OBJECTIVE:Assess knowledge of and adherence to DGA food group recommendations and their associations and evaluate beliefs about whether individuals with SCI/D should follow the same guidelines as those without SCI/D, and how these beliefs relate to adherence. DESIGN:Cross-sectional survey. SETTING:National Veterans Health Administration SCI/D Centers, Midwest Regional SCI Model System of Care, and Shirley Ryan AbilityLab. PARTICIPANTS:Veterans and civilians with SCI/D recruited by mailed invitation letters. OUTCOME MEASURES:Knowledge of, adherence to, and beliefs about DGA applicability for individuals with SCI/D across food groups. RESULTS:Participants were, on average, 58 years old, with a duration of injury of 12 years, and 57% had paraplegia. Knowledge of the DGA recommendation for each food group ranged from 24%-44%. Fewer than one-third adhered to DGA for all food groups. Knowledge was associated with better adherence for most food groups except vegetables. Forty-four percent or fewer believed each food group guideline applied to people with SCI/D; yet a greater proportion of those who did believe also met dairy, grain, protein, and oil guidelines. CONCLUSION:Knowledge of and adherence to DGA were low, as were beliefs about DGA suitability for individuals with SCI/D. Greater knowledge of DGA and beliefs about suitability were both associated with better adherence to most food groups. Findings underscore the need to clarify the applicability of guidelines in persons with SCI/D and address knowledge gaps once determined.

STUDY DESIGN:Little is known about the factors associated with perceived burdensomeness (PB) and thwarted belongingness (TB) in persons living with SCI/D. Similarly, limited studies have examined the Interpersonal Need Questionnaire (INQ) specifically among this population to measure these concepts. OBJECTIVES:To identify variables independently associated with PB and thwarted belongingness TB in individuals living with SCI/D using the INQ. SETTING:A random sample of community-dwelling Veterans with SCI/D who used Veteran Health Administration healthcare services between 2017-2022. METHODS:A cross-sectional, national survey was conducted in 2023 via telephone to collect PB and TB responses along with demographic, injury, and health characteristics. Independent t-tests and Analysis of Variance (ANOVA) were performed for bivariate comparisons. RESULTS:The overall sample (n = 92) had a mean (SD) PB score of 14 (9.6) and mean (SD) TB score of 28 (13). Individuals with SCI/D who reported significantly higher (p < .05) PB and TB were older at injury onset (60+ years), reported fair/poor general health, had greater frequency of poor physical and mental health days, had dysfunctional sleep, and bowel dysfunction. CONCLUSIONS:Subgroups of individuals with SCI/D often have strained relationships and social participation barriers post-SCI/D, that may result in feeling like a burden to others and a lack of belongingness. Efforts to reduce feelings of burdensomeness and improve belongingness should begin by focusing on individuals who are older when they sustain their SCI/D, report poor general, physical and mental health, and experience dysfunctional sleep and bowel complications.

CONTEXT:Individuals with SCI/D with motor paralysis are at increased risk of obesity. They also experience reduced resting metabolic rate, premature chronic conditions, and secondary complications (e.g. pain) that challenge weight management. As such, careful attention to weight-loss strategies such as exercise and diet is needed. This study aims to identify the prevalence of intentional weight-loss strategies among individuals with SCI/D and to examine associations between their use of these strategies and health, dietary, and activity factors. DESIGN:Cross-sectional survey. SETTING:National Veterans Health Administration SCI/D Centers, Midwest Regional SCI Model System of Care, and Shirley Ryan AbilityLab. PARTICIPANTS:Veterans and civilians with SCI/D recruited by mailed invitation letters. INTERVENTIONS:NA. OUTCOME MEASURES:Questions assessing demographic and injury characteristics, chronic health conditions, secondary complications, and dietary and physical activity factors. RESULTS:301 participants with SCI/D (mean age: 57 years, 67% men, 74% white, and 56% paraplegia) completed the outcome item on weight-loss strategies. 69% of participants reported using weight-loss strategies, with general dieting (40%), restricted-calorie intake (34%), and eliminating specific food categories/types (31%) the most common strategies. Being overweight/obese (OR = 6.93), having diabetes (OR = 7.49), having urinary tract infections (OR = 2.98), preparing meals oneself (OR = 4.01), and having the last eating occasion before 8 pm (OR = 2.52) were associated with the use of weight-loss strategies. CONCLUSION:Weight-loss strategies for individuals with SCI/D are prevalent and are associated with dietary habits and health conditions. These findings highlight opportunities to improve informed and sustainable weight management practices after SCI/D.

