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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] [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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Sakamoto MS, Hanson KL, Chanfreau-Coffinier C, Lai MHC, Román CAF, Clark AL, Marquine MJ, Delano-Wood L, Merritt VC. An Examination of Racial/Ethnic Differences on the Neurobehavioral Symptom Inventory Among Veterans Completing the Comprehensive Traumatic Brain Injury Evaluation: A Veterans Affairs Million Veteran Program Study. Arch Clin Neuropsychol 2023; 38:929-943. [PMID: 36702773 PMCID: PMC10656879 DOI: 10.1093/arclin/acad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore racial/ethnic differences in neurobehavioral symptom reporting and symptom validity testing among military veterans with a history of traumatic brain injury (TBI). METHOD Participants of this observational cross-sectional study (N = 9,646) were post-deployed Iraq-/Afghanistan-era veterans enrolled in the VA's Million Veteran Program with a clinician-confirmed history of TBI on the Comprehensive TBI Evaluation (CTBIE). Racial/ethnic groups included White, Black, Hispanic, Asian, Multiracial, Another Race, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander. Dependent variables included neurobehavioral symptom domains and symptom validity assessed via the Neurobehavioral Symptom Inventory (NSI) and Validity-10, respectively. RESULTS Chi-square analyses showed significant racial/ethnic group differences for vestibular, somatic/sensory, and affective symptoms as well as for all Validity-10 cutoff scores examined (≥33, ≥27, ≥26, >22, ≥22, ≥13, and ≥7). Follow-up analyses compared all racial/ethnic groups to one another, adjusting for sociodemographic- and injury-related characteristics. These analyses revealed that the affective symptom domain and the Validity-10 cutoff of ≥13 revealed the greatest number of racial/ethnic differences. CONCLUSIONS Results showed significant racial/ethnic group differences on neurobehavioral symptom domains and symptom validity testing among veterans who completed the CTBIE. An enhanced understanding of how symptoms vary by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of all veterans. Results highlight the importance of establishing measurement invariance of the NSI across race/ethnicity and underscore the need for ongoing research to determine the most appropriate Validity-10 cutoff score(s) to use across racially/ethnically diverse veterans.
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Affiliation(s)
- McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Karen L Hanson
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Mark H C Lai
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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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] [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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Gress Smith JL, Roberts NA, Borowa D, Bushnell M. An interdisciplinary approach to the screening, diagnosis, and treatment of OEF/OIF Veterans with mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:793-801. [PMID: 32873065 DOI: 10.1080/23279095.2020.1810690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To implement an Integrated TBI Screening Clinic (ITSC) during the mandatory TBI evaluation process at the Department of Veterans Affairs. Referral outcomes were examined regarding Veterans who were determined to need a full neuropsychological evaluation versus those for whom mental health treatment was clinically indicated. Correlations among cognitive measures, posttraumatic stress disorder (PTSD), anxiety, depression, and insomnia symptoms were also examined. METHOD This study was a retrospective chart review study that included 138 Veterans seen between 2011 and 2014 in a post-deployment primary care clinic. Descriptive statistics and correlations were completed using the: screening Module of the Neuropsychological Assessment Battery (S-NAB), PTSD Checklist-Military version (PCL-M), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Insomnia Severity Index (ISI). RESULTS 19.8% of Veterans required a referral for a full neuropsychological exam and 72.7% were referred for additional mental health services (with some Veterans being referred to both). Significant correlations were found among higher PTSD, depression, anxiety symptoms, with poorer attention and memory (all p < .05). Only PTSD was significantly correlated with poorer executive functioning (r = 0.19, p < .05). CONCLUSION Integration of a multidisciplinary neuropsychological screening exam during a primary care visit with OEF/OIF Veterans may assist in better delineating symptoms.
