VA tests new screening tool for early cancer detection
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VA is partnering with Grail, LLC, to test a new cancer screening tool with the potential to detect cancer at an early stage through blood testing. The Wilkes-Barre VA Medical Center is the first of 10 VA sites to participate in the study, which will eventually make the Galleri multi-cancer early detection blood test available to 10,000 Veterans to test its effectiveness. In an earlier clinical trial, the Galleri test was able to detect more than 50 types of cancer, more than 45 of which currently lack recommended screening tests. If successful, the new blood test could make it possible to detect many different forms of cancer at early stages, when treatment is most likely to succeed. (May 25, 2023)
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Researchers use rock-paper-scissors to test new brain-computer interface
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VA San Diego researchers developed a noninvasive brain-computer interface capable of decoding hand gestures. The team used magnetoencephalography – measuring the brain’s magnetic fields to decode the electrical activity of neurons – to predict what gestures participants were thinking of during a rock-paper-scissors game. A machine learning algorithm was then able to decode the correct hand gestures from brain scans with high accuracy. The results show the potential of this noninvasive approach to allow users to control prosthetic devices with their minds. (Cerebral Cortex, May 13, 2023)
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PTSD treatment could lower cardiovascular risk
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Durham VA and Duke University researchers learned that psychotherapy treatments for PTSD may also lower the risk of coronary heart disease. Researchers compared cardiovascular biomarkers between participants with PTSD receiving cognitive processing therapy and those on a waiting list. Those receiving psychotherapy showed significant improvements in several measures of heart rate variability, which is a sign of cardiovascular risk. The researchers concluded that effective treatment of PTSD not only reduces psychological distress but could also lower risk of heart disease. (Journal of Psychosomatic Research, May 2, 2023)
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Providers can use PACT Act to help Vets with feelings of institutional betrayal
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A New Jersey VA research team interviewed a small group of Veterans to assess feelings of institutional betrayal, specifically, the perception that the U.S. government has failed to adequately prevent, acknowledge, and treat conditions caused by military environmental exposures, and in doing so has betrayed its promise of caring for Veterans. The interviews also explored the notion of institutional courage, a term developed to describe organizations that proactively protect and care for their members. Veterans’ depictions of courageous institutions contained key themes of being accountable, proactive, and mindful of unique experiences, supporting advocacy, addressing stigma related to public benefits, and offering safety. The study found the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) provides an opportunity to improve care for Veterans with environmental exposure concerns, mitigate institutional betrayal, and promote institutional courage. (MDPI, May 17, 2023)
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New AI tool better identifies Vets with evictions who need additional help
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VA researchers in Massachusetts recently developed a new natural language processing (NLP) model, which is a branch of artificial intelligence, to identify eviction status in electronic health records. The new system, known as the Knowledge Injection based on Ripple Effects of Social and Behavioral Determinants of Health (KIRESH), has already been shown to substantially outperform other state-of-the-art NLP models. When combined with a novel prompt the team designed, KIRESH was able to automatically detect Veterans’ eviction status from VA electronic health records. Researchers aim to use KIRESH as an eviction surveillance system to help address commonly related effects for Veterans, such as housing insecurity, unemployment, long-term poverty, and mental health problems. (Journal of the American Medical Informatics Association, May 18, 2023)
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New treatment may reduce abdominal aortic aneurysms, preventing rupture
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A VA-funded study found that mesenchymal stromal cells (MSCs), a type of stem cell, may be effective in slowing the growth of abdominal aortic aneurysms by reducing inflammation. Investigators at the Indianapolis VA Medical Center administered intravenous MSCs from a healthy donor to a patient with a small abdominal aortic aneurysm. The analysis found the procedure was safe, causing no allergic reactions. Seven days after treatment, there was a significant increase in the concentration of anti-inflammatory IL-10 among participants in both the high- and low-dose MSC groups compared with the placebo group. At day 14, there was a significant decrease in the percentage of inflammatory Th17 cells in both the high- and low-dose MSC groups. The researchers say further study is recommended. (American Heart Association, May 10, 2023)
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VA, Denmark test AI model to predict pancreatic cancer
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A Boston VA study applied artificial intelligence (AI) methods to clinical data from 6 million patients in the Danish National Patient Registry and 3 million patients in the VA’s Corporate Data Warehouse to create a machine learning model that can predict pancreatic cancer as much as five years in advance. Approximately 80% of patients with pancreatic cancer are diagnosed in the late stage, when long-term survival is extremely uncommon: just 2% to 9% at five years. This makes early detection critical, but current methods such as biomarkers and family history only catch a fraction of cases. The AI was based on predictive machine learning models for other types of cancer, and researchers designed it to report risk scores for pancreatic cancer occurrence at intervals of three, six, 12, 36, and 60 months of the date of risk assessment. These results improve the ability to design realistic surveillance programs for patients at elevated risk and could provide life-saving early detection of an aggressive cancer. (Nature Medicine, May 8, 2023)
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VA program provides Veterans self-care skills for chronic pain
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The Empower Veterans Program (EVP) is a 10-week interdisciplinary group medical appointment that provides Veterans with a host of chronic pain self-care skills for a whole-health driven approach to pain management. The initiative is in alignment with the 2016 Comprehensive Addiction and Recovery Act and VA’s Stepped Care Model, and it is funded by the Offices of Rural Health and Pain Management, Opioid Safety, and Prescription Drug Monitoring Program. A sample of 639 Veterans enrolled in EVP between May 2015 and December 2017 indicated participants showed significant improvement in three primary pain outcomes – intensity, interference, and catastrophizing – and 12 of 17 secondary outcomes, including quality of life, acceptance, and mindfulness measures. The data proves positive psychological and physical outcomes are possible through nonpharmacological means. (BMC Health Services Research, May 3, 2023)
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VA considers multiple factors for telehealth, foremost is patient preference
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A study by Greater Los Angeles VA researchers revealed that primary care team members consider several factors when assessing both the suitability of telehealth for appointments and whether to use phone or video. The decisions were largely guided by patient-related factors, including patient preferences, specific health issues, and access to technology. Additional considerations centered on team members’ personal preferences and factors that supported the wellbeing of the team, such as the flexibility to work from home and protection from infection. Generally, participants viewed the option of both telephone and video telehealth modalities as useful tools in the care of patients, although a few respondents emphasized its inferiority to in-person care. The findings determined that telehealth should be considered a useful tool both for care of patients and employee well-being, but suitability should be determined by multiple factors like resources, preferences, and timing. (Journal of Primary Care & Community Health, May 12, 2023)
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VA care is better than or equal to non-VA care
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A review by VA Greater Los Angeles researchers found that VA care is consistently as good or better than non-VA care. The researchers looked at 37 studies published between 2015 and 2023 comparing care in the VA health care system with VA-paid community care. Clinical quality and safety of VA care was rated better than non-VA care in most studies. All studies found patient experience in VA to be better than or equal to non-VA care. Results on care access, cost, and efficiency were mixed, although few studies addressed these areas. (Journal of General Internal Medicine, April 19, 2023)
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VA study identifies potential new treatment for fatty liver disease
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VA Nebraska-Western Iowa Health Care System researchers discovered a potential new treatment for alcoholic fatty liver disease. Their work with ethanol-fed rats showed that alcohol consumption leads to the formation of lipid droplets, which is a type of fat accumulation in the liver. Rats given supplements of betaine, a compound naturally created in the liver, developed fewer and smaller lipid droplets. The researchers concluded that treatment with betaine has the potential to slow or prevent the development of alcoholic fatty liver disease. (Biology, March 16, 2023)
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Personality disorders frequent in justice-involved Veterans
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A VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention study found that justice-involved Veterans were much more likely than other Veterans to have a personality disorder diagnosis. Researchers examined data on more than 1.6 million Veterans, about 12% of whom had been involved with the criminal justice system. Veterans who accessed VA justice-related services were about three times more likely to have a personality disorder. This connection was true for both male and female Veterans. The researchers suggested that VA’s justice-related services be augmented with psychotherapy to address possible personality disorders in these Veterans. (Journal of Nervous and Mental Disease, May 1, 2023)
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Sleep apnea may explain link between anger and PTSD, chronic pain
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VA researchers showed that sleep problems may be to blame for anger issues linked to mental health conditions in Veterans. In a group of more than 1,500 Veterans and service members, PTSD symptoms; pain interference, the extent to which pain interferes with life; and hazardous alcohol use were associated with uncontrolled or chronic anger. Analysis revealed that obstructive sleep apnea largely accounted for the link between anger and both PTSD and pain. The researchers concluded that treating obstructive sleep apnea could be a new way to reduce anger problems caused by PTSD and chronic pain. (Journal of Psychiatric Research, March 2023)
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Frailty increases risk of death after bypass surgery
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A study of more than 13,000 Veterans found that frail Veterans were significantly more likely to die after bypass surgery for coronary artery disease. Frail Veterans had a 75% higher risk of dying from any cause within five years of coronary artery bypass grafting surgery compared to Veterans without frailty, while Veterans assessed as pre-frail had a 20% higher risk. Frail and pre-frail Veterans were more likely to die or return to the hospital in the first year after surgery. The results suggest a need to address frailty before coronary surgery. The study group included researchers from the Cleveland, Boston, and Pittsburgh VA health care systems. (Journal of the American Geriatric Society, April 21, 2023)
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Researchers develop potential new liver cancer treatment
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VA San Diego and University of California San Diego researchers created a potential new way to treat liver cancer. The researchers developed nanoparticles derived from the cowpea (black-eyed pea) mosaic virus, a virus that normally only infects legumes. Using a mouse model of liver cancer, they tested the nanoparticles on tumors along with cryoablation, a process that uses extreme cold to destroy tumor cells. The combined treatment delayed and inhibited cancer growth and also caused some shrinking in tumors not directly targeted by the treatment. This treatment triggered an increase in immune cells and reduced expression of compounds that promote tumor growth. The therapy could lead to an effective treatment for hepatocellular carcinoma, the most common form of liver cancer. (Journal of Vascular and Interventional Radiology, March 28, 2023)
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Sepsis treatments accelerated while decreasing use of antibiotics
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A VA Ann Arbor Healthcare System study proved it was possible to hasten sepsis treatment while simultaneously decreasing overall antibiotic use. The study reported on temporal trends in antibiotic prescribing among more than 1.5 million hospitalizations in nationwide VA and Kaiser Permanente Northern California health care systems. Between 2013 and 2018, the average time to administer antimicrobial treatments among sepsis hospitalizations decreased by 37 minutes, while overall antibiotic use also decreased in the majority of instances. Clinical outcomes, such as mortality from sepsis, also improved over time. Researchers believe this study shows the feasibility of accelerating sepsis care while reducing overall antibiotic use. (JAMA Internal Medicine, June 27, 2022)
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Cardiovascular risk factors linked to Alzheimer’s disease
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A team including researchers from the San Diego and San Francisco VAs found that cardiovascular risk factors could play a critical role in the development of Alzheimer’s disease. The study assessed adults 50 and older without dementia for cognition, biomarkers of Alzheimer’s disease in the blood, and cardiovascular risk factors such as high blood pressure, diabetes, and obesity. Those with high cardiovascular risk factors were more likely to have increased Alzheimer’s biomarker levels and lower cognitive processing. The results suggest that poor cardiovascular health is linked to cognitive degeneration. (Alzheimer’s & Dementia, March 8, 2023)
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Serious adverse events from dentist-prescribed opioids rare in Veterans
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VA researchers from Hines, Ill., and Pittsburgh showed that poisoning or death from opioids prescribed by VA dentists were rare. Dentists are one of the leading prescribers of opioids, and dentist-prescribed opioids have been linked to serious adverse events. Out of nearly 140,000 Veterans prescribed an opioid by a dentist between 2015 and 2018, only 0.1% suffered opioid poisoning, and 1.1% died from any cause within six months of a dental visit. The rates of adverse events from VA dental prescriptions were lower than those reported in other studies on dental prescribing. (Journal of Public Health Dentistry, Feb. 17, 2023)
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Suicidal ideations among Veterans fell during pandemic
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Despite concerns that Veterans would be at a high risk of suicide because of the COVID-19 pandemic, a recent study by VA Connecticut researchers found that rates of suicidal thoughts in Veterans actually decreased after the onset of the pandemic. The study included more than 2,000 Veterans assessed for suicidal thoughts. In this group, 9.3% reported suicidal thoughts pre-pandemic in 2019, which dropped to 6.8% in 2020 before increasing slightly to 7.7% in 2022. Only 0.4% of participants attempted suicide during the pandemic, a rate consistent with pre-pandemic numbers. The factors most associated with new suicidal thoughts were higher education, lifetime substance use disorder, pre-pandemic loneliness, and lower pre-pandemic purpose in life. (JAMA Psychiatry, April 5, 2023)
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Risk of death from COVID-19 decreased, still higher than flu risk
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St. Louis VA researchers learned that the risk of death from COVID-19 is still higher than the risk of death from the flu despite a decreasing COVID-19 mortality risk. The researchers analyzed VA hospital admissions between October 2022 and January 2023. Death rates for patients admitted for COVID-19 were 6%, while death rates for flu patients were 4%. In 2020, 17% to 21% of patients hospitalized with COVID-19 died, compared with 4% of patients hospitalized for the flu. The researchers attribute the decreased COVID-19 death rate to vaccinations and improved clinical care, as well changes in virus variants. (JAMA, April 6, 2023)
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Anti-HIV drug could lower diabetes risk
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Researchers from the VAMC in Columbia, S.C., alongside colleagues from the University of Virginia, have identified an HIV medication with the potential to help prevent diabetes. The research team analyzed data on more than 32,000 Veterans with HIV who were treated in VA facilities from 2000 to 2021. Those exposed to nucleoside reverse treascriptase inhibitors (NRTIs) had a reduced risk of developing prediabetes and type 2 diabetes. Previous research with cells and animal models showed that NRTIs can improve insulin sensitivity and uptake. The results suggest that NRTIs could help lower the risk of diabetes in both people with HIV and the general population. (MedComm–Future Medicine, April 3, 2023)
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Rheumatoid arthritis linked to increased health burden
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A VA San Diego study found that Veterans with rheumatoid arthritis were more likely to be older, in a minority ethnic group, unpartnered, or have a lower income. They were also more likely to be combat Veterans with a greater trauma burden, as well as having medical conditions such as osteoarthritis, chronic pain, cardiovascular conditions, insomnia, PTSD, or alcohol use disorder. On average, 1 in 20 Veterans will have rheumatoid arthritis. The results suggest an elevated health burden may be associated with rheumatoid arthritis. (Journal of Psychiatric Research, March 2021)
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Veterans receive equal heart care whether rural or urban
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VA researchers in White River Junction, Vermont, proved rural and urban Veterans receive equal levels of care for congestive heart failure in VA clinics. The VA study analyzed electronic health records from nearly 300,000 VA patients who had congestive heart failure between 2012 and 2017. Unlike disparities often seen in non-VA care, researchers found there was no meaningful differences in care received between rural and urban Veterans. The study also found that rural Veterans were slightly less likely to use specialty care in VA, but more likely to use VA primary care and telemedicine. The findings suggest that VA may have successfully addressed access and health disparities typically seen in rural patients with congestive heart failure. The study also suggested the Veterans Choice Program may have enabled more patients to receive heart care at non-VA facilities. (Journal of Rural Health, April 2, 2023)
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Veterans support suicide screenings as part of primary care
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VA Portland researchers and colleagues surveyed 868 Veterans about VA’s suicide risk screening initiative, Risk ID, and more than 90% of Veterans said it was appropriate for doctors, nurses, or medical assistants to ask Veterans about thoughts of suicide during primary care visits. About half thought Veterans should be asked about suicidal thoughts at every visit. While Veterans were supportive of the screening process, they did indicate that additional staff training would be useful to ensure patients felt heard and to increase patient understanding of the purpose of the screenings. The survey suggests a patient-centered approach can encourage disclosure of suicidal thoughts in Veterans. (Journal of General Internal Medicine, March 20, 2023)
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Paxlovid lowers risk of COVID post-conditions, hospitalization, death
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A study by VA St. Louis researchers found that the antiviral drug Paxlovid lowers the risk of long COVID and death. The researchers looked at outcomes of more than 280,000 high-risk VA COVID-19 patients, nearly 36,000 of whom had been prescribed Paxlovid (generic name nirmatrelvir). Patients who were given the medication within five days of a positive COVID-19 test had a 26% lower risk of developing post-COVID conditions, a 47% lower risk of death from the disease, and a 24% lower risk of needing hospitalization. Paxlovid reduced the risk of long COVID symptoms in people who were unvaccinated, vaccinated, and boosted, and in people with their first infection or a reinfection. Study author Dr. Ziyad Al-Aly said the findings support using Paxlovid for high-risk patients both to treat acute COVID-19 and to lower the risk of lasting effects. (JAMA Network Open, March 23, 2023)
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Electronic analysis identifies social determinants of health as suicide risks
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A team led by VA National Center of Homelessness Among Veterans researchers used a computer program to show that social factors affecting health are risk factors for suicide among Veterans. The researchers developed a program using natural language processing to identify social determinants of health — factors such as socioeconomic status, education, and housing — from both structured and unstructured electronic health record notes. By analyzing records of more than 6 million Veterans, the team found that social factors that negatively affect health also increased suicide risk. The social determinants of health with the largest effect on suicide risk were legal problems, violence, and nonspecific psychosocial needs. The results suggest that natural language processing could help identify risk factors for suicide that may otherwise be missed. (JAMA Network Open, March 1, 2023)
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Heart problems linked to kidney problems
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Early signs of heart failure may be linked to the development of kidney disease. A team including VA researchers from Chicago, San Francisco, and San Diego compared heart and kidney function in more than 2,000 participants of a cardiovascular health study. Those who showed signs of strain on the heart muscles and heart dysfunction that did not yet rise to the clinical definition of heart failure also had higher levels of markers for kidney dysfunction. The results suggest that heart problems may lead to a decline in kidney function even in people without clinical heart failure. (Kidney360, March 8, 2023)
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VA group intervention decreases intimate partner violence
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A new VA group intervention program called Strength at Home proved cognitive behavioral therapy and motivational approaches can lead to reductions in intimate partner violence. VA researchers from Central Texas, Boston, and Washington, DC, evaluated results of the program at 73 VA health care facilities. Strength at Home led to a 17% decrease in the use of physical aggression in relationships, a 23% decrease in psychological intimate partner violence, and an 18% decrease in coercive control behavior. Symptoms of PTSD and alcohol misuse also declined as a result of the program. The results show the importance of intimate partner violence intervention as part of routine health care. (JAMA Network Open, March 14, 2023)
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Study identifies chemical that could protect kidneys from inflammation
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Researchers with the VA Calcium Signaling Laboratory in Washington, DC, identified a chemical that could help protect the kidneys from damage caused by inflammation. The team showed that the amino acid L-Arginine, which occurs naturally in the body, activates a receptor that controls how much calcium enters kidney cells. In this way, the chemical can lower the levels of chemicals that can cause scarring, inflammation, and death in kidney cells. The findings suggest that L-Arginine has the potential to help prevent kidney damage caused by conditions such as diabetes, high blood pressure, and COVID-19. (International Immunopharmacology, Feb. 22, 2023)
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Veterans with past firearm injuries twice as likely to die by suicide
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VA Portland researchers found that past nonfatal firearm injuries were linked to increased risk of Veterans dying by suicide. Out of nearly 10 million Veterans included in the study, more than 11,000 experienced nonfatal firearm injuries: 65% were unintentional injuries, 12% were intentional self-harm, and 19% were assault. Of the Veterans with previous injuries, 69 later died by suicide. Veterans with a previous firearm injury were more than twice as likely as those without a previous injury to die by suicide, even when the previous injury was accidental. The results suggest that nonfatal firearm injuries, regardless of intent, should be included in suicide risk assessments. (Academic Emergency Medicine, March 4, 2023)
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VA health care protects Veterans from medical financial hardship
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A VA study showed that low-income Veterans who use VA health care were less likely to face financial hardships caused by medical issues than those who did not. Out of more than 2,000 low-income Veterans surveyed, about 35% had VA health coverage. Those Veterans were less likely to experience both objective and subjective medical financial hardships compared to Veterans with Medicare and no VA coverage. Hardships included spending a high percentage of income on health care, difficulty paying medical bills, worrying about health care expenses, and delaying or forgoing care. VA provides low- or no-cost care to Veterans with low income, yet many eligible Veterans are not enrolled. The study team, made up of researchers from Portland, Oregon; Greater Los Angeles; and San Francisco VA health care systems, called for efforts to address Veterans’ lack of health coverage. (American Journal of Preventive Medicine, March 9, 2023)
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Self-perceived hearing loss may be linked to PTSD
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VA Pittsburgh researchers found that PTSD assessments could be useful for identifying potential hearing problems that don’t show up on normal hearing tests. The researchers looked at medical records from 286 Veterans who reported difficulties with their hearing despite normal audiometric results, and they found 16 different health conditions that may be linked to the self-reported hearing loss, with PTSD and related symptoms being the most prevalent conditions. The researchers concluded that Veterans with a higher number of diagnosed medical conditions, especially including PTSD, were more likely to have self-perceived hearing impairment as well. (Journal of the American Academy of Audiology, Jan. 19, 2023)
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Veteran cannabis, stimulant use disorder diagnoses have increased in recent years
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A study by San Francisco and Greater Los Angeles VA researchers revealed that substance use disorder diagnoses among Veterans have increased over the last decade, especially for cannabis and amphetamine use. Looking at medical records data, the researchers found substance use disorders increased for most substances between 2010 and 2015. Alcohol, cannabis, and stimulant use disorders increased by between 4% to 18% annually for 2016 to 2019, while cocaine, opioid, and sedative use disorders changed less than one percent in that time frame. Alcohol use disorder was the most common diagnosis. Amphetamine and cannabis misuse increased the most rapidly in both time periods, and older Veterans had the largest increases in diagnoses across substances. The findings highlight a need to address cannabis and amphetamine misuse, which have fewer treatment options than alcohol or opioid use disorders. (American Journal of Addictions, March 8, 2023)
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Veterans with dementia more likely to visit emergency departments
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In a study of data from more than 3 million Veterans, VA researchers from Durham, North Carolina, and Palo Alto, California, learned that Veterans with dementia are significantly more likely to use emergency departments than those without. In the study group of Veterans 65 years and older, about 8% had a dementia diagnosis. These Veterans were nearly twice as likely to have an emergency department visit and were admitted to the hospital at higher rates. The most common reasons for emergency department visits were falls, weakness, and abnormal mental state, all of which were more common in Veterans with dementia. The results show that emergency departments are common health care access points for Veterans with dementia and suggest that targeted interventions may be needed to improve acute care for these Veterans. (Academic Emergency Medicine, Feb. 9, 2023)
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Stressful life events increase Veterans’ risk of homelessness
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A VA study showed that stressful life events after transitioning from military to civilian life are a key factor in the risk of homelessness. The researchers surveyed more than 16,500 military members while they were on active duty and again after they returned from service. Those who faced stressful life events such as serious illness, financial crisis, and interpersonal problems were significantly more likely to experience homelessness after their service. Personal betrayal by a loved one and economic problems played the largest roles in homelessness risk. The study team included VA researchers from Birmingham, Alabama, Washington, DC, and San Diego. They conclude that Veteran homelessness might be reduced by gearing interventions toward the effects of stressful life events experienced during the transition back to civilian life. (Public Health Reports, Feb. 1, 2023)
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Interaction between other medications and genes could make opioids less effective
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An analysis of how different medications interact with genes showed that many Veterans are taking drug combinations that make opioid treatment less effective. Researchers looked at data on 2.4 million Veterans with at least one opioid prescription for pain. About 22% had an elevated risk of an undesirable response to opioid medication based on the other drugs they were taking and their genetic profiles. A gene called CYP2D6 influences how the body metabolizes opioids. Some antidepressants also interact with CYP2D6, which can alter how opioids act in the body. Based on these gene interactions, the researchers found that about 4% of Veterans studied had drug combinations that increased the risk of toxicity and 17% were taking combinations that could lead to poorer metabolization of opioids, which can make them less effective. The researchers conclude that using genetic testing to find these interactions could make precision medicine and pain management more effective. (Pain, Dec. 1, 2022)
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Veterans with or without head trauma benefit from magnetic treatment for depression
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VA researchers demonstrated that traumatic brain injury does not lower the effectiveness of transcranial magnetic stimulation (TMS) to treat depression. In a group of more than 600 Veterans who received TMS for depression, both those with and without a history of mild traumatic brain injury saw depression symptom improvement regardless of how many traumas they had. TMS applies a magnetic field to the outside of the head to alter brain electrical signals, but researchers weren’t previously sure whether a history of traumatic brain injury would make the TMS less effective at treating depression. The research team consisted of investigators from Providence, Rhode Island, and San Diego and Palo Alto in California. The results show that mild traumatic brain injury should not disqualify Veterans from TMS treatment. (Neuromodulation, Feb. 1, 2023)
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Rural Veterans more likely to be overprescribed antibiotics
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VA researchers from Providence, Rhode Island, found that inappropriate antibiotic prescribing is more common in rural areas. Excessive antibiotic use can lead to drug-resistant infections and side effects. The researchers looked at data for 1.4 million Veterans who received outpatient antibiotic prescriptions in VA over a 10-year period. Veterans living in rural areas were more likely than Veterans in urban areas to be prescribed fluoroquinolones, which are broad-spectrum antibiotics often overprescribed when more selective antibiotics are available. Rural Veterans were also more likely to receive longer antibiotic prescriptions. The researchers conclude that outpatient antibiotic prescribing must be improved, particularly for rural Veterans. (Antibiotics (Basel), Jan. 20, 2023)
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Cancer drug has potential for repurposing as arthritis treatment
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A team including researchers from the Jesse Brown VA Medical Center in Chicago identified a drug with potential to reduce arthritis pain and prevent joint damage. Using a mouse model, the researchers tested the effects of pazopanib, a drug normally used to treat kidney cancer, on osteoarthritis pain. They found that injections of pazopanib immediately relieved pain and also prevented cartilage degeneration. The drug suppresses the expression of proteins involved in pain signaling and cell growth. The researchers are hopeful that pazopanib can be developed into an effective treatment for osteoarthritis in humans. (International Journal of Biological Sciences, Jan. 1, 2023)
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Homeless Veterans receive better depression care in homeless-tailored clinics
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VA Greater Los Angeles researchers and colleagues looked at treatment data for nearly 3,000 homeless Veterans who screened positive for depression, 13% of whom were treated in homeless-tailored primary care clinics. About 63% of Veterans receiving homeless-tailored care had a follow-up appointment within 84 days of depression screening, compared with 46% of those receiving standard care. The study also found that slightly more Veterans in homeless-tailored care received the correct amount of mental health treatment: 89% versus 82% in standard care. The results highlight the benefit of tailoring mental health care to the specific needs of homeless Veterans. (Journal of General Internal Medicine, Feb. 21, 2023)
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Insomnia only indirectly linked to suicidal thoughts
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VA Rocky Mountain researchers showed that insomnia is linked to mental health disorders, but not directly to suicidal thoughts. In an analysis of more than 300 Veterans, those with insomnia were more likely to have depression, PTSD, and anxiety symptoms than Veterans without insomnia. The researchers did not find a direct link between insomnia and suicidal thoughts after the other mental health conditions were taken into consideration. The findings suggest that insomnia may contribute to suicide risk through worsening mental health symptoms, rather than directly increasing risk. (Journal of Clinical Psychology, Jan. 25, 2023)
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Physical activity improves memory in older adults
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VA San Diego researchers and colleagues demonstrated that engaging in physical activity can help improve memory and cognitive function in older people. Forty-three older adults wore accelerometers for a week to measure their activity levels before undergoing cognitive testing. More time spent in moderate to vigorous activity was linked to better memory and executive function. MRI scans showed that physical activity may also improve cerebrovascular health. The results add to the evidence that exercise not only improves physical health, but also mental health. (Journal of the International Neuropsychological Society, Feb. 15, 2023)
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Memphis study proves providing support to parent caregivers helps Veterans
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Memphis VA researchers provided either six one-hour, one-on-one, behavioral sessions or six 30-minute prerecorded, online, educational webinars to 163 parent caregivers of Veterans and then assessed them for mental health outcomes. Parents in both groups improved significantly in depression, anxiety, and burden. Their ability to report troubling behaviors in the Veterans under their care also improved. Parents in the one-on-one group reported greater satisfaction, understanding of post-9/11 injuries, and coping skills. Both groups said the interventions improved their self-reflection, feelings of loneliness, self-efficacy, and ability to help. The results show that organizations with varying resources can provide meaningful support to caregivers of Veterans. (NeuroRehabilitation, Jan. 20, 2023)
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Medication for gout, kidney stones may help preserve diabetic patients’ vision
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Columbia VA researchers found that allopurinol, a medication used to treat gout and kidney stones, could reduce the risk of diabetic macular edema, a condition that can lead to blindness. Allopurinol stops the release of substances in the body that cause inflammation, which may prevent fluid build-up in the retinas. In a group of Veterans with type 2 diabetes, those taking allopurinol had a 25% lower risk of diabetic macular edema, which is one of the major causes of vision problems in people with diabetes. The researchers concluded that this drug has the potential to be repurposed for diabetic patients. (Ocular Immunology and Inflammation, Feb. 7, 2023)
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Computer model could help predict response to depression treatment
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VA researchers developed a machine learning model to predict how well Veterans would respond to combined antidepressants and psychotherapy treatment for depression. The computer model accurately predicted the 30% of Veterans who responded favorably to the combined treatment out of more than 600 Veterans in the study. The most important predictors of treatment response were psychological resilience, symptoms and co-occurring health conditions, recent stressors, and treatment characteristics. This type of machine learning approach could help doctors predict how patients with depression will respond to treatment and allow them to adjust accordingly. (Journal of Affective Disorders, Jan. 26. 2023)
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Vitamin D supplementation linked to lower suicide risk
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A VA study found that vitamin D supplements might drastically reduce suicidal ideations in Veterans. Canandaigua VA Medical Center researchers looked at data from 2010 to 2018 and found that Veterans with vitamin D prescriptions had a 45% lower risk of suicide attempts and a 48% lower risk of self-harm. The difference in risk level was even higher in Black Veterans and those with lower starting vitamin D levels. Vitamin D deficiency is more common in people with darker skin tones. Researchers also found that Veterans prescribed higher doses of vitamin D supplements had lower suicide risk than those given lower doses. The results suggest that vitamin D supplements hold promise as a treatment to help prevent suicide. (PLoS One, Feb. 1, 2023)
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Female Veterans report frequent mental distress
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A VA Pittsburgh study found female Veterans are more likely to experience mental distress than male Veterans or female non-Veterans. Researchers analyzed data on self-reported mental distress in a national sample of people over a 17-year period. In each year, female Veterans reported significantly more days of mental distress and a higher prevalence of frequent mental distress than male Veterans. In several of the years studied, female Veterans also reported greater levels of mental distress than non-Veteran women. The findings highlight the need for more specific efforts to address mental health among female Veterans. (Journal of Behavioral Health Services and Research, January 2023)
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Racial disparities in chronic pain care
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Iowa City VA researchers identified potential racial disparities in Veteran chronic pain treatment. The study included more than 2 million Veterans who received treatment in VA for chronic pain in 2018. The researchers found no differences based on race in pain-related primary care visits. However, Black Veterans were less likely than White Veterans to receive pain clinic visits. Black Veterans who lived in rural areas were even less likely to visit a pain clinic. Black and Hispanic Veterans were more likely than White Veterans to go to the emergency department or urgent care for chronic pain. On the other hand, Black, Hispanic, and Asian Veterans were more likely to receive pain-related physical therapy visits than White Veterans. Although rates of primary care visits were similar, the researcher concluded that lower pain clinic visits and increased use of urgent care could indicate inadequate chronic pain management among Black Veterans. (Journal of Rural Health, Jan. 25, 2023)
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Study tests how long anti-clotting drugs should be taken after heart surgery
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VA Boston researchers determined that nine months may be the ideal amount of time for patients to take anti-clotting medication after heart surgery. Doctors prescribe antiplatelet medicines to prevent clotting after implanting a stent to clear blocked arteries. While these medications are needed to lower the risk of heart attack and other heart concerns, they also raise the risk of major bleeding problems. Researchers compared outcomes of more than 40,000 patients who had stent surgery and were prescribed dual antiplatelet therapy for different lengths of time. The risk of death was higher when patients stopped taking the medications less than nine months after surgery, compared with longer medication times. Discontinuing medication after nine months was linked to lower risk of death, heart attack, and major bleeding compared to continuing the medication for longer. Many current guidelines call for prescribing the medications for more than 12 months, but the results clearly support stopping dual antiplatelet therapy after nine months. (Journal of the American Heart Association, Jan. 17, 2023)
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Effects of military service on brain injury symptoms vary
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A VA study found that combat deployment, era of service, and length of service all affect how Veterans are affected by traumatic brain injury (TBI). Researchers looked at data on nearly 8,000 people with TBI treated at private-sector hospitals. One year after the injury, those with a history of combat deployment were more likely to have lung disorders, PTSD, and sleep disorders than non-Veterans and Veterans who did not see combat. Veterans who served in the post-draft era were more likely than non-Veterans and Veterans from earlier eras to have chronic pain, liver disease, and arthritis. Veterans who served for more than four years had increased risk of high cholesterol, PTSD, and sleep disorder compared to those who were in the military for a shorter period. Veterans who did not see combat had better cognition and psychological health in the first five years after injury than non-Veterans. The results show that multiple individual factors need to be considered when assessing Veterans’ post-TBI health. (Journal of Neurotrauma, Dec. 28, 2022)
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VA doctors develop elder abuse screening tool
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VA researchers and clinicians at the Louis Stokes Cleveland VA Medical Center emergency department developed a tool to screen older patients for elder abuse during visits. Emergency visits for injury or illness may be the only time isolated older Veterans leave their homes, but most VA emergency departments do not have standardized elder abuse assessment protocols. Out of 251 Veterans screened with the new tool, nine screened positive for possible elder abuse: a screen rate similar to those found by other measures of elder abuse. Based on the success of the pilot, six additional VA emergency departments began using the screening tool, and work is underway to add the tool to the VA electronic health record system. (Academic Emergency Medicine, Dec. 27, 2022)
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Military sexual trauma increases suicidal thoughts and attempts
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A VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) for Suicide Prevention study showed military sexual trauma is frequently associated with suicidal thoughts and attempts in female Veterans. More than 300 female Veterans receiving reproductive health care through VA participated in the survey, and about 69% screened positive for military sexual trauma. Women who had experienced either sexual harassment or sexual assault had increased risk of suicidal thoughts following military service. Furthermore, 31% of study participants reported military sexual trauma on the survey but had a negative screen in their electronic health record, highlighting the problem of military sexual trauma underreporting. The researchers recommend increasing efforts to remove barriers to military sexual trauma disclosure. (Journal of Interpersonal Violence, Jan. 25, 2023)
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Back hunching linked to increased risk of death in older men
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A study by VA researchers and colleagues found that back hunching caused by age is linked to increased risk of death in older men. Many older people develop an exaggerated, forward rounding of the upper back, called hyperkyphosis, usually caused by weakening of the spinal bones. Researchers followed more than 6,000 men age 65 or older for an average of eight years after measuring back curvature. Those with greater back curvature had a higher chance of death than those with straighter posture. The association remained even when the researchers adjusted for other measures of physical function such as bone density and walking speed. The findings suggest that hyperkyphosis identified during a physical exam should be evaluated and treated to prevent worsening health. (Journal of the American Geriatrics Society, Oct. 28, 2022)
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Trauma-associated sleep disorder common in Veterans
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A study by VA Durham researchers found that trauma-associated sleep disorder is common in Veterans. Trauma-associated sleep disorder refers to nightmares and disturbed sleep linked to traumatic experiences. While nightmares are often associated with PTSD, trauma survivors commonly report nightmares even when they don’t have PTSD. In a group of nearly 4,000 Veterans, 12% had trauma-associated sleep disorder. Male and female Veterans had similar rates of sleep disorder. Veterans with the condition had almost four times the prevalence of PTSD and major depressive disorder, compared with those without the sleep disorder. The results highlight the need for improved screening for trauma-associated sleep disorder in Veterans, which is not currently part of routine clinical practice. (Sleep Advances, Jan. 12, 2023)
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VA tablet program increased Veterans’ telehealth use during pandemic
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The VA Office of Connected Care widely expanded its video-enabled tablet program at the onset of the pandemic, increasing the number of Veterans who received tablets nearly six-fold. When VA Palo Alto researchers and colleagues compared pandemic access numbers to those from 2019 and 2020, they found that Veterans who received tablets during the pandemic were more likely to use video care, and they did so more frequently than those who received tablets before the pandemic. However, older Veterans, or those unstably housed, were less likely to use video visits than other groups. The researchers concluded interventions may be needed to improve telehealth access for Veterans with unstable housing or who are less familiar with technology. (Journal of Medical Internet Research, Dec. 20, 2022)
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Patients who have had surgery for lung cancer might not need extra surveillance
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A VA St. Louis study found that high-frequency surveillance may not improve outcomes for patients who had surgery for lung cancer. Researchers followed Veterans who had surgery for non-small cell lung cancer for an average of seven years. About half had computed tomography (CT) scans every 6 to 12 months, while the other half had CT scans every 3 to 6 months. The analysis did not show any difference in cancer recurrence rates or overall survival between the two groups. The researchers suggest that future lung cancer treatment guidelines consider less frequent surveillance imaging to reduce patient anxiety and mitigate costs. (Journal of the National Cancer Institute, Nov. 29, 2022)
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VA identifies predictors of Veteran homelessness
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Researchers analyzed data from 2012 to 2021 on more than 570,000 Veterans in order to identify predictors for who is most likely to use VA’s Supportive Services for Veteran Families (SSVF) program and achieve stable housing. SSVF is the nation’s largest program for homelessness prevention and rapid rehousing services. Veterans with higher levels of education had longer and more frequent SSVF use and were less likely to exit the program for stable housing — researchers speculated this may be due to higher prevalence of vulnerabilities, such as lack of social support or more time searching for jobs that met Veterans’ qualifications. Veterans with greater disease burden were also less likely to achieve stable housing. However, those with mental health diagnoses or higher VA outpatient costs were more likely to find stable housing, suggesting greater engagement. Naturally, Veterans with a higher income were associated with a higher likelihood of exiting the program for stable housing, as well as shorter time in SSVF and fewer repeat usage episodes. Rural Veterans were also more likely to exit SSVF for stable housing and had fewer repeat uses than urban Veterans. These findings could help the VA to better direct resources to Veterans most in need of homelessness assistance. (Evaluation and Program Planning, Dec. 26, 2022)
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Potential new treatment to prevent dementia
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James A. Haley Veterans Hospital researchers and colleagues developed a potential new approach to preventing dementia onset caused by aging. Previous research has shown defective insulin signaling in the brain plays a role in the early stages of dementia. Using a mouse model, the researchers showed that the RNA gene GAS5 regulates insulin signaling and affects neuron health. Nasal spray treatment with a molecular compound called NPC86, which binds to GAS5, increased GAS5 expression and improved neuron cellular function in mice. The results suggest that medications targeting the GAS5 gene have potential to slow or prevent the beginning of neurodegenerative diseases, such as Alzheimer’s disease. (Scientific Reports, Jan. 6, 2023)
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Social workers in primary care teams lead to more palliative care use
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Adding social workers to primary care teams increased palliative care use by Veterans in VA health care. Palliative care refers to health care aiming to improve quality of life and ease suffering in patients with serious, complex illnesses rather than focusing only on the condition. Researchers analyzed data on more than 43,000 Veterans receiving care at 71 VA primary care sites. Adding social workers to Patient Aligned Care Teams led to a two-fold increase in the number of Veterans who used palliative or hospice care after a hospital stay. Researchers concluded that including social workers in primary care teams can improve Veterans’ quality of care and use of high-value services. (JAMA Network Open, Jan. 3, 2023)
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Higher suicide rates among lower-ranking soldiers
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A study by the VA Rocky Mountain Mental Illness Research Education and Clinical Center found that lower-ranking enlisted soldiers had higher suicide rates than higher ranks. The study included more than 860,000 Army soldiers who returned from deployment in Afghanistan or Iraq from 2008 through 2014. The lowest-ranking soldiers had a suicide rate 1.58 times higher than higher-ranking enlisted soldiers and 2.41 times higher than officers. Suicide rates for lower-ranking soldiers remained higher for 11 years after deployment. This difference between ranks was consistent between both men and women. The results highlight the importance of targeting lower-ranking military members for post-deployment suicide prevention efforts. (Injury Epidemiology, Dec. 23, 2022)
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Horse riding program could benefit Veterans with PTSD
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A VA Salt Lake City study showed Veterans with PTSD may benefit from a horse-riding program. Eighteen Veterans with PTSD demonstrated mood symptom improvement after participating in a pilot program of horsemanship lessons and trail rides. Participants also showed signs of enhanced psychological flexibility, defined as the ability to be present in the moment and fully aware of emotions and thoughts. No injuries occurred, showing the program can be run with minimal risk. The results provide preliminary evidence equine therapy may be useful for Veterans with PTSD even without a mental health treatment component. (Complementary Therapies in Medicine, Dec. 16, 2022)
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Pharmacy specialist involvement improves diabetes care
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A VA North Florida/South Georgia study found Veterans were prescribed diabetes medication with cardiovascular benefits more often when clinical pharmacy specialists were involved in their diabetes care decisions. Cardiovascular disease commonly occurs with diabetes cases. While some newer diabetes medications may protect against heart failure, there are several other diabetes medications that might worsen cardiovascular disease. Researchers analyzed data on more than 8,000 VA patients with diabetes. Of the 2,000-plus Veterans who had their treatment co-managed by a clinical pharmacy specialist, about 19% were prescribed heart-beneficial medications, compared to only 3% of those without specialist involvement. Researchers concluded clinical pharmacy specialists can help optimize treatment for patients with diabetes. (Journal of Pharmacy Practice, Dec. 5, 2022)
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Online screening tool helps connect Veterans to mental health care
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Iowa City VA researchers showed that an online screening tool can help connect service members returning from deployment with mental health care. More than 400 Reserve and National Guard service members tried the Web-Ed online program, which includes mental health screenings, personalized education, and links to VA health care. Sixty-nine percent of women and 72% of men screened positive for at least one mental health condition. Almost half said they planned to seek further assessment from a health care provider as a direct result of Web-Ed. Most users said they would recommend Web-Ed to other Veterans and that they received useful information. Personalized, online screening has the potential to engage Veterans who have not sought mental health care, according to the researchers. (Military Medicine, Dec. 13, 2022)
