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Robles-Vera PI, Molina-Vicenty IL, Borrás-Fernandez IC, Jovet-Toledo G, Motta-Valencia K, Dismuke CE, Pope C, Reyes-Rosario C, Ríos-Padín J. Sociodemographic and Health Characteristics of Hispanic Veteran Patients With Traumatic Brain Injury and Its Association to Mortality: A Pilot Study. Mil Med 2024:usae346. [PMID: 39042559 DOI: 10.1093/milmed/usae346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/04/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is among the most common conditions in the military. VA Caribbean Healthcare System (VACHS) patients with Traumatic Brain Injury (TBI) have a higher mortality rate than Veterans in other VA health care systems in the United States. The main goal of this study was to develop sociodemographic profiles and outline health characteristics of Hispanic patients with TBI treated at the VA Caribbean Healthcare System in a search for potential explanations to account for the higher mortality rate. This study advocates for equity in health services provided for minorities inside the militia. MATERIALS AND METHODS Data collected from electronic medical records and VA databases were used to create sociodemographic and health characteristics profiles, in addition to survival models. The population of the study were post 911 Veteran soldiers who had been diagnosed with TBI. Adjusted models were created to provide hazard ratios (HR) for mortality risk. RESULTS Out of the 16,549 files available from all 10 selected VA sites, 526 individuals were identified as treated at the VACHS. Of 526 subjects screened, 39 complied with the inclusion/exclusion criteria. Results include: 94.4% male, 48.7% between the ages of 21 and 41 years, 89.7% have depression, 66.7% have post-traumatic stress disorder (PTSD), 82.1% receive occupational therapy, 94.9% have severe headaches, 100% suffer from pain, 94.9% have memory problems, and 10.3% have had suicidal thoughts. Over 60% had a first-hand explosion experience, be it just the explosion or with another type of injury. Data showed that 33% of our patients had a Magnetic Resonance Imaging (MRI), 31% had a CT, 15.4% had a SPECT, and 2.6% had PET scan. Significant associations were found between MRIs and speech therapies, and MRIs and total comorbidities. The Cox proportional-hazards model for survival adjusted for age, gender, race/ethnicity, and comorbidities shows that VACHS Veterans diagnosed with a TBI had a higher mortality risk rate (HR 1.23 [95% CI 1.10, 1.37]) when compared to the other 9 health centers with the highest percentage of Hispanic Veterans. CONCLUSIONS Since explosions were the most common mechanism of injury, further research is needed into the experiences of Veterans in connection with this specific variable. A high percentage of the patients suffered from depression and PTSD. Additionally, over half of the patients had an unmeasured TBI severity. The effects these aspects have on symptomatology and how they hinder the recovery process in Hispanic patients should be examined in further detail. It is also important to highlight that family and friends' support could be key for injury treatment. This study highlights the use of the 4 types of scans (MRI, CT, PET/CT, and SPECT/CT) as ideal diagnosis tools. The alarming number of patients with suicidal thoughts should be a focus in upcoming studies. Future studies should aim to determine whether increased death rates in TBI Veterans can be linked to other United States islander territories. Concepts, such as language barriers, equal resource allocation, and the experiences of Veterans with TBIs should be further explored in this Veteran population.
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Affiliation(s)
- Paola I Robles-Vera
- VA Caribbean Health Care System, Research and Development Service, Nuclear Medicine and Molecular Imaging Research Section, San Juan, PR 00921, USA
- Biology Department, Universidad de Puerto Rico, Río Piedras Campus, San Juan, PR 00925, USA
| | - Irma L Molina-Vicenty
- VA Caribbean Health Care System, Research and Development Service, Nuclear Medicine and Molecular Imaging Research Section, San Juan, PR 00921, USA
- Biology Department, Universidad de Puerto Rico, Río Piedras Campus, San Juan, PR 00925, USA
- Student Mentorship Program for Hispanic Health Research (sMPH2r), Hispanic -Serving Health Professions Schools (HSHPS), Washington, DC 20005, USA
| | - Isabel C Borrás-Fernandez
- Student Mentorship Program for Hispanic Health Research (sMPH2r), Hispanic -Serving Health Professions Schools (HSHPS), Washington, DC 20005, USA
- VA Caribbean Health Care System, Physical Medicine & Rehabilitation Service, San Juan, PR 00921, USA
| | - Gerardo Jovet-Toledo
- VA Caribbean Health Care System, Research and Development Service, Nuclear Medicine and Molecular Imaging Research Section, San Juan, PR 00921, USA
| | - Keryl Motta-Valencia
- Student Mentorship Program for Hispanic Health Research (sMPH2r), Hispanic -Serving Health Professions Schools (HSHPS), Washington, DC 20005, USA
- VA Caribbean Health Care System, Physical Medicine & Rehabilitation Service, San Juan, PR 00921, USA
| | - Clara E Dismuke
- Student Mentorship Program for Hispanic Health Research (sMPH2r), Hispanic -Serving Health Professions Schools (HSHPS), Washington, DC 20005, USA
- Ralph H. Johnson VA Medical Center, COIN: Charleston Health Equity and Rural Outreach Innovation Center (HEROIC) Charleston SC, Charleston, SC 29401, USA
- Health Economics Resource Center (HERC), VA Palo Alto Health Care System Palo Alto, Palo Alto, CA 94025, USA
| | - Charlene Pope
- Ralph H. Johnson VA Medical Center, COIN: Charleston Health Equity and Rural Outreach Innovation Center (HEROIC) Charleston SC, Charleston, SC 29401, USA
| | - Coral Reyes-Rosario
- VA Caribbean Health Care System, Research and Development Service, Nuclear Medicine and Molecular Imaging Research Section, San Juan, PR 00921, USA
- Biology Department, Universidad de Puerto Rico, Río Piedras Campus, San Juan, PR 00925, USA
- Student Mentorship Program for Hispanic Health Research (sMPH2r), Hispanic -Serving Health Professions Schools (HSHPS), Washington, DC 20005, USA