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Affiliation(s)
- Jenna L Gress Smith
- Department of Psychology, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Nicole A Roberts
- Department of Psychology, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA
| | - Dominika Borowa
- Health Psychology Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - MaryLu Bushnell
- Department of Psychology, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
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Ward RE, Nguyen XMT, Li Y, Lord EM, Lecky V, Song RJ, Casas JP, Cho K, Gaziano JM, Harrington KM, Whitbourne SB. Racial and Ethnic Disparities in U.S. Veteran Health Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052411. [PMID: 33801200 PMCID: PMC7967786 DOI: 10.3390/ijerph18052411] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Racial/ethnic health disparities persist among veterans despite comparable access and quality of care. We describe racial/ethnic differences in self-reported health characteristics among 437,413 men and women (mean age (SD) = 64.5 (12.6), 91% men, 79% White) within the Million Veteran Program. The Cochran-Mantel-Haenszel test and linear mixed models were used to compare age-standardized frequencies and means across race/ethnicity groups, stratified by gender. Black, Hispanic, and Other race men and women reported worse self-rated health, greater VA healthcare utilization, and more combat exposure than Whites. Compared to White men, Black and Other men reported more circulatory, musculoskeletal, mental health, and infectious disease conditions while Hispanic men reported fewer circulatory and more mental health, infectious disease, kidney, and neurological conditions. Compared to White women, Black women reported more circulatory and infectious disease conditions and Other women reported more infectious disease conditions. Smoking rates were higher among Black men, but lower for other minority groups compared to Whites. Minority groups were less likely to drink alcohol and had lower physical fitness than Whites. By identifying differences in burden of various health conditions and risk factors across different racial/ethnic groups, our findings can inform future studies and ultimately interventions addressing disparities.
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Affiliation(s)
- Rachel E. Ward
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Correspondence:
| | - Xuan-Mai T. Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL 61820, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Yanping Li
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Emily M. Lord
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Vanessa Lecky
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Rebecca J. Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
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Robinson-Freeman KE, Collins KL, Garber B, Terblanche R, Risling M, Vermetten E, Besemann M, Mistlin A, Tsao JW. A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI. Front Neurol 2020; 11:836. [PMID: 32982907 PMCID: PMC7477387 DOI: 10.3389/fneur.2020.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.
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Affiliation(s)
| | - Kassondra L Collins
- Department of Physical Therapy, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bryan Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Ronel Terblanche
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Marten Risling
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Eric Vermetten
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Markus Besemann
- Physical Medicine and Rehabilitation, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Alan Mistlin
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, Children's Foundation Research Institute, Memphis, TN, United States
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7
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Hawkins LG, Eggleston D, Brown CC. Utilizing a Narrative Therapy Approach with Couples Who Have Experienced a Traumatic Brain Injury to Increase Intimacy. CONTEMPORARY FAMILY THERAPY 2018. [DOI: 10.1007/s10591-018-9484-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Dismuke-Greer CE, Gebregziabher M, Ritchwood T, Pugh MJ, Walker RJ, Uchendu US, Egede LE. Geographic Disparities in Mortality Risk Within a Racially Diverse Sample of U.S. Veterans with Traumatic Brain Injury. Health Equity 2018; 2:304-312. [PMID: 30374469 PMCID: PMC6203888 DOI: 10.1089/heq.2018.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Traumatic brain injury (TBI) is a signature injury among the U.S. veterans. Hispanic U.S. veterans diagnosed with TBI have been found to have higher risk-adjusted mortality. This study examined the adjusted association of geographic location with all-cause mortality in 114,593 veterans diagnosed with TBI between January 1, 2000 and December 31, 2010, and followed through December 31, 2014. Methods: National Veterans Health Administration (VHA) databases containing administrative data including International Classification of Diseases, 9th Revision (ICD-9) codes, sociodemographic characteristics, and survival were linked. TBI was identified based on ICD-9 codes. Cox proportional hazards regression methods were used to examine the association of time from first TBI ICD-9 code to death with geographic location, after adjustment for TBI severity, race/ethnicity, other sociodemographic characteristics, military factors, and Elixhauser comorbidities. Results: Relative to urban mainland veterans with a median survival of 76.4 months, veterans living in the U.S. territories had a median survival of 69.1 months, whereas rural mainland veterans had a median survival of 77.1 months, and highly rural mainland veterans had a mean survival of 77.6 months. The final model adjusted for race/ethnicity, TBI severity, sociodemographic, military, and comorbidity covariates showed that residing in the U.S. territories was associated with a higher risk of death (hazard ratios=1.24; 95% confidence interval 1.15-1.34) relative to residing on the U.S. mainland. The race/ethnicity disparity previously found for the U.S. veterans diagnosed with TBI seems to be accounted for by living in the U.S. territories. Conclusion: The study shows that among veterans with TBI, mortality rates were higher in those who reside in the U.S. territories, even after adjustment. Previous documented higher mortality among Hispanic veterans seems to be explained by residing in the U.S. territories. The VA has a mission of ensuring equitable treatment of all veterans, and should investigate targeted policies and interventions to improve the survival of the U.S. territory veterans diagnosed with TBI.
