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Pereira S, Apodaca C, Slominski K, Lipsky RK, Coarfa C, Walker CL, McGuire AL, Steele L, Helmer DA. "Holy cow, where do I sign up?" Attitudes of Military Veterans toward Epigenomic Biomarker Toxic Exposure Testing. medRxiv 2024:2024.04.09.24305554. [PMID: 38699358 PMCID: PMC11065004 DOI: 10.1101/2024.04.09.24305554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background With the signing of the PACT Act in 2022, there is great interest and investment in studying toxic exposures encountered during military service. One way to address this is through the identification of epigenomic biomarkers associated with exposures. There is increasing evidence suggesting that exposure to toxic substances may result in alterations to DNA methylation and resultant gene expression. These epigenomic changes may lead to adverse health effects for exposed individuals and their offspring. While the development of epigenomic biomarkers for exposures could facilitate understanding of these exposure-related health effects, such testing could also provide unwanted information. Objectives Explore Veterans' attitudes toward epigenomic biomarker research and the potential to test for past exposures that could pose intergenerational risk. Methods Semi-structured interviews with Veterans (n=22) who experienced potentially harmful exposures during their military service. Results Twenty Veterans said they would hypothetically want to receive epigenomic information related to their toxic exposures and potential health impacts as part of a research study. Veterans identified nine potential benefits of this research, including promoting insights concerning intergenerational health, identification of early health interventions to mitigate the impact of exposures, and additional knowledge or explanation for their experiences. At the same time, 16 participants noted potential risks, including psychological distress in response to results, concerns about receiving non-actionable, uncertain, or inaccurate results, and issues related to privacy and discrimination. Ten participants also identified at least one condition in their children that they thought could be related to their exposure and most said they would be interested in receiving research results related to their children's and grandchildren's risk of developing a health condition associated with their exposure. Discussion Results suggest that Veterans might welcome benefits of epigenomic research related to military exposures yet have some concerns about potential negative impacts.
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Kane NS, Hassabelnaby R, Sullivan NL, Graff F, Litke DR, Quigley KS, Pigeon WR, Rath JF, Helmer DA, McAndrew LM. Veteran Beliefs About the Causes of Gulf War Illness and Expectations for Improvement. Int J Behav Med 2024; 31:169-174. [PMID: 36973578 DOI: 10.1007/s12529-023-10166-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Individuals' beliefs about the etiology of persistent physical symptoms (PPS) are linked to differences in coping style. However, it is unclear which attributions are related to greater expectations for improvement. METHOD AND RESULTS A cross-sectional regression analysis (N = 262) indicated that Veterans with Gulf War Illness (GWI) who attributed their GWI to behavior, (e.g., diet and exercise), had greater expectations for improvement (p = .001) than those who attributed their GWI to deployment, physical, or psychological causes (p values > .05). CONCLUSIONS Findings support the possible clinical utility of exploring perceived contributing factors of PPS, which may increase perceptions that improvement of PPS is possible. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Naomi S Kane
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA.
- VA Ann Arbor Healthcare System, Ann Arbor, USA.
- Department of Psychiatry, Michigan Medicine, 2215 Fuller Road (116C), Ann Arbor, MI, 48105-2103, USA.
| | - Raghad Hassabelnaby
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
- William Paterson University, Wayne, NJ, USA
| | - Nicole L Sullivan
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Fiona Graff
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - David R Litke
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Karen S Quigley
- Department of Veteran Affairs, Bedford Memorial Hospital, Bedford, MA, USA
- Northeastern University, Boston, MA, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA
- Department of Psychiatry, University of Rochester, Rochester, NY, USA
| | - Joseph F Rath
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lisa M McAndrew
- Department of Veterans Affairs, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
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Harrington KM, Quaden R, Steele L, Helmer DA, Hauser ER, Ahmed ST, Aslan M, Radhakrishnan K, Honerlaw J, Nguyen XMT, Muralidhar S, Concato J, Cho K, Gaziano JM, Whitbourne SB. The Million Veteran Program 1990-1991 Gulf War Era Survey: An Evaluation of Veteran Response, Characteristics, and Representativeness of the Gulf War Era Veteran Population. Int J Environ Res Public Health 2024; 21:72. [PMID: 38248536 PMCID: PMC10815483 DOI: 10.3390/ijerph21010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
To address gaps in understanding the pathophysiology of Gulf War Illness (GWI), the VA Million Veteran Program (MVP) developed and implemented a survey to MVP enrollees who served in the U.S. military during the 1990-1991 Persian Gulf War (GW). Eligible Veterans were invited via mail to complete a survey assessing health conditions as well as GW-specific deployment characteristics and exposures. We evaluated the representativeness of this GW-era cohort relative to the broader population by comparing demographic, military, and health characteristics between respondents and non-respondents, as well as with all GW-era Veterans who have used Veterans Health Administration (VHA) services and the full population of U.S. GW-deployed Veterans. A total of 109,976 MVP GW-era Veterans were invited to participate and 45,270 (41%) returned a completed survey. Respondents were 84% male, 72% White, 8% Hispanic, with a mean age of 61.6 years (SD = 8.5). Respondents were more likely to be older, White, married, better educated, slightly healthier, and have higher socioeconomic status than non-respondents, but reported similar medical conditions and comparable health status. Although generally similar to all GW-era Veterans using VHA services and the full population of U.S. GW Veterans, respondents included higher proportions of women and military officers, and were slightly older. In conclusion, sample characteristics of the MVP GW-era cohort can be considered generally representative of the broader GW-era Veteran population. The sample represents the largest research cohort of GW-era Veterans established to date and provides a uniquely valuable resource for conducting in-depth studies to evaluate health conditions affecting 1990-1991 GW-era Veterans.
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Affiliation(s)
- Kelly M. Harrington
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Rachel Quaden
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
| | - Lea Steele
- Veterans Health Research Program, Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (D.A.H.); (S.T.A.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center-Durham, Department of Veterans Affairs, Durham, NC 27705, USA;
- Department of Biostatistics and Bioinformatics, Duke Molecular Physiology Institute, Duke University, Durham, NC 27705, USA
| | - Sarah T. Ahmed
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (D.A.H.); (S.T.A.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (M.A.)
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511, USA;
| | - Krishnan Radhakrishnan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (M.A.)
- National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
| | - Jacqueline Honerlaw
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
| | - Xuan-Mai T. Nguyen
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL 61820, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC 20420, USA;
| | - John Concato
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511, USA;
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Kelly Cho
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - J. Michael Gaziano
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Stacey B. Whitbourne
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
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Staggers KA, Minard C, Byers M, Helmer DA, Wu TD. Metabolic Dysfunction, Triglyceride-Glucose Index, and Risk of Severe Asthma Exacerbation. J Allergy Clin Immunol Pract 2023; 11:3700-3705.e2. [PMID: 37716524 PMCID: PMC10840907 DOI: 10.1016/j.jaip.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Metabolic conditions may worsen asthma. There is a need to define a composite biomarker of metabolic dysfunction that has relevance to asthma outcomes. OBJECTIVE To determine the association of the triglyceride-glucose index (TyG), a biomarker of metabolic syndrome and insulin resistance, with risk of severe asthma exacerbation. METHODS A 5-year retrospective cohort of patients with asthma receiving health care from the US Veterans Health Administration from January 1, 2015, to December 31, 2019, was constructed. Fasting TyG values were extracted. Patients were followed for a severe asthma exacerbation, defined as an asthma-related corticosteroid prescription fill or an emergency encounter or hospitalization for asthma. Adjusted models estimated the relative hazard of exacerbation associated with elevated TyG, accounting for known exacerbation risk factors. RESULTS A total of 108,219 patients fulfilled study criteria. Over 286,343 person-years of follow-up, 21,467 exacerbations were identified, corresponding to a crude rate of 7.5 exacerbations/100 person-years. In exploratory analysis, we found a threshold effect at a TyG of 8.3, which was defined as elevated. In a fully adjusted model, patients with an elevated TyG had a 6% (95% CI, 3%-10%) higher hazard for severe asthma exacerbation, independent of eosinophil count, smoking, obesity, and asthma treatment intensity. CONCLUSIONS Elevated TyG is a risk factor for severe asthma exacerbation independent of conventional predictors. Elevated TyG may identify patients who warrant more intensive asthma treatment and who are candidates for future clinical trials of metabolic intervention for purposes of improving asthma morbidity.
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Affiliation(s)
- Kristen A Staggers
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Charles Minard
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Michelle Byers
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Tianshi David Wu
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas.
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Sullivan N, Schorpp H, Crosky S, Thien S, Helmer DA, Litke DR, Pigeon WR, Quigley KS, McAndrew LM. Treatment and life goals among veterans with Gulf War illness. PLoS One 2023; 18:e0295168. [PMID: 38033143 PMCID: PMC10688846 DOI: 10.1371/journal.pone.0295168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Medically unexplained syndromes (MUS), also termed persistent physical symptoms, are both prevalent and disabling. Yet treatments for MUS are marked by high rates of patient dissatisfaction, as well as disagreement between patients and providers on the management of persistent physical symptoms. A better understanding of patient-generated goals could increase collaborative goal setting and promote person-centered care, a critical component of MUS treatment; yet research in this area is lacking. This paper aimed to develop a typology of treatment and life goals among Gulf War veterans with a medically unexplained syndrome (Gulf War Illness). We examined participants' responses to open-ended questions about treatment and life goals using Braun and Clarke's thematic analysis methodology. Results showed that treatment goals could be categorized into four overarching themes: 1) Get better/healthier, 2) Improve quality of life, 3) Improve or seek additional treatment, and 4) Don't know/Don't have any. Life goals were categorized into six overarching themes: 1) Live a fulfilling life, 2) Live a happy life, 3) Live a healthy life, 4) Be productive/financially successful, 5) Manage GWI, and 6) Don't know/Don't have any. Treatment goals were largely focused on getting better/healthier (e.g., improving symptoms), whereas life goals focused on living a fulfilling life. Implications for the treatment of Gulf War Illness and patient-provider communication are discussed. ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Hannah Schorpp
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Psychology, William Paterson University, Wayne, NJ, United States of America
| | - Sarah Crosky
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
| | - Scott Thien
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - David R. Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States of America
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA, United States of America
| | - Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States of America
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
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Ahmed ST, Li R, Richardson P, Ghosh S, Steele L, White DL, Djotsa AN, Sims K, Gifford E, Hauser ER, Virani SS, Morgan R, Delclos G, Helmer DA. Association of Atherosclerotic Cardiovascular Disease, Hypertension, Diabetes, and Hyperlipidemia With Gulf War Illness Among Gulf War Veterans. J Am Heart Assoc 2023; 12:e029575. [PMID: 37772504 PMCID: PMC10727258 DOI: 10.1161/jaha.123.029575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Approximately 30% of the 700 000 Gulf War veterans report a chronic symptom-based illness of varying severity referred to as Gulf War illness (GWI). Toxic deployment-related exposures have been implicated in the cause of GWI, some of which contribute to metabolic dysregulation and lipid abnormalities. As this cohort ages, the relationship between GWI and atherosclerotic cardiovascular disease (ASCVD) is a growing concern. We evaluated associations between GWI and ASCVD, diabetes, hyperlipidemia, and hypertension in veterans of the Gulf War (1990-1991). METHODS AND RESULTS Analysis of survey data collected in 2014 to 2016 from a national sample of deployed Gulf War veterans (n=942) and Veterans Health Administration electronic health record data (n=669). Multivariable logistic regression models tested for associations of GWI with self-reported ASCVD, diabetes, hyperlipidemia, and hypertension, controlling for confounding factors. Separate models tested for GWI associations with ASCVD and risk factors documented in the electronic health record. GWI was associated with self-reported hypertension (adjusted odds ratio [aOR], 1.67 [95% CI, 1.18-2.36]), hyperlipidemia (aOR, 1.46 [95% CI, 1.03-2.05]), and ASCVD (aOR, 2.65 [95% CI, 1.56-4.51]). In the subset of veterans with electronic health record data, GWI was associated with documented diabetes (aOR, 2.34 [95% CI, 1.43-3.82]) and hypertension (aOR, 2.84 [95% CI, 1.92-4.20]). Hyperlipidemia and hypertension served as partial mediators of the association between GWI and self-reported ASCVD. CONCLUSIONS Gulf War veterans with GWI had higher odds of hyperlipidemia, hypertension, diabetes, and ASCVD compared with Gulf War veterans without GWI. Further examination of the mechanisms underlying this association, including a possible shared exposure-related mechanism, is necessary.
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Affiliation(s)
- Sarah T. Ahmed
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Ruosha Li
- Department of Biostatistics and Data Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Peter Richardson
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Saurendro Ghosh
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Lea Steele
- Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTX
| | - Donna L. White
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Alice Nono Djotsa
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
| | - Kellie Sims
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
| | - Elizabeth Gifford
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center–Durham, Durham VA Medical CenterDurham VA Health Care SystemDurhamNC
- Duke Molecular Physiology Institute and Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamNC
| | - Salim S. Virani
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Cardiology and Cardiovascular Research, Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiology, Department of MedicineMichael E. DeBakey VA Medical CenterHoustonTX
| | - Robert Morgan
- Department of Management, Policy and Community Health, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - George Delclos
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonHoustonTX
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical CenterHoustonTX
- Section of Health Services Research, Department of MedicineBaylor College of MedicineHoustonTX
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Lesnewich LM, Hyde JK, McFarlin ML, Bolton RE, Bayley PJ, Chandler HK, Helmer DA, Phillips LA, Reinhard MJ, Santos SL, Stewart RS, McAndrew LM. 'She thought the same way I that I thought:' a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness. Psychol Health 2023:1-19. [PMID: 37654203 DOI: 10.1080/08870446.2023.2248481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance-shared understanding between patient and provider about illness causes, course, and treatment-is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges. Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data. Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance. Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients' experiences, communicating knowledge about MUS, and establishing trust.
