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1.  The Relationship between Body Mass Index and Mental Health Among Iraq and Afghanistan Veterans 
Journal of General Internal Medicine  2013;28(Suppl 2):563-570.
ABSTRACT
BACKGROUND
Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period.
OBJECTIVE
To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years.
DESIGN
Retrospective, longitudinal cohort analysis of veterans’ health records
PARTICIPANTS
A total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011).
MAIN MEASURES
BMI, mental health diagnoses.
KEY RESULTS
Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: “stable overweight” represented the largest class; followed by “stable obese;” “overweight/obese gaining;” and “obese losing.” During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression.
CONCLUSIONS
The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-013-2374-8) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-013-2374-8
PMCID: PMC3695271  PMID: 23807066
women’s health; veteran; mental health; obesity
2.  Gender Differences in Health Service Utilization Among Iraq and Afghanistan Veterans with Posttraumatic Stress Disorder 
Journal of Women's Health  2012;21(6):666-673.
Abstract
Background
Little is known about gender differences in healthcare use among newly returning veterans with posttraumatic stress disorder (PTSD). We investigated gender differences in Veterans Affairs (VA) medical center health service use among Iraq and Afghanistan veterans with PTSD with and without comorbid depression and alcohol use disorders (AUD).
Methods
Using VA administrative data, bivariate and multivariate statistics were used to examine gender differences in health service use among 159,705 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD seeking VA healthcare from October 7, 2001, to December 31, 2010.
Results
Female veterans with PTSD were more likely to be black and single and to have higher mental health, primary care, and emergency care use compared to men with PTSD. Men were more likely to have higher mental health inpatient use compared to women. Women and men with comorbid PTSD and depression or comorbid PTSD and AUD were more likely to have higher use in all domains compared to their counterparts with PTSD without these comorbid disorders. Women with comorbid PTSD and depression were 12.5 times more likely to have a mental health inpatient hospitalization compared to their female counterparts without depression and twice as likely to have a mental health hospitalization compared to men with comorbid PTSD and depression.
Conclusions
Women with PTSD had higher use than men in almost all areas, as did all veterans with comorbid PTSD and depression and comorbid PTSD and AUD, regardless of gender. Better understanding these health service use differences will allow for targeted evaluation and integrated treatment interventions in veterans with PTSD.
doi:10.1089/jwh.2011.3113
PMCID: PMC3366102  PMID: 22313026
3.  Adipose Tissue and Metabolic Factors Associated with Steatosis in HIV/HCV coinfection: Histology versus Magnetic Resonance Spectroscopy 
Background
Hepatic steatosis is common in persons with HIV and hepatitis C virus (HCV); yet biopsy measurement of steatosis is prone to sampling error. We compared magnetic resonance spectroscopy (MRS) measurement of steatosis to histology in HIV/HCV-coinfected patients, and explored the associated adipose tissue and metabolic factors.
Methods
Cross-sectional analysis of 42 HIV/HCV-coinfected men and women. Logistic regression analysis identified factors [MRI-measured visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) and Homeostasis Model Assessment (HOMA) estimated insulin resistance] associated with histologic steatosis (≥5% of hepatocytes with fat) and MRS steatosis (≥5% of hepatic fat).
Results
MRS steatosis was strongly associated with histologic steatosis, when measured continuously [odds ratio: 10.2 per doubling of MRS-measured hepatic fat; 95% confidence interval (CI):2.9, 69.3] and dichotomously (Kappa coefficient=0.52; p=0.0007). Four of the 10 with MRS-measured steatosis did not have histologic steatosis; 3 of 9 with histologic steatosis did not have MRS-measured steatosis (67% sensitivity; 88% specificity). Associations of VAT and abdominal SAT were associated with both histologic and MRS-measured steatosis. Insulin resistance was also associated with both.
Conclusions
When compared to histology, MRS was similarly associated with adipose tissue and metabolic factors. MRS is a useful non-invasive alternative to biopsy in HIV/HCV coinfection.
doi:10.1097/QAI.0b013e3181e1d963
PMCID: PMC2943991  PMID: 20512045
Steatosis; Magnetic Resonance Spectroscopy; HIV; HCV; Adipose tissue; Insulin Resistance
4.  Association of Antiretroviral Therapy with Fibrinogen Levels in HIV Infection 
AIDS (London, England)  2008;22(6):707-715.
doi:10.1097/QAD.0b013e3282f560d9
PMCID: PMC3156620  PMID: 18356600
fibrinogen; HIV; protease inhibitors; non-nucleoside reverse transcriptase inhibitors
5.  Screening Prevalence and Incidence of Colorectal Cancer Among American Indian/Alaskan Natives in the Indian Health Service 
Digestive Diseases and Sciences  2011;56(7):2104-2113.
Background
Studies on colorectal cancer (CRC) screening and incidence among American Indian/Alaska Natives (AI/AN) are few.
Aims
Our aim was to determine CRC screening prevalence and to calculate CRC incidence among AI/AN receiving care within the Indian Health Service (IHS).
Methods
A retrospective cohort study of AI/AN who utilized IHS from 1996 to 2004. AI/AN who were average-risk for CRC and received primary care within IHS were identified by searching the IHS Resource Patient Management System for selected ICD-9/CPT codes (n = 142,051). CRC screening prevalence was calculated and predictors of screening were determined for this group. CRC incidence rates were ascertained for the entire AI/AN population ages 50–80 who received IHS medical care between 1996 and 2004 (n = 283,717).
Results
CRC screening was performed in 4.0% of average-risk AI/AN. CRC screening was more common among women than men (RR = 1.6, 95% CI 1.4–1.7) and among AI/AN living in the Alaska region compared to the Pacific Coast region (RR = 2.5, 95% CI 2.2–2.8) while patients living in the Northern Plains (RR = 0.4, 95% CI 0.3–0.4) were less likely to have been screened. CRC screening was less common among patients with a greater number of primary care visits. The age-adjusted CRC incidence among AI/AN ages 50–80 was 227 cancers per 100,000 person-years.
Conclusions
CRC was common among AI/AN receiving medical care within IHS. However, CRC screening prevalence was far lower than has been reported for the U.S. population.
doi:10.1007/s10620-010-1528-3
PMCID: PMC3112488  PMID: 21234688
Screening; Incidence; Colonoscopy; Health disparity

Results 1-5 (5)