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Affiliation(s)
- Clara E Dismuke-Greer
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Division of Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Tiarney Ritchwood
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,IDEAS Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Uche S Uchendu
- Chief Officer for Health Equity, US Department of Veterans Affairs, Washington, DC.,Principal, Health Management Associates, Washington, DC
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
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Worse baseline executive functioning is associated with dropout and poorer response to trauma-focused treatment for veterans with PTSD and comorbid traumatic brain injury. Behav Res Ther 2018; 108:68-77. [DOI: 10.1016/j.brat.2018.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/28/2018] [Accepted: 07/13/2018] [Indexed: 11/23/2022]
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Moore DH, Powell-Cope G, Belanger HG. The Veterans Health Administration’s Traumatic Brain Injury Screen and Evaluation: Service Delivery Insights. Mil Med 2018; 183:e494-e501. [DOI: 10.1093/milmed/usy036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Helen Moore
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Veterans Health Administration, James A. Haley Veterans’ Hospital, 8900 Grand Oak Circle, Tampa, FL
| | - Gail Powell-Cope
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Veterans Health Administration, James A. Haley Veterans’ Hospital, 8900 Grand Oak Circle, Tampa, FL
- College of Nursing, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL
- College of Public Health, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL
| | - Heather G Belanger
- Center of Innovation on Disability and Rehabilitation Research (CINDRR), Health Services Research and Development Service (HSR&D), Veterans Health Administration, James A. Haley Veterans’ Hospital, 8900 Grand Oak Circle, Tampa, FL
- Department of Psychiatry and Behavioral Neurosciences, College of Medicine, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL
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Panaite V, Brown R, Henry M, Garcia A, Powell-Cope G, Vanderploeg RD, Belanger HG. Post-deployment Mental Health Screening: A Systematic Review of Current Evidence and Future Directions. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:850-875. [PMID: 29603055 DOI: 10.1007/s10488-018-0869-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Population-based post-deployment screening programs within the Departments of Defense and Veterans Affairs have been implemented to assess for mental health conditions and traumatic brain injury. The purpose of this paper is to systematically review the literature on post-deployment screening within this context and evaluate evidence compared to commonly accepted screening implementation criteria. Findings reflected highly variable psychometric properties of the various screens, variable treatment referral rates following screening, low to moderate treatment initiation rates following screening, and no information on treatment completion or long-term outcomes following screening. In sum, the evidence supporting population based post-deployment screening is inconclusive. Implications are discussed.
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Affiliation(s)
- Vanessa Panaite
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA.
- Departments of Psychology, University of South Florida, Tampa, FL, USA.
| | - Racine Brown
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
| | | | - Amanda Garcia
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
| | - Gail Powell-Cope
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
| | - Rodney D Vanderploeg
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
- Departments of Psychology, University of South Florida, Tampa, FL, USA
- Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Defense and Veterans Brain Injury Center, Tampa, FL, USA
| | - Heather G Belanger
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Hospital, 8900 Grand Oak Circle, 104B, Tampa, FL, 33637, USA
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, FL, USA
- Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Defense and Veterans Brain Injury Center, Tampa, FL, USA
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Smith BM, Martinez RN, Evans CT, Saban KL, Balbale S, Proescher EJ, Stroupe K, Hogan TP. Barriers and strategies for coordinating care among veterans with traumatic brain injury: a mixed methods study of VA polytrauma care team members. Brain Inj 2018. [PMID: 29537883 DOI: 10.1080/02699052.2018.1444205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Veterans who experience traumatic brain injury (TBI) may have long-term needs placing a premium on well-coordinated care. This study aimed to (1) identify barriers to care coordination for Veterans with TBI; and (2) describe strategies used by VA polytrauma care team members to coordinate care for Veterans with TBI. METHODS We utilised a mixed method design, including an online survey of VA polytrauma care team members (N = 236) and subsequent semi-structured interviews (N = 25). Analysis of the survey data was descriptive; interview data was analysed using constant comparative techniques. RESULTS The most common system-related barriers 25 for access to military records (64%) and insufficient time (58%). The most common patient-related barriers were missed appointments/no shows (87%) and the mental health issues (74%). Strategies reported on the survey to promote coordination reflected the centrality of teamwork and communication, and included promoting multidisciplinary team collaboration (32%) and holding 30 regular meetings (23%). Interview findings were consistent, emphasising the effective functioning of multidisciplinary clinics. CONCLUSION Polytrauma care team members encounter barriers to care coordination for Veterans with TBI, and have developed strategies in response. Information sharing, provider workload, communication, and patient engagement will be critical to address in future efforts to enhance care coordination in this context.
