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Aurora P, Paquette CE, Beckham JC, Pugh MJ, Kimbrel NA, Calhoun PS. Mental health treatment utilization among Gulf War era veterans with probable alcohol use disorder. J Subst Use Addict Treat 2024; 160:209295. [PMID: 38272121 PMCID: PMC11060892 DOI: 10.1016/j.josat.2024.209295] [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: 07/27/2023] [Revised: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is prevalent among veterans, and excessive alcohol use is associated with significant mental and physical health consequences. Currently, the largest cohort of veterans seeking services at the VA are those from the 1990s Gulf War Era. This cohort of veterans is unique due to the nature of their deployment resulting in a myriad of unexplained symptoms collectively known as "Gulf War Illness" and higher rates of mental health problems. The present study sought to examine the association between probable AUD and mental health treatment utilization in a sample of 1126 (882 male) Gulf War-era veterans. METHODS Veterans completed a self-report survey including the AUDIT-C, questions about mental health treatment engagement, and demographic questions. RESULTS Results demonstrated that approximately 20 % of the sample screened positive for probable AUD, determined by standard AUDIT-C cutoff scores. Among those screening positive for AUD, 25 % reported engaging in mental health treatment in the past year. Veterans with probable AUD who use VA care had 3.8 times the odds of receiving mental health services than veterans not using VA care. Use of mental health services was associated with mental health comorbidity and identifying as Black/African American. CONCLUSIONS The results of the present study highlight a significant unmet need for mental health treatment among Gulf War-era veterans with AUD.
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Affiliation(s)
- Pallavi Aurora
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.
| | - Catherine E Paquette
- Durham VA Health Care System, Durham, NC, USA; Department of Psychology and Neuroscience, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Mary Jo Pugh
- School of Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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Howard JT, Stewart IJ, Walker LE, Amuan M, Rayha K, Janak JC, Pugh MJ. Comparison of Racial and Ethnic Mortality Disparities among Post-9/11 Veterans with and without Traumatic Brain Injury to the Total U.S. Adult Population. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02004-1. [PMID: 38622427 DOI: 10.1007/s40615-024-02004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The extent of racial/ethnic disparities and whether they are attenuated in the Veteran population compared to the total US population is not well understood. We aimed to assess racial/ethnic mortality disparities from all-cause, cardiovascular (CVD) and cancer among post-9/11 military Veterans with and without exposure to TBI, compared to the total US population. METHODS This cohort study included 2,502,101 US military Veterans (18,932,083 person-years) who served after 09/11/2001 with 3 or more years of care in the Military Health System (MHS); or had 3 or more years of care in the MHS and 2 or more years of care in the Veterans Health Administration. Mortality follow-up occurred from 01/01/2002 to 12/31/2020. Mortality rate ratios (MRR) from negative binomial regression models were reported for racial/ethnic groups compared to White non-Hispanic Veterans for all-cause, CVD and cancer mortality. Veteran MRR were compared to the total US population. RESULTS Mortality rates for Black Non-Hispanic Veterans were higher for all-cause (MRR = 1.21;95%CI: 1.13-1.29; p < 0.001), CVD (MRR = 1.78;95%CI: 1.62-1.96; p < 0.001) and cancer (MRR = 1.17;95%CI: 1.10-1.25; p < 0.001) than in White Non-Hispanic Veterans. Among Veterans with TBI, only Black Non-Hispanics had higher mortality than White Non-Hispanics and only for CVD (MRR = 1.32;95%CI: 1.12-1.54; p < 0.001), while CVD mortality was higher among Veterans without TBI (MRR = 1.77;95%CI: 1.63-1.93;p < 0.001). MRR for Black Non-Hispanics in the total US population, were consistently higher than those in the Veteran population for all-cause (MRR = 1.52;95%CI: 1.46-1.58; p < 0.001), CVD (MRR = 2.03;95%CI: 1.95-2.13; p < 0.001) and cancer (MRR = 1.26;95%CI: 1.22-1.30; p < 0.001). CONCLUSION This Veteran cohort experienced less racial/ethnic disparity in mortality than the total US population, especially among Veterans with TBI.
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Affiliation(s)
- Jeffrey T Howard
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Ian J Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA
- Military Cardiovascular Outcomes Research Program, Bethesda, MD, USA
| | - Lauren E Walker
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Megan Amuan
- University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, Utah, USA
- United States Department of Veterans Affairs, 550 Foothill Dr, Salt Lake City, Utah, USA
| | - Kara Rayha
- Department of Psychology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, USA
| | | | - Mary Jo Pugh
- University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, Utah, USA
- United States Department of Veterans Affairs, 550 Foothill Dr, Salt Lake City, Utah, USA
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Kennedy E, Ozmen M, Bouldin ED, Panahi S, Mobasher H, Troyanskaya M, Martindale SL, Merritt VC, O'Neil M, Sponheim SR, Remigio-Baker RA, Presson A, Swan AA, Werner JK, Greene TH, Wilde EA, Tate DF, Walker WC, Pugh MJ. Phenotyping Depression After Mild Traumatic Brain Injury: Evaluating the Impact of Multiple Injury, Gender, and Injury Context. J Neurotrauma 2024; 41:924-933. [PMID: 38117134 DOI: 10.1089/neu.2023.0381] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The chronic mental health consequences of mild traumatic brain injury (TBI) are a leading cause of disability. This is surprising given the expectation of significant recovery after mild TBI, which suggests that other injury-related factors may contribute to long-term adverse outcomes. The objective of this study was to determine how number of prior injuries, gender, and environment/context of injury may contribute to depressive symptoms after mild TBI among deployed United States service members and veterans (SMVs). Data from the Long-term Impact of Military-Relevant Brain Injury Consortium Prospective Longitudinal Study was used to assess TBI injury characteristics and depression scores previously measured on the Patient Health Questionnaire-9 (PHQ-9) among a sample of 1456 deployed SMVs. Clinical diagnosis of mild TBI was defined via a multi-step process centered on a structured face-to-face interview. Logistical and linear regressions stratified by gender and environment of injury were used to model depressive symptoms controlling for sociodemographic and combat deployment covariates. Relative to controls with no history of mild TBI (n = 280), the odds ratios (OR) for moderate/severe depression (PHQ-9 ≥ 10) were higher for SMVs with one mild TBI (n = 358) OR: 1.62 (95% confidence interval [CI] 1.09-2.40, p = 0.016) and two or more mild TBIs (n = 818) OR: 1.84 (95% CI 1.31-2.59, p < 0.001). Risk differences across groups were assessed in stratified linear models, which found that depression symptoms were elevated in those with a history of multiple mild TBIs compared with those who had a single mild TBI (p < 0.001). Combat deployment-related injuries were also associated with higher depression scores than injuries occurring in non-combat or civilian settings (p < 0.001). Increased rates of depression after mild TBI persisted in the absence of post-traumatic stress disorder. Both men and women SMVs separately exhibited significantly increased depressive symptom scores if they had had combat-related mild TBI. These results suggest that contextual information, gender, and prior injury history may influence long-term mental health outcomes among SMVs with mild TBI exposure.
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Affiliation(s)
- Eamonn Kennedy
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mustafa Ozmen
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Department of Electrical and Electronics Engineering, Antalya Bilim University, Döşemealtı/Antalya, Türkiye
| | - Erin D Bouldin
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Samin Panahi
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Helal Mobasher
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Holcombe Boulevard Houston, Texas, USA
| | - Sarah L Martindale
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, North Carolina, USA
- Department of Physiology & Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Victoria C Merritt
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Maya O'Neil
- VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Scott R Sponheim
- Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rosemay A Remigio-Baker
- Traumatic Brain Injury Center of Excellence (TBICoE), Silver Spring, Maryland, USA
- Compass Government Solutions, Annapolis, Maryland, USA
| | - Angela Presson
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - J Kent Werner
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tom H Greene
- Division of Biostatistics, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Elisabeth A Wilde
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David F Tate
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - William C Walker
- Physical Medicine and Rehabilitation Service, Richmond Veterans Affairs Medical Center, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Lin C, Pugh MJ, Krishnamurthy V, Krishnamurthy LC, Walker WC. Editorial: Neurological and neuropsychiatric disorders affecting military personnel and veterans. Front Neurol 2024; 15:1392721. [PMID: 38533412 PMCID: PMC10963390 DOI: 10.3389/fneur.2024.1392721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Affiliation(s)
- Chen Lin
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Birmingham VA Medical Center, Birmingham, AL, United States
| | - Mary Jo Pugh
- Department of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Medical Center, Salt Lake City, UT, United States
| | - Venkatagiri Krishnamurthy
- Atlanta VA Medical Center, Decatur, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Lisa C. Krishnamurthy
- Atlanta VA Medical Center, Decatur, GA, United States
- Department of Physics and Astronomy, Georgia State University, Atlanta, GA, United States
- Joint GSU, Georgia Tech, and Emory Center for Translational Research in Neuroimaging and Data Science (TReNDS), Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Willliam C. Walker
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
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Kalvesmaki AF, Trevino AY, Charron E, Kroll-Desrosiers A, Peterson K, Pugh MJ. The Impact of Resilience on Employment Among Post-9/11 Veterans With and Without Military Sexual Trauma Exposure. Mil Med 2024; 189:e493-e501. [PMID: 37464907 DOI: 10.1093/milmed/usad267] [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: 02/07/2023] [Revised: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Successful employment is a functional outcome of high importance for veterans after military discharge. There is a significant rising concern regarding exposure to military sexual trauma (MST) and related mental health outcomes that can impair functional outcomes, such as employment. Although resilience training is a key component of preparing for military service, to date the impact of resilience on employment outcomes for veterans with exposure to MST has yet to be examined. We sought to examine the relationship between resilience and employment in a national sample of post-9/11 veterans with and without MST exposure. MATERIALS AND METHODS A national survey was conducted between October 2021 and January 2022 to respond to the 2021 National Defense Authorization Act mandate to identify factors affecting post-9/11 women veteran's unemployment. Of veterans, 1,185 completed the survey. Of these, 565 (47.6%) were post-9/11 veterans. The survey collected data on demographics and employment; MST, adult sexual trauma (AST, outside of military), and childhood sexual trauma (CST) exposure; resilience (Response to Stressful Experiences Scale); Post Traumatic Stress Disorder (PTSD) Checklist (PCL-5); and depression (Patient Health Questionnaire-2). Multivariable logistic regression models identified gender-specific associations of resilience with employment among those exposed and not exposed to MST, adjusting for AST, CST, PTSD, and depression. Significance was set at P < .05. RESULTS Of 322 women and 243 men post-9/11 veterans, 86.5% were employed. MST exposure (MST[+]) was reported by 31.4% (n = 101) of women and 16.9% (n = 41) of men. MST(+) women veterans were more likely to report CST (35.6% vs. 14.5%; P < .001), AST (68.3% vs. 17.2%; P < .001), and both CST and AST (19.8% vs. 7.2%; P < .001) than MST(-) women. MST(+) men were more likely to report AST (65.9% vs. 7.9%; P < .001), and both CST and AST (14.6% vs. 1.0%; P < .001) than MST(-) men. Levels of self-reported resilience were similar for MST(+) women and men and their MST(-) counterparts (women: 11.1 vs. 11.0; men: 11.5 vs. 12.0). For MST(+) women, each unit increase in resilience was associated with a 36% increase in odds of employment (OR: 1.36, 95% CI, 1.08-1.71); resilience was not associated with increased odds of employment among MST(-) women. Among MST(+) men veterans, each unit increase in resilience was associated with an 83% increase in odds of employment (aOR: 1.83, 95% CI, 1.13-2.98), and like women veterans, resilience was not associated with employment among MST(-) men. CONCLUSIONS Among MST(+) women and men post-9/11 veterans, higher resilience was associated with increased odds of employment, whereas resilience was not associated with employment in MST(-) veterans. These findings suggest that resiliency during and after military service is a key component for potentially improving long-term outcomes. Improving resilience using evidence-based approaches among post-9/11 veterans exposed to MST may be an important avenue for increasing successful functional outcomes such as employment. Moreover, MST(+) women and men veterans may benefit from trauma-informed care as a substantial proportion of these individuals also report exposure to CST, AST, PTSD, and depression.
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Affiliation(s)
- Andrea F Kalvesmaki
- Informatics Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Amira Y Trevino
- Department of Educational Psychology, University of Utah College of Education, Salt Lake City, UT 84112, USA
| | - Elizabeth Charron
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa, OK 74135, USA
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, 421 North Main Street, Leeds, MA 01053, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01605, USA
| | - Kelly Peterson
- Informatics Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Mary Jo Pugh
- Informatics Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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Panahi S, Mayo J, Kennedy E, Christensen L, Kamineni S, Sagiraju HKR, Cooper T, Tate DF, Rupper R, Pugh MJ. Identifying clinical phenotypes of frontotemporal dementia in post-9/11 era veterans using natural language processing. Front Neurol 2024; 15:1270688. [PMID: 38426171 PMCID: PMC10902457 DOI: 10.3389/fneur.2024.1270688] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Frontotemporal dementia (FTD) encompasses a clinically and pathologically diverse group of neurodegenerative disorders, yet little work has quantified the unique phenotypic clinical presentations of FTD among post-9/11 era veterans. To identify phenotypes of FTD using natural language processing (NLP) aided medical chart reviews of post-9/11 era U.S. military Veterans diagnosed with FTD in Veterans Health Administration care. Methods A medical record chart review of clinician/provider notes was conducted using a Natural Language Processing (NLP) tool, which extracted features related to cognitive dysfunction. NLP features were further organized into seven Research Domain Criteria Initiative (RDoC) domains, which were clustered to identify distinct phenotypes. Results Veterans with FTD were more likely to have notes that reflected the RDoC domains, with cognitive and positive valence domains showing the greatest difference across groups. Clustering of domains identified three symptom phenotypes agnostic to time of an individual having FTD, categorized as Low (16.4%), Moderate (69.2%), and High (14.5%) distress. Comparison across distress groups showed significant differences in physical and psychological characteristics, particularly prior history of head injury, insomnia, cardiac issues, anxiety, and alcohol misuse. The clustering result within the FTD group demonstrated a phenotype variant that exhibited a combination of language and behavioral symptoms. This phenotype presented with manifestations indicative of both language-related impairments and behavioral changes, showcasing the coexistence of features from both domains within the same individual. Discussion This study suggests FTD also presents across a continuum of severity and symptom distress, both within and across variants. The intensity of distress evident in clinical notes tends to cluster with more co-occurring conditions. This examination of phenotypic heterogeneity in clinical notes indicates that sensitivity to FTD diagnosis may be correlated to overall symptom distress, and future work incorporating NLP and phenotyping may help promote strategies for early detection of FTD.
