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Logue MW, Sherva R, Zhang R, Harrington K, Fonda J, Merritt V, Panizzon MS, Hauger RL, Wolf E, Miller M. A genetically informed examination of posttraumatic stress disorder and traumatic brain injury’s impact on dementia risk in US Veterans. Alzheimers Dement 2022. [DOI: 10.1002/alz.061487] [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: 12/24/2022]
Affiliation(s)
- Mark W. Logue
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
| | | | - Rui Zhang
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
| | | | | | | | | | - Richard L. Hauger
- Center for Behavior Genetics of Aging, School of Medicine, University of California La Jolla CA USA
- • Center for Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System San Diego CA USA
| | - Erika Wolf
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
| | - Mark Miller
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
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Sherva R, Zhang R, Farrer LA, Sahelijo N, Jun GR, Anglin T, Chanfreau C, Cho K, Fonda J, Gaziano JM, Harrington K, Ho Y, Kremen WS, Litkowski EM, Lynch J, Neale Z, Roussos P, Marra DE, Mez JB, Miller M, Salat DH, Tsuang DW, Wolf E, Zeng Q, Panizzon MS, Merritt V, Hauger RL, Logue MW. A Million Veteran Program GWAS of Alzheimer’s Disease and Related Dementias in African Americans Identifies Multiple Genome‐Wide Significant Dementia Risk Loci. Alzheimers Dement 2022. [DOI: 10.1002/alz.063860] [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: 12/24/2022]
Affiliation(s)
- Richard Sherva
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
| | - Rui Zhang
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
| | | | | | | | - Tori Anglin
- VA Informatics and Computing Infrastructure (VINCI) Salt Lake City UT USA
| | | | - Kelly Cho
- VA Boston Healthcare System Boston MA USA
| | | | | | | | - Yuk‐Lam Ho
- VA Boston Healthcare System Boston MA USA
| | - William S. Kremen
- University of California, San Diego La Jolla CA USA
- VA San Diego Healthcare System San Diego CA USA
| | | | - Julie Lynch
- VA Informatics and Computing Infrastructure (VINCI) Salt Lake City UT USA
| | - Zoe Neale
- VA Boston Healthcare System Boston MA USA
| | - Panos Roussos
- Icahn School of Medicine at Mount Sinai New York NY USA
| | | | - Jesse B. Mez
- Boston University School of Medicine Boston MA USA
| | - Mark Miller
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
| | - David H Salat
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System Boston MA USA
| | - Debby W Tsuang
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System Seattle WA USA
| | - Erika Wolf
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
| | - Qing Zeng
- VA Washington DC Healthcare System Washington DC USA
| | | | | | - Richard L. Hauger
- Center for Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System San Diego CA USA
- Center for Behavior Genetics of Aging, School of Medicine, University of California La Jolla CA USA
| | - Mark W. Logue
- National Center for PTSD, VA Boston Healthcare System Boston MA USA
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Bernstein JPK, Fonda J, Currao A, Kim S, Milberg WP, McGlinchey RE, Fortier CB. Post-traumatic stress disorder and depression are uniquely associated with disability and life dissatisfaction in post-9/11 veterans. Psychiatry Res 2022; 313:114589. [PMID: 35533471 DOI: 10.1016/j.psychres.2022.114589] [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: 08/21/2021] [Revised: 02/09/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022]
Abstract
Veterans who served in post-9/11 conflicts and experience deployment trauma sequelae frequently endorse disability and dissatisfaction with life. Although correlated, disability and life dissatisfaction represent distinct constructs with separate implications for quality of life. We examined associations between deployment trauma sequelae, disability and life dissatisfaction in 288 post-9/11 Veterans. Participants completed assessments of psychiatric, somatic and social functioning. Self-reports evaluating disability and life dissatisfaction were used to group participants based on established criteria (i.e., Disability and Dissatisfaction, Disability Only, Dissatisfaction Only, or No Disability or Dissatisfaction). Multinomial logistic regressions revealed that greater post-traumatic stress disorder (PTSD) and depressive symptom severity were independently associated with increased odds of being in the Disability and Dissatisfaction group, the Disability Only group and the Dissatisfaction Only group, relative to the No Disability or Dissatisfaction group. Number of prior mild traumatic brain injuries (mTBI) was not associated with disability or dissatisfaction after accounting for other trauma sequelae. Social support attenuated the relationship between depression and membership in the Disability and Dissatisfaction group. Participants who reported greater dissatisfaction than disability endorsed greater depression and mTBI frequency. Overall, PTSD and depression convey a heightened risk of both disability and life dissatisfaction, while social support may be protective.