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Mindfulness could help Veterans with suicidal thoughts
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Mindfulness training has the potential to help Veterans admitted to a facility for suicidal thoughts, according to a VA Salt Lake City study. Mindfulness refers to being aware of the present moment through meditation and mental exercises. In this pilot study, 20 Veterans admitted to a psychiatric unit for suicidal thoughts received either mindfulness training or treatment as usual. The training was feasible in an in-patient setting, with no adverse effects. Participants in the mindfulness group were better able to view their experiences with curiosity while disengaging from experience without emotional overreaction. Both groups experienced significant reductions in suicidal thoughts. There was no difference between groups in in-patient or emergency department admissions after treatment. The results show that teaching mindfulness could help Veterans with suicidal thoughts, according to the researchers, but larger studies are needed to determine its effectiveness. (Military Medicine, Oct. 8, 2022)
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Special operation forces experience greater TBI symptoms
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Special operations forces personnel reported greater traumatic brain injury (TBI) symptom severity compared to conventional forces, in a study by James A. Haley Veterans’ Hospital researchers and colleagues. Special operations forces are at increased risk of TBI compared with conventional forces. In a group of service members and Veterans receiving in-patient rehabilitation for TBI, special operations personnel had greater PTSD symptoms, but less alcohol and drug use, than conventional forces. These personnel also reported greater neurobehavioral symptoms, such as dizziness, vision problems, and slowed thinking. Addressing TBI symptoms in special operations forces may be especially important, concluded the researchers. (Military Medicine, Oct. 29, 2022)
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Peer health coaching could help address health care needs of homeless Veterans
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Peer coaching can help address the health care needs of homeless Veterans, according to a VA study. Twenty homeless Veterans who frequently used acute health care were offered weekly health coaching sessions with a peer over 12 weeks. On average, participants attended a little over six sessions. Satisfaction with the program was high, and Veterans’ perceptions of their health improved after the sessions. Feedback from participants suggested that increasing the length of the intervention could improve goal setting and coordination with primary care. This pilot study shows that peer health coaching could improve homeless Veterans’ health and reduce frequent use of acute care, according to the researchers. (BMC Primary Care, Dec. 19, 2022)
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Sleep apnea linked to worse cognitive function in people with traumatic brain injury
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Obstructive sleep apnea may lead to worse cognitive performance in people recovering from traumatic brain injury, found a study by James A. Haley Veteran’s Hospital researchers. Obstructive sleep apnea is common in people with TBI. Those with the condition may stop breathing or have decreased airflow during sleep because the muscles supporting the throat temporarily relax. Sixty participants with TBI had their sleep analyzed. Nearly 77% of participants had obstructive sleep apnea. Participants with apnea showed worse processing speed, memory, and executive functioning than those without apnea. Compared to those with moderate-to-severe apnea, participants with mild apnea had worse working memory and executive function. The results support including obstructive sleep apnea diagnosis in routine clinical care for TBI, according to the researchers. (Sleep Medicine, December 2022)
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Danger during deployment linked to gun ownership in women Veterans
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Perceived threat during deployment is linked to firearm ownership in women Veterans, according to a VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention study. Firearms are the leading means of suicide among women Veterans. The researchers surveyed nearly 500 women Veterans about their deployment experience and gun ownership. Veterans who felt more exposed to danger during deployment were more likely to own a firearm, regardless of their beliefs about safety in their civilian lives. Other deployment experiences, including sexual harassment and assault, general harassment, and combat experiences, were not directly associated with firearm ownership. Perceived threat of harm and negative thoughts about the world after military service were also not directly linked to firearm ownership. Efforts to address firearm access and safety in women Veterans may benefit from assessing heightened sense of danger during deployment, the researchers concluded. (Journal of Psychiatric Research, Nov. 14, 2022)
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Anxiety sensitivity influences PTSD treatment effectiveness
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Anxiety sensitivity influences the effectiveness of PTSD treatment, according to a VA study. Anxiety sensitivity refers to fear of anxiety-related sensations and beliefs that anxiety is dangerous. Researchers looked at outcomes for Veterans with PTSD being treated with prolonged exposure (a psychotherapy), medication, or both. At 24 weeks into treatment, Veterans with high anxiety sensitivity also had high PTSD severity. Anxiety sensitivity did not lead to dropout of any treatment type. Anxiety sensitivity also significantly decreased in all treatment groups during the treatment period. The results suggest that anxiety can reduce the effect of PTSD treatment, but PTSD treatment can also improve anxiety, according to the researchers. (Journal of Traumatic Stress, Nov. 30, 2022)
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Opioid reduction practices improved in VA
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Handling of opioid de-prescribing within VA has improved in recent years, according to a VA study. In 2013, VA implemented the Opioid Safety Initiative to enhance safe and appropriate opioid use. To study the program's effects, researchers compared data on VA patients who had their opioid prescriptions lowered or stopped in 2013 and 2017. Clinical pharmacists and pain management specialists were more involved in 2017. More patients in 2017 had their doses tapered, and the tapering plans were executed over a longer time period. Transitions to non-opioid pain therapy were also higher in 2017. The findings show that the Opioid Safety Initiative has led to better opioid management in VA, according to the researchers. (Journal of General Internal Medicine, December 2022)
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Engaging family and friends has potential to improve diabetes management
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A health coaching intervention focusing on family and friend support led to improved self-efficacy in people with diabetes, found a VA Pittsburgh and VA Ann Arbor study. Researchers recruited participants with diabetes along with a supporter, such as a spouse. Participants received a health coaching session followed by 12 months of telephone coaching calls. Compared to pairs receiving only general diabetes information, pairs in the coaching program saw improvements in willingness and ability to take independent action to manage their health. The coached participants also improved in healthy eating and satisfaction with health system support. However, both groups had similar improvements in measures of diabetes control. While engaging family and friend support can help people improve their diabetes care, more intensive direct coaching may be needed to improve diabetes outcomes, according to the study. (JAMA Network Open, Nov. 1, 2022)
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Social stressors and health among transgender Veterans
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Older transgender and gender diverse Veterans have higher odds than older cisgender Veterans of having social stressors and health conditions, but lower odds of substance use, found a study by VA Bedford researchers and colleagues. Cisgender people are those whose personal identity corresponds to the sex they were assigned at birth. The researchers looked at data on nearly 5,000 Veterans. They found that older transgender and gender diverse Veterans were less likely than cisgender Veterans to have alcohol use disorder, drug use disorder, tobacco use, and anxiety. Transgender and gender diverse Veterans were more likely to experience depression, Alzheimer’s disease, cancer, violence, social and family problems, lack of access to health care, and military sexual trauma. These Veterans were also more likely to experience multiple social stressors. Interventions are needed to reduce health disparities for older transgender and gender diverse Veterans, according to the researchers. (LGBT Health, Nov. 29, 2022)
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Veterans with Parkinson’s at higher risk of suicide
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Veterans with Parkinson’s disease are at increased risk of suicide, found a VA Rocky Mountain study. Researchers looked at data on nearly 1.5 million Veterans who used VA health care over a 19-year period. They found that Veterans with Parkinson’s disease had about a 50% greater risk of suicide, compared to those without. Veterans with Parkinson’s also had higher rates of mood, anxiety, and psychotic disorders. For both groups, 79% of suicides involved firearms. There was no significant difference in suicide methods between groups. Additional screenings and interventions are needed to prevent suicide in Veterans with Parkinson’s disease, say the researchers. (Parkinsonism and Related Disorders, Nov. 4, 2022)
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Veteran video-based health care use differs by type, demographics
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VA Palo Alto researchers identified which Veteran populations are routinely using video-based health care. Out of more than 5 million Veterans, about 27% had at least one video health visit. Rates of video-based health care differed based on type of care: 15% of Veterans had at least one primary care video visit, 11% had a mental health video visit, and 6% had a specialty care video visit. Veterans with a history of housing instability had the highest rates of video care, driven by high usage of mental health care. American Indian/Alaska Native Veterans and low-income Veterans had lower odds of video visits compared with other groups. Outreach to these groups is needed to address disparities in health care access, according to the researchers. (Health Services Research, Nov. 7, 2022)
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Longer drive time linked to lower receipt of recommended health care
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Patients with longer drive times are less likely to receive recommended health care services, according to a Minneapolis VA study. Researchers looked at data for Veterans receiving VA care for osteoporosis, chronic obstructive pulmonary disease (COPD), or ischemic heart disease. The longer a Veteran had to drive to reach a health care facility, the less likely they were to receive recommended care. Compared to Veterans with a drive time of 30 minutes or less, those whose drive time was 61 to 90 minutes were 10% less likely to receive screening for osteoporosis or COPD. Those with a drive time of 91 to 120 minutes were 20% less likely to receive cardiac rehabilitation. New strategies are needed to limit patient travel burden, say the researchers. (JAMA Network Open, Nov. 1, 2022)
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COVID-19 reinfection increases risk of death and health problems
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COVID-19 reinfection increases the risk of death and health problems, according to a VA St. Louis study. Researchers used VA’s health care database to compare health outcomes of nearly 444,000 Veterans who had COVID-19 once, nearly 41,000 who had it two or more times, and over 5 million who never had it. They found that those who had multiple COVID-19 infections were at higher risk of death and hospitalization than those who only had COVID-19 once. They were also at higher risk for a variety of health problems, including lung and heart problems, diabetes, and mental health disorders. The risk was highest when people were first sick, but many still had elevated risk six months later. Risk of death and health problems increased with the number of infections. The results show that strategies are needed to prevent COVID-19 reinfection to protect against additional health risks, say the researchers. (Nature Medicine, Nov. 10, 2022)
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Genetic risks of opioid use disorder identified
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Researchers with VA’s Million Veteran Program identified new genetic traits linked to opioid use disorder. The researchers analyzed the genomes on nearly 426,000 MVP participants. They identified 14 areas of the human genome where variations are linked to the risk of opioid use disorder. Twelve of these areas had not previously been linked to the disorder. The study also showed that opioid use disorder shares genetic traits with many other conditions, including psychiatric disorders and other substance use disorders. The findings add to the understanding of the biological basis of opioid use disorder and provide further evidence that it is a brain disease, according to the researchers. (Nature Neuroscience, October 2022)
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Assessment tool can help weigh risks of lung cancer surgery
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VA St. Louis researchers and colleagues developed a tool to accurately predict a patient’s risk of death after lung cancer surgery. Surgery is the preferred treatment for early-stage non-small cell lung cancer. But for high-risk patients, the dangers may outweigh the benefits. Researchers developed a risk prediction score that takes into account factors such as age, body mass index, health history, and cancer characteristics. They tested the new tool using data from nearly 10,000 Veterans who underwent lung cancer surgery between 2006 and 2016. The risk score was able to accurately predict which patients were likely to die within 90 days of surgery. The tool could help surgeons and patients assess risk and decide between surgery and other cancer treatments, say the researchers. (Annals of Surgery, Oct. 17, 2022)
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Paxlovid lowers risk of Long COVID
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The antiviral medication Paxlovid lowers the risk of developing Long COVID, according to a VA St. Louis study. The study reviewed the records of more than 56,000 Veterans with a positive COVID-19 test. Those given Paxlovid within five days of infection—a medication that can reduce the risk of severe COVID-19 and hospitalization—had a 25% decreased risk of developing 10 of 12 different Long COVID conditions. Paxlovid was associated with a decreased risk of long COVID for both a first COVID-19 infection and a reinfection, and also for individuals who were unvaccinated, vaccinated, or boosted. Paxlovid could be an important asset to address the serious issue of Long COVID, say the researchers. The study was released as a pre-print in the interest of public health. (medRxiv, Nov. 5, 2022)
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Younger and female LGBTQ+ Veterans less likely to use VA health care
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Younger and female LGBTQ+ Veterans may be less likely to use VA health care than cisgender, heterosexual Veterans, found a VA study. Researchers analyzed data on more than 20,000 Veterans who completed a survey on health care use. Overall, both LGBTQ+ and non-LGBTQ+ Veterans used VA or military care as their primary health care at about the same rates. LGBTQ+ Veterans age 34 or younger were significantly less likely than young non-LGBTQ+ Veterans to use VA or military health care, 25% versus 44%. Only about 13% of female LGBTQ+ Veterans used VA or military health care, compared to 29% of non-LGBTQ+ female Veterans. Future studies should examine the potential reasons for these disparities, say the researchers. (Health Services Research, Nov. 4, 2022)
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PTSD, depression linked to accelerated brain aging
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Psychiatric disorders may be linked to accelerated cellular aging in the brain, according to a VA Boston study. Psychiatric and traumatic stress have been associated with biological aging of cells that outpaces chronological aging. Researchers used RNA sequencing to look at the gene expression in brain tissue from the VA National PTSD Brain Bank. They found that tissue in a region of the brain called the ventromedial prefrontal cortex from patients with PTSD or depression had more signs of advanced cellular age compared with samples from people without psychiatric conditions. PTSD and depression were also linked to increased biomarkers related to inflammation and immune response. The results suggest that inflammation and immune system dysregulation could be responsible for accelerated brain aging caused by psychiatric disorders, say the researchers. (Depression and Anxiety, Oct. 25, 2022)
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E-cigarettes may weaken muscle strength and healing
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E-cigarette use may weaken muscle strength and healing, according to a study by VA San Diego researchers and colleagues. E-cigarettes use a heated aerosol mixture to deliver nicotine. Smoking E-cigarettes, also called vaping, has been linked to harmful effects such as lung injury and inflammation. To study how vaping affects muscle function, researchers exposed mice to nicotine-containing aerosol. Those exposed to the vapor had reduced leg muscle force and running speed. They also only recovered 80% of muscle strength after an overuse injury. Exposure to the chemicals used to dissolve nicotine in vapes, polyethylene glycol and vegetable glycerin, decreased running speed and prevented full recovery from injury even when no nicotine was included. The results suggest that both nicotine and the chemicals used in E-cigarettes are harmful to muscle function, say the researchers. (American Journal of Physiology, Oct. 17, 2022)
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Mandatory vaccination of health care workers lowers flu risk
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Mandatory vaccination lowers flu infection in health care workers, found a study by VA researchers and colleagues. The study compared flu rates at four VA health care system outpatient sites—which do not require employees to get a flu shot—with three non-VA health system facilities with mandatory flu vaccination. About 63% of employees at the VA facilities were vaccinated, compared with 93% at the other sites. Analysis showed that flu infections would have been reduced by 52% at the VA sites if they had the same level of vaccination as the non-VA sites. However, flu vaccination was associated with an increased risk of other respiratory viral infections. Mandatory flu vaccination of health care workers could lower risk of the flu, say the researchers, but the increase of other infections needs further research. (Infection Control and Hospital Epidemiology, September 2022)
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Sleep problems from traumatic brain injury lead to lower life participation
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Sleep problems related to mild traumatic brain injury lead to lower social and community participation, found a VA Rocky Mountain study. Out of nearly 9,000 Veteran participants with mild TBI, 87% had sleep problems. Sleep problems were linked with greater social and community participation restrictions. Two TBI symptoms, anxiety and forgetfulness, largely affected this association. Sleep problems were also linked with lowered productivity due to headaches and forgetfulness. The findings suggest that sleep treatment should play a prominent role in rehabilitation for Veterans with mild TBI, say the researchers. (Frontiers in Rehabilitation Sciences, October 12, 2022)
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Bacteria transplantation could treat alcohol use disorder
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Gut microbe transplant could reduce alcohol consumption and help treat alcohol use disorder, suggests a study by a team including Richmond VA researchers. Previous research suggests that fecal transplant to introduce helpful bacteria to the digestive tract can reduce alcohol cravings in people with alcohol use disorder. The researchers introduced stool from a human trial into mice. Those colonized with helpful bacteria showed less interest in alcohol than those given a sterile control substance. Fecal transplants from humans with more types of gut microbes were linked to lower alcohol intake in mice. Those mice showed changes in immune response, inflammation, and other changes in the intestine. The findings suggest that targeting gut bacteria could lead to treatments for alcohol use disorder, say the researchers. (Nature Communications, Oct. 19, 2022)
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Clinician views on medication reconciliation
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VA researchers developed a questionnaire to assess medication reconciliation programs in VA. Medication reconciliation can detect prescription discrepancies and help avoid negative drug events. However, organizations often struggle to implement reconciliation programs. The researchers developed at 21-question survey and distributed it to nearly 9,000 clinicians at 142 VA sites. Most staff agreed that medication reconciliation could improve drug safety. However, 90% expressed concerns about changes to workflow. One-third of respondents said they prioritized other duties over medication reconciliation. Only 47% said they had enough resources to address problems. This questionnaire can help identify barriers to medication reconciliation programs and lead to safer prescribing to Veterans, say the researchers. (BMJ Quality Open, October 2022)
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More intensive chronic pain treatment may be needed for Black Veterans with mental health disorders
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Black Veterans with mental health disorders were more engaged in treatment than those without mental health disorders in a study on chronic pain, found an Atlanta VA study. However, Veterans with mental health disorders did not experience reductions in pain-related disability. Researchers looked at outcomes for Black Veterans who participated in a walking program designed to treat chronic pain. The program involved telephone coaching sessions to encourage walking. Participants with mental health disorders, such as PTSD and depression, were more likely to complete the coaching sessions. They also reported improvements in how they perceived their pain and its interference with their lives. However, six months later, the intervention was only associated with improved pain-related disability in patients without mental health disorders. The results suggest that Black Veterans with mental health disorders may require more intensive treatment for chronic pain, according to the researchers. (Journal of Pain, Sept. 23, 2022)
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Hepatitis C medications linked to lower alcohol use
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Hepatitis C medications were linked to lower alcohol use in patients with alcohol use disorder and PTSD, in a study by White River Junction VA researchers. The study looked at alcohol use in more than 1,000 patients with co-occurring alcohol use disorder and PTSD. All patients were taking one of three direct-acting antivirals for hepatitis C infection. All three medication groups showed substantial reductions in alcohol use. Treatment with ledipasvir/sofosbuvir led to the highest frequency of clinically meaningful alcohol use improvement. The results suggest that further exploration of direct-acting antivirals in alcohol use disorder treatment is warranted, say the researchers. (Journal of Dual Diagnosis, Sept. 23, 2022)
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Multiple factors affect social integration in Veterans recovering from homelessness
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VA Greater Los Angeles researchers and colleagues identified factors associated with recovery from homelessness among Veterans in permanent supportive housing. The Department of Housing and Urban Development-VA Supportive Housing program provides permanent housing, financial subsidies, and supportive services to Veterans experiencing homelessness. Previous studies have shown that full “recovery” from homelessness requires social integration. Among Veterans using the program, health-related quality of life, psychiatric symptoms, and case management frequency affected how well Veterans integrated into their communities. Most participants did not perceive HUD-VASH services as relevant to their social integration. More services that enhance social integration may help Veterans recover from homelessness, say the researchers. (Journal of Community Psychology, July 2022)
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Veterans continue to find tinnitus management skills useful
 Photo: ©Getty Images/Aleksej Sarifulin (10/17/2022)
Veterans continue to use skills learned in tinnitus management workshops up to 10 years after learning them, according to a Bay Pines VA study. Tinnitus refers to ringing or other sounds heard when no external sound is present. It is the most common service-connected disability in Veterans. Researchers followed up with Veterans who completed VA’s progressive tinnitus management workshops in 2010 to 2014. Progressive tinnitus management teaches Veterans to manage tinnitus with therapeutic sound, relaxation, planning pleasant activities, and changing thoughts and feelings. The follow-up showed that more than half of respondents used all four self-managements skills 10 years later. About 69% said they were better able to control their reactions to tinnitus. Most said that the workshop experience was positive, and 89% said they would recommend the workshop to someone with bothersome tinnitus. The results suggest that skills learned in the workshop continue to be useful for Veterans with tinnitus, say the researchers. (American Journal of Audiology, September 2022)
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COVID-19 increases risk of neurologic disorders
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COVID-19 increases the risk of long-term neurologic disorders, according to a VA St. Louis study. Researchers compared data on over 150,000 VA patients who contracted COVID-19 with more than 11 million people who did not. A year after recovering from COVID-19, individuals had a higher risk of a wide array of neurologic conditions, including stroke, memory disorders, nervous system disorders, episodic disorders like migraines and seizures, Guillain-Barré syndrome, and sensory disorders. Following COVID-19 infection, individuals had elevated risks and burdens even when they did not require hospitalization during their illness. The results highlight a need for health care system planning to address the potential long-term consequences of COVID-19, say the researchers. (Nature Medicine, Sept. 22, 2022)
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Traumatic brain injury linked to less social support
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Veterans who screen positive for traumatic brain injury (TBI) receive less social support than those who screen negative, according to a study by VA San Diego researchers. The study included nearly 10,000 Veterans participating in the Million Veteran Program. Those who screened positive for TBI reported significantly lower levels of social support compared with those who screened negative. Lower levels of social support were associated with more severe neurobehavioral and psychiatric symptoms and worse cognitive functioning. Psychiatric symptoms appeared to control the link between TBI status and social support. The results show the importance of considering social support when treating Veterans with TBI, say the researchers. (Social Science & Medicine, Sept. 16, 2022)
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Fracture risk in older men
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A study by Minneapolis VA researchers and colleagues identified the strongest risk factors for hip fractures in elderly men. The five-year study followed more than 3,000 men who were 80 years or older. Fall history, body mass index, and recent fractures were found to be strong risk factors for hip fracture. Age and having multiple health conditions were the strongest predictors of death in the study group. Age, body mass index, and fall history were associated with both hip fracture and death. Identifying men in later-life who would benefit from treatment to prevent fracture is challenging because of high death rates. The findings suggest that decisions about osteoporosis drug treatment should consider fracture risk versus overall life expectancy, according to the researchers. (Journal of Gerontology, Aug. 2, 2022)
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New prediction model to estimate risk of COVID-19 death
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VA researchers developed a new prediction model to estimate the probability of death from COVID-19. The mathematical model, called PDeathDx, uses diagnostic codes from medical records to survey all of a patient's preexisting conditions to estimate the risk that COVID-19 poses. Starting with data from 1997, the researchers used diagnoses from the first time a patient sought care until 14 days before a positive COVID-19 test, then compared that to COVID outcomes for nearly 350,000 patients treated in VA. They found that the new model outperformed other conventional prediction models. The study also showed that certain underlying conditions—such as neurological diseases, dementia, and severe disability—are much more likely to result in severe COVID or death. The approach used here could be adapted to predict outcomes for other diseases and conditions, say the researchers. (Biological Methods & Protocols, Aug. 4, 2022)
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Whole health care model could reduce suicide risk
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A whole health model shows promise to reduce suicide risk and need for mental health services for Veterans with psychiatric illnesses, found a study by VA Salt Lake City researchers. However, whole health services were found to be underutilized. Whole health is a health care model that focuses on health promotion and disease prevention rather than disease treatment only. VA is implementing this model in its health care system. Researchers looked at outcomes for over 7,000 Veterans with a mental health diagnosis. Whole health interventions included mindfulness training, health education, nutrition classes, and health coaching. Only 305 Veterans had at least one whole health appointment. Whole health participation was associated with decreased risk of suicide and reduced use of mental health services. The findings suggest that a whole health approach could benefit Veterans with mental illness, but more efforts are needed to increase patient engagement, say the researchers. (Complementary Therapies in Medicine, Sept. 9, 2022)
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Using social media to recruit loved ones to Veteran suicide prevention training
 Photo: ©Getty Images/Tero Vesalainen (09/29/2022)
Social media could be a useful tool to recruit Veterans’ loved ones in suicide prevention training, found a VA Portland study. Researchers used Facebook sponsored ads to recruit Veterans’ friends and family for VA’s free suicide prevention training module. The team was able to meet two benchmarks: enrolling an average of 20 participants a week and less than 50% loss to follow-up at the end of the 6-month study. Focusing on family and friends, an urgent call to action to help a Veteran, prior exposure to suicide, emphasizing the benefit of the training, and using a university as messenger all helped recruit participants. Recruitment barriers included generic ads, referring to “research” in the text, and Facebook as the ad platform. The results show that this approach is feasible, say the researchers, and the next step is to measure the training effectiveness with a larger group. (Contemporary Clinical Trials Communication, Sept. 5, 2022)
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Institutional betrayal linked to suicidal behavior
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Institutional betrayal is linked to suicidal behavior and worse mental health in women who experienced military sexual trauma, according to a Rocky Mountain Regional VA Medical Center study. Institutional betrayal refers to harm caused by an institution (such as the military) to someone dependent on that institution. Researchers surveyed 229 women Veterans who screened positive for military sexual trauma. Those who felt a sense of institutional betrayal had increased odds of suicidal thoughts and attempts following their military service. They also had more severe depression and PTSD symptoms. Institutional betrayal was not linked to non-suicidal self-injury or substance misuse. The results underscore the need to address institutional betrayal among women who experience military sexual trauma, say the researchers. (Journal of Trauma & Dissociation, Sept. 7, 2022)
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Health records inaccurate on drug overdoses
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Nonfatal drug overdoses are underreported in health records, found a study by Birmingham VA researchers and colleagues. Researchers compared self-reported overdoses over three years with diagnostic codes in the medical records of Veterans receiving care both in VA and in the community. Only about 28% of alcohol, 23% of sedative, 12% of opioid, and 6% of cocaine overdoses were recorded with diagnostic codes. Veterans with substance use disorder diagnoses were more likely to self-report overdoses. The findings support the need for alternative approaches to overdose surveillance in public health, according to the researchers. (American Journal on Addictions, Aug. 24, 2022)
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Traumatic brain injury may increase risk of cardiovascular disease
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Veterans who have had a traumatic brain injury (TBI) had increased odds of developing cardiovascular disease, found a study by VA researchers and colleagues. The study analyzed data on more than 1.5 million Veterans, including over 300,000 with a history of TBI. Those with TBI history were more likely to develop cardiovascular disease. All levels of TBI increased the risk of stroke, coronary artery disease, and peripheral artery disease. Both mild and moderate to severe TBI were associated with increased risk of death due to cardiovascular disease. The results suggest that Veterans who have sustained a TBI may have increased burden of cardiovascular disease as they age, say the researchers. More study is needed to determine whether this increased risk can be modified. (JAMA Neurology, Sept. 6, 2022)
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PTSD symptoms linked to suicide risk
 Photo: ©Getty Images/Suriyawut Suriya (09/14/2022)
Improving PTSD symptoms can reduce the risk of suicide, found a study by White River Junction VA researchers and colleagues. The study included data on more than 750,000 Veterans diagnosed with PTSD between 1999 and 2018. Researchers found that any level of PTSD symptoms was linked to double the rate of death by suicide one month after assessment, compared to those without PTSD symptoms. Worsening PTSD symptoms were associated with a 25% greater long-term suicide mortality rate. Veterans who achieve remission from PTSD had a much lower suicide rate than those who still had PTSD symptoms. The results show lowering PTSD symptoms can reduce suicide risk, say the researchers, but only if Veterans reach remission levels. (British Journal of Psychiatry, Aug. 23, 2022)
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Intensive lifestyle intervention improves diabetes in older adults
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A lifestyle intervention strategy can be highly effective for older adults with diabetes, according to a Michael E. DeBakey VA Medical Center study. One hundred older adults with diabetes were assigned either one year of intensive lifestyle intervention or healthy lifestyle control treatment. The lifestyle intervention involved a weight management program and exercise training, including weekly interactions with dietitians and trainers. The control treatment consisted of group educational sessions about a healthy diet. A1c, a measure of diabetes control, improved significantly more in the intervention group. This group also saw greater weight loss and better performance on physical performance tests. Participants in the lifestyle intervention group were also able to decrease their insulin doses. The results show that an intensively managed lifestyle intervention can help improve older diabetic patients’ health and quality of life, say the researchers. (Diabetes Care, Sept. 1, 2022)
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Patient engagement video improves telehealth visits
 Photo: ©Getty Images/Yaroslav Olieinikov (09/14/2022)
A pre-visit video before a telehealth appointment can improve patient communication and outcomes, found a VA study. Use of video for medical appointments has increased drastically in recent years, especially during the COVID-19 pandemic. While telehealth can improve access to care, lack of in-person contact can affect patient engagement. Researchers had patients watch a pre-visit video promoting active communication before video appointments. Patients who watched the video rated their physicians’ communication and empathy higher than those who only received a pamphlet on the subject. They also were more engaged in their care and showed a stronger cooperative relationship with their doctors. The results show that training patients about engagement and active communication can improve the telehealth experience, according to the researchers. (PEC Innovation, Sept. 12, 2022)
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Melatonin may lower risk of death from sepsis
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Melatonin lowered the risk of death from sepsis, in a Columbia VA study. Sepsis is a potentially life-threatening condition in which chemicals released by the body to fight infection damage its own tissue. Prior research has suggested that melatonin—a hormone related to sleep regulation—could benefit sepsis patients. The researchers studied data on more than 9,000 patients admitted to the hospital with sepsis. Those given melatonin within the first day of hospitalization had a 38% reduced risk of 30-day, in-hospital mortality, compared with those not given melatonin. The findings suggest that melatonin may have important effects beyond sleep regulation and could be a useful treatment for sepsis, say the researchers. (Journal of Pineal Research, September 2022)
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Use of complementary and integrative health for Gulf War illness
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Many Veterans with Gulf War illness use complementary and integrative health (CIH) treatments, found a VA study. CIH practices include non-mainstream care such as acupuncture, yoga, and chiropractic care. Researchers looked at health care data on more than 1,000 Gulf War-era Veterans. Over half had used at least one CIH approach in the last six months. Women Veterans, white Veterans, and Veterans with higher levels of education were the most likely to use CIH. Those with a Gulf War illness diagnosis and higher symptom severity were more likely to use CIH. Over three-quarters of Veterans who used CIH to treat Gulf War illness symptoms said it was helpful. About 72% indicated that they would use CIH approaches if they were available at VA. The results could inform decisions on expanding CIH treatments for Veterans, say the researchers. (Complementary Therapies in Clinical Practice, July 31, 2022)
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Robot-assisted surgery increasing in VA
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The use of robot-assisted surgery in VA has increased significantly, according to a VA study. Researchers looked at data on three common surgery types performed in VA. Out of more than 100,000 surgeries, nearly 5% used robotics during the five-year study period. The proportion of robotically assisted surgeries increased from 1.5% to 10.5% from 2015 to 2019. Hernia repair surgery had the greatest increase in robotic use. The Northeast, Midwest, and West Coast of the United States saw the largest increases in robotic use. The results suggest that VA continues to be at the forefront of medical research and innovation, according to the researchers, but the reasons for regional differences should be investigated. (Journal of Surgical Research, Aug. 11, 2022)
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Sense of belonging increases Veteran engagement with VA care
 Photo: ©Getty Images/Drazen Zigic (08/24/2022)
VA Portland researchers identified factors that strengthen Veterans’ sense of belonging in the VA health care system. The study team interviewed 27 VA patients. They found that a sense of belonging promotes appointment attendance and patient engagement. The Veterans identified three factors that related to a sense of belonging. Feelings of camaraderie and commitment toward other Veterans improved the patient experience. Interactions with all staff influenced the engagement a patient felt toward a particular clinic and VA. And personalized communication and messaging can humanize VA and demonstrate its interest in engaging with Veterans. Continuing to strengthen patients’ sense of belonging can help increase appointment attendance and engagement in VA care, according to the researchers. (Medical Care, July 26, 2022)
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Most young non-daily cigarette smokers continue to smoke
 Photo: ©Getty Images/Miljan Zivkovic (08/24/2022)
Most young adults who smoke cigarettes intermittently continue the habit and may need help quitting, according to a study by VA San Diego researchers and colleagues. Increasing evidence shows that non-daily cigarette smoking is common in early adulthood. Researchers assessed 579 non-daily smokers between the ages of 18 and 24 for three years. They found that 55% smoked intermittently throughout the study. About 43% consistently stopped smoking by the end of the study. Few from either group transitioned to daily smoking. Quitting smoking was associated with having fewer smoking friends, smoking less in social situations, experiencing lower positive reinforcement from smoking, and having a stronger intent to quit. The findings suggest that efforts to get young adults to quit smoking should focus on reducing expectations of positive effects and social motivations of smoking, say the researchers. (Nicotine & Tobacco Research, Aug. 5, 2022)
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Prescription opioid use disorder treatment lowers death risk compared with methadone
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A prescription medication used to treat opioid use disorder may lower the risk of death compared with methadone, found a White River Junction VA study. Opioid agonist treatments (OATs) are medications that reduce opioid withdrawal and cravings. Methadone is usually given at a treatment facility as a daily liquid dose. Buprenorphine can be prescribed and does not require observed dosing like methadone. Researchers looked at outcomes for nearly 62,000 VA patients with opioid use disorder taking one of the two treatments. Buprenorphine was linked to a 20% lower risk of death from any cause compared to methadone, and a 40% lower risk of suicide. The rates of death from overdose were similar with the two treatments. The results support less restrictive buprenorphine prescribing to help patients with opioid use disorder, say the researchers. (Acta Psychiatra Scandinavia, July 15, 2022)
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Drug may help treat lupus skin damage
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A team including a Corporal Michael J. Crescenze VA Medical Center researchers identified a drug that may help treat a form of lupus that involves the skin. Lupus is an autoimmune disease, in which the body’s immune system attacks its own tissue. One form, cutaneous lupus erythematosus, can cause irreversible skin damage. The researchers compared outcomes for patients with lupus treated with a drug called litifilimab and those given a placebo. Those treated with the drug showed improvements in skin disease severity, compared to the placebo group. While larger trials are needed, the results suggest that litifilimab may be a useful treatment for this type of lupus, say the researchers. (New England Journal of Medicine, July 28, 2022)
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Firearm safety discussions rare in Veteran health care
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Most Veterans who own firearms have not had firearm safety discussions with a health care provider, according to a study by Rocky Mountain Regional VA Medical Center researchers. Seventy percent of suicides among Veterans involve firearms. Because of this, suicide prevention guidelines recommend addressing firearm safety during medical care. The study surveyed Veterans who owned firearms on whether they have had this discussion. About 32% of Veterans surveyed used VA health care. Overall, only 9% reported a health care provider speaking to them about firearm safety. About 14% of those who used VA care and 7% of those who did not use VA said they discussed firearm safety. The findings suggest that additional efforts are needed to increase these safety discussions, say the researchers. (Suicide & Life-Threatening Behavior, Aug. 4, 2022)
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HIV may increase risk of head and neck cancers
 Photo: ©Getty Images/Lars Neumann (08/18/2022)
Veterans with HIV/AIDS may have increased risk of head and neck cancers, found a study by Michael E. DeBakey VA Medical Center researchers and colleagues. The study looked at VA patient data from 1999 to 2016. It included more than 45,000 Veterans with HIV/AIDS and over 160,000 HIV-negative Veterans. Those with HIV/AIDS had nearly twice the risk of head and neck cancers. Veterans with HIV/AIDS were more likely to be human papilloma virus (HPV)-positive than HIV-negative Veterans. The results suggest that HIV may play a role in the development of head and neck cancers, including those caused by viruses such as HPV, according to the researchers. (Cancer, July 22, 2022)
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COVID-19 boosters effective against Omicron and Delta variants
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COVID-19 vaccine boosters were highly effective against recent virus variants, found a study by VA White River Junction researchers and colleagues. The study included data on more than 110,000 Veterans, mostly older and male, who had a COVID test between November 2021 and January 2022. Protection against both the Omicron and Delta COVID-19 variants was better in those who also had a booster dose of an mRNA vaccine, compared with those who only had a two-dose vaccine. Boosters were 64% effective against Omicron infection, while initial vaccination was only 12% effective. For the Delta variant, vaccinations with a booster were 90% effective against infection, versus 54% for initial vaccination. For preventing hospitalization, booster doses were 89% effective during the Omicron period and 94% effective during the Delta period, compared with the two-dose vaccines, which were 63% effective against Omicron and 75% effective against Delta. For preventing death, vaccines combined with a booster dose were 94% effective against Omicron and 96% against the Delta variant. The results show that vaccine boosters increase the effectiveness of COVID-19 vaccination against infection, hospitalization, and death, according to the researchers. (BMJ Open, Aug. 3, 2022)
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Using AI to predict suicide risk
 Photo: ©Getty Images/FG Trade (08/09/2022)
Analyzing electronic health records with artificial intelligence could help predict which Veterans are at risk for suicide, found a VA White River Junction study. Researchers applied natural language processing (NLP) to VA electronic health records from 2015 and 2016. NLP is a branch of artificial intelligence that teaches computers to understand the way that humans speak and write language. The NLP technique was applied to unstructured health records, which are clinician-written notes that do not include key words and diagnostic codes. The NLP computer model was accurate at predicting which Veterans in the sample population died by suicide. It correctly predicted 74% of suicide cases in the study sample. This approach has potential to improve the accuracy of suicide risk prediction, say the researchers. (Psychiatry Research, July 1, 2022)
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Web tool could help reduce medication discrepancies
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A secure patient messaging system has potential to help reduce medication discrepancies, according to a study by VA Boston researchers and colleagues. Medication discrepancies, such as incorrect prescriptions dosages, can lead to adverse drug effects and patient harm. The researchers developed a web-based tool to help identify and fix medication discrepancies when patients transition from hospital to home. The team surveyed 20 Veterans who received care at a VA medical center about their experiences with the messaging system. Most patients found it was easy to use at home and liked the fact that they could review medications at their own pace. They added that it was helpful at clarifying medication directions and dosages, and for removing incorrectly listed medications from their electronic health records. Some Veterans struggled to use the portal due to technology-related barriers. Adoption of the secure messaging tool in clinical practice could reduce medication discrepancies, say the researchers. (JMIR Human Factors, Aug. 3, 2022)
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Underlying risk factors may explain racial/ethnic differences in PTSD recovery
 Photo: ©Getty Images/Drazen Zigic (08/08/2022)
Underlying social risk factors may explain racial/ethnic differences in mental health recovery after a traumatic event, according to a study by VA Palo Alto researchers and colleagues. More than 1,300 patients were assessed for PTSD after a severe injury. Hispanic, Black, and multiracial participants had higher PTSD symptoms than white patients. Symptoms remained higher in Black and multiracial patients six months after hospitalization. PTSD symptoms improved faster in Hispanic than in white patients. Risk factors such as discrimination, financial stress, and past mental health problems accounted for most of the differences between groups. Addressing these risk factors could reduce disparities in PTSD recovery, say the researchers. (Psychological Medicine, July 29, 2022)
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Arm prosthetic satisfaction survey adapted to capture women’s needs
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VA Providence researchers and colleagues modified an upper-limb prosthetic satisfaction survey to make it more responsive to women. Women with an upper-arm amputation are more likely than men to stop using their prostheses. The researchers added items specifically tailored to women to a widely used survey on prosthetic use and satisfaction. The new survey questions addressed topics such as device size, appearance, and fit under clothes. The updated survey showed good reliability in a test of 468 participants with amputation. The researchers recommend that new comfort and appearance subscales be added to the assessment in clinical use to better address the concerns of women prosthetic users. (Archives of Physical Medicine and Rehabilitation, June 12, 2022)
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Less diabetes medication not linked to worse outcomes for Veterans in nursing homes
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Reducing diabetes medication in older Veterans residing in nursing homes did not lead to worse outcomes, in a study by VA Pittsburgh researchers. Guidelines advise against tight glycemic control in diabetic patients with advanced dementia or limited life expectancy. Researchers analyzed data on more than 2,000 older diabetic Veterans living in nursing homes. Of those, 27% had their diabetes medications de-intensified. Veterans taking less medication had similar rates of emergency room visits, hospitalization, and death as those taking higher doses. The results suggest that reducing diabetes treatment could be a way to lower medication burden and avoid overtreatment in this population, say the researchers. (Diabetes Care, July 7, 2022)
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High antibiotic, opioid prescribing linked
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High antibiotic prescribing is associated with high opioid prescribing at health care facilities, according to a VA study. Over-prescribing of antibiotics can lead to drug-resistant infections. Opioid over-prescribing is linked to addiction and overdose. Researchers looked at VA electronic health records prescribing data for both medical providers and dentists. They found that providers that prescribed the most antibiotics were also the highest prescribers of opioids. For medical providers, older age, region of the country, lower VA facility complexity, and rurality were linked with higher opioid prescribing. In dentists, younger age, male gender, specific region of the country, and lower number of dentists at a facility were linked to higher opioid prescribing. The results suggest that efforts targeting both medication classes may improve prescribing practices, say the researchers. (Pharmacotherapy, July 22, 2022)
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Vets with mental health conditions have less fragmented health care
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Having a mental health condition was linked to less fragmented health care, in a study by VA Palo Alto researchers and colleagues. Health care fragmentation—seeing many different providers—can lead to worse health complications. Health care providers worry that mental health conditions could amplify this problem. The researchers looked at more than 125,000 older VA patients also enrolled in Medicare. Contrary to what the researchers expected, patients with mental health conditions had less fragmented non-mental health care than those without mental health conditions. Those with mental health conditions saw fewer providers and had their care concentrated more with their primary provider. The finding could suggest higher quality care but also could indicate underuse of medical care in these patients, explain the researchers. (Journal of General Internal Medicine, July 22, 2022)
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Toxic exposure may be linked to infertility
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Toxic exposure during military service may be linked to infertility, according to an Iowa City VA study. Researchers surveyed both male and female Veterans between the ages of 20 and 45. In both men and women, those who reported environmental, chemical, and hazardous exposures during military service had increased rates of infertility. Toxic exposures linked to infertility included petrochemicals and polychlorinated biphenyls, chemicals known to cause cancer and birth defects. Veterans reporting infertility also had a higher number of total exposures. While causation between toxic exposure and infertility cannot be proven, say the researchers, more research between a possible link is needed. (American Journal of Obstetrics and Gynecology, July 13, 2022)
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Pre-surgery lung cancer care linked to better survival
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Inadequate access to pre-operative care is linked to worse lung cancer outcomes, found a VA St. Louis study. Quality pre-surgery care measures included timely surgery, imaging, smoking management, and lung function testing. Researchers looked at care quality measures for nearly 10,000 VA patients undergoing surgery for non-small cell lung cancer. About 35% received all four quality measures. Those who received these measures were significantly less likely to die after surgery, compared to patients not receiving all measures. Black patients, those from poorer areas, and those who lived farther from the hospital were less likely to receive the four quality measures. The results show that VA should focus on providing more equitable pre-surgery care for Veterans with lung cancer, say the researchers. (Annals of Thoracic Surgery, June 17, 2022)
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Bad cholesterol may be risk factor for Alzheimer’s