PURPOSE/OBJECTIVE:Research on food avoidance behaviors in individuals with chronic spinal cord injuries and disorders (SCI/D) is scarce. The objective was to assess food avoidance, reasons, and associated variables in persons with chronic SCI/D. RESEARCH METHOD/DESIGN:A cross-sectional survey was conducted. Bivariate and multivariable analyses identified variables associated with food avoidance. RESULTS:Of 365 respondents, 63% engaged in food avoidance behaviors. Reasons included intentional weight loss (49%), lack of hunger cues (40%), fear of bowel complications (32%), fear of gastrointestinal concerns (26%), uninterested in food (26%), and lack of help needed to prepare/eat food (11%). Bivariate analysis showed that a greater proportion of individuals with SCI/D who engaged in food avoidance behaviors compared with those who did not had low blood pressure (29% vs. 19%), heart problems (13% vs. 5%), sleep problems (86% vs. 66%), musculoskeletal pain (82% vs. 63%), bowel complications (78% vs. 69%), bladder complications (77% vs. 65%), gastroesophageal reflux disease (49% vs. 30%), osteoporosis (37% vs. 24%), posttraumatic stress (35% vs. 16%), and loneliness (31% vs. 14%; all p < .05). Variables that remained independently associated with food avoidance in multivariable analysis included: heart conditions (OR = 3.09, 95% confidence interval [CI]: 1.18-8.12), gastroesophageal reflux disease (OR = 1.77, 95% CI: 1.05-2.97), musculoskeletal pain (OR = 2.00, 95% CI: 1.11-3.62), sleep problems (OR = 1.81, 95% CI: 1.01-3.30), and loneliness (OR = 2.19, 95% CI: 1.17-4.10; all p < .05). CONCLUSIONS/IMPLICATIONS:Many individuals with SCI/D engaged in food avoidance behaviors. Food avoidance may be a strategy people use to modify their diet to manage health conditions, or it may suggest disordered avoidant eating behaviors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

OBJECTIVE:To identify factors associated with oral health problems in individuals with spinal cord injuries and disorders (SCI/D). DESIGN:Cross-sectional survey conducted in 2024-2025. SETTING/PARTICIPANTS:Veterans and civilians with SCI/D from Veterans Health Administration and private sector organizations. INTERVENTIONS:N/A MAIN OUTCOMES MEASURES: Oral health problems, chronic conditions, secondary complications, and psychosocial health. RESULTS:The sample (n=370) had a mean age of 58 years (18-91y; SD, 15); 71% were men, 57% had paraplegia, and the mean injury duration was 12 years (1-64y; SD, 13). Oral health problems were reported by 26%. Unadjusted analyses showed that a greater proportion of those with oral health problems (vs those without) were not employed (92% vs 83%; P=.04) and lived alone (30% vs 18%; P=.02), and had a higher age at injury onset (50y vs 44y; P=.01), sleep problems (62% vs 49%; P=.04), high blood pressure (49% vs 37%; P=.04), heart problems (16% vs 8%; P=.04), musculoskeletal pain (88% vs 83%; P=.004), and respiratory problems (46% vs 26%; P=.0004). A greater proportion with oral health problems experienced depression (58% vs 37%; P=.0005), anxiety (53% vs 36%; P=.003), frequent mental distress (37% vs 24%; P=.01), posttraumatic stress (41% vs 34%; P=.002), and loneliness (32% vs 22%; P=.05). Multivariable regression showed that variables independently associated with oral health problems included living alone (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.5; P=.03), musculoskeletal pain (OR, 2.7; 95% CI, 1.1-6.7; P=.03), and respiratory conditions (OR, 2.0; 95% CI, 1.1 - 4.5; P=.04). CONCLUSIONS:Oral health problems were more common among people who lived alone and had physical and psychosocial health concerns. Future studies should identify barriers to oral health in this population, especially for those who live alone and experience musculoskeletal pain, as each of these may contribute to oral hygiene difficulties and challenges accessing preventive services. Given the compromised respiratory function in many people with SCI/D, efforts to alleviate oral health problems that could be contributing to respiratory conditions should be addressed.