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Affiliation(s)
- Samin Panahi
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jamie Mayo
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Eamonn Kennedy
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lee Christensen
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Sreekanth Kamineni
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | | | - Tyler Cooper
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - David F. Tate
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Randall Rupper
- VA Salt Lake City Health Care System, Geriatric Research, Education and Clinical Center, Salt Lake City, UT, United States
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
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Stewart IJ, Howard JT, Poltavskiy E, Dore M, Amuan ME, Ocier K, Walker LE, Alcover KC, Pugh MJ. Traumatic Brain Injury and Subsequent Risk of Brain Cancer in US Veterans of the Iraq and Afghanistan Wars. JAMA Netw Open 2024; 7:e2354588. [PMID: 38358743 PMCID: PMC10870183 DOI: 10.1001/jamanetworkopen.2023.54588] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/07/2023] [Indexed: 02/16/2024] Open
Abstract
Importance While brain cancer is rare, it has a very poor prognosis and few established risk factors. To date, epidemiologic work examining the potential association of traumatic brain injury (TBI) with the subsequent risk of brain cancer is conflicting. Further data may be useful. Objective To examine whether a history of TBI exposure is associated with the subsequent development of brain cancer. Design, Setting, and Participants A retrospective cohort study was conducted from October 1, 2004, to September 20, 2019, and data analysis was performed between January 1 and June 26, 2023. The median follow-up for the cohort was 7.2 (IQR, 4.1-10.1) years. Veterans Affairs (VA) and Department of Defense (DoD) administrative data on 1 919 740 veterans from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium were included. Exposure The main exposure of interest was TBI severity (categorized as mild, moderate or severe [moderate/severe], and penetrating). Main Outcomes and Measures The outcome of interest was the development of brain cancer based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes in either the DoD/VA medical records or from the National Death Index. Results After 611 107 exclusions (predominately for no encounter during the study period), a cohort including 1 919 740 veterans was included, most of whom were male (80.25%) and non-Hispanic White (63.11%). Median age at index date was 31 (IQR, 25-42) years. The cohort included 449 880 individuals with TBI (mild, 385 848; moderate/severe, 46 859; and penetrating, 17 173). Brain cancer occurred in 318 individuals without TBI (0.02%), 80 with mild TBI (0.02%), 17 with moderate/severe TBI (0.04%), and 10 or fewer with penetrating TBI (≤0.06%). After adjustment, moderate/severe TBI (adjusted hazard ratio [AHR], 1.90; 95% CI, 1.16-3.12) and penetrating TBI (AHR, 3.33; 95% CI, 1.71-6.49), but not mild TBI (AHR, 1.14; 95% CI, 0.88-1.47), were associated with the subsequent development of brain cancer. Conclusions and Relevance In this cohort study of veterans of the Iraq and Afghanistan wars, moderate/severe TBI and penetrating TBI, but not mild TBI, were associated with the subsequent development of brain cancer.
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Affiliation(s)
- Ian J. Stewart
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
- Military Cardiovascular Outcomes Research Program, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Jeffrey T. Howard
- Miltary & Health Research Foundation, Laurel, Maryland
- Department of Public Health, University of Texas, San Antonio
| | | | - Michael Dore
- Department of Medicine, Duke University, Durham, North Carolina
| | - Megan E. Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Krista Ocier
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Lauren E. Walker
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland
| | - Karl C. Alcover
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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Esmaeili A, Dismuke-Greer C, Pogoda TK, Amuan ME, Garcia C, Del Negro A, Myers M, Kennedy E, Cifu D, Pugh MJ. Cannabis use disorder contributes to cognitive dysfunction in Veterans with traumatic brain injury. Front Neurol 2024; 15:1261249. [PMID: 38292293 PMCID: PMC10824930 DOI: 10.3389/fneur.2024.1261249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
Background While emerging evidence supports a link between traumatic brain injury (TBI) and progressive cognitive dysfunction in Veterans, there is insufficient information on the impact of cannabis use disorder (CUD) on long-term cognitive disorders. This study aimed to examine the incidences of cognitive disorders in Veterans with TBI and CUD and to evaluate their relationship. Methods This retrospective cohort study used the US Department of Veterans Affairs and Department of Defense administrative data from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium Phenotype study. Diagnoses suggesting cognitive disorders after a TBI index date were identified using inpatient and outpatient data from 2003 to 2022. We compared the differential cognitive disorders incidence in Veterans who had the following: (1) no CUD or TBI (control group), (2) CUD only, (3) TBI only, and (4) comorbid CUD+TBI. Kaplan-Meier analyses were used to estimate the overall cognitive disorders incidence in the above study groups. The crude and adjusted Cox proportional hazards models were used to estimate crude and adjusted hazard ratios (HRs) for cognitive disorders. Results A total of 1,560,556 Veterans [82.32% male, median (IQR) age at the time of TBI, 34.51 (11.29) years, and 61.35% white] were evaluated. The cognitive disorder incidence rates were estimated as 0.68 (95% CI, 0.62, 0.75) for CUD only and 1.03 (95% CI, 1.00, 1.06) for TBI only per 10,000 person-months of observations, with the highest estimated cognitive disorder incidence observed in participants with both TBI and CUD [1.83 (95% CI, 1.72, 1.95)]. Relative to the control group, the highest hazard of cognitive disorders was observed in Veterans with CUD+TBI [hazard ratio (HR), 3.26; 95% CI, 2.91, 3.65], followed by those with TBI only (2.32; 95 CI%, 2.13, 2.53) and with CUD (1.79; 95 CI%, 1.60, 2.00). Of note, in the CUD only subgroup, we also observed the highest risk of an early onset cognitive disorder other than Alzheimer's disease and Frontotemporal dementia. Discussion The results of this analysis suggest that individuals with comorbid TBI and CUD may be at increased risk for early onset cognitive disorders, including dementia.
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Affiliation(s)
- Aryan Esmaeili
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Clara Dismuke-Greer
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Boston University School of Public Health, Boston, MA, United States
| | - Megan E. Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Carla Garcia
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Ariana Del Negro
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Maddy Myers
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Eamonn Kennedy
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - David Cifu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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Esmaeili A, Pogoda TK, Amuan ME, Garcia C, Del Negro A, Myers M, Pugh MJ, Cifu D, Dismuke-Greer C. The economic impact of cannabis use disorder and dementia diagnosis in veterans diagnosed with traumatic brain injury. Front Neurol 2024; 14:1261144. [PMID: 38283672 PMCID: PMC10811113 DOI: 10.3389/fneur.2023.1261144] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Background Studies have demonstrated that individuals diagnosed with traumatic brain injury (TBI) frequently use medical and recreational cannabis to treat persistent symptoms of TBI, such as chronic pain and sleep disturbances, which can lead to cannabis use disorder (CUD). We aimed to determine the Veterans Health Administration (VHA) healthcare utilization and costs associated with CUD and dementia diagnosis in veterans with TBI. Methods This observational study used administrative datasets from the population of post-9/11 veterans from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium and the VA Data Warehouse. We compared the differential VHA costs among the following cohorts of veterans: (1) No dementia diagnosis and No CUD group, (2) Dementia diagnosis only (Dementia only), (3) CUD only, and (4) comorbid dementia diagnosis and CUD (Dementia and CUD). Generalized estimating equations and negative binomial regression models were used to estimate total annual costs (inflation-adjusted) and the incidence rate of healthcare utilization, respectively, by dementia diagnosis and CUD status. Results Data from 387,770 veterans with TBI (88.4% men; median [interquartile range (IQR)] age at the time of TBI: 30 [14] years; 63.5% white) were followed from 2000 to 2020. Overall, we observed a trend of gradually increasing healthcare costs 5 years after TBI onset. Interestingly, in this cohort of veterans within 5 years of TBI, we observed substantial healthcare costs in the Dementia only group (peak = $46,808) that were not observed in the CUD and dementia group. Relative to those without either condition, the annual total VHA costs were $3,368 higher in the CUD only group, while no significant differences were observed in the Dementia only and Dementia and CUD groups. Discussion The findings suggest that those in the Dementia only group might be getting their healthcare needs met more quickly and within 5 years of TBI diagnosis, whereas veterans in the Dementia and CUD group are not receiving early care, resulting in higher long-term healthcare costs. Further investigations should examine what impact the timing of dementia and CUD diagnoses have on specific categories of inpatient and outpatient care in VA and community care facilities.
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Affiliation(s)
- Aryan Esmaeili
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Boston University School of Public Health, Boston, MA, United States
| | - Megan E. Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Carla Garcia
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Ariana Del Negro
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Maddy Myers
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - David Cifu
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Clara Dismuke-Greer
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
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Stromberg KM, Martindale SL, Walker WC, Ou Z, Pogoda TK, Miles SR, Dismuke-Greer CE, Carlson KF, Rowland JA, O’Neil ME, Pugh MJ. Mild traumatic brain injury, PTSD symptom severity, and behavioral dyscontrol: a LIMBIC-CENC study. Front Neurol 2024; 14:1286961. [PMID: 38274880 PMCID: PMC10808394 DOI: 10.3389/fneur.2023.1286961] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/23/2023] [Indexed: 01/27/2024] Open
Abstract
Background Behavioral dyscontrol occurs commonly in the general population and in United States service members and Veterans (SM/V). This condition merits special attention in SM/V, particularly in the aftermath of deployments. Military deployments frequently give rise to posttraumatic stress disorder (PTSD) and deployment-related mild TBI traumatic brain injury (TBI), potentially leading to manifestations of behavioral dyscontrol. Objective Examine associations among PTSD symptom severity, deployment-related mild traumatic brain injury, and behavioral dyscontrol among SM/V. Design Secondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium prospective longitudinal study among SM/V (N = 1,808). Methods Univariable and multivariable linear regression models assessed the association and interaction effects between PTSD symptom severity, as assessed by the PTSD Checklist for the Diagnostic and Statistical Manual, 5th edition (PCL-5), and deployment-related mild TBI on behavioral dyscontrol, adjusting for demographics, pain, social support, resilience, and general self-efficacy. Results Among the 1,808 individuals in our sample, PTSD symptom severity (B = 0.23, 95% CI: 0.22, 0.25, p < 0.001) and deployment-related mild TBI (B = 3.27, 95% CI: 2.63, 3.90, p < 0.001) were significantly associated with behavioral dyscontrol in univariable analysis. Interaction effects were significant between PTSD symptom severity and deployment mild TBI (B = -0.03, 95% CI: -0.06, -0.01, p = 0.029) in multivariable analysis, indicating that the effect of mild TBI on behavioral dyscontrol is no longer significant among those with a PCL-5 score > 22.96. Conclusion Results indicated an association between PTSD symptom severity, deployment-related mild TBI, and behavioral dyscontrol among SM/V. Notably, the effect of deployment-related mild TBI was pronounced for individuals with lower PTSD symptom severity. Higher social support scores were associated with lower dyscontrol, emphasizing the potential for social support to be a protective factor. General self-efficacy was also associated with reduced behavioral dyscontrol.
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Affiliation(s)
- Kelsee M. Stromberg
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Sarah L. Martindale
- Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Department of PM&R, Central Virginia VA Health Care System, Richmond, VA, United States
| | - Zhining Ou
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
| | - Shannon R. Miles
- Mental Health and Behavioral Sciences Services, James A. Haley Veterans’ Hospital, Tampa, FL, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Clara E. Dismuke-Greer
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Kathleen F. Carlson
- VA HSR&D Center to Improve Veteran Involvement in Care (CIVIC) and RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, OR, United States
- Oregon Health and Science University – Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, United States
| | - Jared A. Rowland
- Research and Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Maya E. O’Neil
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
- Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
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Wade BSC, Tate DF, Kennedy E, Bigler ED, York GE, Taylor BA, Troyanskaya M, Hovenden ES, Goodrich-Hunsaker N, Newsome MR, Dennis EL, Abildskov T, Pugh MJ, Walker WC, Kenney K, Betts A, Shih R, Welsh RC, Wilde EA. Microstructural Organization of Distributed White Matter Associated With Fine Motor Control in US Service Members With Mild Traumatic Brain Injury. J Neurotrauma 2024; 41:32-40. [PMID: 37694678 DOI: 10.1089/neu.2022.0094] [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] [Indexed: 09/12/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is the most common form of brain injury. While most individuals recover from mTBI, roughly 20% experience persistent symptoms, potentially including reduced fine motor control. We investigate relationships between regional white matter organization and subcortical volumes associated with performance on the Grooved Pegboard (GPB) test in a large cohort of military Service Members and Veterans (SM&Vs) with and without a history of mTBI(s). Participants were enrolled in the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium. SM&Vs with a history of mTBI(s) (n = 847) and without mTBI (n = 190) underwent magnetic resonance imaging and the GPB test. We first examined between-group differences in GPB completion time. We then investigated associations between GPB performance and regional structural imaging measures (tractwise diffusivity, subcortical volumes, and cortical thickness) in SM&Vs with a history of mTBI(s). Lastly, we explored whether mTBI history moderated associations between imaging measures and GPB performance. SM&Vs with mTBI(s) performed worse than those without mTBI(s) on the non-dominant hand GPB test at a trend level (p < 0.1). Higher fractional anisotropy (FA) of tracts including the posterior corona radiata, superior longitudinal fasciculus, and uncinate fasciculus were associated with better GPB performance in the dominant hand in SM&Vs with mTBI(s). These findings support that the organization of several white matter bundles are associated with fine motor performance in SM&Vs. We did not observe that mTBI history moderated associations between regional FA and GPB test completion time, suggesting that chronic mTBI may not significantly influence fine motor control.