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High cholesterol may be involved in the development of Alzheimer’s disease, according to a study by an Atlanta VA researcher and colleagues. The gene APOE is a risk factor for Alzheimer’s and is also associated with high low-density lipoprotein (LDL) cholesterol, also called “bad” cholesterol. Researchers followed 559 participants who developed dementia for seven years. They found that LDL cholesterol levels were associated with all measures of Alzheimer’s progression. The findings suggest that LDL cholesterol is involved in Alzheimer’s independent of APOE. Cholesterol could be a modifiable risk factor for Alzheimer’s disease, they say. (Journal of Neurology, Neurosurgery, and Psychiatry, June 30, 2022)
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Leg power, grip strength predict fall injury risk in older men
 Photo: ©Getty Images/Mladen Zivkovic (07/12/2022)
Lower leg power and grip strength can predict fall injury risk in older men, according to a study including a VA Palo Alto researcher. In a study of more than 5,000 older men, 40% had at least one fall injury over a nine-year period. Those with lower leg power, as measured by a leg press, had an increased risk of fall injury. Weaker hand grip strength was also linked to greater risk of fall injury. Both measures predicted future fall injury risk independent of physical performance on a walking speed test. Leg power may identify fall injury risk better than grip strength, according to the researchers, but grip strength may be easier to measure in a clinical setting. The results suggest muscle strength decline likely precedes functional impairments, they say. (Journals of Gerontology, Series A, June 5, 2022)
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PTSD avoidance symptoms linked to alcohol cravings
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PTSD avoidance symptoms and alcohol cravings may be linked, found a Coatesville VA Medical Center study. PTSD and alcohol or substance use disorders often occur together. Researchers interviewed 167 Veterans to see whether specific PTSD symptoms were linked to drug or alcohol misuse. Avoidance, in which patients distance themselves from things that could remind them of their trauma, was significantly linked with alcohol cravings. No specific PTSD symptoms were linked to stimulant drug cravings. Veterans with avoidance symptoms may experience alcohol cravings because they believe alcohol will ease thoughts, feelings, or reminders of trauma, according to the researchers. This relationship should be considered when treating co-occurring PTSD and alcohol use disorder, they say. (Journal of Dual Diagnosis, June 27, 2022)
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Low-value health services common in VA
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More than 1 in 10 Veterans enrolled in VA health care received a low-value health service, according to a study of 5.2 million Veterans. Researchers looked at health care services delivered at VA facilities or paid for through VA in a single fiscal year. They analyzed the data for low-value care, meaning services with harms or costs that outweigh the benefits. About 14% of Veterans received low-value services. This added up to a total cost of $205.8 million. The most frequent low-value service was prostate-specific antigen testing—a blood test to detect prostate cancer—for men 75 or older. The most expensive low-value services were spinal injections for back pain and stenting for stable heart disease. The results can help guide VA’s efforts to reduce delivery and spending on low-value care, say the researchers. (JAMA Internal Medicine, July 5, 2022)
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Stressful life events increase risk of Veteran suicide
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Stressful life events are a major factor in suicide attempts for Veterans recently separated from the military, found a VA study. Researchers looked at data on Veterans surveyed during active duty and again after separating from the military. About 15% of those surveyed were deemed high-risk for suicide attempts. Those at high risk of suicide where significantly more likely to experience post-separation stressful life events. These events included housing instability, legal problems, financial strain, and relationship problems. The link between stressful life events and actual suicide attempts was much stronger in the high-risk group, compared with those at lower risk for suicide. It might be possible to prevent some Veteran suicides by targeting interventions for common stressful life events, according to the researchers. (Psychological Medicine, May 27, 2022)
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Sickle cell trait linked to increase risk of COVID-19 death
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Sickle cell trait is linked to an increased risk of death from COVID-19, found a VA Million Veteran Program study. People with sickle cell trait have one sickle cell gene and one normal gene. Those with the trait usually do not have symptoms of sickle cell disease—a blood disorder primarily affecting people of African descent. Researchers studied MVP data of nearly 3,000 people with sickle cell trait, 13% of whom contracted COVID-19. They compared them to nearly 130,000 people without sickle cell trait, 10% of whom had COVID-19. Those with sickle cell trait had higher odds of death from COVID-19. The sickle cell group also had increased rates of acute kidney failure. About 21% of COVID-19 deaths were due to acute kidney failure for patients with sickle cell trait. The results strongly support including sickle cell trait as a risk factor for worse COVID-19 outcomes, say the researchers. (JAMA Internal Medicine, June 27, 2022)
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Barriers to positive airway pressure use
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San Francisco VA researchers identified physical and psychological barriers to positive airway pressure use. Positive airway pressure (PAP) is an effective treatment for sleep apnea, but many patients have trouble tolerating it. Researchers interviewed 30 Veterans who did not use their PAP machines every day. The Veterans described physical and psychological barriers to use at about the same rate. The most common physical barriers were mask leaks and dry throat and nose. Psychological barriers included anxiety, claustrophobia, and worsening insomnia. Health care providers most often offered solutions for physical barriers. Solutions for psychological barriers were rarely proposed. The researchers recommend that patients receive individualized assessment to address both physical and psychological barriers to PAP use. (Translational Behavioral Medicine, May 30, 2022)
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Poor diabetes control linked to weakened bones
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Poor glycemic control is linked to bone weakness in men with diabetes, according to a study by Michael E. DeBakey VA Medical Center researchers and colleagues. The study assessed bone quality and strength in 169 men. Those with A1C—a measure of sugar levels in the blood—above 7% had higher trabecular separation and lower trabecular number than those with lower A1C scores. Trabecular bone tissue acts like a network of support beams that give bones their structure. Participants with high A1C also had worse measures of bone strength. They further had significantly lower bone turnover markers. Bone turnover, in which the body resorbs old bone tissue and produces new bone, helps the body maintain bone strength and health. A1C above 7% appears to be a threshold for bone impairment in men with diabetes, according to the researchers. (Calcified Tissue International, June 4, 2022)
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Few differences in safety of Moderna, Pfizer COVID-19 vaccines
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Both the Moderna and Pfizer COVID-19 vaccines have a low risk of adverse events, found a study by VA Boston researchers. The study looked at data on more than 400,000 Veterans who were vaccinated. Risks were low after 38 weeks for either vaccine. Veterans receiving the Moderna vaccine were slightly less likely to experience stroke, heart attack, blood clots, or kidney damage. However, the difference was less than two-tenths of one percent. The results show that either vaccine is safe and effective for individuals, say the researchers, but the differences may help inform future population-level vaccination efforts. (JAMA Internal Medicine, June 13, 2022)
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Airborne virus linked to hospital COVID-19 spread
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Hospital COVID-19 infection may result from airborne virus particles introduced by employees and patients in common hospital areas, according to a study by VA Boston researchers and colleagues. The researchers studied the genome sequence of viruses from infected nurses and patients during a hospital COVID-19 outbreak. They compared these to virus particles from air samples. They learned that viruses found in nurses and patients were genetically identical to virus particles in the air. The findings suggest that very small, aerosolized virus particles can lead to COVID-19 spread in hospitals, according to the researchers. Isolating infected health care providers and improving ventilation and masking could help decrease the spread, they say. (JAMA Network Open, June 8, 2022)
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Adverse childhood experiences linked to heart disease risk factors
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Adverse childhood experiences are linked to heart disease risk factors, according to a study by VA San Diego researchers. They analyzed data from more than 36,000 survey participants. Those who experienced childhood household dysfunction, mistreatment, or more than one adversity type were more likely to smoke tobacco, be overweight or obese, and have depression—all risk factors for cardiovascular disease. Having multiple childhood adversities was linked to the most risk factors, including high cholesterol and lipid levels. The results suggest that heart disease prevention programs should target these related risk factors together, say the researchers. (Stress and Health, May 26, 2022)
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New treatment for antibiotic-resistant urinary tract infections
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Michael E. DeBakey VA Medical Center researchers and colleagues developed a treatment to combat urinary tract infections. Urinary tract infections from catheters affect one million patients per year in the United States. High rates of drug resistance make treating these infections difficult. The researchers created a cocktail containing phages, viruses that infect bacteria, to combat E. coli bacteria. The cocktail decreased cell viability of E. coli biofilms (layers of bacteria) isolated from the urine of spinal cord injury patients by 80%. Using antibiotics with the phage cocktail prevented or decreased bacteria infections in the urine of patients using catheters. This cocktail has high potential to treat antibiotic-resistant, catheter-associated urinary tract infections, say the researchers. (Frontiers in Microbiology, May 10, 2022)
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Palliative care reduces suicide risk
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Palliative care can help prevent suicide in Veterans at high risk for death from other causes, according to a Corporal Michael J. Crescenz VA Medical Center study. Palliative care refers to care aiming to improve quality of life and reduce symptom burden in patients with complex and life-shortening conditions. Researchers looked at VA data on more than 580,000 patients who had a high risk of death within a year. A high percentage of Veterans who died by suicide were diagnosed with chronic pulmonary disease, as well as mental health and substance use conditions. One palliative care consultation in the 90 days before death decreased the odds of suicide by 71%. Two or more consultations lowered the risk of suicide by 78%. The results highlight the importance of palliative care in preventing suicide for patients with serious illness, say the researchers. (Journal of Pain and Symptom Management, April 28, 2022)
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Non-heterosexual Veterans at higher risk of disordered eating
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Non-heterosexual Veterans are more likely than heterosexual Veterans to have disordered eating, found a study by VA Boston researchers. The study surveyed over 800 female and over 500 male post-9/11 Veterans. Disordered eating—such as bulimia and binge eating disorder—was prevalent across gender and sexual orientation. Women identifying as bisexual and men identifying as gay had higher rates of disordered eating, compared to heterosexual Veterans. Experiencing discrimination in the military was linked to disordered eating. More research is needed on the causes of this disparity and the role of discrimination in disordered eating, according to the researchers. (International Journal of Eating Disorders, April 2022)
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Vaccines only modestly reduce long COVID risk in breakthrough infection patients
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Vaccines only modestly reduce the risk of long COVID in patients with breakthrough infection, according to a large study by VA St. Louis researchers. Long COVID refers to a wide range of ongoing health conditions that some people experience after recovering from COVID-19. Researchers studied data on nearly 34,000 people who had breakthrough COVID-19 infections after being vaccinated. They compared this group to more than 13 million controls. People with breakthrough infection had lower rates of death and long COVID symptoms six months after infection, compared to those who had never been vaccinated. However, breakthrough patients had a significantly higher risk of death and health problems compared to patients who never contracted COVID-19. These patients experienced many different symptoms, including cardiovascular, clotting, kidney, and mental health problems. The results show an urgent need to develop additional layers of protection beyond vaccines to protect against the long-term consequences of COVID-19, say the researchers. (Nature Medicine, May 25, 2022)
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Role of immune system dysregulation in PTSD
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A growing body of research shows that immune system dysregulation is an important contributor to PTSD, according to a review by VA Connecticut researchers. Recent research suggests that biological processes of the immune system contribute to PTSD. Researchers conducted a literature search and found 77 studies on the immune system response in PTSD. Traumatic experiences appear to cause dysregulation in the immune system that leads to inflammation in the brain and nervous system. Changes to gene expression could lead to hormones being produced that cause an inflammatory response in the brain, which is linked to PTSD symptoms. However, this dysregulation can be both pro-inflammatory and anti-inflammatory, depending on the patient. This shows that PTSD is a complex disorder than has many potential sub-types, say the researchers. More research is needed on the role of the immune system in PTSD, they say. (Biomedicines, May 10, 2022)
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Exercise therapy lowers adverse outcomes from chronic pain
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Exercise therapy lowers adverse outcomes in Veterans with chronic pain, found a VA study. Exercise therapy includes physical procedures such as stretching, strength training, and gait training. Researchers looked at data for nearly 94,000 soldiers with chronic pain who enrolled in VA health care after leaving the army. Those who attended at least eight sessions of exercise therapy for their pain while in the military had significantly lower risk of alcohol and drug disorders, suicidal thoughts, and death compared to those not given exercise therapy. This trend was especially true for those prescribed opioids before starting exercise therapy. The results suggest that exercise therapy should be considered as a non-drug treatment for chronic pain, according to the researchers. (Military Medicine, March 21, 2022)
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Guilt reduction therapy effective treatment for PTSD
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Therapy aimed at addressing guilt is an effective way to reduce posttraumatic symptoms and distress, found a VA study. Guilt is common after a traumatic experience and can even persist after PTSD treatment. Researchers compared two psychotherapies for reducing guilt in Veterans with guilt related to traumatic events during deployment to Iraq or Afghanistan. Trauma-informed guilt reduction helps patients accurately appraise their role in the trauma and re-engage with their values. Supportive care therapy focuses on understanding and support, without necessarily directly addressing guilt. While both therapies decreased guilt, the decrease was greater with the guilt-specific treatment. The guilt reduction method also was more effective at reducing PTSD and depression symptoms. Patients receiving trauma-informed guilt reduction had a higher likelihood of PTSD treatment response, loss of PTSD diagnosis, and meaningful change in depression. The results show that targeting a prominent symptom like guilt can be an effective way to reduce PTSD and distress, say the researchers. (Depression and Anxiety, April 2022)
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Computer simulations show muscle weakness caused by peripheral artery disease
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VA Nebraska-Western Iowa researchers used computer simulations to understand the walking problems of patients with peripheral artery disease. In peripheral artery disease, narrowed blood vessels reduce blood flow to the limbs. Patients with the condition have reduced muscle strength in the legs, which can cause walking problems. Researchers recorded gait and force metrics for 12 patients with the condition and 10 healthy patients. They then created computer simulations to study walking differences. Patients with peripheral artery disease walked slower than controls, with less hip extension. Several groups of leg muscles delivered inadequate force during stepping, compared with controls. The findings could be used to develop rehabilitation targeting specific muscles to improve walking in patients with peripheral artery disease, according to the researchers. (Journal of Biomechanics, April 2022)
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Opioid prescribing decreased for Veterans in community living centers
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Opioid prescribing decreased in recent years for Veterans with dementia in community living centers, found a study by VA Finger Lakes researchers and colleagues. The study included data from three time periods: 2012–2013, 2014–2015, and 2017–2018. More than 12,000 older Veterans living in community living centers were included. Opioid administration decreased after the publication of opioid safety guidelines for Veterans with dementia. Opioid prescribing was 26% lower in the second time period, and 34% lower in the third period. High-dose and long-term opioid use decreased more than 40% from the first time period. Prescriptions of both opioids and benzodiazepines (a dangerous combination) were 11% lower in the second period and 34% lower in the third period. Veterans with dementia and serious mental illness were less likely to be given opioids than those without mental illness. The results suggest that new guidelines reduced opioid use in community living centers, according to the researchers. More study is needed on how these opioid reductions affected health outcomes, they say. (Journal of the American Geriatrics Society, April 9, 2022)
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Genetic links between severe COVID-19 and other diseases
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A VA Million Veteran Program study identified genetic links between COVID-19 severity and certain serious medical conditions. Researchers analyzed genetic and health record data on more than 650,000 Veterans who volunteered for MVP. They compared gene variations previously found to be linked to severe COVID-19 risk with gene variants connected to other conditions. The analysis showed that gene variants linked to severe COVID-19 are also linked to medical conditions known to be COVID-19 risk factors. The strongest links were found for venous embolism and thrombosis, as well as type 2 diabetes and ischemic heart disease. The study also showed genetic links between severe COVID-19 and neutropenia—low white blood cell count—in Veterans of African and Hispanic ancestry. This link was not seen in Veterans of European ancestry. Conversely, gene variants associated with severe COVID-19 were associated with reduced risk of immune-related conditions such as lupus and rheumatoid arthritis. The findings shed light on genetic risk for COVID-19 and could lead to paths for new treatments, say the researchers. (PLOS Genetics, April 28, 2022)
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Dog ownership linked to physical exercise in older adults
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Dog ownership is linked to positive physical health behavior in older adults, found a study by VA researchers. The study assessed multiple health outcomes in adults 65 and older. Dog owners were more likely than those without pets to walk for exercise. They also reported better subjective health. Cat owners did not differ from non-pet owners in self-reported health or walking. The researchers did not find a relationship between pet ownership and depression symptoms. White participants were more likely than Black participants to own pets. Sex, race, and geographic location did not affect the findings. The results show that dog ownership may lead to healthy behavior, but should not be viewed as a simple solution for depression, say the researchers. (International Journal of Environmental Research and Public Health, May 6, 2022)
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Factors linked to suicidal behavior remission
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VA researchers and colleagues identified three factors linked to remission from suicidal thoughts and actions in Veterans. Researchers analyzed a broad range of social, demographic, and health data from a large survey of U.S. Veterans. They found that purpose in life, dispositional gratitude, and conscientiousness were linked to remission from suicidal thoughts and behaviors. Dispositional gratitude refers to a tendency to appreciate the positive aspects of life. Conscientiousness means being goal-oriented and attentive to details. All three factors were linked to remission even after accounting for other risk and protective variables. These three elements could be targets for interventions to help prevent Veteran suicides, according to the researchers. (Journal of Psychiatric Research, May 2022)
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Alcohol use disorder prevalent among Veterans
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Alcohol use disorder is prevalent among Veterans, according to a study by VA San Diego researchers. The study included more than 4,000 Veterans. About 41% of participants reported signs of alcohol use disorder in their lifetime, with 11% having the condition within the last year. Veterans with alcohol use disorder had higher rates of psychiatric disorders and suicidal behavior, compared with those without the disorder. Rates of these conditions increased with higher alcohol use disorder severity. Alcohol use disorder was linked to being younger, male, white, unmarried, retired, and having adverse childhood experiences and traumas. The results underscore the need for comprehensive alcohol use screening for Veterans, say the researchers. (Drug and Alcohol Dependence, Feb. 1, 2022)
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Genetic testing could protect against adverse drug interactions
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Genetic testing could help avoid adverse drug interactions for patients taking multiple medications, found a study by VA Puget Sound researchers. In a pilot study, researchers tested the genomes of 53 Veterans to predict how they would respond to specific medications. All participants were taking multiple medications for psychiatric conditions. Their health care providers were given the results of the genetic tests. For 83% of participants, providers changed their original medication plan based on the genetic results. Over 12 weeks of treatment, patients saw improvements in depression and mental health quality of life. Adverse drug effects were unchanged or improved over time with genetic testing, compared with original medication plans. The results show that genetic testing could benefit patients taking multiple medications, say the researchers. (Journal of Clinical Pharmacology, Jan. 24, 2022)
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Post-concussive symptoms linked to suicide risk
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Concussions may increase suicide risk in Veterans by limiting social participation, found a VA study. Mild traumatic brain injury, also called concussion, has been linked to increased risk of suicide. Researchers assessed 145 Veterans with concussion history. They found that more severe post-concussive symptoms were linked to less participation in socially or culturally meaningful activities. Greater participation was associated with lower odds of suicidal thoughts. The researchers concluded that post-concussive symptoms may heighten the risk of suicidal thoughts by limiting social participation. The results suggest that occupational therapy could help prevent Veteran suicide by encouraging Veterans to engage in social activity, say the researchers. (American Journal of Occupational Therapy, May 1, 2022)
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Pain in non-amputated arm common in Veterans with arm amputation
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Pain in the non-amputated arm is common in Veterans who have had an arm amputated, found a study by Providence VA researchers. The study surveyed nearly 800 Veterans with an upper-limb amputation—almost 600 participants were surveyed again one year later. About 73% had pain in the intact arm at baseline, 72% had pain one year later, and about 60% had persistent pain. Veterans who had conditions affecting the non-amputated arm, neck pain, and residual-limb pain had higher odds of having pain in the non-amputated arm. Black race, back pain, and older age were all associated with greater arm pain intensity. Women had lower pain intensity than men. Participants who used a cosmetic prosthesis also had less intense pain than those who used a body-powered prosthesis. The findings suggest that over-reliance on the non-amputated limb leads to pain in people with an upper-limb amputation, conclude the researchers. (Journal of Prosthetics and Orthotics, April 12, 2022)
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Older and underweight Veterans at higher risk of death from COVID-19
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Older and underweight Veterans had a higher risk of death from COVID-19, in a study by Salt Lake City VA researchers and colleagues. Researchers studied data on more than 400,000 Veterans who tested positive for COVID-19 in 2020 and 2021. Those 65 and older and those who were underweight were more likely to require mechanical ventilation and die in the hospital, compared with younger Veterans and those with normal weight. Veterans 85 and older had an almost five times greater rate of death. Asian and American Indian/Alaska Native Veterans also had higher risk of ventilation and death compared to white Veterans. Black Veterans had a 31% higher risk than white Veterans of hospitalization, but did not have a higher risk of death. Hospitalization, ventilation, and death rates decreased for all groups over time. The results show that age and weight are important variables to consider in COVID-19 risk, say the researchers. (Annals of Epidemiology, April 21, 2022)
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Transgender Veterans more likely to be prescribed opioids
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Transgender Veterans had higher odds than cisgender Veterans of being prescribed opioids in VA, but not higher odds of high-risk opioid doses, found a study by VA Pittsburgh researchers. Researchers looked at data on nearly 10,000 transgender and more than 29,000 cisgender (someone who’s gender identity and sex assigned at birth are the same) Veterans receiving care in VA. They found that transgender Veterans had a 20% higher risk of being prescribed outpatient opioids. However, odds of high-risk prescribing were the same for transgender and cisgender Veterans. High-risk prescribing includes high doses, more than one opioid prescription, or prescriptions for both opioids and benzodiazepines. Overall, transgender Veterans had more than twice the risk of opioid poisoning compared with cisgender Veterans. But the risk was the same when only those prescribed opioids were analyzed. More research is needed on why opioid prescribing differs in these groups, say the researchers. (American Journal of Preventive Medicine, April 5, 2022)
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Using genetic tests to assess disease risk
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VA Boston researchers and colleagues developed processes to assess patients for genetic risk for several diseases. A polygenic risk score summarizes a person’s gene variations to assess their genetic risk for a disease. While scientists have created many of these scores, assessing individual patients and then applying the findings clinically is more difficult. The researchers developed a process to analyze the genomes of more than 36,000 patients. They then compared the findings to polygenic risk scores for coronary artery disease, diabetes, atrial fibrillation, colorectal cancer, prostate cancer, and breast cancer. This method showed good accuracy for predicting disease risk. The team also developed a report to help clinicians interpret the results and share risk information with their patients. The study shows that individualized laboratory tests for genetic disease risk are feasible and could help improve patient health, say the researchers. (Nature Medicine, April 18, 2022)
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Standing wheelchair performs well in testing
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A manual standing wheelchair designed by Minneapolis VA researchers performed well and can improve users’ mobility. Standing wheelchairs allow users to raise from a seated to a standing position, enabling them to interact with people and objects at eye level. The study team previously designed a wheelchair that a user can propel manually in both the seated and standing position. They refined the design based on user feedback, including the weight and width of the chair. The new design met safety standards in stability testing. During a 100-meter test, study participants were able to move the wheelchair at speeds similar to those typical of wheelchair use in the home while both seated and standing. In the standing position, participants achieved speeds about three times faster than walking speeds seen with exoskeletons designed to help paralyzed users stand and walk. With some engineering changes, one participant was able to reach standing-configuration speeds similar to a nondisabled person when walking. This shows that the standing wheelchair could allow users to keep pace with family and friends, say the researchers. The standing wheelchair shows potential to improve users’ quality of life and health, they add. (Disability and Rehabilitation. Assistive Technology, Feb. 23, 2022)
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Veterans’ health worsens over time after leaving military
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Veterans may experience worsening health over time after leaving the military, according to a VA study. Researchers surveyed nearly 4,000 Veterans within three months of leaving the military. Each Veteran completed five additional surveys at six-month intervals. Most aspects of Veterans’ health and broader well-being worsened over time. The most noteworthy declines were in mental health and community involvement. Declines in good health and well-being were most notable in women Veterans. The findings highlight the need to increase health prevention and early intervention efforts as Veterans transition out of the military, according to the researchers. Women Veterans’ unique adjustment concerns especially need to be addressed, they say. (Social Science and Medicine, February 2022)
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Military sexual trauma linked to multiple health problems
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Military sexual trauma is linked to elevated health burden, according to a VA study. Researchers surveyed more than 4,000 Veterans. They found that 44% of female and 4% of male Veterans had experienced military sexual trauma. Women with military sexual trauma histories had five-times greater odds of having PTSD, compared with other women. They were twice as likely to engage in mental health treatment. They also scored lower on measures of psychosocial functioning and had more physical health symptoms. Men with a military sexual trauma history had three-fold higher odds of suicidal thoughts. They were two- to three-times more likely to have PTSD, depression, and generalized anxiety disorder compared to men without a history of military sexual trauma. These male Veterans also had two-times greater odds of being disabled. The results underscore the importance of increasing outreach to both male and female Veterans with military sexual trauma history, say the researchers. (Journal of Affective Disorders, March 15, 2022)
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Seizure drug may help treat posttraumatic irritability
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A seizure drug may be an effective treatment for posttraumatic irritability, found a VA study. Irritability after traumatic brain injury can become a chronic problem that interferes with daily function. The study tested the effects of divalproex sodium, an epilepsy medication, on patients with posttraumatic irritability and a history of alcohol use disorder. Participants taking the drug showed significant, sustained reduction of irritability, compared with controls. Alcohol use did not change as a result of treatment. No adverse side-effects occurred. Larger clinical trials are needed to explore this potential new treatment, say the researchers. (Journal of Neuropsychiatry and Clinical Neuroscience, March 11, 2022)
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Mindfulness program could lower opioid misuse
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A mindfulness program led to a reduction in opioid misuse and chronic pain improvements, according to a study led by a VA Salt Lake City researcher. Participants included 250 patients on long-term opioid therapy for chronic pain who were misusing opioid medication. Half received eight weeks of training focusing on mindfulness and savoring positive experiences. The other half attended supportive group psychotherapy. Nine months after treatment, 45% of the mindfulness group and 24% of the control group were no longer misusing opioids. The mindfulness group reported lower pain severity than the other group during the nine-month follow-up, as well as lower emotional distress and opioid craving. The mindfulness group also reduced their opioid dose more than the control group. The results suggest that mindfulness could be an effective approach to address opioid misuse, according to the researchers. (JAMA Internal Medicine, April 1, 2022)
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Post-surgery opioid use increases opioid use disorder and overdose risk
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Patients who develop persistent post-surgery opioid use are at increased risk of opioid use disorder and overdose, according to a VA Maine study. Persistent opioid use is common after surgery. Researchers looked at data on more than 300,000 VA patients who had surgery. Patients were followed for multiple years. Those who developed persistent opioid use after surgery were at 88% higher risk of opioid use disorder, compared with those without persistent use. The risk of an opioid overdose was 78% higher in patients with persistent post-surgery use. Clinicians need to be aware of the risks when prescribing opioids after surgery, according to the researchers. (Annals of Surgery, Jan. 25, 2022)
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VA depression screening leads to treatment, but improvements needed
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Most VA patients who screened positive for depression received treatment but fewer received timely follow-up, found a VA Greater Los Angeles study. VA mandates annual depression screening in primary care. Researchers studied data on more than 600,000 VA patients who were screened during a four-year period. About 8% screened positive for depression. Of those, 77% completed at least minimal depression treatment. However, only 32% met guidelines for timely follow-up after the positive screen. Younger patients, Black patients, and those with other psychiatric diagnoses were most likely to receive timely follow-up. The results show that VA’s universal depression screening has improved treatment, but improvements are still needed, say the researchers. (JAMA Network Open, March 1, 2022)
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Behavioral health provider burnout
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VA Ann Arbor researchers and colleagues identified factors linked to burnout in VA behavioral health providers. They analyzed four years of employee survey responses from nearly 60,000 VA psychiatrists, psychologists, and social workers. Between 31% and 38% reported feeling burnout. Reasonable workload, having appropriate resources, supervisor support, and opportunities to improve skills were linked to lower burnout. Feeling that their work improved Veterans’ lives and that care provided was well-coordinated were also linked to lower burnout. Staffing vacancies, clerical work, and collateral duties that reduced availability for patient care were all associated with feelings of burnout. Workload was the strongest predictor of burnout. The findings highlight the importance of having necessary resources and support in behavioral health care, say the researchers. (Health Services Research, March 1, 2022)
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COVID-19 increases diabetes risk
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COVID-19 increases the risk of developing diabetes, found a VA St. Louis study. Researchers studied data on more than 180,000 VA patients who had recovered from COVID-19. They compared these patients to over 4 million people who did not contract COVID-19 and over 4 million controls from before the pandemic. Those who had COVID-19 were at a 40% higher risk of being newly diagnosed with diabetes at least 30 days after infection, compared with controls. Odds of being prescribed medication for glycemic control were also increased. Diabetes risk was increased even in patients with mild COVID-19. More severe COVID-19 symptoms were linked to greater risk of developing diabetes. The results show that diabetes should be considered a facet of long COVID, and that strategies to address rising diabetes cases are needed, say the researchers. (Lancet Diabetes and Endocrinology, March 21, 2022)
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Stem cells could speed up wound healing
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Stem cells from fat could help speed up wound healing, according to a James A. Haley Veteran’s Hospital study. Chronic inflammation can often lead to problems with wound healing in the skin. Researchers isolated particles called exosomes from human fat stem cells. They showed that RNA strands in these exosomes are central to promoting wound repair. The researchers then simulated low-grade inflammation in lab-grown cells. They found that the exosomes from fat cells regulated inflammation pathways when introduced to the cells. The results show that exosomes harvested from fat cells could speed up healing in slow-healing skin wounds, such as those related to diabetes or obesity, say the researchers. (Biology, March 11, 2022)
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Racial disparities in menopause management
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Racial disparities may exist in menopause symptom reporting and treatment, according to a San Francisco VA study. Researchers studied electronic health record data for more than 200,000 women receiving care in VA. They found that Black women Veterans had lower odds of documented menopause symptoms, compared with white women Veterans. Black women also had lower estrogen use than white women. Black and Hispanic/Latina women were less likely than white women to be prescribed systemic hormone therapy to treat menopause symptoms. Hispanic/Latina women had higher odds than white women of a vaginal estrogen prescription. The findings show lower menopause symptom reporting and treatment in minority Veterans despite previous research that suggests higher menopause symptom burden in Black women. This suggests that important disparities in menopause care may exist, say the researchers. (Menopause, March 7, 2022)
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COVID-19 vaccines largely effective over long-term
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COVID-19 vaccines are effective at preventing the disease long-term, according to a review by VA Iowa City researchers and colleagues. Most studies on vaccine effectiveness have looked at outcomes within three months after vaccination. The researchers conducted a literature search for studies of long-term vaccine efficacy. They found 16 studies that included nearly 18 million patients who received either the Pfizer, Moderna, AstraZeneca, or Janssen vaccines. At least five months after vaccination, average vaccine effectiveness was 84%. Average protection against COVID-19 hospitalization was 89%. Vaccine effectiveness during the delta variant wave was 61%. The findings show that COVID-19 vaccines convey protection for months after vaccination, say the researchers. More studies are needed on the effectiveness of a third dose, mixing different vaccines, and against newly emerging variants, they say. (Antimicrobial Stewardship & Healthcare Epidemiology, Feb. 14, 2022)
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Strengths, weaknesses of housing-first homelessness program
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VA Greater Los Angeles researchers identified strengths and weaknesses of a housing-first program to combat Veteran homelessness. The Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program prioritizes quickly finding permanent housing for homeless people without sobriety or mental health treatment prerequisites. Researchers surveyed Veterans and HUD-VASH providers on how well the program has been implemented. Overall, those surveyed believed that the program benefits Veterans and is sustainable. Weaknesses include client-to-staff ratio, frequency of client-provider contact, and time to housing. Factors such as housing scarcity and staff turnover affect the program’s sustainability. Staff also identified changes in leadership and unmet resource needs as challenges. The findings show that housing-first initiatives can help homeless Veterans, say the researchers, but improvements could be made. (Health Services Research, March 3, 2022)
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Suicide rate increasing in American Indian and Alaska Native Veterans
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Suicide is an increasing problem among American Indian and Alaska Native Veterans, according to a VA study. Researchers analyzed VA data on this group from between 2002 and 2014. They found that suicide rates more than doubled over the study period. The youngest age group (age 18–39) had the highest suicide rate. Firearms were the most frequently used means of suicide. The findings are similar to those seen in the general American Indian/Alaska Native population. The results show a compelling need to strengthen VA suicide prevention efforts for American Indian and Alaska Native Veterans, say the researchers. (Medical Care, April 1, 2022)
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Small shifts in VA colon cancer screening during pandemic
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VA facilities achieved only limited success in efforts to switch from colonoscopy to fecal testing to improve colon cancer screening during the COVID-19 pandemic, according to a VA Ann Arbor study. A VA directive encourages the use of chemical fecal testing in place of colonoscopy for colon cancer screening to address screening backlogs. These backlogs were exacerbated during the pandemic. Researchers looked at data on screenings from both before and during the pandemic. They found a 9% decrease in colonoscopy screening in VA from the pre-COVID period to during the pandemic. The average monthly volume of fecal tests increased by 8% during this time. The results suggest poor system-wide uptake of the shift in screening type, say the researchers. More efforts are needed to increase access to cancer screening through stool-based testing, they say. (Gastroenterology, Feb. 24, 2022)
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Stigma makes Veterans less likely to disclose suicidal behavior
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Worry about stigma may stop Veterans from disclosing suicidal thoughts and behaviors, according to a study by VA researchers and colleagues. Past research has shown that stigma—feelings of shame or disapproval—is linked to less help-seeking for mental health issues. The researchers surveyed 500 participants, half of whom were Veterans. Greater feelings of self-stigma and anticipated stigma related to suicide were linked to a lower likelihood of disclosing suicidal thoughts and actions. This relationship was not seen in non-Veterans. Whether a Veteran used VA health care did not affect the fear of being stigmatized. The findings suggest that Veterans’ worries about suicide stigma may be grounded in past experiences in the military, say the researchers. Efforts are needed to protect against negative associations with talking about suicide in Veterans. (Psychiatry Research, March 2022)
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Diabetes drug could help treat flu
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The diabetes drug metformin may lower the risk of death from the flu, found a Columbia VA study. Metformin is a medication used to control high blood sugar. Researchers compared data on diabetic patients taking and not taking metformin, along with non-diabetic patients. All patients had been diagnosed with the flu. Flu patients prescribed metformin had lower rates of death than those not on metformin. There was no statistical difference between non-diabetic patients and diabetic patients not taking metformin. The results suggest that more research is warranted on metformin as a flu treatment, say the researchers. (Pathogens, Feb. 19, 2022)
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Integrated mental health care may improve physical health
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Integrating mental health care into primary care clinics may improve patients’ physical health, found a study of VA patients. VA integrated mental health into all primary care clinics beginning in 2008. Researchers studied outcomes of nearly 830,000 patients seen at these clinics. About 6% of patients were seen by mental health specialists during their primary care visits. Diabetic patients seen at clinics with greater mental health care use showed better glycemic control. Patients diagnosed with hypertension had moderately lower odds of elevated blood pressure at clinics with more mental health use. The results suggest that integrating mental health care into primary settings can improve not only mental health, but physical health as well, say the researchers. (Journal of General Internal Medicine, Feb. 9, 2022)
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Self-directed care program helps older Veterans live independently
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Older Veterans using a self-directed care program had fewer avoidable health care events, especially in rural settings, according to a VA study. The Veteran-Directed Care (VDC) program allows Veterans to pick for themselves the services and support they need to remain independent in the community, paid for by VA. Among other options, it allows participants to hire family members and neighbors as paid caregivers. Researchers studied data on more than 37,000 Veterans using VA-paid home and long-term care services. Both rural and urban Veterans using VDC were less likely to be admitted to a nursing home, compared with those using other care services. Rural VDC enrollees had significantly fewer acute care admissions and emergency room visits than those using other services. The results show that VDC has the potential to help older Veterans remain in the community. This is especially true in rural areas where health care options are more limited, say the researchers. (Journal of the American Geriatrics Society, Jan. 13, 2022)
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Alcohol and drug use severity affect PTSD differently
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VA Southeast Louisiana Health Care System researchers identified mechanisms through which drug and alcohol use affect PTSD symptoms. PTSD and substance use disorders frequently occur together in Veterans. The researchers found that PTSD symptom severity was related to alcohol use severity through anxiety sensitivity, the fear of anxiety-related sensations. Drug use influenced PTSD severity through distress intolerance. Distress intolerance is the perceived inability to tolerate negative emotional states. Alcohol use was not linked to distress intolerance, and drug use was not linked to anxiety sensitivity. The findings suggest new ways to approach co-occurring PTSD and substance use disorders, according to the researchers. (Addictive Behaviors, March 2022)
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Electronic appointment reminders improve VA wait times
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Electronic appointment reminders improved wait times for VA patients, according to a study led by a VA Puget Sound researcher. The study included data on VA medical appointments across 130 VA medical centers made between January and October 2018. An interactive mobile text messaging system called VEText was rolled out across VA in that year. The data set included 39 million appointments from 5 million patients. Average wait time was shortened by 6.5 days after VEText adoption. However, VEText was also associated with an increase of 8.5 days waiting for patients who canceled or no-showed their appointments. The results suggest that electronic reminders can be a useful tool to decrease wait times, but challenges still exist, say the researchers. (JAMA Network Open, Feb. 1, 2022)
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Horse riding could help Veterans with addiction
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A horse-riding program has potential as a therapy for patients with addictive disorders, found a VA Salt Lake City study. Some evidence suggests that equine therapy can reduce anxiety and depression and enhance quality of life. Researchers conducted a pilot program of recreational trail rides with 18 Veterans with addictive disorders, such as drug or alcohol misuse. After the program, participants showed decreases in anxiety, negative emotions, and cravings. They also experienced increased positive emotions. The rides were carried out with minimal safety risks, although trail riding comes with some inherent dangers. The results show that recreational trail riding is a feasible complementary treatment for patients with addiction, say the researchers. (Complementary Therapies in Medicine, Feb. 3, 2022)
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Gene strands linked to cognitive decline identified
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A team including an Atlanta VA researcher identified RNA strands that are involved in cognitive decline. The team studied the postmortem brain microRNA of more than 500 volunteers who had been diagnosed with dementia. MicroRNA are small, non-coding strands of genetic molecules that regulate gene expression. The researchers identified two specific strands that were particularly associated with cognitive trajectory. Together, the presence of these two genetic strands explained 13% of the variation in rate of cognitive decline seen in patients. Their effect on cognitive decline was independent of other neurodegeneration factors. The results will help scientists understand the molecular processes behind dementia and could lead to new treatments, according to the researchers. (Translational Psychiatry, Feb. 1, 2022)
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COVID-19 increases mental health risks
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COVID-19 increases the risk of multiple mental health conditions, according to a study by St. Louis VA researchers. The researchers examined data from more than 150,000 VA patients who had recovered from COVID-19. They compared the data to VA data on 5.8 million people who did not get COVID-19 during the pandemic era and 5.9 million controls from before the pandemic. Patients who contracted COVID-19 had a 60% higher risk of mental health disorders one year after recovering. This includes higher risk for anxiety, depression, stress disorders, opioid use, substance use disorders, and sleep conditions, as well as cognitive problems such as “brain fog.” Risk was increased even in patients who had less severe COVID-19 and were not admitted to the hospital. But this risk was highest in patients with more severe COVID-19. The results show that tackling mental health disorders among COVID-19 survivors should be a priority, say the researchers. (BMJ, Feb. 16, 2022)
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Biomarkers may predict depression in pregnancy
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VA researchers and colleagues identified biomarkers that could help predict depression during pregnancy. Depression during and after pregnancy affects up to 20% of pregnant women. Researchers analyzed blood samples and symptoms in 114 pregnant women during each trimester and after pregnancy. They found that levels of two proteins, interleukin-1beta and interleukin-6, were linked to depression severity both during and after pregnancy. Measuring a combination of these proteins, called cytokines, and molecules linked to the amino acid tryptophan during the second trimester yielded a greater than 99% accurate prediction of third-trimester depression. The findings could help predict depression in pregnant women and may also lead to new treatment options, according to the researchers. (Translational Psychiatry, Jan. 26, 2022)
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Automated wheelchair system to travel over curbs
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Engineers with the VA Pittsburgh’s Human Engineering Research Laboratories designed a system to help automated wheelchairs recognize and negotiate curbs. Common electric wheelchairs cannot safely travel over barriers such as curbs. Robotic wheelchairs are designed to overcome this obstacle. But they require proper alignment before passing curbs, which can be difficult for users with physical or sensory impairments. The researchers combined their existing mobility enhancement robot (MEBot) with a spatial-recognition algorithm called Polylidar3D. The system allows the MEBot wheelchair to automatically approach curbs correctly. It was able to successfully recognize curbs at 14 out of 15 starting positions and correctly determine the height and distance that the MEBot would need to travel. This allowed the wheelchair to climb curbs safely. The new system could improve accessibility and safety for automated wheelchair users, say the researchers. (Sensors, Nov. 24, 2021)
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COVID-19 increases cardiovascular risk
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COVID-19 increases the risk of cardiovascular complications, found a study by VA St. Louis researchers. The study included data on more than 150,000 VA patients who contracted COVID-19, comparing them with more than 5 million controls who did not have COVID-19 and more than 5 million pre-pandemic patients. Patients who had recovered from COVID-19 were significantly more likely to have heart and vascular disease a year after infection. Overall, COVID-19 patients had a 4% higher rate of heart disease. Compared with controls, they had a 72% higher risk of coronary artery disease, 63% higher risk of heart attack, and 52% higher risk of stroke. The risk was evident regardless of age, race, sex, or other cardiovascular risk factors. Even those who had mild COVID-19 had higher cardiovascular risk, although the risk increased with disease severity. The findings show that post-COVD-19 care needs to include cardiovascular health, say the researchers. (Nature Medicine, Feb. 7, 2022)
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Problem drinking patterns after traumatic brain injury
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Trends in problematic drinking after a traumatic brain injury differ based on severity of injury, according to a VA study. Young service members and Veterans are at risk for problematic alcohol use. Research suggests that TBI may increase this risk. The study followed 265 service members and Veterans younger than 40 who had sustained a TBI for a period of five years. Those with moderate-to-severe TBI reported reduced alcohol consumption in the first two years after injury, followed by an increase in alcohol use. Those with mild TBI showed an opposite trend. Many had a period of increased alcohol use after injury, before declining to baseline levels of drinking. The difference between groups may be due to more severely injured patients receiving more advice to limit alcohol consumption as part of their TBI care. The results suggest that the period of two to five years after a TBI may be a critical window for efforts to lower alcohol use, say the researchers. (Journal of Head Trauma Rehabilitation, Feb. 1, 2022)