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Affiliation(s)
- Laura M Lesnewich
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Justeen K Hyde
- Department of Medicine, Section General Internal Medicine, Boston University, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
| | | | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Helena K Chandler
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness & Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L Alison Phillips
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- Department of Psychology, Iowa State University, IA, USA
| | - Matthew J Reinhard
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Susan L Santos
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Rachel S Stewart
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- University at Albany, State University of New York (SUNY), Albany, NY, USA
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8
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Wendt FR, Pathak GA, Vahey J, Qin X, Koller D, Cabrera-Mendoza B, Haeny A, Harrington KM, Rajeevan N, Duong LM, Levey DF, De Angelis F, De Lillo A, Bigdeli TB, Pyarajan S, Gaziano JM, Gelernter J, Aslan M, Provenzale D, Helmer DA, Hauser ER, Polimanti R. Modeling the longitudinal changes of ancestry diversity in the Million Veteran Program. Hum Genomics 2023; 17:46. [PMID: 37268996 PMCID: PMC10239111 DOI: 10.1186/s40246-023-00487-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/05/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The Million Veteran Program (MVP) participants represent 100 years of US history, including significant social and demographic changes over time. Our study assessed two aspects of the MVP: (i) longitudinal changes in population diversity and (ii) how these changes can be accounted for in genome-wide association studies (GWAS). To investigate these aspects, we divided MVP participants into five birth cohorts (N-range = 123,888 [born from 1943 to 1947] to 136,699 [born from 1948 to 1953]). RESULTS Ancestry groups were defined by (i) HARE (harmonized ancestry and race/ethnicity) and (ii) a random-forest clustering approach using the 1000 Genomes Project and the Human Genome Diversity Project (1kGP + HGDP) reference panels (77 world populations representing six continental groups). In these groups, we performed GWASs of height, a trait potentially affected by population stratification. Birth cohorts demonstrate important trends in ancestry diversity over time. More recent HARE-assigned Europeans, Africans, and Hispanics had lower European ancestry proportions than older birth cohorts (0.010 < Cohen's d < 0.259, p < 7.80 × 10-4). Conversely, HARE-assigned East Asians showed an increase in European ancestry proportion over time. In GWAS of height using HARE assignments, genomic inflation due to population stratification was prevalent across all birth cohorts (linkage disequilibrium score regression intercept = 1.08 ± 0.042). The 1kGP + HGDP-based ancestry assignment significantly reduced the population stratification (mean intercept reduction = 0.045 ± 0.007, p < 0.05) confounding in the GWAS statistics. CONCLUSIONS This study provides a characterization of ancestry diversity of the MVP cohort over time and compares two strategies to infer genetically defined ancestry groups by assessing differences in controlling population stratification in genome-wide association studies.
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Affiliation(s)
- Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Jacqueline Vahey
- Durham VA Medical Center, Durham, NC, USA
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA
| | - Xuejun Qin
- Durham VA Medical Center, Durham, NC, USA
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA
| | - Dora Koller
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Angela Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kelly M Harrington
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Nallakkandi Rajeevan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
| | - Linh M Duong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Flavio De Angelis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | | | - Tim B Bigdeli
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- VA New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Saiju Pyarajan
- Massachusetts Area Veterans Epidemiology, Research, and Information Center (MAVERIC), Jamaica Plain, MA, USA
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, MA, USA
| | - John Michael Gaziano
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, MA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA CT Healthcare System, West Haven, CT, USA
| | - Mihaela Aslan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dawn Provenzale
- Durham VA Medical Center, Durham, NC, USA
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth R Hauser
- Durham VA Medical Center, Durham, NC, USA.
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA.
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.
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Colbert SMC, Wendt FR, Pathak GA, Helmer DA, Hauser ER, Keller MC, Polimanti R, Johnson EC. Declining autozygosity over time: An exploration in over 1 million individuals from three diverse cohorts. Am J Hum Genet 2023; 110:1008-1014. [PMID: 37178685 PMCID: PMC10257001 DOI: 10.1016/j.ajhg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Previous studies have hypothesized that autozygosity is decreasing over generational time. However, these studies were limited to relatively small samples (n < 11,000) lacking in diversity, which may limit the generalizability of their findings. We present data that partially support this hypothesis from three large cohorts of diverse ancestries, two from the US (All of Us, n = 82,474; the Million Veteran Program, n = 622,497) and one from the UK (UK Biobank, n = 380,899). Our results from a mixed-effect meta-analysis demonstrate an overall trend of decreasing autozygosity over generational time (meta-analyzed slope = -0.029, SE = 0.009, p = 6.03e-4). On the basis of our estimates, we would predict FROH to decline 0.29% for every 20-year increase in birth year. We determined that a model including an ancestry-by-country interaction term fit the data best, indicating that ancestry differences in this trend differ by country. We found further evidence to suggest a difference between the US and UK cohorts by meta-analyzing within country, observing a significant negative estimate in the US cohorts (meta-analyzed slope = -0.058, SE = 0.015, p = 1.50e-4) but a non-significant estimate in the UK (meta-analyzed slope = -0.001, SE = 0.008, p = 0.945). The association between autozygosity and birth year was substantially attenuated when accounting for educational attainment and income (meta-analyzed slope = -0.011, SE = 0.008, p = 0.167), suggesting they may partially account for decreasing autozygosity over time. Overall, we demonstrate decreasing autozygosity over time in a large, modern sample and speculate that this trend can be attributed to increases in urbanization and panmixia and differences in sociodemographic processes lead to country-specific differences in the rate of decline.
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Affiliation(s)
- Sarah M C Colbert
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, West Haven, CT, USA; Department of Anthropology, University of Toronto, Mississauga, ON, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, West Haven, CT, USA
| | - Drew A Helmer
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA; Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Elizabeth R Hauser
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA; VA Cooperative Studies Program Epidemiology Center-Durham, Department of Veterans Affairs, Durham, NC 27705, USA
| | - Matthew C Keller
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, West Haven, CT, USA
| | - Emma C Johnson
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
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Lesnewich LM, Lu SE, Weinreb KS, Sparks SO, Litke DR, Helmer DA, Pigeon WR, McAndrew LM. Associations between risky alcohol use, disability, and problem-solving impairment among Veterans with Gulf War Illness: Secondary data analysis of a randomized clinical trial. J Psychosom Res 2023; 170:111336. [PMID: 37087893 DOI: 10.1016/j.jpsychores.2023.111336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/30/2023] [Accepted: 04/09/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Gulf War Illness (GWI) and alcohol use are both major sources of disability among Gulf War Veterans. The goal of this secondary data analysis was to examine associations between risky alcohol use, problem-solving impairment, and disability among Veterans in a randomized clinical trial of problem-solving treatment (PST) for GWI. We examined cross-sectional associations and conducted longitudinal analyses to test if alcohol use moderated treatment outcome of PST. METHODS Participants were 268 United States military Veterans with GWI randomized to PST or a control intervention. Participants were assessed at four timepoints. Measures included the World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0), Problem Solving Inventory (PSI), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). We conducted multivariate regression (cross-sectional) and mixed model analyses (longitudinal) with separate models for WHO-DAS 2.0 and PSI. All models included AUDIT-C and household income. This analysis was pre-registered on the Open Science Framework. RESULTS Cross-sectional analyses revealed a significant negative association with small effect size between AUDIT-C and WHO-DAS 2.0 (p = 0.006; f2 = 0.05); worse disability was associated with less risky alcohol use. There was no evidence that risky alcohol use moderated effects of PST on disability or PSI. CONCLUSION If replicated, the cross-sectional findings suggest high levels of disability may deter heavy drinking among Veterans with GWI. We did not find evidence that risky alcohol use moderated treatment outcome of PST for GWI. More research is needed to identify moderators of GWI interventions and to understand risky drinking among Veterans with complex health problems.
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Affiliation(s)
- Laura M Lesnewich
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA.
| | - Shou-En Lu
- Rutgers School of Public Health, 683 Hoes Ln. W, Piscataway, NJ 08854, USA; Rutgers Cancer Institute of New Jersey, 195 Little Albany St., New Brunswick, NJ 08901, USA
| | - Karly S Weinreb
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA; Montclair State University, 1 Normal Ave., Montclair, NJ 07043, USA
| | - Sharron O Sparks
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA; Felician University, 1 Felician Way, Rutherford, NJ 07070, USA
| | - David R Litke
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA; Department of Rehabilitation Medicine, New York University Grossman School of Medicine, 240 E. 38th St., New York, NY 10016, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness & Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd. (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, 1 Taub Loop, Houston, TX 77030, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, 400 Fort Hill Ave., Canandaigua, New York 14424, USA; University of Rochester Medical Center, 300 Crittenden Blvd. - Box PSYCH, Rochester, NY 14642, USA
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018, USA
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11
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Winograd DM, Hyde JK, Bloeser K, Santos SL, Anastasides N, Petrakis BA, Pigeon WR, Litke DR, Helmer DA, McAndrew LM. Exploring the acceptability of behavioral interventions for veterans with persistent "medically unexplained" physical symptoms. J Psychosom Res 2023; 167:111193. [PMID: 36822031 DOI: 10.1016/j.jpsychores.2023.111193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This study evaluated the factors that led to enrollment in, and satisfaction with, behavioral interventions for Veterans living with Gulf War Illness (GWI). METHODS One-on-one interviews were conducted pre- and post-intervention with participants randomized to receive either telephone delivered problem-solving treatment (n = 51) or health education (N = 49). A total of 99 Veterans were interviewed pre-intervention and 60 post-intervention. Qualitative data were thematically coded and similarities in themes across the two interventions were examined. RESULTS Before the study began, participants reported desiring to learn new information about their GWI, learn symptom-management strategies, and support improvements to care for other patients with GWI. After the intervention, Veterans felt positively about both interventions because they built strong therapeutic relationships with providers, their experiences were validated by providers, and they were provided GWI information and symptom-management strategies. Results also suggested that interventions do not have to be designed to meet all of the needs held by patients to be acceptable. A minority of participants described that they did not benefit from the interventions. CONCLUSION The results suggest that satisfaction with behavioral interventions for GWI is driven by a strong therapeutic relationship, validating patient's experiences with GWI, and the intervention meeting some of the patient's needs, particularly increasing knowledge of GWI and improving symptom management.
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Affiliation(s)
- Darren M Winograd
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA; University at Albany, State University of New York, Albany, NY, USA
| | - Justeen K Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA; Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Katharine Bloeser
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA; Silberman School of Social Work at Hunter College, The City University of New York, New York, NY, USA
| | - Susan L Santos
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA
| | - Nicole Anastasides
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Veterans Affairs Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - David R Litke
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA; Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Baylor College of Medicine, Houston, TX 77030, USA
| | - Lisa M McAndrew
- Veterans Affairs New Jersey Healthcare System, 385 Tremont Ave. East Orange, NJ 07018, USA.
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12
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Malhotra D, Boyle SH, Gifford EJ, Sullivan BA, Nguyen Wenker TH, Abs ND, Ahmed ST, Upchurch J, Vahey J, Stafford C, Efird JT, Hunt SC, Bradford A, Sims KJ, Hauser ER, Helmer DA, Williams CD. Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder. Neurogastroenterol Motil 2023; 35:e14548. [PMID: 36942766 DOI: 10.1111/nmo.14548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans. METHODS Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). KEY RESULTS The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD- group (aORIBS = 3.12, 95% CI: 1.93-5.05; aORGERD = 2.04, 95% CI: 1.44-2.90; aORCP = 1.85, 95% CI: 1.23-2.80), which had a higher odds of these disorders than the GWI- group (aORIBS = 4.38, 95% CI: 1.55-12.36; aORGERD = 2.51 95% CI: 1.63-3.87; aORCP = 2.57, 95% CI: 1.53-4.32). CONCLUSIONS & INFERENCES GW veterans with GWI and PTSD have significantly higher odds of specific self-reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease.