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Affiliation(s)
- Benjamin S C Wade
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - David F Tate
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Eamonn Kennedy
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erin D Bigler
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | | | - Brian A Taylor
- Department of Imaging Physics, the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Elizabeth S Hovenden
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Naomi Goodrich-Hunsaker
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Emily L Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Tracy Abildskov
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Mary Jo Pugh
- Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Decision-Enhancement and Analytic Sciences Center, Department of Informatics, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - William C Walker
- Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Center for Neuroscience and Regenerative Medicine, Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Aaron Betts
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Robert Shih
- American Institute for Radiologic Pathology, Silver Spring, Maryland, USA
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | - Elisabeth A Wilde
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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Dang S, Garcia-Davis S, Noël PH, Hansen J, Brintz BJ, Munoz R, Valencia Rodrigo WM, Rupper R, Bouldin ED, Trivedi R, Penney LS, Pugh MJ, Kinosian B, Intrator O, Leykum LK. Measuring the unmet needs of American military Veterans and their caregivers: Survey protocol of the HERO CARE survey. J Am Geriatr Soc 2023; 71:3814-3825. [PMID: 37698336 DOI: 10.1111/jgs.18577] [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: 03/15/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Empowering Veterans to age in place is a Department of Veterans Affairs priority. Family or unpaid caregivers play an important role in supporting Veterans to achieve this goal. Effectively meeting the needs of Veterans and caregivers requires identifying unmet needs and relevant gaps in resources to address those needs. METHODS Using a modified Socio-Ecological Model, we developed a prospective longitudinal panel design survey. We randomly selected 20,000 community-dwelling Veterans enrolled in the Veterans Health Administration (VHA), across five VHA sites. We oversampled Veterans with a higher predicted 2-year long-term institutional care (LTIC) risk. Veterans were mailed a packet containing a Veteran survey and a caregiver survey, to be answered by their caregiver if they had one. The Veteran survey assessed the following health-related domains: physical, mental, social determinants of health, and caregiver assistance. Caregivers completed questions regarding their demographic factors, caregiving activities, impact of caregiving, use of VA and non-VA services, and caregiver support resources. Follow-up surveys will be repeated twice at 12-month intervals for the same respondents. This article describes the HERO CARE survey protocol, content, and response rates. RESULTS We received responses from 8,056 Veterans and 3,579 caregivers between July 2021 and January 2022, with 95.6% being received via mail. Veteran respondents were mostly males (96.5%), over 65 years of age (94.9%), married (55.0%), Non-Hispanic White (75.2%), and residing in urban areas (80.7%). CONCLUSIONS This longitudinal survey is unique in its comprehensive assessment of domains relevant to older Veterans stratified by LTIC risk and their caregivers, focusing on social determinants, caregiver support, and the use of caregiver support resources. Survey data will be linked to Centers for Medicare & Medicaid Services and VA data. The results of this study will inform better planning of non-institutional care services and policy for Veterans and their caregivers.
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Affiliation(s)
- Stuti Dang
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- Miami VA Healthcare System, Geriatric Research, Education, & Clinical Center GRECC, Miami, Florida, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami, Coral Gables, Florida, USA
| | - Polly H Noël
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
- School of Medicine, Family & Community Medicine, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jared Hansen
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Benjamin J Brintz
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Richard Munoz
- Robert Stempel College of Public Health & Social Work, Department of Health Policy & Management, Florida International University, Miami, Florida, USA
| | | | - Rand Rupper
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- GRECC George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA
| | - Erin D Bouldin
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ranak Trivedi
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- Department of Psych/Public Mental Health Population Sciences, Stanford University, Stanford, California, USA
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Lauren S Penney
- Center for Scientific Review, National Institutes of Health, Bethesda, Maryland, USA
| | - Mary Jo Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah Health, Salt Lake City, Utah, USA
| | - Bruce Kinosian
- Department of Internal Medicine, Division of Geriatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Orna Intrator
- Geriatrics & Extended Care Data Analysis Center and Finger Lakes Healthcare System, Canandaigua Veterans Affairs Medical Center, Canandaigua, New York, USA
- Department of Public Health Sciences, University of Rochester, Rochester, New York, USA
| | - Luci K Leykum
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, Texas, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, Texas, USA
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13
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Wright BM, Zhang C, Fisher RR, Karmarkar AM, Bjork JM, Pugh MJ, Hodges CB, Martindale SL, Wilde EA, Kenney K, McDonald SD, Scheibel RS, Newsome MR, Cook LJ, Walker WC. Relation of Aerobic Activity to Cognition and Well-being in Chronic Mild Traumatic Brain Injury: A LIMBIC-CENC Study. Mil Med 2023; 188:124-133. [PMID: 37948207 DOI: 10.1093/milmed/usad056] [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: 11/30/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Because chronic difficulties with cognition and well-being are common after mild traumatic brain injury (mTBI) and aerobic physical activity and exercise (PAE) is a potential treatment and mitigation strategy, we sought to determine their relationship in a large sample with remote mTBI. MATERIALS AND METHODS The Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study is a national multicenter observational study of combat-exposed service members and veterans. Study participants with positive mTBI histories (n = 1,087) were classified as "inactive" (23%), "insufficiently active" (46%), "active" (19%), or "highly active" (13%) based on the aerobic PAE level. The design was a cross-sectional analysis with multivariable regression. PAE was reported on the Behavioral Risk Factor Surveillance System. Preselected primary outcomes were seven well-validated cognitive performance tests of executive function, learning, and memory: The California Verbal Learning Test-Second Edition Long-Delay Free Recall and Total Recall, Brief Visuospatial Memory Test-Revised Total Recall, Trail-Making Test-Part B, and NIH Toolbox for the Assessment of Neurological Behavior and Function Cognition Battery Picture Sequence Memory, Flanker, and Dimensional Change Card Sort tests. Preselected secondary outcomes were standardized self-report questionnaires of cognitive functioning, life satisfaction, and well-being. RESULTS Across the aerobic activity groups, cognitive performance tests were not significantly different. Life satisfaction and overall health status scores were higher for those engaging in regular aerobic activity. Exploratory analyses also showed better working memory and verbal fluency with higher aerobic activity levels. CONCLUSIONS An association between the aerobic activity level and the preselected primary cognitive performance outcome was not demonstrated using this study sample and methods. However, higher aerobic activity levels were associated with better subjective well-being. This supports a clinical recommendation for regular aerobic exercise among persons with chronic or remote mTBI. Future longitudinal analyses of the exercise-cognition relationship in chronic mTBI populations are recommended.
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Affiliation(s)
- Brennan M Wright
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | - Renae R Fisher
- Department of Rehabilitation Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Sheltering Arms Institute, Richmond, VA 23233, USA
| | - James M Bjork
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Mental Health Service, Central Virginia VA Health Care System, Richmond, VA 23249, USA
| | - Mary Jo Pugh
- VA Salt Lake City IDEAS Center for Innovation and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84312, USA
| | - Cooper B Hodges
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Research Service Line, Washington DC VA Medical Center, Washington, DC 20422, USA
| | - Sarah L Martindale
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC 28144, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Elisabeth A Wilde
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT 84148, USA
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kimbra Kenney
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Scott D McDonald
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Mental Health Service, Central Virginia VA Health Care System, Richmond, VA 23249, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Randall S Scheibel
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Mary R Newsome
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - William C Walker
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- PM&R Service, Richmond Veterans Affairs Medical Center, Richmond, VA 23249, USA
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Lopez MR, VanCott AC, Amuan ME, Panahi S, Henion A, Pugh MJ. Prescribing Trends of Antiseizure Drugs in Women Veterans With Epilepsy. Mil Med 2023; 188:e3628-e3634. [PMID: 37283266 PMCID: PMC11022647 DOI: 10.1093/milmed/usad194] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/21/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Antiseizure medications (ASMs) are frequently used for other indications, such as migraine, pain syndromes, and psychiatric disorders. Possible teratogenic effects are therefore of wide concern and the risks imposed by the medications must be weighed against the risk with the disorder treated. It is our objective to update family practitioners on the implications of starting ASM for women with epilepsy during childbearing age. We hypothesized that clinicians would prescribe ASM based on avoiding teratogenesis and treating associated comorbidities simultaneously. METHODS The study cohort was derived from women veterans with epilepsy (WVWE) prescribed ASM who received Veterans Health Administration care for at least 3 years in Veterans Health Administration between fiscal years (FY)01 and FY19. Regimens were classified as monotherapy or polytherapy. Multivariant logistic regression examined the association between demographics, military characteristics, physical/psychiatric comorbidities, neurological care, and use of each ASM. RESULTS Among 2,283 WVWE, in ages between 17 and 45, the majority (61%) received monotherapy in FY19. Commonly prescribed ASM included 29% gabapentin, 27% topiramate, 20% lamotrigine, 16% levetiracetam, and 8% valproate (VPA). Comorbid diagnosis of headache predicted use of topiramate and VPA, bipolar disease predicted use of LMT and VPA, pain predicted gabapentin, and schizophrenia was associated with VPAs use. Women receiving levetiracetam and lamotrigine were significantly more likely to receive neurology care previously. CONCLUSION The presence of medical comorbidities influences the selection of ASM. VPAs use in WVWE during childbearing age continues, despite the high teratogenic risk, especially in women with bipolar disorder and headaches. Multidisciplinary care integrating family practice doctors, mental health, and neurology can prevent the enduring problem of teratogenesis in women taking ASM.
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Affiliation(s)
- Maria Raquel Lopez
- VA Epilepsy Centers of Excellence, Miami Veterans Health Care System, Miami, FL 33125, USA
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33125, USA
| | - Anne C VanCott
- VA Pittsburgh Healthcare System, University of Pittsburgh, University Drive C, Pittsburgh, PA 15240, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15240, USA
| | - Megan E Amuan
- Department of Medicine, Texas A&M Health Science Center, Bryan, TX 78229, USA
- Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, MA 01730, USA
| | - Samin Panahi
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Amy Henion
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Mary Jo Pugh
- Division of Epidemiology, Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
- Internal Medicine, Division of Epidemiology, Research Career Scientist VA, Salt Lake City, UT 84132, USA
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Zelkowitz RL, Halverson TF, Patel TA, Beckham JC, Calhoun PS, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury methods among U.S. Veterans: Latent class analysis and associations with psychosocial outcomes. Psychiatry Res 2023; 329:115558. [PMID: 37890405 DOI: 10.1016/j.psychres.2023.115558] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a debilitating concern among U.S. veterans, with wall/object-punching commonly endorsed as an NSSI method. We examined how this behavior relates to other NSSI methods and psychosocial outcomes. We conducted a latent class analysis (LCA) of NSSI methods among 1,138 Gulf War Era veterans, (77.9% male), 21.7% of whom endorsed lifetime NSSI. We categorized classes based on their associations with age, sex, combat and military sexual assault exposure, then examined the association of class membership with psychosocial indicators. LCA results supported four classes: 1) High punching/banging NSSI (2.5%); 2) Multimethod NSSI methods (6.3%); 3) High-risk, multimethod NSSI (3.1%); and 4) Low-risk NSSI (88.1%). Psychosocial indicators (suicide attempt, ideation, possible depressive or posttraumatic stress disorders, poor psychosocial functioning) were worse for members of the NSSI classes versus those in the low-risk group. A subset of U.S. veterans may engage in NSSI primarily via punching/banging methods. All patterns of NSSI engagement were associated with negative psychosocial outcomes relative to those in the low-risk class of the behavior.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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16
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Akin FW, Swan AA, Kalvesmaki A, Hall CD, Riska KM, Stressman KD, Nguyen H, Amuan M, Pugh MJ. Factors That Impact the Long-Term Outcome of Postconcussive Dizziness Among Post-9/11 Veterans. Am J Audiol 2023; 32:706-720. [PMID: 37040302 DOI: 10.1044/2023_aja-22-00150] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
PURPOSE The primary aim of this study was to examine the factors associated with long-term outcomes of postconcussive disruptive dizziness in Veterans of the post-9/11 wars. METHOD For this observational cohort study, the Neurobehavioral Symptom Inventory-Vestibular subscale (NSI-V) score was used as an outcome measure for dizziness in 987 post-9/11 Veterans who indicated disruptive dizziness at an initial Veterans Health Administration Comprehensive Traumatic Brain Injury Evaluation (CTBIE). An NSI-V change score was calculated as the difference in the scores obtained at the initial CTBIE and on a subsequent survey. Differences in the NSI-V change scores were examined for demographics, injury characteristics, comorbidities, and vestibular and balance function variables, and multiple linear regression analyses were used to explore associations among the variables and the NSI-V change score. RESULTS The majority of Veterans (61%) demonstrated a decrease in the NSI-V score, suggesting less dizziness on the survey compared with the CTBIE; 16% showed no change; and 22% had a higher score. Significant differences in the NSI-V change score were observed for traumatic brain injury (TBI) status, diagnoses of post-traumatic stress disorder (PTSD), headache and insomnia, and vestibular function. Multivariate regressions revealed significant associations between the NSI-V change score and the initial CTBIE NSI-V score, education level, race/ethnicity, TBI status, diagnoses of PTSD or hearing loss, and vestibular function. CONCLUSIONS Postconcussive dizziness can continue for years following an injury. Factors associated with poor prognosis include TBI, diagnoses of PTSD or hearing loss, abnormal vestibular function, increased age, identification as a Black Veteran, and high school education level.