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Veterans with and without mental illness equally likely to get COVID-19 vaccine
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VA patients with and without serious mental illness were equally likely to get a COVID-19 vaccine, found a Greater Los Angeles VA study. Researchers looked at data from nearly 5 million VA patients. They compared vaccine rates during the period of December 2020 to June 2021. About 48% of Veterans with a serious mental health diagnosis received a COVID-19 vaccine during the time period. For Veterans without serious mental illness, the vaccination rate was 46%. The results show that VA outreach has led to equitable COVID-19 vaccine distribution, according to the researchers. (Psychiatric Services, Jan. 18, 2022)
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Digital app could improve loneliness and quality of life
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A mental health therapy app improved loneliness and quality of life, found a study by VA Palo Alto researchers. The Meru Health Program is a therapist-supported digital program aimed at decreasing depression and anxiety. It focuses on mindfulness and cognitive behavioral interventions. Researchers looked at outcomes for 50 older participants using the app. Program use led to increases in mental health quality of life and decreases in loneliness. These changes were largely due to increases in mindfulness, according to study analysis. The results show that therapist-supported digital interventions can be a useful tool for improving mental health, say the researchers. (Frontiers in Public Health, Dec. 9, 2021)
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Possible new biomarker for antidepressant effectiveness
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A team including a Jesse Brown VA Medical Center researcher identified a biomarker that may help predict how well patients with depression respond to antidepressants. The researchers studied blood samples of 49 subjects with major depressive disorder and 59 healthy controls. Subjects with depression had significantly lower activity of an enzyme called adenylyl cyclase. The protein Gsα is known to activate adenylyl cyclase. However, in patients with depression this protein is often concentrated inside lipid rafts, structures within cell membranes made of lipid molecules. The researchers compared blood samples of patients with depression after six weeks of antidepressant treatment. They found that those who responded best to antidepressants had higher activation of the enzyme than those who did not respond to treatment. Antidepressants may aid in the movement of Gsα outside of lipid rafts, where they would be more likely to activate adenylyl cyclase, according to the researchers. The results could lead to a simple blood test for these molecules to predict how well antidepressants will work, they say. (Molecular Psychiatry, Jan. 5, 2022)
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Brain structure changes linked to impairment after stroke
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Reduced gray matter volume is connected to impairments after stroke, according to a study by a worldwide consortium including VA. A majority of stroke survivors experience sensorimotor impairments such as difficulty with fine motor skills. Structures in the gray matter are important in the regulation of sensorimotor movements. The researchers studied brain scans of more than 800 patients with stroke. In the early days of stroke recovery, sensorimotor problems were linked to lower volume of the thalamus on the same side of the brain as the stroke damage. In chronic stroke (symptoms lasting at least 180 days), a lower volume of the brain structures putamen and accumbens and larger lateral ventricle size were linked to worse sensorimotor behavior. The results show how changes in brain structure after stroke may cause motor and sensory problems, say the researchers. (Brian Communications, Oct. 27, 2021)
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Gene variants increase COVID-19 kidney risk in patients with African ancestry
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Veterans of African ancestry with specific gene variants were at heightened risk of acute kidney injury from COVID-19, found a VA Million Veteran Program study. COVID-19 can cause significant risk of acute kidney injury. Previous research has shown that people of African ancestry with two copies of specific variants of the APOL1 gene have increased rates of kidney disease. Researchers looked at genetic data on 990 MVP participants of African ancestry who were hospitalized with COVID-19. They found that patients with two copies of the high-risk APOL1 variants had higher odds of acute kidney disease, higher kidney disease severity, and death, compared with patients with one or none of the gene variants. This risk existed even in patients with prior normal kidney function. The findings suggest that genetic risk assessment could help predict kidney risk from COVID-19 in patients with African ancestry, say the researchers. (JAMA Internal Medicine, Jan. 28, 2022)
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Depression may be linked to genetic cause of Alzheimer’s
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Depression may have a causal role in Alzheimer’s disease, according to a study by an Atlanta VA researcher and colleagues. Depression is known to be associated with increased Alzheimer’s risk. Researchers performed a genome-wide association study of more than 800,000 people to examine the genetic link between depression and Alzheimer’s. Data suggest that the two conditions have a shared genetic basis. Further, depression appears to add to the development of Alzheimer’s, but Alzheimer’s does not contribute to depression. The researchers identified 46 RNA molecules and seven proteins previously known to be linked to depression that also contribute to cognitive decline, Alzheimer’s pathologies, and Alzheimer’s diagnosis. Additionally, higher depression genetic risk was associated with faster memory decline. The results suggest genetic targets for possible future Alzheimer’s therapies, say the researchers. (Biological Psychiatry, Dec. 16, 2021)
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Sound waves could help treat musculoskeletal injury
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Sustained acoustic medicine has potential as a treatment for musculoskeletal injury, according to a VA review. Sustained acoustic medicine uses high-frequency ultrasound waves to stimulate circulation and cell growth. James A. Haley VA Hospital researchers performed a literature search of studies on this technique. They found 13 clinical studies on the topic. Patients in the studies were being treated for neck and back pain and injury, knee pain from osteoarthritis, or soft tissue injury. Acoustic treatment was shown to improve patient function and reduce pain. It was linked to heating that aided tissue recovery. Because it is non-invasive and non-narcotic, sustained acoustic medicine could be a good treatment option for musculoskeletal pain when patients do not respond to physical therapy, say the researchers. (BMC Sports Science, Medicine & Rehabilitation, Dec. 18, 2021)
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Telehealth may be best method to deliver PTSD therapy
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Telehealth therapy is an efficient and effective way to treat PTSD, according to a study by South Texas VA researchers and colleagues. Active-duty service members and Veterans with PTSD underwent 12 sessions of cognitive processing therapy, a psychotherapy. Therapy was delivered one of three ways: face-to-face with the therapist in-office; through a computer video link; or in the patient’s home, with the therapist traveling to the home. All three methods resulted in significant PTSD symptom reductions. In-home and telehealth symptom reductions were about twice as large as those for in-office treatment. In-home treatment had the lowest dropout rate, but the differences were not statistically significant. While in-home treatment led to the strongest PTSD improvements and lowest dropout, it was also the least accepted treatment by patients. In-home treatment also required double the amount of therapist time and had unexpected complications for both patients and therapists. The results provide strong support for the use of telehealth for PTSD treatment, say the researchers. (BMC Psychiatry, Jan. 17, 2022)
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Moral injury increases Veterans’ suicide risk
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Moral injury during military service increases suicide risk in both men and women, according to a VA study. Moral injury is defined as perpetrating, failing to prevent, or bearing witness to acts that go against deeply held moral beliefs. Researchers surveyed more than 14,000 Veterans. They found that men who experienced moral injury were 50% more likely to attempt suicide during their service and twice as likely to do so after leaving the military, compared with those without moral injury. Men who felt betrayed were nearly twice as likely than those without these feelings to attempt suicide during service, but no more likely after service. Women who experienced betrayal were over 50% more likely to attempt suicide both during and after service. Perpetrating a morally injurious act did not increase the suicide risk of women Veterans. The findings indicate that moral injury assessment should take gender difference into account, say the researchers. (Psychological Medicine, Jan. 17, 2022)
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Oxytocin may improve opioid use disorder treatment adherence
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Using oxytocin nasal spray may improve patients’ adherence to opioid treatment programs, found a study by VA researchers. Use of stimulants such as cocaine or methamphetamine in people with opioid use disorder (OUD) has increased drastically in recent years. Stimulant users have lower treatment retention and poorer outcomes than those with OUD only. In the study, Veterans receiving medication treatment for OUD (such as methadone) also received twice-daily intranasal oxytocin for six weeks. Oxytocin is a hormone linked to social bonding. Some research suggests that it could have anti-addiction effects. Oxytocin did not decrease patients’ stimulant use or cravings. However, those receiving oxytocin attended significantly more daily opioid medication visits. The results suggest that oxytocin could improve engagement and social connection, leading to better adherence to OUD treatment, according to the researchers. (Frontiers in Psychiatry, Jan. 17, 2022)
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Study identifies gene variant that may protect against severe COVID-19
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An international study using VA Million Veteran Program data identified a specific gene variant that may protect against severe COVID-19 infection. The team, including a VA Boston researcher, studied the genome of nearly 3,000 patients of African ancestry with COVID-19 and more than 130,000 controls of African ancestry. They found that individuals with a specific variant on the gene OAS1 had a decreased chance of developing severe COVID-19. Previous studies of people of European ancestry identified the region on the genome containing OAS1 as related to COVID-19 risk. By examining this region in those with African ancestry, the researchers were able both to show that people of different ancestry shared this protection and to home in on the specific gene variant. People with this gene variant produce a longer form of a specific protein, which is more effective at breaking down the virus that causes COVID-19 than other forms of the protein. The finding could help develop new drugs against COVID-19, according to the researchers. The study also shows the importance of including ethnically diverse populations in genetic studies, they say. (Nature Genetics, Jan. 13, 2022)
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VA patients may receive better diabetes care than non-VA patients
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Diabetic patients receiving VA care had better blood pressure and cholesterol management than those receiving non-VA care, found a study by VA researchers and colleagues. Of more than 5,000 patients, VA and non-VA patients had similar diabetes outcomes. However, VA patients had more diabetes risk factors, including high blood pressure and cholesterol, older age, and cardiovascular disease. VA patients were more likely to be on blood pressure- and cholesterol-lowering medications, leading to better cholesterol numbers than those seen in non-VA patients. The results suggest that VA patients received better diabetes care despite having more diabetes complications, say the researchers. (Diabetes Research and Clinical Practice, Dec. 28, 2021)
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Women Veterans less likely than men to be prescribed statins
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Women are less likely than men to receive statin therapy for cardiovascular care, according to a Ralph H. Johnson VA Medical Center study. Statins, drugs that lower cholesterol, are often prescribed to patients with cardiovascular disease and diabetes. Researchers looked at data on more than 700,000 VA patients with diabetes. They found that women Veterans had 14% lower odds of being prescribed statins, compared with men. Lower access to health care and higher mental health diagnoses seem to explain this disparity. Women were 10% less likely than men to be on high-intensity statins. After the researchers adjusted for health care access and mental health burden, women actually had higher odds of high-intensity statin use. The study highlights a persistent health disparity between men and women Veterans, say the researchers. (Women’s Health Issues, Dec. 20, 2021)
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Group cohesion an important part of suicide prevention group therapy
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Establishing group cohesion is an important part of group therapy for Veteran suicide prevention, according to a study by Robley Rex VA Medical Center researchers. They performed a three-year follow-up of Veterans who received group therapy after discharge from inpatient psychiatric care following a suicidal crisis. No suicides occurred during the study period. Higher group cohesion was linked to a lower likelihood of psychiatric hospitalization and higher engagement in mental health services. Group cohesion refers to forming a collaborative, accepting relationship with the therapy group. Factors that led to group cohesion included shared experiences and having similar service backgrounds, as well as building intimacy and trust. The results show that group therapy could be a useful long-term treatment for suicidal behavior, say the researchers. (Psychological Services, Dec. 30, 2021)
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Less racial disparity in VA than non-VA care for bladder cancer
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Lower racial disparities in bladder cancer outcomes were seen in VA versus outside care, in a study by VA San Diego researchers. African American patients with bladder cancer tend to have worse outcomes than white patients, likely due to difference in health care access. The study included more than 36,000 VA patients and more than 120,000 non-VA patients with bladder cancer. African Americans were more likely than Whites to have muscle-invasive disease (a more serious form of bladder cancer) and cancer metastasis, when cancer spreads to other parts of the body, in both groups. But this racial difference was smaller in VA patients. In non-VA patients, African Americans were more likely than Whites to die from bladder cancer or other causes. Mortality rates between races were similar in VA patients. The findings show that receiving care in an equal-access system such as VA lowers cancer care disparities, according to the researchers. (Journal of the National Cancer Institute, Dec. 16, 2021)
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Lower risk of death from surgery in VA hospitals than outside facilities
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Patients who have surgery at VA facilities had a lower risk of death than those receiving non-VA surgery, found a VA study. Researchers looked at data on nearly 4 million surgeries performed between 2015 and 2018. Surgeries from eight different non-cardiac specialties were examined. Compared with private sector care, VA care was associated with a lower risk of death during surgery and recovery. VA surgeries also had lower failure to rescue, defined as inability to prevent a patient’s deterioration and death after a complication arises. The results suggest that VA hospitals may be better equipped to care for the unique surgery needs of Veterans, say the researchers. Veterans are often more frail and have more medical conditions than the general population. (JAMA Surgery, Dec. 29, 2021)
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Potential new treatment for cocaine use disorder
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A team including a Providence VA researcher identified a potential new treatment for cocaine use disorder. Researchers studied gene expression in the brain tissue of people with cocaine use disorder who died from cocaine-related causes. They identified several gene expression patterns associated with the disorder. Ibrutinib, a drug used to treat certain cancers, appears to interact with the biological pathways associated with cocaine use disorder. Using a fruit fly model, the researchers found that ibrutinib reduced cocaine-induced startle response and seizures. The findings suggest that ibrutinib could be a useful treatment for cocaine use disorder, say the researchers. (Translational Psychiatry, Dec. 8, 2021)
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Crowded psychiatric units may increase suicide risk
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Inpatient psychiatric unit overcrowding may increase suicide risk, found a study of VA patients. Researchers looked at data from 111 VA medical centers with psychiatric units from 2011 to 2016, a period in which Veteran suicides increased. They found that inpatient psychiatric unit occupancy above 95% was associated with a 10% increase in Veteran suicide risk in the region. The total number of beds in a psychiatric unit did not affect suicide risk. The researchers suggest that mental health care providers may make different decisions on whether to admit patients for suicidal thoughts or other mental health diagnoses based on psychiatric bed availability. Ensuring psychiatric units have enough beds could be an important part of preventing Veteran suicide, they say. (BMJ Quality & Safety, Aug. 16, 2021)
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Phone app may help treat insomnia
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A mobile app can help treat insomnia in Veterans, found a VA Bedford study. CBT-i Coach is a smartphone program designed to deliver cognitive behavioral therapy to treat insomnia. Cognitive behavioral therapy is psychological treatment focused on changing patterns of thinking related to stress and trauma. Veterans with chronic insomnia using the app reported significant improvements in sleep quality and insomnia symptoms. Benefits were similar in those with and without PTSD or sleep apnea. Adding a physical activity regimen to the app treatment did not affect outcomes. The results show that app-directed self-management can be a useful tool for Veterans with insomnia. (JMIR Formative Research, Dec. 9, 2021)
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Risk factors for Veteran suicide
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A seven-year study by VA researchers identified risk factors for suicide in Veterans. The researchers followed more than 2,000 Veterans for seven years to see how their baseline characteristics affected suicide risk. The strongest suicide risk factors were loneliness, low dispositional gratitude (the ability to appreciate positive aspects of life), thoughts of self-harm, and new traumas. Having more than one risk factor increased suicide risk. Veterans with all four risk factors had a 55% higher risk of a suicide attempt. The results suggest that suicide prediction models should consider how risk factors combine, say the researchers. (Suicide and Life-Threatening Behavior, Dec. 6, 2021)
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COVID-19 antibodies decline after six months in nursing home residents
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Antibodies from the COVID-19 vaccine declined significantly in nursing home residents six months after vaccination, found a Cleveland VA study. Researchers tested the blood of 130 nursing home residents and 95 health care workers two weeks and six months after they received the Pfizer mRNA vaccine. At two weeks, nursing home residents had only one-quarter of the antibodies as health care workers. The difference was likely due to age and health-related risk factors. All subjects who did not contract COVID-19 after vaccination had drastically lower antibody levels after six months. Of nursing home residents who never caught COVID-19, 69% had antibody levels below the limit of detection after six months. Residents with COVID-19 infection before vaccination had slightly higher antibody levels, but antibody levels still dropped by at least 81%. The results highlight the need for vaccine boosters, especially in older populations, say the researchers. (Clinical Infectious Diseases, Nov. 19, 2021)
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Drug may help prevent cardiovascular complications of kidney disease
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The drug finerenone may improve cardiovascular outcomes in patients with diabetes and chronic kidney disease, found a study that included a Richard L. Roudebush VA Medical Center researcher. Finerenone (sold as Kerendia) has been shown to improve outcomes in patients with advanced kidney disease. But its effects on those with less advanced kidney disease are unknown. More than 7,000 patients with chronic kidney disease and type 2 diabetes were given either finerenone or placebo. Researchers followed patients for more than three years. The finerenone group had lower rates of death from cardiovascular causes, heart attack, stroke, and hospitalization for heart failure, compared with the placebo group. Those taking finerenone also had lower frequency of kidney failure, decreased kidney function, and kidney-related death. The results suggest that finerenone may be an attractive therapeutic option to prevent cardiovascular complications of kidney disease, say the researchers. (New England Journal of Medicine, Dec. 9, 2021)
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Psychotherapy an effective treatment for anger
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The psychotherapy cognitive behavioral intervention (CBI) is an effective treatment for anger problems in Veterans, found a VA study. Problems with anger and aggression are common in post-9/11 Veterans. Researchers compared the effectiveness of CBI versus supportive intervention for anger in 92 Veterans. CBI focuses on recognizing and changing how a patient thinks and reacts to anger and traumatic thoughts. Supportive intervention focuses on support, hope, and motivation. Patients receiving CBI has significantly more improvement in anger severity, social and interpersonal functioning, and quality of life. The treatment was effective regardless of whether the patient had PTSD. The results show that CBI can be an effective treatment for post-deployment anger for patients both with and without PTSD, say the researchers. (Depression and Anxiety, Dec. 8, 2021)
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Genetic mutations linked to esophageal cancer identified in African American patients
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Washington, DC VA researchers identified genome mutations that could explain the aggressiveness of esophageal cancer in African Americans. Esophageal cancer—cancer of the tube that runs from the throat to the stomach—has a low survival rate because of a lack of diagnostic markers for early detection. In the United States, 75% of patients diagnosed with esophageal squamous cell carcinoma are of African descent. Researchers analyzed the genomes of 10 tumors from African American patients, compared with health control tissue. This was the first such genetic study in African American patients. They identified several gene mutations that could help explain why esophageal cancer is so aggressive in this population. The findings could lead to new diagnostic and treatment techniques, according to the researchers. (Scientific Reports, July 20, 2021)
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Lithium can stabilize circadian rhythm in bipolar disorder
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Lithium treatment is associated with reduced circadian rhythm disruption in patients with bipolar disorder, found a study by VA San Diego researchers and colleagues. Bipolar disorder often involves depression and disrupted circadian rhythms. A circadian rhythm is a natural, internal process that regulates the sleep-wake cycle and repeats about every 24 hours. Lithium is an effective treatment for bipolar disorder, but only 30% to 40% of patients respond. It is unclear how important lithium’s effect on circadian rhythm is to the treatment’s effectiveness. Researchers measured sleep patterns in 386 patients with bipolar disorder. They found that patients who had never taken lithium had the most circadian disruption. Patients who responded to 12 weeks of lithium treatment showed significant improvements in depression symptoms that disturb sleep patterns. The results suggest that stabilizing circadian rhythms may be an important feature of lithium treatment for bipolar disorder, say the researchers. (Bipolar Disorder, Nov. 26, 2021)
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Diabetes drug metformin may lower liver cancer risk in diabetic patients
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Metformin use and glycemic control were linked to reduced risk of liver cancer in patients with diabetes and nonalcoholic fatty liver disease, found a Michael E. DeBakey VA Medical Center study. Nonalcoholic fatty liver disease patients who also have diabetes have a high risk of developing liver cancer. Researchers looked at data from nearly 86,000 VA patients with both conditions. Use of the diabetes drug metformin was linked to a 20% lower risk of liver disease compared to patients not taking the drug. Adequate control of blood sugar levels was linked to a 31% lower risk of cancer. Taking insulin alone did not affect cancer risk. Insulin combined with other oral medications was linked with a 1.6-fold higher risk of liver cancer. The results support the idea that metformin may help prevent liver cancer in these patients, say the researchers. (Hepatology, Nov. 15, 2021)
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Combination antibiotics may effectively treat drug-resistant bacteria
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Combination antibiotics may be more effective than older medication at treating antibiotic-resistant infections, according to a review by Hines VA researchers and colleagues. Antibiotic-resistant bacteria, such as carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa, are serious health care concerns. Combination antibiotics pair older drugs with a drug called beta-lactamase inhibitor. The researchers reviewed scientific studies to see whether these new antibiotics are more effective than older drugs at treating the two infections. They found that combination antibiotics produced similar clinical results as older drugs. The new drugs appear to be more effective at controlling bacteria levels. The results support recommendations that combination antibiotics be used to overcome antibiotic resistance, say the researchers. (Antimicrobial Stewardship & Healthcare Epidemiology, Nov. 25, 2021)
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Asthma drug may reduce lung cancer risk
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Asthma medication may reduce the risk of lung cancer, found a study by Columbia VA researchers. Drugs called leukotriene inhibitors are used to treat asthma. Some research suggest that they may also suppress tumor growth. Researchers studied data on more than 550,000 VA patients with asthma. Patients taking a leukotriene inhibitor had a 22% reduced risk of lung cancer, compared with patients not on the drug. The researchers caution that other factors may be at play because treatment was not randomized. The findings suggest that leukotriene inhibitors have potential as lung cancer prevention, say the researchers. (Pulmonary Pharmacology and Therapeutics, Oct. 15, 2021)
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Lithium does not appear to improve suicide risk
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Adding lithium to medication regimens does not help prevent suicide-related events in patients with mood disorders, found a VA study. Prior studies have suggested that lithium may prevent suicide in patients with bipolar disorder or depression. Researchers added lithium to the treatment of VA patients with bipolar disorder or depression who had survived a recent suicide-related event, such as a suicide attempt or a hospital admission to prevent suicide. The trial was stopped for futility after 519 Veterans were enrolled. No difference between lithium and placebo treatment was found. Both the lithium and placebo groups had similar rates of suicidal behavior. The findings suggest that adding lithium has no effect on suicidal behavior for patients with mood disorders, say the researchers. (JAMA Psychiatry, Nov. 17, 2021)
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Telemedicine could help reduce emergency department overcrowding
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Tele-urgent care could safely decrease emergency department overcrowding, according to a San Francisco VA study. Emergency department use for non-emergency issues often leads to overcrowding and decreased quality of care. Researchers tested a telehealth program for urgent care to address this issue. Out of 2,510 patients who used tele-urgent care, 21% were referred to in-person emergency care. Among those not referred to in-person care, 11% ended up visiting an emergency department within 72 hours. Only one in five in this group required hospitalization. The results show that a virtual platform may offer an effective and safe way to assess patients and decrease emergency department burden, say the researchers. (Journal of Telemedicine and Telecare, June 21, 2021)
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Smartphone app aims to help prevent Veteran suicide
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Researchers from the Providence VA developed a smartphone app to help prevent suicide. The Mobile Application for the Prevention of Suicide (MAPS) uses assessment in the moment to identify suicide risk and deliver real-time treatment strategies. The app is personalized to each patient. Eight Veterans hospitalized for suicidal behavior tried MAPS for two weeks. They reported high levels of satisfaction. All eight Veterans opted to continue using the app after the trial period ended. MAPS could be a useful addition to treatment and may help better track suicide risk and provide assistance for high-risk Veterans, according to the researchers. (Military Psychology, Oct. 28, 2021)
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Daily fasting could improve metabolic health, suggests mouse study
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Fasting is an important aspect of a calorie-restricted diet, suggests a study by William S. Middleton Memorial Veterans Hospital researchers. Calorie restriction has been shown to promote healthy aging in mouse models. But in such models, feeding usually happens once per day, altering normal feeding behavior. Researchers studied multiple feeding patterns in mice to see how periods of fasting affect calorie restriction benefits. They found that prolonged fasting is necessary for key metabolic and molecular benefits of calorie restriction to take effect. A calorie-restricted diet improved glucose tolerance, body composition, and age-related frailty, but only in mice that fasted for extended period between meals. The results suggest that when a person eats, not just how much they eat, is important to health and diet, according to the researchers. Daily prolonged fasting could have real benefits for metabolic and aging health in humans, they say. (Nature Metabolism, October 2021)
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Homelessness, justice involvement linked to mental health difficulties
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Homelessness and justice involvement are linked to greater mental health difficulties, according to a VA Rocky Mountain MIRECC study. Researchers looked at data from a 2018 survey of more than 15,000 post-9/11 Veterans. They found that homelessness and a history of involvement with the criminal justice system were both linked to more severe PTSD, depression, and substance use symptoms, compared with other Veterans. Those who experienced homelessness or justice involvement also had increased rates of suicidal thoughts and attempts. Veterans with a history of both homelessness and justice involvement had the most severe mental health symptoms and suicide risk of the study group. The findings show that increased access to mental health services is needed in these Veteran populations, say the researchers. (Journal of Psychiatric Research, Nov. 3, 2021)
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Solar activity may be linked to high blood pressure in elderly men
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Sunspots may be linked to higher blood pressure in older men, found a study including VA Boston researchers. The researchers studied blood pressure readings for 675 elderly men between 2000 and 2017. Participants were born between 1884 and 1945. They found that periods with high magnetic field activity from the sun corresponded with higher diastolic and systolic blood pressure patterns. The pattern was most evident when the number of sunspots and disturbance to Earth’s magnetic field were high 16 days before blood pressure reading. The link between solar radiation and blood pressure was independent of pollution or ambient radioactivity levels. Previous research has shown that changes in magnetic field linked to sunspots and solar wind can affect autonomic nervous system activity. The results could have implications for long-term management of blood pressure, and also may help scientists interpret data from long studies, according to the researchers. (Journal of the American Heart Association, Nov. 2, 2021)
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COVID-19 vaccine effectiveness wanes, but remains high against death
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Vaccine protection against COVID-19 declined during 2021, but protection against death after infection remained high, according to a study by VA San Francisco researchers. The study looked at COVID-19 infection rates and deaths for more than 780,000 VA patients between February and October 2021. Effectiveness against infection for the three vaccines being given in the United States—created by Pfizer, Moderna, and Janssen—fell from an average of 88% to 48% as the Delta variant of the virus emerged. Although breakthrough infections increased, the vaccines proved to be highly protective against death from COVID-19. Protection against death from COVID-19 remained above 73% for all three vaccines in patients younger than 65, and above 70% for older patients. The findings support efforts to increase vaccination, booster campaigns, and additional layers of protection against infection, say the researchers. (Science, Nov. 4, 2021)
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E-cigarettes may increase inflammation, disease risk
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E-cigarettes may increase inflammation and weaken immune response, according to a VA San Diego study. Researchers measured the levels of several biomarkers in the saliva, sputum, and blood of e-cigarette users and non-smoking controls. E-cigarette smokers had higher levels of proteins that indicate inflammation. Smokers also had lower levels of proteins that signal the immune response to help fight off infections. The immune response was also blunted in smokers when challenged by a bacteria. This suggests a decreased ability to respond to infection. The findings raise concerns that smoking e-cigarettes may make people more vulnerable to infectious disease, say the researchers. (American Journal of Physiology, Oct. 27, 2021)
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PTSD medication disparities between rural and urban VA patients mostly eliminated
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Disparities in PTSD treatment between rural and urban VA patients have improved in the last decade, found an Iowa City VA study. Researchers looked at VA prescribing data from 2009 and 2019. They found that recommended PTSD medications were prescribed significantly less often in rural clinics than in larger medical centers in 2009. By 2019, recommended prescribing was about equal in rural and urban settings. In 2009, prescribing of medications not recommended for PTSD patients was higher among rural than urban residents. The rates were largely equal by 2019. The results show that rural discrepancies in PTSD prescribing in VA had largely been corrected by 2019, according to the researchers. (Journal of Rural Health, Nov. 9, 2021)
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Tau protein linked to traumatic brain injury, processing problems
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High levels of the protein tau are linked with a history of traumatic brain injury and reduced processing speed in Vietnam-era Veterans, found a study by VA San Diego researchers. The team checked the levels of several biomarkers in the cerebrospinal fluid of 102 Veterans, half of whom had history of TBI. The TBI group had significantly higher levels of both p-tau and t-tau, two forms of a protein often found in the brain and spinal cord. Researchers did not find differences in levels of amyloid beta, a peptide associated with Alzheimer’s disease. Those with TBI history and high tau levels had reduced performance on a measure of cognitive processing. The findings suggest that tau accumulation may be a mechanism of dementia risk for Veterans with TBI, according to the researchers. (Alzheimer’s and Dementia, Oct. 14, 2021)
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Pregnancy-related anxiety linked to postpartum depression
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Pregnancy-related anxiety was linked to postpartum depression and parent-child bonding difficulties, in a study of pregnant Veterans. Twenty-eight pregnant Veterans completed questionnaires during and after pregnancy. Results showed that pregnancy-related anxiety was a stronger predictor of postpartum depression than depression during pregnancy. Postpartum depression was in turn associated with parenting stress. More depressed mothers were more likely to have greater difficulties bonding with their child and experienced more feelings of rejection, anger, anxiety, and stress. The results suggest that treating anxiety during pregnancy could help prevent postpartum depression and subsequent parenting difficulties, say the researchers. (Maternal Child Health Journal, Oct. 9, 2021)
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Transcranial magnetic stimulation can improve depression, PTSD
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Transcranial magnetic stimulation (TMS) was shown to reduce depression and PTSD symptoms, in the largest study to date of the treatment in Veterans. TMS noninvasively uses magnetic fields to affect the electrical signals in the brain. Researchers studied its effectiveness in 770 Veterans with major depressive disorder. Of those, 68% also had PTSD. TMS led to clinically meaningful symptom reductions for both conditions. Of patients who received an adequate dose of TMS, 41% saw depression symptom improvements, with a remission rate of 20%. For patients with PTSD, 65% had meaningful symptom reduction, and 46% no longer met the criteria for PTSD. The results support the effectiveness and safety of TMS for treating both depression and PTSD, say the researchers. (Journal of Affective Disorders, Oct. 20, 2021)
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Low-value prostate cancer screening common in VA
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Low-value cancer screenings in VA were low for some cancers, but high for prostate cancer, found a study by VA Puget Sound researchers. Clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits. Researchers looked at data on almost 6 million VA patients. For men of average risk, 19% underwent prostate cancer screening and 5% underwent colorectal cancer screening. For women of average risk, 5% underwent breast cancer screening and 14% underwent cervical cancer screening. Low-value screening was defined as screening outside of recommended age ranges or mortality risks. It was rare for breast, cervical, and prostate cancers. However, more than one-third of prostate cancer screens were low-value. Patient race and ethnicity, sociodemographic factors, and health burdens were linked to the likelihood of receiving low-value tests. Individualized recommendations for cancer screenings could help limit low-value screenings, say the researchers. (JAMA Network Open, Oct. 1, 2021)
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Mild traumatic brain injury linked to prolonged health problems
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Deployment-related mild traumatic brain injury was associated with multiple persistent post-concussive symptoms, in a VA study. Researchers interviewed 613 Veterans and service members who served in Afghanistan and Iraq. They found that mild TBI was linked to headaches, sleep disturbance, and difficulty making decisions an average of 10 years after injury. Deployment-related TBI was also associated with nausea/upset stomach and numbness or tingling. These symptoms were seen in deployment-related TBI but not normally in TBI patients. The results show that mild TBIs sustained during deployment have enduring negative health effects, according to the researchers. (Brain Injury, Sept. 20, 2021)
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Statin use may increase diabetes progression
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Statin use is linked to worsening diabetes progression, according to a study led by a VA North Texas researcher. Statins are drugs intended to lower cholesterol. Researchers compared data on over 80,000 VA patients with diabetes who took statins and a matched group not on statins. They found that diabetes worsened in 56% of patients taking statins, compared with 48% of those not on the drug. Patients taking statins were more likely to have begun insulin treatment, have high blood sugar, have diabetes complications, and take an increased number of prescriptions. Results show that the risks and benefits of statin use need to be carefully weighed in diabetes patients, say the researchers. (JAMA Internal Medicine, Oct. 4, 2021)
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Biological pathways of suicide risk identified
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VA Million Veteran Program researchers identified several biological factors related to suicide risk. Researchers conducted a genome-wide association study comparing Veterans with a history of suicide attempts with those without suicidal behavior. They found 30 biologic pathways associated with an increased risk of suicide attempts. Those pathways included differences in the signaling of oxytocin, a hormone involved in social bonding. Multiple stress pathways, including cortisol secretion and blood pressure regulation, were also found to be related to suicide risk. Subject groups also showed differences related to circadian rhythm. Identifying biological factors related to suicide risk could help identify new treatments, according to the researchers. (American Society of Human Genetics, Oct. 18, 2021)
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Statin use disparities
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Disparities exist between which patients continue to take statins when experiencing side effects, according to a study by Michael E. DeBakey VA Medical Center researchers and colleagues. Statins are drugs that lower cholesterol. Side effects—such as headache, muscle pain, digestive problems, and poor sleep—are the leading cause of statin discontinuation. Researchers studied data on more than 1 million patients with atherosclerotic cardiovascular disease. Females, white patients, and those with high blood pressure or ischemic heart disease were at increased risk of statin side effects. Those receiving care at a teaching facility had lower risk. Among patients experiencing side effects, those with diabetes or ischemic heart disease and those with more cardiology visits were more likely to remain on statins. Being female was linked with lower odds of remaining on statins. The results suggest areas for improvement in optimizing statin use, say the researchers. (Journal of Clinical Lipidology, Oct. 2, 2021)
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Many VA health care enrollees purchase outside insurance
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Many enrollees of VA health care also acquire health insurance outside VA, found an Edward Hines, Jr. VA Hospital study. Researchers surveyed almost 4,000 Veterans enrolled in VA health care. Of those, 32% also had non-VA insurance. The most common reasons for having outside insurance were wanting coverage for emergency situations or family members. The largest barrier to outside insurance coverage was affordability. The results show the importance of meeting all of VA enrollees’ health care needs within VA and community care financed through VA, according to the researchers. (Medical Care Research and Review, Oct. 8, 2021)
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Military sexual trauma independently increased suicide risk
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Military sexual trauma is a risk factor for suicide in Veterans without mental health diagnoses, found a study by VA Connecticut researchers. While sexual trauma is associated with suicidal ideation—thinking about suicide—less is known about this relationship when other mental health concerns, such as depression or PTSD, are not involved. Researchers examined more than 41,000 Veterans without a mental health diagnosis. They found that 28% of women and 3% of men reported military sexual trauma. Fifteen percent of women and 17% of men experienced suicidal ideation. Military sexual trauma was linked to a higher risk of suicidal ideation in both men and women. The findings suggest that instances of military sexual trauma should prompt suicide screening, say the researchers. (Psychiatric Research, September 2021)
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Legal involvement increases risk of opioid overdose death
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Legal system involvement was linked to increased risk of opioid overdose and death, in a study of VA patients. Researchers looked at data of more than 5 million Veterans who used VA health care. Of those, around 32,000 had legal system involvement, meaning they spent time in prison or jail. Veterans with legal involvement were significantly more likely to die from an opioid overdose, compared with those without legal involvement. The results show that opioid overdose prevention and naloxone distribution should target legally involved Veterans, say the researchers. (American Journal of Preventive Medicine, Sept. 11, 2021)
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Poor diet quality in older Veterans with PTSD
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Older Veterans with PTSD may have poor quality of diet, found a pilot study by Durham VA researchers. Older Veterans with PTSD are at an increased risk of obesity and cardiovascular disease. Researchers examined the eating habits of 54 older Veterans participating in a supervised exercise trial. They found that consumption of added sugar exceeded dietary recommendations. Consumption of healthy foods such as whole grains, fruits and vegetables, and calcium fell short of recommendations. Participating in the exercise program did not affect diet quality. Interventions that target both diet and exercise are needed to address obesity and cardiovascular disease in Veterans with PTSD, conclude the researchers. (Translational Behavioral Medicine, Sept. 6, 2021)
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Severe obesity a risk factor for death from COVID-19
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Severe obesity increases the risk of death from COVID-19, according to a study of VA patients. Researchers looked at outcomes for more than 16,000 VA patients hospitalized with COVID-19 between March and November of 2020. Of those, 12% died in the hospital. Severe obesity, defined as a body mass index above 40 kg/m2, increased the risk of death by 43%. Obesity (BMI between 30 and 40) and sleep apnea did not increase the risk of death from COVID-19. According to the Centers for Disease Control and Prevention, a BMI between 18.5 and 24.9 is considered a healthy weight. Severe obesity should be considered an underlying medical condition when prioritizing treatment and predicting severe COVID-19 risk, conclude the researchers. (International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Aug. 23, 2021)
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Disability compensation may affect PTSD treatment response
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Disability compensation status may affect how well Veterans respond to PTSD treatment, found a study by Battle Creek VA Medical Center researchers and colleagues. The researchers reviewed the charts of 105 Veterans undergoing cognitive processing therapy, a PTSD psychotherapy. Those seeking compensation from the Veterans Benefits Administration saw less symptom improvement. About 67% of non-compensation seeking Veterans saw clinically significant improvements. Only 40% of those who were seeking VBA benefits saw PTSD improvement. Some researchers and clinicians have suggested that Veterans may be concerned with losing their disability status if they show symptom improvement. Others fear that some Veterans may participate in mental health treatment to establish a basis for a PTSD claim, only to drop out after their claim is adjudicated. More research is needed on whether the benefits process unintentionally discourages PTSD improvement, say the researchers. (Psychiatric Quarterly, Sept. 17, 2021)
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Transcranial magnetic stimulation safe for patients with alcohol use disorder
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Transcranial magnetic stimulation is safe for patients with alcohol use disorder (AUD), according to a Providence VA study. In transcranial magnetic stimulation, a magnetic field is applied to the skull to influence brain impulses. One form of this treatment, intermittent theta burst stimulation (iTBS), has potential as a treatment for PTSD and depression. However, there are some safety concerns about the treatment in patients with AUD. Researchers studied 50 Veterans with PTSD receiving iTBS, 17 of whom had AUD. iTBS was shown to be safe for AUD patients. These patients also had greater improvements in depression symptoms, compared to patients without AUD. AUD did not impact PTSD symptom change. The results suggest that AUD should not be excluded from receiving iTBS treatment, say the researchers. (Journal of Affective Disorders, Oct. 1, 2021)
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Heart rate variability as a biomarker of PTSD treatment response
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Heart rate variability could be a useful predictor of how patients with PTSD will respond to transcranial magnetic stimulation, according to a study by VA Providence researchers. PTSD is linked to problems with autonomic functions, such as elevated heart rate and reduced heart rate variability. Intermittent theta-burst stimulation (iTBS) is a form of transcranial magnetic stimulation, in which a magnetic field is applied to the head to affect brain signals. Researchers examined how well Veterans with PTSD responded to this treatment. Those with less dysfunction had greater PTSD symptom improvements from iTBS. Measuring abnormalities such as heart rate variability could be a useful way to gauge how patients will react to iTBS, say the researchers. (Neuromodulation, Sept. 27, 2021)
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Cough medicine may reduce flu hospitalizations
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The drug dextromethorphan may reduce hospitalization from the flu, found a Columbia VA study. Dextromethorphan is an over-the-counter cough suppressant. It is sold as Robitussin, Delsym, and several other brands. Researchers looked at data on more than 18,000 Veterans with confirmed flu cases, nearly 3,000 of whom were given dextromethorphan. Those treated with the drug had a 34% reduced risk of being hospitalized. The chances of being hospitalized for a respiratory problem were even lower for treated patients, compared with patients not given the drug. The results suggest that dextromethorphan could be repurposed as a treatment for the flu, say the researchers. (Pharmacotherapy, Aug. 24, 2021)
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Gender-based health care disparities
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A study by Michael E. DeBakey VA Medical Center researchers and colleagues examined how gender affects cost-related health care disparities. The researchers looked at data from a CDC survey of more than 1.7 million people. They found that women were more likely than men to delay health care, be unable to see a doctor because of cost, and have cost-related medication non-adherence. Women were less likely to not have health coverage or a primary care physician. These disparities were most pronounced in women younger than 45 and Black women. Identifying such health care barriers is crucial to ensuring equitable health care access for all, according to the researchers. (Preventive Medicine, Sept. 3, 2021)
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Primary care employment support helps Veterans with psychiatric disorders
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Offering employment support in primary care helps Veterans with psychiatric disorders find meaningful employment, found a Tuscaloosa VA Medical Center study. Individual placement and support (IPS) is a program that helps Veterans with disabilities find personally matched work. But many find it stigmatizing to receive this service through mental health care. Some Veterans fear that they will not be able to find employment if their psychiatric needs are disclosed. Researchers studied the effectiveness of IPS integrated with VA primary care. Nearly twice as many IPS participants achieved steady work, compared with controls receiving standard vocational rehabilitation. IPS participants worked significantly more weeks and earned more income from competitive jobs. The results show that integrating IPS with primary care is feasible and effective, say the researchers. (Psychiatric Services, Sept. 15, 2021)
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Gulf War chemical exposure could cause cell dysfunction
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A combination of toxins can cause cell dysfunction related to Gulf War illness, according to a study by VA New Jersey researchers. Previous studies have suggested that GWI is related to exposure to various toxins during service. Researchers exposed human cells in the lab to three chemicals: a pesticide, an insect repellant, and a nerve gas antitoxin. Service members were commonly exposed to these chemicals during the Gulf War. Exposure to all three together caused mitochondrial dysfunction in the cells. Problems with cell function could cause GWI symptoms such as fatigue, forgetfulness, and muscle pain, according to the researchers. Combined exposure to all three toxins should be examined as a possible cause of GWI, they say. (Journal of Biochemical and Molecular Toxicology, Sept. 15, 2021)
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Differentiating between Veterans who think about and attempt suicide
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A study of more than 4,000 Veterans identified demographic differences between those who only have suicidal thoughts and those who attempt suicide. Out of the sample, 26% thought about suicide at some point in their lives. Four percent attempted suicide. Several factors distinguished Veterans with a history of a suicide attempt from those with suicidal thoughts only. Factors linked to suicide attempts were younger age, nonsuicidal self-injury, adverse childhood experiences, alcohol use disorder, lower household income, and physical disability. These factors should be considered when assessing Veterans for suicide risk, say the researchers. (General Hospital Psychiatry, September-October 2021)
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Review: No link between cinnamon and lower cardiovascular risk