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Affiliation(s)
- D Malhotra
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - S H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - B A Sullivan
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - T H Nguyen Wenker
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Nono-Djotsa Abs
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, Washington, USA
| | - S T Ahmed
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - J Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J Vahey
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Stafford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J T Efird
- VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts, USA
- Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - S C Hunt
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - A Bradford
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - K J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA
| | - D A Helmer
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - C D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
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13
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Kamdar N, Hundt NE, Ramsey DJ, Sansgiry S, Utech A, Horning M, Helmer DA. Characteristics associated with persistent versus transient food insecurity among US veterans screened in the Veteran Health Administration. J Acad Nutr Diet 2023:S2212-2672(23)00125-9. [PMID: 36898479 DOI: 10.1016/j.jand.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 01/03/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Awareness of negative health impacts associated with food insecurity among US veterans is growing. Yet, little research has examined characteristics associated with persistent versus transient food insecurity. OBJECTIVE To investigate characteristics associated with persistent versus transient food insecurity among US veterans. DESIGN The study used a retrospective, observational design to examine data from Veteran Health Administration (VHA) electronic medical records. PARTICIPANTS/SETTING The sample consisted of veterans (N=64,789) who screened positive for food insecurity in VHA primary care during fiscal years 2018-2020 and were rescreened within 3-15 months. MAIN OUTCOME MEASURES Food insecurity was operationalized using the VHA food insecurity screening question. Transient food insecurity was a positive screen followed by a consecutive negative screen within 3-15 months. Persistent food insecurity was a positive screen followed by a consecutive positive screen within 3-15 months. STATICAL ANALYSES A multivariable logistic regression model was used to assess characteristics (e.g., demographics, disability rating, homelessness, physical and mental health conditions) associated with persistent versus transient food insecurity. RESULTS Veterans with increased odds of persistent versus transient food insecurity included men (AOR=1.08, 95%CI[1.01, 1.15]) and those from Hispanic (AOR=1.27, 95%CI[1.18, 1.37]) or Native American (AOR=1.30, 95%CI[1.11, 1.53]) racial/ethnic groups. Psychosis (AOR=1.16, 95%CI[1.06, 1.26]), substance use disorder excluding tobacco/alcohol (AOR=1.11, 95%CI[1.03, 1.20]), and homelessness (AOR=1.32, 95%CI[1.26, 1.39]) were associated with increased odds of persistent versus transient food insecurity. Veterans who were married (AOR=0.87, 95%CI[0.83, 0.92]) or had service-connected disability rating of 70-99% (AOR=0.85, 95%CI[0.79, 0.90]) or 100% (AOR=0.77, 95%CI[0.71, 0.83]) had lower odds of persistent versus transient food insecurity. CONCLUSIONS Veterans at risk for persistent versus transient food insecurity may struggle with underlying issues like psychosis, substance use, and homelessness alongside racial/ethnic inequities and gender differences. More research is needed to understand characteristics and mechanisms that increase risk for persistent versus transient food insecurity among veterans.
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Affiliation(s)
- Nipa Kamdar
- Health Science Specialist, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX 77021; Instructor, Department of Medicine, Baylor College of Medicine, 1 Moursund St, Houston, TX 77030.
| | - Natalie E Hundt
- Investigator, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX 77021; Associate Professor, Department of Psychiatry & Behavioral Science, Baylor College of Medicine, 1 Moursund St, Houston, TX 77030
| | - David J Ramsey
- Biostatician, Department of Medicine, Baylor College of Medicine, 1 Moursund St, Houston, TX 77030
| | - Shubhada Sansgiry
- Chief Methodologist, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX 77021; Associate Professor, Department of Medicine, Section of Health Services Research, Baylor College of Medicine, 1 Moursund St, Houston, TX 77030
| | - Anne Utech
- National Director, Nutrition & Food Services, US Department of Veteran Affairs, 810 Vermont Ave NW, Washington, DC 20420
| | - Melissa Horning
- Associate Professor, University of Minnesota, 6-138G Weaver Densford Hall 308 Harvard Street SE Minneapolis, MN 55426.
| | - Drew A Helmer
- Physician Researcher, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX 77021; Professor, Department of Medicine, Baylor College of Medicine, 1 Moursund St, Houston, TX 77030
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14
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Duong LM, Nono Djotsa ABS, Vahey J, Steele L, Quaden R, Harrington KM, Ahmed ST, Polimanti R, Streja E, Gaziano JM, Concato J, Zhao H, Radhakrishnan K, Hauser ER, Helmer DA, Aslan M, Gifford EJ. Association of Gulf War Illness with Characteristics in Deployed vs. Non-Deployed Gulf War Era Veterans in the Cooperative Studies Program 2006/Million Veteran Program 029 Cohort: A Cross-Sectional Analysis. Int J Environ Res Public Health 2022; 20:258. [PMID: 36612580 PMCID: PMC9819371 DOI: 10.3390/ijerph20010258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Gulf War Illness (GWI), a chronic multisymptom illness with a complex and uncertain etiology and pathophysiology, is highly prevalent among veterans deployed to the 1990-1991 GW. We examined how GWI phenotypes varied by demographic and military characteristics among GW-era veterans. Data were from the VA's Cooperative Studies Program 2006/Million Veteran Program (MVP) 029 cohort, Genomics of GWI. From June 2018 to March 2019, 109,976 MVP enrollees (out of a total of over 676,000) were contacted to participate in the 1990-1991 GW-era Survey. Of 109,976 eligible participants, 45,169 (41.1%) responded to the 2018-2019 survey, 35,902 respondents met study inclusion criteria, 13,107 deployed to the GW theater. GWI phenotypes were derived from Kansas (KS) and Centers for Disease Control and Prevention (CDC) GWI definitions: (a) KS Symptoms (KS Sym+), (b) KS GWI (met symptom criteria and without exclusionary health conditions) [KS GWI: Sym+/Dx-], (c) CDC GWI and (d) CDC GWI Severe. The prevalence of each phenotype was 67.1% KS Sym+, 21.5% KS Sym+/Dx-, 81.1% CDC GWI, and 18.6% CDC GWI severe. These findings affirm the persistent presence of GWI among GW veterans providing a foundation for further exploration of biological and environmental underpinnings of this condition.
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Affiliation(s)
- Linh M. Duong
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System 151B, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Alice B. S. Nono Djotsa
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jacqueline Vahey
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA
- Computational Biology and Bioinformatics Program, Duke University, Durham, NC 27705, USA
| | - Lea Steele
- Veterans Health Research Program, Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Sarah T. Ahmed
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Renato Polimanti
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System 151B, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Elani Streja
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System 151B, West Haven, CT 06516, USA
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - John Concato
- Yale School of Medicine, Yale University, New Haven, CT 06511, USA
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Hongyu Zhao
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System 151B, West Haven, CT 06516, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Krishnan Radhakrishnan
- National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA
- Department of Biostatistics and Bioinformatics, Duke Molecular Physiology Institute, Duke University, Durham, NC 27705, USA
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System 151B, West Haven, CT 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT 06511, USA
| | - Elizabeth J. Gifford
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, NC 27708, USA
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McAndrew LM, Quigley KS, Lu SE, Litke D, Rath JF, Lange G, Santos SL, Anastasides N, Petrakis BA, Greenberg L, Helmer DA, Pigeon WR. Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2245272. [PMID: 36472870 PMCID: PMC9856484 DOI: 10.1001/jamanetworkopen.2022.45272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions. OBJECTIVE To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020. INTERVENTIONS Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue. RESULTS A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Karen S. Quigley
- Bedford VA Medical Center, Bedford, Massachusetts
- Department of Psychology, Northeastern University, Boston, Massachusetts
| | - Shou-En Lu
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - David Litke
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- Department of Rehabilitation Medicine, New York University School of Medicine, New York
| | - Joseph F. Rath
- Department of Rehabilitation Medicine, New York University School of Medicine, New York
| | - Gudrun Lange
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Susan L. Santos
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
| | | | - Lauren Greenberg
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- VA Palo Alto Health Care System, Palo Alto, California
| | - Drew A. Helmer
- War Related Illness and Injury Study Center, Veterans Affairs (VA) New Jersey Health Care System, East Orange
- Center for Innovations in Quality, Effectiveness and Safety at Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
| | - Wilfred R. Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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16
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Nadkarni S, Ecker AH, Waid-Ebbs JK, Pickett LC, Ray K, Chandler HK, McAndrew LM, Helmer DA. Assessing Change in Participation in Clinical Evaluations of Deployed Veterans with Medically Unexplained Symptoms. Health Soc Work 2022; 47:253-261. [PMID: 36099160 DOI: 10.1093/hsw/hlac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/16/2021] [Accepted: 09/16/2021] [Indexed: 06/15/2023]
Abstract
Many deployed veterans experience issues reintegrating into civilian life. Addressing this in a clinical setting can prove challenging; however, assessing participation, defined as involvement in a life situation by the World Health Organization's International Classification of Functioning, Disability and Health, may be helpful. The Community Reintegration of Injured Service Members-Computer Adaptive Test (CRIS-CAT) is a measure of participation developed and validated in veteran populations. The War Related and Illness and Injury Study Center, which provides comprehensive evaluations to veterans with medically unexplained deployment-related concerns, used the CRIS-CAT as part of their social work evaluations during these visits and follow-up telephone calls. This retrospective review of clinical data examines the link between participation as assessed by the CRIS-CAT and factors that are mutable (such as relationships with others) and immutable (personal characteristics) as assessed in the social work evaluation over 12 months. The findings indicate that these veteran patients did not experience change in their participation as measured by the CRIS-CAT. Multivariable regression models demonstrated relationships only between change in CRIS-CAT scales and baseline scores and race. Article concludes by discussing lessons learned from this evaluation of the utility of the CRIS-CAT in clinical care and in longitudinal evaluation.
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Affiliation(s)
- Shree Nadkarni
- BS, is a medical student, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anthony H Ecker
- PhD, is research health scientist, VA South Central Mental Illness Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Psychiatry and Behavioral Sciences, Houston, TX, USA
| | - Julia Kay Waid-Ebbs
- PhD, is a health science specialist, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
| | - Lisa C Pickett
- LCSW, is War Related Illness and Injury Study Center (WRIISC) social work coordinator, VA NJ Healthcare System, East Orange, NJ, USA
| | - Kathleen Ray
- PhD, is director of MSW program, Ramapo College, Mahwah, NJ, USA
| | - Helena K Chandler
- PhD, is director of research, WRIISC, VA New Jersey Healthcare System, East Orange, NJ, USA
| | - Lisa M McAndrew
- PhD, is director of research, WRIISC, VA New Jersey Healthcare System, East Orange, NJ, USA
| | - Drew A Helmer
- MD, MS, is Deputy Director of the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, and professor of medicine, Baylor College of Medicine, both in Houston, TX, USA
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17
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Thomas B, Thadani A, Chen PV, Christie IC, Kern LM, Rajan M, Kadiyala H, Helmer DA. Veterans’ ambulatory care experience during COVID-19: veterans’ access to and satisfaction with primary care early in the pandemic. BMC Prim Care 2022; 23:245. [PMID: 36131246 PMCID: PMC9491256 DOI: 10.1186/s12875-022-01851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 09/11/2022] [Indexed: 11/10/2022]
Abstract
Background The COVID-19 pandemic caused widespread changes to healthcare, but few studies focus on ambulatory care during the early phase of the pandemic. We characterize veterans’ ambulatory care experience, specifically access and satisfaction, early in the pandemic. Methods We employed a semi-structured telephone interview to capture quantitative and qualitative data from patients scheduled with a primary care provider between March 1 – June 30, 2020. Forty veterans were randomly identified at a single large urban Veterans Health Administration (VHA) medical center. The interview guide utilized 56 closed and open-ended questions to characterize veterans’ perceptions of access to and satisfaction with their primary care experience at VHA and non-VHA primary care sources. We also explored the context of veterans' daily lives during the pandemic. We analyzed quantitative data using descriptive statistics and verbatim quotes using a matrix analysis. Results Veterans reported completing more appointments (mean 2.6 (SD 2.2)) than scheduled (mean 2.3 (SD 2.2)) mostly due to same-day or urgent visits, with a shift to telephone (mean 2.1 (SD 2.2)) and video (mean 1.5 (SD 0.6)). Among those who reported decreased access to care early in the pandemic (n = 27 (67%)), 15 (56%) cited administrative barriers (“The phone would hang up on me”) and 9 (33%) reported a lack of provider availability (“They are not reaching out like they used to”). While most veterans (n = 31 (78%)) were highly satisfied with their VHA care (mean score 8.6 (SD 2.0 on a 0–10 scale), 9 (23%) reported a decrease in satisfaction since the pandemic. The six (15%) veterans who utilized non-VHA providers during the period of interest reported, on average, higher satisfaction ratings (mean 9.5 (SD 1.2)). Many veterans reported psychosocial effects such as the worsening of mental health (n = 6 (15%)), anxiety concerning the virus (n = 12 (30%)), and social isolation (n = 8 (20%), “I stay inside and away from people”). Conclusions While the number of encounters reported suggest adequate access and satisfaction, the comments regarding barriers to care suggest that enhanced approaches may be warranted to improve and sustain veteran perceptions of adequate access to and satisfaction with primary care during times of crisis. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01851-3.