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Affiliation(s)
- Faith W Akin
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Department of Audiology & Speech-Language Pathology, East Tennessee State University, Johnson City
| | - Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio
| | - Andrea Kalvesmaki
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Courtney D Hall
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Physical Therapy Program, East Tennessee State University, Johnson City
| | - Kristal M Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Kara D Stressman
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Huong Nguyen
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Megan Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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Howard JT, Stewart IJ, Amuan ME, Janak JC, Howard KJ, Pugh MJ. Trends in Suicide Rates Among Post-9/11 US Military Veterans With and Without Traumatic Brain Injury From 2006-2020. JAMA Neurol 2023; 80:1117-1119. [PMID: 37639278 PMCID: PMC10463169 DOI: 10.1001/jamaneurol.2023.2893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/16/2023] [Indexed: 08/29/2023]
Abstract
This cohort study examines trends in suicide rates for veterans with and without traumatic brain injury compared with the US adult population.
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Affiliation(s)
- Jeffrey T. Howard
- Department of Public Health, University of Texas at San Antonio, San Antonio
| | - Ian J. Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda
| | - Megan E. Amuan
- University of Utah School of Medicine, Salt Lake City
- Department of Veterans Affairs, Salt Lake City, Utah
| | | | | | - Mary Jo Pugh
- University of Utah School of Medicine, Salt Lake City
- Department of Veterans Affairs, Salt Lake City, Utah
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18
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Walker WC, Clark SW, Eppich K, Wilde EA, Martin AM, Allen CM, Cortez MM, Pugh MJ, Walton SR, Kenney K. Headache among combat-exposed veterans and service members and its relation to mild traumatic brain injury history and other factors: a LIMBIC-CENC study. Front Neurol 2023; 14:1242871. [PMID: 37808506 PMCID: PMC10552781 DOI: 10.3389/fneur.2023.1242871] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Headache (HA) is a common persistent complaint following mild traumatic brain injury (mTBI), but the association with remote mTBI is not well established, and risk factors are understudied. Objective Determine the relationship of mTBI history and other factors with HA prevalence and impact among combat-exposed current and former service members (SMs). Design Secondary cross-sectional data analysis from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study. Methods We examined the association of lifetime mTBI history, demographic, military, medical and psychosocial factors with (1) HA prevalence ("lately, have you experienced headaches?") using logistic regression and (2) HA burden via the Headache Impact Test-6 (HIT-6) using linear regression. Each lifetime mTBI was categorized by mechanism (blast-related or not) and setting (combat deployed or not). Participants with non-credible symptom reporting were excluded, leaving N = 1,685 of whom 81% had positive mTBI histories. Results At a median 10 years since last mTBI, mTBI positive participants had higher HA prevalence (69% overall, 78% if 3 or more mTBIs) and greater HA burden (67% substantial/severe impact) than non-TBI controls (46% prevalence, 54% substantial/severe impact). In covariate-adjusted analysis, HA prevalence was higher with greater number of blast-related mTBIs (OR 1.81; 95% CI 1.48, 2.23), non-blast mTBIs while deployed (OR 1.42; 95% CI 1.14, 1.79), or non-blast mTBIs when not deployed (OR 1.23; 95% CI 1.02, 1.49). HA impact was only higher with blast-related mTBIs. Female identity, younger age, PTSD symptoms, and subjective sleep quality showed effects in both prevalence and impact models, with the largest mean HIT-6 elevation for PTSD symptoms. Additionally, combat deployment duration and depression symptoms were factors for HA prevalence, and Black race and Hispanic/Latino ethnicity were factors for HA impact. In sensitivity analyses, time since last mTBI and early HA onset were both non-significant. Conclusion The prevalence of HA symptoms among formerly combat-deployed veterans and SMs is higher with more lifetime mTBIs regardless of how remote. Blast-related mTBI raises the risk the most and is uniquely associated with elevated HA burden. Other demographic and potentially modifiable risk factors were identified that may inform clinical care.
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Affiliation(s)
- William C. Walker
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
| | - Sarah W. Clark
- Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, United States
| | - Kaleb Eppich
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Elisabeth A. Wilde
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT, United States
- Department of Neurology, Traumatic Brain Injury and Concussion Center, University of Utah, Salt Lake City, UT, United States
| | - Aaron M. Martin
- Mental Health and Behavioral Science Service, James A. Haley Veterans’ Hospital, Tampa, FL, United States
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Chelsea M. Allen
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Melissa M. Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Samuel R. Walton
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Weber DM, Halverson TF, Daruwala SE, Pugh MJ, Calhoun PS, Beckham JC, Kimbrel NA. Love Is Not All You Need: Understanding the Association Between Relationship Status and Relationship Dysfunction With Self-Directed Violence in Veterans. Arch Suicide Res 2023:1-16. [PMID: 37548583 DOI: 10.1080/13811118.2023.2237097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Research indicates that being married is associated with reduced risk of suicide and self-directed violence (SDV) relative to being divorced. Simultaneously, difficulties within relationships predict poorer health outcomes. However, research on relationship status rarely examines relationship functioning, obfuscating the joint contribution of these variables for SDV risk. METHOD Veterans (N = 1,049) completed a survey that included assessment of relationship status, relationship functioning, and SDV history. Logistic regression models tested how (a) relationship status, (b) relationship dysfunction, and (c) being divorced compared to being in a low- or high-dysfunction relationship were associated with SDV, controlling for several intrapersonal risk factors. RESULTS Veterans in a relationship did not differ in SDV history compared to divorced/separated veterans. However, more dysfunction within relationships was associated with greater odds of a history of SDV and suicidal cognitions. Finally, SDV histories were more likely among veterans endorsing high-dysfunction relationships compared with (a) low-dysfunction relationships and (b) divorced veterans. CONCLUSION It may be insufficient to only consider relationship status when evaluating interpersonal risk factors for SDV. A single item assessing relationship dysfunction was associated with enacted SDV and suicidal cognitions over and above intrapersonal risk factors. Integrating such single-item measures into clinical practice could improve identification and subsequent tailored intervention for veterans at greater risk for SDV.
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Dams-O'Connor K, Awwad HO, Hoffman S, Pugh MJ, Johnson VE, Keene CD, McGavern L, Mukherjee P, Opanashuk L, Umoh N, Sopko G, Zetterberg H. Alzheimer's Disease-Related Dementias Summit 2022: National Research Priorities for the Investigation of Post-Traumatic Brain Injury Alzheimer's Disease and Related Dementias. J Neurotrauma 2023; 40:1512-1523. [PMID: 36927167 PMCID: PMC10494902 DOI: 10.1089/neu.2022.0514] [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] [Indexed: 03/18/2023] Open
Abstract
Traumatic Brain Injury (TBI) is a risk factor for Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) and otherwise classified post-traumatic neurodegeneration (PTND). Targeted research is needed to elucidate the circumstances and mechanisms through which TBI contributes to the initiation, development, and progression of AD/ADRD pathologies including multiple etiology dementia (MED). The National Institutes of Health hosts triennial ADRD summits to inform a national research agenda, and TBI was included for a second time in 2022. A multidisciplinary expert panel of TBI and dementia researchers was convened to re-evaluate the 2019 research recommendations for understanding TBI as an AD/ADRD risk factor and to assess current progress and research gaps in understanding post-TBI AD/ADRD. Refined and new recommendations were presented during the MED special topic session at the virtual ADRD Summit in March 2022. Final research recommendations incorporating broad stakeholder input are organized into four priority areas as follows: (1) Promote interdisciplinary collaboration and data harmonization to accelerate progress of rigorous, clinically meaningful research; (2) Characterize clinical and biological phenotypes of PTND associated with varied lifetime TBI histories in diverse populations to validate multimodal biomarkers; (3) Establish and enrich infrastructure to support multimodal longitudinal studies of individuals with varied TBI exposure histories and standardized methods including common data elements (CDEs) for ante-mortem and post-mortem clinical and neuropathological characterization; and (4) Support basic and translational research to elucidate mechanistic pathways, development, progression, and clinical manifestations of post-TBI AD/ADRDs. Recommendations conceptualize TBI as a contributor to MED and emphasize the unique opportunity to study AD/ADRD following known exposure, to inform disease mechanisms and treatment targets for shared common AD/ADRD pathways.
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Affiliation(s)
- Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hibah O. Awwad
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Stuart Hoffman
- Office of Research and Development, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Mary Jo Pugh
- Department of Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Victoria E. Johnson
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Linda McGavern
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Pratik Mukherjee
- Department of Veterans Affairs, San Francisco VA Health Care System, San Francisco, CA, U.S.A., University of California, San Francisco, San Francisco, California, USA
| | - Lisa Opanashuk
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Nsini Umoh
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - George Sopko
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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21
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Swan AA, Kennedy E, Cooper DB, Amuan ME, Mayo J, Tate DF, Song K, Eapen BC, Van Cott AC, Lopez MR, Pugh MJ. Comorbidity and polypharmacy impact neurobehavioral symptoms and symptom validity failure among post-9/11 veterans with mild traumatic brain injury. Front Neurol 2023; 14:1228377. [PMID: 37538260 PMCID: PMC10395329 DOI: 10.3389/fneur.2023.1228377] [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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Objective The study aimed to examine the association between post-concussive comorbidity burdens [post-traumatic stress disorder (PTSD), depression, and/or headache] and central nervous system (CNS) polypharmacy (five or more concurrent medications) with reported neurobehavioral symptoms and symptom validity screening among post-9/11 veterans with a history of mild traumatic brain injury (mTBI). Setting Administrative medical record data from the Department of Veterans Affairs (VA) were used in the study. Participants Post-9/11 veterans with mTBI and at least 2 years of VA care between 2001 and 2019 who had completed the comprehensive traumatic brain injury evaluation (CTBIE) were included in the study. Design Retrospective cross-sectional design was used in the study. Main measures Neurobehavioral Symptom Inventory (NSI), International Classification of Diseases, Ninth Revision, and Clinical Modification diagnosis codes were included in the study. Results Of the 92,495 veterans with a history of TBI, 90% had diagnoses of at least one identified comorbidity (PTSD, depression, and/or headache) and 28% had evidence of CNS polypharmacy. Neurobehavioral symptom reporting and symptom validity failure was associated with comorbidity burden and polypharmacy after adjusting for sociodemographic characteristics. Veterans with concurrent diagnoses of PTSD, depression, and headache were more than six times more likely [Adjusted odds ratio = 6.55 (99% CI: 5.41, 7.92)]. to fail the embedded symptom validity measure (Validity-10) in the NSI. Conclusion TBI-related multimorbidity and CNS polypharmacy had the strongest association with neurobehavioral symptom distress, even after accounting for injury and sociodemographic characteristics. Given the regular use of the NSI in clinical and research settings, these findings emphasize the need for comprehensive neuropsychological evaluation for individuals who screen positively for potential symptom overreporting, the importance of multidisciplinary rehabilitation to restore functioning following mTBI, and the conscientious utilization of symptom validity measures in research efforts.
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Affiliation(s)
- Alicia A. Swan
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, United States
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Eamonn Kennedy
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
- University of Utah School of Medicine Department of Neurology, Salt Lake City, UT, United States
| | - Douglas B. Cooper
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, United States
- Departments of Rehabilitation Medicine and Psychiatry, The University of Texas Health San Antonio, San Antonio, TX, United States
| | - Megan E. Amuan
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
| | - Jamie Mayo
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
| | - David F. Tate
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- University of Utah School of Medicine Department of Neurology, Salt Lake City, UT, United States
| | - Kangwon Song
- Augusta University Medical Center, Augusta University, Augusta, GA, United States
| | - Blessen C. Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anne C. Van Cott
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Veterans Affairs, Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Maria R. Lopez
- Bruce Carter Hospital, Miami Veterans Health Administration, Miami, FL, United States
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Mary Jo Pugh
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
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Pogoda TK, Adams RS, Carlson KF, Dismuke-Greer CE, Amuan M, Pugh MJ. Risk of Adverse Outcomes Among Veterans Who Screen Positive for Traumatic Brain Injury in the Veterans Health Administration But Do Not Complete a Comprehensive Evaluation: A LIMBIC-CENC Study. J Head Trauma Rehabil 2023; Publish Ahead of Print:00001199-990000000-00092. [PMID: 37335204 PMCID: PMC10728337 DOI: 10.1097/htr.0000000000000881] [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] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To examine whether post-9/11 veterans who screened positive for mild traumatic brain injury (mTBI) but did not complete a Comprehensive TBI Evaluation (CTBIE) were at higher risk of subsequent adverse events compared with veterans who screened positive and completed a CTBIE. Upon CTBIE completion, information assessed by a trained TBI clinician indicates whether there is mTBI history (mTBI+) or not (mTBI-). SETTING Veterans Health Administration (VHA) outpatient services. PARTICIPANTS A total of 52 700 post-9/11 veterans who screened positive for TBI were included. The follow-up review period was between fiscal years 2008 and 2019. The 3 groups studied based on CTBIE completion and mTBI status were: (1) mTBI+ (48.6%), (2) mTBI- (17.8%), and (3) no CTBIE (33.7%). DESIGN This was a retrospective cohort study. Log binomial and Poisson regression models adjusting for demographic, military, pre-TBI screening health, and VHA covariates examined risk ratios of incident outcomes based on CTBIE completion and mTBI status. MAIN MEASURES Incident substance use disorders (SUDs), alcohol use disorder (AUD), opioid use disorder (OUD), overdose, and homelessness documented in VHA administrative records, and mortality as documented in the National Death Index, 3 years post-TBI screen. VHA outpatient utilization was also examined. RESULTS Compared with the no CTBIE group, the mTBI+ group had 1.28 to 1.31 times the risk of incident SUD, AUD, and overdose, but 0.73 times the risk of death 3 years following TBI screening. The mTBI- group had 0.70 times the risk of OUD compared with the no CTBIE group within the same period. The no CTBIE group also had the lowest VHA utilization. CONCLUSIONS There were mixed findings on risk of adverse events for the no CTBIE group relative to the mTBI+ and mTBI- groups. Future research is needed to explore the observed differences, including health conditions and healthcare utilization, documented outside VHA among veterans who screen positive for TBI.