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Consuming cinnamon does not appear to reduce cardiovascular risk, according to a review by Michael E. DeBakey VA Medical Center researchers. Cinnamon is used as a traditional medicine for a variety of conditions by many cultures. Researchers performed a literature review of published studies on the effects of cinnamon on cardiovascular risk. They identified 23 studies. The existing research shows no differences in hemoglobin A1c levels or both types of cholesterol for patients who did or did not consume cinnamon. The results suggest that cinnamon has no effect on these measures of cardiovascular risk, say the researchers. (American Journal of Medicine, Aug. 16, 2021)
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High altitude may negatively affect brain chemistry
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Living at a higher altitude could negatively affect brain chemistry, found a study by VA Salt Lake City researchers and colleagues. Epidemiological studies have suggested that living at high altitude may be a risk factor for mood disorders, substance abuse, and suicide. The researchers used brain imaging to compare metabolite levels in the brains of patients living in Utah, Massachusetts, and South Carolina. Metabolites are molecules that the brain needs to function properly. Patients in Utah, which is at a higher elevation, had lower levels of several brain metabolites, compared with patients in the two other locations closer to sea level. Larger studies are needed to examine how altitude affects brain chemistry and mental health conditions, according to the researchers. (Psychiatry Research: Neuroimaging, Aug. 30, 2021)
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PTSD and traumatic brain injury alter brain connectivity
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Patients with PTSD and blast-related mild traumatic brain injury showed significant alterations to neural connections in the brain, in a Salisbury VA and Wake Forest School of Medicine study. Researchers used imaging to map the network of connections in patients’ brains. Patients with both PTSD and mild TBI shared structural characteristics in the brain that were not present in patients with PTSD only. The findings demonstrate that TBI and PTSD interact to create distinct neurological damage in the brain. The evidence strongly supports mild TBI as a risk factor for PTSD, according to the researchers. The connection patterns identified could aid in diagnosing both conditions, they say. (Journal of Neurotrauma, Aug. 26, 2021)
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COVID-19 pandemic has not increased suicide risk in Veterans
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The COVID-19 pandemic has not increased suicidal behavior among Veterans, according to a VA National Center for PTSD study. Many scholars warned that hardships and isolation caused by the pandemic could create a “perfect storm” of suicide risk among vulnerable populations. Researchers surveyed more than 3,000 Veterans in November 2019, and again in November 2020. They found that rates of suicidal thoughts actually decreased by nearly a third during the pandemic, from 10.6% of Veterans surveyed to 7.8%. The number of suicide attempts did not increase during the study period. However, Veterans who contracted COVID-19 were more than twice as likely to report suicidal thoughts than they were before infection. The results suggest that the resiliency of Veterans and increased social support may be protective against suicide risk during a health crisis, according to the researchers. More research is needed into how the physical and social effects of COVID-19 infection may affect suicide, they say. (JAMA Psychiatry, Aug. 25, 2021)
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PTSD treatment improves sleep
 ©iStock/Wavebreakmedia Photo for illustrative purposes only. (08/30/2021)
PTSD treatments improve sleep difficulties, according to a review that included a VA Greater Los Angeles researcher. Patients with PTSD often have difficulties with sleep. Researchers reviewed 89 studies on various PTSD treatments. They found that treatments that improved PTSD symptoms also improved sleep. Different types of treatment all led to better sleep. Interventions that specifically targeted sleep were more effective at improving sleep outcomes than other PTSD treatments. The results show that treatments that target sleep improvement may be helpful for patients with PTSD, say the researchers. (Sleep Medicine, Aug. 19, 2021)
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Testosterone treatment not associated with cardiovascular events
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Testosterone treatment in not associated with increased risk of cardiovascular events, found a study by VA Puget Sound researchers and colleagues. Concerns have been raised that treating men with testosterone could lead to cardiovascular events such as heart attack and stroke. The researchers studied more than 200,000 male Veterans with low testosterone levels. They found that testosterone treatment was not linked to increased cardiovascular events in patients without cardiovascular disease. In patients with cardiovascular disease, testosterone treatment was linked to lower risk. The results provide some reassurance that testosterone treatment does not pose a significant risk for cardiovascular events, say the researchers. (Journal of the American Heart Association, Aug. 21, 2021)
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New tool to predict suicide risk
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Durham VA researchers and colleagues created an accurate tool for predicting future suicide attempts. The researchers gathered data from a nationwide study and two smaller Veteran studies, for a total of over 35,000 participants. They developed a tool, the Durham Risk Score, based on psychiatric, social, economic, and health risk factors. The score proved to be a strong predictor of future suicide attempts. It performed well among multiple subgroups, including people of different ethnicities, Veterans, low-income people, and LGBTQ people. The results suggest that the Durham Risk Score represents a significant advancement in suicide risk prediction, say the researchers. (PLoS Medicine, Aug. 5, 2021)
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Smoking, alcohol use tied to lower mortality risk in COVID-19 patients
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Risk factors for death differ in COVID-19 infected and uninfected patients, found a Durham VA and Duke University study. Researchers compared mortality rates between Veterans with and without COVID-19 who had similar risk factors. They looked at outcomes of more than 340,000 male Veterans tested for COVID-19 between March and September 2020. Of those, 7% tested positive. Older age and obesity both increased the chance of death in patients with COVID-19 beyond the risk in similar patients not infected. Surprisingly, COVID-19 patients who smoked or had alcohol use disorder had lower mortality risk than patients who did not smoke or had alcohol use disorder. Both smoking and alcohol use disorder increased mortality risk in patients without COVID-19. More study is needed on why normally harmful behaviors might be associated with better mortality outcomes in COVID-19 patients, say the researchers. (International Journal of Environmental Research and Public Health, Aug. 11, 2021)
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Treating vitamin D deficiencies could lower risk of heart attack, death
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Treatment of vitamin D deficiencies may help prevent heart attacks and death, according to a study by Kansas City VA and University of Kansas Medical Center researchers. The study included more than 20,000 VA patients with low vitamin D levels. Patients given vitamin D to correct the deficiency had significantly lower chance of death from any cause, compared with those not given vitamin D. Patients whose vitamin D levels were maintained above a certain level were less likely to have a heart attack, compared with patients treated with a lower level of vitamin D. The findings suggest that correcting vitamin D deficiency could improve patients’ health outcomes, say the researchers. (Journal of the Endocrine Society, July 15, 2021)
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Racial gaps in PTSD treatment outcomes
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A VA study found that Black Veterans saw less improvement than white Veterans from PTSD treatment. Researchers looked at outcomes for 2,870 Veterans in a residential rehabilitation treatment program. Compared with white Veterans, Black Veterans had lower PTSD symptom reduction during treatment. They also had greater depression symptom recurrence four months after discharge. Importantly, both Black and white Veterans had PTSD symptom improvements during treatment. More study is needed to understand the causes of these differences in mental health treatment outcomes, say the researchers. (Psychiatric Services, Aug. 9, 2021)
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Convalescent plasma treatment did not affect COVID-19 mortality
 Image: ©iStock/Floriana (08/18/2021)
Convalescent plasma treatment did not reduce mortality in patients with non-severe COVID-19, in a study of VA patients. Convalescent plasma is a treatment using the blood from a person who has recovered from COVID-19. Scientists hypothesized that transferring antibodies to the new patients could improve recovery. Out of nearly 5,000 VA patients admitted for non-severe COVID-19 between May and November of 2020, about 8% received convalescent plasma. Thirty-day mortality for the convalescent plasma patients was 6.5%, compared with 6.2% in other patients. The results show no meaningful differences between patients treated or not treated with convalescent plasma for non-severe COVID-19, according to the researchers. (Journal of Infectious Disease, June 21, 2021)
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Toxic exposure increases Gulf War illness likelihood in women Veterans
 Photo: ©iStock/Brasil2 (08/18/2021)
Women Gulf War Veterans exposed to toxins were significantly more likely to have Gulf War illness than those without toxic exposures, found a study by VA Boston researchers. They surveyed 202 women Veterans who deployed during the Gulf War. Self-reported exposure to pesticides, oil well fires, and anti-nerve gas medication increased the likelihood of meeting Gulf War illness criteria. Results also suggest that women exposed to particular toxic substances may benefit from more targeted treatment strategies, according to the researchers. (Life Sciences, Sept. 1, 2021)
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Chronic pain may disrupt nervous system, lead to walking problems
 Photo: ©iStock/Piyapong Thongcharoen (08/10/2021)
Chronic pain may impact the body’s nervous system responses and disrupt a person’s walking, found a study including a Malcom Randall VA Medical Center researcher. Researchers measured sympathetic reactivity—how the body responds to danger or complex tasks such as walking on uneven terrain—by measuring skin conductivity. They found that participants with chronic pain had lower sympathetic reactivity when walking over obstacles, compared with participants without pain. They also found that blunted sympathetic reactivity was linked to disruptions in the brain’s autonomic network structure, the part of the brain responsible for involuntary actions such as heartbeat and breathing. The results suggest that chronic pain may negatively impact the body’s autonomic responses, which could lead to walking problems and falls, say the researchers. (Chronic Stress, July 7, 2021)
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Gulf War illness symptoms persist 25 years later
 Photo: ©iStock/robertcicchetti (08/10/2021)
A survey of Gulf War Veterans by Durham VA researchers found evidence of sustained, multis-symptom illness decades after deployment. Researchers surveyed more than 1,000 Veterans of the Gulf War era for Gulf War illness symptoms. Using the Centers for Disease Control and Prevention (CDC) definition of Gulf War illness, 84% of Veterans surveyed had the condition. Under the Kansas criteria, a different measure of the condition, 40% had the condition. Veterans who were deployed had higher odds of having symptoms related to Gulf War illness, compared with non-deployed Veterans. Symptom differences between deployed and non-deployed Veterans have diminished since initial reports. This suggests that definitions of Gulf War illness need to be updated to take into account age-related conditions, say the researchers. (Life Science, Aug. 1, 2021)
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TBI and PTSD affect coping skills and self-efficacy differently
 ©iStock/molchanovdmitry (08/10/2021)
Traumatic brain injury and PTSD change Veterans’ coping skills and self-efficacy, according to a study by VA San Diego researchers. Analysis of a group of Iraq and Afghanistan-era Veterans revealed that those with both mild TBI and PTSD had lower self-efficacy than Veterans with TBI only or neither condition. Self-efficacy refers to confidence in one’s ability to achieve goals. Veterans with PTSD but not TBI used less action-focused coping than those with only TBI or neither condition. The results suggest that treatments for TBI and PTSD should consider the interplay of the two conditions, say the researchers. (Journal of Clinical Psychology, May 15, 2021)
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Equal access to VA COVID-19 testing among racial groups
 Photo: ©iStock/ljubaphoto (08/04/2021)
Minority Veterans have had equal or greater access as White Veterans to COVID-19 testing from VA during the pandemic, found a VA Greater Los Angeles study. Researchers looked at data on the nearly 1 million Veterans who sought care through VA for COVID-19 symptoms or exposure in 2020. Early in the pandemic, Hispanic, Black, and other non-White minorities were more likely than White patients to receive COVID-19 tests. As the pandemic continued, testing was similar in VA among all racial and ethnic groups. As periodic testing shortages continue, it is important to ensure that groups with increased COVID-19 exposure risk continue to have equal access to testing, say the researchers. (Preventive Medicine Reports, July 22, 2021)
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Gulf War toxic exposure may be linked to damaging gene expression changes
 Photo: ©iStock/koto_feja (08/04/2021)
Toxic exposure during the Gulf War may alter gene expression in the hippocampus, which could cause memory problems, found a VA New Jersey study. The hippocampus is a part of the brain involved in spatial memory. Researchers simulated Gulf War toxic exposure in mice using three chemicals: two insecticides and an anti-sarin prophylactic. The chemical exposure resulted in inflammation and other changes in gene expression in the hippocampus. Genes involved in neuron health were downregulated after chemical exposure. The results suggest that exposure to these toxic substances could cause chronic neurodegeneration. The findings could help explain how Gulf War illness develops, according to the researchers. (Life Sciences, July 20, 2021)
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Knee replacement surgery at VA facilities leads to fewer complications than community surgeries
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Veterans receiving knee replacement surgery at VA facilities generally have fewer complications than those who receive VA-purchased surgery in the community, found a VA study. In addition to delivering health care directly, VA is increasingly purchasing health care for Veterans in the community. Researchers compared post-surgery complications between Veterans who had knee replacement surgery at VA and in the community. Overall, complication rates were significantly lower for VA-performed surgeries. However, there were five locations where VA-purchased care outperformed VA-delivered care. However, there were five locations where VA-purchased care outperformed VA-delivered care. In an email, lead researcher Dr. Alex Sox-Harris emphasized that the findings at those sites should not be “misinterpreted to mean those five facilities provided suboptimal care. We did not look at that directly. What we can say is that those five facilities managed to purchase care of even better quality than they delivered.” The results highlight the importance of monitoring quality of care both at VA facilities and where Veterans receive outside care, say the researchers. (Health Affairs, August 2021)
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Shorter antibiotic treatments effective at treating UTIs in men
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A shorter course of antibiotics can effectively treat urinary tract infections in men, according to a study by Minneapolis VA and Michael E. DeBakey VA Medical Center researchers. Standard treatment for UTIs is antibiotics for 7 to 14 days. In a study of more than 300 men, taking antibiotics for seven days was as effective as a 14-day course at resolving symptoms. Being on antibiotics for a shorter period of time is easier on patients who may experience side effects, say the researchers. Shortening the course of antibiotic treatment is also important for preserving the overall effectiveness of antibiotics. (JAMA, July 27, 2021)
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Program could prevent suicide after psychiatric hospitalization
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A brief intervention could help prevent suicide after psychiatric hospitalization, found a White River Junction VA study. Risk for suicide is high after psychiatric hospitalization. The World Health Organization’s Brief Intervention and Contact (BIC) program has shown some success at preventing suicide for these patients. Researchers tested the effectiveness of the BIC adapted for VA patients. The VA BIC program consists of six sessions within three months of discharge. Sessions include education about suicide prevention resources and conversations about motivation and social support. They found that, one month after discharge, the intervention led to meaningful reductions in suicidal thoughts. VA BIC also led to improvements in social connectedness, feelings of hopelessness, and engagement. The results show that the VA BIC program may be useful for preventing Veteran suicide during a vulnerable time, according to the researchers. (Psychiatric Services, May 12, 2021)
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Factors associated with homelessness
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Birmingham VA researchers and colleagues identified both individual and community risk factors for homelessness in Veterans. They surveyed more than 5,000 Veterans. Of those, 9% had at least seven nights unsheltered over a six-month period. Veterans experiencing homelessness were more likely to report criminal justice history, poor social support, medical and drug problems, financial hardships, and being unmarried. The communities they lived in had poorer shelter access and warmer temperatures. Having more than one of these risk factors increased the chances of homelessness significantly. The results show the need to consider both individual and community factors when addressing Veteran homelessness, say the researchers. (American Journal of Preventive Medicine, July 15, 2021)
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Nasal swab COVID-19 test less sensitive, easier than sinus swab
 Photo: ©iStock/Giuseppe Lombardo (07/21/2021)
Nasal swabs are less sensitive than deeper sinus swabs at detecting the virus that causes COVID-19 but are still highly accurate, found a study by a VA researcher. The “gold standard” for detecting SARS-CoV-2 is a nasopharyngeal swab, which takes a sample from the back of the sinuses through the nose. Researchers reviewed studies of how effective this type of COVID-19 test was compared with nasal swabs taken from the nostrils. They found that nasal swabs were 82% to 88% effective at detecting the virus, compared with 98% for nasopharyngeal swabs. However, nasal swabs are quicker to perform and require less protective equipment. The lower sensitivity of nasal swabs is balanced by the ability to screen more patients and the easier procedure, conclude the researchers. (PLoS One, July 20, 2021)
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Remdesivir linked to longer hospital stays for COVID-19 patients
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Remdesivir treatment was associated with longer hospital stays for COVID-19 patients, in a study by Iowa City VA researchers. Previous studies suggested that the drug remdesivir can reduce recovery time for COVID-19 patients. Researchers looked at data on nearly 6,000 Veterans treated for COVID-19 at VA medical centers. Of those, 40% received remdesivir. Patients given remdesivir had longer median hospital stays than patients not treated with the drug. Remdesivir did not appear to reduce patients’ 30-day risk of death. Because the treatment lasts several days, remdesivir may increase the need for hospital beds for COVID-19 patients while not improving survival, say the researchers. (JAMA Network Open, July 1, 2021)
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Eating disorder symptoms linked to trouble at work
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An eating disorder can lead to worse functioning at work in women Veterans, according to a VA Boston study. Researchers surveyed 198 female Veterans. They found that high eating disorder symptoms were linked to worse occupational functioning, a measure of how well an employee performs at a job. Eating disorder symptoms were not linked to employment status. The link between having an eating disorder and having trouble at work was largely mediated by depression symptoms. The results suggest that depression may be an important treatment target for women with eating disorders and work problems, say the researchers. (Eating Behaviors, June 21, 2021)
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Telehealth increases specialty pain care use
 Photo: ©iStock/Nattakorn Maneerat (07/14/2021)
Telehealth led to an increase in specialty pain services use among VA patients with chronic care, found a study by VA Puget Sound researchers. The study examined health care use by more than 33,000 Veterans over a five-year period. Specialty pain care use increased from 11% to 16% after a telehealth program was introduced. This increase occurred in both urban and rural patients, although the increase was smaller for rural patients. Among rural patients using specialty pain care, 12% used telehealth, compared with only 3% of urban patients. The results suggest that telehealth may increase patients’ access to specialty pain services, say the researchers. (Pain Medicine, June 18, 2021)
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Brief intimate partner violence counseling program shows promise
 Photo: ©iStock/Jose Girarte (07/14/2021)
A counseling program for women who experience intimate partner violence proved potentially helpful, in a VA pilot study. Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment. It involves motivational interviewing in up to six sessions. Fifteen women Veterans who experienced intimate partner violence within the past year participated in a pilot of the program. Results suggest RISE improves psychosocial well-being. Both participants and clinicians gave positive feedback on the program, with the participants giving high retention and satisfaction ratings. The results show that RISE could be effective for women who experience intimate partner violence, say the researchers. (Psychological Services, June 2021)
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Transportation a barrier to colon cancer care
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Transportation is a barrier to colorectal cancer care, according to a study by VA researchers and colleagues. Researchers mailed surveys to 115 Veterans with colorectal cancer. Of those, 18% reported transportation barriers that made attending appointments difficult. The distance a patient lived from a VA facility was not linked to transportation barriers. The greatest contributor to transportation barriers was a chaotic lifestyle. Identifying Veterans with chaotic lifestyles for interventions such as organizational skills training could improve colorectal cancer outcomes, say the researchers. (BMC Health Services Research, April 13, 2021)
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Race more important than rural-urban residency in suicide risk
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Race significantly affects the relationship between rural residence and suicide risk, according to a VA White River Junction study. Researchers looked at data on nearly 11 million VA patients over a 15-year period. They found that patients who live in rural areas have a significantly higher risk of suicide, compared with more urban residents. However, this connection disappeared when race was considered. Rural living significantly increased suicide risk for Hispanic patients, but not for Black or White patients. White VA patients had the highest suicide rates of any group, regardless of where they lived. The results show that race must be considered when studying the effects of location of suicide risk, say the researchers. (Journal of Rural Health, June 15, 2021)
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Public transportation, high Veteran population increase VA health care use
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Public transportation and the size of Veteran populations influence how likely formerly homeless Veterans are to use VA health care, found a VA study. Researchers looked at data on 711 Veterans in VA’s permanent supportive housing program. They found that Veterans in neighborhoods with a high percentage of Veteran residents were more likely to use emergency departments, compared to those in other areas. In areas with high public transportation use, Veterans had increased likelihood of emergency department and primary care visits. Neighborhoods with more property vacancies had increased outpatient mental health visits. The results highlight the importance of public transportation availability and social engagement with other Veterans in getting homeless Veterans to use VA health care, according to the researchers. (Psychological Services, June 3, 2021)
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A1c variability linked to increased risk of death in diabetes patients
 Photo: ©iStock/jarun011 (07/06/2021)
Maintaining hemoglobin A1c at steady levels lowers risk of death in older patients with diabetes, found a VA Boston study. Hemoglobin A1c is a type of blood cell that is linked to sugar. Measuring A1c levels is a common test of how well diabetes is being managed. Researchers studied how variations in A1c levels affected outcomes in more than 400,000 older Veterans with diabetes. Patients whose A1c levels were less often within the targeted range set by each individual’s doctors had a higher risk of death, compared with patients whose A1c levels were more stable. More variable A1c levels were also associated with greater cardiovascular disease risk. The results show that reducing A1c variability is important for lowering mortality and cardiovascular risk in diabetic patients, say the researchers. (Diabetes Care, June 14, 2021)
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Social and behavioral risk factors did not increase COVID-19 mortality risk in Veterans
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Social and behavioral risk factors were not associated with death from COVID-19 in VA patients, in a study of more than 27,000 Veterans. Researchers looked at data on Veterans with a positive COVID-19 test between March and September of 2020. They found that Veterans with risk factors traditionally associated with barriers to care had no higher risk of dying from COVID-19 than patients without those risk factors. Social risk factors included housing problems and financial hardship. Behavioral risk factors included tobacco, alcohol, and drug use. The results show that an integrated health system such as VA can transcend social vulnerabilities that often lead to health care disparities, according to the researchers. (JAMA Network Open, June 9, 2021)
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Psychiatric issues increase risk of multiple suicide attempts
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Veterans who attempt suicide had greater psychiatric issues than those with only one suicide attempt, according to a VA study. Half of military Veterans who attempt suicide report more than one attempt. Researchers looked at data on more than 4,000 Veterans who attempted suicide. They found that Veterans with multiple attempts had higher rates of lifetime depression, non-suicidal self-injury, and substance use disorder, compared with those who made only one attempt. Veterans with multiple suicide attempts were also less likely to be married or living with a partner. The results highlight the importance of examining risk factors for single and multiple suicide attempts separately, say the researchers. (Journal of Psychiatric Research, June 7, 2021)
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High-performance brain-to-text communication
 Photo: ©iStock/baona (06/29/2021)
A team including a Providence VA researcher developed a brain-computer interface that allowed a paralyzed user to quickly type just by thinking. Brain-computer interfaces allow people who have lost the ability to move or speak to interact directly with computers by reading brain signals. Most brain-computer interfaces for typing have focused on moving and clicking a computer cursor. The researchers developed a system in which a paralyzed participant thought about writing by hand. The computer analyzed patterns in the participant’s motor cortex and converted them to text. The participant achieved typing speeds of 90 characters per minute. Raw typing accuracy was 94%, with 99% accuracy using an autocorrect program. This type of brain-computer interface could enable faster communication than point-and-click typing, say the researchers. (Nature, May 12, 2021)
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Predictors of response to PTSD treatment
 Photo for illustrative purposes only. ©iStock/Courtney Hale (06/23/2021)
Time since trauma is an important predictor of how well patients respond to PTSD treatment, found a VA study. Patients were given a combination of prolonged exposure psychotherapy and the drug sertraline (sold as Zoloft). Those with a longer time since their trauma exposure had the greatest PTSD symptom improvement 24 weeks after treatment. Higher baseline pain severity predicted smaller symptom improvement. Hispanic patients also showed greater improvement than non-Hispanics. Alcohol use did not impede the effectiveness of treatment. The findings suggest that patients who might not seek help for years following trauma can still benefit from PTSD treatment, say the researchers. (Journal of Clinical Psychiatry, June 15, 2021)
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Phone intervention can relieve PTSD caregiver burden
 Photo: ©iStock/KatarzynaBialasiewicz (06/23/2021)
A behavioral intervention program can help relieve burden for caregivers of Veterans with PTSD, found a Memphis VA study. Loved ones caring for Veterans with PTSD often face stress that may seem overwhelming. The REACH VA intervention aims to help caregivers cope and manage PTSD-related concerns. It includes four one-hour sessions delivered by phone. In a group of 161 caregivers, the program significantly improved burden, depression, anxiety, frustrations, general stress, time providing care, troubling behavior, and safety risk. REACH can help reduce caregivers’ psychological distress and can improve their ability to care for Veterans with PTSD, concluded the researchers. (Military Behavioral Health, May 27, 2021)
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Discussing firearms storage safety in primary care
 Photo: ©iStock/NoDerog (06/23/2021)
Veterans are open to discussing firearms storage safety in primary care as long as it is done in a Veteran-centric manner, according to a study by VA Portland researchers. Two-thirds of Veteran suicides involve a firearm. Researchers surveyed 68 Veterans about their views on discussing firearms during health care visits. The Veterans generally accepted discussing firearms in primary care. However, most did not support direct questions about gun ownership because of fears of having firearm access taken away or limited. Participants suggested using personalized, caring, and conversational approaches to the discussions rather than scripted checklists. They said that Veterans should be engaged in a non-judgmental manner that respects a Veteran’s knowledge of firearms. Participants also suggested that care teams provide information on legal consequences of disclosing gun ownership. The results show that discussing firearms storage safety could help with suicide prevention efforts when done correctly, say the researchers. (Journal of General Internal Medicine, June 2021)
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Trauma-sensitive yoga effective treatment for PTSD
 Photo: ©iStock/fizkes (06/16/2021)
Trauma-sensitive yoga may be an effective treatment for PTSD in women Veterans who experienced military sexual trauma, found an Atlanta VA study. Women Veterans with PTSD participated in either a yoga program or cognitive processing therapy, a psychotherapy. The yoga program involved 10 weekly 60-minute group sessions. Trauma-sensitive yoga focuses on establishing safety, individual choice, and being in the present moment, along with the physical movements. Both groups saw clinically meaningful improvements in PTSD symptoms after treatment. While improvement rates were similar, 60% of the women in the yoga group completed their treatment. Only 35% in the cognitive processing therapy group completed treatment. The results show that yoga could be an effective alternative to trauma-focused therapy, say the researchers. (Journal of Alternative and Complementary Medicine, March 2021)
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Chronic pain linked to cognitive processing problems in Gulf War Veterans
 Photo: ©iStock/ljubaphoto (06/16/2021)
Pain interferes with cognitive processing in Gulf War Veterans, according to a William S. Middleton Memorial Veterans Hospital study. Both disrupted thinking and chronic musculoskeletal pain are common in Gulf War Veterans. Researchers performed magnetic resonance imaging on Veterans with chronic pain while running through cognitive tests. Imaging showed that Veterans with chronic musculoskeletal pain required more neural resources to sustain cognitive performance during pain stimuli, compared with controls without chronic pain. The results suggest that Veterans with chronic pain linked to Gulf War illness may have abnormal pain processing, according to the researchers. (Life Sciences, May 26, 2021)
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Soldiers with chronic pain likely to use VA health care
 Photo: ©iStock/gsheldon (06/16/2021)
The majority of soldiers with chronic pain were likely to use VA health care after separating from the military, found a study by VA researchers. The study looked at data on nearly 140,000 soldiers who served between 2008 and 2014. Of those who met the criteria for chronic pain, 79% began using VA health care after leaving the military. Veterans who used VA health care as a non-enrollee prior to military separation were more likely to use VA after separation. Separating for disability, having mental health conditions, and being of Black or Hispanic ethnicity all predicted VA health care use. Of all the soldiers who enrolled in VA health care, about 50% had chronic pain. The findings show that careful coordination of pain management between the military health service and VA is needed to optimize care, say the researchers. (BMC Health Services Research, May 24, 2021)
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Alzheimer’s screening tool highly effective in Mexican American patients
 Photo for illustrative purposes only. ©iStock/ajr_images (06/08/2021)
A blood-based screening tool can help detect Alzheimer’s disease and may increase Mexican Americans’ access to clinical research, found a study including VA researchers. Mexican Americans have been poorly represented in Alzheimer’s disease research. As part of the Health & Aging Brain among Latino Elders (HABLE) study, researchers studied data on 1,600 patients. About half were Mexican American, and the other half were non-Hispanic whites. Profiling the protein content of patients’ blood was highly accurate in detecting mild cognitive impairment and dementia. Blood protein profiles varied significantly between ethnic groups and disease state. The findings could help bridge the gap between community-based and clinical settings and recruit more Hispanic patients into Alzheimer’s disease research, say the researchers. (Alzheimer’s and Dementia, May 31, 2021)
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Diabetes linked to worse COVID-19 outcomes
 Photo: ©iStock/vitapix (06/08/2021)
Diabetes is linked to worse outcomes from COVID-19 infection, according to a VA Puget Sound study. Researchers looked at outcomes form nearly 36,000 VA patients who tested positive for COVID-19. Patients with diabetes had greater odds of hospitalization, intensive care unit admission, and death than patients without diabetes. Prior use of the diabetes medication sulfonylurea was linked to increased odds of hospitalization. Prior insulin use was linked to increased odds of both hospitalization and death. Statin use was associated with lower chance of death, and angiotensin receptor blockers (ARBs) were associated with lower odds of hospitalization. The results show that diabetes can increase the danger posed by COVID-19. (BMJ Open Diabetes Research and Care, June 2021)
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Some VA therapists more effective than others at treating PTSD
 Photo: ©iStock/FatCamera (06/08/2021)
Some therapists are more effective than others at keeping patients engaged in PTSD treatment, found a study by VA researchers. The study looked at data on nearly 3,000 therapists providing the psychotherapies cognitive processing therapy (CPT) or prolonged exposure (PE) to more than 18,000 VA patients with PTSD. Results showed that dropout rates varied by 11% for CPT and 6% for PE between different therapists. Whether or not patients received an adequate psychotherapy dose varied by as much as 9% for both therapies based on therapist. The VA facility where a patient received care accounted for only a 1% to 3% variance in dropout and adequate dose rates. The results show that therapist skill and work environment are important to the success of PTSD treatment, say the researchers. (Journal of Traumatic Stress, May 28, 2021)
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COVID-19 vaccines largely effective in inflammatory bowel disease patients taking immunosuppressants
 Photo: ©iStock/Juanmonino (06/03/2021)
Vaccination against COVID-19 proved mostly effective in patients with inflammatory bowel disease, found a Michael J Crescenz VA Medical Center study. Clinical trials of COVID-19 vaccines mostly excluded patients taking immunosuppressive medication, which keep the immune system in check. The researchers studied outcomes for nearly 15,000 patients taking medication for inflammatory bowel disease. Full vaccination—meaning patients were at least a week past the second vaccine dose—showed 80% effectiveness against COVID-19. Unvaccinated patients in this population had a much higher rate of COVID-19 infection than vaccinated patients. Partial vaccination did not significantly reduce the hazard of infection. The results could help increase patient and provider willingness to vaccinate immunosuppressed patients, say the researchers. (Gastroenterology, May 25, 2021)
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Depression and other conditions often co-occur
 Photo: ©iStock/Srdjanns74 (06/03/2021)
Veterans with depression often have other psychiatric conditions, according to a study by VA researchers and colleagues. Researchers surveyed nearly 3,000 Veterans receiving treatment for depression in VA. They found that almost all patients screened positive for at least one other mental health condition. About half had four or more conditions. The most common conditions were generalized anxiety disorder, PTSD, and panic/phobia. Results showed that depression severity plays a large role in impairment caused by other mental health conditions. The findings suggest that addressing depression could help improve symptoms of other mental health conditions, say the researchers. (Journal of Affective Disorders, April 27, 2021)
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Affordable Care Act reduced catastrophic health costs for young Veterans
 Photo: ©iStock/hudiemm (06/03/2021)
The Affordable Care Act reduced catastrophic health expenditure among young Veterans, found a study by VA Greater Los Angeles researchers. While some Veterans receive health care through VA, many get their health coverage outside the system. Researchers looked at health care costs for more than 13,000 Veterans receiving health care outside VA before and after the Affordable Care Act was passed. Catastrophic health expenditure was defined as health care costs of more than 10% of the yearly family income. They found that the Act was linked to a 26% decrease in the likelihood of a catastrophic health expenditure in Veterans aged 18 to 64. Veterans 65 and older did not see a similar reduction in catastrophic health care costs. The results highlight gaps in Veterans’ financial protection based on age, say the researchers. (Journal of General Internal Medicine, May 6, 2021)
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Most adult COVID-19 patients develop antibodies
 Image: ©iStock/wildpixel (05/27/2021)
Most adults with COVID-19 develop antibodies that stay in the body after infection, according to a review by VA Portland researchers. The researchers surveyed studies published on COVID-19 in 2020. They found that most adults had detectable levels of antibodies after infection with the SARS-CoV-2 virus. Levels of IgM, short-term antibodies that protect from initial infection, peak at about 20 days after infection and then decline. IgG—longer-term antibodies—levels peak about 25 days after symptom onset and remain detectable for at least 120 days. Some evidence suggests that older age, greater COVID-19 severity, and presence of symptoms may be linked to higher antibody levels. Some adults do not develop antibodies for unclear reasons. (Annals of Internal Medicine, March 16, 2021)
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PTSD treatment more effective in patients with specific brain traits
 Image: ©iStock/johan63 (05/27/2021)
VA San Diego researchers identified brain network traits that could predict which patients will see an improvement of PTSD symptoms from psychotherapy. The researchers took magnetic resonance imaging (MRI) scans of the brains of 53 patients with both PTSD and alcohol use disorder. They found that a subgroup of patients with specific brain connectivity traits were more likely than others to benefit from prolonged exposure therapy. They did not find any brain connectivity patterns related to alcohol consumption. The results could lead to treatments that target brain connectivity to boost treatment effectiveness, say the researchers. (Psychological Medicine, April 30, 2021)
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Veterans more likely to use community care in rural areas
 Photo: ©iStock/JamesBrey (05/27/2021)
How rural the area is and the closeness of VA facilities affected how frequently Veterans used community health care, found a VA Boston study. In 2014, the Veterans Choice Act made it possible for some VA patients to receive health care in the community instead of from VA facilities. Researchers looked at data from over 3,000 counties across the country. Rural counties saw the greatest increase in community care use. Counties with a VA facility were less likely to see community care increases. The results suggest that community care may enhance primary care access for Veterans in areas farther away from VA facilities, according to the researchers. (Medical Care, June 1, 2021)
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Brain connectivity disruption may explain poor social connection in PTSD patients
 Image: ©iStock/Naeblys (05/20/2021)
Poor social connection in people with PTSD may be related to abnormalities in brain structure, found a White River Junction VA study. Researchers looked at 31 participants with PTSD and 21 controls with trauma exposure but no PTSD. The PTSD group reported smaller social networks and greater loneliness. The researchers used magnetic resonance imaging (MRI) while participants performed a memory task involving social relationships. Imaging of the PTSD group during the memory task showed hyperactivation of the default network, the connection between different parts of the brain. MRI also revealed less functional connectivity between specific brain systems in the PTSD group. The results suggest that poor social connection in people with PTSD could be caused by disrupted brain connectivity, according to the researchers. (Depression and Anxiety, Feb. 23, 2021)
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Cognitive behavioral therapy beneficial for dementia patients
 Photo: ©iStock/Enes Evren (05/20/2021)
Cognitive behavioral therapy could improve mood and insomnia in people with dementia, found a review by Michael E. DeBakey VA Medical Center researchers and colleagues. Cognitive behavioral therapy aims to improve mental distress by helping a person modify and control their thought processes. Researchers reviewed the available evidence on this approach for people with mild cognitive impairment and dementia. Multiple studies showed that cognitive behavioral therapy can improve anxiety, depression, and quality of life in these patients. Some evidence also suggests that the therapy can reduce insomnia and improve sleep quality. The results show a need for more study on cognitive behavioral therapy in dementia patients, especially with regard to insomnia, say the researchers. (Alzheimer’s Disease and Associated Disorders, April 28, 2021)
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High blood pressure could cause peripheral artery disease
 Photo: ©iStock/Ivan-balvan (05/20/2021)
Higher blood pressure is likely to cause peripheral artery disease, according to a study by VA researchers and colleagues. In peripheral artery disease, narrowed arteries reduce blood flow to the limbs. Researchers looked at genome-wide study data on blood pressure and cardiovascular disease. They found that higher pulse pressure and mean arterial pressure directly increase the risk of peripheral artery disease. Use of blood pressure medications such as beta-blockers and diuretics was linked to lower risk of peripheral artery disease. This suggests that medications that lower blood pressure protect against the disease. More research is needed to clarify how exactly blood pressure influences peripheral artery disease, say the researchers. (Arteriosclerosis, Thrombosis, and Vascular Biology, April 15, 2021)
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Comparing different forms of transcranial magnetic stimulation
 Photo: ©iStock/Henrik5000 (05/11/2021)
One form of transcranial magnetic stimulation may be better than another method at treating PTSD and depression, found a Providence VA study. In TMS, magnetic pulses are applied to the outside of the head to influence the electrical signals in the brain. It has been shown to help with both PTSD and major depressive disorder. The researchers compared two types of TMS, 5 Hz TMS and intermittent theta burst stimulation (iTMS), in 10 Veterans each with PTSD and depression. The treatments are similar but use different frequencies and duration. Both methods were safe and reduced PTSD and depression symptoms. However, Veterans who received iTMS reported poorer outcomes. Separate studies of iTMS showed similar outcomes to 5 Hz TMS when the iTMS exposure time was longer. The results could help clinicians choose the best form of TMS for their patients, say the researchers. (Journal of Traumatic Stress, May 11, 2021)
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Gene therapy could prevent learning and memory loss from Alzheimer’s disease
 Photo: ©iStock/Evgenyi_Eg (05/11/2021)
VA San Diego researchers and colleagues used gene therapy to prevent learning and memory loss in a mouse model of Alzheimer’s disease. The researchers introduced a compound called AAV-SynCav1—a protein that can potentially activate mechanisms to prevent structural damage in the brain—into the hippocampus brain region of mice with deficits similar to Alzheimer’s. The hippocampus is one of the first parts of the brain affected by Alzheimer’s. At nine and 11 months after treatment, hippocampus-related learning and memory were preserved. Important membrane structures and receptors also remained intact in the treated mice, while control mice had damage. The results show the treatment has potential to restore brain plasticity and improve function in humans with Alzheimer’s, according to the researchers. (Molecular Therapy, March 29, 2021)
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Cannabis use disorder linked to aggression
 Photo: ©iStock/Olga Novikova (05/11/2021)
Cannabis use disorder and aggression appear to be linked, according to a Durham VA study. Cannabis use disorder refers to addiction to the substance and negative social impacts of excessive use. Evidence suggests that some Veterans attempt to self-medicate with cannabis for conditions such as PTSD. The researchers studied cannabis use and psychological factors for more than 3,000 Iraq/Afghanistan-era Veterans. They found that cannabis use disorder was associated with increased odds of difficulty managing anger, aggressive impulses, and problems controlling violence. The study could not determine whether cannabis use disorder causes aggression, or whether people with more aggressive tendencies were more likely to develop the disorder. The results show a need to assess violent tendencies along with cannabis use disorder, say the researchers. (Journal of Psychiatric Research, April 22, 2021)
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Combined PTSD, substance use disorder lead to worse social well-being
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Veterans with both PTSD and substance use disorder face significant social problems, found a Durham VA study. Researchers analyzed data on social functioning for more than 1,000 Veterans. Those with both PTSD and SUD were particularly likely to experience homelessness, violent behavior, and suicidal behavior. Veterans with both conditions were more likely to report worse social well-being, compared to those with only PTSD, only SUD, or neither disorder. Veterans with both conditions were also more likely to have worse job and financial well-being. The findings suggest that multiple aspects of well-being should be assessed together in Veterans with PTSD and SUD, according to the researchers. (Psychological Trauma, March 4, 2021)
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Cognitive and motor performance linked in stroke recovery
 Image: ©iStock/peterschreiber.media (04/27/2021)
Cognitive function affects physical motor performance after stroke, according to a study by Providence VA researchers and colleagues. The study assessed how 50 patients recovering from stroke did on two arm movement tasks. Patients performed worse on the more cognitively demanding task, especially immediately after their strokes. Poorer performance on the more complex test was linked to broad injury beyond the parts of the brain involved with movement, while performance on the simpler task was mostly linked to injury of the brain regions related to motor function. The results show that motor ability and cognitive function must be considered together when treating stroke patients, say the researchers. (Neurology, April 15, 2021)
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Transportation an important barrier to colorectal cancer care
 Photo: ©iStock/Kichigin (04/27/2021)
Transportation is an important barrier to colorectal cancer care, found a study by Durham VA researchers. Researchers surveyed 115 Veterans with colorectal cancer. Of those, 18% said they had transportation barriers that made accessing care difficult. Their distance from a VA facility was not strongly linked to transportation difficulty. Rather, a chaotic lifestyle was the largest cause of transportation barriers. Chaotic lifestyle mainly means that patients have an unpredictable schedule. Identifying Veterans with chaotic lifestyles could allow for timely intervention to improve their cancer care, say the researchers. (BMC Health Services Research, April 13, 2021)
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COVID-19 ‘long-haulers’ face increased risk of death and many other health problems
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A large VA study showed that people who have had COVID-19 are at heightened risk of both death and many other health problems. In the largest post-acute COVID-19 study to date, VA Saint Louis Health Care System researchers characterized many potential long-term consequences of COVID-19. The researchers looked at outcomes on more than 73,000 VA patients who survived COVID-19 and close to 5 million who did not contract the disease. The COVID-19 group had a higher risk of dying six months after diagnosis. People who have recovered from COVID-19 also are at increased risk of health problems affecting virtually every organ system in the body, not just the lungs. About 8% to 10% of people affected by COVID-19 will likely have long-term effects, according to the researchers. (Nature, April 22, 2021)
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Inflammation linked to Alzheimer’s disease risk
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Inflammation in the brain is linked to greater Alzheimer’s disease risk, found a VA San Diego study. Researchers analyzed the cerebrospinal fluid and performed cognitive testing on 81 cognitively normal older adults and 137 with mild cognitive impairment. In the cognitive impairment group, those with biomarkers for vascular inflammation also had increased levels of tau proteins, which have been linked to Alzheimer’s. Higher levels of tau protein were associated with poorer memory performance in the cognitive impairment group only. However, in the cognitively normal group, participants with lower pulse pressure who had greater inflammation showed signs of lower burden of amyloid-beta, an amino acid also linked to Alzheimer’s. The findings suggest that pulse pressure and inflammation have a complex effect on markers of Alzheimer’s disease, say the researchers. (Journal of Alzheimer’s Disease, March 4, 2021)
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Non-suicidal self-injury linked to suicide attempts
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Non-suicidal self-injury disorder is strongly linked to suicide attempts among Veterans, found a study by Durham VA researchers and colleagues. The study looked at more than 100 Veterans with at least one mental health disorder. Forty-eight percent had a diagnosis of non-suicidal self-injury disorder. Suicide attempts were reported in 28% of the participants. Those with non-suicidal self-injury disorder were nearly five times more likely to have a suicide attempt than those without. The results show that understanding the link between self-injury and suicide could improve prevention, say the researchers. (Journal of Affective Disorders, March 15, 2021)
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Older adults show low physical activity in and out of nursing facilities
 Photo: ©iStock/Dean Mitchell (04/21/2021)
Older adults in skilled nursing facilities showed low physical activity both during and after their stays, according to a study led by an Eastern Colorado VA researcher. The study followed patients during the last few days of their stay at a skilled nursing facility and a few days after discharge. Participants spent a median of 12% of their time in the facility and 17% at home standing upright. The number of steps taken per day was very low and did not increase much when patients returned home. Patients thought that they were more physically active than they actually were. The results highlight the need to encourage physical activity both in and out of skilled nursing facilities, say the researchers. (Disability and Rehabilitation, April 9, 2021)
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Higher risk of suicidal thoughts in American Indian, Alaska Native Veterans
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American Indian and Alaska Native (AI/AN) Veterans have more than twice the risk of suicidal thoughts compared to white Veterans, found a VA Salt Lake City study. Researchers looked at data from two large national surveys. In the Behavioral Risk Factor Surveillance System, 9.1% of AI/AN Veterans reported suicidal thoughts, compared with 3.5% of white Veterans. In the National Survey on Drug Use and Health, 8.9% of AI/AN Veterans reported suicidal thoughts, compared with 3.7% of white Veterans. Suicide prevention efforts in collaboration with these communities are needed, conclude the researchers. (Military Psychology, April 8, 2021)
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Veterans open to firearms safety discussions in primary care to prevent suicides
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Veterans are open to discussing firearms safety in primary care, according to a study by VA Portland researchers and colleagues. More than half of Veterans who die by suicide visit their primary care provider a month before their death. The researchers surveyed 27 Veterans with depression and PTSD. All participants received health care through VA. The majority felt that discussing firearms safety was acceptable and needed, even if discussions were uncomfortable. They cited the urgent need to prevent Veteran suicide for this feeling. The Veterans identified the need for providers to be transparent in their reasons for asking about firearms and to respect Veterans’ unique relationships with firearms. The findings show that a Veteran-focused approach to firearms safety could help address Veteran suicide, say the researchers. (Journal of the American Board of Family Medicine, March–April 2021)
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PTSD symptoms linked to unhealthy diet