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18
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Uzdavines A, Helmer DA, Spelman JF, Mattocks KM, Johnson AM, Chardos JF, Lynch KE, Kauth MR. Sexual Health Assessment Is Vital to Whole Health Models of Care. JMIRx Med 2022; 3:e36266. [PMID: 37725523 PMCID: PMC10414374 DOI: 10.2196/36266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/30/2022] [Accepted: 05/19/2022] [Indexed: 09/21/2023]
Abstract
Sexual health is the state of well-being regarding sexuality. Sexual health is highly valued and associated with overall health. Overall health and well-being are more than the absence of disease or dysfunction. Health care systems adopting whole health models of care need to incorporate a holistic assessment of sexual health. This includes assessing patients' sexual orientation and gender identity (SOGI). If health systems, including but not limited to the Veterans Health Administration (VHA), incorporate sexual health into whole health they could enhance preventive care, promote healthy sexual functioning, and optimize overall health and well-being. Assessing sexual health can give providers important information about a patient's health, well-being, and health goals. Sexual concerns or dysfunction may also signal undiagnosed health conditions. Additionally, collecting SOGI information as part of a sexual health assessment would allow providers to address problems that drive disparities for lesbian, gay, bisexual, transgender, queer, and similar minority (LGBTQ+) populations. Health care providers do not routinely assess sexual health in clinical practice. One barrier is a gap in communication between patients and providers. Providers cite beliefs that patients will bring up sexual concerns themselves or might be offended by discussing sexual health. Patients often report an expectation that providers will bring up sexual health and being comfortable discussing sexual health with their providers. Within the VHA, the lack of a sexual health template within the electronic health record (EHR) adds an additional barrier. The VHA's transition toward whole health and updates to its EHR provide unique opportunities to integrate sexual health assessment into routine care. We highlight system modifications to address this within the VHA. These examples may be helpful for other health care systems interested in moving toward whole health. It will be vital for health care systems integrating a whole health approach to develop both practical and educational interventions to address the communication gap. These interventions will need to target both providers and patients in health care systems that transition to a whole health model of care, not just the VHA. Both the communication gap between providers and patients, and the lack of support within some EHR systems for sexual health assessment are barriers to assessing sexual health in primary care clinics. Routine sexual health assessment would benefit patient well-being and present an opportunity to address health disparities for LGBTQ+ populations. Health care systems (ie, both the VHA and other systems) can overcome these barriers by implementing educational interventions and updating their EHRs and back-end data structures. VHA's expertise in developing and implementing health education interventions and EHR-based quality improvements may help inform interventions beyond VHA.
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Affiliation(s)
- Alex Uzdavines
- South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Juliette F Spelman
- VA Connecticut Healthcare System, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
- University of Massachusetts Medical School, Worcester, MA, United States
| | | | - John F Chardos
- VA Palo Alto Health Care System, Palo Alto, CA, United States
- Stanford University, Palo Alto, CA, United States
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Michael R Kauth
- South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- LGBTQ+ Health Program, Patient Care Services, Veterans Health Administration, Washington, DC, United States
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19
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Therkorn JH, Hu S, Sotolongo AM, Christie IC, Wu TD, Van Doren WW, Sajja VSSS, Jani N, Klein-Adams JC, Helmer DA, Falvo MJ. Relationship between clinician documented blast exposure and pulmonary function: a retrospective chart review from a national specialty clinic. Respir Res 2022; 23:153. [PMID: 35689238 PMCID: PMC9188057 DOI: 10.1186/s12931-022-02071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Service member exposure to explosive blast overpressure waves is common with considerable attention to traumatic brain injury (TBI) and neuropsychological sequalae. Less is known about the impacts on the respiratory system, particularly long-term effects, despite vulnerability to overpressure. Using a national registry, we previously observed an independent relationship between self-reported blast exposure and respiratory symptoms; however, the impact on objective measures of pulmonary function is poorly understood.
Methods 307 Veterans referred to our national specialty center for post-deployment health concerns underwent a comprehensive multi-day evaluation that included complete pulmonary function testing (PFT), occupational and environmental medicine history, neuropsychological or psychological evaluation. We developed an a priori chart abstraction process and template to classify Veterans into blast exposure groups: (1) none, (2) single-mild, or (3) multiple-mild. This template focused primarily on clinician documented notes of blast related TBI that were used as proxy for blast overpressure injury to thorax. PFT variables characterizing flow (FEV1%; %∆FEV1), volume (TLC%), diffusion (DLCO%) and respiratory mechanics (forced oscillometry) were selected for analysis. Results Veterans (40.5 ± 9.7 years; 16.3% female) were referred 8.6 ± 3.6 years after their last deployment and presented with considerable comorbid conditions and health problems (e.g., 62% post-traumatic stress, 55% dyspnea). After chart abstraction, Veterans were assigned to none (n = 208), single mild (n = 52) and multiple mild (n = 47) blast exposure groups. Among the blast exposed, clinicians documented 73.7% were < 50 m from the blast and 40.4% were physically moved by blast. PFT outcome measures were similar across all groups (p value range: 0.10–0.99). Conclusions In this referred sample of deployed Veterans, PFT measures of flow, volume, diffusion, and respiratory mechanics were not associated with clinician documented blast exposure per the retrospective chart abstraction methodology applied. Yet, these clinical findings suggest future research should determine and assess distinction between Veteran recollections of perceived blast experiences versus overpressure wave exposure to the respiratory system. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02071-0.
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Affiliation(s)
- Jennifer H Therkorn
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07018, USA
| | - Sean Hu
- New Jersey Medical School, Rutgers, The State University, Newark, NJ, USA
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07018, USA.,New Jersey Medical School, Rutgers, The State University, Newark, NJ, USA
| | - Israel C Christie
- Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Tianshi David Wu
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - William W Van Doren
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07018, USA
| | | | - Nisha Jani
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07018, USA
| | - Jacquelyn C Klein-Adams
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07018, USA
| | - Drew A Helmer
- Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA.,Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07018, USA. .,New Jersey Medical School, Rutgers, The State University, Newark, NJ, USA.
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20
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Shen C, Jain K, Shah T, Schaefer E, Zhou S, Fried D, Helmer DA, Sadeghi-Nejad H. Relationships between erectile dysfunction, prostate cancer treatment type and inflatable penile prosthesis implantation. Investig Clin Urol 2022; 63:316-324. [PMID: 35534219 PMCID: PMC9091830 DOI: 10.4111/icu.20210445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The prevalence of erectile dysfunction (ED) and the utilization of inflatable penile prosthesis (IPP) among prostate cancer patients are understudied. The aim of the study was to examine the relationships between ED, prostate cancer treatment type and IPP implantation in a national cohort. MATERIALS AND METHODS We identified a retrospective cohort of Surveillance, Epidemiology, and End Results (SEER)-Medicare patients diagnosed with locoregional prostate cancer between 2006 and 2011 and treated with surgery or radiation. Chi-square tests were used to detect significant differences in ED rates as well as use of IPP among the subset with ED. Multivariable logistic regression was used to examine factors associated with the use of IPP. RESULTS Among 31,233 patients in our cohort, 10,334 (33.1%) received prostatectomy and 20,899 (66.9%) received radiation. ED within 5 years was significantly more common in the prostatectomy group relative to those the radiation group (65.3% vs. 33.8%, p<0.001). In the subset of 13,812 patients with ED, the radiation group had greater median time to ED diagnosis compared to the prostatectomy group (346 vs. 133 days, p<0.001). IPP implantation was more frequent for prostatectomy patients than for radiation patients (3.6% vs. 1.4%, p<0.001). Cancer treatment type, race, and marital status were significantly associated with IPP utilization. CONCLUSIONS ED is highly prevalent among prostate cancer patients, and IPP implantation is be underutilized. ED rates, time to ED diagnosis and utilization of IPP differed significantly by prostate cancer treatment type.
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Affiliation(s)
- Chan Shen
- Department of Surgery, Division of Outcomes Research and Quality, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA.
| | - Kunj Jain
- Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tejash Shah
- Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Eric Schaefer
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, USA
| | - Dennis Fried
- War-Related Injury & Illness Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Hossein Sadeghi-Nejad
- War-Related Injury & Illness Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
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21
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Kane NS, Anastasides N, Litke DR, Helmer DA, Hunt SC, Quigley KS, Pigeon WR, McAndrew LM. Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness. PLoS One 2021; 16:e0259341. [PMID: 34874939 PMCID: PMC8651123 DOI: 10.1371/journal.pone.0259341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Conditions defined by persistent "medically unexplained" physical symptoms and syndromes (MUS) are common and disabling. Veterans from the Gulf War (deployed 1990-1991) have notably high prevalence and disability from MUS conditions. Individuals with MUS report that providers do not recognize their MUS conditions. Our goal was to determine if Veterans with MUS receive an ICD-10 diagnosis for a MUS condition or receive disability benefits available to them for these conditions. METHODS A chart review was conducted with US Veterans who met case criteria for Gulf War Illness, a complex MUS condition (N = 204, M = 53 years-old, SD = 7). Three coders independently reviewed Veteran's medical records for MUS condition diagnosis or service-connection along with comorbid mental and physical health conditions. Service-connection refers to US Veterans Affairs disability benefits eligibility for conditions or injuries experienced during or exacerbated by military service. RESULTS Twenty-nine percent had a diagnosis of a MUS condition in their medical record, the most common were irritable colon/irritable bowel syndrome (16%) and fibromyalgia (11%). Slightly more Veterans were service-connected for a MUS condition (38%) as compared to diagnosed. There were high rates of diagnoses and service-connection for mental health (diagnoses 76% and service-connection 74%), musculoskeletal (diagnoses 86%, service-connection 79%), and illness-related conditions (diagnoses 98%, service-connection 49%). CONCLUSION Given that all participants were Gulf War Veterans who met criteria for a MUS condition, our results suggest that MUS conditions in Gulf War Veterans are under-recognized with regard to clinical diagnosis and service-connected disability. Veterans were more likely to be diagnosed and service-connected for musculoskeletal-related and mental health conditions than MUS conditions. Providers may need education and training to facilitate diagnosis of and service-connection for MUS conditions. We believe that greater acknowledgement and validation of MUS conditions would increase patient engagement with healthcare as well as provider and patient satisfaction with care.
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Affiliation(s)
- Naomi S. Kane
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - Nicole Anastasides
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
| | - David R. Litke
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Drew A. Helmer
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- Michael DeBakey VA Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, United States of America
| | - Stephen C. Hunt
- VA Puget Sound Health Care System, Seattle, WS, United States of America
- Department of Medicine, University of Washington, Seattle, WS, United States of America
| | - Karen S. Quigley
- VA Bedford Healthcare System, Center for Health Organization & Implementation Research (CHOIR), Bedford, MA, United States of America
- Department of Psychology, Northeastern University, Boston, MA, United States of America
| | - Wilfred R. Pigeon
- Finger Lakes Healthcare System/VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, United States of America
- Psychiatry Department, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Lisa M. McAndrew
- VA New Jersey Health Care System, War Related Illness and Injury Study Center, East Orange, NJ, United States of America
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY, United States of America
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22
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Kamdar NP, Horning ML, Geraci JC, Uzdavines AW, Helmer DA, Hundt NE. Risk for depression and suicidal ideation among food insecure US veterans: data from the National Health and Nutrition Examination Study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2175-2184. [PMID: 33770225 DOI: 10.1007/s00127-021-02071-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide and food insecurity (i.e., lack of access to food) are two major issues that affect US Veterans. PURPOSE Using a US-based sample, we evaluated the association between food insecurity and suicidal ideation among Veterans. Because depression often precedes suicide, we also examined the association between food insecurity and depression. METHODS Using data from 2630 Veterans who participated in the National Health and Nutrition Examination Survey 2007-2016, we conducted an adjusted linear regression model to evaluate the association between food insecurity (measured using 18-item Household Food Security Survey) and depression (measured using PHQ-9) and an adjusted binary logistic regression model to evaluate the association between food insecurity and suicidal ideation (measured using PHQ-9 Question 9). Models were adjusted for gender, age, income-to-poverty ratio, race/ethnicity, and education level. RESULTS Of the sample, 11.5% were food insecure, depression scores averaged 2.86 (SD = 4.28), and 3.7% endorsed suicidal ideation. Veterans with marginal (β = 0.68, 95%CI [0.09,1.28]), low (β = 1.38, 95%CI [0.70,2.05]) or very low food security (β = 3.08, 95%CI [2.34, 3.83]) had significantly increased depression scores compared to food secure Veterans. Veterans with low (OR = 2.15, 95%CI [1.08, 4.27]) or very low food security (OR = 3.84, 95%CI [2.05, 7.20]) had significantly increased odds for suicidal ideation compared to food secure Veterans. CONCLUSION Food insecurity in Veterans is associated with increased depression symptoms and suicidal ideation. This association strengthens as food insecurity worsens. Veterans with food insecurity should be screened for depression and suicidal ideation. Simultaneously, depression treatment plans and suicide prevention programs should consider basic needs like food security.
