the Harry W. Colmery Educational Assistance Act of 2017, also known as the “Forever GI Bill.”
We plan on sending out periodic communications trying to keep everyone up to date on the 34 provisions of the law. For example, just yesterday I did interviews with 23 radio and TV stations across the country talking about the wonderful new benefits of the Colmery Act. Earlier this month, we outlined several sections that went into effect immediately. Today we’re underscoring the wide range of expanded educational benefit eligibility for Veterans and dependents that go into effect on August 1, 2018. While that may seem like a long ways off, we’re putting things in place now to ensure our Veterans are informed and the process is as smooth as possible.
Expansion of qualifying time for Post-9/11 GI Bill to certain Reserve and Guardmembers - The law expands the definition of “active duty” to include Reservists and Guardmembers ordered to active duty to receive authorized medical care, or to be medically evaluated for disability, or complete a Department of Defense (DoD) health care study. The expansion applies to service on or after September 11, 2001. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
Purple Heart recipient Post-9/11 GI Bill eligibility - Servicemembers and honorably discharged Veterans who were awarded a Purple Heart on or after September 11, 2001, will be entitled to Post-9/11 GI Bill benefits for up to 36 months. This facet of the law closes a sort of “loophole” where Servicemembers who may not have otherwise had enough time in for full Post-9/11 eligibility are now fully entitled. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
Yellow Ribbon extension to Fry Scholarship and Purple Heart recipients - Recipients of the Fry Scholarship and Purple Heart will be eligible for the Yellow Ribbon Program. This program provides assistance with tuition and fee charges not covered by the Post-9/11 GI Bill, such as charges over the annual cap for a private school or out-of-state charges. Institutions enter into an agreement with VA to pay uncovered charges (schools decide the amount), and VA matches the amount the school waives. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
Expansion of qualifying Reserve service - Those called to active duty under 12304, 12304(a), and 12304(b) orders on or after June 30, 2008 may have this service credited towards their Post-9/11 GI Bill eligibility. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
These amendments extend educational benefit eligibility to a greater population of Veterans and dependents who have responded to the call to serve - and sacrifice - for our country. This Veterans Month, and every day, we continue to thank you.
As always, thank you for your service and feel free to pass this on.
Regards,
Curtis L. Coy
Deputy Under Secretary for Economic Opportunity
Veterans Benefits Administration
U.S. Department of Veterans Affairs
Washington, D.C. 20420 United States
DoD's international HIV/AIDS prevention program saves lives, builds lasting relationshipsAir Force Capt. Crystal Karahan, U.S. Air Forces in Europe, Air Forces Africa international health specialist, talks to Cameroonian nursing students during a clean site delivery workshop in Douala, Cameroon. (Courtesy photo) by: Military Health System Communications Office
Navy Capt. Gregg Montalto remembers the first time he met the young Ugandan teenager a couple of years ago sitting across the table. The boy was HIV positive with AIDS.
“He’s a pretty shy kid,” said Montalto, a pediatrician now stationed at Naval Medical Center San Diego. He met the boy through DHAPP, the Department of Defense HIV/AIDS Prevention Program. DHAPP is the DoD’s implementing arm of the President’s Emergency Plan for AIDS Relief, also known as PEPFAR, which is the largest commitment by any nation in history to combat a single disease.
“We talked a little bit, and I learned he was severely underweight at just 38 kilograms [about 83 pounds] and orphaned,” said Montalto. He recalled that the boy’s CD4 count, the amount of HIV virus-killing cells in the body, read just four. Anything below 200 means the AIDS virus is allowing other infections to attack the body.
The Department of Defense recognizes World AIDS Day Dec. 1 as a time to commemorate not just this Ugandan teenager but the millions of lives that have been impacted by HIV/AIDS in the last 35 years. It is an epidemic that continues to infect more than 37,000 people globally every week, and threatens the health and prosperity of families and communities.