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Affiliation(s)
- John P K Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States.
| | - Jennifer Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Alyssa Currao
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States
| | - Sahra Kim
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States
| | - William P Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Health Care System, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Fortenbaugh F, Fonda J, Fortier C, Amick M, McGlinchey R, Milberg W. Predicting Functional Disability in OEF/OIF/OND Veterans. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.08.065] [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: 11/29/2022]
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Barber C, Gagnon D, Fonda J, Cho K, Hermos J, Miller M. Assessing the impact of prescribing directives on opioid prescribing practices among Veterans Health Administration providers. Pharmacoepidemiol Drug Saf 2017; 26:40-46. [PMID: 27530106 DOI: 10.1002/pds.4066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/09/2015] [Revised: 05/13/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE The study aimed to test whether directives on opioid prescribing released by the Veterans Health Administration (VHA) or the Food and Drug Administration (FDA) had an impact on prescribing among VHA providers. METHODS We used the VHA's linked pharmacy and patient medical records database to identify new prescriptions written for propoxyphene, fentanyl, and controlled release (CR) oxycodone between 1/1/2000 and 12/31/2009. We plotted the monthly proportion of these prescriptions that complied with components of four specific safety alerts or directives for these substances issued by the VHA or FDA between 1/1/2001 and 12/31/2008. We modeled compliance using interrupted time series analysis and a generalized additive model with the addition of an indicator variable to flag prescriptions that followed the directive's release date. RESULTS A total of 32.2 million new prescriptions for fentanyl, oxycodone CR, and propoxyphene were written for VHA patients meeting inclusion criteria. Compliance with guidelines in the directives increased steadily throughout the entire study period, with no clinically meaningful inflection point near the date of each directive's release. Generalized additive modeling and interrupted time series analysis found that the indicator flag slightly improved the fit of the data, but visual inspection of the plots revealed no change at a level of practical significance. CONCLUSIONS While prescribing compliance increased throughout the period, release of FDA and VHA alerts and guidelines did not appear to contribute to this change. Given the fivefold increase in the rate of drug-related overdose deaths since 1990, identifying effective methods to communicate safety messages and change prescriber behavior remains a priority for future work. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Catherine Barber
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
| | - David Gagnon
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - Jennifer Fonda
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - Kelly Cho
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - John Hermos
- VA Boston Healthcare System, Massachusetts Area Veterans Research and Information Center (MAVERIC), Boston, MA, USA
| | - Matthew Miller
- Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA
- Department of Health Sciences, Northeastern University, Boston, MA, USA
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Stojanovic MP, Fonda J, Fortier CB, Higgins DM, Rudolph JL, Milberg WP, McGlinchey RE. Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans. Pain Med 2016; 17:2017-2025. [PMID: 27040665 DOI: 10.1093/pm/pnw042] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels. DESIGN Cross-sectional. SUBJECTS 310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study. METHODS All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data. RESULTS In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P < 0.0001 and P = 0.0005, respectively). Pain levels in veterans with mTBI only were comparable to control participants. CONCLUSIONS Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain.