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Affiliation(s)
- Nipa P Kamdar
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US.
| | - Melissa L Horning
- University of Minnesota School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, Minnesota, 55455, US
| | - Joseph C Geraci
- US Department of Veterans Affairs, VISN 2 Mental Illness, Research, Education, and Clinical Center, 130 W Kingsbridge Rd, The Bronx, New York City, 10468, US
| | - Alexander W Uzdavines
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US
| | - Drew A Helmer
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US
| | - Natalie E Hundt
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, Texas, 77021, US.,Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, US
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23
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Razjouyan J, Helmer DA, Lynch KE, Hanania NA, Klotman PE, Sharafkhaneh A, Amos CI. Smoking Status and Factors associated with COVID-19 In-hospital Mortality among U.S. Veterans. Nicotine Tob Res 2021; 24:785-793. [PMID: 34693967 PMCID: PMC8586728 DOI: 10.1093/ntr/ntab223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Introduction The role of smoking in risk of death among patients with COVID-19 remains unclear. We examined the association between in-hospital mortality from COVID-19 and smoking status and other factors in the United States Veterans Health Administration (VHA). Methods This is an observational, retrospective cohort study using the VHA COVID-19 shared data resources for February 1 to September 11, 2020. Veterans admitted to the hospital who tested positive for SARS-CoV-2 and hospitalized by VHA were grouped into Never (as reference, NS), Former (FS), and Current smokers (CS). The main outcome was in-hospital mortality. Control factors were the most important variables (among all available) determined through a cascade of machine learning. We reported adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) from logistic regression models, imputing missing smoking status in our primary analysis. Results Out of 8 667 996 VHA enrollees, 505 143 were tested for SARS-CoV-2 (NS = 191 143; FS = 240 336; CS = 117 706; Unknown = 45 533). The aOR of in-hospital mortality was 1.16 (95%CI 1.01, 1.32) for FS vs. NS and 0.97 (95%CI 0.78, 1.22; p > .05) for CS vs. NS with imputed smoking status. Among other factors, famotidine and nonsteroidal anti-inflammatory drugs (NSAID) use before hospitalization were associated with lower risk while diabetes with complications, kidney disease, obesity, and advanced age were associated with higher risk of in-hospital mortality. Conclusions In patients admitted to the hospital with SARS-CoV-2 infection, our data demonstrate that FS are at higher risk of in-hospital mortality than NS. However, this pattern was not seen among CS highlighting the need for more granular analysis with high-quality smoking status data to further clarify our understanding of smoking risk and COVID-19-related mortality. Presence of comorbidities and advanced age were also associated with increased risk of in-hospital mortality. Implications Veterans who were former smokers were at higher risk of in-hospital mortality compared to never smokers. Current smokers and never smokers were at similar risk of in-hospital mortality. The use of famotidine and nonsteroidal anti-inflammatory drugs (NSAIDs) before hospitalization were associated with lower risk while uncontrolled diabetes mellitus, advanced age, kidney disease, and obesity were associated with higher risk of in-hospital mortality.
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Affiliation(s)
- Javad Razjouyan
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- VA Quality Scholars Coordinating Center, IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, USA
- Corresponding Author: Javad Razjouyan, Ph.D., Baylor College of Medicine, Implementation Science & Innovation Core, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd Suite 01Y, Houston, TX 77021, USA. Telephone: (713)798-7928; Fax: (713)798-3658; E-mail: ;
| | - Drew A Helmer
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kristine E Lynch
- VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Nicola A Hanania
- VA Salt Lake City Health Care System and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Paul E Klotman
- Integrative Molecular and Biomedical Sciences Program, Baylor College of Medicine, Houston, TX,USA
- Margaret M. and Albert B. Alkek Department of Medicine, Nephrology, Baylor College of Medicine, Houston, TX,USA
| | - Amir Sharafkhaneh
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX,USA
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24
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Bloeser K, McCarron KK, Merker VL, Hyde J, Bolton RE, Anastasides N, Petrakis BA, Helmer DA, Santos S, Litke D, Pigeon WR, McAndrew LM. "Because the country, it seems though, has turned their back on me": Experiences of institutional betrayal among veterans living with Gulf War Illness. Soc Sci Med 2021; 284:114211. [PMID: 34271400 DOI: 10.1016/j.socscimed.2021.114211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
People living with medically unexplained symptoms (MUS) often have poor quality of life and health outcomes. Many struggle to engage with and trust in healthcare systems. This qualitative study examined how experiences with institutions influence perceptions of medical care for MUS by applying the theoretical framework of institutional betrayal to narratives of U.S. military Veterans living with Gulf War Illness (GWI). Institutional betrayal refers to situations in which the institutions people depend upon for safety and well-being cause them harm. Experiences of institutional betrayal both during active military service and when first seeking treatment appeared to shape perceptions of healthcare in this sample. Veterans expressed the belief that the military failed to protect them from environmental exposures. Veterans' concerns regarding subsequent quality of healthcare were intrinsically linked to a belief that, despite official documentation to the contrary, the predominant paradigm of both the U.S. Department of Defense and the U.S. Department of Veterans Affairs (VA) is that GWI does not exist. Veterans reported that providers are not adequately trained on treatment of GWI and do not believe Veterans' descriptions of their illness. Veterans reported taking up self-advocacy, doing their own research on their condition, and resigning themselves to decrease engagement with VA healthcare or seek non-VA care. The study's findings suggest institutional level factors have a profound impact on perceptions of care and the patient-provider relationship. Future research and policy aimed at improving healthcare for people living with MUS should consider the concept of institutional betrayal.
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Affiliation(s)
- Katharine Bloeser
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Silberman School of Social Work at Hunter College, The City University of New York, NY, USA.
| | - Kelly K McCarron
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Vanessa L Merker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Boston University, Department of Medicine, Section General Internal Medicine, Boston, MA, USA
| | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Brandeis University, Heller School for Social Policy and Management, MA, USA
| | - Nicole Anastasides
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Drew A Helmer
- VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA
| | - Susan Santos
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - David Litke
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Wilfred R Pigeon
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa M McAndrew
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Department of Educational and Counseling Psychology, University at Albany, State University of New York, NY, USA
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25
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Falvo MJ, Sotolongo AM, Osinubi OY, Helmer DA, Galvin JR, Franks TJ. Reply: Expected Disability From Isolated Small Airway Disease. Mil Med 2021; 186:205-206. [PMID: 33693748 DOI: 10.1093/milmed/usab097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ 07018, USA.,New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ 07101, USA
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ 07018, USA
| | - Omowunmi Y Osinubi
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ 07018, USA.,School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jeffrey R Galvin
- Department of Radiology and Nuclear Medicine (Chest Imaging), University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Teri J Franks
- Department of Pulmonary and Mediastinal Pathology, Department of Defense, The Joint Pathology Center, Silver Spring, MD 20910, USA
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26
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Natelson BH, Stegner AJ, Lange G, Khan S, Blate M, Sotolongo A, DeLuca M, Van Doren WW, Helmer DA. Vagal nerve stimulation as a possible non-invasive treatment for chronic widespread pain in Gulf Veterans with Gulf War Illness. Life Sci 2021; 282:119805. [PMID: 34237313 DOI: 10.1016/j.lfs.2021.119805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
AIMS Widespread pain and headache are common in Gulf War Illness with suboptimal treatments available. We tested the efficacy of non-invasive, transcutaneous vagal nerve stimulation (nVNS) for relief of widespread pain and migraine in Gulf War Veterans with GWI. MAIN METHODS A 10-week double-blind, randomized controlled trial of nVNS used the gammaCore (ElectroCore, Inc.) compared to sham stimulation with the same device followed by a 10-week open-label follow up with active nVNS. The primary outcome was a numerical pain rating at the end of the blinded period. Secondary outcomes included physical function, migraine frequency and severity, and impression of change during the blinded and open-label periods. Two-factor MANOVA models tested for significant differences between groups from baseline to end of the blinded period and during the open-label period. KEY FINDINGS Among 27 participants enrolled and issued a nVNS device, there was a slight improvement in pain ratings from baseline to the end of the blinded phase [6.18 (±0.82) vs. 5.05 (±2.3); p = 0.040] which did not differ between active and sham nVNS. Physical function was also slightly improved overall without group differences. There were no significant changes in migraine frequency or severity during the blinded period. Twenty participants started in the open-label phase; no statistically significant changes in pain, physical function, migraine measures, or impression of change were noted during this phase. SIGNIFICANCE Veterans with GWI actively treated with nVNS reported no improvement in either widespread pain or migraine frequency or severity relative to Veterans with GWI who received sham nVNS.
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Affiliation(s)
- Benjamin H Natelson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aaron J Stegner
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA..
| | - Gudrun Lange
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Khan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Blate
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anays Sotolongo
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Michelle DeLuca
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - William W Van Doren
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston TX, USA
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27
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Van Doren WW, Iqbal UH, Helmer DA, Litke DR, Simon JE, Wu Q, Zhao D, Yin Z, Ho L, Osinubi O, Pasinetti GM. Changes in polyphenol serum levels and cognitive performance after dietary supplementation with Concord grape juice in veterans with Gulf War Illness. Life Sci 2021; 292:119797. [PMID: 34237311 DOI: 10.1016/j.lfs.2021.119797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/19/2022]
Abstract
AIMS We investigated whether the consumption of Concord grape juice (CGJ) was associated with increased bioavailability of serum metabolites and their potential impact on cognitive performance in Veterans with Gulf War Illness (GWI). MAIN METHODS Twenty-six veterans were selected from a cohort of 36 enrolled in a 24-week randomized, double-blind, Phase I/IIA clinical trial exploring whether the consumption of Concord grape juice (CGJ) was tolerable and safe in Veterans with GWI and improved cognitive function and fatigue. These 26 veterans were selected based on their completion of the entire 24-week protocol and documented adherence to the study beverage ≥80%. Differences in serum metabolite levels between CGJ and placebo at midpoint and endpoint were evaluated using two-way repeated measures ANOVA with post hoc Sidak's multiple comparison test. Bivariate correlations to assess for possible relationships between change in serum metabolite levels and change in cognitive function as measured by the Halstead Category Test-Russell Revised Version (RCAT) were also conducted. KEY FINDINGS Seventy-six metabolites were identified and quantified in this study, with three (cyanidin-glucuronide, me-cyanidin-glucuronide, and me-malvidin-glucuronide) found to be significantly higher (p < 0.05) in the CGJ group compared to placebo at 24 weeks. Significant associations between changes in cognitive function and changes in serum levels of epicatechin-sulphate (r = 0.48, p = 0.01) and petunidin-glucuronide (r = 0.53, p < 0.01) from baseline to 24 weeks were also observed. SIGNIFICANCE Our data suggest that dietary supplementation with CGJ is associated with increased bioavailability of specific phenolic metabolites, some of which may be correlated with cognitive performance.
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Affiliation(s)
- William W Van Doren
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA.
| | - Umar Haris Iqbal
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
| | - David R Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA; Department of Rehabilitation Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
| | - James E Simon
- New Use Agriculture and Natural Plant Products Program, School of Environmental and Biological Sciences, Rutgers University, 59 Dudley Road, New Brunswick, NJ 08901, USA.
| | - Qingli Wu
- New Use Agriculture and Natural Plant Products Program, School of Environmental and Biological Sciences, Rutgers University, 59 Dudley Road, New Brunswick, NJ 08901, USA.
| | - Danyue Zhao
- New Use Agriculture and Natural Plant Products Program, School of Environmental and Biological Sciences, Rutgers University, 59 Dudley Road, New Brunswick, NJ 08901, USA
| | - Zhiya Yin
- New Use Agriculture and Natural Plant Products Program, School of Environmental and Biological Sciences, Rutgers University, 59 Dudley Road, New Brunswick, NJ 08901, USA.
| | - Lap Ho
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| | - Omowunmi Osinubi
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA; Department of Environmental & Occupational Health, Rutgers University School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
| | - Giulio Maria Pasinetti
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA.
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28
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Radhakrishnan K, Hauser ER, Polimanti R, Helmer DA, Provenzale D, McNeil RB, Maffucci A, Quaden R, Zhao H, Whitbourne SB, Harrington KM, Vahey J, Gelernter J, Levey DF, Huang GD, Gaziano JM, Concato J, Aslan M. Genomics of Gulf War Illness in U.S. Veterans Who Served during the 1990-1991 Persian Gulf War: Methods and Rationale for Veterans Affairs Cooperative Study #2006. Brain Sci 2021; 11:brainsci11070845. [PMID: 34202057 PMCID: PMC8301942 DOI: 10.3390/brainsci11070845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Approximately 697,000 members of the U.S. Armed Forces were deployed to the Persian Gulf in support of the 1990–1991 Persian Gulf War (GW). Subsequently, many deployed and some non-deployed veterans developed a chronic multi-symptom illness, now named Gulf War Illness (GWI). This manuscript outlines the methods and rationale for studying the genomics of GWI within the Million Veteran Program (MVP), a VA-based national research program that has linked medical records, surveys, and genomic data, enabling genome-wide association studies (GWASs). Methods: MVP participants who served in the military during the GW era were contacted by mail and invited to participate in the GWI study. A structured health questionnaire, based on a previously tested instrument, was also included in the mailing. Data on deployment locations and exposures, symptoms associated with GWI, clinical diagnoses, personal habits, and health care utilization were collected. Self-reported data will be augmented with chart reviews and structured international classification of disease codes, to classify participants by GWI case status. We will develop a phenotyping algorithm, based on two commonly used case definitions, to determine GWI status, and then conduct a nested case-control GWAS. Genetic variants associated with GWI will be investigated, and gene–gene and gene–environment interactions studied. The genetic overlap of GWI with, and causative mechanisms linking this illness to, other health conditions and the effects of genomic regulatory mechanisms on GWI risk will also be explored. Conclusions: The proposed initial GWAS described in this report will investigate the genomic underpinnings of GWI with a large sample size and state-of-the-art genomic analyses and phenotyping. The data generated will provide a rich and expansive foundation on which to build additional analyses.