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Affiliation(s)
- Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Dr Pogoda); Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts (Drs Pogoda and Adams); VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado (Dr Adams); Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, and Epidemiology, Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland (Dr Carlson); Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California (Dr Dismuke-Greer); Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah (Ms Amuan and Dr Pugh); and Department of Internal Medicine, Division of Epidemiology, University of Utah Spence Fox Eccles School of Medicine, Salt Lake City (Dr Pugh)
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23
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Panahi S, Kennedy E, Roghani A, VegaYon G, VanCott A, Gugger JJ, Raquel Lopez M, Jo Pugh M. Veteran perspectives of epilepsy care: Impact of Veteran satisfaction, knowledge, and proactivity. Epilepsy Behav 2023; 144:109218. [PMID: 37263107 DOI: 10.1016/j.yebeh.2023.109218] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Veterans are at elevated risk of epilepsy due to higher rates of traumatic brain injury (TBI). However, little work has examined the extent to which quality of care is associated with key outcomes for Veterans with epilepsy (VWE). This study aimed to examine the impact of quality of care on three outcomes: patients' knowledge of epilepsy self-care, proactive epilepsy self-management, and satisfaction with care. METHOD We conducted a cross-sectional study of Post-9/11 Veterans with validated active epilepsy who received VA care (n = 441). Veterans were surveyed on care processes using American Academy of Neurology epilepsy quality measures, and a patient-generated measure related to the use of emergency care. Outcome measures included epilepsy self-care knowledge, proactive epilepsy self-management, and satisfaction with epilepsy care. Covariates included sociodemographic and health status variables and a measure of patient-provider communication. An ordinary least-squares (OLS) regression model was used to determine if the quality of care was associated with the outcomes adjusting for multiple comparisons. RESULTS Self-reported measures of quality of care were broadly associated with satisfaction with care and epilepsy knowledge. OLS modeling indicated that healthcare provider guidance on when to seek emergency care was significantly associated with higher Veteran satisfaction with care (p < 0.01). Veterans who were asked about seizure frequency at every visit by their provider also reported higher satisfaction with care (p < 0.01) and increased epilepsy knowledge (p < 0.01). Veteran-provider communication was positively associated with epilepsy knowledge and proactive epilepsy self-management. Veterans with epilepsy with drug resistance epilepsy were significantly less satisfied with their care and reported lower proactivity compared to epilepsy controlled with medications. Further analysis indicated Black VWEs reported lower scores on epilepsy self-care knowledge compared to Whites (p < 0.001). CONCLUSIONS This study found that quality measures were associated with satisfaction and epilepsy knowledge but not associated with proactive self-management in multivariable models. The finding that better communication between providers and Veterans suggests that in addition to technical quality, interpersonal quality is important for patient outcomes. The secondary analysis identified racial disparities in epilepsy knowledge. This work offers opportunities to improve the quality of epilepsy care through the practice of patient-centered care models that reflect Veteran priorities and perceptions.
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Affiliation(s)
- Samin Panahi
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States; University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, United States
| | - Eamonn Kennedy
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States; University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, United States
| | - Ali Roghani
- University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, United States
| | - George VegaYon
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States; University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, United States
| | - Anne VanCott
- University of Pittsburgh School of Medicine, Department of Neurology, Pittsburgh, PA, United States; VA Pittsburgh Health Care System, Pittsburgh, PA, United States
| | - James J Gugger
- The University of Pennsylvania School of Medicine, Department of Neurology, Philadelphia, PA, United States
| | - Maria Raquel Lopez
- The University of Miami Miller School of Medicine, Department of Neurology, Miami, Florida, United States
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States; University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, United States.
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Halverson TF, Calhoun PS, Elbogen EB, Andover MS, Beckham JC, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury among veterans is associated with psychosocial impairment, suicidal thoughts and behaviors, and underutilization of mental health services. Death Stud 2023; 48:238-249. [PMID: 37235533 PMCID: PMC10676439 DOI: 10.1080/07481187.2023.2216169] [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] [Indexed: 05/28/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a robust predictor of suicide attempts. However, understanding of NSSI and associated treatment utilization among Veterans is limited. Although impairment may be assumed, few studies examine the association between NSSI and psychosocial functioning, a core component of the rehabilitation framework of mental health. In a national survey of Veterans, current NSSI (n = 88) was associated with higher rates of suicidal thoughts and behaviors and more severe psychosocial impairment after adjusting for demographics and probable diagnoses of posttraumatic stress disorder, major depressive disorder, and alcohol use disorder, compared to Veterans without NSSI (n = 979). Only half of Veterans with NSSI were engaged with mental health services, with few appointments attended, suggesting that these Veterans are not receiving treatment interventions. Results underscore the adverse outcomes associated with NSSI. Underutilization of mental health services highlights the importance of screening for NSSI among Veterans to improve psychosocial outcomes.
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Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Eric B Elbogen
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA National Center on Homelessness Among Veterans, Tampa, Florida, USA
| | | | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
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25
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Kennedy E, Dennis EL, Lindsey HM, deRoon-Cassini T, Du Plessis S, Fani N, Kaufman ML, Koen N, Larson CL, Laskowitz S, Lebois LAM, Morey RA, Newsome MR, Palermo C, Pastorek NJ, Powers A, Scheibel R, Seedat S, Seligowski A, Stein DJ, Stevens J, Sun D, Thompson P, Troyanskaya M, van Rooij SJH, Watts AA, Tomas CW, Williams W, Hillary FG, Pugh MJ, Wilde EA, Tate DF. Harmonizing PTSD severity scales across instruments and sites. Neuropsychology 2023; 37:398-408. [PMID: 35797175 PMCID: PMC9948684 DOI: 10.1037/neu0000823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The variety of instruments used to assess posttraumatic stress disorder (PTSD) allows for flexibility, but also creates challenges for data synthesis. The objective of this work was to use a multisite mega analysis to derive quantitative recommendations for equating scores across measures of PTSD severity. METHOD Empirical Bayes harmonization and linear models were used to describe and mitigate site and covariate effects. Quadratic models for converting scores across PTSD assessments were constructed using bootstrapping and tested on hold out data. RESULTS We aggregated 17 data sources and compiled an n = 5,634 sample of individuals who were assessed for PTSD symptoms. We confirmed our hypothesis that harmonization and covariate adjustments would significantly improve inference of scores across instruments. Harmonization significantly reduced cross-dataset variance (28%, p < .001), and models for converting scores across instruments were well fit (median R² = 0.985) with an average root mean squared error of 1.46 on sum scores. CONCLUSIONS These methods allow PTSD symptom severity to be placed on multiple scales and offers interesting empirical perspectives on the role of harmonization in the behavioral sciences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Eamonn Kennedy
- Department of Neurology, University of Utah School of Medicine
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine
| | | | - Terri deRoon-Cassini
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin
| | | | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town
| | | | | | | | | | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine
| | - Cori Palermo
- Department of Psychiatry, Harvard Medical School
| | - Nicholas J Pastorek
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Randall Scheibel
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine
| | - Soraya Seedat
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University
| | | | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town
| | - Jennifer Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Delin Sun
- Brain Imaging and Analysis Center, Duke University
| | - Paul Thompson
- Imaging Genetics Center, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC
| | - Maya Troyanskaya
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | | | | | | | - Mary Jo Pugh
- Department of Neurology, University of Utah School of Medicine
| | | | - David F Tate
- Department of Neurology, University of Utah School of Medicine
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Roghani A, Bouldin E, Mobasher H, Kalvesmaki A, Panahi S, Henion A, VanCott A, Raquel Lopez M, Jo Pugh M. COVID-19 pandemic experiences among people with epilepsy: Effect on symptoms of co-occurring health conditions and fear of seizure. Epilepsy Behav 2023; 144:109206. [PMID: 37236022 DOI: 10.1016/j.yebeh.2023.109206] [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: 01/13/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Coronavirus disease 2019 (COVID-19) pandemic profoundly affected people worldwide, but little is known about how it impacted people with epilepsy (PWE). We examined the associations between COVID-19 stressors and health outcomes including increases in other health symptoms and fear of seizure among PWE. METHODS This cross-sectional study used data from an online survey that asked about demographic characteristics, health conditions, and potential life stressors during COVID-19. Data were collected from October 30 to December 8, 2020. COVID-19 stressors were anger, anxiety, stress, healthcare access, fear of seeking healthcare, social isolation, sense of control over their lives, and alcohol consumption. A binary variable was created for each of these measures to indicate whether PWEs experienced a negative change versus a neutral or positive change. We used multivariable logistic regression to assess the associations of COVID-19 stressors with primary outcomes: exacerbated co-occurring health conditions and increasing fear of seizure during the pandemic. RESULTS Of the 260 PWE included in the study, 165 (63.5%) were women; the average age was 38.7 years. During the survey administration period, 79 (30.3%) of the respondents reported exacerbated co-occurring health conditions, and 94 (36.2%) reported an increased fear of seizures. Regression results indicated that the fear of seeking healthcare during COVID-19 was associated with both exacerbated co-occurring health conditions (aOR 1.12; 95%CI 1.01-1.26) and increasing fear of seizure (aOR 2.31; 95%CI 1.14-4.68). Social isolation was associated with exacerbated co-occurring health conditions during COVID-19 (aOR 1.14; 95%CI 1.01-1.29). Reduced access to physical healthcare was associated with increasing fear of seizure (aOR 2.58; 95%CI 1.15-5.78). CONCLUSION A considerable number of PWE experienced more symptoms of existing health conditions and fear of seizure during the initial year of the pandemic (2020). Fear of seeking healthcare services was associated with both negative outcomes. Assuring access to health care and reducing social isolation could potentially reduce negative outcomes for PWE. It is necessary to provide adequate support for PWE to reduce risks as COVID-19 continues to be a health concern.
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Affiliation(s)
- Ali Roghani
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin Bouldin
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Helal Mobasher
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrea Kalvesmaki
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Samin Panahi
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Amy Henion
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anne VanCott
- VA Pittsburgh Health Care System, Pittsburgh, PA, USA; Department of Neurology, Epilepsy Division University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Raquel Lopez
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary Jo Pugh
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA; VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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27
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Viny M, Trevino AY, Bouldin ED, Kalvesmaki A, Roghani A, Pugh MJ. Caregiver burden and COVID-19: How epilepsy caregivers experienced the pandemic. Epilepsy Behav 2023; 141:109151. [PMID: 36907084 PMCID: PMC9968611 DOI: 10.1016/j.yebeh.2023.109151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/14/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Caregivers of adults with epilepsy face unique challenges, yet most studies focus on the impact of epilepsy on those living with the condition, rather than the impact on caregivers. Our objective was to evaluate whether caregivers' pandemic-related changes and experiences - namely those related to their health, healthcare access, and well-being - were associated with their caregiving burden. METHODS Caregivers of adults with epilepsy (n = 261) were recruited through Qualtrics Panels to participate in an online survey examining health, well-being, COVID-19 experiences, and caregiver burden from October-December, 2020. The burden was measured using the Zarit 12-item measure; the clinically significant burden was defined as a score greater than 16. Adjustments were made to account for burden scores related to exposures of interest. Chi-square tests, t-tests, and generalized linear regression models were used to compare cross-sectional associations between COVID-19 experiences and burden. RESULTS Over half (57.9%) of caregivers had clinically significant caregiver burden. Most reported increased anxiety (65%), stress (64%), and sense of social isolation (58%) during the pandemic. Many caregivers reported that their sense of control over their life (44%) and their use of healthcare changed (88%) due to COVID-19. In adjusted models, caregivers who reported increased anger, increased anxiety, decreased sense of control, or changes in healthcare utilization during COVID-19 had about twice the odds of having clinically significant caregiver burden compared to caregivers who did not report changes. DISCUSSION Changes experienced by caregivers of adults with epilepsy during the pandemic were strongly associated with clinically significant levels of caregiver burden. These findings demonstrate the link between mass-level events, such as a pandemic, the burden caregivers of adults with epilepsy may carry, and subsequent psychological outcomes. CONCLUSION Caregivers of adults with epilepsy may need support to reduce the negative impact of COVID-19-related experiences and should be connected to healthcare and resources that can help alleviate their burden.
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Affiliation(s)
- Mikayla Viny
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Amira Y Trevino
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Department of Educational Psychology, University of Utah College of Education, Salt Lake City, UT, United States.
| | - Erin D Bouldin
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Andrea Kalvesmaki
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States.
| | - Ali Roghani
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States; Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, United States.
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Brenner RJ, Hansen J, Brintz BJ, Bouldin ED, Pugh MJ, Rupper R, Munoz R, Garcia-Davis S, Dang S. Association between specific unmet functional needs and desire to institutionalize among caregivers of older veterans. J Am Geriatr Soc 2023. [PMID: 36815450 DOI: 10.1111/jgs.18307] [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: 08/04/2022] [Revised: 12/23/2022] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To evaluate the associations between specific functional needs of older Veterans and the desire to institutionalize (DTI) among their caregivers. METHODS Cross-sectional multivariable logistic regression analysis of 3579 Hero Care survey responses from caregivers of Veterans at five US sites from July to December 2021. Unmet needs were areas in which the caregiver reported the Veteran needed a little more or a lot more help. Caregiver DTI was defined as the caregiver reporting that they had discussed, considered, or taken steps toward a nursing home or assisted living placement for the Veteran or that they felt the Veteran would be better off in such a setting or they were likely to move the Veteran to another living arrangement. RESULTS Caregivers were largely white, retired, females with an average age of 71 and with some college education who spent an average of 8-9 h per day 6 days a week caring for a Veteran spouse. There was evidence of associations between the following needs and a DTI: managing incontinence, using the telephone, transportation, and arranging services in the home such as visiting nurses, home care aides, or meals on wheels. Unmet functional needs in other selected domains were not associated with the DTI. CONCLUSION Among caregivers of older Veterans, a need for more assistance managing incontinence, telephone use, transportation, and arranging in-home services were associated with the DTI. These may represent functional markers of important clinical determinants for institutionalization as well as potential targets for intervention to reduce caregiver DTI, such as programs that provide more caregiver or Veteran support in the home to meet these needs and reduce caregiver burden.