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Affiliation(s)
- Bridget M Smith
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital , Chicago , IL , USA.,b Department of Pediatrics and Center for Community Health , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Rachael N Martinez
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital , Chicago , IL , USA
| | - Charlesnika T Evans
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital , Chicago , IL , USA.,c Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Karen L Saban
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital , Chicago , IL , USA.,d Transition & Care Management Team , Jesse Brown VA Medical Center , Chicago , IL , USA.,e Marcella Niehoff School of Nursing , Loyola University Chicago , Maywood , IL , USA
| | - Salva Balbale
- c Center for Healthcare Studies and Department of Preventive Medicine Institute for Public Health and Medicine , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Eric J Proescher
- d Transition & Care Management Team , Jesse Brown VA Medical Center , Chicago , IL , USA
| | - Kevin Stroupe
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital , Chicago , IL , USA.,f Stritch School of Medicine , Loyola University Chicago , Maywood , IL , USA
| | - Timothy P Hogan
- g Center for Healthcare Organization and Implementation Research (CHOIR) , Edith Nourse Rogers Memorial Veterans Hospital , Bedford , MA , USA.,h Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences , University of Massachusetts Medical School , Worcester , MA , USA
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Belanger HG, Vanderploeg RD, Sayer N. Screening for Remote History of Mild Traumatic Brain Injury in VHA: A Critical Literature Review. J Head Trauma Rehabil 2018; 31:204-14. [PMID: 26394295 DOI: 10.1097/htr.0000000000000168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors reviewed the existing literature on the Veterans Health Administration's (VHA's) traumatic brain injury (TBI) screening and evaluation program to provide a qualitative synthesis and critical review of results focusing on the psychometric properties of the screen. METHODS All studies of the VHA's screening and evaluation process were reviewed, both those involving primary data collection and those relying upon VHA data. Diagnostic statistics were summarized and also recalculated on the basis of a positive screening rate of 20%, the observed rate within the VHA, and an estimated population prevalence of TBI of 15% within the Department of Veterans Affairs (VHA). RESULTS The TBI screen within the VHA is administered to nearly every eligible patient. The majority of clinical presentations are deemed to be due to mental health and/or a combination of mental health and TBI factors. The screen has good internal consistency, variable test-retest reliability, and questionable validity, with poor agreement between the TBI screen and criterion standards overall. Studies based on nonrepresentative samples reported high sensitivity. Assuming the VHA's TBI screening rate of 20% in a hypothetical sample, sensitivity is poor (the screen misses 30%-60% of TBI cases). However, specificity remains adequate. Studies based on samples with high rates of TBI reported much higher positive predictive values (and slightly lower negative predictive values) than those observed when a hypothetical TBI prevalence of 15% was used. CONCLUSION Questions remain about the validity of the TBI screen. Future research should address the utility of screening for TBI.