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Veterans with PTSD symptoms often have a more unhealthy diet than those without PTSD, found a VA National Center for PTSD study. Researchers assessed more than 800 Veterans twice during a three-year period. They found that trauma exposure directly predicted diet quality. Participants with greater PTSD symptoms at baseline were more likely to have a poor diet, compared to those without PTSD symptoms. The findings suggest that consuming unhealthy food was driven by emotional suppression. The researchers did not find any link between PTSD symptoms and amount of exercise. The results could help treat medical comorbidities in patients with PTSD, say the researchers. (European Journal of Psychotraumatology, March 2021)
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Feelings of anger often lead to self-injury
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Feelings of anger and hostility often lead to self-injury, found a study by Durham VA researchers. Forty Veterans diagnosed with nonsuicidal self-injury disorder completed an electronic diary for 28 days. During the time period, 9% of participants reported self-injury, and 19% said they had the urge to self-injure. The most common type of self-injury was punching walls or objects. Momentary feelings of anger or hostility were linked to subsequent self-injury urges. The reverse was not true: self-injury did not lead to feelings of anger. The results highlight the need to assess and treat patients who self-injure for anger issues, say the researchers. (Journal of Psychiatric Research, March 2021)
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Stem cell therapy offers potential treatment for ischemia
 Image: ©iStock/luismmolina (04/06/2021)
Stem cells may be an effective treatment for life-threatening ischemia, according to a mouse study led by a VA Connecticut researcher. Ischemia is when an organ does not get enough blood, which can cause serious organ problems. Researchers treated ischemic mice with smooth muscle cells derived from pluripotent stem cells that had been grown in a lab. Pluripotent stem cells are base cells that can be reprogramed to form into different types of body cells. Treated mice had improved functional outcomes and blood flow, compared with controls. They also showed signs of improved wound healing. The results show that stem-cell therapy has potential to effectively treat ischemia in humans, say the researchers. (Cells, April 2, 2021)
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Peer-led program leads to better Veteran engagement and well-being
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A peer-led program resulted in greater Veteran health care engagement and well-being, found a study by VA Bedford researchers and colleagues. Forty-eight Veterans took part in a group-led VA program called Taking Charge of My Life and Health. The nine-week program used peer support to improve patient engagement and health by teaching whole health concepts and strategies. Participants had a significant decrease in perceived stress. They also showed significant improvements in mental health and quality of life. Patients were more engaged with their health care after the program. The findings suggest that using peers to guide patients in exploring their values and goals can improve their health and engagement, say the researchers. (Journal of Alternative and Complementary Medicine, March 2021)
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Black patients face credibility bias
 Photo for illustrative purposes only. ©iStock/monkeybusinessimages (03/31/2021)
Black patients may face systemic bias in physicians’ perceptions of their credibility, according to a study that included a VA Portland researcher. The researchers identified three linguistic features that may indicate disbelief in medical notes: putting patient statements in quotation marks, using judgment words such as “claims” or “insists,” and reporting patients’ symptoms and experiences as hearsay. They then used machine learning to look for these features in more than 9,000 medical notes. Notes written about Black patients were more likely to contain all three signs of disbelief, compared with notes on white patients. Notes about female patients were more likely than male patient notes to contain quotes. The results suggest that Black patients are less likely to be believed when they describe their symptoms or experiences, say the researchers. (Journal of General Internal Medicine, March 22, 2021)
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Challenges of providing telehealth care
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A study of VA nurse practitioners and patients identified challenges of using telehealth for care. Nurses identified several logistical problems that made providing care over video more difficult. They noted the complexity of scheduling appointments, local barriers to care, and difficulty of remotely managing acutely ill patients. The nurses surveyed also said that it is harder to gather sensory data during remote visits. Video makes it harder to build provider-patient relationships, as well. Patients were aware of the limitations on physical exams but not the logistical challenges. Training videos and mentoring on best practices could improve the telehealth experience, according to the researchers. (Journal of Nurse Practitioners, March 20, 2021)
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Process behind kidney stone formation
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Researchers with the VA Calcium Signaling Laboratory explored how a disease called acidosis can lead to the formation of kidney stones. A region of the kidney called the proximal tubule helps control the acid-base balance in the blood. Acidosis is when acids are not properly removed from the blood into the urine by the proximal tubule. In addition to causing problems with the blood, acidosis causes the urine to become more alkaline. The researchers used a mouse model of this condition to study how this shift may lead to kidney stones. They found that the shift in urine pH causes a build-up of calcium ions, which may form into stones. Dysregulation of the proximal tubule can also cause cell damage, which further leads to stone formation when damaged cellular fragments bind with calcium crystals. The results improve the understanding of the biological processes behind kidney stones, say the researchers. (International Journal of Molecular Sciences, March 17, 2021)
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Mild traumatic brain injury and PTSD frequently occur together
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Mild traumatic brain injury and PTSD are strongly linked in Veterans, according to a VA study. Researchers assessed more than 1,500 former and current military personnel with a history of combat exposure. Eighty-two percent had a history of mild TBI. Of those, 41% also screened positive for PTSD. Only 24% of participants without a history of TBI had PTSD. Mild TBI was a good predictor of more severe neurological symptoms related to PTSD. The results suggest that TBI and PTSD should be evaluated and treated together in Veterans and service members who experienced combat, say the researchers. (Journal of Head Trauma Rehabilitation, Feb. 22, 2021)
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Morphine could improve heart function in diabetic patients
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Morphine could help restore heart function damaged by diabetes, found a study by VA San Diego researchers. Diabetes can increase the risk of serious heart problems, largely through increased obesity risk. Opioids are known to aid in cardiac stress tolerance, but diabetes disrupts how the body responds to opioids. The researchers tested a five-day, high-dose morphine treatment in a mouse model of type 2 diabetes. The treatment improved blood pressure stability, reversed cardiac depression, and improved heart function. It also restored impaired molecular heart processes. The findings suggest that short-term, high-dose morphine could help diabetic patients recover from acute cardiovascular events, say the researchers. (FASEB J, March 2021)
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Addiction possibly linked to brain asymmetry
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Addiction may be linked to brain asymmetry, found a large international study that included a VA San Diego researcher. The researchers analyzed brain scans of nearly 1,800 patients who were dependent on alcohol, nicotine, cocaine, methamphetamine, or cannabis. They compared them to scans of almost 1,000 patients without substance dependence. The results showed that addiction was significantly linked to asymmetry of the nucleus accumbens, a region in the lower middle of the brain. The right side of the nucleus accumbens was smaller in patients with substance dependence. This effect was largest in patients with alcohol and nicotine dependence. More research is needed on whether substance use causes the brain asymmetry, or whether the asymmetry increases the risk of addiction, according to the researchers. (Addiction Biology, Jan. 28, 2021)
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Increasing physical distance in schools not linked to fewer COVID-19 cases
 Photo: ©iStock/izusek (03/17/2021)
Maintaining three feet versus six feet of physical distance between students did not affect COVID-19 case rates, found a study by VA Boston researchers and colleagues. Researchers looked at COVID-19 infection data for nearly 540,000 students and more than 99,000 staff attending in-person schools in the Massachusetts public school system. They found that the infection rate was similar in districts with policies requiring three feet of physical distance, compared with districts requiring six feet. Increasing physical distance may not be necessary to prevent COVID-19 cases in schools, concluded the researchers, provided that universal mask mandates and other precautions are implemented. (Clinical Infectious Diseases, March 10, 2021)
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Moral injury increases Veteran suicide risk
 Photo: ©iStock/Drazen Zigic (03/17/2021)
Morally injurious experiences are linked to increased risk of suicidal behavior, found a VA study of more than 1,000 Veterans. Moral injury experienced during deployment includes perpetrating, failing to prevent, witnessing, or learning about acts that transgress deeply held moral beliefs. Of the Veterans surveyed, 36% had at least one morally injurious experience. Reports of transgressions by others and feelings of betrayal were more common than personal transgressions. These experiences were linked with a higher risk of suicidal thoughts, making a suicide plan, and suicide attempts. While the effect of moral injury on suicidal behavior was significant, PTSD and depression had greater effects on suicide risk. The results show that more work to evaluate and address moral injury in Veterans is needed, say the researchers. (Depression and Anxiety, March 5, 2021)
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Rural Veterans may have less access to lung cancer screenings
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Access to lung cancer screening varies widely based on location in the Veterans Health Administration, found a study by VA Bedford researchers. The researchers looked at data on screening exams at VA facilities and partner sites over a six-year period. They found that screening numbers varied by more than 30-fold across different regions. Screenings were particularly low in more rural locations. Nine of the 12 states with the highest proportions of rural Veterans had three or fewer lung cancer screening facilities. The findings indicate that VA needs to make efforts to provide more equitable access to lung cancer screening, according to the researchers. (Chest, Feb. 19, 2021)
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Meditation program may reduce nursing burnout
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An online mantram meditation program could help nurses with stress management and lead to improved patient care, according to a Edward Hines, Jr. VA Hospital study. Nurses often experience high levels of stress and burnout, which has been exacerbated by the COVID-19 pandemic. Registered nurses working in VA acute care units participated in an online mantram repetition program to learn stress coping skills. The program involved repeating a spiritually meaningful word or phrase, called a mantram, to slow down one’s thoughts and refocus. Nurses who participated in the program reported increased mindfulness, spiritual well-being, and presence while with patients. They also experienced less burnout. Patients being treated by participating nurses noticed greater levels of presence from nurses and were highly satisfied with their care. The results suggest that portable stress reduction techniques can help alleviate nursing burnout, say the researchers. (Nursing Outlook, Feb. 8, 2021)
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Traumatic brain injury increases sleep disorder risk
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Veterans with traumatic brain injury have an increased risk of developing sleep disorders, found a study by San Francisco VA researchers. The study included data from nearly 200,000 Veterans over a 14-year period. Veterans who had a TBI were 41% more likely to develop a sleep disorder, compared with Veterans with no TBI history. The association between sleep disorders and TBI was most common in mild TBIs, or concussions. Sleep disorders seen in this population included sleep apnea, insomnia, excessive sleepiness during the day, and sleep-related movement disorders. The findings show that better prevention and long-term management for sleep are needed for Veterans with TBI, say the researchers. (Neurology, March 3, 2021)
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MRI could help detect early Alzheimer’s
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Magnetic resonance imaging (MRI) of the locus coeruleus brain region could aid in early detection of Alzheimer’s disease, according to a study of Vietnam-era male Veterans. The locus coeruleus is a structure in the brainstem involved in the sleep-wake cycle and in cognitive function. It is known to undergo extensive degeneration during Alzheimer’s progression. Researchers assessed cognitive function and MRI scans in nearly 500 older Veterans. They found that reduced locus coeruleus integrity was linked to sleep dysfunction, poorer memory, and greater odds of mild cognitive impairment. The results suggest that assessing locus coeruleus structural integrity with MRI could be used as an early measure of Alzheimer’s risk, according to the researchers. (Alzheimer’s and Dementia, Feb. 13, 2021)
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Height loss linked to higher hip fracture risk in older men
 Photo: ©iStock/RealPeopleGroup (03/03/2021)
Height loss in elderly men is associated with a higher risk of hip fracture, found a study by Minneapolis VA researchers and colleagues. Losing height is common in older adults as age-related changes in the bones, muscles, and joints occur. The researchers studied a sample of nearly 3,500 older men. They found that men who had lost at least three centimeters in height over a period of seven years had nearly double the risk of a hip fracture, compared with those who lost less than a centimeter in height. Men who lost at least three centimeters had an 11.6% chance of a hip fracture. Those losing less than a centimeter had a 2.7% chance of hip fracture. The risk of other bone fractures was also higher in men who had lost height. The results suggest that height loss should be considered when assessing fracture risk, say the researchers. (Journal of Bone and Mineral Research, Feb. 22, 2021)
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Simulating feeling in amputated feet
 Photo: ©iStock/xavierarnau (03/03/2021)
Researchers with the VA Advanced Platform Technology Center were able to simulate foot sensations in patients with lower-limb amputations using electrodes. People with lower-limb amputation often experience postural instability because of missing sensory information from the foot. Researchers simulated sensation in patients missing a foot due to amputation during standing using implanted electrodes. They compared the patients’ reactions to how they reacted to vibrations felt in the intact foot. Participants adjusted their posture in much the same way in both situations. This told the researchers that the participants perceived the electrical stimulation as if it were coming from the missing foot. The results could lead to using electrical stimulation to provide sensory feedback when walking with a leg prosthesis and improve gait stability, according to the researchers. (Frontiers in Neuroscience, Feb. 18, 2021)
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Kidney transplant patients have lower risk of death when receiving VA care
 Image: ©iStock/peterschreiber.media (03/03/2021)
Risk of death after a kidney transplant was significantly lower in patients whose post-surgery care was through VA, compared to those cared for outside VA, found a study by VA Pittsburgh researchers. The study focused on data from over 6,000 Veterans enrolled in both VA health care and Medicare. Of those, 16% had a kidney transplant at a VA hospital. Out of all kidney transplant patients, 12% received their post-transplant care from VA only, while 34% received care only at non-VA hospitals through Medicare. The remaining 54% used both VA and non-VA care. Patients who used only non-VA post-transplant care were more than twice as likely to die within five years of their surgery, compared with patients who used VA only. Compared with VA-only patients, patients who used both VA and Medicare were 1.5 times more likely to die within five years. The results show the need to monitor patient outcomes for Veterans receiving care outside VA, say the researchers. (Clinical Journal of the American Society of Nephrology, Feb. 18, 2021)
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Quitting smoking linked to less pain
 Photo: ©iStock/Sezeryadigar (02/23/2021)
Quitting smoking was linked to significantly lower pain levels, in a VA study. Researchers studied data on nearly 2,000 Veterans who smoked an average of 15 cigarettes a day and had chronic pain. Participants were involved in a program of proactive outreach to help them quit smoking. At six and 12 months after the program, researchers asked participants whether they had smoked in the last seven days. Participants at all pain levels who had stopped smoking had significantly less pain at the six-month check-in. After 12 months, participants with severe pain had lower pain. The results show that abstinence from smoking may lower pain levels, according to the researchers. (Pain Medicine, Jan. 27, 2021)
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Transgender Veterans at high risk of suicide
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Transgender Veterans are at an elevated risk of suicide, found a study of more than 32,000 Veterans. Researchers assessed VA data from a 17-year period. They found that transgender patients had more than twice the risk of suicide, compared with cisgender patients—those whose gender identity matches their sex assigned at birth. This difference was especially pronounced among younger (18-39 years) and older (65 and older) patients. Overall, transgender patients had slightly lower risk of death from any cause, compared with cisgender patients. The results highlight an urgent need for more efforts to prevent suicide among transgender patients, say the researchers. (LGBT Health, Feb. 5, 2021)
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Secure messaging changes how Veterans access health care
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Secure messaging decreased in-person health care visits and increased telephone visits, according to a study of VA health care use. Secure messaging allows patients and health care providers to send messages back and forth online while protecting patient information. Researchers looked at how use of secure messaging on VA’s MyHealtheVet patient portal affected health care usage in 2016. In-person health care visits decreased by 16% for secure messaging users and 10% for users who did not use secure messaging. Telephone visits increased by 11% for secure messaging users and 7% for non-users. The results show that secure messaging could improve clinic appointment availability, say the researchers. They also point out that secure messaging will likely increase providers’ time commitments for not-traditional forms of access. (Journal of General Internal Medicine, Feb. 2, 2021)
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Anticoagulants could lower COVID-19 mortality risk
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Anticoagulation medication could lower the risk of death from COVID-19, according to a study by VA researcher and colleagues. The study looked at data on more than 4,000 patients hospitalized with COVID-19. Most of the patients were given medication to prevent blood clots. Results show that patients given the medication had a 27% lower risk of dying from COVID-19 within 30 days of hospitalization, compared with patients not receiving anticoagulants. Anticoagulant use was not associated with serious bleeding events. The findings provide strong evidence for the use of anticoagulants as an initial treatment for COVID-19, say the researchers. (BMJ, Feb. 11, 2021)
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Recovery needs after suicide attempt vary by gender
 Photo: ©iStock/Marjan_Apostolovic (02/16/2021)
Men and women have different needs when recovering from a suicide attempt, found a study by VA Portland researchers and colleagues. Researchers interviewed 25 female and 25 male Veterans who had attempted suicide but survived. When talking about their recovery needs, women focused on developing connections with others and wanting to increase their self-knowledge and self-worth. Men were more concerned with trying to live up to their ideal selves by living and doing “right.” Men also wanted to feel like they were needed by others. Both men and women said they wanted to feel a sense of purpose. The results suggest that patients who attempt suicide could benefit from gender-specific treatment approaches, according to the researchers. (Medical Care, Feb. 1, 2021)
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Temporary financial assistance helps homeless Veterans find stable housing
 Photo: ©iStock/turk_stock_photographer (02/16/2021)
Temporary financial assistance increases the likelihood of homeless Veterans finding stable housing, found a VA study. Researchers looked at data on nearly 42,000 Veterans experiencing homelessness who were enrolled in the VA Supportive Services for Veteran Families program. About 70% of those Veterans received temporary financial assistance for housing-related expenses. In total, 81% of Veterans in the program achieved stable housing. Veterans who received financial assistance were significantly more likely to find stable housing. Receiving more financial assistance led to a greater chance of finding stable housing. The results suggest that providing temporary financial assistance may be an effective way to address Veteran homelessness, say the researchers. (JAMA Network Open, Feb. 1, 2021)
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Unexpected or morally questionable combat experiences increase suicide risk
 Photo: ©iStock/Rockfinder (02/10/2021)
A study by VA Puget Sound researchers and colleagues identified specific combat experiences that may be linked with increased suicide risk in service members. Researchers looked at data on nearly 58,000 service members. Any combat exposure did not increase suicide risk. However, high combat severity and specific events were associated with the chance of suicide attempts. In particular, being attacked or ambushed, seeing dead bodies or human remains, and being directly responsible for the death of a noncombatant significantly increased a service member’s risk of suicide. This connection was often mediated by PTSD. The results suggest that clinicians should inquire about the nature of combat experiences when assessing service members for suicide risk, say the researchers. (JAMA Network Open, Feb. 1, 2021)
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Back and neck pain common after upper-limb amputation
 Photo: ©iStock/Aleksej Sarifulin (02/10/2021)
Back and neck pain is common in Veterans with upper-limb amputations, found a Providence VA Medical Center study. People with an upper-limb amputation may experience back and neck pain because they change the way they move to compensate for the missing limb. Researchers evaluated nearly 800 Veterans with upper-limb amputation for pain. They found that 61% had back pain and 48% had neck pain. About 52% of respondents had both back and neck pain. Persistent pain was associated with lower quality of life. The findings show that additional pain prevention and intervention are needed in Veterans with amputation, according to the researchers. (American Journal of Physical Medicine and Rehabilitation, Jan. 11, 2021)
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Bacteria immunization may improve stress response
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Immunization with M. vaccae bacteria could improve the body’s response to stress, according to a study led by a VA Rocky Mountain MIRECC researcher. Mycobacterium vaccae is a bacterium derived from soil. It has been shown to have anti-inflammatory and immune regulation properties. Researchers immunized mice with M. vaccae to study its effects on the stress response. The bacterium stabilized the gut microbiome in the mice. This in turn led to a more proactive behavioral response to stress exposure through the connection between the gut and the brain. The immunization also appeared to promote stress resilience. The results suggest that M. vaccae could be used to improve negative reactions to stress. (Frontiers in Physiology, Jan. 5, 2021)
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Veterans with ALS at high suicide risk
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Veterans with amyotrophic lateral sclerosis (ALS) are at high risk for suicide, according to a VA Rocky Mountain Mental Illness Research Education and Clinical Center study. ALS is a disease that affects nerve cells in the brain and spinal cord, causing muscle weakness and an increasing loss of function. There is no cure. Researchers looked at data on more than 7,000 Veterans with ALS and 1.5 million without. They found that Veterans with ALS had nearly four times higher risk of suicide. The most common means of suicide was with a firearm. The results show a need for additional efforts to prevent suicide in Veterans with ALS, according to the researchers. (Muscle and Nerve, Jan. 20, 2021)
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Technology-based physical activity therapy for COPD cost-effective
 Photo: ©iStock/Antic Zlatko (02/02/2021)
A technology-based physical activity therapy is cost-effective for chronic obstructive pulmonary disease (COPD), found a VA study. Regular physical activity is recommended for patients with COPD. COPD patients were given either a pedometer alone, or a pedometer along with website-based support. The website provided goal-setting, feedback, motivation, and support. Researchers assessed cost-effectiveness by comparing cost per quality-adjusted life years, a measure of disease burden. Cost of both interventions fell below participants’ willingness to pay for better quality of life. The results show that a technology-based approach to physical activity can directly benefit COPD patients. (American Journal of Respiratory and Critical Care Medicine, Dec. 23, 2020)
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Study: Shock waves can cause structural brain damage
 Image: ©iStock/4X-image (02/02/2021)
A study by VA researchers and colleagues using a mouse model provides new insights into how the brain is affected by shock waves from explosions. Researchers measured shock wave pressure and velocity during a simulated explosion experiment. The measurements will help researchers better understand how much force is absorbed by the brain during a shockwave. Mice exposed to low-intensity blasts showed signs of structural damage to the cells of the brain. Researchers found abnormalities in cell mitochondria, axons, and synapses. The findings provide new data on how blast exposure can cause traumatic brain injury, say the researchers. (Military Medicine, Jan. 25, 2021)
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Identifying chronic cough with natural language processing
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Natural language processing can identify chronic cough through patient records, found a study by a Richard L. Roudebush VA Medical Center researcher and colleagues. Chronic cough was defined as a cough lasting eight or more weeks. Chronic cough is difficult to identify in electronic health records because of incomplete diagnostic codes. Researchers used natural language processing, a form of machine learning that looks at written health care notes, to study more than 200,000 appointments. More than 20,000 of those patients had chronic cough. Natural language processing was able to identify chronic cough in 74% of these patients. Looking at diagnoses or prescriptions alone identified only 15% of chronic cough cases. Natural language processing could be a useful tool in treating unrecognized chronic coughs, according to the researchers. (Chest, Dec. 17, 2020)
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Timed muscle stimulation makes wheelchair use easier
 Photo: ©iStock/ljubaphoto (01/26/2021)
Stimulating trunk and hip muscles at the right time can improve manual wheelchair propulsion, found a VA Advanced Platform Technology Center study. Researchers used an accelerometer attached to a manual wheelchair user’s wrist to time the two main phases of propulsion: contact and recovery. Using this data, they were able to time stimulation of trunk and hip muscles to assist in the movements. With properly timed stimulation, the wheelchair user had improved acceleration and reported that pushing the wheelchair was easier. The findings show that a simple accelerometer can detect wheelchair user movements. These measurements can improve muscle stimulation and make wheelchair use easier, say the researchers. (American Journal of Physical Medicine and Rehabilitation, Jan. 11, 2021)
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Stepped care treatment model improves knee osteoarthritis
 Photo: ©iStock/thebigland88 (01/26/2021)
A stepped care model could be an effective way of delivering exercise therapy to patients with knee osteoarthritis, according to a Durham VA study. In a stepped care model, patients move through different steps if initial treatment is not effective. In the knee osteoarthritis program, step 1 is three months of an internet-based exercise program. If patients do not have pain improvement, they proceed to step 2, three months of biweekly physical activity coaching phone calls. Those who advance to step 3 receive in-person physical therapy visits. In a group of 230 patients, 65% progressed to step 2 and 35% progressed to step 3. After nine months, patients in the step program had modest improvements in knee osteoarthritis symptoms, compared to a control group. The results show that the stepped care model could be an efficient therapy method for osteoarthritis, say the researchers. (Annals of Internal Medicine, Dec. 29, 2020)
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Potential new medication for treating COVID-19
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A team led by a Jesse Brown VA Medical Center researcher created a potential new medication to treat COVID-19. The virus behind COVID-19 binds with an enzyme in the body called ACE2, which allows it to enter human cells. The researchers designed a peptide (a chain of amino acids) that blocks ACE2 from binding with the spike proteins on the outside of the virus. They gave the new peptide to mice with symptoms that mimic COVID-19 as a nasal spray. The spray reduced fever, protected the lungs, and improved heart function and the mice’s movement. The results could lead to an important new treatment for COVID-19, according to the researchers. (Journal of Neuroimmune Pharmacology, Jan. 11, 2021)
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Sleep coach program improves insomnia
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A program combining cognitive behavioral therapy and positive airway pressure can improve insomnia, found a study by VA researchers and colleagues. Patients with both insomnia and obstructive sleep apnea participated in weekly sessions with a “sleep coach,” along with using a C-PAP machine. The sleep coach used cognitive behavioral therapy, a psychotherapy focused on dealing with distressful thoughts, to provide support on several sleep-related behaviors, such as stimulus control and relaxation techniques. A C-PAP uses air pressure to improve the user’s breathing during sleep. Patients receiving the coaching showed greater improvement in sleep quality, compared with a control group. They also more frequently used their C-PAP machines. The results show that the program can improve both C-PAP adherence and insomnia, say the researchers. (Sleep, Nov. 21, 2020)
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Cognitive impairment common in homeless adults
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Cognitive and functional impairments are common among homeless adults, found a study by VA San Diego researchers. One hundred participants staying at a homeless shelter completed a neurological assessment. Overall, 65% of participants had signs of cognitive impairment. About 30% had impaired processing speed, and 11% met the criteria for cognitive disability. Of the total sample, 48% were assessed with functional impairment, meaning cognitive problems made carrying out functions of their daily lives difficult. Poorer cognitive performance was linked to greater functional impairment. The results underscore the need for routine cognitive screening as part of homelessness services, say the researchers. (Psychiatric Services, Jan. 5, 2021)
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Frailty increases the risk of death after surgery
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Frailty raises the risk of death after most types of surgery, found a study by VA researchers. Frailty refers to increased vulnerability and weakness associated with aging. Researchers analyzed data on outcomes after surgery in nine non-cardiac specialties. They found that frail patients had a significantly higher risk of dying compared to non-frail patients, regardless of the type of surgery. This held true for low-intensity procedures such as plastic surgery, moderate-intensity surgeries such as neurosurgery, and high-intensity operations like vascular surgery. The results suggest that frailty should be assessed before surgery across all specialties, according to the researchers. (JAMA Surgery, Nov. 18, 2020)
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Patients with kidney disease have mixed results on blood thinners
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Beginning blood thinners for patients with kidney disease and atrial fibrillation has both benefits and problems, according to a study by Memphis VA Medical Center researchers and colleagues. Researchers looked at data on more than 22,000 Veterans with end-stage renal disease and atrial fibrillation (erratic heart beat) who began dialysis treatment. Patients with atrial fibrillation are often prescribed the blood thinner warfarin to prevent conditions like stroke, but its effect on dialysis is unknown. Warfarin use was linked to a higher risk of ischemia (lack of blood flow to an organ) and bleeding. However, patients taking warfarin had a lower risk of death than other patients. More study is needed to determine the net benefit of blood thinners in patients with kidney disease, say the researchers. (JACC Clinical Electrophysiology, Dec. 14, 2020)
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Brain volume abnormalities linked to impulsive suicide attempts
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Impulsive suicide attempts are linked with abnormalities in the cingulate cortex of the brain, found a VA study. The cingulate cortex is a brain region known to be involved in inhibitions and impulsive behavior. Researchers conducted magnetic resonance imaging on the brains of 52 Veterans with either suicidal thoughts or attempts. They found that those who had attempted suicide had lower white matter volume in the cingulate cortex, compared with those who had suicidal thoughts but not attempts. Those with lower white matter volume also scored higher on an assessment of impulsivity. The results suggest that abnormalities in this part of the brain could lead to more unplanned suicide attempts, according to the researchers. (Journal of Affective Disorder, Dec. 3, 2020)
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Disadvantaged patients less likely to receive flu shots
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Socioeconomic factors can predict the likelihood of flu vaccination in patients with diabetes, found a study including a Michael E. DeBakey VA Medical Center researcher. The study looked at data on more than 25,000 patients with diabetes. About 36% of those did not receive a flu shot. Younger age, Black race, being uninsured, and having no usual source of health care all decreased the odds of getting a flu shot. Nearly 64% of patients with all four of these socioeconomic factors did not receive a flu shot. The findings highlight the need to increase vaccine coverage in disadvantaged communities, say the researchers. (Journal of the Endocrine Society, Sept. 24, 2020)
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Nerve stimulation may improve cognitive performance
 Illustration: ©iStock/sankalpmaya (01/06/2021)
Stimulating the vagus nerve may improve cognitive performance, found a study by VA San Diego researchers. The vagus nerve is a large nerve connected to the brain. It is involved with controlling the heart, lungs, and digestive tract. The researchers stimulated the nerve from outside the body using electrical current in 15 subjects, who then performed cognitive tests. Compared with participants who did not receive nerve stimulation, the subjects had higher accuracy on both easy and hard mental reasoning tests. The researchers hypothesize that stimulating the vagus nerve could increase attention, thereby enhancing cognitive function. The results suggest that vagus stimulation could be a low-risk, low-cost treatment for cognitive disorders, according to the researchers. (Neuromodulation, Nov. 25, 2020)
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Higher suicide risk in sexual minority Veterans
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Suicide rates are high in sexual minority Veterans, according to a VA Salt Lake City study. Researchers looked at data on more than 8 million Veterans for an 18-year period. They found that risk of death from suicide was four times higher in sexual minority Veterans, compared with the general population. Sexual minority Veterans had more than twice the risk of death by suicide than the general Veteran population. Sexual minority was defined as identifying as gay, lesbian, bisexual, or other sexual orientations not heterosexual. In 2017, suicide was the fifth-leading cause of death in sexual minority Veterans. For both men and women Veterans belonging to a sexual minority, suicide was the most common cause of death for 18- to 20-year olds. The most common method of suicide for this group was by firearm, used in 40% of deaths. The results suggest that more attention to suicide prevention is needed in this population, say the researchers. (JAMA Network Open, Dec. 1, 2020)
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Lab study sheds light on insomnia caused by alcohol withdrawal
 Photo: ©iStock/1281086710.jpg (12/22/2020)
Researchers at the Harry S. Truman Memorial Veterans’ Hospital found the possible cause of alcohol withdrawal-related insomnia, using a mouse model. Insomnia is the most common symptom of alcohol withdrawal. However, why alcohol withdrawal causes insomnia is not known. In the study, mice exposed to chronic alcohol had severe insomnia-like symptoms, similar to those in humans with alcohol use disorder. During seven days of alcohol withdrawal, the mice had a significant reduction in a chemical process called histone acetylation in several parts of the brain. This process allows histones (a type of protein) to regulate gene expression. Giving the mice a chemical compound called Trichostatin A, which aids in histone acetylation, reduced insomnia symptoms. The results could explain how alcohol withdrawal causes insomnia and lead to better treatment, say the researchers. (Neuropharmacology, Dec. 1, 2020)
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Veterans homeless services use reduces death by suicide
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Use of homeless services by Veterans significantly lowered the risk of death, including from suicide, according to a study by the VA National Center of Homelessness among Veterans. Researchers studied data on almost 170,000 Veterans who reported housing instability between 2012 and 2016. More than half of the Veterans studies accessed VA homeless services, such as emergency housing or work therapy programs. Those who used these services had a 6% reduction in the risk of death from any cause, compared with those not using the services. Veterans who accessed VA homeless services had a 21% lower risk of dying by suicide. The results show that social programs that address homelessness can be an important method to prevent Veteran suicide, according to the researchers. (Journal of Epidemiology and Community Health, Nov. 18, 2020)
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Higher rates of drug use disorder among transgender patients
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Transgender VA patients have increased odds of having drug use disorders, found a VA Puget Sound study. Researchers looked at data on nearly 9 million VA patients, more than 8,000 of whom were transgender. Transgender patients had a 67% higher likelihood of having any drug use disorder, compared with cisgender patients. The difference was highest for amphetamine use. The presence of mental health conditions did not affect the disparity in drug use disorder rates. The results point to a need for more research into health disparities for transgender patients, say the researchers, particularly toward potential barriers to substance use treatment. (Journal of Addiction Medicine, Nov. 25, 2020)
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Nurses at higher risk of COVID-19 than other health care workers
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Nurses are more likely than other health care workers to test positive for the virus causing COVID-19, found a study including an Edward Hines, Jr. VA Hospital researcher. Researchers looked at COVID-19 test data for more than 6,500 health care workers. Nearly 2,000 of those were nurses. About 5% tested positive for the virus. Nurses had nearly twice the odds of testing positive, compared with other health care workers. Administrators who worked in hospitals but did not interact with patients were the least likely to test positive. Nurses who saw patients receiving high-flow oxygen therapy had a 45% higher risk of contracting the virus, and those treating patients receiving kidney dialysis had 57% higher odds, compared with other nurses. The results show that health care workers who spend more time around COVID-19 patients, such as nurses, are at increased risk from the virus, say the researchers. (Open Forum Infectious Disease, Dec. 9, 2020)
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Number of concussions does not affect cognitive treatment response
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The number of concussions one sustains does not affect treatment response, according to a study of service members with a history of brain injury. Participants underwent six weeks of cognitive rehabilitation for traumatic brain injury. All patients in the study improved in cognitive deficits and psychological distress over the course of treatment. Participants who had more concussions showed about the same level of improvement as those with fewer concussions. Participants with more concussions did report more cognitive difficulties both before and after treatment. The results show that cognitive rehabilitation is effective regardless of the number of concussions sustained, say the researchers. (Archives of Clinical Neuropsychology, Dec. 3, 2020)
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Psychiatric conditions not linked to worse nicotine withdrawal
 Photo: ©iStock/Juanmonino (12/16/2020)
Patients with PTSD or depression had less increase in nicotine withdrawal symptoms than those without psychiatric conditions, in a study of Veterans who smoked. Smokers with psychiatric disorders often have increased trouble quitting. Researchers measured smokers’ nicotine withdrawal symptoms both before and during a two-day period without nicotine. Contrary to what the researchers expected, those without psychiatric conditions had greater increases in withdrawal symptoms when deprived of nicotine. The researchers suggest that high levels of distress and craving, not increased withdrawal symptoms, may account for the difficulties people with psychiatric conditions have to quit smoking. (Nicotine and Tobacco Research, Nov. 27, 2020)
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Race-based COVID-19 disparities
 Photo: ©iStock/JONGHO SHIN (12/10/2020)
African American and Hispanic populations have higher rates of COVID-19 infection and death compared with other ethnic groups, according to a VA Portland review. Researchers reviewed 37 studies on COVID-19 data. They found that African American and Hispanic patients had disproportionately higher rates of virus infection, hospitalization, and death from COVID-19, compared with white patients. While these groups had a higher proportion of deaths from COVID-19, they did not show a higher risk of death in confirmed COVID-19 cases. Asian patients had similar COVID-19 rates as white patients. Not enough data exist on other racial groups to draw conclusions. The higher COVID-19 rates appear to be due to differences in health care access and exposure risk rather than any biological disposition, according to the researchers. (Annals of Internal Medicine, Dec. 1, 2020)
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Post-traumatic headaches are often more complex than non-traumatic headaches
 Photo: ©iStock/Nenad Cavoski (12/10/2020)
Headaches caused by traumatic brain injury usually include more symptom features than non-traumatic headaches, found a study by VA researchers and colleagues. Headaches are a common symptom of mild traumatic brain injury. Researchers assessed more than 1,000 soldiers for different headache features, such as pain level, pulsating sensation, and visual auras. Soldiers with post-traumatic headaches were more likely to have all 12 headache features assessed, compared with soldiers with headaches but no traumatic brain injury. Unsurprisingly, soldiers who experienced a wider variety of headache symptoms, termed headache complexity, were more likely to use health care services. The results suggest that post-traumatic headaches differ from non-traumatic headaches in severity more than type of headache, say the researchers. Headache complexity could be a useful tool to assess post-traumatic headaches. (Cephalalgia, Nov. 27, 2020)
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New technique could improve wound healing
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A study led by a Corporal Michael J. Crescenz VA Medical Center researcher has demonstrated a process that could lead to better wound healing. Wounds often heal with fibrous scar tissue that can cause problems. In a mouse model, researchers used medication to activate pain receptor cells in the skin to promote wound healing. Activating the pain receptors stimulated the skin cells to produce interleukins, proteins involved in the body’s immune response. Triggering this immune response led to less scar tissue and promoted tissue regeneration. The results present a new avenue for research into faster and healthier wound healing, according to the researchers. (Science Immunology, Aug. 28, 2020)
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Elevated immune response leads to more severe COVID-19
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Elevated immune response is associated with more severe COVID-19 and death, found a review led by a Michael E. DeBakey VA Medical Center researcher. The review analyzed 16 previous studies. Researchers found that COVID-19 patients with higher levels of interleukins, proteins secreted by the immune system, were more likely to have worse symptoms or die, compared with patients with lower levels. Conversely, high levels of a different type of immune proteins (CD4 and CD8) were linked to better prognosis in COVID-19 patients. The results suggest that medications that block interleukin production could be a useful treatment for COVID-19, say the researchers. A number of interleukin blockers are already being tested as possible treatments. (Diabetes and Metabolic Syndrome, November–December 2020)
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Blood pressure medications not linked to worse COVID-19
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Common blood pressure drugs are not linked to worse COVID-19 outcomes, according to a review by VA Portland researchers. Researchers reviewed 17 studies on how angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) interact with the SARS-CoV-2 virus. Both types of drugs are used to treat high blood pressure and heart failure. Evidence suggests that taking ACE inhibitors or ARBS does not lead to more severe COVID-19. The drugs also were not linked to positive SARS-CoV-2 test results. The researchers found four studies looking at ACE inhibitors or as COVID-19 treatments, but results from these studies are not yet available. (Annals of Internal Medicine, Aug. 4, 2020)
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Phone-based diabetic kidney disease care effective for African American patients
 Photo: ©iStock/kali9 (12/02/2020)
A telehealth program could effectively slow kidney decline in African American patients, according to a Durham VA and Duke University study. Pharmacists delivered a phone-based intervention to patients with diabetic kidney disease. The program focused on behavioral and medication management. African American patients who received the program had significantly greater control of eGFR levels (a measure of kidney function), compared with patients receiving usual care. Non-African American patients in the program had a much faster decline in eGFR levels. The results suggest that this high-risk population may respond well to a telehealth approach to diabetic kidney disease care, say the researchers. (Medical Care, November 2020)
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Inflammation may cause motor slowing in patients with schizophrenia
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Inflammation may play a role in schizophrenia-related movement problems, according to an Atlanta VA and Emory University study. Fine motor deficits are common in patients with schizophrenia. Researchers had patients with schizophrenia complete motor tasks (e.g., a finger tap test) and also tested their blood. As expected, patients with schizophrenia were slower on motor tests than controls without the disease. Patients with slower motor performance also had higher concentrations of molecules associated with inflammation in their blood. The results add to growing evidence that inflammation is the cause of motor slowing in people with schizophrenia and other mental conditions, say the researchers. (NJP Schizophrenia, April 1, 2020)
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Walking program improves diabetes control
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A new walking program improves older patients’ health and diabetes control, found a South Texas Veterans Health Care System study. Patients 60 and older with diabetes participated in the Geriatrics Walking Clinic (GWC), a six-week program to promote physical activity. Participants were given a pedometer and weekly phone calls to monitor progress and give encouragement. Participants showed lowered HbA1c levels—a measure of diabetes control—at three, six, and 12-month follow-ups. They also improved their walking speed. The results highlight the benefits of exercise programs such as GWC for older patients with diabetes. (Geriatric Nursing, Nov. 3, 2020)
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Perceived discrimination linked to worse arthritis outcomes
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Perceived discrimination contributes to poor osteoarthritis outcomes, found a study by VA researchers and colleagues. Researchers evaluated more than 500 older Veterans with knee osteoarthritis. They found that those with higher cumulative disadvantage had significantly higher perceived discrimination. Cumulative disadvantage was defined as belonging to multiple socially disadvantaged groups. The researchers identified female gender, African American race, low income earning, and unemployment due to disability as known social disadvantages. Those with higher disadvantage also had higher pain and depression symptoms. Analysis showed that perceived discrimination was largely responsible for this connection. The results show that discrimination can lead to poorer physical and mental health outcomes, say the researchers. (Arthritis Care & Research, Oct. 7, 2020)
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Stroke survivor mental deficits negatively affect caregiver well-being
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Stroke patients’ emotional or cognitive deficits negatively impact caregiver well-being, found a North Florida/South Georgia VA study. Researchers surveyed 109 caregivers of stroke survivors. They found that higher cognitive and emotional deficits in the stroke patient led to more depression and burden in the caregiver. Cognitive/emotional deficits negatively affected caregiver mental quality of life. Higher motor or functional deficits in those they cared for did not significantly affect caregiver outcomes. The results suggest that cognitive/emotional deficits impact caregivers more than physical deficits, say the researchers. (Disability and Health Journal, Nov. 4, 2020)
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Program helps lower self-stigma from PTSD
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A new group program could help Veterans with PTSD deal with self-stigma, according to a VA Maryland study. Self-stigma is when someone comes to believe that common negative stereotypes and assumptions about PTSD are true of oneself. Researchers began a pilot program: Ending Self-Stigma for PTSD. The program involves nine group sessions aimed at learning tools to address PTSD stigma and self-stigma. Compared with Veterans receiving usual care, those in the program showed significantly less self-stigma and depression symptoms. They also had higher social confidence and feelings of belonging. The results show that the new program could help Veterans cope with negative views of PTSD, say the researchers. (Journal of Traumatic Stress, Oct. 15, 2020)
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Exercise alleviates sleep problems caused by nicotine withdrawal
 Photo: ©iStock/PeopleImages (11/19/2020)
Exercise can help with sleep problems caused by nicotine withdrawal, found a Pittsburgh VA study. Sleep disturbances, including insomnia, are common symptoms of nicotine withdrawal. Researchers tested the effects of exercise on 49 daily smokers who were quitting. They found that engaging in daily exercise improved the patients’ ability to stay asleep. Patients with the greatest withdrawal severity had the most trouble falling asleep. But these participants also had the greatest benefits from afternoon exercise in how long it took them to fall asleep. The findings suggest that an exercise routine can improve sleep problems in people trying to quit smoking. (Experimental and Clinical Psychopharmacology, Oct. 29, 2020)
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Gene variant increases risk of blast-induced memory problems
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A specific gene variant may make people more vulnerable to cognitive problems from explosive blasts, found a study by VA Boston researchers and colleagues. Researchers examined the genomes of nearly 500 Veterans. They found that those with a common variant of the apolipoprotein (APOE) gene had an increased risk of memory problems after close-range blast exposure. This APOE variant is known to be a risk factor for Alzheimer’s disease. The results suggest that carriers of the gene variant could suffer worse outcomes from blast injuries than those with different forms of the gene, according to the researchers. They point out the importance of considering genetic risk when studying cognitive effects of trauma. (Journal of the International Neuropsychological Society, Nov. 3, 2020)
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Involuntary opioid dose reduction does not lead to more chronic pain
 Photo: ©iStock/Charles Wollertz (11/12/2020)
Involuntary opioid dose reduction did not affect chronic pain severity, in a VA study. The study involved nearly 300 VA patients with chronic pain. Over the past year, about equal numbers had their opioid doses reduced involuntarily, reduced voluntarily, or kept the same. All three groups had similar pain levels before medication doses were adjusted. After 18 months, no significant differences in pain severity were found between the three groups. The findings suggest that reducing opioid dosing, whether voluntarily or involuntarily, does not lead to an increase in chronic pain, according to the researchers. (Journal of General Internal Medicine, Nov. 3, 2020)
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Toxic exposure linked to rheumatoid arthritis-related antibodies
 Photo: ©iStock/katleho Seisa (11/12/2020)