Research Objectives To assess weight loss/control behaviors among individuals with spinal cord injuries and disorders (SCI/D). Design Cross-sectional survey Setting Community Participants Veterans and civilians with SCI/D Interventions N/A Main Outcome Measures Bivariate analyses compared demographic, injury, and health characteristics of individuals who engaged in weight loss behaviors vs. those who did not. Results The sample (n=370) had a mean age of 58 years (range: 18-91 y), were mostly men (71%), and 38% were college graduates. The mean injury duration was 12 years (1-64 y) and 56% had paraplegia. During the prior 6-months, 69% engaged in at least one weight loss/control behavior, including dieting (40%), caloric restriction (34%), eliminating specific food types, e.g., carbohydrates (31%), skipping daily meals (25%), time-restricted eating (15%), full-day prolonged fasting (4%), weight loss pills (3%), diuretics to feel ‘lighter’ (2%), laxatives for calorie elimination (2%), and excessive exercise (2%). Those who engaged in > 1 weight loss behavior compared with those who did not were older (58 vs. 53, p=.009), had higher average BMI (30 kg/m2 vs. 26 kg/m2, p<.0001), and a greater proportion experienced unintentional weight gain of 5% or more during the prior 6 months (83%) vs those who did not engage in weight loss behaviors (66%), p=.04. Of those who engaged in weight loss/control behaviors, a greater proportion was overweight/obese (81%) than healthy weight (43%) or underweight (33%), p<.0001 and had (vs. did not have) high blood pressure (80% vs. 61%, p<.001), high cholesterol (80% vs. 66%, p=.05), high triglycerides (100% vs. 66%, p=.003), diabetes (94% vs. 64%, p<.0001), heart disease (87% vs. 66%, p=.02), respiratory complications (79% vs 65%, p=.02), and dysfunctional sleep (74% vs. 62%, p=.03). A greater proportion of those who engaged in weight loss/control behaviors prepared their own food (77%) vs. someone else preparing their food (65%) or using a meal preparation/kit service (42%), p=.01 and independently selected their groceries (73%), or selected groceries with another person (74%) vs. someone else selecting the groceries they consumed (53%), p=.007. Conclusions Individuals with SCI/D with several chronic conditions, and who independently prepare and shop for their own food, were more likely to engage in weight loss/control behaviors. Dietary guidelines suggest endorsing a healthy dietary pattern that does not include behaviors such as fad dieting, caloric restriction, skipping meals, eliminating food groups, or prolonged fasting. Additional work is needed to understand if these are potentially harmful, unhealthy weight loss behaviors.

CONTEXT:Peer-based volunteering is a potential strategy to alleviate loneliness. OBJECTIVE:To evaluate the impact of participating as a volunteer letter writer on pre/post-program loneliness outcomes and to examine experiences with participation. METHODS:Volunteers with spinal cord injury/dysfunction (SCI/D) participated in a 6-month program writing letters to peers. Mixed methods were used to evaluate volunteers' experiences with the letter writing program. Pre/post loneliness outcomes were examined using a paired t-test. Post-program evaluation included satisfaction, benefit, and negative impact ratings. Qualitative interviews were coded inductively and analyzed using qualitative content analysis. RESULTS:Volunteer peer letter writers (n = 28) were male (82%), had paraplegia (57%) and incomplete injuries (50%). On average they were 55 years of age and injured for 18 years. Volunteer peer letter writers with SCI/D had a statistically significant reduction in loneliness from pre- to post-program (3-item UCLA score 4.0 to 3.7, P = .04). The majority found the program beneficial (72%), with no/neutral negative impacts (93%), and were satisfied (82%). Volunteer peers with SCI/D: (1) liked and felt good about helping others with SCI/D; (2) believed the program provided an opportunity for self-reflection, including awareness and appreciation of their own circumstances and social connections; (3) liked sharing their injury experiences with and being connected to the letter recipient, and (4) found value in the writing process itself. CONCLUSIONS:Loneliness was reduced in peer letter writers from pre- to post-program. Volunteers had beneficial and satisfactory experiences. Work to develop and test interventions peer-based volunteering intervention to address loneliness and other psychosocial outcomes is needed.