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Affiliation(s)
- Heather G Belanger
- Department of Mental Health and Behavioral Sciences, James A. Haley VA, Tampa, Florida (Drs Belanger and Vanderploeg); Departments of Psychology and Psychiatry, University of South Florida, Tampa (Drs Belanger and Vanderploeg); Defense and Veterans Brain Injury Center, Tampa, Florida (Drs Belanger and Vanderploeg); Tampa HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research (CIDRR8), Tampa, Florida (Drs Belanger and Vanderploeg); Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota (Dr Sayer); and Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis (Dr Sayer)
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14
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Miles SR, Harik JM, Hundt NE, Mignogna J, Pastorek NJ, Thompson KE, Freshour JS, Yu HJ, Cully JA. Delivery of mental health treatment to combat veterans with psychiatric diagnoses and TBI histories. PLoS One 2017; 12:e0184265. [PMID: 28886114 PMCID: PMC5590892 DOI: 10.1371/journal.pone.0184265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/21/2017] [Indexed: 11/18/2022] Open
Abstract
Traumatic brain injury (TBI) and mental health (MH) disorders are prevalent in combat veterans returning from Afghanistan and/or Iraq (hereafter referred to as returning veterans). Accurate estimates of service utilization for veterans with and without TBI exposure (referred to as TBI history) are imperative in order to provide high quality healthcare to returning veterans. We examined associations between TBI history and MH service utilization in a subsample of returning veterans who were newly diagnosed with posttraumatic stress disorder (PTSD), depression, and/or anxiety in the 2010 fiscal year (N = 55,458). Data were extracted from the Veterans Health Administration (VHA) National Patient Care Database. Veterans with MH diagnoses and TBI histories attended significantly more psychotherapy visits, (M = 8.32 visits, SD = 17.15) and were more likely to attend at least 8 psychotherapy visits, (15.7%) than veterans with MH diagnoses but no TBI history (M = 6.48 visits, SD = 12.12; 10.1% attended at least 8 sessions). PTSD and TBI history, but not depression or anxiety, were associated with a greater number of psychotherapy visits when controlling for demographic and clinical variables. PTSD, anxiety, depression, and TBI history were associated with number of psychotropic medication-management visits. TBI history was related to greater MH service utilization, independent of MH diagnoses. Future research should examine what MH services are being utilized and if these services are helping veterans recover from their disorders.
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Affiliation(s)
- Shannon R. Miles
- Health Service Research and Development Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans’ Hospital, Tampa, Florida, United States of America
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
- * E-mail:
| | - Juliette M. Harik
- National Center for PTSD-Executive Division, VA Medical Center (116D), White River Junction, Vermont, United States of America
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Natalie E. Hundt
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, MEDVAMC (152), Houston, Texas, United States of America
| | - Joseph Mignogna
- Center of Excellence for Research on Returning War Veterans, Waco, Texas, United States of America
- Central Texas Veterans Healthcare System, Waco, TX Texas A&M Health Science Center, Temple, Texas, United States of America
- Texas A&M Health Science Center, Temple, Texas, United States of America
| | - Nicholas J. Pastorek
- Rehabilitation and Extended Care Line, MEDVAMC, Houston, Texas, United States of America
| | - Karin E. Thompson
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
| | - Jessica S. Freshour
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
| | - Hong J. Yu
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
| | - Jeffrey A. Cully
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E DeBakey VA Medical Center (MEDVAMC 152), Houston, Texas, United States of America
- Baylor College of Medicine, One Baylor Plaza, Houston, Texas, United States of America
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, MEDVAMC (152), Houston, Texas, United States of America
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Evaluation and Treatment of Mild Traumatic Brain Injury Through the Implementation of Clinical Video Telehealth: Provider Perspectives From the Veterans Health Administration. PM R 2016; 9:231-240. [DOI: 10.1016/j.pmrj.2016.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/28/2016] [Accepted: 07/09/2016] [Indexed: 11/30/2022]
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Arriola VD, Rozelle JW. Traumatic Brain Injury in United States Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hispanic Veterans-A Review Using the PRISMA Method. Behav Sci (Basel) 2016; 6:E3. [PMID: 26771647 PMCID: PMC4810037 DOI: 10.3390/bs6010003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/01/2016] [Accepted: 01/06/2016] [Indexed: 11/16/2022] Open
Abstract
Traumatic brain injury (TBI) is commonly defined by Menon et al. as an "alteration of the brain function, or other evidence of brain pathology, caused by an external force." TBI can be caused by penetrating trauma to the head in which the magnitude of the injury is dependent on the magnitude of the forces that are applied to the head. The consequences of TBI can range from minimal to severe disability and even death. The major objectives of this systematic review are to survey the current literature on Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Hispanic veterans with TBI. To complete this analysis, the Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA) identified 875 articles in common and retrieved a total of 34 articles that met the inclusion criteria, consisted of OEF/OIF Hispanic veterans, reported quantitative data, and were conducted with adult U.S. veterans living in the United States. Since TBI diagnosis was unclear in most articles, only five articles that used the VATBIST instrument were analyzed. The results suggested that there is a lack of research on OEF/OIF Hispanic veterans and Hispanic subgroups. Future studies need to be conducted to consider minority groups while analyzing data involving TBI.