Military toxic exposure was linked to antibodies associated with rheumatoid arthritis, in a VA study. In rheumatoid arthritis, the body’s immune system attacks its own tissue, including joints. Participants in a Veteran rheumatoid arthritis study were surveyed about inhalant exposures during their military service. The researchers found that Veterans with military burn pit or waste disposal exposure were more likely to have anti-cyclic citrullinated peptide antibodies, compared with those without toxic exposure. This type of antibody is an immune protein that mistakenly attacks healthy cells in the body. It is common in patients with rheumatoid arthritis. The results suggest that toxic exposure changes antibody expression and can increase the risk of rheumatoid arthritis, say the researchers. (Arthritis & Rheumatology, Oct. 15, 2020)
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Molecular DNA changes linked to depression
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A study involving an Atlanta VA researcher identified molecular DNA changes in the brain that may contribute to major depressive disorder. Researchers studied DNA methylation in the brain tissue of more than 600 older patients. DNA methylation is a process in which molecules called methyl groups attach to the DNA molecule. The researchers identified four new locations on the genome where methylation appears to be linked to major depressive disorder risk. Notably, the association between methylation levels and depression was stronger in men than in women. The results help explain how molecular changes could be involved in depression, according to the researchers. (Translational Psychiatry, July 30, 2020)
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Cannabis use linked to psychiatric problems
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Cannabis use is linked to psychiatric problems in Veterans, found a study by VA San Diego researchers and colleagues. Researchers surveyed more than 3,000 Veterans about their cannabis use and mental health. Those who used cannabis had higher odds of PTSD and mood, anxiety, and substance use disorders, compared with those who never used cannabis. Cannabis users also had higher rates of current suicidal thoughts, suicide attempts, and mental health treatment utilization. Veterans with cannabis use disorder (CUD) had higher odds of PTSD, mood and anxiety disorders, nicotine and alcohol dependence, and suicidal thoughts, compared with those who used cannabis but did not meet CUD criteria. While the researchers suggest that cannabis use could increase mental health burden, it is also possible that many Veterans with psychiatric issues turn to cannabis as a form of self-medication. Outreach and education are needed about possible cannabis-related psychiatric burden, say the researchers. (Journal of Affective Disorder, Sept. 29, 2020)
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Risk factors for COVID-19 death
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VA Puget Sound researchers identified risk factors for death from COVID-19. The study included almost 89,000 patients tested in the VA health system. More than 10,000 tested positive for COVID-19. Higher risk of death from the disease was linked to being older than 50, being male, and having more health conditions. The researchers could not confirm several risk factors identified in other, smaller studies. These factors include obesity, Black race, Hispanic ethnicity, and smoking. The findings can help predict disease outcomes and plan treatment accordingly, say the researchers. (JAMA Network Open, Sept. 1, 2020)
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Cigarette smoke makes lung infection bacteria more dangerous
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Cigarette smoke alters the genes of bacteria in the lungs, making them more resistant to the immune system, found a VA San Diego study. Researchers exposed the bacteria P. aeruginosa to cigarette smoke extract. Infection with this bacteria often leads to pneumonia. Smoke exposure changed the gene expression in the bacterium, making it more resistant to white blood cells. Cigarette smoke also increased biofilm formation, making the bacteria more resistant to antibiotics. P. aeruginosa also became more harmful in a mouse model of pneumonia when exposed to smoke. The results show one way that smoking cigarettes can increase the danger of lung infections, say the researchers. (Infection and Immunity, Oct. 19, 2020)
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Transcranial magnetic stimulation reduces PTSD-linked anger
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Transcranial magnetic stimulation could reduce anger in Veterans with PTSD, found a Providence VA study. In transcranial magnetic stimulation, magnetic fields are applied to the outside of the skull to influence electrical currents in the brain. Researchers applied a form of this treatment called intermittent theta burst stimulation to patients with PTSD in 10 daily sessions. Patients receiving the treatment reported significantly reduced anger, compared with control patients. The change remained one month after treatment. Results suggest that the treatment could be an effective way to control increased anger caused by PTSD, according to the researchers. (Neuromodulation, Sept. 17, 2020)
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Identity disruption linked to Veteran reintegration trouble
 Photo for illustrative purposes only. ©iStock/Geber86 (10/28/2020)
Identity disruption is linked to Veteran difficulty reintegrating into civilian life, according to a Minneapolis VA study. Identity disruption refers to questioning one’s sense of self and place in the world. Researchers surveyed more than 200 Veterans who served in Afghanistan and Iraq. About 49% of those surveyed showed signs of identity disruption. Identity disruption was linked to more severe PTSD symptoms, lower satisfaction with life, greater reintegration difficulty, and less social support. The findings suggest that understanding identity disruption could help Veterans better reintegrate into civilian life, say the researchers. (Developmental Psychology, November 2020)
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Poor oral health linked to less gut bacteria diversity
 Veterans Health Administration photo (10/21/2020)
Oral health is linked to changes in the makeup of colon bacteria that could contribute to disease, found a study by Michael E. DeBakey VA Medical Center researchers and colleagues. Poor oral health has been associated with several diseases, but the reason for this link is not well understood. Researchers examined colonoscopy biopsies along with oral health questionnaires of 62 patients. They found that more tooth loss and gum disease were linked to lower bacteria diversity in the digestive tract. People with more tooth loss had lower levels or Faecalibacterium, bacterium known to be anti-inflammatory. Lower levels of this bacterium could indicate systemic inflammation, according to the researchers. The results suggest that poor oral health could lead to other health problems by altering the gut microbiota. (Digestive Diseases and Sciences, Sept. 24, 2020)
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Immunotherapy improves cancer survival
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Immune checkpoint inhibitors seem to improve cancer patients’ survival, according to a VA Boston study. Immune checkpoint inhibitors are drugs that block specific proteins. This allows immune cells to recognize and attack cancer cells. The researchers looked at data on more than 11,000 VA patients, in one of the largest studies on the topic. The most common type of cancer treated was lung cancer, followed by melanoma. Odds of survival a year after treatment were somewhat lower in this group of VA patients, compared with other studies of immune checkpoint inhibitors. However, mortality rates were similar after adjusting for frailty. Patients given immune checkpoint inhibitors generally survived longer than patients receiving standard care. This study provides a platform for further analysis of immunotherapy outcomes in real-world patients, say the researchers. (Journal of Clinical Oncology, Oct. 19, 2020)
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TBI increases risk of dementia to different degrees based on race
 Photo for illustrative purposes only. ©iStock/Juanmonino (10/21/2020)
Traumatic brain injury significantly increases the risk of dementia, and race appears to affect this relationship, found a San Francisco VA study. Researchers studied data on nearly a million older Veterans. Overall, Veterans with a TBI were more than twice as likely to be diagnosed with dementia than those without TBI. White Veterans were nearly three times more likely to have dementia if they had a TBI. Dementia was more than twice as likely in Black Veterans with TBI, compared to Black Veterans without TBI. TBI nearly doubled the risk of dementia in Hispanic Veterans. More research is needed to understand how race contributes to TBI’s connection to dementia, say the researchers. (Neurology, Sept. 29, 2020)
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Many Veterans with suicidal thoughts not receiving mental health care
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More than 3 in 5 Veterans who have suicidal thoughts are not engaged in mental health treatment, according to a VA study. Researchers looked at data from 2011 on more than 3,000 Veterans. About 7% said they have suicidal thoughts. Only 36% of those were receiving mental health treatment. Younger Veterans; women; those with current depression; and those with more lifetime suicide attempts, lifetime trauma, and medical problems were more likely to be in treatment. Mistrust of mental health providers and fear of damaging one’s reputation were linked to lower mental health treatment. The results highlight a need to find new ways to engage Veterans at risk for suicide in mental health care, say the researchers. (Journal of Psychiatric Research, July 29, 2020)
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Novel risk factors for heart attack in younger patients
 Photo for illustrative purposes only. ©iStock/digitalskillet (10/14/2020)
Younger patients who had heart attacks had both traditional and non-traditional risk factors, found a study by Michael E. DeBakey VA Medical Center researchers and colleagues. The study looked at characteristics of patients younger than 55 who had a heart attack. Younger patients were at higher risk of heart attack if they had HIV, lupus, and obstructive sleep apnea. Younger patients with rheumatoid arthritis had a lower risk of heart attack. Cigarette smoking, obesity, high lipid (fat) content in the blood, and a family history of coronary artery disease were linked to heart attack risk in both younger and older patients. Younger patients with HIV, lupus, or sleep apnea should be monitored for heart attack, in addition to those with traditional risk factors, conclude the researchers. (International Journal of Cardiology, Sept. 23, 2020)
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Yoga a cost-effective treatment for back pain
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Yoga can be a cost-effective treatment for Veterans with chronic low back pain, found a VA San Diego study. Patients were assigned to either 60-minute yoga sessions twice a week for 12 weeks or delayed treatment, in which they would receive the yoga treatment after the study. Yoga instruction could be provided for about $300 per participant. An analysis indicated that the costs of this program are offset by long-term reductions in health care costs for participants. Research suggests that yoga may have health benefits similar to physical therapy and can likely be delivered at a lower cost. The study suggests that yoga could be a useful non-opioid option for patients with chronic low back pain, say the researchers. (Medical Care, September 2020)
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Head and neck cancer rates increasing
 Illustration: ©iStock/Nerthuz (10/08/2020)
Head and neck cancer in VA patients has become more common in recent years, found a Michael E. DeBakey VA Medical Center study. Researchers looked at data on more than 12,000 patients with head and neck cancers. They found that the incidence of this type of cancer in VA patients declined between 2000 and 2006, but then increased between 2006 and 2012. The increase was seen across ethnic and age groups. Although smoking remains highly connected to this type of cancer, the percentage of cancer in those who never smoked has increased. About 8% of those with head or neck cancer were nonsmokers in 2000. This number increased to 16% in 2012. The finding suggests a different cause of the cancer beyond smoking, such as human papilloma virus, say the researchers. (Head and Neck, Sept. 12, 2020)
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Air pollution linked to stroke risk in atrial fibrillation patients
 Photo: ©iStock/lapandr (10/08/2020)
Higher air pollution increases the risk of stroke in patients with atrial fibrillation, found a study by VA Pittsburgh and University of Pittsburgh researchers. The study followed more than 31,000 patients with atrial fibrillation along with pollution measures for a number of years. Atrial fibrillation refers to irregular heartbeat. Those exposed to greater fine particulate matter had a significantly higher risk of stroke, compared with those exposed to less pollution. Fine particulate matter refers to airborne particles less than 2.5 micrometers in diameter. The higher the air pollution, the higher the risk of stroke. The results highlight the need to address how air pollution contributes to cardiovascular disease, according to the researchers. (JAMA Network Open, Sept. 1, 2020)
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American Indian/Alaskan Native Veterans have higher risk of death
 Photo for illustrative purposes only. ©iStock (10/08/2020)
American Indian/Alaskan Native Veterans had higher death rates than other ethnic groups, found a VA Greater Los Angeles study. Researchers looked at health and census data on more than 5 million Veterans. They found that American Indian/Alaskan Native Veterans had a 7% higher risk of death from any cause in a given year, compared to Black and white Veterans. Mortality rates were similar between other ethnic groups when controlling for other factors. Neighborhood segregation was a large contributor to this disparity. American Indian/Alaskan Native Veterans who lived areas with greater non-Hispanic Black segregation had a lower risk of death than those in other areas. Living near tribal reservations also seemed to lessen the disparity. The results suggest that social characteristics of neighborhoods need to be examined to address racial disparities, say the researchers. (Health Services Research, October 2020)
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Risk factors for lower-limb re-amputation
 Photo: ©iStock/Morsa Images (09/30/2020)
VA Puget Sound researchers identified risk factors that led to further lower-limb amputation in Veterans. The study included more than 7,000 VA patients who had an amputation because of diabetes or peripheral artery disease. Re-amputation included removing tissue and bone near the amputation site or amputation higher on the leg, and might become necessary because of improper healing. Re-amputation was highest (41%) in patients who had part of the foot removed. About 25% of amputations at the tibia and 9% at the femur required re-amputation. Risks for re-amputation included chronic obstructive pulmonary disease, reduced blood flow, and alcohol misuse. Different levels of amputation carried different risk factors. The results will help surgeons and patients make decisions on amputation level, according to the researchers. (European Journal of Vascular and Endovascular Surgery, Aug. 12, 2020)
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Combat exposure linked to suicidal thoughts through PTSD symptoms
 U.S. Army photo by Maj. Thomas Cieslak (09/30/2020)
PTSD symptom severity largely controls the link between combat exposure and suicidal thoughts in Veterans, found a Durham VA study. Previous findings have been mixed on whether combat exposure is directly related to suicidal thoughts or if other factors are involved. Researchers evaluated 319 Veterans at the beginning of the study, as well as six and 12 months later. They found that the link between combat exposure and the risk of suicidal thoughts was controlled by how severe PTSD symptoms were in 64% of cases. The results emphasize the importance of addressing PTSD symptoms when trying to prevent suicide, say the researchers. (Suicide and Life-Threatening Behavior, Aug. 8, 2020)
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One-day mental health workshop helps rural Veterans in distress
 Photo: ©iStock/davidperks (09/30/2020)
Rural Veterans in mental distress found community-based mental health workshops helpful, in a VA study. VA researchers partnered with nonprofit organizations to identify distressed Veterans in rural areas. They conducted a one-day acceptance and commitment therapy group workshop in rural locations for 31 Veterans. Each Veteran was interviewed after the workshop, as well as one and three months later. Veterans appreciated the structure, content, and environment of the workshops. Most used the learned coping skills in their daily lives, and some initiated new treatment after the workshop. Veterans scored better on measures of functioning and reintegration afterward. They also showed higher feelings of meaning and purpose and reduced distress. The results show that partnering with rural non-profits can help engage rural Veterans in mental health care, say the researchers. (Journal of Behavioral Medicine, Sept. 17, 2020)
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Nondrug therapy use for chronic pain common
 Photo by Robert Turtil (09/23/2020)
Nondrug therapy use is common in Veterans with chronic pain, found a Minneapolis VA study. Researchers surveyed nearly 9,000 Veterans who had been prescribed long-term opioid therapy for chronic pain. In the past year, 80% used at least one nondrug therapy for pain. Therapies included meditation, psychotherapy, yoga, and other techniques. Younger Veterans and female Veterans were more likely to use nondrug therapies. Greater pain severity was linked to lower use of exercise and movement therapies. Further research into complementary and integrative health could lead to more nondrug treatment for chronic pain, say the researchers. (Medical Care, September 2020)
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Exploring gene expression in prostate cancer
 Photo: ©iStock/jamesbenet (09/23/2020)
A team including Southeast Louisiana Veterans Health Care System researchers found multiple gene expression trends linked to prostate cancer. Gene expression refers to the creation of proteins based on genetic instructions. The team studied data from three large genomic databases. They found that gene expression of the protein FBXW7 was significantly lower in prostate cancer, compared to in normal prostate tissue. Expression of several related proteins (FBXW8–10) was higher in prostate cancer, as well. The study also found higher expression of several different FBXW proteins in metastatic castration-resistant prostate cancer, a hard-to-treat form of the cancer, compared with more common prostate cancers. The results help explain the role genes play in prostate cancer risk, say the researchers. They also suggest that FBXW7 has potential as a treatment to suppress tumor growth. (American Journal of Clinical and Experimental Urology, Aug. 15, 2020)
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Cause of light sensitivity the same in multiple conditions
 Photo: ©iStock/laflor (09/23/2020)
Light sensitivity associated with three separate conditions could share a common cause, according to a review by VA researchers and colleagues. Patients with dry eye disease, migraines, and traumatic brain injury all commonly have a sensitivity to light. These conditions are usually considered different types of medical issues. However, they often occur together. By reviewing available studies, the researchers found that light sensitivity is linked to disruptions in brain connectivity in all three conditions. Light sensitivity is closely connected to increased activity of the protein CGRP. The results suggest that treatments that target neural pathways should be considered for light sensitivity in these conditions, according to the researchers. (British Journal of Ophthalmology, July 23, 2020)
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Understanding prostate cancer molecular processes
 Photo: ©iStock/selvanegra (09/17/2020)
Minneapolis VA researchers explored molecular processes involved in prostate cancer growth. Protein kinase CK2 is an enzyme involved in the life cycle of the cell. It is known to be elevated in many types of cancer, but its function within cancer cells is not well known. The researchers exposed prostate cancer cell lines in the lab to compounds that inhibit protein kinase CK2. They found that inhibiting the enzyme led to decreased levels of calcium ions in the body of the cell and increased levels in the endoplasmic reticulum and mitochondria, two discrete or structures in the cell. Calcium ions are known to drive signaling of processes within cells. Calcium levels were much lower within cells given enough protein kinase CK2 inhibitors to kill the cell. This study increases the understanding of the processes involved in cancer cell growth and death. It could lead to new areas of study for treatment of prostate cancer. (Molecular and Cellular Biochemistry, July 2020)
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Opioid misuse linked to emotion dysregulation
 Photo: ©iStock/VladimirSorokin (09/17/2020)
Opioid misuse could cause emotion dysregulation, according to a study by VA Salt Lake City researchers and colleagues. Researchers had patients on long-term opioid therapy for chronic pain complete an emotion regulation task. The task involved viewing emotionally charged pictures while trying to control one’s emotions. Patients were measured for heart rate and galvanic skin response (a change in the electrical resistance of skin caused by emotional stress). Patients who correctly followed their medication protocols were able to control their emotional responses. Those who misused opioids had increases in the reaction measures during tests involving negative emotion. They also did not show signs of emotional control during positive emotion tests. The results suggest that opioid misuse is linked with an inability to control emotions that occurs immediately after emotional provocation, say the researchers. (Progress in Neuro-Psychopharmacology and Biological Pharmacology, June 24, 2020)
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Blast exposure linked to attention problems
 DOD photo by Lance Cpl. Immanuel Johnson (09/17/2020)
Blast pressure from an explosion contributes to cognitive problems caused by traumatic brain injury (TBI), found a VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC) study. Explosions cause a pressure wave in the air that can strike people near the blast. More than 250 post-9/11 Veterans completed cognitive tests and surveys about blast exposure. Those with a mild TBI performed worse on cognitive tests than those without TBI. The severity of blast pressure seemed to control this relationship. In Veterans with mild TBI, those who had experienced more severe blasts showed lower performance on a simple attention task, even with the same TBI diagnosis. The results show that severe pressure waves could lead to persisting attention difficulties that impede cognitive function in Veterans with TBI, say the researchers. (Neuropsychology, July 16, 2020)
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3D-printed masks can be decontaminated of coronavirus using standard methods
 Photo: ©iStock/beerkoff (09/11/2020)
VA researchers identified several methods that effectively decontaminate 3D-printed mask material of the virus that causes COVID-19. The researchers tested viral activity on mask material using multiple disinfectants. They found three solutions that inactivated the virus: bleach, quaternary ammonium sanitizer, and hydrogen peroxide. Likewise, exposing the material to dry heat for 30 minutes inactivated the viruses. The liquid alcohol isopropanol was not as effective. The cleaning methods tested did not interfere with the integrity of the 3D-printed material. Standard decontamination methods can be an effective way to allow for reuse of 3D-printed material when surgical mask supplies are limited, conclude the researchers. (Infection Control and Hospital Epidemiology, Aug. 12, 2020)
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Educational program increases Veterans’ confidence in suicide crisis hotline
 Photo for illustrative purposes only. ©iStock/BraunS (09/11/2020)
Educating Veterans about the Veterans Crisis Line improves their views of the suicide prevention resource, found a study by the VA Center for Clinical Management and Research. The Veterans Crisis Line is a toll-free, confidential hotline staffed by mental health professionals 24 hours a day. It offers support and help to Veterans thinking about suicide. Usage numbers suggest that the hotline is likely underutilized by high-risk Veterans. Researchers developed a program to educate Veterans about the hotline. It includes discussing participants’ perceived barriers and calling the hotline together with their therapist to provide firsthand experience with the service. Researchers provided the program to 301 Veterans. Preliminary results suggest that the program significantly increased Veterans’ comfort with and confidence in the hotline. The program could increase the likelihood of high-risk Veterans in crisis using the hotline for help. The Veterans Crisis Line can be reached by calling 1-800-273-8255 or texting #838255. (Cognitive and Behavioral Practice, June 25, 2020)
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Testing for virus presence after COVID-19 infection
Photo: ©iStock/homeworks255 (09/11/2020)
Researchers from the San Francisco VA and University of California San Francisco studied how long it took health care workers with COVID-19 to test negative after initial infection. They tested 12 employees with reverse transcriptase polymerase chain reaction (RT-PCR). RT-PCR measures the amount of a specific type of RNA (genetic material). It can be used to test for the presence of the virus that causes COVID-19. The time between initial COVID-19 infection and a negative test ranged from seven to 57 days. The average time was 34.5 days. Understanding this time range could help institutions make decisions on when it is safe for employees to return to work, say the researchers. (Journal of Occupational and Environmental Medicine, Aug. 13, 2020)
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Veterans Choice Program did not reduce appointment wait times
 Photo: ©iStock/SDI Productions (09/02/2020)
Giving Veterans the choice to receive specialty care from non-VA community providers did not lower appointment wait times, according to a VA Boston study. The Veterans Choice Program, passed in 2014, allowed Veterans to access care in the community if they live far from a VA facility. Researchers looked at data from 2013 to 2019 to study wait times in four specialties: cardiology, gastroenterology, orthopedics, and urology. The data included 6.9 million VA consultations and 869,000 community visits. The results showed that average wait times for appointments within VA were shorter than those in the community. Administrative delays did not account for the difference. Wait times in VA declined during the study period. However, the decline began before Veterans Choice was implemented. Geographical areas with the highest VA wait times also had the highest community wait times. The results suggest that increasing eligibility for community care may be insufficient to lower Veterans’ wait times, say the researchers. (JAMA Network Open, Aug. 3, 2020)
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HIV drug may increase kidney disease, fractures
 Photo: ©iStock/erdikocak (09/02/2020)
A common treatment for HIV was associated with higher odds of chronic kidney disease and osteoporotic fractures, found a study by Columbia VA researchers and colleagues. The team compared outcomes for nearly 5,000 VA patients with HIV. Some were on the medication tenofovir disoproxil fumarate, sold as Viread, while others were not. Those taking the drug had 48% higher odds of chronic kidney disease. They also had more than twice the risk of osteoporotic fracture. In osteoporosis, bones become more fragile due to bone deterioration or low bone mass. HIV regimens using this drug have been associated with impaired kidney function and loss of bone mineral density in the past. The results shed light on the extent of this association. (Current Medical Research and Opinion, Aug. 28, 2020)
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Patient portal use higher in those with more severe depression
(09/02/2020)
Patients with more severe depression were more likely to use an online patient portal, found a study of VA users. Researchers looked at whether more than 3,000 Veterans with depression used the patient portal My HealtheVet. My HealtheVet allows VA patients to refill prescriptions, manage appointments, message their doctors, and view their health records. Patients with more severe depression were more likely to have registered for the portal and downloaded medical records, compared to those with milder symptoms. Male patients had lower rates of registration than women. Older patients were also less likely to register than younger patients. African American Veterans had lower rates of portal use, compared with other races. The results highlight the need to address barriers to patient portal use, say the researchers. (Journal of Affective Disorder, Oct. 1, 2020)
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Lower weight, diabetes increase risk of death from pulmonary hypertension
 Photo: ©iStock/Rostislav_Sedlacek (08/26/2020)
Lower weight and diabetes are risk factors for death in patients with pulmonary hypertension, found an Atlanta VA study. Pulmonary hypertension refers to high blood pressure in the arteries of the lungs and heart. Researchers looked at data on more than 110,000 Veterans diagnosed with pulmonary hypertension. Diabetes increased patients’ risk of death by 28% to 33%. Surprisingly, higher body mass index was linked to lower mortality. Underweight and normal weight patients were at higher risk of death than those who were overweight or obese. The results underscore the need for more research on how metabolic factors affect pulmonary hypertension, say the researchers. (American Journal of Cardiology, Aug. 15, 2020)
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Neurostimulation could prevent wheelchair falls
 Photo: ©iStock/vadimguzhva (08/26/2020)
Researchers with the VA Advanced Platform Technology Center in Cleveland developed a neurostimulation system to help stop users from falling out of wheelchairs. The team developed an algorithm to detect sudden stops during wheelchair use. Sudden stops are often a cause of falls in paralyzed wheelchair users. The team then tested the algorithm with three volunteers with spinal cord injury who had an implanted neurostimulation system and three nondisabled volunteers. When the program detected a sudden stop, the system triggered stimulation to stiffen the muscles of the user’s trunk. This allowed the user to maintain a seated posture. The system was able to detect sudden stops with a 93% success rate. The participants consistently reported feeling safer when the system signaled their implants to stiffen their muscles, providing more stability. The results suggest that the neurostimulation system could improve wheelchair safety for paralyzed users, according to the researchers. (Journal of Spinal Cord Medicine, Aug. 14, 2020)
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Racial/ethnic disparities exist in diabetes control
 Photo: ©iStock/vitapix (08/26/2020)
Disparities in diabetes control based on race and ethnicity exist across the country, found a study of VA patients. Researchers looked at data on more than a million VA patients with diabetes. They found that the percentage of patients with uncontrolled diabetes varied by location, ranging from 19% to 29%. Hispanic patients and non-Hispanic Black patients were more likely to have uncontrolled diabetes, compared with non-Hispanic white patients. The disparity was consistent across most geographic areas. The results highlight areas that need to be addressed in diabetes care, say the researchers. (Diabetes Care, Aug. 7, 2020)
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Treatment for depression linked to apathy
 Photo: ©iStock/duncan1890 (08/19/2020)
Selective serotonin reuptake inhibitor (SSRI) use may be linked with higher rates of apathy syndrome, found a Central Arkansas Veterans Healthcare System study. SSRIs are a common treatment for depression. Apathy has been reported as a potential side effect of SSRIs, but this association has not been systematically assessed. Apathy refers to loss of motivation, energy, and curiosity. The researchers compared scores on an apathy evaluation scale between patients in mental health treatment taking an SSRI and those not on the medication. They found that 92% of patients on SSRIs had clinically significant apathy, compared to 61% not on SSRIs. Apathy was most common in patients with dementia. The results suggest that clinicians should assess apathy when evaluating patients on SSRIs, say the researchers. (Medicine, Aug. 14, 2020)
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Many patients receive potentially dangerous medication combinations from dentists
 Photo: ©iStock/licsiren (08/19/2020)
Many older patients receive opioids from dentists that can cause adverse reactions with their other medications, according to a study by VA researchers and colleagues. The researchers looked at data on more than 40,000 older dental patients. They found that about 10% were prescribed a potentially inappropriate medication combination. Patients given potentially dangerous combinations were more likely to seek health care for an acute condition after the dental visit. Higher opioid doses prescribed by a dentist increased this likelihood. More support is needed to make sure dentists are aware of possible dangerous medication combinations, say the researchers. (Pharmacotherapy, Aug. 7, 2020)
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Keeping women Veterans in PTSD therapy
 Photo: ©iStock/SDI Productions (08/19/2020)
Women Veterans with PTSD are more likely to stay in psychotherapy when treatment aligns with their preferences, found a study by VA Palo Alto researchers. The researchers surveyed more than 6,000 women Veterans with PTSD. They found that 79% used psychotherapy. Of those, 42% received enough psychotherapy (at least eight visits) to be clinically meaningful. According to the survey, receiving treatment aligned with gender- and group-related preferences was associated with higher therapy retention. Other mental health conditions, exposure to military sexual trauma, and being a minority were also linked to higher psychotherapy use. Being a parent was linked to lower retention. Enhancing efforts to use shared decision-making for mental health care could increase PTSD treatment retention for women Veterans, according to the researchers. (Women’s Health Issues, July 14, 2020)
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Potential new migraine medication developed
 Photo: ©iStock/NickyLloyd (08/12/2020)
An international team including an Iowa City VA researcher has developed a potential new nasal migraine medication. Previous research has established that the peptide (a string of amino acids) CGRP is involved in migraine development. The researchers prepared a compound that blocks the receptors in the brain that bind to CGRP. Using a mouse model, they found that the compound significantly reduced CGRP’s ability to activate the receptors, compared to other compounds. The compound can be formulated into a dry powder without degrading, meaning it potentially could be used nasally to treat migraines, according to the researchers. (Journal of Pharmacy and Pharmacology, June 25, 2020)
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Acid reflux may accelerate COPD progression
 Photo: ©iStock/stevanovicigor (08/12/2020)
Gastroesophageal reflux disease (GERD) may accelerate chronic obstructive pulmonary disease (COPD) progression, according to a study by Minneapolis VA researchers. GERD, a chronic form of acid reflux, commonly occurs with COPD. The researchers looked at nearly 6,000 patients with COPD over a five-year study. They found that those with GERD had faster decline in some measures of lung function, compared to those without GERD. Patients taking common medications for GERD had faster lung function decline than those not taking the medications. Although the lung function differences were relatively small, say the researchers, more study is warranted on how GERD affects COPD progression because of its high prevalence. (Respiratory Health, Aug. 3, 2020)
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Veterans with unstable housing at greater risk of death
 Photo: ©iStock/Rawf8 (08/12/2020)
Veterans who experience homelessness or a threat of unstable housing have a higher risk of death from external causes, found a large VA study. Researchers looked at data on nearly 6 million Veterans over a four-year period. About 3% had unstable housing or were at imminent risk of homelessness during the study period. Veterans with unstable housing had a 1.69 times risk of death than those with stable housing. Those at imminent risk of housing instability had a nearly 1.5 times higher risk of death as well. Unstably housed Veterans had over three times greater risk of dying by homicide and unintentional injury. They also had a 1.75 times higher risk of dying by suicide. Veterans at imminent risk for housing instability had over twice the risk of dying by homicide and nearly two times the risk of dying by injury or suicide. The results show that more proactive measures are needed to prevent death in Veterans with unstable housing, say the researchers. (Journal of Social Distress and Homelessness, Aug. 5, 2020)
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Copper-impregnated hospital surfaces may reduce microbial contamination
 Photo: ©iStock/monkeybusinessimages (08/07/2020)
Copper-impregnated surfaces may reduce microbial contamination in hospital rooms, according to a Central Texas VA study. High-touch hospital surfaces such as sinks, tray tables, and bedrails were replaced with a new material made of 20% copper oxide in a polymer-based resin. Researchers tested for bacterial colonies on high-touch surfaces in hospital rooms with and without copper-impregnated materials. Surfaces were tested three times a day for three days to see whether the copper stopped microbes from re-accumulating. In further evidence of copper’s germ-fighting ability, copper-impregnated surfaces had about 40% the bacterial count as standard laminate surfaces. Copper-impregnated solid surfaces could reduce microbial contamination in patient rooms, conclude the researchers. (Open Forum Infectious Diseases, June 19, 2020)
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Implanted electrical stimulation device for paralysis safe and effective
 Photo: ©iStock/jxfzsy (08/07/2020)
Researchers from VA’s Advanced Platform Technology Center showed that nerve health is maintained after implanting an electrode stimulation device in a patient with spinal cord injury (SCI). A patient with leg paralysis from an SCI was given an implanted nerve cuff electrode device to stimulate his leg muscles and allow him to stand. In the first such human trial, the researchers examined physiologic changes to the nerves during the surgery and a year later. After a year, the nerves remained healthy. The patient showed strengthened motor responses from the electrical stimulation. Some nerve irritation occurred during the surgery but did not continue afterwards. The results show that implanted electrodes to restore function after SCI can be safe and effective, according to the researchers. (Journal of NeuroEngineering and Rehabilitation, July 14, 2020)
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New assessment for pulmonary hypertension
 Photo: ©iStock/yodiyim (08/07/2020)
VA researchers and colleagues have established what they propose as a new standard for assessing pulmonary hypertension. Pulmonary hypertension is high blood pressure in the lung arteries. If the condition is left untreated, average survival is two to three years after diagnosis. However, a uniform, evidence-based definition for pulmonary hypertension has not existed till now. The researchers looked at data on more than 40,000 patients in the VA health care system over a nine-year period. They found that patients with pulmonary vascular resistance of 2.2 Wood units (a measure of blood flow from the pulmonary artery to the lungs) or higher were at elevated risk of death. This number is well below what is currently associated with the disease in clinical practice. The new standard will help identify patients at risk of death who previously had been considered normal, say the researchers. (Lancet Respiratory Medicine, July 27, 2020)
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Measuring brain connectivity after magnetic stimulation
 Photo: ©iStock/fotografixx (07/29/2020)
Researchers at the Providence VA Medical Center have developed a way to study how brain connectivity is affected by transcranial magnetic stimulation (TMS). In TMS, magnetic pulses are used to affect brain signals as a treatment for PTSD or depression. The researchers studied intermittent theta burst stimulation (iTBS), a form of TMS that uses low-frequency magnetic pulses. They used an EEG (electroencephalography) to image the brains of participants with PTSD and controls before and after iTBS. They also used machine learning programs to track changes. This system was able to successfully track which patients had received iTBS 75% of the time. Using the brain imaging, the researchers were able to show that iTBS increased connectivity between the midline central/occipital regions of the brain and decreased it between the frontal and central regions. The results could provide a window into exactly how TMS affects the brain, according to the researchers. This approach could help develop individualized treatment methods for PTSD, they say. (European Archives of Psychiatry and Clinical Neuroscience, July 27, 2020)
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Alcohol use changes linked to HIV medication non-adherence
 Photo: ©iStock/eclipse_images (07/29/2020)
Changes in alcohol use were linked to non-adherence to HIV medication, found a study of VA patients. Researchers looked at how well more than 21,000 patients with HIV kept up with their antiretroviral therapy. They found that increased alcohol use led to a decrease in medication adherence. The finding confirms previous research that found alcohol use increases non-adherence. However, the study also found that a decline in alcohol use was linked to decreased medication adherence. Patients whose alcohol use remained steady had the most stable HIV medication adherence. The results suggest that unstable alcohol use—which could reflect underlying alcohol use disorder—can lead to lower antiretroviral therapy adherence, say the researchers. (AIDS and Behavior, July 2, 2020)
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History of sexual assault linked to increased emergency department use
 Photo: ©iStock/MJFelt (07/29/2020)
Women Veterans who had experienced sexual assault were more likely to use emergency departments, in an Iowa City VA study. Researchers conducted phone interviews with nearly 1,000 women Veterans who used VA health care. Of those, 64% had visited a VA or non-VA emergency department in the previous five years. Women with a history of mental health diagnosis and those who had experienced sexual assault were almost twice as likely to have visited an emergency department, compared with those without a history of sexual assault. It is unclear whether the findings are due to greater health care needs, suboptimal access to treatment, or lack of health care coordination, say the researchers. (Women’s Health Issues, June 19, 2020)
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Efforts to change sexual orientation increases suicidal thoughts, actions
 Photo: ©iStock/kieferpix (07/22/2020)
Efforts to change one’s sexual orientation lead to much higher rates of suicidal behavior, found a study by a VA Pittsburgh researcher and colleagues. Researchers looked at survey data from more than 1,500 non-transgender lesbian, gay, and bisexual adults. About 7% had experienced sexual orientation change efforts. These efforts, sometimes referred to as conversion therapy, include various approaches, meant to condition a person against attraction to the same gender. More than 80% of change efforts in the study were administered by religious leader. Participants who experienced change efforts were nearly twice as likely to have suicidal thoughts at some point in their lives. Change efforts increased odds of planning to attempt suicide by 75%. Odds of a suicide attempt increased by 88% with change efforts. The results support minimizing exposure to sexual orientation change efforts and offering identity-confirming care to sexual minorities, say the researchers. (American Journal of Public Health, June 10, 2020)
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Medical record notes often inaccurate
 Photo: ©iStock/Zinkevych (07/22/2020)
Medical records often contain errors that may affect care and billing, found a Jesse Brown VA Medical Center study. Patients covertly recorded medical appointments to compare with medical record notes. In 105 appointments, the study found 636 documentation errors. The errors included 181 charted findings that did not take place and 455 findings that were not charted. Almost all (90%) of the notes contained at least one error. The results show that the medical records should not be assumed to reflect care delivered, according to the researchers. Efforts are needed to improve documentation requirements, they say. (Journal of the American Medical Informatics Association, May 1, 2020)
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Possible molecular link between nonalcoholic fatty liver disease and cancer
 Photo: ©iStock/jxfzsy (07/22/2020)
A team including Harry S. Truman Veterans’ Hospital researchers has identified the possible connection between liver cancer and nonalcoholic fatty liver disease (NAFLD). The rates of both NAFLD and hepatocellular carcinoma (liver cancer) have been increasing at an alarming rate. While NAFLD appears to be a risk factor for liver cancer, the mechanism behind this relationship is largely unknown. Researchers found that patients with liver cancer had reduced activity from the HADHA gene. They also found that mice with a deficiency of a protein analogous to HADHA were likely to develop NAFLD when young. Older mice with the protein deficiency developed hepatocellular carcinoma. The results suggest that impairment of this gene can lead to the progression from NAFLD to liver cancer, say the researchers. (International Journal of Cancer, March 16, 2020)
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Increased blood flow in the brain linked to blast exposure
 Photo: ©iStock/mr.suphachai praserdumrongchai (07/16/2020)
Blast exposure may cause increased blood perfusion in the brain, found a VA Boston study. Perfusion refers to blood flow from the blood vessels to organ tissue. Previous studies have shown that damage to blood vessels may be related to poorer brain function after traumatic brain injury. Researchers performed brain scans on 160 military personnel. They found that as the number of blast exposures increased, perfusion also increased in many areas of the brain. The findings suggest that perfusion could be an important biomarker of brain health after blast exposure, say the researchers. (Journal of Cerebral Blood Flow and Metabolism, June 24, 2020)
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New wheelchair design reduces bacterial contamination
 Photo by April Eilers (07/16/2020)
A new ergonomic wheelchair designed by Minneapolis VA researchers reduces bacterial hand contamination. In most manual wheelchairs, users push directly on the tires or on a push rim directly connected to the tires to move forward. This can allow contaminants from the ground to get on the hands. VA researchers designed a wheelchair with separate push rims connected to the wheels with a bicycle chain. The intent was to improve shoulder ergonomics. The researchers measured bacteria on the hands of volunteers using both the new design and standard wheelchairs in a hospital. Bacterial counts on the hands were 10-fold lower using the ergonomic wheelchair. The results show that this new design can keep wheelchair users’ hands cleaner in addition to improving shoulder ergonomics, according to the researchers. (Disability and Rehabilitation: Assistive Technology, July 3, 2020)
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Racial disparity in sleep apnea treatment adherence
 Photo: ©iStock/yelo34 (07/16/2020)
Black patients were less likely than white patients to use prescribed sleep apnea devices, in a VA Greater Los Angeles Healthcare System study. Researchers looked at data on more than 2,000 Veterans diagnosed with obstructive sleep apnea. All patients were prescribed a positive airway pressure (PAP) machine. Black patients were 36% less likely than white patients to adhere to PAP use 30 days after diagnosis. The results suggest health inequality related to sleep apnea, according to the researchers. More research is needed on the cause of this disparity, they say. (Journal of Clinical Sleep Medicine, April 8, 2020)
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Cirrhosis hospitalizations decline due to COVID-19
 Photo: ©Peter Horrox (07/16/2020)
Hospitalizations for cirrhosis have dropped sharply because of COVID-19, found a study by Corporal Michael J. Crescenz VA Medical Center researchers. They looked at data on more than 7,000 VA patients with cirrhosis in 2019 and 2020. Hospitalizations related to cirrhosis per week were significantly fewer in mid-2020, compared with before the pandemic. Shelter-in-place orders or rates of COVID-19 cases and deaths did not affect the weekly average. The researchers found significantly more end-stage liver disease admissions as the pandemic went on, indicating more severity. This finding suggests cirrhosis patient outcomes are being hurt by the pandemic, say the researchers. The study also showed that as the pandemic went on, academic hospital admissions, length of stay, and hospital transfers all decreased. These changes likely reflect efforts to preserve inpatient resources, and guidance urging people to stay home, say the researchers. How these patients are being managed as outpatients is unclear, but it is likely they do not currently have adequate health care access, say the researchers. They add that the findings parallel changes seen in other resource-intensive conditions, such as congestive heart failure. (Gastroenterology, May 6, 2020)
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Trauma exposure worsens work-related outcomes in women Veterans
 Photo: ©iStock/PeopleImages (07/09/2020)
Women Veterans who experienced trauma had worse work-related outcomes, in a study by VA Boston researchers. More than 350 women Veterans answered surveys about trauma experiences and work. Participants reported high rates of trauma exposure. Nearly half were not working. Military-related trauma, military sexual assault, and adult sexual assault were all linked to worse job functioning. Participants with PTSD and depression related to trauma were less likely to be employed than those without these conditions. The results highlight the need to screen for trauma exposure and address work-related needs of women Veterans, say the researchers. (International Journal of Environmental Research and Public Health, June 25, 2020)
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Telehealth adherence in patients with heart failure
 Photo: ©iStock/FG Trade (07/09/2020)
VA researchers identified factors that added to home telehealth adherence for patients with heart failure. The researchers studied data on Veterans with heart failure in the VA Home Telehealth Program at several time points after enrollment. Patients in the program are expected to participate in daily monitoring of their symptoms and health. The researchers found that participation increased the longer patients remained in the program. Being older and not having depression were also associated with greater program adherence. Black and other non-white patients had lower adherence, compared with white patients. The findings can help target patients who need more encouragement to use the program, according to the researchers. (Journal of Gerontological Nursing, July 1, 2020)
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Statin use linked to lower risk of death in older patients
 Photo: ©iStock/rogerashford (07/09/2020)
Taking statins was linked to lower risk of death in older patients, in a study by VA Boston Healthcare System researchers. Statins are medications for lowering cholesterol. Until recently, medical guidelines recommended halting statin therapy at age 75. The study of more than 300,000 Veterans using VA health care found that people 75 and older without heart disease who were prescribed a statin had a 25% lower risk of all-cause mortality and a 20% lower risk of heart-related death, compared with those not on the drug The results suggest that age is not a reason to not prescribe statins, say the researchers. (JAMA, July 7, 2020)
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Treadmill training helps correct walking problems in prosthetic users
 Photo: ©iStock/JohnnyGreig (07/06/2020)
Split-belt treadmill walking can help people with prosthetic legs correct gait asymmetry, found a VA Eastern Colorado study. People who use a prosthetic leg because of an amputation often have trouble taking the same sized step with both legs. Researchers had participants with gait asymmetry walk on a treadmill with separate belts for each leg. When each belt was moving at a different speed, participants were able to adjust their gait. They were able to maintain this adaptation after the belts were returned to the same speed, creating more symmetry in their gait in the short term. The results show that adapting step-length symmetry is possible without modifying the prosthetic limb, say the researchers. (Gait & Posture, May 31, 2020)
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Hormone biomarkers give insight into PTSD treatment response
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A VA study showed that biomarkers could be used to tell which patients are likely to respond well to PTSD treatment. Researchers studied function of the neuroendocrine system—which regulates hormones—in patients undergoing prolonged exposure therapy for PTSD. Prolonged exposure therapy involved confronting traumatic memories, and is one of the gold standards in PTSD treatment. The researchers found that higher cortisol levels during therapy was linked to more severe PTSD. They also found that baseline levels of three hormones, allopregnanolone, pregnanolone, and cortisol, could predict how well patients reacted to treatment. Higher levels of these hormones before prolonged exposure were linked to greater reductions in PTSD. The findings suggest that neuroendocrine biomarkers could be used to monitor PTSD treatment response, according to the researchers. (Psychoneuroendocrinology, June 8, 2020)
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Frailty linked to low bone mineral density in men
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Frailty is associated with lower bone mineral density in males, found a study by VA researchers and colleagues. Frailty refers to increased vulnerability and weakness due to age. It is often linked to poor health, including low bone mass and fracture risk. Researchers assessed frailty and bone mineral density in both male and female patients with rheumatoid arthritis. They found that women had a higher rate of frailty than men. However, frailty was associated with low bone mineral density only in male patients. The results suggest that sex may influence the relationship between bone mineral density and frailty. (Bone Reports, May 22, 2020)
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Opioid misuse common in older adults
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Opioid misuse is common in older adults, found a study by Providence VA researchers and colleagues. Most research on opioid misuse focuses on younger people. The researchers studied Medicare data on more than 7 million patients over the age of 65 to find opioid use disorder rates. In the year studied, 1% of patients had opioid use disorder documented on a hospital claim. Among this group, 17% had opioid use disorder as the primary diagnosis, and 83% had it as a secondary diagnosis. One in five opioid-related hospitalizations were for overdose. Given the high prevalence, more research is needed on the needs of older adults with opioid use disorder, say the researchers. (Journal of the American Medical Directors Association, April 2020)
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Exercise training reduces protein linked to muscle pain
 Photo: ©iStock/Mary Swift (06/23/2020)
A study by Iowa City VA researchers explored the biological process behind muscle pain caused by exercise. Pain can often limit how much exercise people can engage in. Researchers found that mice undergoing high-intensity interval training had less immediate pain after exercise, based on brain scans. These mice had lower levels of proteins called acid-sensing ion channels (ASICs) in neuron cells. The researchers also found that mice that genetically did not produce the ASIC protein did not experience immediate exercise-induced muscle pain. The results suggest that pain after exercise is linked to ASICs. They also suggest that high-intensity exercise training reduces ASIC production, thereby reducing muscle fatigue. Low-intensity exercise was not linked to less ASIC. The findings help explain why training increases exercise capacity, according to the researchers. (Journal of Applied Physiology, May 28, 2020)
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Less sleep time may predict higher chance of dementia
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Total sleep time may be a useful biomarker of dementia, according to a Michael E. DeBakey VA Medical Center study. Researchers studied data from nearly 70,000 sleep studies conducted over a 20-year period in VA. They found that lower total sleep time predicted greater odds of dementia diagnosis in patients. The study suggests that less than 360 minutes (six hours) per night is a good cut-off to predict greater odds of dementia. This cut-off could help clinicians assess a patient’s risk of dementia, say the researchers. (Sleep, May 27, 2020)