Cross-sectional cohort study. To examine lifestyle behaviors independently associated with loneliness among Veterans living with spinal cord injuries and disorders (SCI/D). The Veteran Health Administration SCI/D System of Care, including 25 regional SCI/D Centers and associated Hubs. A national random sample of community-dwelling Veterans with SCI/D who used VHA healthcare services between 2017–2022 participated in a survey. We assessed unadjusted associations with moderate/high loneliness vs no/low loneliness. Multivariable logistic regression model assessed factors independently associated with moderate/high loneliness. Among 2466 Veterans with SCI/D, 592 completed surveys (24

PURPOSE/OBJECTIVE:To evaluate the Caring Connections intervention compared to an attention control condition on loneliness, perceived burdensomeness (PB), and thwarted belongingness (TB). RESEARCH METHOD/DESIGN:In a two-arm parallel randomized controlled trial (RCT), 58 individuals with spinal cord injuries and disorders were randomized 1:1 to the intervention or the attention control condition. Block randomization with random block sizes of 2, 4, or 6 and allocation concealment were used to assign individuals to arms. RESULTS:Both groups showed within-group improvements in loneliness from baseline to post-RCT, but no statistically significant differences in change scores between the conditions over time. The treatment group showed within-group improvement in PB from baseline to post (p = .0008), but not in TB. The control group showed within-group improvement in TB from baseline to post (p = .04), but not in PB. No significant differences over time were found for either PB or TB between conditions. A greater proportion of the treatment versus control group found the program to be beneficial (76% vs. 45%, p = .02) and satisfactory (79% vs. 52%, p = .03). CONCLUSIONS/IMPLICATIONS:We did not demonstrate that the Caring Connections intervention reduced feelings of loneliness compared to the control condition. We found significant within-group improvements in loneliness from baseline to post-RCT for both groups. Within-group improvements in PB were seen in the treatment group and TB in the control group, but no significant differences in change scores over time between conditions. Communication over a 6-month period (from personalized peer letters or informational material on quality of life) had some impact on loneliness, PB, and TB. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PURPOSE:Better understanding patient uptake of pharmacogenomic (PGx) testing may inform its implementation and maximize the benefits that such testing can confer. This study examined patient and provider factors associated with PGx test ordering in a national health care system in which panel-based testing was implemented as part of routine care. METHODS:We used a retrospective matched cohort design and data from the Veterans Health Administration Corporate Data Warehouse. A conditional logistic model was used to identify factors associated with a PGx order receipt and estimate odds ratios and 95% confidence intervals. RESULTS:The following patient factors predicted receipt of a PGx test order: younger age, married status, rural residence, non-Hispanic Black or Hispanic race/ethnicity, PGx educational mailer receipt, depression diagnosis, allergy to a drug on the panel, prescriptions for drugs on the panel, and specialty care visits (P < .05). Additionally, patients whose providers were female, younger, a nurse practitioner/physician assistant or pharmacist, or participated in an educational mailer program were more likely to receive an order (P < .05). CONCLUSION:This study highlights factors that may facilitate or hinder the widespread and equitable implementation of PGx testing in a large national health care system. The information is being used to further refine the program.