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Affiliation(s)
- Vanessa D Arriola
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA.
| | - Jeffrey W Rozelle
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA.
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Amyot F, Arciniegas DB, Brazaitis MP, Curley KC, Diaz-Arrastia R, Gandjbakhche A, Herscovitch P, Hinds SR, Manley GT, Pacifico A, Razumovsky A, Riley J, Salzer W, Shih R, Smirniotopoulos JG, Stocker D. A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. J Neurotrauma 2015; 32:1693-721. [PMID: 26176603 PMCID: PMC4651019 DOI: 10.1089/neu.2013.3306] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The incidence of traumatic brain injury (TBI) in the United States was 3.5 million cases in 2009, according to the Centers for Disease Control and Prevention. It is a contributing factor in 30.5% of injury-related deaths among civilians. Additionally, since 2000, more than 260,000 service members were diagnosed with TBI, with the vast majority classified as mild or concussive (76%). The objective assessment of TBI via imaging is a critical research gap, both in the military and civilian communities. In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities (computed tomography [CT], magnetic resonance imaging [MRI], transcranial Doppler [TCD], positron emission tomography, single photon emission computed tomography, electrophysiologic techniques [magnetoencephalography and electroencephalography], and functional near-infrared spectroscopy) to assess the spectrum of TBI from concussion to coma. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This paper describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.
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Affiliation(s)
- Franck Amyot
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - David B. Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, Texas
- Brain Injury Research, TIRR Memorial Hermann, Houston, Texas
| | | | - Kenneth C. Curley
- Combat Casualty Care Directorate (RAD2), U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Amir Gandjbakhche
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Peter Herscovitch
- Positron Emission Tomography Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sidney R. Hinds
- Defense and Veterans Brain Injury Center, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Silver Spring, Maryland
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Anthony Pacifico
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | | | - Jason Riley
- Queens University, Kingston, Ontario, Canada
- ArcheOptix Inc., Picton, Ontario, Canada
| | - Wanda Salzer
- Congressionally Directed Medical Research Programs, Fort Detrick, Maryland
| | - Robert Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James G. Smirniotopoulos
- Department of Radiology, Neurology, and Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Derek Stocker
- Walter Reed National Military Medical Center, Bethesda, Maryland
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Dismuke CE, Gebregziabher M, Yeager D, Egede LE. Racial/Ethnic Differences in Combat- and Non-Combat-Associated Traumatic Brain Injury Severity in the Veterans Health Administration: 2004-2010. Am J Public Health 2015; 105:1696-702. [PMID: 26066928 DOI: 10.2105/ajph.2014.302545] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between traumatic brain injury (TBI) severity and combat exposure by race/ethnicity. METHODS We estimated logit models of the fully adjusted association of combat exposure with TBI severity in separate race/ethnicity models for a national cohort of 132 995 veterans with TBI between 2004 and 2010. RESULTS Of veterans with TBI, 25.8% had served in a combat zone. Mild TBI increased from 11.5% to 40.3%, whereas moderate or severe TBI decreased from 88.5% to 59.7%. Moderate or severe TBI was higher in non-Hispanic Blacks (80.0%) and Hispanics (89.4%) than in non-Hispanic Whites (71.9%). In the fully adjusted all-race/ethnicity model, non-Hispanic Blacks (1.44; 95% confidence interval [CI] = 1.37, 1.52) and Hispanics (1.47; 95% CI = 1.26, 1.72) had higher odds of moderate or severe TBI than did non-Hispanic Whites. However, combat exposure was associated with higher odds of mild TBI in non-Hispanic Blacks (2.48; 95% CI = 2.22, 2.76) and Hispanics (3.42; 95% CI = 1.84, 6.35) than in non-Hispanic Whites (2.17; 95% CI = 2.09, 2.26). CONCLUSIONS Research is needed to understand racial differences in the effect of combat exposure on mild TBI and on interventions to prevent TBI across severity levels.