According to the Centers for Disease Control and Prevention, an estimated 35 million people worldwide live with HIV/AIDS; more than two-thirds are in Sub-Saharan Africa. Nearly 75 percent of the 2.1 million new HIV infections in 2013 occurred in this area. The Navy was previously the Department of Defense executive agent for DHAPP, which includes Army, Navy, and Air Force medical assets. Recently, DHAPP transitioned to the Defense Health Agency for oversight.
“We identify partner militaries and approach their medical folks,” said Richard Shaffer, DHAPP’s division chief and an epidemiologist. “We ask if there’s anything the U.S. military can help with when it comes to their medical programs that support their military members and family members with HIV.”
DHAPP collaborates with partner militaries to plan activities and implement programs to combat HIV/AIDS in their military services. Through direct military-to-military cooperation, its goal is to maximize program impact by focusing on the HIV epidemic specific to the partner military. DHAPP’s support includes training health care workers to provide HIV clinical services and implementing testing strategies, such as the use of mobile testing units, to reach individuals most at-risk. It also helps equip laboratories and clinics for testing and diagnostics, links HIV-positive individuals into treatment, promotes health education, and provides training against stigma and discrimination.
Fifteen years after its inception, DHAPP’s partnership with 57 other countries’ militaries, mostly in Africa, works to help lower the incidence of HIV and AIDS in those countries. Shaffer said not only does the program make a difference for the people living in those countries; it benefits American troops who may one day operate in those areas.
“Any time we can develop capable partners, it takes a health care burden off our U.S. military,” he said, adding that medical aid is a great foot in the door to help develop deeper relationships with other militaries and the larger civilian population.
In addition, American military doctors get to see other diseases firsthand they might have only read about. “We’ve got people who have learned about yellow fever in the United States through medical school, but never saw a case until they went with us to southern Africa to work on an HIV program,” said Shaffer. “Our medical departments are getting more experience than what they did before DHAPP.”
Moving responsibility of DHAPP to the Defense Health Agency gives the program a more defined DoD-wide role, said Shaffer. “There are so many organizational benefits I see coming out of this. We already had a good relationship with the combatant commands, and being part of the Defense Health Agency will help to improve that relationship. This transition gives us the ability to engage more at the military Joint Staff and interagency levels.”
Montalto recently saw the Ugandan boy again. He had gained about 45 pounds in two years, and his CD4 count was at about 300-400, meaning his immune system was far better equipped to keep him healthy. The captain said the youth had improved in part because he was taking better care of himself, when many in that condition might have just given up.
“I asked him what motivated him to take care of himself,” said Montalto. “He said, ‘I looked around and saw a lot of other kids who were having problems, and I wanted to help other people. The only way to do that is by helping myself.’”
Helping people who help themselves and improving HIV outcomes is what DHAPP is all about. Montalto waved off any credit he may have had in the process, crediting the local doctors for making DHAPP a success, especially in parts of Africa where it’s still a big issue despite gains made since HIV/AIDS was at extreme epidemic levels in the 1990s.
“The members of the team in the HIV treatment clinic in Uganda are the ones doing the heavy lifting,” said Montalto. “They sit down with these kids and talk. The team we send from San Diego brings a concept of adolescent health to the clinicians already on the ground there.”
Montalto encouraged other military doctors and other health care providers to get involved in DHAPP by contacting the program. Then DHAPP can assess skills and match the provider to a program area or country where the skill set can be best utilized.
“You never want to go somewhere, take a few pictures, feel good about yourself, and never show up again,” said Montalto, who wants the program to continue until AIDS is eradicated.
“The reason programs such as DHAPP work is not because the people in it come and go,” he said. “They bring hope and stay.”Read More ...
Eating disorders, disordered eating: A look into the personal struggle for balanceEating disorders, which are a mix of psychological, physiological, and behavioral factors, can affect every system in the body. (U.S. Air Force illustration by Staff Sgt. Keith Ballard) by: Military Health System Communications Office
For almost two decades, the spouse of an active duty service member kept a secret from loved ones. No one knew of her guilt after she binged on a bag of cookies or snuck candy when she was alone. She was overweight, and yet remained determined to cut out sugar and treats. Her struggle with food continued for years, but she never expected to hear a psychiatrist diagnose a binge eating disorder.