Multi-phase root cause analysis (RCA) Determine the root cause of why veterans developed a novel CAPrI following the completion of the CAPP-FIT intervention from the providers and veterans’ perspectives. A Midwest Veteran Health Administration (VHA) facility SCI clinic. RCA using Five Why’s method and chronology mapping for veterans with spinal cord injury who developed a novel community-acquired pressure injury (CAPrI) following use of a decision support tool to prevent CAPrIs, called the Community Acquired Pressure Injury Prevention—Field Implementation Tool (CAPP-FIT). Data sources include the electronic health record and veteran responses to the CAPP-FIT. Key themes emerged describing differing provider/veteran perspectives and barriers that led to the development of a novel CAPrI. Themes included (1) disagreement in level of care needed due to complexity of needs or differing priorities; (2) focus on education and treatment over prevention; (3) barriers in accessing VHA care; and (4) veteran and informal resource engagement. CAPrI’s develop quickly, and some can be prevented. Improving the speed that veterans gain access to critical services (e.g., caregiver and specialists), as well as improving communication at the system level (i.e., across VHA facilities and to private facilities) can decrease the risk of CAPrI’s.

BACKGROUND:Community-acquired pressure injuries (CAPrIs) are common and costly among individuals living with spinal cord injury (SCI). OBJECTIVES:Describe feasibility, usability, and satisfaction of a decision support tool to prevent CAPrIs in individuals with SCI and effect of the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT) on CAPrI incidence 6 months post CAPP-FIT implementation. METHODS:Preparation for the pilot included redesigning clinic workflow and training providers using a simulation with a standardized patient. The CAPP-FIT was piloted with community-dwelling veterans with scheduled in-person and telehealth clinic visits. Processes were assessed using contextual inquiry and monthly provider meetings. Feasibility, usability, and satisfaction were assessed using the mobile application rating scale with veterans and focus groups with providers. CAPrI incidence 6 months post CAPP-FIT intervention was assessed using a propensity match of veterans who did not receive the CAPP-FIT intervention. A modified Poisson regression with difference in differences was used to estimate the incidence rate ratio of CAPrIs. RESULTS:Participants included 7 providers (3 registered nurses, 2 nurse practitioners, 2 physicians). Veteran participants (n=103) had a mean age of 64; 50% White, 33% Black; 56% with paraplegia; and 72% with incomplete injury. Veteran participants were satisfied with the CAPP-FIT, agreed questions were relevant, and improved their conversations with providers. Providers felt the CAPP-FIT was easy to use, improved communications, and promoted preventive care. Participants experienced a lower CAPrI incidence rate compared with a propensity-matched sample at the pilot site, with the decrease among CAPP FIT participants being more pronounced than among non-participants. However, the difference in difference was not statistically significant with IRR: 0.23, 95% CI: 0.048-1.066 (P=0.060). CONCLUSIONS:The CAPP-FIT seems to be a useful tool in the SCI Clinic to prevent CAPrIs in veterans with SCI, but further testing is warranted.

Context/Objective: Examine demographics, injury characteristics, objective measures of social isolation and health factors that are associated with perceived social isolation (PSI) among Veterans with spinal cord injury and disorders (SCI/D). Design: Cross-sectional survey. Setting: The Veterans Health Administrations (VHA) SCI/D system of care. Participants :Veterans with SCI/D who have used the VHA health care system. Intervention: Not applicable. Outcomes Measures: We assessed unadjusted associations of high PSI (above population mean) vs low (normative/below population mean), and multivariable logistic regression for independent associations with PSI. Results: Out of 1942 Veterans with SCI/D, 421 completed the survey (22% response rate). Over half (56%) had PSI mean scores higher than the general population. Among the objective measures, having a smaller social network size was associated with increased odds of high PSI (OR 3.59, P < .0001); additionally, for health factors, having depression (OR 3.98, P < 0.0001), anxiety (OR 2.29, P = 0.009), and post-traumatic stress (OR 2.56, P = 0.003) in the previous 6 months, and having 4 or more chronically occurring secondary conditions (OR 1.78, P = 0.045) was associated with increased odds of high PSI. The most commonly identified contributors to feelings of PSI included mobility concerns (63%), having a SCI/D (61%), and concerns about being a burden on others (57%). Conclusions: Factors such as social network size may be used to identify individuals with SCI/D at risk for PSI. Additionally, by identifying mental health problems, presence of multiple chronically occurring secondary conditions, and Veteran-identified contributors of PSI, we can target these factors in a patient-centered interventions to identify and reduce PSI.