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Affiliation(s)
- Krishnan Radhakrishnan
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA;
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Renato Polimanti
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Rebecca B. McNeil
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
| | - Alysia Maffucci
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
| | - Hongyu Zhao
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jacqueline Vahey
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Computational Biology and Bioinformatics Program, Duke University, Durham, NC 27705, USA
| | - Joel Gelernter
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Daniel F. Levey
- Division of Human Genetics, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06511, USA;
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT 06516, USA
| | - Grant D. Huang
- Cooperative Studies Program, VA Office of Research and Development, Washington, DC 20420, USA;
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - John Concato
- School of Medicine, Yale University, New Haven, CT 06511, USA;
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
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Cheema AK, McNeil RB, Craddock T, Broderick G, Abreu MM, Aenlle K, Helmer DA, Ashford JW, Sullivan K, Bested A, Cohen DE, Shungu D, Chandler H, Fletcher MA, Krengel M, Klimas N. Gulf War Illness Clinical Trials and Interventions Consortium (GWICTIC): A collaborative research infrastructure for intervention and implementation. Life Sci 2021; 278:119636. [PMID: 34015289 DOI: 10.1016/j.lfs.2021.119636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
AIMS There is an inadequate portfolio of treatments for Gulf War Illness (GWI), a complex disease involving multiple organ systems, and early-phase clinical trials are hampered by many logistical problems. To address these challenges, the Gulf War Illness Clinical Trials and Interventions Consortium (GWICTIC) was formed with the aims of (i) creating a collaborative consortium of clinical and scientific researchers that will rapidly implement rigorous and innovative phase I and II clinical trials for GWI, (ii) perform at least four phase I or II clinical trials, (iii) provide a foundation of scalable infrastructure and management in support of the efficient and successful operation of the GWICTIC, and (iv) partner with the Boston Biorepository, Recruitment & Integrated Network for GWI and other GWI investigators to develop a common data element platform for core assessments and outcomes. MAIN METHODS The GWICTIC brings together a multidisciplinary team of researchers at several institutions to provide scientific innovation, statistical and computational rigor, and logistical efficiency in the development and implementation of early-phase low-risk clinical trials for GWI. The GWICTIC core trials adhere to a Veteran-centered philosophy and focus on interventions with multiple mechanistic targets to maximize the likelihood of efficacy. To support rapid and efficient study startup and implementation across the GWI research community, the GWICTIC will share infrastructure with investigator-initiated research studies funded under separate mechanisms. SIGNIFICANCE The GWICTIC will leverage the efficiencies of centralized research support and innovative trial designs to address several longstanding needs in the GWI interventions research community.
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Affiliation(s)
- Amanpreet K Cheema
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Nutrition, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Halmos College of Natural Sciences and Oceanography, Nova Southeastern University, Fort Lauderdale, FL, United States.
| | | | - Travis Craddock
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Psychology and Neuroscience, Nova Southeastern University, Fort Lauderdale, FL, United States; Department of Computer Science, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Maria M Abreu
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Kristina Aenlle
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States; Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - J Wesson Ashford
- War Related Illness & Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States; Department of Psychiatry & Behavioral Sciences, College of Medicine, Stanford University, Palo Alto, CA, United States
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Alison Bested
- Department of Integrative Medicine, Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, United States
| | - Devra E Cohen
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Dikoma Shungu
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Helena Chandler
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ, United States
| | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Maxine Krengel
- VA Boston Healthcare System, Boston, MA, United States; Department of Neurology, Boston University School of Medicine, Boston, MA, United States
| | - Nancy Klimas
- Institute for Neuro Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States; Miami VA Healthcare System, Miami, FL, United States
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30
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Falvo MJ, Sotolongo AM, Osinubi OY, Helmer DA, Galvin JR, Franks TJ. Diagnostic Workup of Constrictive Bronchiolitis in the Military Veteran. Mil Med 2021; 185:472-475. [PMID: 32761145 DOI: 10.1093/milmed/usaa192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018.,New Jersey Medical School, Rutgers Biomedical and Health Sciences, 185 South Orange Ave, Newark, NJ, 07101
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018
| | - Omowunmi Y Osinubi
- Airborne Hazards and Burn Pits Center of Excellence, War Related Illness and Injury Study Center, VA New Jersey Health Care System, 385 Tremont Ave., East Orange, NJ 07018.,School of Public Health, Rutgers Biomedical and Health Sciences, 675 Hoes Lane West, Piscataway, NJ 08854
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030.,Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030
| | - Jeffrey R Galvin
- Department of Radiology and Nuclear Medicine (Chest Imaging), University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore MD 21201
| | - Teri J Franks
- Department of Pulmonary and Mediastinal Pathology, Department of Defense, The Joint Pathology Center, 606 Stephen Sitter Ave, Silver Spring, MD 20910
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31
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Winograd DM, Sullivan NL, Thien SR, Pigeon WR, Litke DR, Helmer DA, Rath JF, Lu SE, McAndrew LM. Veterans with Gulf War Illness perceptions of management strategies. Life Sci 2021; 279:119219. [PMID: 33592197 DOI: 10.1016/j.lfs.2021.119219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
AIMS Gulf War Illness (GWI) is a prevalent and disabling condition characterized by persistent physical symptoms. Clinical practice guidelines recommend self-management to reduce the disability from GWI. This study evaluated which GWI self-management strategies patients currently utilize and view as most effective and ineffective. MATERIALS AND METHODS Data were collected from 267 Veterans during the baseline assessment of a randomized clinical trial for GWI. Respondents answered 3 open-ended questions regarding which self-management strategies they use, view as effective, and view as ineffective. Response themes were coded, and code frequencies were analyzed. KEY FINDINGS Response frequencies varied across questions (in-use: n = 578; effective: n = 470; ineffective: n = 297). Healthcare use was the most commonly used management strategy (38.6% of 578), followed by lifestyle changes (28.5% of 578), positive coping (13% of 578), and avoidance (13.7% of 578). When asked about effective strategies, healthcare use (25.9% of 470), lifestyle change (35.7% of 470), and positive coping (17.4% of 470) were identified. Avoidance was frequently identified as ineffective (20.2% of 297 codes), as was invalidating experiences (14.1% of 297) and negative coping (10.4% of 297). SIGNIFICANCE Patients with GWI use a variety of self-management strategies, many of which are consistent with clinical practice guidelines for treating GWI, including lifestyle change and non-pharmacological strategies. This suggests opportunities for providers to encourage effective self-management approaches that patients want to use.
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Affiliation(s)
- Darren M Winograd
- University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, USA
| | - Nicole L Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA
| | - Scott R Thien
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Veterans Affairs Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - David R Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA; Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Joseph F Rath
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Shou-En Lu
- Rutgers Unviersity, Piscataway, NJ 08854, USA
| | - Lisa M McAndrew
- University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, USA; War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA.
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Fried D, McAndrew LM, Helmer DA, Markowitz S, Quigley KS. Interrelationships between symptom burden and health functioning and health care utilization among veterans with persistent physical symptoms. BMC Fam Pract 2020; 21:124. [PMID: 32611312 PMCID: PMC7329405 DOI: 10.1186/s12875-020-01193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/15/2020] [Indexed: 11/12/2022]
Abstract
Background Between 10 and 50% of primary care patients present with persistent physical symptoms (PPS). Patients with PPS tend to utilize excessive or inappropriate health care services, while being stuck in a deleterious cycle of inactivity, deconditioning, and further worsening of symptoms and disability. Since military deployment (relative to non-deployment) is associated with greater likelihood of PPS, we examined the interrelationships of health care utilization, symptom burden and functioning among a sample of recently deployed Veterans with new onset persistent physical symptoms. Methods This study analyzed a cohort of 790 U.S. soldiers who recently returned from deployment to Iraq or Afghanistan. Data for this analysis were obtained at pre- and post-deployment. We used moderation analyses to evaluate interactions between physical symptom burden and physical and mental health functioning and four types of health care utilization one-year after deployment, after adjusting for key baseline measures. Results Moderation analyses revealed significant triple interactions between physical symptom burden and health functioning and: primary care (F = 3.63 [2, 303], R2Δ = .02, p = 0.03), specialty care (F = 6.81 [2, 303] R2Δ =0.03, p < .001), allied therapy care (F = 3.76 [2, 302], R2Δ = .02, p = 0.02), but not mental health care (F = 1.82 [1, 303], R2Δ = .01, p = .16), one-year after deployment. Conclusions Among U.S. Veterans with newly emerging persistent physical symptoms one-year after deployment, increased physical symptom burden coupled with decreased physical and increased mental health functioning was associated with increased medical care use in the year after deployment. These findings support whole health initiatives aimed at improving health function/well-being, rather than merely symptom alleviation.
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Affiliation(s)
- Dennis Fried
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA. .,Department of Epidemiology, Rutgers, The State University of New Jersey, 185 South Orange Avenue, MSB, Newark, NJ, 07101, USA.
| | - Lisa M McAndrew
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA
| | - Drew A Helmer
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA.,New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, MSB, Newark, NJ, 07101, USA
| | | | - Karen S Quigley
- Interdisciplinary Affective Science Laboratory, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.,Department of Veterans Affairs, Bedford Memorial Hospital, 200 Springs Rd, Bedford, MA, 01730, USA
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33
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Helmer DA, Dwibedi N, Rowneki M, Tseng CL, Fried D, Rose D, Jani N, Sambamoorthi U. Mental Health Conditions and Hospitalizations for Ambulatory Care Sensitive Conditions Among Veterans with Diabetes. Am Health Drug Benefits 2020; 13:61-71. [PMID: 32724500 PMCID: PMC7370828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/12/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Veterans with diabetes and mental health conditions have a higher risk for suboptimal care and complications related to their diseases than veterans with diabetes who do not have mental health conditions. We hypothesized that among veterans with diabetes, patients with mental health conditions are more likely to be hospitalized for ambulatory care sensitive conditions (ACSC) than those without mental health conditions. OBJECTIVES To examine the association between depression, anxiety, and serious mental illness and hospitalizations for ACSC among veterans with diabetes after controlling for demographics and comorbidities. METHODS We used a retrospective cohort design with merged Veterans Health Administration (VHA) and Medicare electronic health records from 2008 to 2010. Andersen's Behavioral Model of Health Services Use was used to select the variables associated with hospitalizations for ACSC (ie, predisposing, enabling and need characteristics, personal health practices, and external environment). We used chi-square tests and logistic regressions for our analyses. RESULTS Among the dual VHA/Medicare-enrolled veterans with any hospitalization in 2010, 30% had hospitalizations for ACSC. Veterans with diabetes and co-occurring depression were at increased likelihood to be hospitalized for ACSC, after adjusting for all other covariates (adjusted odds ratio, 1.08; 95% confidence interval, 1.04-1.11). Similar findings were observed for anxiety. Veterans with serious mental illness were as likely as veterans without serious mental illness to be hospitalized for ACSC. CONCLUSION Veterans with depression and anxiety were more likely to be hospitalized for any or acute ACSC than veterans without mental health conditions. Patients hospitalized for acute ACSC were more susceptible than patients hospitalized for chronic ACSC to have mental health conditions. As the VHA continues to evolve from care provider to community care payer (per the Veterans Affairs MISSION Act), our results highlight the ongoing importance of care coordination and communication between payers and providers.
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Affiliation(s)
- Drew A Helmer
- Director, War Related Illness and Injury Study Center (WRIISC), Veterans Affairs (VA) New Jersey Healthcare System, East Orange
| | - Nilanjana Dwibedi
- Assistant Professor, Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown
| | - Mazhgan Rowneki
- Health Services Data Analyst, WRIISC, VA New Jersey Healthcare System
| | - Chin-Lin Tseng
- Health Services Scientist, WRIISC, VA New Jersey Healthcare System
| | - Dennis Fried
- Epidemiologist, WRIISC, VA New Jersey Healthcare System
| | - Danielle Rose
- Health Research Scientist, Veteran Affairs Greater Los Angeles Healthcare System, Sepulveda, CA
| | - Nisha Jani
- Epidemiologist, WRIISC, VA New Jersey Healthcare System
| | - Usha Sambamoorthi
- Professor, Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy
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Waid-Ebbs JK, Wen PS, Graham DP, Leroux AJ, O’Connor MK, Helmer DA. Measurement Properties of the MPAI-4 in Veterans With mTBI. Arch Phys Med Rehabil 2020; 101:789-796. [DOI: 10.1016/j.apmr.2019.10.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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Sullivan N, Phillips LA, Pigeon WR, Quigley KS, Graff F, Litke DR, Helmer DA, Rath JF, McAndrew LM. Coping with Medically Unexplained Physical Symptoms: the Role of Illness Beliefs and Behaviors. Int J Behav Med 2020; 26:665-672. [PMID: 31701389 DOI: 10.1007/s12529-019-09817-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medically unexplained syndromes (MUS) are both prevalent and disabling. While illness beliefs and behaviors are thought to maintain MUS-related disability, little is known about which specific behavioral responses to MUS are related to disability or the way in which beliefs and behaviors interact to impact functioning. The purpose of the present study was to examine the relationship between illness beliefs and disability among patients with MUS, and assess the extent to which behaviors mediate this relationship. METHODS The study examined data from the baseline assessment of a multi-site randomized controlled trial (RCT). Participants were 248 veterans with MUS. Illness beliefs, behavioral responses to illness, and disability were assessed through self-report questionnaire. Data were analyzed using mediation analysis. RESULTS Threat-related beliefs predicted greater disability through decreased activity and increased practical support seeking. Protective beliefs predicted less disability through reductions in all-or-nothing behavior and limiting behavior. CONCLUSIONS These outcomes suggest that all-or-nothing behavior, limiting behavior, and practical support seeking are important in the perpetuation of disability among those with MUS. This has implications for improving MUS treatment by highlighting potential treatment targets. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02161133.