“Not even my husband knew,” said the spouse, who preferred to remain anonymous. Food was constantly on her mind. She learned she had a disorder after starting the process for gastric bypass, which required an appointment with a psychiatrist before surgery.
“I was in total denial,” said the spouse, who underwent about eight months of treatment. “But when I started going through therapy, I thought, ‘Yeah, you know what, I do have that.’ Therapy has changed my life.”
While most people would have been surprised to learn of her disorder, being overweight had a big impact on her life and her health, she said. In therapy, she talked about why and when she binged, which helped her become more aware of her habits. In just nine weeks, she lost 44 pounds. While it hasn’t been easy, she’s healthier, happier, and able to think of food differently than before treatment.
Despite the name, eating disorders are about more than nutrition. These disorders involve psychological, physiological, and behavioral characteristics. According to the National Institute of Mental Health, eating disorders include anorexia nervosa, bulimia nervosa, and binge eating, and can often coexist with depression, anxiety disorders, and substance abuse.
Anorexia nervosa, the most deadly of the disorders, is characterized by extreme thinness and food restriction. People with anorexia have a distorted body view, usually seeing themselves as overweight rather than severely underweight. Bulimia nervosa involves frequent episodes of eating unusually large amounts of food, followed by purging, excessive exercise, or strict food restriction. Binge eating, the most common eating disorder in the United States, occurs when someone loses control over his or her eating and consumes an unusually large amount of food in a single sitting. Unlike bulimia, binge eating isn’t followed by excessive exercise, purging, or food restrictions.
Angela Gray, a licensed clinical psychologist for the Psychological Health Center of Excellence, said eating disorders can affect people of any age and any weight. Both women and men are impacted by eating disorders, but women are more likely to show symptoms and seek treatment, she added.
While no specific causes have been found, risk factors include a mix of biological, environmental, and psychological factors, according to information provided by NIMH. Factors such as trauma, major life changes, or family history can contribute to an individual’s risk for developing an eating disorder.
“Any time you’re looking at large life shifts, that can be a time period where somebody feels a loss of control, and sometimes that loss of control and not being sure how to cope with those emotions will channel into focusing on food,” said Army Maj. Susan Stankorb, a dietitian at Blanchfield Army Community Hospital at Fort Campbell, Kentucky.
Symptoms include difficulty concentrating, being withdrawn, and looking distressed during group meals, said Gray. Other signs include preoccupation with thoughts of food or meal preparation, over exercising (such as spending three or four hours at a time in the gym), skipping meals, and losing weight, she added.
Treatment for eating disorders is usually geared to meeting individual needs. According to information from NIMH, the goal of treatment is to restore nutrition, maintain a healthy weight, and reduce harmful behaviors, such as excessive exercise and purging. The first line of treatment is psychotherapy, such as cognitive behavioral health therapy; however, treatment can also include nutritional counseling, medications, and group or family psychotherapy.
“Ultimately, we want to make sure that everyone is operating at their optimal psychological and physical health,” said Gray.Read More ...
Navy bells, Army colors mark NCR change of leadershipFrom left, Navy Rear Adm. David Lane, Navy Vice Adm. Raquel Bono, and Army Maj. Gen. Ronald Place during the change of authority ceremony for the National Capital Region Medical Directorate. (Courtesy photo) by: Military Health System Communications Office
In a ceremony combining time-honored traditions from the Army and the Navy, Rear Adm. David Lane relinquished his position as director of the National Capital Region Medical Directorate (NCR-MD) to Army Maj. Gen. Ronald Place.
The ceremony was held on Wednesday, Nov. 29, at the Gaylord National Resort and Conference Center in Oxon Hill, Maryland, during the 126th annual meeting of AMSUS, the Society of Federal Health Professionals.
“Bringing together two different traditions pays greater homage and respect to each,” said Vice Adm. Raquel Bono, director of the Defense Health Agency. Bono officiated the change of authority ceremony, which also included elements from the Air Force, Marine Corps, and Public Health Service.