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Affiliation(s)
- Rachel J Brenner
- Salt Lake City VA Geriatric Research Education and Clinical Center, Division of Geriatrics, University of Utah, Salt Lake City, Utah, USA
| | - Jared Hansen
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Ben J Brintz
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Erin D Bouldin
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Mary Jo Pugh
- Salt Lake City VA IDEAS Center, Division of Epidemiology, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Randall Rupper
- Division of Geriatrics, Salt Lake City VA Geriatric Research Education and Clinical Center, University of Utah, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Salt Lake City, Utah, USA
| | - Richard Munoz
- Department of Health Policy & Management, Florida International University, Robert Stempel College of Public Health & Social Work, Miami, Florida, USA
| | - Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stuti Dang
- Miami VA Geriatric Research Education and Clinical Center, University of Miami Miller School of Medicine, Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Miami, Florida, USA
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Walker WC, O'Neil ME, Ou Z, Pogoda TK, Belanger HG, Scheibel RS, Presson AP, Miles SR, Wilde EA, Tate DF, Troyanskaya M, Pugh MJ, Jak A, Cifu DX. Can mild traumatic brain injury alter cognition chronically? A LIMBIC-CENC multicenter study. Neuropsychology 2023; 37:1-19. [PMID: 36174184 PMCID: PMC10117581 DOI: 10.1037/neu0000855] [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] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE While outcome from mild traumatic brain injury (mTBI) is generally favorable, concern remains over potential negative long-term effects, including impaired cognition. This study examined the link between cognitive performance and remote mTBIs within the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) multicenter, observational study of Veterans and service members (SMs) with combat exposure. METHOD Baseline data of the participants passing all cognitive performance validity tests (n = 1,310) were used to conduct a cross-sectional analysis. Using multivariable regression models that adjusted for covariates, including age and estimated preexposure intellectual function, positive mTBI history groups, 1-2 lifetime mTBIs (nonrepetitive, n = 614), and 3 + lifetime mTBIs (repetitive; n = 440) were compared to TBI negative controls (n = 256) on each of the seven cognitive domains computed by averaging Z scores of prespecified component tests. Significance levels were adjusted for multiple comparisons. RESULTS Neither of the mTBI positive groups differed from the mTBI negative control group on any of the cognitive domains in multivariable analyses. Findings were also consistently negative across sensitivity analyses (e.g., mTBIs as a continuous variable, number of blast-related mTBIs, or years since the first and last mTBI). CONCLUSIONS Our findings demonstrate that the average veteran or SM who experienced one or more mTBIs does not have postacute objective cognitive deficits due to mTBIs alone. A holistic health care approach including comorbidity assessment is indicated for patients reporting chronic cognitive difficulties after mTBI(s), and strategies for addressing misattribution may be beneficial. Future study is recommended with longitudinal designs to assess within-subjects decline from potential neurodegeneration. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Terri K Pogoda
- Center for Healthcare Organization and Implementation Research
| | | | | | | | | | | | - David F Tate
- Department of Physical Medicine and Rehabilitation
| | | | - Mary Jo Pugh
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System
| | - Amy Jak
- VA San Diego Healthcare System
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation
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30
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Kumar RG, Klyce D, Nakase-Richardson R, Pugh MJ, Walker WC, Dams-O'Connor K. Associations of Military Service History and Health Outcomes in the First Five Years after Traumatic Brain Injury. J Neurotrauma 2022. [PMID: 36401499 DOI: 10.1089/neu.2022.0340] [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] [Indexed: 11/21/2022] Open
Abstract
For many years, experts have recognized the importance of studying traumatic brain injury (TBI) among active-duty service members and veterans. A majority of this research has been conducted in Veterans Administration (VA) or Department of Defense settings. However, far less is known about military personnel who seek their medical care outside these settings. Studies that have been conducted in civilian settings have either not enrolled active duty or veteran participants, or failed to measure military history, precluding study of TBI outcomes by military history. The purpose of the present study was to determine associations between military history and medical (prevalence of 25 comorbid health conditions), cognition (Brief Test of Adult Cognition by Telephone), and psychological health (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7, suicidality [9th item from PHQ-9]) in the first 5 years after TBI. In this prospective study, we analyzed data from the TBI Model Systems National Database. Participants were 7797 individuals with TBI admitted to one of 21 civilian inpatient rehabilitation facilities from April 1, 2010, to November 19, 2020, and followed up to 5 years. We assessed the relationship between military history (any versus none, combat exposure, service era, and service duration) and TBI outcomes. We found specific medical conditions were significantly more prevalent 1 year post-TBI among individuals who had a history of combat deployment (lung disorders, post-traumatic stress disorder [PTSD], and sleep disorder), served in post-draft era (chronic pain, liver disease, arthritis), and served >4 years (high cholesterol, PTSD, sleep disorder). Individuals with military history without combat deployment had modestly more favorable cognition and psychological health in the first 5 years post-injury relative to those without military history. Our data suggest that individuals with TBI with military history are heterogeneous, with some favorable and other deleterious health outcomes, relative to their non-military counterparts, which may be driven by characteristics of service, including combat exposure and era of service.
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Affiliation(s)
- Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Klyce
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University (VCU), Richmond, Virginia, USA.,Mental Health Service, Central Virginia VA Health Care System, Richmond, Virginia, USA.,Sheltering Arms Institute, Richmond, Virginia, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavior Sciences, Defense Health Agency TBI Center of Excellence, James A. Haley Veterans Hospital, Tampa, Florida, USA.,Pulmonary/Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - William C Walker
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University (VCU), Richmond, Virginia, USA.,Sheltering Arms Institute, Richmond, Virginia, USA.,PM&R Service, Richmond Veterans Affairs Medical Center, Central Virginia Veterans Affairs Health Care System, Richmond, Virginia, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Bouldin E, Brintz B, Hansen J, Rupper R, Brenner R, Intrator O, Kinosian B, Pugh MJ. GERIATRIC AND EXTENDED CARE TRAJECTORIES AND TRANSITIONS AMONG VETERANS WITH LONG-TERM CARE NEEDS. Innov Aging 2022. [PMCID: PMC9766125 DOI: 10.1093/geroni/igac059.174] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We aimed to identify clusters of geriatric and extended care services used by Veterans, describe transitions between clusters, and identify factors influencing transition. We explored services across the continuum of care from clinic to home-based and institutional care services. Analyses include 104,837 Veterans Health Administration (VHA) patients 65 years and older, and used VHA and Centers for Medicare & Medicaid Services (CMS) data from FY15-FY17. Using latent class and latent transition analyses, we identified 5 latent classes: 1) No Services, 2) CMS Services, 3) Home-Centered Interdisciplinary Care, 4) Personal Care Services, and 5) VHA-CMS Care Continuum. Veterans most commonly transitioned from the CMS Care Continuum class to No Services. Veterans also frequently transitioned into the VHA-CMS Care Continuum class over time. Identifying service patterns can inform service delivery, program development, and future resource allocation to better meet aging Veterans’ needs.
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Affiliation(s)
- Erin Bouldin
- University of Utah, Salt Lake City, Utah, United States
| | - Benjamin Brintz
- VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
| | - Jared Hansen
- VA Salt Lake City, Salt Lake City, Utah, United States
| | | | | | - Orna Intrator
- Canandaigua VA Medical Center, Canandaigua, New York, United States
| | - Bruce Kinosian
- University of pennsylvania, Philadelphia, Pennsylvania, United States
| | - Mary Jo Pugh
- University of Utah, Salt Lake City, Utah, United States
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Pogoda T, Amuan M, Carlson K, Adams R, Dismuke-Greer C, Pugh MJ. Adverse Outcomes among Veterans who Screen Positive for TBI/do not Complete a TBI Evaluation. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Kalvesmaki AF, Gonzales E, George RT, Nguyen H, Pugh MJ. Post-9/11 veterans perceptions of the pandemic: Areas of greatest impact on health and well-being. PEC Innovation 2022; 1:100096. [PMID: 36348640 PMCID: PMC9635259 DOI: 10.1016/j.pecinn.2022.100096] [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: 04/11/2022] [Revised: 10/10/2022] [Accepted: 11/03/2022] [Indexed: 11/08/2022]
Abstract
Objective Assess potential impacts of the COVID-19 pandemic on a subset of Post-9/11 U.S. Veterans included in a study of post-traumatic epilepsy (PTE). Methods Two measures were added to a structured health interview for Veterans during temporary pandemic research shutdown: a validated health questionnaire [1] previously completed by survey, and a semi-structured instrument developed to assess whether pandemic conditions affected responses to the health questionnaire and identify unique impacts. Interviews were conducted between August 2020 – February 2021. Scaled items were calculated and t-tests used to compare results. Open-ended items were coded using thematic analyses. Results Veterans identified eight major areas of impact with negative and positive impacts: mental health, family, social, work/employment, access to resources, physical health, finances, and education. Innovation The temporary shut-down of a large health study for Post-9/11 Veterans provided an opportunity to devise an instrument to assess COVID-19's impact on health and well-being. The instrument was accepted as of the first Veteran instrument in a pandemic SDOH research repository [2], and is being used in other studies. Conclusion This study highlights the need to assess and understand interrelated relationships of factors impacting health and well-being, especially as COVID-19 moves from pandemic to endemic with reverberating effects across multiple social determinants of health (SDOH).
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Kelton K, Young JR, Evans MK, Eshera YM, Blakey SM, Mann AJD, Pugh MJ, Calhoun PS, Beckham JC, Kimbrel NA. Complementary/integrative healthcare utilization in US Gulf-War era veterans: Descriptive analyses based on deployment history, combat exposure, and Gulf War Illness. Complement Ther Clin Pract 2022; 49:101644. [PMID: 35947938 PMCID: PMC9669216 DOI: 10.1016/j.ctcp.2022.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/30/2022] [Revised: 06/20/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
Complementary and integrative health (CIH) approaches have gained empirical support and are increasingly being utilized among veterans to treat a myriad of conditions. A cluster of medically unexplained chronic symptoms including fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems, often referred to as Gulf War Illness (GWI) prominently affect US Gulf War era (GWE) veterans, yet little is known about CIH use within this population. Using data collected as part of a larger study (n = 1153), we examined the influence of demographic characteristics, military experiences, and symptom severity on CIH utilization, and utilization differences between GWE veterans with and without GWI. Over half of the sample (58.5%) used at least one CIH modality in the past six months. Women veterans, white veterans, and veterans with higher levels of education were more likely to use CIH. GWE veterans with a GWI diagnosis and higher GWI symptom severity were more likely to use at least one CIH treatment in the past six months. Over three quarters (82.7%) of veterans who endorsed using CIH to treat GWI symptoms reported that it was helpful for their symptoms. Almost three quarters (71.5%) of veterans indicated that they would use at least one CIH approach if it was available at VA. Results provide a deeper understanding of the likelihood and characteristics of veterans utilizing CIH to treat health and GWI symptoms and may inform expansion of CIH modalities for GWE veterans, particularly those with GWI.
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Affiliation(s)
- Katherine Kelton
- South Texas Veteran Health Care System, Audie L. Murphy Veteran Hospital San Antonio, TX, USA; National Center for Homelessness Among Veterans, USA.