| | - José Ríos-Padín
- VA Caribbean Health Care System, Research and Development Service, Nuclear Medicine and Molecular Imaging Research Section, San Juan, PR 00921, USA
- Biology Department, Universidad de Puerto Rico, Río Piedras Campus, San Juan, PR 00925, USA
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Pavel DG, Henderson TA, DeBruin S, Cohen PF. The Legacy of the TTASAAN Report - Premature Conclusions and Forgotten Promises About SPECT Neuroimaging: A Review of Policy and Practice Part II. Front Neurol 2022; 13:851609. [PMID: 35655621 PMCID: PMC9152128 DOI: 10.3389/fneur.2022.851609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970s. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was not stabilized until 1993 and most early SPECT scans were performed on single-head gamma cameras. These early scans were of inferior quality. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. This two-part series explores the policies and procedures related to perfusion SPECT functional neuroimaging. In Part I, the comparison between the quality of the SPECT scans and the depth of the data for key neurological and psychiatric indications at the time of the TTASAAN report vs. the intervening 25 years were presented. In Part II, the technical aspects of perfusion SPECT neuroimaging and image processing will be explored. The role of color scales will be reviewed and the process of interpreting a SPECT scan will be presented. Interpretation of a functional brain scans requires not only anatomical knowledge, but also technical understanding on correctly performing a scan, regardless of the scanning modality. Awareness of technical limitations allows the clinician to properly interpret a functional brain scan. With this foundation, four scenarios in which perfusion SPECT neuroimaging, together with other imaging modalities and testing, lead to a narrowing of the differential diagnoses and better treatment. Lastly, recommendations for the revision of current policies and practices are made.
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Affiliation(s)
- Dan G Pavel
- PathFinder Brain SPECT, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,Neuro-Laser Foundation, Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Baltimore, MD, United States
| | - Philip F Cohen
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Thornton JF, Schneider H, Cohen PF, DeBruin S, Uszler JM, Siow YH, McLean MK, van Lierop MJ, Pavel DG, Henderson TA. Longitudinal Single Photon Emission Computed Tomography Neuroimaging as an Indication of Improvement in Psychiatric Disorders in a Community Psychiatric Practice. Front Psychiatry 2022; 13:787186. [PMID: 35401270 PMCID: PMC8990854 DOI: 10.3389/fpsyt.2022.787186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
In the community, there is a need to more objectively evaluate the response of common chronic psychiatric disorders to treatment. Brain single photon emission computed tomography (SPECT) indirectly measures cerebral functional activity by uptake of a radiotracer, which follows regional cerebral blood flow. Brain 3D Thresholded SPECT scans are thresholded three dimensional images derived from brain SPECT data. A retrospective community study of longitudinal (before and after treatment) brain 3D Thresholded SPECT scans of 73 patients with all-cause psychiatric disorders (most frequent diagnostic clusters: attention-deficit hyperactivity disorder, post-mild traumatic brain injury, affective disorders, psychotic disorders, post-viral chronic syndromes), shows these baseline SPECT scans predict improvement (non-worsening to large improvement) in clinical functioning with a sensitivity of 94% (95% confidence interval 86-98%) and a specificity of 67% (95% confidence interval 21-94%). In contrast, contemporaneous analysis by the same radiologist of conventional 2D reading of the same before and after treatment brain SPECT scan data of the same 73 patients, predicted improvement (non-worsening to large improvement) in clinical functioning with a sensitivity of only 26% (95% confidence interval 17-37%) although with a specificity of 100% (95% confidence interval 44-100%). These data suggest 3D Thresholded SPECT scans can provide the clinician with a more objective measure for verifying improvement in psychiatric disorders seen in the community, consistent with prior studies of SPECT as a measure of neurobiological change. Furthermore, these data suggest 3D Thresholded SPECT scans may have clinical application in guiding treatment and potentially improving outcomes.
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Affiliation(s)
- John F. Thornton
- Rossiter-Thornton Associates, Toronto, ON, Canada
- International Society of Applied Neuroimaging, Denver, CO, United States
| | - Howard Schneider
- International Society of Applied Neuroimaging, Denver, CO, United States
- Sheppard Clinic North, Vaughan, ON, Canada
| | - Philip F. Cohen
- International Society of Applied Neuroimaging, Denver, CO, United States
- Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - John Michael Uszler
- International Society of Applied Neuroimaging, Denver, CO, United States
- DrSPECTscan Inc., Lake Elsinore, CA, United States
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yin-Hui Siow
- International Society of Applied Neuroimaging, Denver, CO, United States
- Nuclear Medicine, Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Mary K. McLean
- International Society of Applied Neuroimaging, Denver, CO, United States
- Private Practice, Toronto, ON, Canada
| | - Muriel J. van Lierop
- International Society of Applied Neuroimaging, Denver, CO, United States
- Private Practice, Toronto, ON, Canada
| | - Dan G. Pavel
- International Society of Applied Neuroimaging, Denver, CO, United States
- PathFinder Brain SPECT LLC, Deerfield, IL, United States
| | - Theodore A. Henderson
- International Society of Applied Neuroimaging, Denver, CO, United States
- Dr. Theodore Henderson, Inc., Denver, CO, United States
- The Synaptic Space, Inc., Denver, CO, United States
- Neuro-Luminance, Inc., Denver, CO, United States
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