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Affiliation(s)
- Clara E Dismuke
- Clara E. Dismuke, Mulugeta Gebregziabher, Derik Yeager, and Leonard E. Egede are with the Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. Clara E. Dismuke and Leonard E. Egede are also with the Center for Health Disparities Research and Division of General Internal Medicine & Geriatrics, Medical University of South Carolina, Charleston. Mulugeta Gebregziabher is also with the Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Mulugeta Gebregziabher
- Clara E. Dismuke, Mulugeta Gebregziabher, Derik Yeager, and Leonard E. Egede are with the Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. Clara E. Dismuke and Leonard E. Egede are also with the Center for Health Disparities Research and Division of General Internal Medicine & Geriatrics, Medical University of South Carolina, Charleston. Mulugeta Gebregziabher is also with the Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Derik Yeager
- Clara E. Dismuke, Mulugeta Gebregziabher, Derik Yeager, and Leonard E. Egede are with the Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. Clara E. Dismuke and Leonard E. Egede are also with the Center for Health Disparities Research and Division of General Internal Medicine & Geriatrics, Medical University of South Carolina, Charleston. Mulugeta Gebregziabher is also with the Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Leonard E Egede
- Clara E. Dismuke, Mulugeta Gebregziabher, Derik Yeager, and Leonard E. Egede are with the Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC. Clara E. Dismuke and Leonard E. Egede are also with the Center for Health Disparities Research and Division of General Internal Medicine & Geriatrics, Medical University of South Carolina, Charleston. Mulugeta Gebregziabher is also with the Department of Public Health Sciences, Medical University of South Carolina, Charleston
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Walker WC, Cifu DX, Hudak AM, Goldberg G, Kunz RD, Sima AP. Structured Interview for Mild Traumatic Brain Injury after Military Blast: Inter-Rater Agreement and Development of Diagnostic Algorithm. J Neurotrauma 2015; 32:464-73. [DOI: 10.1089/neu.2014.3433] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
- H.H. McGuire Veterans Affairs Medical Center, Richmond Virginia
| | - David X. Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
- H.H. McGuire Veterans Affairs Medical Center, Richmond Virginia
| | - Anne M. Hudak
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
- H.H. McGuire Veterans Affairs Medical Center, Richmond Virginia
| | - Gary Goldberg
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
- H.H. McGuire Veterans Affairs Medical Center, Richmond Virginia
| | - Richard D. Kunz
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Adam P. Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
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21
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GABA and glutamate levels in occlusal splint-wearing males with possible bruxism. Arch Oral Biol 2015; 60:1021-9. [PMID: 25889171 DOI: 10.1016/j.archoralbio.2015.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The inhibitory neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the pathophysiology of anxiety behavioural disorders such as panic disorder and post-traumatic stress disorder and is also implicated in the manifestation of tooth-grinding and clenching behaviours generally known as bruxism. In order to test whether the stress-related behaviours of tooth-grinding and clenching share similar underlying mechanisms involving GABA and other metabolites as do anxiety-related behavioural disorders, we performed a Magnetic Resonance Spectroscopy (MRS) study for accurate, in vivo metabolite quantification in anxiety-related brain regions. DESIGN MRS was performed in the right hippocampus and right thalamus involved in the hypothalamic-pituitary-adrenal axis system, together with a motor planning region (dorsal anterior cingulate cortex/pre-supplementary motor area) and right dorsolateral prefrontal cortex (DLPFC). Eight occlusal splint-wearing men (OCS) with possible tooth-grinding and clenching behaviours and nine male controls (CON) with no such behaviour were studied. RESULTS Repeated-measures ANOVA showed significant Group×Region interaction for GABA+ (p = 0.001) and glutamate (Glu) (p = 0.031). Between-group post hoc ANOVA showed significantly lower levels of GABA+ (p = 0.003) and higher levels of Glu (p = 0.002) in DLPFC of OCS subjects. These GABA+ and Glu group differences remained significant (GABA+, p = 0.049; Glu, p = 0.039) after the inclusion of anxiety as a covariate. Additionally, GABA and Glu levels in the DLPFC of all subjects were negatively related (Pearson's r = -0.75, p = 0.003). CONCLUSIONS These findings indicate that the oral behaviours of tooth-grinding and clenching, generally known as bruxism, may be associated with disturbances in brain GABAergic and glutamatergic systems.
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