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Furst A.J.,War Related Illness and Injury Study Center | Furst A.J.,Stanford University | Furst A.J.,University of California at Davis | Lal R.A.,War Related Illness and Injury Study Center
Journal of Alzheimer's Disease | Year: 2011

This study used PET with the amyloid-β (Aβ) imaging agent 11 C Pittsburgh Compound-B (PIB) and the glucose metabolic tracer 18F-fluorodeoxyglucose (FDG) to map the relationship of Aβ deposition to regional glucose metabolism in Alzheimers disease (AD). Comparison of 13 AD patients FDG scans with 11 healthy controls confirmed a typical temporo-parietal hypometabolic pattern in AD. In contrast, PIB distribution-volume-ratios showed a distinct pattern of specific tracer retention in fronto-temporo-parietal regions and striatum in AD with peaks in left frontal cortex, precuneus, temporal cortex, striatum and right posterior cingulate. There were no region-to-region or within region correlations between FDG and PIB uptake in PIB positive AD patients but when the impact of Aβ load on glucose metabolism was assessed via probabilistic maps, increased amyloid burden was coupled with decreased metabolism in temporo-parietal regions and the posterior cingulate. However, importantly, severe Aβ burden was not associated with comparable metabolic decreases in large parts of the frontal lobes, the striatum and the thalamus. © 2011 IOS Press and the authors. All rights reserved.


Falvo M.J.,War Related Illness and Injury Study Center | Falvo M.J.,Rutgers Biomedical Health science | Osinubi O.Y.,War Related Illness and Injury Study Center | Sotolongo A.M.,War Related Illness and Injury Study Center | And 3 more authors.
Epidemiologic Reviews | Year: 2015

More than 2.6 million military personnel have been deployed to recent conflicts in Iraq and Afghanistan and were likely exposed to a variety of airborne hazards during deployment. Despite several epidemiologic reports of increased respiratory symptoms, whether or not these respiratory illnesses lead to reductions in lung function and/ or specific pulmonary disease is unclear. We reviewed data published from 2001 to 2014 pertaining to respiratory health in military personnel deployed to Iraq and Afghanistan and found 19 unique studies. Study designs were primarily retrospective and observational in nature with patient symptom reporting and medical encounter data as primary outcome measures. Two case series reported on rare respiratory diseases, and one performed a standardized evaluation of new-onset respiratory symptoms. Respiratory outcomes in relation to proximity to a specific air pollution source (i.e., smoke from burning trash and sulfur mine fire) were described in 2 separate studies. Only 2 longitudinal investigations were identified comparing pre- and postdeployment measurement of exercise capacity. In summary, published data based on case reports and retrospective cohort studies suggest a higher prevalence of respiratory symptoms and respiratory illness consistent with airway obstruction. However, the association between chronic lung disease and airborne hazards exposure requires further longitudinal research studies with objective pulmonary assessments.


Earhart G.M.,University of Washington | Falvo M.J.,War Related Illness and Injury Study Center
Comprehensive Physiology | Year: 2013

Parkinson disease (PD) is a progressive, neurodegenerative movement disorder. PD was originally attributed to neuronal loss within the substantia nigra pars compacta, and a concomitant loss of dopamine. PD is now thought to be a multisystem disorder that involves not only the dopaminergic system, but other neurotransmitter systems whose role may become more prominent as the disease progresses (189). PD is characterized by four cardinal symptoms, resting tremor, rigidity, bradykinesia, and postural instability, all of which are motor. However, PD also may include any combination of a myriad of nonmotor symptoms (195). Both motor and nonmotor symptoms may impact the ability of those with PD to participate in exercise and/or impact the effects of that exercise on those with PD. This article provides a comprehensive overview of PD, its symptoms and progression, and current treatments for PD. Among these treatments, exercise is currently at the forefront. People with PD retain the ability to participate in many forms of exercise and generally respond to exercise interventions similarly to age-matched subjects without PD. As such, exercise is currently an area receiving substantial research attention as investigators seek interventions that may modify the progression of the disease, perhaps through neuroprotective mechanisms. © 2013 American Physiological Society.