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Affiliation(s)
- Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.
| | | | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Karen S Quigley
- Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, 01730, USA.,Department of Psychology, Northeastern University, Boston, MA, 02115, USA
| | - Fiona Graff
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - David R Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.,Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.,Department of Medicine, Rutgers University- New Jersey Medical School, Newark, NJ, USA
| | - Joseph F Rath
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA.,Rusk Institute of Rehabilitation Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.,Department of Educational and Counseling Psychology, University at Albany, 1400 Washington Ave Ext, Albany, NY, 12222, USA
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Friedlander ML, Kangos K, Maestro K, Muetzelfeld H, Wright ST, Silva ND, Kimber J, Helmer DA, McAndrew LM. Introducing the System for Observing Medical Alliances (SOMA): A Tool for Studying Concordance in Patient-Physician Relationships. Couns Psychol 2019; 47:796-819. [PMID: 32372766 DOI: 10.1177/0011000019891434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We developed the System for Observing Medical Alliances (SOMA) to study relationships between medical providers and patients with medically unexplained symptoms (MUS). Based on literature in health psychology, medicine, and the psychotherapeutic alliance, the SOMA operationalizes three medical alliance dimensions: Engagement in the Consultation Process, Trust in the Provider, and Concordance of Illness Beliefs and Treatment Recommendations. Specific behavioral indicators, tallied as observed by trained judges, are used as the basis for rating each dimension. In a sample of 33 medical consultations with veterans who had MUS, interrater reliabilities ranged from .79 to .94. Notably, the other dimension ratings accounted for 40% of the variability in Concordance, with Trust in the Provider contributing unique variance. In addition to research, psychologists in integrated health settings can use the SOMA to consult and train medical providers on communication skills that enhance concordance.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lisa M McAndrew
- Veterans Affairs New Jersey Health Care System, University at Albany
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37
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Leroux AJ, Waid-Ebbs JK, Wen PS, Helmer DA, Graham DP, O’Connor MK, Ray K. An Investigation of Exposure Control Methods With Variable-Length CAT Using the Partial Credit Model. Appl Psychol Meas 2019; 43:624-638. [PMID: 31551640 PMCID: PMC6745632 DOI: 10.1177/0146621618824856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this simulation study was to investigate the effect of several different item exposure control procedures in computerized adaptive testing (CAT) with variable-length stopping rules using the partial credit model. Previous simulation studies on CAT exposure control methods with polytomous items rarely considered variable-length tests. The four exposure control techniques examined were the randomesque with a group of three items, randomesque with a group of six items, progressive-restricted standard error (PR-SE), and no exposure control. The two variable-length stopping rules included were the SE and predicted standard error reduction (PSER), along with three item pools of varied sizes (43, 86, and 172 items). Descriptive statistics on number of nonconvergent cases, measurement precision, testing burden, item overlap, item exposure, and pool utilization were calculated. Results revealed that the PSER stopping rule administered fewer items on average while maintaining measurement precision similar to the SE stopping rule across the different item pool sizes and exposure controls. The PR-SE exposure control procedure surpassed the randomesque methods by further reducing test overlap, maintaining maximum exposure rates at the target rate or lower, and utilizing all items from the pool with a minimal increase in number of items administered and nonconvergent cases.
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Affiliation(s)
| | - J. Kay Waid-Ebbs
- Veterans Administration North
Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | | | - Drew A. Helmer
- Veterans Administration New Jersey
Health Care System, East Orange, NJ, USA
- Rutgers University, Newark, NJ,
USA
| | - David P. Graham
- Michael E. DeBakey Veterans Affairs
Medical Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, TX,
USA
| | | | - Kathleen Ray
- Veterans Administration New Jersey
Health Care System, East Orange, NJ, USA
- Ramapo College of New Jersey, Mahwah,
NJ, USA
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Abstract
The Persian Gulf War of 1990 to 1991 involved the deployment of nearly 700,000 American troops to the Middle East. Deployment-related exposures to toxic substances such as pesticides, nerve agents, pyridostigmine bromide (PB), smoke from burning oil wells, and petrochemicals may have contributed to medical illness in as many as 250,000 of those American troops. The cluster of chronic symptoms, now referred to as Gulf War Illness (GWI), has been studied by many researchers over the past two decades. Although over $500 million has been spent on GWI research, to date, no cures or condition-specific treatments have been discovered, and the exact pathophysiology remains elusive.Using the 2007 National Institute of Health (NIH) Roadmap for Medical Research model as a reference framework, we reviewed studies of interventions involving GWI patients to assess the progress of treatment-related GWI research. All GWI clinical trial studies reviewed involved investigations of existing interventions that have shown efficacy in other diseases with analogous symptoms. After reviewing the published and ongoing registered clinical trials for cognitive-behavioral therapy, exercise therapy, acupuncture, coenzyme Q10, mifepristone, and carnosine in GWI patients, we identified only four treatments (cognitive-behavioral therapy, exercise therapy, CoQ10, and mifepristone) that have progressed beyond a phase II trial.We conclude that progress in the scientific study of therapies for GWI has not followed the NIH Roadmap for Medical Research model. Establishment of a standard case definition, prioritized GWI research funding for the characterization of the pathophysiology of the condition, and rapid replication and adaptation of early phase, single site clinical trials could substantially advance research progress and treatment discovery for this condition.
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Affiliation(s)
- Jeremy E Chester
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Avenue, East Orange, NJ, 07018, USA. .,War Related Illness and Injury Study Center, Veterans Affairs Medical Center, 50 Irving St., Washington, DC, NW, 20422, USA.
| | - Mazhgan Rowneki
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - William Van Doren
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.,Rutgers University, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
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Rai P, Dwibedi N, Rowneki M, Helmer DA, Sambamoorthi U. Dipeptidyl Peptidase-4 Inhibitors and Joint Pain: A Retrospective Cohort Study of Older Veterans with Type 2 Diabetes Mellitus. Am Health Drug Benefits 2019; 12:223-231. [PMID: 32015789 PMCID: PMC6979048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In recent years, dipeptidyl peptidase (DPP)-4 inhibitors have been added to the diabetes treatment algorithm. Few published studies have shown that the use of DPP-4 inhibitors is associated with joint pain. To our knowledge, no population-based studies in the United States have studied this association. OBJECTIVE To evaluate the association between a new prescription of DPP-4 inhibitors and joint pain within 1 year among older veterans with diabetes. METHODS This was a retrospective cohort study of older veterans (aged ≥66 years) who were dually enrolled in Medicare and the Veterans Health Administration (VHA; N = 134,488). Data were derived from linked Medicare claims and VHA electronic health records from 2008 to 2010. Diabetes during the baseline and joint pain during the follow-up period were identified with International Classification of Diseases, Ninth Revision codes. Filled prescriptions for DPP-4 inhibitors during the baseline period were identified from Medicare Part D and VHA pharmacy records. The adjusted associations between DPP-4 inhibitors and joint pain were examined with logistic regressions. RESULTS Approximately 8.4% of the 134,488 study patients received at least 1 prescription for DPP-4 inhibitors and 11.7% were diagnosed with joint pain during the follow-up period. An unadjusted analysis showed significant differences in joint pain by DPP-4 inhibitor status (12.9% among users vs 11.6% among nonusers; P <.0001). In a fully adjusted model, having a DPP-4 inhibitor prescription had higher odds of joint pain (adjusted odds ratio, 1.17; 95% confidence interval, 1.10-1.24) compared with no prescription for a DPP-4 inhibitor. CONCLUSION In a cohort of older veterans who did not have documented joint pain at baseline, a prescription for DPP-4 inhibitors was significantly associated with a newly documented joint pain.
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Affiliation(s)
- Pragya Rai
- PharmD Candidate, Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown
| | - Nilanjana Dwibedi
- Assistant Professor, Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown
| | - Mazhgan Rowneki
- Health Science Specialist, Veterans Affairs New Jersey Healthcare System, War Related Illness and Injury Study Center, East Orange
| | - Drew A Helmer
- Director of War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, War Related Illness and Injury Study Center, East Orange
| | - Usha Sambamoorthi
- Professorm Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown
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McAndrew LM, Friedlander ML, Litke D, Phillips LA, Kimber J, Helmer DA. Medically Unexplained Physical Symptoms: What They Are and Why Counseling Psychologists Should Care about Them. Couns Psychol 2019; 47:741-769. [PMID: 32015568 PMCID: PMC6996203 DOI: 10.1177/0011000019888874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Medically unexplained symptoms and syndromes (MUS) affect the health of 20%-30% of patients seen in primary care. Optimally, treatment for these patients requires an interdisciplinary team consisting of both primary care and mental health providers. By developing an expertise in MUS, counseling psychologists can improve the care of patients with MUS who are already in their practice, expand the number of patients they help, and enhance the integration of counseling psychology into the broader medical community. Additionally, counseling psychologists' expertise in culture, attunement to therapeutic processes, and our focus on prioritizing patients' perspectives and quality of life can fill the gap in research on MUS and bringing increased attention to counseling psychologists' unique contributions to health service delivery.
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Affiliation(s)
- Lisa M McAndrew
- Veterans Affairs New Jersey Health Care System University at Albany
| | | | - David Litke
- Veterans Affairs New Jersey Health Care System
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41
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Butzko RP, Sotolongo AM, Helmer DA, Klein-Adams JC, Osinubi OY, Berman AR, Ortiz-Pacheco R, Falvo MJ. Forced oscillation technique in veterans with preserved spirometry and chronic respiratory symptoms. Respir Physiol Neurobiol 2019; 260:8-16. [DOI: 10.1016/j.resp.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/15/2018] [Accepted: 11/28/2018] [Indexed: 01/01/2023]
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42
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Anastasides N, Chiusano C, Gonzalez C, Graff F, Litke DR, McDonald E, Presnall-Shvorin J, Sullivan N, Quigley KS, Pigeon WR, Helmer DA, Santos SL, McAndrew LM. Helpful ways providers can communicate about persistent medically unexplained physical symptoms. BMC Fam Pract 2019; 20:13. [PMID: 30651073 PMCID: PMC6334465 DOI: 10.1186/s12875-018-0881-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/23/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Communication between patients and providers about persistent "medically unexplained" physical symptoms (MUS) is characterized by discordance. While the difficulties are well documented, few studies have examined effective communication. We sought to determine what veterans with Gulf War Illness (GWI) perceive as the most helpful communication from their providers. Veterans with GWI, a type of MUS, have historically had complex relationships with medical providers. Determining effective communication for patients with particularly complex relationships may help identify the most critical communication elements for all patients with MUS. METHODS Two hundred and-ten veterans with GWI were asked, in a written questionnaire, what was the most useful thing a medical provider had told them about their GWI. Responses were coded into three categories with 10 codes. RESULTS The most prevalent helpful communication reported by patients was when the provider offered acknowledgement and validation (N = 70). Specific recommendations for managing GWI or its symptoms (N = 48) were also commonly reported to be helpful. In contrast, about a third of the responses indicated that nothing about the communication was helpful (N = 63). There were not differences in severity of symptoms, disability or healthcare utilization between patients who found acknowledgement and validation, specific recommendations or nothing helpful. CONCLUSIONS Previous research has documented the discord between patients and providers regarding MUS. This study suggests that most patients are able to identify something helpful a provider has said, particularly acknowledgement and validation and specific treatment recommendations. The findings also highlight missed communication opportunities with a third of patients not finding anything helpful.
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Affiliation(s)
- Nicole Anastasides
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Carmelen Chiusano
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Christina Gonzalez
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Fiona Graff
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - David R Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Erica McDonald
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Jennifer Presnall-Shvorin
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Nicole Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Karen S Quigley
- Edith Nourse Rogers Memorial VA Hospital, Bedford, 01730, MA, USA
- Department of Psychology, Northeastern University, Boston, 02115, MA, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Susan L Santos
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ, 07018, USA.
- Department of Educational and Counseling Psychology, University at Albany, 1400 Washington Ave Ext, Albany, NY, 12222, USA.
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43
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Khalil L, McNeil RB, Sims KJ, Felder KA, Hauser ER, Goldstein KM, Voils CI, Klimas NG, Brophy MT, Thomas CM, Whitley RL, Dursa EK, Helmer DA, Provenzale DT. The Gulf War Era Cohort and Biorepository: A Longitudinal Research Resource of Veterans of the 1990-1991 Gulf War Era. Am J Epidemiol 2018; 187:2279-2291. [PMID: 30060060 DOI: 10.1093/aje/kwy147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/13/2018] [Indexed: 01/07/2023] Open
Abstract
The US Department of Veterans Affairs (VA) Gulf War Era Cohort and Biorepository (GWECB) is a nationally representative longitudinal cohort of US veterans who served during the 1990-1991 Gulf War era. The GWECB combines survey data, such as demographic, health behavior, and environmental exposure data; medical records; and a linked biorepository of blood specimens that can support a broad range of future research regarding health concerns unique to veterans of this era. To build this resource, the VA Cooperative Studies Program initiated a pilot study (2014-2016) to establish the GWECB and evaluate the processes required to build and maintain the resource. Participants (n = 1,275) consented to future sharing of their data and biospecimens for research purposes. Here we describe the pilot study, including recruitment and enrollment procedures, data collection and management, quality control, and challenges experienced. The GWECB data available to investigators under approved sharing mechanisms and the procedures for accessing them are extensively detailed. The study's consenting documents and a website link for the research survey are provided. Our hope is that new research drawing on the GWECB data and biospecimens will result in effective treatments and improved approaches to address the health concerns of Gulf War-era veterans.