The ceremony combined the sea service’s tradition of bells to mark arrivals – six for Lane and Place, and eight for Bono, corresponding to their ranks – and the land force’s tradition of “passing colors,” to ensure the continuation of leadership. Bono said the melding was particularly appropriate, given the joint nature of NCR-MD.
The directorate was established in October 2013 to exercise authority, direction, and control over Walter Reed National Military Medical Center in Bethesda, Maryland; Fort Belvoir Community Hospital in Virginia; and their subordinate clinics.
“We serve the largest concentration of DoD beneficiaries in the world,” said Lane, the outgoing director. Earlier, he noted the directorate extends as far east as Annapolis, as far north as Fort Meade, in Maryland; and as far south as Quantico, Virginia, “with patients that live far beyond those named places.”
During the ceremony, Bono thanked Lane for his superb leadership. “We all need to recognize the potential of what we can do collectively,” Bono said. “Dedication, focus, and innovation have allowed NCR-MD to thrive.”
To continue the success, Bono said, “you need to have the right kind of leader.” That leader, she said, is Place. He began his career as a staff general surgeon at Martin Army Community Hospital at Fort Benning, Georgia.
Board-certified in both general and colorectal surgery, Place deployed to Afghanistan with the 250th Forward Surgical Team (Airborne) in October 2001. For most of last year, Place has been a focal point in managing and coordinating the historic MHS reforms included in the 2017National Defense Authorization Act.
In his remarks, Place said change is never easy and that Lane is “a tough act to follow.”
“But readiness is our central mission, and that’s not going to change,” Place said. “We need to continue focusing on the health readiness of the force – fit to fight, ready to win – and a ready medical force that can perform the mission anytime, anywhere, at a moment’s notice.”
“Practice may never make perfect,” Place said, “but it’s our obligation to continuously learn.”Read More ...
Questions for MHS?
STAY CONNECTED:
Military Health System
The Pentagon
Washington, D.C. 20301, United States
---VA Office of Economic Opportunity in Washington, D.C., United States for Thursday, 30 November 2017 "Forever GI Bill Update"
Dear Fellow Veterans and Colleagues,
In this 99th year of commemorating Veterans Day on November 11, VA has broadened that observance and appreciation to designate the entire month of November as National Veterans and Military Families Month. At VA, we like to say that every day is Veterans Day, but this month and year it has been especially evident as we begin implementing several new provisions enacted by the Harry W. Colmery Educational Assistance Act of 2017, also known as the “Forever GI Bill.”
We plan on sending out periodic communications trying to keep everyone up to date on the 34 provisions of the law. For example, just yesterday I did interviews with 23 radio and TV stations across the country talking about the wonderful new benefits of the Colmery Act. Earlier this month, we outlined several sections that went into effect immediately. Today we’re underscoring the wide range of expanded educational benefit eligibility for Veterans and dependents that go into effect on August 1, 2018. While that may seem like a long ways off, we’re putting things in place now to ensure our Veterans are informed and the process is as smooth as possible.
Expansion of qualifying time for Post-9/11 GI Bill to certain Reserve and Guardmembers - The law expands the definition of “active duty” to include Reservists and Guardmembers ordered to active duty to receive authorized medical care, or to be medically evaluated for disability, or complete a Department of Defense (DoD) health care study. The expansion applies to service on or after September 11, 2001. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
Purple Heart recipient Post-9/11 GI Bill eligibility - Servicemembers and honorably discharged Veterans who were awarded a Purple Heart on or after September 11, 2001, will be entitled to Post-9/11 GI Bill benefits for up to 36 months. This facet of the law closes a sort of “loophole” where Servicemembers who may not have otherwise had enough time in for full Post-9/11 eligibility are now fully entitled. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
Yellow Ribbon extension to Fry Scholarship and Purple Heart recipients - Recipients of the Fry Scholarship and Purple Heart will be eligible for the Yellow Ribbon Program. This program provides assistance with tuition and fee charges not covered by the Post-9/11 GI Bill, such as charges over the annual cap for a private school or out-of-state charges. Institutions enter into an agreement with VA to pay uncovered charges (schools decide the amount), and VA matches the amount the school waives. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
Expansion of qualifying Reserve service - Those called to active duty under 12304, 12304(a), and 12304(b) orders on or after June 30, 2008 may have this service credited towards their Post-9/11 GI Bill eligibility. An individual may use this entitlement to pursue a course of education beginning on or after August 1, 2018.