Teichman R.,Teichman Occupational Health Associates | Teichman R.,War Related Illness and Injury Study Center
Journal of Occupational and Environmental Medicine | Year: 2012

There is a long history of Veterans returning from war with concerns regarding environmental hazards that they may have experienced while in theater. The author describes some of the tools in place within the Department of Defense to capture the frequency and nature of exposure concerns of returning troops. This article then reviews the exposures of concern to Service members returning from military service in the current and recent conflicts in Afghanistan and Iraq. The author then presents some of the recent published literature on these concerns. To address these exposure concerns of Veterans, there is then a brief discussion of a new program being put in place at the Department of Veterans Affairs. Copyright © 2012 by American College of Occupational and Environmental Medicine.


Abbi B.,War Related Illness and Injury Study Center | Natelson B.H.,Pain and Fatigue Study Center
QJM | Year: 2013

Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are medically unexplained syndromes that can and often do co-occur. For this reason, some have posited that the two are part of the same somatic syndrome-examples of symptom amplification. This hypothesis would suggest that few differences exist between the two syndromes. To evaluate this interpretation, we have searched the literature for articles comparing CFS to FM, reviewing only those articles which report differences between the two. This review presents data showing differences across a number of parameters- implying that the underlying pathophysiology in CFS may differ from that of FM. We hope that our review encourages other groups to look for additional differences between CFS and FM. By continuing to preserve the unique illness definitions of the two syndromes, clinicians will be able to better identify, understand and provide treatment for these individuals. © The Author 2012. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.


Dursa E.K.,Post Deployment Health Epidemiology Program | Reinhard M.J.,War Related Illness and Injury Study Center | Barth S.K.,Post Deployment Health Epidemiology Program | Schneiderman A.I.,Post Deployment Health Epidemiology Program
Journal of Traumatic Stress | Year: 2014

Multiple studies have reported the prevalence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans; however, these studies have been limited to populations who use the Department of Veterans Affairs (VA) for health care, specialty clinic populations, or veterans who deployed. The 3 aims of this study were to report weighted prevalence estimates of a positive screen for PTSD among OEF/OIF and nondeployed veterans, demographic subgroups, and VA health care system users and nonusers. The study analyzed data from the National Health Study for a New Generation of U.S. Veterans, a large population-based cohort of OEF/OIF and OEF/OIF-era veterans. The overall weighted prevalence of a positive screen for PTSD in the study population was 13.5%: 15.8% among OEF/OIF veterans and 10.9% in nondeployed veterans. Among OEF/OIF veterans, there was increased risk of a positive screen for PTSD among VA health care users (OR = 2.71), African Americans (OR = 1.61), those who served in the Army (OR = 2.67), and those on active duty (OR = 1.69). The same trend with decreased magnitude was observed in nondeployed veterans. PTSD is a significant public health problem in OEF/OIF-era veterans, and should not be considered an outcome solely related to deployment. © 2014.


Furst A.J.,Stanford University | Furst A.J.,War Related Illness and Injury Study Center | Bigler E.D.,Brigham Young University
Neurology | Year: 2016

Over the past decade, the rate of traumatic brain injury (TBI)-related emergency department visits has increased by 70% and was estimated in 2010 at a staggering 2.5 million visits. This number is an underestimate as it does not include individuals who did not seek/receive medical care, are part of the US military service, or cared for by the Department of Veterans Affairs. One estimate states that 3 to 5 million Americans live with a TBI-related disability. 1 Of particular concern, recent data suggest an increased risk of dementia after TBI. However, it remains unclear whether there is indeed a specific link between the occurrence of Alzheimer disease (AD) later in life and a history of TBI. The suspicion of a causal relationship between TBI and AD mostly stems from the sudden emergence of the toxic β-amyloid (Aβ) protein observed in the brains of even young patients. This finding has been puzzling, as Aβ is a hallmark of AD, a late-life dementia. Whether the primarily axonal increase of Aβ is simply an epiphenomenon of TBI pathology or actually a precursor to the distinctively different extraneuronal fibrillar Aβ plaques seen in AD remains elusive. © 2016 American Academy of Neurology.


