BACKGROUND: Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common. OBJECTIVE: The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure. DESIGN: We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5. PARTICIPANTS: A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White. MEASURES: The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences. Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.

Purpose Demographic, behavioral and environmental factors have been associated with increased risk of colorectal cancer (CRC). We reviewed the published evidence and explored associations between risk factors and CRC incidence. Methods We identified 12 established non-screening CRC risk factors and performed a comprehensive review and meta-analyses to quantify each factor’s impact on CRC risk. We used random effects models of the logarithms of risks across studies: inverse variance weighted averages for dichotomous factors and generalized least squares for dose-response for multi-level factors. Results Significant risk factors include inflammatory bowel disease (RR = 2.93, 95% CI: 1.79–4.81); CRC history in first-degree relative (RR = 1.79, 95% CI: 1.60–2.02); body mass index (BMI) to overall population (RR = 1.10 per 8 kg/m2 increase, 95% CI: 1.08–1.12); physical activity (RR = 0.88, 95% CI: 0.86–0.91 for 2 standard deviations increased physical activity score); cigarette smoking (RR = 1.06, 95% CI: 1.03–1.08 for 5 pack-years), and consumption of red meat (RR = 1.13, 95% CI: 1.09–1.16 for 5 servings/week), fruit (RR = 0.85, 95% CI: 0.75–0.96 for 3 servings/day), and vegetables (RR = 0.86, 95% CI: 0.78–0.94 for 5 servings/day). Conclusions We developed a comprehensive risk modeling strategy that incorporates multiple effects to predict an individual’s risk of developing colorectal cancer. Inflammatory bowel disease and history of CRC in first-degree relatives are associated with much higher risk of CRC. Increased BMI, red meat intake, cigarette smoking, low physical activity, low vegetable consumption, and low fruit consumption were associated with moderately increased risk of CRC.

IMPORTANCESuicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente.OBJECTIVES To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates.EVIDENCE REVIEW A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies.FINDINGS From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (Ն0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (Յ0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics.CONCLUSIONS AND RELEVANCE To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.

PE is an efficacious treatment for active-duty Army soldiers with PTSD from deployments to Iraq or Afghanistan. Results extend previous evidence supporting the efficacy of PE to active-duty military personnel and raise important questions for future research on VRE. (PsycINFO Database Record

ResultsDeployment was not associated with the rate of suicide (hazard ratio, 0.96; 99% CI, 0.87-1.05). There was an increased rate of suicide associated with separation from military service (hazard ratio, 1.63; 99% CI, 1.50-1.77), regardless of whether service members had deployed or not. Rates of suicide were also elevated for service members who separated with less than 4 years of military service or who did not separate with an honorable discharge. Conclusions and RelevanceFindings do not support an association between deployment and suicide mortality in this cohort. Early military separation (<4 years) and discharge that is not honorable were suicide risk factors.