These amendments extend educational benefit eligibility to a greater population of Veterans and dependents who have responded to the call to serve - and sacrifice - for our country. This Veterans Month, and every day, we continue to thank you.
As always, thank you for your service and feel free to pass this on.
Regards,
Curtis L. Coy
Deputy Under Secretary for Economic Opportunity
Veterans Benefits Administration
U.S. Department of Veterans Affairs
Washington, D.C. 20420 United States
VA Core Values: Integrity, Commitment, Advocacy, Respect, Excellence (“I CARE”)
US Department of Veterans Affairs
Veterans Benefits Administration
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Veterans Affairs Office of Inspector General (OIG) in the Washington, D.C., United States for Thursday, 30 November 2017 "Healthcare Inspection—Unexpected Death of a Patient: Alleged Methadone Overdose, Grand Junction VA Health Care System, Grand Junction, CO"
Oversight Reports for Veterans Affairs Office of Inspector General (OIG). This information has recently been updated, and is now available.
Healthcare Inspection—Unexpected Death of a Patient: Alleged Methadone Overdose, Grand Junction VA Health Care System, Grand Junction, CO
OIG conducted a healthcare inspection in response to an allegation received in 2016 that a patient died of an accidental methadone overdose 2 days after receiving a prescription for methadone from a primary care physician (PCP) at the Grand Junction VA Health Care System (System), Grand Junction, CO. We substantiated the allegation that the patient identified in the complaint died 2 days after receiving a prescription for methadone from a System PCP. We were unable to substantiate that methadone contributed to or was the cause of the patient’s death. Neither an autopsy or toxicology study was performed, so additional information was not available. The System lacked a process to ensure prescribers were aware of, or considered, current Veterans Health Administration (VHA) directives, policies, and guidance related to obtaining an electrocardiogram before prescribing methadone for the management of chronic pain. VHA’s “Consent for Long-Term Opioid Therapy for Pain” is an electronic document that is used to obtain consent for long-term opioid therapy. The template document may also be used as a patient education tool but does not include risk factors specific for methadone. System PCPs we interviewed were not aware of how to add methadone specific risk factors to the electronic consent form. After investigating the events surrounding the death of the patient identified in the complaint, System leaders did not confer with the Office of Chief Counsel to determine if an institutional disclosure was necessary. We made five recommendations.
Healthcare Inspection—Unexpected Death of a Patient: Alleged Methadone Overdose, Grand Junction VA Health Care System, Grand Junction, CO
OIG conducted a healthcare inspection in response to an allegation received in 2016 that a patient died of an accidental methadone overdose 2 days after receiving a prescription for methadone from a primary care physician (PCP) at the Grand Junction VA Health Care System (System), Grand Junction, CO. We substantiated the allegation that the patient identified in the complaint died 2 days after receiving a prescription for methadone from a System PCP. We were unable to substantiate that methadone contributed to or was the cause of the patient’s death. Neither an autopsy or toxicology study was performed, so additional information was not available. The System lacked a process to ensure prescribers were aware of, or considered, current Veterans Health Administration (VHA) directives, policies, and guidance related to obtaining an electrocardiogram before prescribing methadone for the management of chronic pain. VHA’s “Consent for Long-Term Opioid Therapy for Pain” is an electronic document that is used to obtain consent for long-term opioid therapy. The template document may also be used as a patient education tool but does not include risk factors specific for methadone. System PCPs we interviewed were not aware of how to add methadone specific risk factors to the electronic consent form. After investigating the events surrounding the death of the patient identified in the complaint, System leaders did not confer with the Office of Chief Counsel to determine if an institutional disclosure was necessary. We made five recommendations.
Veterans Affairs Office of Inspector General (OIG)
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