Borders A.,War Related Illness and Injury Study Center | Rothman D.J.,War Related Illness and Injury Study Center | Mcandrew L.M.,War Related Illness and Injury Study Center
Psychological Trauma: Theory, Research, Practice, and Policy | Year: 2015

Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans have high rates of posttraumatic stress disorder (PTSD), depression, and sleep problems. Identifying potential contributing factors to these mental health problems is crucial for improving treatments in this population. Rumination, or repeated thoughts about negative experiences, is associated with worse PTSD, depression, and sleep problems in nonveterans. Therefore, we hypothesized that rumination would be associated with worse sleep problems, PTSD, and depressive symptoms in OIF/OEF veterans. Additionally, we proposed a novel hypothesis that sleep problems are a mechanism by which rumination contributes to depressive and PTSD symptoms. In this cross-sectional study, 89 OIF/OEF veterans completed measures of trait rumination, sleep problems, and PTSD and depressive symptoms. Analyses confirmed that greater rumination was associated with worse functioning on all mental health measures. Moreover, greater global sleep problems statistically mediated the association between higher rumination and more PTSD and depressive symptoms. Specifically, sleep disturbance and daytime somnolence but not sleep quantity emerged as significant mediators. Although it is impossible with the current nonexperimental data to test causal mediation, these results support the idea that rumination could contribute to impaired sleep, which in turn could contribute to psychological symptoms. We suggest that interventions targeting both rumination and sleep problems may be an effective way to treat OIF/OEF veterans with PTSD or depressive symptoms. © 2014 American Psychological Association.


Mccarron K.K.,War Related Illness and Injury Study Center | Reinhard M.J.,War Related Illness and Injury Study Center | Bloeser K.J.,War Related Illness and Injury Study Center | Mahan C.M.,Federal office of Public Health of Fribourg | Kang H.K.,Institute for Clinical Research
Journal of Traumatic Stress | Year: 2014

To guide budgetary and policy-level decisions, the U.S. Department of Veterans Affairs (VA) produces quarterly reports that count the number of Iraq and Afghanistan veterans with International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for posttraumatic stress disorder (PTSD; 309.81) in their electronic medical record administrative data. We explored the accuracy of VA administrative data (i.e., diagnostic codes used for billing purposes), by comparing it to chart review evidence of PTSD (i.e., medical progress notes and all other clinical documentation contained in the entire VA medical record). We reviewed VA electronic medical records for a nationwide sample of 1,000 Iraq and Afghanistan veterans with at least one ICD-9-CM code for PTSD in their VA administrative data. Among veterans sampled, 99.9% had 2 or more ICD-9-CM codes for PTSD. Reviewing all VA electronic medical record notes for these 1,000 veterans for the full course of their VA health care history revealed that PTSD was diagnosed by a mental health provider for 89.6%, refuted for 5.6%, and PTSD was never evaluated by a mental health provider for 4.8%. VA treatment notes for the 12 months preceding chart review showed that 661 veterans sampled received a VA PTSD diagnosis during that 12-month timeframe, and of these 555 were diagnosed by a mental health provider (83.9%). Thus, the presence of an ICD-9-CM code for PTSD approximated diagnoses by VA mental health providers across time points (89.6% for entire treatment history and 83.9% for 12 months prior to chart review). Administrative data offer large-scale means to track diagnoses and treatment utilization; however, their limitations are many, including the inability to detect false-negatives. © 2014.


Yan G.W.,War Related Illness and Injury Study Center | Beder J.,Yeshiva University
Military Medicine | Year: 2013

Chaplains play a unique role in the Veterans Affairs (VA) health care systems and have numerous responsibilities. Compassion satisfaction (CS), compassion fatigue (CF), and burnout (BO) are three major phenomenons that have been documented in other helping professions, but little is known about VA Chaplains' professional quality of life. This study examines a national sample of VA Chaplains and their professional quality of life along with associated factors. Two-hundred and seventeen VA Chaplains completed an anonymous Internet survey, and regression analyses were conducted to determine which variables affect professional quality of life. On average, participants report high levels of CS and low levels of CF and BO. Gender, perceived support from VA administration, and mental health (MH) integration were significant predictors for CS. MH integration and perceived support significantly affected CF. Age, MH integration, and perceived support affected BO. Significant interaction effects were found for CF and BO. In summary, younger Chaplains and Chaplains who report low levels of collaboration with MH professionals are most likely to develop CF and BO. This supports continued support from the VA for interdisciplinary initiatives and mentorship of younger Chaplains.

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