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Affiliation(s)
- Lara Khalil
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
| | - Rebecca B McNeil
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
- Center for Clinical Research Network Coordination, Division of Biostatistics and Epidemiology, RTI International, Durham, North Carolina
| | - Kellie J Sims
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
| | - Kristina A Felder
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
| | - Elizabeth R Hauser
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
- Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina
| | - Karen M Goldstein
- Durham Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina
- Division of General Internal Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Corrine I Voils
- Durham Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina
- William S. Middleton Memorial Veterans Hospital, Department of Veterans Affairs, Madison, Wisconsin
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Nancy G Klimas
- Miami VA Healthcare System, Miami, Florida
- Institute for Neuro-Immune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mary T Brophy
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Catherine M Thomas
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
| | - Richard L Whitley
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
| | - Erin K Dursa
- Post-Deployment Health Epidemiology Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC
| | - Drew A Helmer
- War Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, New Jersey
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Dawn T Provenzale
- VA Cooperative Studies Program Epidemiology Center–Durham, Durham VA Health Care System, Durham, North Carolina
- Durham Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
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44
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McAndrew LM, Friedlander ML, Alison Phillips L, L Santos S, Helmer DA. Concordance of illness perceptions: The key to improving care of medically unexplained symptoms. J Psychosom Res 2018; 111:140-142. [PMID: 29935748 DOI: 10.1016/j.jpsychores.2018.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Lisa M McAndrew
- Veterans Affairs New Jersey Health Care System, East Orange, NJ United States.
| | | | | | - Susan L Santos
- Veterans Affairs New Jersey Health Care System, United States
| | - Drew A Helmer
- Veterans Affairs New Jersey Health Care System, United States
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45
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McAndrew LM, Helmer DA, Lu SE, Chandler HK, Slotkin S, Quigley KS. Longitudinal relationship between onset of physical symptoms and functional impairment. J Behav Med 2018; 41:819-826. [PMID: 29948542 DOI: 10.1007/s10865-018-9937-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/15/2018] [Indexed: 01/04/2023]
Abstract
Patients with chronic physical symptoms (e.g., chronic pain) often have significant functional impairment (i.e., disability). The fear avoidance model is the dominant theoretical model of how the relationship between chronic physical symptoms and functional impairment develops and proposes a cyclical/bidirectional relationship. There has never been a definitive test of the proposed bi-directional relationship. The current study followed 767 Operation Enduring Freedom/Operation Iraqi Freedom soldiers from pre-deployment, when they were relatively healthy, to 1 year after deployment, when it was anticipated that symptoms would increase or develop. Over the four assessment time points, physical symptom severity consistently predicted worse functional impairment at the subsequent time point. Functional impairment did not show a consistent relationship with worsening of physical symptom severity. These findings suggest that changes to functional impairment do not have a short-term impact on physical symptom severity.
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Affiliation(s)
- Lisa M McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs - New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07081, USA. .,Department of Educational and Counseling Psychology, University at Albany, Albany, USA.
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Veterans Affairs - New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07081, USA.,New Jersey Medical School, Rutgers University, Newark, USA
| | - Shou-En Lu
- War Related Illness and Injury Study Center, Veterans Affairs - New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07081, USA.,School of Public Health, Rutgers University, Piscataway, USA
| | - Helena K Chandler
- War Related Illness and Injury Study Center, Veterans Affairs - New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ, 07081, USA
| | - Sarah Slotkin
- Department of Educational and Counseling Psychology, University at Albany, Albany, USA
| | - Karen S Quigley
- Department of Veterans Affairs, Bedford Memorial Hospital, Bedford, USA.,Interdisciplinary Affective Science Laboratory, Northeastern University, Boston, USA
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46
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Helmer DA, Rowneki M, Feng X, Tseng CL, Rose D, Soroka O, Fried D, Jani N, Pogach LM, Sambamoorthi U. State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis. Inquiry 2018; 55:46958018756216. [PMID: 29490533 PMCID: PMC5846924 DOI: 10.1177/0046958018756216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most Veterans who use the Veterans Health Administration (VHA) also utilize private-sector health care providers. To better inform local and regional health care planning, we assessed the association between reliance on VHA ambulatory care and total and system-specific preventable hospitalization rates (PHRs) at the state level. We conducted a retrospective dynamic cohort study using Veterans with diabetes mellitus, aged 66 years or older, and dually enrolled in VHA and Medicare parts A and B from 2004 to 2010. While controlling for median age and proportion of males, we measured the association between reliance on VHA ambulatory care and PHRs at the state level using multivariable ordinary least square regression, geographically weighted regression, and generalized additive models. We measured geospatial patterns in PHRs using global Moran’s I and univariate local indicator spatial analysis. Approximately 30% of hospitalized Veterans experienced a preventable hospitalization. Reliance on VHA ambulatory care at the state level ranged from 13.92% to 67.78% and was generally not associated with PHRs. Geospatial analysis consistently identified a cluster of western states with low PHRs from 2006 to 2010. Given the generally low reliance on VHA ambulatory care and lack of association between this reliance and PHRs, policy changes to improve Veterans’ health care outcomes should address private-sector care in addition to VHA care.
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Affiliation(s)
- Drew A Helmer
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA.,2 Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Mazhgan Rowneki
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Xue Feng
- 3 West Virginia University, School of Pharmacy, Morgantown, USA
| | - Chin-Lin Tseng
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Danielle Rose
- 4 Veteran Affairs Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Orysya Soroka
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Dennis Fried
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Nisha Jani
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA.,5 Rutgers University, School of Public Health, Newark, NJ, USA
| | - Leonard M Pogach
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
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McAndrew LM, Greenberg LM, Ciccone DS, Helmer DA, Chandler HK. Telephone-Based versus In-Person Delivery of Cognitive Behavioral Treatment for Veterans with Chronic Multisymptom Illness: A Controlled, Randomized Trial. Mil Behav Health 2018; 6:56-65. [PMID: 31192051 PMCID: PMC6561490 DOI: 10.1080/21635781.2017.1337594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The goal of this randomized clinical trial was to examine the efficacy of a cognitive behavioral stress reduction treatment for reducing disability among veterans with chronic multisymptom illness (CMI). METHOD Veterans (N=128) who endorsed symptoms of CMI were randomized to: usual care (n=43), in-person (n=42) or telephone-delivered cognitive behavioral stress management (n=43). Assessments were conducted at baseline, three months, and twelve months. The primary outcome was limitation in roles at work and home (i.e., 'role physical'). Reductions in catastrophizing cognitions were evaluated as a mechanism of action. RESULTS Intent-to-treat analyses showed no statistically significant main effect (F(2, 164)=.58, p=.56) or interaction effect (F(4,164)=.94, p=.45) for role physical. Over time, veterans improved in their physical function (F(2,170)=5.34, p<.01; ὴ2 partial=.06), PTSD symptoms (F(2,170)=9.39, p<.01; ὴ2 partial=.10), depressive symptoms (F(2,170)=10.81, p<.01, ὴ2 partial=.11), and physical symptoms (F(2, 172)=12.65, p<.01; ὴ2 partial=.13), but these improvements did not differ across study arms over time. Completer analyses yielded similar results. There were no differences in catastrophizing between arms. CONCLUSION Findings suggest stress reduction may not be the right target for improving disability among veterans with CMI. Veterans with CMI may need intervention that directly impacts medical self-management to improve disability.
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Affiliation(s)
- Lisa M. McAndrew
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A.,Department of Educational and Counseling Psychology, University at Albany, Albany, NY, U. S. A
| | - Lauren M. Greenberg
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
| | - Donald S. Ciccone
- Department of Psychiatry, New Jersey Medical School, Rutgers University, Newark, NJ, U. S. A
| | - Drew A. Helmer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A.,Department of Medicine, New Jersey Medical School, Rutgers University, Newark, NJ, U. S. A
| | - Helena K. Chandler
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ, U. S. A
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48
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Jani N, Falvo MJ, Sotolongo A, Osinubi OY, Tseng CL, Rowneki M, Montopoli M, Morley SW, Mitchell V, Helmer DA. Blast Injury and Cardiopulmonary Symptoms in U.S. Veterans: Analysis of a National Registry. Ann Intern Med 2017; 167:753-755. [PMID: 28975227 DOI: 10.7326/m17-0711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nisha Jani
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Michael J Falvo
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Anays Sotolongo
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Omowunmi Y Osinubi
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Chin-Lin Tseng
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Mazhgan Rowneki
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Michael Montopoli
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Sybil W Morley
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Vincent Mitchell
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
| | - Drew A Helmer
- From Veterans Affairs New Jersey Health Care System, East Orange, New Jersey, and Veterans Affairs Central Office, Washington, DC
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49
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McAndrew LM, Phillips LA, Helmer DA, Maestro K, Engel CC, Greenberg LM, Anastasides N, Quigley KS. High healthcare utilization near the onset of medically unexplained symptoms. J Psychosom Res 2017; 98:98-105. [PMID: 28554378 DOI: 10.1016/j.jpsychores.2017.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/03/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) soldiers to understand the relationship of increasing physical symptom burden to healthcare utilization. METHODS Data was examined from a prospective study of OEF/OIF soldiers assessed before and one year after deployment (n=336). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA). RESULTS Increases in physical symptom burden predicted greater healthcare utilization one year after deployment: primary care practitioner (slope=-0.26, F=4.07, p=0.04), specialist (slope=-0.43, F=8.67, p=0.003), allied health therapy (e.g., physical therapy) (slope=-0.41, F=5.71, p=0.02) and mental health (slope=-0.32, F=4.04, p=0.05). There were no significant difference in utilization between those with consistently high levels and those with increases in physical symptom burden. CONCLUSION This is the first prospective study to examine, and show, a relationship between onset of clinically significant physical symptoms and greater healthcare utilization. Our data suggest that patients with increasing physical symptom burden have the same level of healthcare as patients with chronic physical symptom burden. Needed next steps are to better understand the quality of care at inception and determine how to intervene so that recommended approaches to care are provided from the onset.
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Affiliation(s)
- Lisa M McAndrew
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, United States; Department of Educational and Counseling Psychology, University at Albany, United States.
| | - L Alison Phillips
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, United States; Iowa State University, Department of Psychology, United States.
| | - Drew A Helmer
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, United States; Rutgers University Jersey Medical School, United States.
| | - Kieran Maestro
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, United States; Department of Educational and Counseling Psychology, University at Albany, United States.
| | - Charles C Engel
- Behavioral and Policy Sciences, RAND Corporation, United States.
| | - Lauren M Greenberg
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, United States.
| | - Nicole Anastasides
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, United States.
| | - Karen S Quigley
- Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States; Department of Psychology, Northeastern University, Boston, MA, United States.
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Wen PS, Waid-Ebbs JK, Graham DP, Helmer DA. Psychometric Properties of 2 Participation Measures in Veterans With Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2017; 99:S86-S93. [PMID: 28583464 DOI: 10.1016/j.apmr.2017.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/15/2017] [Accepted: 04/29/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the psychometric properties of 2 commonly used participation measures: the Community Reintegration of Service Members (CRIS) and the Participation Assessment with Recombined Tools-Objective (PART-O) in veterans with mild traumatic brain injury (mTBI). DESIGN Data were collected from 2 cross-sectional observation studies conducted in 2 Veterans Affairs medical centers. SETTING Questionnaires were completed in-person or by mail. PARTICIPANTS Veterans with mTBI (N=201) were recruited from the Michael E. DeBakey Veterans Affairs Medical Center in Houston (n=94) and the Malcom Randall North Florida/South Georgia Veterans Health System (n=107). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES CRIS and PART-O. RESULTS We conducted Rasch analysis on the PART-O and on 3 subscales of the CRIS (extent of participation, perceived limitation, and satisfaction). For PART-O, results showed PART-O has questionable unidimensionality. For both instruments, some rating categories were underused, and rating scales did not advance accordingly. Compared with PART-O, the CRIS was able to distinguish more categories of person's ability (>5 vs 2 for PART-O) and had better internal consistency as indicated by higher Cronbach α (.96-.98 vs .65 for PART-O). CONCLUSIONS To capture participation unique to veterans with mTBI, CRIS has greater potential to detect a change in participation and is therefore recommended over PART-O. Rating scales of both instruments, however, need further refinement. We suggest future studies examine collapsed rating categories and use qualitative methods to redefine categories.
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Affiliation(s)
- Pey-Shan Wen
- Occupational Therapy Department, Georgia State University, Atlanta, GA.
| | - J Kay Waid-Ebbs
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, Gainesville, FL
| | - David P Graham
- Neurorehabilitation: Neurons to Network, Traumatic Brain Injury Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Menninger Departments of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX
| | - Drew A Helmer
- War Related Illness and Injury Study Center Veterans Affairs-New Jersey Health Care System, East Orange, NJ; Rutgers University-New Jersey Medical School, Newark, NJ
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