Purpose/Objective: Individuals with spinal cord injuries and disorders (SCI/D) are at increased risk for experiencing loneliness and social isolation. The aim is to describe facilitators identified by individuals living with SCI/D to alleviate loneliness and perceived social isolation. Research Method/Design: Descriptive qualitative design using in-depth interviews with veterans with SCI/D (n = 23). Descriptive statistics was used to calculate demographic and injury characteristics. Audio-recorded and transcribed verbatim transcripts were coded and analyzed using Braun and Clarke's (2006) six thematic analysis phases. Results: Participants were male (70%), white (78%), and not currently married (35%), with an average age of 66 years (42-88). Participants had paraplegia (61%), with traumatic etiology (65%) and were injured 14 years (1-45) on average. Eight themes were identified by participants living with SCI/D that described facilitators to alleviate loneliness and perceived social isolation. (a) Engage in/pursue interests; (b) Interact with/spend time with others; (c) Embrace acceptance; (d) Take part in reciprocity; (e) Find a purpose/accomplish goals; (f) Get out of residence, get outside; (g) Connect with SCI/D community/SCI/D peers; and (h) Seek help from (mental) healthcare professionals. Conclusions/Implications: Individuals with SCI/D identified facilitators to alleviate loneliness that encompasses changes in ways of thinking, actions to expand participation in life, and efforts focused on involving others. Findings can be used to guide healthcare delivery and develop interventions to target feelings of loneliness and social isolation in persons with SCI/D, which may be particularly impactful if they involve reciprocal interactions with peers with SCI/D.

OBJECTIVE:To identify variables independently associated with moderate to high loneliness in individuals living with Spinal Cord Injuries or Disorders (SCI/D). DESIGN:A cross-sectional, national survey of a random sample of community-dwelling Veterans with SCI/D in the United States. Survey methodology was used to collect data on demographic and injury characteristics, general health, chronic and SCI-secondary conditions, and loneliness. SETTING:The VHA SCI/D System of Care including 25 regional SCI/D Centers (or Hubs). PARTICIPANTS:Among 2466 Veterans with SCI/D, 592 completed surveys (24%). Most participants were men (91%), white (81%), not currently married (42%), had tetraplegia (33%), and on average injured for 18 years at the time of data collection (N=562). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE:The dependent variable, loneliness, was collected using the UCLA-3 instrument. Loneliness was dichotomized into never/low loneliness and moderate/high loneliness (UCLA score ≥ 4). RESULTS:Bivariate analyses assessed unadjusted associations in demographics, injury characteristics, chronic disease, and SCI-secondary conditions. Multivariable logistic regression was used to identify factors independently associated with moderate/high loneliness. Participants had a mean loneliness score of 5.04, SD=1.99. The point prevalence of moderate to high loneliness was 66%. Lower duration of injury, paraplegia, being unmarried, being in fair/poor general health, having dysfunctional sleep, and having a diagnosis of bowel dysfunction were each independently associated with greater odds of moderate/high loneliness. CONCLUSIONS:Findings suggest that interventions to reduce/manage loneliness in the Veteran SCI/D population should focus on those who are more newly injured, have paraplegia, currently unmarried, have bowel problems, and experience dysfunctional sleep.

