Veteran's Health

March 2016

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Clinical challenge

Volume 45, No.3, March 2016 Pages 159-159

Questions for this month’s clinical challenge are based on articles in this issue. The clinical challenge is endorsed by the RACGP Quality Improvement and Continuing Professional Development (QI&CPD) program and has been allocated 4 Category 2 points (Activity ID:41042).

Answers to this clinical challenge are available immediately following successful completion online at http://gplearning.racgp.org.au. Clinical challenge quizzes may be completed at any time throughout the 2014–16 triennium; therefore, the previous months answers are not published.

Case 1

The Plarracort Medical Centre sees a large number of patients who are veterans; that is, they were previously in the Australian Defence Force (ADF). Donal, who supervises the general practice registrars in the practice, will be interviewing potential trainees for the next intake later this week. While preparing for this event, Donal has been considering the demographics of veteran attendances.

Question 1

When compared with the general population, the management rate of musculoskeletal problems in veterans aged 18–69 years who hold a Department of Veterans’ Affairs (DVA) medical entitlement card (DVA patients) is:

  1. higher in males but not females
  2. higher in females but not males
  3. equal in both males and females
  4. higher in both males and females.

Question 2

When compared with the general population, the rate of smoking in DVA patients is:

  1. higher in males but not females
  2. higher in females but not males
  3. equal in both males and females
  4. higher in both males and females.

Question 3

When compared with the general population, the management rate of psychological problems in DVA patients aged 18–54 years is:

  1. higher in males but not females
  2. higher in females but not males
  3. equal in both males and females
  4. higher in both males and females.

Question 4

When compared with their age group general population peers, which of the following are more common in veterans?

  1. Criminal behaviour
  2. Domestic violence
  3. Suicide
  4. At-risk alcohol use
  5. None of the above

Donal reflects on the substantive changes in veteran demographics that he has noticed over the past 20 years, particularly the role and welfare of women in the ADF.

Question 5

Which one of the following statements regarding women in the ADF is the most correct?

  1. The proportion of women in the ADF has grown from 4% in 1951 to 25% in 2015.
  2. Compared with the general population, servicewomen were less likely to be diagnosed with major depression.
  3. Compared with their male counterparts, servicewomen reported feeling less supported following deployment.
  4. Research has indicated that most mothers have negative deployment experiences.

Donal returns to the consulting room to see his next patient, Cliff, age 65 years, who is a veteran of the Vietnam War. Cliff has recently read that Vietnam War veterans may be at higher risk of particular medical conditions and would like to have a ‘check-up’. He has also read that family members of Vietnam War veterans may be at higher risk of health problems.

Question 6

When compared with the wider community, Vietnam War veterans are at an increased risk of:

  1. dementia
  2. alcohol misuse     
  3. cardiovascular disease
  4. autoimmune disease
  5. all of the above.

Question 7

Which one of the following statements regarding Vietnam War veterans and their families is most correct?

  1. Children of Vietnam War veterans who were deployed have similar health outcomes as children of Vietnam War veteran who were not deployed.
  2. General practitioners have a role in addressing the trans-generational impact of military service.
  3. The majority of children of military personnel from the Vietnam War era suffer from mental health conditions.
  4. The diagnosis of post-traumatic stress disorder in a Vietnam War veteran is not associated with adverse health outcomes in their children.

Question 8

Worsening of mental health symptoms has been noted in some ex-military personnel a few years after leaving service. Reasons for these presentations may include:

  1. loss of military structure
  2. deficient social supports
  3. loss of supportive mechanisms
  4. difficult intimate family relationships
  5. all of the above.

Donal considers using the Medicare-funded ADF Post-discharge GP Health Assessment Tool.

Question 9

Which one of the following assessments is not a key component of this tool?

  1. Sleep
  2. Psychological distress
  3. Alcohol consumption
  4. Smoking
  5. Vision

Question 10

The common reasons why ADF personnel and veterans avoid seeking help for mental health problems include each of the following EXCEPT:

  1. Stigma
  2. Side effects of medications
  3. Being treated differently
  4. Reduced career prospects
  5. Fear of reduced deployability

Correspondence afp@racgp.org.au

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Type

Clinical challenge

2016