| | - Jonathan R Young
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Mariah K Evans
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Yasmine M Eshera
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Shannon M Blakey
- Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System and IDEAS Center of Innovation, Salt Lake City UT, USA; University of Utah School of Medicine, Department of Medicine, Salt Lake City UT, USA
| | - Patrick S Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
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Elbogen EB, Amuan M, Kennedy E, Blakey SM, Graziano RC, Hooshyar D, Tsai J, Nelson RE, Vanneman ME, Jones AL, Pugh MJ. Criminal legal involvement among recently separated veterans: Findings from the LIMBIC study. Law Hum Behav 2022; 46:385-394. [PMID: 36227321 DOI: 10.1037/lhb0000497] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study investigated individual-level and neighborhood-level predictors of criminal legal involvement of veterans during the critical transition period from military to civilian life. HYPOTHESES We hypothesized that substance use, mental health, and personality disorders will increase the incidence of criminal legal involvement, which will be highest among veterans living in socioeconomically disadvantaged neighborhoods after military discharge. METHOD We analyzed data from a longitudinal cohort study of 418,624 veterans who entered Department of Veterans Affairs (VA) health care after leaving the military. Department of Defense (DoD) data on clinical diagnoses, demographics, and military history were linked to VA data on neighborhood of residence and criminal legal involvement. RESULTS Criminal legal involvement in the 2 years following military discharge was most strongly predicted by younger age, substance use disorder, and being male. Other predictors included the military branch in which veterans served, deployment history, traumatic brain injury, serious mental illness, personality disorder, having fewer physical health conditions, and living in socioeconomically disadvantaged neighborhoods. These factors combined in multivariable analysis yielded a very large effect size for predicting criminal legal involvement after military separation (area under the curve = .82). The incidence of criminal legal involvement was 10 times higher among veterans with co-occurring substance use disorder, serious mental illness, and personality disorder than among veterans with none of these diagnoses, and these rates were highest among veterans residing in more socioeconomically disadvantaged neighborhoods. CONCLUSIONS To our knowledge, this is the largest longitudinal study of risk factors for criminal legal involvement in veterans following military discharge. The findings supported the hypothesis that veterans with co-occurring mental disorders living in socioeconomically disadvantaged neighborhoods were at higher risk of criminal legal involvement, underscoring the complex interplay of individual-level and neighborhood-level risk factors for criminal legal involvement after veterans leave the military. These results can inform policy and programs, such as the DoD Transition Assistance Program (TAP) and the VA Military to Civilian Readiness Pathway program (M2C Ready), to enhance community reintegration and prevent criminal legal involvement among veterans transitioning from military to civilian life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Eric B Elbogen
- Veterans Administration, National Center on Homelessness Among Veterans
| | - Megan Amuan
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation
| | - Eamonn Kennedy
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation
| | - Shannon M Blakey
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | | | - Dina Hooshyar
- Veterans Administration, National Center on Homelessness Among Veterans
| | - Jack Tsai
- Veterans Administration, National Center on Homelessness Among Veterans
| | - Richard E Nelson
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation
| | - Megan E Vanneman
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation
| | - Audrey L Jones
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center of Innovation
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Mayo J, Panahi S, Roghani A, Van Cott AC, Pugh MJ. Treatment of Epilepsy in the Setting of Cognitive Decline in Older Adults. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stewart IJ, Amuan ME, Wang CP, Kennedy E, Kenney K, Werner JK, Carlson KF, Tate DF, Pogoda TK, Dismuke-Greer CE, Wright WS, Wilde EA, Pugh MJ. Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9/11-Era Veterans. JAMA Neurol 2022; 79:1122-1129. [PMID: 36066882 PMCID: PMC9449870 DOI: 10.1001/jamaneurol.2022.2682] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Question What is the association of a traumatic brain injury (TBI) with the subsequent risk of cardiovascular disease in veterans of the recent conflicts in Iraq and Afghanistan? Findings In this cohort study of 1 559 928 participants, TBI was associated with the development of a composite end point for cardiovascular disease (coronary artery disease, stroke, and peripheral artery disease). TBI was also associated with the individual components of this composite end point. Meaning Traumatic brain injury is a potentially novel risk factor for cardiovascular disease in veterans. Importance Traumatic brain injury (TBI) was common among US service members deployed to Iraq and Afghanistan. Although there is some evidence to suggest that TBI increases the risk of cardiovascular disease (CVD), prior reports were predominantly limited to cerebrovascular outcomes. The potential association of TBI with CVD has not been comprehensively examined in post-9/11–era veterans. Objective To determine the association between TBI and subsequent CVD in post-9/11–era veterans. Design, Setting, and Participants This was a retrospective cohort study conducted from October 1, 1999, to September 30, 2016. Participants were followed up until December 31, 2018. Included in the study were administrative data from the US Department of Veterans Affairs and the Department of Defense from the Long-term Impact of Military-Relevant Brain Injury Consortium–Chronic Effects of Neurotrauma Consortium. Participants were excluded if dates did not overlap with the study period. Data analysis was conducted between November 22, 2021, and June 28, 2022. Exposures History of TBI as measured by diagnosis in health care records. Main Outcomes and Measures Composite end point of CVD: coronary artery disease, stroke, peripheral artery disease, and cardiovascular death. Results Of the 2 530 875 veterans from the consortium, after exclusions, a total of 1 559 928 veterans were included in the analysis. A total of 301 169 veterans (19.3%; median [IQR] age, 27 [23-34] years; 265 217 male participants [88.1]) with a TBI history and 1 258 759 veterans (80.7%; median [IQR] age, 29 [24-39] years; 1 012 159 male participants [80.4%]) without a TBI history were included for analysis. Participants were predominately young (1 058 054 [67.8%] <35 years at index date) and male (1 277 376 [81.9%]). Compared with participants without a history of TBI, diagnoses of mild TBI (hazard ratio [HR], 1.62; 95% CI, 1.58-1.66; P < .001), moderate to severe TBI (HR, 2.63; 95% CI, 2.51-2.76; P < .001), and penetrating TBI (HR, 4.60; 95% CI, 4.26-4.96; P < .001) were associated with CVD in adjusted models. In analyses of secondary outcomes, all severities of TBI were associated with the individual components of the composite outcome except penetrating TBI and CVD death. Conclusions and Relevance Results of this cohort study suggest that US veterans with a TBI history were more likely to develop CVD compared with veterans without a TBI history. Given the relatively young age of the cohort, these results suggest that there may be an increased burden of CVD as these veterans age and develop other CVD risk factors. Future studies are needed to determine if the increased risk associated with TBI is modifiable.
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Affiliation(s)
- Ian J Stewart
- Department of Medicine, Uniformed Services University, Bethesda, Maryland.,Military Cardiovascular Outcomes Research Program, Bethesda, Maryland
| | - Megan E Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Chen-Pin Wang
- University of Texas Health San Antonio, Department of Population Health Sciences, San Antonio
| | - Eamonn Kennedy
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Neurology, Uniformed Services University, Bethesda, Maryland
| | - J Kent Werner
- Department of Neurology, Uniformed Services University, Bethesda, Maryland
| | - Kathleen F Carlson
- VA Portland Health Care System and Oregon Health and Science University, School of Public Health, Portland
| | - David F Tate
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Terri K Pogoda
- VA Boston Healthcare System, Boston University School of Public Health, Boston, Massachusetts
| | - Clara E Dismuke-Greer
- VA Palo Alto Healthcare System, Health Economics Resource Center, Palo Alto, California
| | - W Shea Wright
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Elisabeth A Wilde
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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Halverson TF, Mann AJD, Zelkowitz RL, Patel TA, Evans MK, Aho N, Beckham JC, Calhoun PS, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury in veterans: Prevalence, clinical characteristics, and gender differences from a national cohort. Psychiatry Res 2022; 315:114708. [PMID: 35868073 PMCID: PMC9378466 DOI: 10.1016/j.psychres.2022.114708] [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: 04/20/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a robust predictor of suicidal thoughts and behaviors; however, while there are typically only small differences observed in the prevalence of NSSI between men and women, this condition has been largely overlooked and underestimated among men. Assessing NSSI methods more common in men may address misidentification as well as allow for more precise NSSI prevalence estimates. Survey data from a national sample of Gulf War I-Era veterans (N = 1063) was used to estimate the prevalence of NSSI and compare prevalence of NSSI methods between men and women veterans. Demographic and clinical correlates of NSSI engagement were also examined. The national lifetime prevalence rate of NSSI among Gulf War I-Era veterans was 22.40%, whereas the past year prevalence rate was 8.10%. In both men and women, wall/object punching was the most common NSSI method endorsed across the lifetime. Men had slightly higher overall NSSI prevalence rates compared with women. This study highlights the need to systematically assess NSSI, particularly among veterans, to better identify, and consequently treat, NSSI in men. This is the first available prevalence estimate of NSSI to include the assessment of wall/object punching in a national sample of adult veterans.
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Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston School of Medicine, Boston, MA, USA
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mariah K Evans
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Natalie Aho
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; School of Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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McGeary DD, Jaramillo C, Eapen B, Blount TH, Nabity PS, Moreno J, Pugh MJ, Houle TT, Potter JS, Young-McCaughan S, Peterson AL, Villarreal R, Brackins N, Sikorski Z, Johnson TR, Tapia R, Reed D, Caya CA, Bomer D, Simmonds M, McGeary CA. Mindfulness-Based Interdisciplinary Pain Management Program for Complex Polymorbid Pain in Veterans: A Randomized Clinical Trial. Arch Phys Med Rehabil 2022; 103:1899-1907. [DOI: 10.1016/j.apmr.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
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Rivera JC, Amuan ME, Pugh MJ. Musculoskeletal Conditions and Secondary Cardiovascular Morbidity Increase Veterans’ Rehabilitation and Orthopaedic Service Utilization. Cureus 2022; 14:e27139. [PMID: 36017301 PMCID: PMC9392965 DOI: 10.7759/cureus.27139] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Musculoskeletal conditions often affect patients’ mobility and ability to participate in health behaviors such as exercise, potentially affecting their systemic health. The purpose of this research is to determine how frequently cardiac-related comorbidities present in a veteran population with musculoskeletal service-connected disability and how this affects musculoskeletal health care utilization. Methodology A retrospective cohort of Iraq and Afghanistan Veterans who received a Veterans Affairs (VA) disability determination for service-connected musculoskeletal disability were categorized according to the diagnosis of cardiac comorbidity including diabetes mellitus, hyperlipidemia, hypertension, and obesity, and atherosclerosis disease documented by ICD-9 codes in the VA administrative data. Among veterans with musculoskeletal service-connected disability, logistic regression was modeled to determine if musculoskeletal clinic utilization was associated with also having a cardiac comorbid condition. Results Veterans with musculoskeletal disability had a comorbid cardiac disorder 43% of the time. Post-traumatic arthritis was the only musculoskeletal condition positively associated with comorbid cardiac conditions. Veterans with comorbid cardiac diagnoses had 26-37% higher odds of receiving care by physical and occupational therapy, physical medicine, and orthopaedic surgery clinics compared to veterans without comorbid cardiac disease. Conclusions Veterans in this cohort with musculoskeletal service-connected disability, plus cardiac conditions had greater clinic use for musculoskeletal and rehabilitation services compared to those without cardiac conditions. These results have implications for the rehabilitation and other health service needs of a new generation of veterans.
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Peter SC, Halverson TF, Blakey SM, Pugh MJ, Beckham JC, Calhoun PS, Kimbrel NA. The Veterans Health Administration's integrated model of care increases accessibility and delivery of mental health services. Psychol Serv 2022; 20:213-221. [PMID: 35787032 PMCID: PMC9810760 DOI: 10.1037/ser0000683] [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] [Indexed: 01/07/2023]
Abstract
Depression and posttraumatic stress disorder (PTSD) are two of the most common mental health conditions experienced by veterans. It is unclear what individual and system level factors are associated with receiving mental health treatment for these concerns. Using a national sample of Gulf War Era veterans who endorsed lifetime diagnoses of either depression or PTSD (N = 425), regression analyses were used to predict past-year treatment utilization. Predictor variables were those indicated in the behavioral model of health care utilization, including predisposing demographic variables (e.g., age, race), enabling variables (e.g., service connection, enrollment in Veterans Health Administration [VHA]), and need-based variables (e.g., current symptom severity). VHA enrollment was associated with a three- and five-times higher odds of being treated for depression or PTSD, respectively. Income and symptom severity were also positively associated with treatment utilization. Among individuals with diagnoses of depression and/or PTSD, VHA enrollment was the strongest predictor of receiving mental health treatment for these diagnoses, controlling for all other variables in the model including recent contact with the health care system, current symptom severity, and the presence of other enabling resources. Results suggest that the VHA's integrated model of care increases accessibility and delivery of effective mental health services. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Tate F. Halverson
- Durham Veterans Affairs (VA) Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Shannon M. Blakey
- Durham Veterans Affairs (VA) Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System
- University of Utah, School of Medicine, Department of Medicine
| | - Jean C. Beckham
- Durham Veterans Affairs (VA) Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Patrick S. Calhoun
- Durham Veterans Affairs (VA) Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery
| | - Nathan A. Kimbrel
- Durham Veterans Affairs (VA) Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery
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Swan AA, Akin FW, Amuan ME, Riska KM, Hall CD, Kalvesmaki A, Padilla S, Crowsey E, Pugh MJ. Disruptive Dizziness Among Post-9/11 Veterans With Deployment-Related Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:199-212. [PMID: 34320551 DOI: 10.1097/htr.0000000000000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms. SETTING Administrative medical record data from the Department of Veterans Affairs (VA). PARTICIPANTS Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation. DESIGN A cross-sectional, retrospective, observational study. MAIN MEASURES International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory. RESULTS Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses. CONCLUSIONS Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.
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Affiliation(s)
- Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio, San Antonio (Dr Swan and Ms Crowsey); South Texas Veterans Health Care System, San Antonio (Dr Swan); James H Quillen VA Medical Center, Mountain Home, Tennessee (Drs Akin and Hall); Departments of Audiology and Speech Language Pathology (Dr Akin) and Rehabilitative Sciences (Dr Hall), East Tennessee State University, Johnson City; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Internal Medicine, University of Utah, Salt Lake City (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina (Dr Riska); and Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina (Dr Riska)
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Copeland LA, Pugh MJ, Bollinger MJ, Wang CP, Amuan ME, Rivera JC, Shireman PK. The VA vascular injury study: A glimpse at quality of care in Veterans with traumatic vascular injury repair. Injury 2022; 53:1947-1953. [PMID: 35422314 DOI: 10.1016/j.injury.2022.04.002] [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: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The high number of limb injuries among Post-9/11 Veterans and their long-term care pose significant challenges to clinicians. Current follow-up for extremity arterial vascular injury (EVI) is based on guideline-concordant care for treatment of peripheral vascular disease (GCC-PVD), including anticoagulant/antiplatelet or statin therapy and duplex ultrasound. No best practices exist for arterial EVI. Our goal was to determine correlates of GCC-PVD and other care among Post-9/11 Veterans with combat-related arterial EVI. MATERIALS AND METHODS We identified Post-9/11 Veterans with arterial EVI who underwent initial limb salvage repair or ligation (e.g., for single-vessel injury) attempt per DoD Trauma Registry validated by chart abstraction. Veterans Health Administration (VHA) data characterized the cohort in the first five years of VHA care. Models predicted (a) GCC-PVD, (b) pain clinic use, (c) mental/behavioral health care, (d) long-term opioid use, and (e) time to complication, controlling for injury severity and type, mental health parameters, and demographics. RESULTS The 490-Veteran cohort with validated arterial injury was 77% White averaging 25.2 years at injury (range: 18-56). Mechanism of injury was primarily explosive (63%). Veterans had Injury Severity Scores classified as mild (60%), moderate (25%) and severe (15%). Approximately 25% received at least one component of VHA GCC-PVD including 8% arterial ultrasounds, 5% statins, and 11% anticoagulants/antiplatelets; 77% had mental/behavioral healthcare. GCC-PVD, as well as PTSD and substance use disorders, were associated with receipt of mental/behavioral health care. Complications affected 46% of the cohort and were more common among those prescribed 90+ days of opioids or receiving GCC-PVD. CONCLUSION Despite injury severity (40% moderate/severe), only 25% of cohort patients received VHA GCC-PVD, and nearly half had complications from their arterial injury. Receiving GCC-PVD appeared to potentiate receiving care for mental and behavioral disorders. IMPACT The treatment gap in Veterans with arterial EVI may be due to lack of appropriate guidelines, lack of vascular specialists in VHA or accessing care outside the VHA. Focused study of care options and their outcomes will help define optimal care processes for combat Veterans with arterial EVI.