ImportanceVenous thromboembolism (VTE) represents a major source of preventable morbidity and mortality and is a leading cause of death in the US after cancer surgery. Previous research demonstrated variability in VTE chemoprophylaxis prescribing, although it is unknown how these rates compare with performance in the Veterans Health Administration (VHA).ObjectiveTo determine VTE rates after cancer surgery, as well as rates of inpatient and outpatient (posthospital discharge) chemoprophylaxis adherence within the VHA.Design, Setting, and ParticipantsThis retrospective cohort study within 101 hospitals of the VHA health system included patients aged 41 years or older without preexisting bleeding disorders or anticoagulation usage who underwent surgical treatment for cancer with general surgery, thoracic surgery, or urology between January 1, 2015, and December 31, 2022. The VHA Corporate Data Warehouse, Pharmacy Benefits Management database, and the Veterans Affairs Surgical Quality Improvement Program database were used to identify eligible patients. Data analysis was conducted between January 2022 and July 2023.ExposuresInpatient surgery for cancer with general surgery, thoracic surgery, or urology.Main Outcomes and MeasuresRates of postoperative VTE events within 30 days of surgery and VTE chemoprophylaxis adherence were determined. Multivariable Poisson regression was used to determine incidence-rate ratios of inpatient and postdischarge chemoprophylaxis adherence by surgical specialty.ResultsOverall, 30 039 veterans (median [IQR] age, 67 [62-71] years; 29 386 men [97.8%]; 7771 African American or Black patients [25.9%]) who underwent surgery for cancer and were at highest risk for VTE were included. The overall postoperative VTE rate was 1.3% (385 patients) with 199 patients (0.7%) receiving a diagnosis during inpatient hospitalization and 186 patients (0.6%) receiving a diagnosis postdischarge. Inpatient chemoprophylaxis was ordered for 24 139 patients (80.4%). Inpatient chemoprophylaxis ordering rates were highest for patients who underwent procedures with general surgery (10 102 of 10 301 patients [98.1%]) and lowest for patients who underwent procedures with urology (11 471 of 17 089 patients [67.1%]). Overall, 3142 patients (10.5%) received postdischarge chemoprophylaxis, with notable variation by specialty.Conclusions and RelevanceThese findings indicate the overall VTE rate after cancer surgery within the VHA is low, VHA inpatient chemoprophylaxis rates are high, and postdischarge VTE chemoprophylaxis prescribing is similar to that of non-VHA health systems. Specialty and procedure variation exists for chemoprophylaxis and may be justified given the low risks of overall and postdischarge VTE.

Background: Spinal cord injury (SCI) healthcare providers are aware of the harmful consequences of overweight/obesity in persons with SCI, but many are unaware of available information and lack training to guide weight management care in the SCI population. Objective: Describe the development and content of an educational curriculum for healthcare providers to help individuals with SCI prevent or manage overweight/obesity.Methods: The biopsychoecological framework guided curriculum planning, data collection, and product development. Thematic analysis of interviews conducted with individuals with SCI, informal caregivers, and SCI healthcare providers pinpointed central educational curriculum topics. SCI healthcare providers evaluated the curriculum.Results: Seven comprehensive topics were developed: 1. Scope and consequences of overweight/obesity in SCI; 2. Classifying and measuring overweight/obesity in SCI; 3. Guidelines related to weight management in SCI; 4. Identifying challenges (and solutions) to weight management in SCI; 5. Strategies for providers to facilitate weight management; 6. Understanding goals, motivators, and desired feedback for weight management; and 7. Knowing how informal caregivers are affected by weight and weight management of care recipients with SCI. High ratings (>80% strong agreement) were achieved on content, word choice, organization, relevance, and actionability. Modification needs were identified and subsequently made to layout, visual aids, and provision of tangible resources. Providers described the curriculum as a scientifically rigorous resource that addresses a knowledge gap, provides populationspecific content, and is useful across interdisciplinary teams.Conclusion: We developed a self-directed learning educational curriculum addressing topics most salient to stakeholders involved in overweight/obesity management of persons with SCI.Published by Elsevier Inc.