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Affiliation(s)
- Milan P Stojanovic
- *Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Jennifer Fonda
- Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Catherine Brawn Fortier
- Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Diana M Higgins
- *Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - James L Rudolph
- Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.,Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William P Milberg
- Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Regina E McGlinchey
- Translational Research Center for TBI And Stress Disorders (TRACTS) & Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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Miller M, Barber CW, Leatherman S, Fonda J, Hermos JA, Cho K, Gagnon DR. Prescription opioid duration of action and the risk of unintentional overdose among patients receiving opioid therapy. JAMA Intern Med 2015; 175:608-15. [PMID: 25686208 DOI: 10.1001/jamainternmed.2014.8071] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The unprecedented increase in unintentional overdose events that has occurred in tandem with escalating sales of prescription opioids over the past 2 decades has raised concerns about whether the therapeutic use of opioids has contributed to increases in overdose injury. Few controlled studies have examined the extent to which ecologic measures of increases in opioid prescribing and overdose injuries reflect risk among patients prescribed opioids, let alone whether some opioid regimens are safer than others. OBJECTIVE To examine whether the risk of unintentional overdose injury is associated with the duration of opioid action (ie, long-acting vs short-acting formulations). DESIGN, SETTING, AND PARTICIPANTS A propensity score-adjusted cohort study was conducted using population-based health care utilization data from the Veterans Administration Healthcare System. The patients were veterans with chronic painful conditions who began therapy with opioid analgesics between January 1, 2000, and December 31, 2009. MAIN OUTCOMES AND MEASURES Unintentional overdoses that are explicitly coded using International Classification of Disease, Ninth Revision codes as drug or medication poisonings of accidental intent (E850.x-860.x) or undetermined intent (E980.x or drug poisoning [960.x-980.x] without an accompanying external cause of injury code). RESULTS A total of 319 unintentional overdose events were observed. Patients initiating therapy with long-acting opioids were more than twice as likely to overdose compared with persons initiating therapy with short-acting opioids. After adjustment for age, sex, opioid dose, and other clinical characteristics, patients receiving long-acting opioids had a significantly higher rate of overdose injury than did those receiving short-acting opioids (hazard ratio [HR], 2.33; 95% CI, 1.26-4.32). The risk associated with long-acting agents was particularly marked during the first 2 weeks after initiation of treatment (HR, 5.25; 1.88-14.72). CONCLUSIONS AND RELEVANCE To our knowledge, the findings of the present study provide the first evidence that the risk of unintentional overdose injury is related to the prescribed opioid's duration of action. If replicated in other cohorts, our findings suggest that clinicians weighing the benefits and risks of initiating different opioid regimens should consider not only the daily dose prescribed but also the duration of opioid action, favoring short-acting agents whenever possible, especially during the first 2 weeks of therapy.
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Affiliation(s)
- Matthew Miller
- Department of Health Sciences and Epidemiology, Northeastern University, Boston, Massachusetts
| | - Catherine W Barber
- Department of Health Policy and Management, Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - Sarah Leatherman
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston4Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Jennifer Fonda
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston5Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - John A Hermos
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston5Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston6Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Boston Healthcare System, Boston4Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
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Lawler EV, Gagnon DR, Fink J, Seliger S, Fonda J, Do TP, Gaziano JM, Bradbury BD. Initiation of anaemia management in patients with chronic kidney disease not on dialysis in the Veterans Health Administration. Nephrol Dial Transplant 2010; 25:2237-44. [PMID: 20083469 DOI: 10.1093/ndt/gfp758] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) are frequently used to treat anaemia of chronic kidney disease (CKD) in the dialysis setting; however, few data are available regarding factors influencing initiation of ESAs and other therapies in non-dialysis patients. METHODS A retrospective cohort study of Veterans Health Administration data from 2003 to 2005 for 89 585 patients identified as having CKD and anaemia based on two outpatient estimated glomerular filtration rates <60 ml/min/1.73 m(2) and at least one outpatient haemoglobin (Hb) <11 g/dL. Hb levels, patient demographics, clinical and provider characteristics and procedures predicted ESA treatment initiation over 1 year of follow-up. Multivariable logistic and pooled logistic survival models identified predictors of ESA initiation. RESULTS Overall, 6381 subjects (7.1%) initiated ESAs within 1 year of the index Hb; initiation was more common (8.6%) for patients with Hb <10 g/dL. Iron therapy use varied by initial Hb levels (27.6% to 52.4%) as did transfusions (12.5% to 42.8%); each was more common at lower Hb levels. Hbs rose to above 11 g/dL for 25-50% of patients in the absence of any treatment or by transfusion/iron therapy. Factors predicting time to ESA initiation included: nephrologist [odds ratio (OR = 2.3)] or haematologist care (OR = 2.2) and iron therapy (OR = 1.6). Transfusions increased for patients with increasing follow-up time. CONCLUSION Iron therapy is more common than ESA treatment in patients with CKD and Hbs <11 g/dL in the VA. Correction of anaemia in the absence of any ESA treatment was common at higher Hbs levels, but much less so when Hb levels fell below 10 g/dL.
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Affiliation(s)
- Elizabeth V Lawler
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA, USA.
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