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Affiliation(s)
- Laurel A Copeland
- Research Service, VA Central Western Massachusetts Healthcare System, 421N Main, Leeds, MA 01053 USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA 01655 USA.
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148 USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84132 USA
| | - Mary J Bollinger
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR 72114 USA; Department of Psychiatry, University of Arkansas for Medical Sciences, 4301W Markham St, Little Rock, AR 72205 USA
| | - Chen-Pin Wang
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA; Department of Population Health Sciences, Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 USA
| | - Megan E Amuan
- VA Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148 USA
| | - Jessica C Rivera
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234 USA; Louisiana State University Health Science Center - New Orleans Department of Orthopaedic Surgery, New Orleans, LA USA
| | - Paula K Shireman
- Geriatric Research, Education & Clinical Center, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229 USA; Department of Surgery, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 USA; Departments of Primary Care & Population Health and Medical Physiology, College of Medicine, Texas A&M Health, 2900 E 29th St, Bryan, TX 77802 USA
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Gugger JJ, Kennedy E, Panahi S, Tate DF, Roghani A, Van Cott AC, Lopez MR, Altalib H, Diaz-Arrastia R, Pugh MJ. Multimodal Quality of Life Assessment in Post-9/11 Veterans With Epilepsy: Impact of Drug Resistance, Traumatic Brain Injury, and Comorbidity. Neurology 2022; 98:e1761-e1770. [PMID: 35387856 PMCID: PMC9071370 DOI: 10.1212/wnl.0000000000200146] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is defined by the occurrence of multiple unprovoked seizures, but quality of life (QOL) in people with epilepsy is determined by multiple factors, in which psychiatric comorbidities play a pivotal role. Therefore, understanding the interplay between comorbidities and QOL across epilepsy phenotypes is an important step towards improved outcomes. Here, we report the impact of QOL across distinct epilepsy phenotypes in a cohort of post-9/11 veterans with high rates of traumatic brain injury (TBI). METHODS This observational cohort study from the Veterans Health Administration included post-9/11 Veterans with epilepsy. A process integrating an epilepsy identification algorithm, chart abstraction, and self-reported measures was used to classify patients into one of four groups: 1. Epilepsy controlled with medications, 2. Drug resistant epilepsy (DRE), 3. Post-traumatic epilepsy (PTE), or 4. Drug resistant post-traumatic epilepsy (PT-DRE). Summary scores for six QOL measures were compared across the groups, adjusting for age, sex, and number of comorbidities. RESULTS A total of 529 survey respondents with epilepsy were included in the analysis: 249 controls (i.e., epilepsy without DRE or PTE), 124 with DRE, 86 with PTE, and 70 with PT-DRE. Drug resistant epilepsy was more common in those with PTE compared with non-traumatic epilepsy (45% vs. 33%, odds ratio 1.6 (95% CI: [1.1-2.4], p=0.01)). Patients with PTE and PT-DRE had significantly more comorbid conditions in health records than those with nontraumatic epilepsy. Those with both PTE and DRE reported the lowest QOL across all six measures, and this persisted after adjustment for comorbidities, and in further linear analyses. DISCUSSION Among those with PTE, DRE prevalence was significantly higher than for non-traumatic epilepsies. PTE was also associated with higher burden of comorbidity, and worse overall QOL compared to those with non-traumatic epilepsies. People with PTE are distinctly vulnerable to the comorbidities associated with TBI and epilepsy. This at-risk group should be the focus of future studies aimed at elucidating the factors associated with adverse health outcomes and developing anti-epileptogenic therapies.
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Affiliation(s)
- James J Gugger
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
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Munger Clary H, Josephson SA, Franklin G, Herman ST, Hopp JL, Hughes I, Meunier L, Moura LMVR, Parker-McFadden B, Pugh MJ, Schultz R, Spanaki MV, Bennett A, Baca C. Seizure Frequency Process and Outcome Quality Measures: Quality Improvement in Neurology. Neurology 2022; 98:583-590. [PMID: 35379694 DOI: 10.1212/wnl.0000000000200239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/02/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Heidi Munger Clary
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - S Andrew Josephson
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Gary Franklin
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Susan T Herman
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Jennifer L Hopp
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Inna Hughes
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Lisa Meunier
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Lidia M V R Moura
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Brandy Parker-McFadden
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Mary Jo Pugh
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Rebecca Schultz
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Marianna V Spanaki
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Amy Bennett
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Christine Baca
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
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Leykum LK, Penney LS, Dang S, Trivedi RB, Noël PH, Pugh JA, Shepherd-Banigan ME, Pugh MJ, Rupper R, Finley E, Parish-Johnson J, Delgado R, Peacock K, Kalvesmaki A, Van Houtven CH. Recommendations to Improve Health Outcomes Through Recognizing and Supporting Caregivers. J Gen Intern Med 2022; 37:1265-1269. [PMID: 34981348 PMCID: PMC8722428 DOI: 10.1007/s11606-021-07247-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Luci K Leykum
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA.
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.
- University of Texas at Austin Dell Medical School, Austin, USA.
- VA Palo Alto Health Care System, Palo Alto, USA.
| | - Lauren S Penney
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Stuti Dang
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Miami VA Healthcare System, Miami, USA
- University of Miami School of Medicine, Miami, USA
| | - Ranak B Trivedi
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Greater Los Angeles Health Care System, Los Angeles, USA
- VA Palo Alto Health Care System, Palo Alto, USA
- Stanford University School of Medicine, Stanford, USA
| | - Polly H Noël
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Jacqueline A Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Megan E Shepherd-Banigan
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Duke University School of Medicine, Durham, USA
- Center of Innovation To Accelerate Discovery and Practice Transformation, Durham VAMC, Durham, USA
| | - Mary Jo Pugh
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Rand Rupper
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Erin Finley
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Julie Parish-Johnson
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Roxana Delgado
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Kimberly Peacock
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA
- Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Andrea Kalvesmaki
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- VA Salt Lake City Health Care System/GRECC, Salt Lake City, USA
- University of Utah Health Care School of Medicine, Salt Lake City, USA
| | - Courtney H Van Houtven
- Department of Veterans Affairs Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, San Antonio, USA
- Duke University School of Medicine, Durham, USA
- Center of Innovation To Accelerate Discovery and Practice Transformation, Durham VAMC, Durham, USA
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Knight SJ, Haibach JP, Hamilton AB, Whittle J, Ono SS, Butler J, Flower M, Ray CD, Pugh MJ, Zickmund SL. Veteran Engagement in Health Services Research: a Conceptual Model. J Gen Intern Med 2022; 37:94-98. [PMID: 35349018 PMCID: PMC8993964 DOI: 10.1007/s11606-021-07309-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/24/2021] [Indexed: 12/13/2022]
Abstract
With 20 million living veterans and millions more immediate family members, and approximately 9 million veterans enrolled in the nationally networked VA healthcare system, representing the interests and needs of veterans in this complex community is a substantial endeavor. Based on the importance of engaging Veterans in research, the VA Health Services Research and Development (HSR&D) Service convened a Working Group of VA researchers and Veterans to conduct a review of patient engagement models and develop recommendations for an approach to engage Veterans in health research that would incorporate their unique lived experiences and interests, and their perspectives on research priorities. The Working Group considered the specific context for Veteran engagement in research that includes other VA stakeholders from the operational and clinical leadership of the VA Health Administration (VHA). The resulting model identifies the range of potential stakeholders and three domains of relevant constructs-processes expected to facilitate Veteran engagement in research with other stakeholders, individual stakeholder and external factors, and outcomes. The expectation is that Veteran engagement will benefit research to policy and practice translation, including increasing the transparency of research and producing knowledge that is readily accepted and implemented in healthcare.
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Affiliation(s)
- Sara J Knight
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA. .,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Jeffrey P Haibach
- Veteran Consulting and Research, Eastern Region, USA.,US Department of Veterans Affairs, Washington, DC, USA
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeff Whittle
- Clement J Zablocki VA Medical Center, Medical College of Wisconsin, Center for Advancing Population Science, Milwaukee, WI, USA.,Department of Medicine, Clement J Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Sarah S Ono
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA.,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jorie Butler
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA.,Geriatric Research Education and Clinical Center, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Mark Flower
- Department of Medicine, Clement J Zablocki VA Medical Center, Milwaukee, WI, USA.,Veteran Peer Services, Mental Health America of Wisconsin, Milwaukee, WI, USA
| | | | - Mary Jo Pugh
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Susan L Zickmund
- Informatics, Decision Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Research and Development Service, VA Salt Lake City Healthcare System, 500 Foothill Drive, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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48
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Kalvesmaki AF, Chapman AB, Peterson KS, Pugh MJ, Jones M, Gleason TC. Analysis of a national response to a White House directive for ending veteran suicide. Health Serv Res 2022; 57 Suppl 1:32-41. [PMID: 35238027 DOI: 10.1111/1475-6773.13931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/19/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Analyze responses to a national request for information (RFI) to uncover gaps in policy, practice, and understanding of veteran suicide to inform federal research strategy. DATA SOURCE An RFI with 21 open-ended questions generated from Presidential Executive Order #1386, administered nationally from July 3 to August 5, 2019. STUDY DESIGN Semi-structured, open-ended responses analyzed using a collaborative qualitative and text-mining data process. DATA EXTRACTION METHODS We aligned traditional qualitative methods with natural language processing (NLP) text-mining techniques to analyze 9040 open-ended question responses from 722 respondents to provide results within 3 months. Narrative inquiry and the medical explanatory model guided the data extraction and analytic process. RESULTS Five major themes were identified: risk factors, risk assessment, prevention and intervention, barriers to care, and data/research. Individuals and organizations mentioned different concepts within the same themes. In responses about risk factors, individuals frequently mentioned generic terms like "illness" while organizations mentioned specific terms like "traumatic brain injury." Organizations and individuals described unique barriers to care and emphasized ways to integrate data and research to improve points of care. Organizations often identified lack of funding as barriers while individuals often identified key moments for prevention such as military transitions and ensuring care providers have military cultural understanding. CONCLUSIONS This study provides an example of a rapid, adaptive analysis of a large body of qualitative, public response data about veteran suicide to support a federal strategy for an important public health topic. Combining qualitative and text-mining methods allowed a representation of voices and perspectives including the lived experiences of individuals who described stories of military transition, treatments that worked or did not, and the perspective of organizations treating veterans for suicide. The results supported the development of a national strategy to reduce suicide risks for veterans as well as civilians.
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Affiliation(s)
- Andrea F Kalvesmaki
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alec B Chapman
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kelly S Peterson
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Veteran Health Administration Office of Analytics and Performance Integration
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Makoto Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Theresa C Gleason
- Department of Veteran Affairs, Clinical Science Research & Development Service (CSRD), Washington, District of Columbia, USA
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49
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Gottshall JL, Agyemang AA, O’Neil M, Wei G, Presson A, Hewins B, Fisher D, Mithani S, Shahim P, Pugh MJ, Wilde EA, Devoto C, Yaffe K, Gill J, Kenney K, Werner JK. Sleep quality: A common thread linking depression, post-traumatic stress, and post-concussive symptoms to biomarkers of neurodegeneration following traumatic brain injury. Brain Inj 2022; 36:633-643. [DOI: 10.1080/02699052.2022.2037711] [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] [Indexed: 11/02/2022]
Affiliation(s)
- Jackie L. Gottshall
- Center for Neuroscience & Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Amma A. Agyemang
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Maya O’Neil
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Guo Wei
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela Presson
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Bryson Hewins
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Daniel Fisher
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sara Mithani
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Pashtun Shahim
- Center for Neuroscience & Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Mary Jo Pugh
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement and Analytics sciences Center, VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
| | - Elisabeth A. Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Neurology, George E. Wahlen VA, Salt Lake City, Utah, USA
| | - Christina Devoto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Kristine Yaffe
- Departments of Psychiatry and Behavioral Sciences, Neurology, and Epidemiology, University of California, San Francisco, California, USA
| | - Jessica Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Psychiatry, San Francisco Veterans Affairs Health Care System; 4150 Clement St. Box 181G, San Francisco, California, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - J. Kent Werner
- Center for Neuroscience & Regenerative Medicine (CNRM), Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
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50
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Kennedy E, Panahi S, Stewart IJ, Tate DF, Wilde EA, Kenney K, Werner JK, Gill J, Diaz-Arrastia R, Amuan M, Van Cott AC, Pugh MJ. Traumatic Brain Injury and Early Onset Dementia in Post 9-11 Veterans. Brain Inj 2022; 36:620-627. [DOI: 10.1080/02699052.2022.2033846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Eamonn Kennedy
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Samin Panahi
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ian J. Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David F. Tate
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elisabeth A. Wilde
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kimbra Kenney
- Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - J. Kent Werner
- Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jessica Gill
- John Hopkins, School of Nursing and Medicine, Baltimore, Maryland, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Megan Amuan
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
| | - Anne C. Van Cott
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- VA Pittsburgh Health Care System, Pittsburgh Pennsylvania, USA
| | - Mary Jo Pugh
- Va Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah, USA
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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