Objectives: To explore the personal meanings of healthy eating and physical activity among individuals living with spinal cord injury (SCI) and the information and resources they find beneficial. Methods: We conducted in-depth semistructured individual interviews to understand the personal meanings of healthy eating and physical activity among individuals with SCI. We completed a thematic analysis of qualitative data. Results: Participants were 11 Veterans and 14 civilians, predominantly male, non-Hispanic White, and with paraplegia. Data were described across two categories, including the personal meaning of healthy eating and the personal meaning of physical activity/exercise. Individuals with SCI described their meaning of healthy eating around four themes: types of food, amounts/portions of food, conscious/mindful eating, and eating to enhance health. Individuals wanted information on tailored diets for individuals with paraplegia and tetraplegia and healthy foods that are easy to prepare by people with SCI. Their personal meaning of physical activity/exercise focused on four themes: types of physical activity and exercise, staying active, moving/movement, and differences from non-SCI. Desired information around physical activity included cardiovascular workouts that are effective and possible to do in a wheelchair so that people with SCI can burn enough of the calories they consume to lose or maintain weight. Conclusion: Results provide a better understanding of what healthy eating and physical activity mean to people with SCI and information they desire toward these goals, which can be used to guide patient-provider discussions, develop health promotion programs, and tailor interventions to capitalize on meaningful concepts and beliefs that facilitate healthy behaviors.

Background: The Veterans Choice Program (VCP), aimed at improving access to care, included expanded options for Veterans to receive primary care through community providers. Objectives: The objective of this study was to characterize and compare Veterans use of Veterans Health Administration (VA) primary care services at VA facilities and through a VA community care network (VA-CCN) provider. Research Design: This was a retrospective, observational over fiscal years (FY) 2015-2018. Subjects: Veterans receiving primary care services paid for by the VA. Measures: Veteran demographic, socioeconomic and clinical factors and use of VA primary care services under the VCP each year. Results: There were 6.3 million Veterans with >54 million VA primary care visits, predominantly (98.5% of visits) at VA facility. The proportion of VA-CCN visits increased in absolute terms from 0.7% in 2015 to 2.6% in 2018. Among Veterans with any VA-CCN primary care, the proportion of VA-CCN visits increased from 22.6% to 55.3%. Logistic regression indicated that Veterans who were female, lived in rural areas, had a driving distance >40 miles, had health insurance or had a psychiatric/depression condition were more likely to receive VA-CCN primary care. Veterans who were older, identified as Black race, required to pay VA copayments, or had a higher Nosos score, were less likely to receive VA-CCN primary care. Conclusion: As the VA transitions from the VCP to MISSION and VA facilities gain experience under the new contracts, attention to factors that impact Veterans' use of primary care services in different settings are important to monitor to identify access barriers and to ensure Veterans' health care needs are met.

Objective: To gain a fuller understanding, in the context of biopsychoecological factors, of drivers/motivators, goal setting, and feedback, individuals with spinal cord injury (SCI) find helpful to gauge their weight management progress. Research Method/Design: We conducted in-depth interviews around weight management in SCI. Participants included veterans and civilians with SCI. Thematic analysis methodology was used to categorize data into relevant recurrent and/or conceptually significant themes. Results: Twenty-five individuals identified three primary reasons they wanted to participate in weight management, including overall health and wellness, appearance, and functional mobility. Their self-identified weight management goals included reaching/maintaining a specific body weight and/or trimming a focused body part; engaging in any or more physical activity/exercise; gaining strength and endurance; participating in life and activities; and alleviating weight-related health symptoms (e.g., pain). Individuals identified progress assessments, recognition, regular check-ins, and encouragement as helpful feedback toward weight management achievement. Conclusions/Implications: Our work identified what drives weight management in individuals with SCI, what is important to them in terms of goal setting, and what feedback they would find helpful. These findings may be used in intervention planning and program development to facilitate participation and behavior modification. Weight management efforts and interventions are needed that 1) incorporate motivators for weight management that are important to individuals with SCI; 2) help them identify actionable process and performance goals to facilitate achievement of self-identified meaningful outcome goals; and 3) provide person-centered weight management progress feedback such as those identified in this study (progress assessments, recognition, regular check-ins, and encouragement). (PsycInfo Database Record (c) 2021 APA, all rights reserved).