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Mental health treatment improves lung cancer outcomes
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Treatment for mental health disorders led to better outcomes in patients with lung cancer, found a study by San Francisco VA researchers and colleagues. Researchers looked at data on more than 55,000 Veterans diagnosed with non-small cell lung cancer. About 18,000 had pre-existing mental health disorders. Among this group, those in mental health treatment programs were less likely to be diagnosed at a later stage of their cancer and were more likely to receive stage-appropriate cancer treatment, compared to those not in mental health treatment. They were also less likely to die from lung cancer or any other cause during the study period. Participation in housing and employment support programs was also linked to similar cancer outcome improvements. The results show that investing in mental health and social needs can improve other aspects of health such as cancer, say the researchers. (JAMA Oncology, June 4, 2020)
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Prolonged exposure therapy reduces trauma-related guilt
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Prolonged exposure therapy for PTSD and substance use disorder reduces feelings of guilt, according to a VA study. PTSD is often accompanied by trauma-related guilt, which is usually related to negative views of one’s actions or inactions during a traumatic event. Researchers assessed guilt in more than 100 Veterans with both PTSD and SUD. Half received prolonged exposure therapy designed to treat both conditions together. The rest received therapy focusing on coping skills. The prolonged exposure group reported significantly lower guilt over time, compared to the other group. The results show that exposure-based treatment for both PTSD and SUD is more effective at reducing guilt than non-exposure treatment, conclude the researchers. (Journal of Traumatic Stress, June 10, 2020)
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Patient-aligned care teams help keep patients in VA care
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Patient-aligned care teams (PACTs) positively affect patient use of VA health care, found a study of data on 1.5 million patients. PACTs are a team-based approach to care that involves the patient in decision-making. The model focuses on easy access to care, care coordination, better communication, and self-management. Researchers used a quality measure of how well PACTs had been implemented at each VA primary care practice. Patient attrition was lower in practices with higher PACT implementation scores, compared to those with worse implementation. Out of the 1.5 million patients, 4.4% dropped out of care during a two-year follow-up. At the lowest-scoring PACT locations, this rate was 4.8%. At the highest-scoring locations, the attrition rate was 4.0%. The results show that better PACT implementation positively affects patients’ decisions to stay in VA care. (Healthcare, June 2020)
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Psychotic symptoms linked to solitary confinement in incarcerated individuals
 Photo: ©iStock/Rattankun Thongbun (06/03/2020)
Incarcerated people with psychotic symptoms are more likely to be placed in solitary confinement, found a Maryland VA researcher and colleague. People with psychiatric disorders are disproportionately represented in the U.S. prison system. The researchers surveyed 176 previously incarcerated people. Those with a schizophrenia diagnosis or psychotic symptoms were more than twice as likely to have been placed in solitary confinement, compared to those without psychiatric conditions. More research is needed to determine whether prisoners are placed in solitary confinement based solely on behaviors related to psychiatric illness, according to the researchers. Such action could violate the Americans with Disabilities Act, they say. (Psychiatry Research, May 21, 2020)
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Secure messaging from clinicians improves diabetes patient self-management
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Diabetes patients who received online messaging support from their clinicians better self-managed their care, in a study by researchers at the Edith Nourse Rogers Memorial Veterans Hospital in Massachusetts. Secure messaging over the internet allows doctors and patients to communicate in between visits. The study included more than 400 Veterans with diabetes who used VA’s My HealtheVet online patient portal. Patients who received at least one proactive message about their care were more likely to engage in better diabetes self-management, compared to patients who were not messaged. They also reported a higher sense of self-confidence. Proactive communication from clinical teams can foster a patient’s sense of autonomy and encourage better self-care, conclude the researchers. (Journal of General Internal Medicine, May 21, 2020)
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Blood thinner linked to higher fracture risk
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Atrial fibrillation patients taking the blood thinner warfarin had a higher risk of fractures than patients taking other blood-thinning drugs, in a study by Minneapolis VA researchers and colleagues. Atrial fibrillation is an irregular heart rate that causes poor blood flow. Patients with the condition are often prescribed blood thinners (anticoagulants) to prevent stroke and other problems. Some evidence has shown that the common anticoagulant warfarin may be linked to poor bone health. The researchers looked at data on nearly 170,000 patients with atrial fibrillation. They found that patients taking warfarin were more likely to have bone fractures, compared to those taking newer oral anticoagulants. This difference was especially high in patients with osteoporosis. The drug apixaban had the lowest fracture risk. The findings suggest that caution should be used when prescribing warfarin to patients with a high risk of fracture, say the researchers. (JAMA Internal Medicine, February 2020)
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Blood pressure variability linked to heart failure risk
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Blood pressure variability is associated with heart failure risk in people with diabetes, according to a study by VA researchers. Blood pressure variability is known to be a risk factor for cardiovascular disease. But its relationship with heart failure is less clear. The study found that variability in both systolic and diastolic blood pressure was connected to increased risk of heart failure. Variability increased the risk independently of elevated average blood pressure. The effects of blood pressure variability appear to be related to dips in pressure, not with elevations. The results will help optimize blood pressure treatment in patients with diabetes, according to the researchers. (Diabetes Care, April 23, 2020)
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Parkinson’s patients with sleep disorder have poorer mental function
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Disordered sleep was linked to poorer mental function in patients with Parkinson’s disease, found a VA San Diego study. Many patients with Parkinson’s disease are affected by rapid eye movement sleep behavior disorder. Researchers compared cognitive performance between Parkinson’s patients with and without the sleep disorder. Those with disordered sleep had poorer executive functioning and learning performance. They also had poorer neuropsychological functioning across all cognitive domains. Those with sleep disorder also showed poorer medication management skills. The results underscore the importance of assessing for sleep disorder in patients with Parkinson’s disease, say the researchers. (Journal of the International Neuropsychological Society, May 7, 2020)
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HIV linked to lung impairment
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HIV-positive men were at increased risk of lung impairment, found a study including a Minneapolis VA researcher. Previous studies have suggested that HIV may increase the risk of chronic lung diseases. The researchers compared several measures of lung function in men with and without HIV infection. Those with HIV had worse defusing capacity, the ability of oxygen to pass from the lungs into the blood. Worse defusing function has been linked to worse quality of life, worse exercise capacity, and higher risk of respiratory disease. HIV status did not affect forced expiratory volume, a measure of how much air can be exhaled during a forced breath. The impairment of the gas defusing capacity may be behind a higher risk of respiratory diseases in men with HIV, according to the researchers. (AIDS, April 13, 2020)
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PTSD suppresses the brain’s immune system
 Photo: iStock/JohnnyGreig (05/21/2020)
A study by VA Connecticut and Yale University researchers showed how PTSD is linked with neuroimmune suppression. The researchers compared brain scans of 23 patients with PTSD and 26 without. They found that patients with lower levels of a protein TSPO in the prefrontal-limbic part of the brain had worse PTSD symptom severity. This protein is a biomarker for activation of microglial cells, the brain’s first form of immune defense. Those with PTSD had significantly lower TSPO levels than those without PTSD. Those with lower TSPO concentration also had higher levels of C-reactive protein, a protein that is increased when inflammation is present in the body. The findings suggest that PTSD hinders the function of the immune system in the brain, according to the researchers. (Nature Communications, May 12, 2020)
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Veterans from lower ranks less likely to use mental health care
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Veterans from lower ranks were less likely to use VA mental health care, found a VA study. Researchers analyzed data on almost 10,000 post-9/11 Veterans. Of those, 34% had at least one mental health condition. Veterans from junior enlisted ranks were significantly less likely than those from higher ranks to use mental health programs and services. Use of these services was similar between male and female Veterans. The study also showed more similarities than differences in mental health care use between Veterans of different racial/ethnic backgrounds. Veterans exposed to combat, with a medical discharge, or with ongoing medical conditions were much more likely to use VA health care services. The results highlight the need to encourage Veterans from lower ranks to seek mental health services, say the researchers. (Psychiatric Services, May 12, 2020)
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Adding social workers to primary care teams reduces emergency room visits
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Including social workers on VA primary care teams reduced emergency room visits, found a study led by Providence VA Medical Center researchers. The study looked at the effects of adding social workers to rural primary care teams in VA facilities. Results showed that, among high-risk patients, introducing a social worker decreased emergency department visits by 3%. Acute hospital admissions declined by 4.4%. Among all Veterans receiving care at these facilities, social work encounters increased by 33% after social workers were integrated into primary care teams. The results show that including social workers in care is a key strategy to improve care coordination for high-risk patients, say the researchers. (Health Affairs, April 2020)
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PTSD may increase risk of autoimmune diseases
 Photo: iStock/KenTannenbaum (05/13/2020)
Service members with PTSD may have a higher risk of autoimmune diseases, found a VA-funded study of active duty personnel. As part of the Millennium Cohort Study, researchers looked at data on more than 120,000 service members. They found that those with a history of PTSD had a 58% higher chance of having an autoimmune disease. Autoimmune diseases included rheumatoid arthritis, lupus, inflammatory bowel diseases, and multiple sclerosis. The connection between PTSD and autoimmune diseases was independent of combat experience or prior trauma. The results add to growing evidence that PTSD is a risk factor for autoimmune disease, say the researchers. (BMC Psychiatry, Jan. 15, 2020)
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PTSD and alcohol use disorder feed into each other
 Photo: iStock/axelbueckert (05/13/2020)
PTSD and alcohol use disorder can feed into one another and make both worse, according to a VA San Diego study. PTSD and alcohol use disorder often occur together. Researchers studied symptoms in 107 Veterans being treated for PTSD and alcohol use disorder. They found that greater PTSD symptom severity was linked with greater future alcohol use. Likewise, greater alcohol use was linked with greater future PTSD symptom severity. The effect of PTSD on drinking was higher than the other way around. The findings support the idea of mutual maintenance between PTSD and alcohol use. Integrated treatments for both PTSD and alcohol use may be better than expecting patients to reduce alcohol use before beginning trauma-focused treatment, say the researchers. (Psychology of Addictive Behavior, Feb. 27, 2020)
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Migraine genetically linked to other health conditions
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Migraine headaches have a shared genetic basis with multiple other conditions, found a study including several VA researchers. The study used data from the UK Biobank, a large repository of genetic information. Researchers found that people with migraine had similar gene variants as those with many other conditions, including heart disease, high cholesterol, and autoimmune diseases. The results confirm past studies suggesting a connection between these conditions. The researchers also identified a genetic similarity between migraine and Type 2 diabetes risk, a connection that had not been identified previously. Notably, the data showed that blood pressure directly contributes to migraine, suggesting that high blood pressure may partially cause migraines in addition to sharing genetic risk factors. (International Journal of Epidemiology, April 19, 2020)
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Elective percutaneous coronary interventions in VA largely appropriate
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Most procedures for stable coronary artery disease in VA medical centers were appropriate, found a study by Rocky Mountain Regional VA and VA Puget Sound researchers. Percutaneous coronary interventions involve treating narrowing arteries with angioplasty or stenting. In patients with stable coronary artery disease, these interventions can relieve symptoms but do not increase survival. They also may cause complications such as bleeding, kidney injury, stroke, or death. Researchers looked at data on these procedures in 59 VA medical centers over a two-year period. They found that 30% of elective procedures were classified as appropriate, and 60% as “may be appropriate.” About 10% were deemed “rarely appropriate.” While most procedures were appropriate or possibly appropriate, efforts to improve patient selection are still needed, according to the researchers. (JAMA Network Open, April 1, 2020)
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Many Veterans prefer virtual health care visits
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Many patients using VA-issued tablets preferred video health care to in-person care, found a VA Palo Alto study. In 2016, VA began issuing tablets to Veterans to allow them to receive care virtually. The program aimed to improve care access for Veterans who face barriers such as transportation issues. Researchers surveyed about 600 tablet recipients about their experiences with telehealth. Satisfaction with the tablet program was high. Almost a third of patients said they preferred virtual care to in-person visits, while 36% said care was “about the same.” Patients were more likely to prefer video visits if they felt uncomfortable in a VA setting, had communicated well with their doctor, had substance use disorder, or lived in a place with better broadband coverage. Patients with more chronic conditions were less likely to prefer video visits. The results will help identify which patients would benefit from virtual care, say the researchers. (Journal of Medical Internet Research, April 15, 2020)
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Survey: Majority of women Veterans feel welcome at VA
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Researchers surveyed women Veterans at 26 VA locations. Out of more than 1,000 women, 85% said they felt welcome at VA. Not quite a third of the women surveyed answered an open-ended prompt about their experience with VA. Of those, 26% told of feeling uncomfortable or being harassed at a VA facility. Suggestions to improve VA included providing additional resources and clinical services for women Veterans, changing male Veterans’ behavior toward women, and making treatment of women and men the same. Although most women Veterans felt welcome in VA, opportunity exists to make them more comfortable and improve their experience in VA, say the researchers. (Women’s Health Issues, April 24, 2020)
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High-dose folic acid may improve diabetic foot ulcer healing
 Photo: iStock/MangTeng (04/29/2020)
High-dose folic acid may improve diabetic foot ulcer healing, found a Hunter Holmes McGuire VA Medical Center study. Researchers reviewed the charts of 29 Veteran patients with chronic, non-healing diabetic foot ulcers who were treated with high-dose folic acid. Of the study group, 90% saw complete wound closure after folic acid treatment. The researchers also compared the wound healing rate of four subjects with patients who had not received high-dose folic acid. Over a four-week period, the patients treated with folic acid showed significant improvements, compared with the non-treated group. The researchers recommend larger randomized clinical trials to establish how effective high-dose folic acid is at treating diabetic foot ulcers. (Wound Repair and Regeneration, March 5, 2020)
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Shifting risk factors for cirrhosis
 Photo: iStock/Rasi Bhadramani (04/29/2020)
The most common risk factors for cirrhosis may have shifted, found a study by Michael E. DeBakey VA Medical Center researchers. Previous studies identified active viral infection with hepatitis B or C as the most common risk factors for cirrhosis and liver cancer. In this study, researchers looked at more than 1,000 patients with cirrhosis. They found that the most common cirrhosis and liver cancer risk factors had shifted to resolved hepatitis C and fatty liver disease. They also found racial and ethnic differences in risk factors. Hispanic patients with cirrhosis were more likely to have obesity, diabetes, and non-alcoholic fatty liver disease, compared with other groups. These risk factors were less common in black patients. Black patients had higher rates of alcoholic liver disease and heavy alcohol drinking than other groups. The results suggest that minorities may still face a higher burden of chronic liver disease, say the researchers, and that multiple risk factors should be examined to monitor for cirrhosis. (Gastroenterology, March 29, 2020)
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High-dose flu vaccine may improve response in rheumatoid arthritis patients
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High-dose flu vaccines posed no risk and offered some benefits to patients with rheumatoid arthritis, found an Iowa City VA study. People with rheumatoid arthritis taking arthritis medications are at risk for severe cases of the flu and may not respond well to the flu vaccine. Rheumatoid arthritis patients were given either a standard or high dose of the flu vaccine. High-dose patients had a higher antibody response, although the difference was small. Neither group showed any safety concerns. Although larger studies are needed, high-dose flu vaccines may be a good option for rheumatoid arthritis patients considering their increased flu risk, say the researchers. (Vaccine, April 12, 2020)
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PTSD increases women Veterans’ risk of heart disease
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PTSD significantly increased the risk of ischemic heart disease in woman Veterans, found a VA Greater Los Angeles Health Care System study. In ischemic heart disease, the heart does not get enough blood because of plaque in the arteries. It is the most common type of heart disease. Researchers looked at data on women Veterans visiting VA medical centers between 2000 and 2017. Out of more than 800,000 women, about 18% had PTSD. These women had significantly higher risk for ischemic heart disease, compared with women without PTSD. This risk was independent of age, obesity, alcohol use, and other factors related to heart disease. Previous research has linked PTSD with ischemic heart disease in men, but studies in women have been limited. The researchers recommend early and routine screening for ischemic heart disease in women Veterans with PTSD. (Journal of the American College of Cardiology, March 2020)
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Opioid agonist therapy infrequent in VA
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Opioid agonist therapy is delivered infrequently in VA hospitals, found a study by VA Portland researchers and colleagues. Opioid agonists are medications, such as methadone and buprenorphine, that help prevent withdrawal from and cravings for opioids. Researchers looked at data on more than 12,000 patients with opioid use disorder who were hospitalized at a VA facility. Only 15% received opioid agonists, mostly to help with withdrawal symptoms. Just 2% began agonist treatment after discharge. Treatment delivery frequency varied across the health system. The results show that policy and educational steps should be taken to promote hospital-based opioid agonist therapy, say the researchers. (Journal of General Internal Medicine, April 14, 2020)
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Brain activity relation to emotions could predict PTSD treatment response
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How well patients respond to PTSD treatment may be linked to how regions of the brain activate and connect with other regions, according to a VA study. Researchers used MRI to study brain signals in Veterans with PTSD. Patients were treated with either prolonged exposure therapy, medication, or both and compared to a control group. Results showed that patients with greater activation in brain regions related to emotional processing and modulation before treatment responded better to all types of treatment. Greater connectivity between brain regions involved in attention and emotional processing also positively affected PTSD improvement. The findings suggest that measuring how these brain regions function could help predict PTSD treatment response, according to the researchers. (Depression and Anxiety, April 19, 2020)
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Editorial: Pandemic could increase suicide risk
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An editorial by VA Puget Sound psychologists warns that COVID-19 may lead to increased risk of suicide. The “secondary consequences” of social distancing could put people at higher risk. These consequences include economic stress, social isolation, decreased community support, and barriers to mental health treatment. Increased national anxiety linked to 24/7 news coverage and a surge in U.S. gun sales could also raise the suicide risk for some, say the researchers. The editorial suggests several steps to improve suicide prevention during the crisis. Staying socially connected by telephone and video can help ease feelings of isolation. Efforts to increased access to mental health care, especially using telemedicine, could give at-risk patients the support they need. The authors also offer an optimistic view of one possible result of the pandemic. Suicide rates have historically declined after national disasters and tragedies such as the 9-11 terrorist attacks. It is possible that pulling together when facing trying times can strengthen social connectedness and make people feel that life is more precious, say the researchers. (JAMA Psychiatry, April 10, 2020)
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Prolonged exposure therapy could improve sexual desire problems
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Prolonged exposure therapy for PTSD could improve sexual desire problems, found a study that included an Atlanta VA researcher. People with PTSD often report difficulties with sexual functioning, including sexual desire. The researchers assessed nearly 200 Veterans who were undergoing prolonged exposure therapy for PTSD. They found that patients who saw PTSD symptom improvement also experienced improved sexual desire. Those who did not respond to the treatment did not see sexual desire improvements. Patients with severe depression at the start of treatment showed less sexual desire improvement than patients without depression, regardless of PTSD improvement. The results suggest that prolonged exposure could help with PTSD-related sexual desire problems. (Psychiatry, April 1, 2020)
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Spiritual difficulties may increase suicidal thoughts
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Spiritual difficulties were linked with increased suicidal thoughts, in a Durham VA study. Researchers collected data on religion and spirituality for a thousand Iraq and Afghanistan Veterans. They found that perceived lack of control and problems with self-forgiveness increased the risk of suicidal thoughts. Perceived punishment by God and a lack of meaning or purpose significantly increased the risk of suicide attempts. The results suggest that screening for spiritual difficulties, possibly in collaboration with chaplains, could help detect Veteran suicide risk, according to the researchers. (Depression and Anxiety, April 5, 2020)
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Study: Patient outcomes similar with nurse practitioners or physicians
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VA patients with a nurse practitioner as their primary care provider (PCP) had similar health outcomes as those with a medical doctor as the PCP, found a VA Puget Sound study. Researchers looked at data on over 800,000 VA patients who had originally been assigned a doctor as their PCP. Each patient’s PCP had left VA practice, meaning the patient was then reassigned to either a doctor or nurse practitioner. The researchers found little difference between the two groups for clinical outcomes, costs, and receipt of diagnostic tests. Patients reassigned to a nurse practitioner were less likely to use primary or specialty care services, but still had similar health results. The study confirms that nurse practitioners offer a cost-effective way to address anticipated shortages of primary care physicians, say the researchers. (Health Services Research, April 2020)
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Mind-body skills intervention improves PTSD symptoms
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A mind-body skills group significantly improved patients’ PTSD symptoms, in a study at the Southeast Louisiana VA. A group of 108 Veterans with PTSD received 10 weeks of either the mind-body skills intervention along with standard treatment, or standard treatment only. The mind-body program included meditation, guided imagery, biofeedback, and group support. Standard treatment consisted of trauma-focused psychotherapy. Patients in the mind-body group had significantly better PTSD improvement compared with the control group. They saw improvements in hyperarousal and avoidance that lasted at least two months after treatment, as well as decreased anger and sleep disturbances. The findings show that the mind-body skills intervention offers promise for relieving PTSD symptoms, according to the researchers. (Psychological Trauma, March 5, 2020)
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Stem cells accelerate diabetic wound healing in mouse model
 Photo: ©iStock/dra_schwartz (04/10/2020)
Stem cells could accelerate diabetic wound healing, found a study that included a VA Connecticut researcher. The team embedded human smooth muscle cells derived from stem cells into a 3-D collagen scaffold. They then placed the scaffold into diabetic wounds on mice. The stem-cell implantation increased concentrations of biological products involved in wound healing. The stem cells accelerated the healing process, compared to control wounds not treated with the scaffold. While the technique has to be studied further, say the researchers, it is a promising potential therapy for diabetic wounds. (Regenerative Medicine, March 31, 2020)
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Patient hassles lead to delayed or skipped care
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Health care hassles greatly increase patients’ likelihood of delaying or forgoing care, according to a VA Greater Los Angeles study. Researchers surveyed women Veterans receiving care at 12 VA medical centers. They found that 39% reported four or more hassles to obtaining care, while 26% reported no hassles. Hassles included the work a patient must do to get questions answered between appointments or to navigate pharmacy, testing, and specialty services. Patients who said they faced four or more hassles were five times more likely to delay or skip care, compared to those with no hassles. Improving communication and coordination hassles is an important step in improving patients’ access to care, say the researchers. (Healthcare (Amsterdam, Netherlands), Feb. 29, 2020)
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Gender differences in newly separated Veterans’ health care use
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Researchers from the VA Central Western Massachusetts Healthcare System identified gender differences in newly separated Veterans’ health care use. They surveyed nearly 50,000 Veterans about 90 days after military separation and then again a year later. Results showed that sleep problems, anxiety, and depression were linked to greater health care use for both men and women. Women were twice as likely as men to use health care in general. However, men and women were equally likely to use VA care. For women Veterans, unstable housing at separation was linked with less health care use a year later, especially for those with mental health issues. The results suggest that VA needs to do more to reach out to women Veterans considering that they are more likely to use health care than men but not more likely to use VA care, say the researchers. One way to improve this disparity, they say, may be housing assistance programs targeting women. (American Journal of Managed Care, March 2020)
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Infectious disease specialist consultation improves long-term S. aureus outcomes
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Infectious disease consultation improves long-term outcomes for patients with Staphylococcus aureus bacteremia, found an Iowa City VA study. Bacteremia is when the bacterial infection makes it into the bloodstream. Studies have shown that 15% to 30% of patients with S. aureus bacteremia die within 30 days. They also have high rates of infection recurrence. Researchers studied data on more than 30,000 VA patients who had the infection. About half of the patients had a consultation with an infectious disease specialist during their initial hospital stay. These patients were 23% less likely than patients who had not had a consultation to die from any cause in the five years after hospitalization. They were also 32% less likely to have a bacteremia recurrence five years later. The results suggest that consulting infectious disease specialists improves patients’ long-term health, say the researchers. (JAMA Network Open, Feb. 5, 2020)
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Trust of electronic health records sharing differs by race
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Patient views on sharing electronic health records differed by race, in a study of nearly 20,000 Veterans. Currently, VA patients must opt in to allow their electronic health records to be shared with outside health care providers. But as VA transitions to a new electronic health record system, it is switching to an opt-out model to make data-sharing easier. In the opt-out model, patient data can be shared with other health care providers unless the patient withdraws consent. Researchers surveyed patients about their preferences for providing data-sharing consent. A majority of white patients, 57%, preferred an opt-out policy. But patients of other races were less likely to prefer the opt-out model: 48% of Asian/Pacific Islander patients, 45% of Hispanic patients, 40% of black patients, and 38% of Native American patients preferred this policy to opt-in. The results show that cultural sensitivity and trust must be considered during the electronic health records implementation, say the researchers. (Journal of the American Informatics Association, March 9, 2020)
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Hoarding treatment shows promise
 Photo: ©iStock/Dennis Torkhov (03/19/2020)
A community-based intervention for hoarding disorder shows promise, found a VA San Diego study. Hoarding refers to compulsively acquiring and saving large quantities of things, and it can often impede daily living. It is much more common in older adults than younger people. Researchers tested a treatment called Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). During an initial two-year program, 15 out of 37 participants completed the program. In those 15, there was significant improvement in hoarding severity and clutter volume. After the initial test, the program was expanded to reach more patients. The results suggest that CREST can be successfully used in the community with positive results, according to the researchers. (International Psychogeriatrics, March 5, 2020)
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Many providers unaware of COPD treatment guidelines
 Photo for illustrative purposes only. ©iStock/nimis69 (03/19/2020)
Many primary care providers in VA are unaware of recommendations for treating chronic obstructive pulmonary disease, found a VA study. Inhaled corticosteroids are recommended for COPD only when patients have frequent exacerbations. But more than 50% of Veterans with mild to moderate COPD are prescribed the medication. A survey of primary care providers at 13 VA facilities found that providers are largely unaware of current evidence and recommendations. For example, 46% of those surveyed did not know of the risk of pneumonia caused by corticosteroids. Providers said they were unable to keep up with current literature because of the broad scope of practice. Many were also reluctant to change prescriptions from other doctors. The results support the idea that lack of awareness on guidelines is an important part of corticosteroid overuse, say the researchers. (Journal of General Internal Medicine, January 2020)
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Augmentee status and mental health risk in women service members
 (U.S. Army Reserve photo by Master Sgt. Michel Sauret,for illustrative purposes only.) (03/12/2020)
Women in the Reserves or National Guard who deploy on temporary duty assignments without their home unit may be at higher risk of mental health problems than those who serve in their regular units. Researchers with the Central Arkansas and Iowa City VA health care systems surveyed women who deployed to Iraq or Afghanistan as individual-augmentees. Individual-augmentees are service members who deploy with a unit other than their regular one. Compared to women who deployed with their home unit, these women were more likely to experience depression, PTSD, and binge drinking. Women in the Reserves or National Guard also had higher mental health risk than active duty women. Prior studies have found similar results in men. The results suggest that particular focus should be given to the mental health risks of Reserve/Guard women who deploy as individual-augmentees, say the researchers. (Women’s Health Issues, Feb. 18, 2020)
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Antimicrobial hospital curtains fall short in curbing contamination
 Photo: ©iStock/pixelci (03/12/2020)
Antimicrobial curtains did not reduce hospital room contamination in an Iowa City VA and University of Iowa study. Researchers compared the microbe levels on hospital room privacy curtains in an intensive care unit. Some rooms had standard curtains, while others had curtains impregnated with halamine, an antimicrobial polymer. The rooms with antimicrobial curtains did not have lower contamination levels than the rooms with standard curtains. Antimicrobial curtains that were sprayed twice weekly with disinfectant had lower microbe levels than unsprayed antimicrobial curtains, but the effect lasted only 72 hours. Further study is needed to find out what, if any, effect antimicrobial curtains have on infection rates, according to the researchers. (American Journal of Infection Control, March 2, 2020)
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Exercise boosts quality of life after liver transplant
 Photo for illustrative purposes only. ©iStock/Yuri_Arcurs (03/12/2020)
Exercise can improve quality of life after a liver transplant, found a review including a VA Pittsburgh researcher. Physical fitness and frailty often improve slowly and may even deteriorate after a liver transplant. Based on a review of the available literature, researchers found that an exercise program can improve both fitness and quality of life for transplant patients. In addition to combating muscle loss and frailty, exercise can counteract post-transplant metabolic syndrome, which causes complications such as diabetes and hypertension. Exercise can improve post-transplant quality of life through both better health and increased social support. The researchers suggest that a tailored exercise program be part of post-transplant care. (Liver Transplant, March 3, 2020)
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Quality of life improvements for PTSD patients differ by gender
 Photos for illustrative purposes only. ©iStock/ Petko Ninov; DigitalSkillset (03/06/2020)
How PTSD treatment improves quality of life differs in men and women patients, found a study by VA San Diego researchers. While cognitive processing therapy has been shown to improve PTSD symptoms, the treatment’s effect on quality of life is less well-understood. The study looked at quality of life outcomes of men and women undergoing this treatment. Results showed that a reduction in depression symptoms was most likely to improve quality of life for women with PTSD. For men, reduced feelings of anger best predicted quality of life improvements. The findings suggest that the effectiveness of PTSD treatment should be evaluated within the context of gender, say the researchers. (Military Medicine, Feb. 20, 2020)
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Neurofeedback has potential as schizophrenia treatment
 Photo: ©iStock/leezsnow (03/06/2020)
Neurofeedback could improve cognitive function in patients with schizophrenia, but more study is needed, according to a VA San Diego and University of California at San Diego study. In neurofeedback, patients are able to directly see visual or auditory representations of their own brain activity. It may allow patients to modulate their neural activity. The review found some evidence that neurofeedback can lead to measurable changes in brain function in schizophrenic patients. However, most studies on the subject are either case studies or studies with small sample sizes. Large, randomized clinical trials are needed to validate the effectiveness of neurofeedback in schizophrenia, according to the researchers. (Schizophrenic Bulletin, March 2, 2020)
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Possible biomarkers of traumatic brain injury identified
 Photo: ©iStock/nicolas (03/06/2020)
VA researchers and colleagues identified six new biomarkers that could possibly be used to identify traumatic brain injury caused by blasts. In a mouse model of blast exposure, the researchers performed two different tests to identify proteins linked to TBI. They found 75 unique proteins present in the thalamus of blast-exposed mice but not in control mice. They also tested the blood and found antibodies linked to 46 proteins in blast-exposed mice. Six of the identified proteins showed up in both tests. These six proteins have potential as biomarkers to identify blast-related TBI through blood tests, say the researchers. (Heliyon, Feb. 17, 2020)
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Study finds unexpected relationship between social connectedness, depression
 Photo: ©iStock/kali9 (02/27/2020)
A VA Portland study found an unexpected relationship between social connectedness and depression. Researchers surveyed 262 Veterans with depression, asking about social connectedness. Social connectedness comprised social support, interpersonal conflict, loneliness, social norms, and number of confidants. Surprisingly, higher levels of loneliness were linked to decreased depression and suicidal thoughts one year later. A higher number of confidants was linked to increased depression. A more expected result was that higher levels of emotional support led to fewer mental health visits. More study is needed on the seemingly paradoxical relationship between depression and social connectedness, say the researchers. (Social Psychiatry and Psychiatric Epidemiology, Nov. 6, 2019)
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Online therapy with peer support useful for depression
 Photo for illustrative purposes only. ©iStock/JohnnyGreig (02/27/2020)
An online cognitive behavioral therapy program with peer specialists improved short-term depression symptoms and quality of life for Veterans with depression, in a VA Ann Arbor study. Patients with depression were given either usual care or a computerized cognitive behavioral therapy treatment supported by peer specialists in addition to usual care. Usual care consisted of medication and in-person psychotherapy. The online program included videos, interactive assignments, and symptom self-monitoring, in addition to peer support. Peer specialists were other Veterans who had lived with depression. The treatment group had greater improvement of depression symptoms than the treatment-as-usual group. However, the groups had similar symptoms six months later. The treatment group did have greater improvements in quality of life and mental health recovery three months after treatment. The results show that cognitive behavioral therapy with peer support may be an effective treatment for depression. (Psychological Services, Jan. 14, 2020)
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Telehealth PTSD treatment as effective as in-person care, but has higher drop-out
 Photo for illustrative purposes only. ©iStock/FatCamera (02/27/2020)
Telehealth is an effective way to deliver PTSD treatment, but it does lead to higher drop-out rates than in-person treatment, found a VA San Diego study. Veteran patients with PTSD received prolonged exposure treatment in one of three ways. Some received treatment at home via teleconferencing. Others received teleconference treatment at a VA facility. For a third group, a therapist traveled to the patient’s home for in-person treatment. All three groups saw similar levels of clinical effectiveness. The results confirm previous studies that found telehealth to be an effective way to treat PTSD. However, patients in the home or office telehealth groups were significantly more likely to drop out of treatment before completion. Patients in the at-home in-person group had lower drop-out rates than the other two groups. The results show that prolonged exposure can be effectively delivered via telehealth, say the research, but that treatment with an in-person element can help curb drop-out. (Depression and Anxiety, Dec. 24, 2019)
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Study: Increased opioid dose not linked to improved chronic pain
 Photo: ©/Charles Wollertz (02/21/2020)
Increasing opioid dosing does not seem to improve chronic pain, found a study by VA Portland researchers and colleagues. The study followed more then 500 patients with musculoskeletal pain for two years. All patients were on a steady opioid dose at the beginning of the study. About 20% of participants had their opioid dose increased at some point. But only 3% of those patients showed any meaningful improvement in their pain. The entire group showed small improvements in pain intensity and other symptoms, regardless of whether their dose had been increased or not. The results suggest that, while stable doses of long-term opioid therapy can improve pain, higher doses do not lead to better results, according to the researchers. (Pain, Jan 24, 2020)
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VA patient portal leads to fewer duplicate lab tests
 Photo by Jerry Daliege (02/21/2020)
Use of the MyHealtheVet digital portal decreased duplicate diabetes testing among patient who use more than one type of health care, found an Iowa City VA study. MyHealtheVet is a website that allows Veterans to access their VA health care information. It includes a feature called VA Blue Button, which allows users to download their VA medical records. The researchers studied how using the portal affected HbA1c testing in patients receiving health care from both VA and non-VA providers. Those who used Blue Button at least once were significantly less likely to have duplicate testing. Duplicate testing was defined as more than five HbA1c tests in a year. The results show that the VA patient portal can lead to better information-sharing and less wasteful testing. (Telemedicine Journal and e-Health, Feb. 11, 2020)
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Mixed results from peer specialists for formerly homeless Veterans
 Photo: ©iStock/kevinruss (02/21/2020)
Peer specialists offered some benefit to formerly homeless Veterans for housing stability, but not behavioral health problems, found a VA study. Researchers looked at outcomes for Veterans in the U.S. Housing and Urban Development-VA Supported Housing (HUD-VASH) program. Participants were assigned peer specialist services or treatment as usual. Peer specialists were other Veterans who had shown significant recovery from mental health issues. They used a structured curriculum to meet with their assigned Veteran participants for up to 40 weeks. Peer meetings focused on mental health, substance use recovery, and community integration. Veterans working with the top-performing peer specialists showed greater housing stability between 400 and 800 days after the program began. However, the overall average time spent in housing for the peer group was not statistically higher than those receiving treatment as usual. Behavioral health problems, such as mental health symptoms and addiction severity, were not affected by the peer specialist program. Further study with more sensitive measures is needed on how beneficial the peer program is to these Veterans, say the researchers. (Medical Care, Jan. 7, 2020)
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Insight on how subtle cognitive difficulties predict decline
 Photo for illustrative purposes only. ©iStock/fizkes (02/13/2020)
Patients with subtle cognitive difficulties showed signs of brain changes linked to cognitive decline and Alzheimer’s disease, in a study by VA San Diego researchers. They ran PET and MRI brain scans on more than 700 patients. The scans showed that patients with subtle cognitive difficulties had faster amyloid accumulation than cognitively normal patients. Amyloid is a toxic protein. Its build-up in the central nervous system has been linked to Alzheimer’s. Patients with subtle cognitive difficulties also showed thinning of a section of the brain called the entorhinal cortex. Patients with mild cognitive impairment—a more advanced stage of cognitive decline—had faster atrophy in the entorhinal cortex and hippocampus. The findings suggest that objective psychological measures of subtle cognitive difficulties could help identify brain changes before impairment becomes noticeable, say the researchers. (Neurology, Jan. 28, 2020)
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Sense of purpose may protect against cognitive decline
 Photo: ©iStock/FG Trade (02/13/2020)
Having a sense of purpose in life may protect against cognitive decline, found an Atlanta VA and Emory University study. In a survey of more than 5,000 middle-aged participants, a greater sense of purpose was linked with less perceived cognitive decline. Statistical analysis showed that purpose in life is a strong predictor of cognitive decline when considered along with known protective and risk factors for cognition. Protective factors include education, exercise, and activity levels. Risk factors for cognitive decline include depression, health problems, and smoking. Interventions to enhance purpose in life as early as middle age may be useful, according to the researchers. (Journal of Affective Disorders, Feb. 15, 2020)
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Benefits of testosterone therapy limited; more research needed
 Photo for illustrative purposes only. ©iStock/FlairImages (02/13/2020)
Testosterone treatment in older men may provide small improvements in sexual functioning and quality of life, but little benefit for other common symptoms of aging, according to a Minneapolis VA review. In men with low testosterone, sexual functioning and quality of life improved after testosterone therapy. However, the improvements were low to moderate. The review found little to no effect of testosterone therapy on physical functioning, depression, energy and vitality, or cognition. Not enough evidence exists to draw conclusions on how testosterone treatment affects cardiovascular events or prostate cancer. More research in needed on the possible harms of the treatment. (Annals of Internal Medicine, Jan. 7, 2020)
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Pet ownership linked to lower risk of high blood pressure
 Photo for illustrative purposes only. ©iStock/adamkaz (02/05/2020)
Pet ownership was associated with lower rates of high blood pressure, in a study by Michael E. DeBakey VA Medical Center researchers and associates. Having a pet has previously been linked to lower cardiovascular risk, mostly due to increased physical activity and social support. Researchers looked at data on more than 10,000 participants to examine the link between pets and health. Pet owners in the study had lower hypertension rates than non-owners. Owning a pet did not seem to affect rates of heart failure, coronary artery disease, diabetes, or stroke. Further studies are needed to draw conclusions on the protective effect of pet ownership, say the researchers. (American Journal of Cardiology, Jan. 29, 2020)
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Study points to shortcomings in VA outcomes for joint replacement surgery
 Photo for illustrative purposes only. ©iStock/sturti (02/05/2020)
VA patients have poorer short-term outcomes than non-VA patients in the general population after hip or knee replacement, found a large retrospective study. Researchers, including one from the VA Central Western Massachusetts Health System, looked at data on more than 10,000 VA and nearly 60,000 non-VA patients who had joint replacement surgery. They found that VA patients were more likely to have hospital readmission, prolonged length of stay, and complications. The finding held even after the researchers adjusted for higher rates of illness in the VA population. More research is needed to understand and address the discrepancy between VA and non-VA outcomes, say the researchers. (Journal of the American Academy of Orthopedic Surgeons, Jan. 30, 2020)
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Toilet flushing may increase bacteria contamination in hospitals
 Photo: ©iStock/contrastaddict (02/05/2020)
Toilet flushing may contribute to the spread of harmful bacteria in hospitals, according to a study including Iowa City VA researchers. Flushing a toilet can send tiny particles of fecal matter into the air. Researchers took air samples in the rooms of patients with C. difficile infections. They found that concentrations C. difficile and other harmful bacteria were significantly higher after the toilet was flushed. The researchers suggest evaluating prevention measures such as adding toilet lids where they are not currently in place. (Infection Control and Hospital Epidemiology, Jan. 31, 2020)
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Sexual dysfunction linked to suicidal thoughts in Veterans with PTSD
 Photo for illustrative purposes only. ©iStock/milanvirijevic (01/30/2020)
Sexual dysfunction was linked to suicidal thoughts in Veterans with PTSD, in a San Diego VA study. Sexual dysfunction is common in people with PTSD. Researchers assessed 138 Veterans and their partners before they began couples-based PTSD treatment. The assessment showed that decreased sexual pleasure and decreased frequency of sexual intercourse were linked with more recent suicidal thoughts in male Veterans. For female Veterans, increased sexual frequency was marginally linked with increased suicidal thoughts. The results stress the importance of assessing sexual function as a component of mental health for Veterans with PTSD, say the researchers. (Archives of Sexual Behavior, Jan. 8, 2020)
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Training program leads to less unnecessary antibiotic prescribing
 Photo: ©iStock/izusek (01/30/2020)
A training program led to less antibiotic prescribing in the VA Pittsburgh Healthcare System. Overprescribing of antibiotics has led to the rise of antimicrobial-resistant bacteria. While many antibiotic stewardship programs have focused on hospitals, most antibiotics are prescribed in outpatient settings. Researchers studied seven VA primary care clinics that underwent antibiotic interventions. The programs involved clinician education, peer comparisons, and computer decision support. The overall number of antibiotic prescriptions decreased significantly after the program. The rate of unnecessary antibiotic prescribing decreased by 36% six months after training. This rate was 25% lower than baseline a year later. The results show that interventions such as this can reduce potentially harmful antibiotic prescribing practices. (Clinical Infectious Diseases, Dec. 9, 2019)
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Understanding chemotherapy-resistant lung cancer
 Photo: ©iStock/Design Cells (01/30/2020)
Researchers with the Miami VA Healthcare System uncovered a mechanism by which some lung cancer cells resist the chemotherapy drug cisplatin. Researchers used cells in the lab, human blood samples, and mouse models to examine cancer cells at a molecular level. They found that cisplatin-resistant cells had higher activity of an enzyme called IDO1 and higher levels of reactive oxygen species, a chemical byproduct found in many cancers. Reactive oxygen species can cause cell breakdown. But IDO1 initiates the metabolization of kynurenine (an amino acid), which helps cancer cells cope with excessive reactive oxygen species. The researchers were able to use drugs to suppress IDO1 activity. This increased reactive oxygen species levels and in turn inhibited cancer cell growth. The results suggest that IDO1 inhibitors may be a suitable treatment in patients whose lung cancer resists cisplatin, say the researchers. (Molecular Cancer Research, January 2020)
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More study needed on best C. difficile prevention practices
 Photo by Mitch Mirkin (01/23/2020)
A study of C. difficile in VA hospitals did not find a clear link between prevention practices and infection rates. Researchers surveyed 123 VA facilities. Since implementing prevention practices in 2012, 49% of facilities reported decreased C. difficile rates. Eighteen percent reported an increase, and 33% reported no change. The variation did not appear to be linked to self-reported cleaning practices, length of contact precautions, use of private rooms, or certification of infection preventionists. More study is needed on what practices prevent C. difficile spread, say the researchers. (Infection Control and Hospital Epidemiology, January 2020)
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Primary care visits linked to better statin adherence
 Photo for illustrative purposes only. ©iStock/monkeybusinessimages (01/23/2020)
More frequent primary care visits were linked to higher statin use and adherence, in a Houston VA study. Researchers looked at more than a million patients with atherosclerotic cardiovascular disease at 130 VA facilities. About 80% of patients were on statins to control cholesterol. Patients who frequently saw their primary care providers had more common statin use, higher-intensity statin use, and better statin adherence. Better adherence may be related to a greater rapport between provider and patients, suggest the researchers. (American Heart Journal, Dec. 7, 2019)
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Genetics linked to cognitive impairment
 Photo: ©iStock/Nicolas (01/23/2020)
Schizophrenic and bipolar patients with cognitive impairment had genetic variations that have also been linked to cognitive problems in the general population, in a study using Million Veteran Program data. Researchers analyzed the genomes of more than 5,000 patients with schizophrenia or bipolar disorder. No single gene variant showed a significant link to cognitive impairment. However, the researchers did find minor correlations between overall cognitive function and a number of variants shown in the past to be involved in cognitive performance, intelligence, and schizophrenia risk. Greater genetic risk of schizophrenia was linked to poorer cognitive performance. The results add to the understanding of how genetics affect cognition, say the researchers. (American Journal of Medical Genetics, Dec. 24, 2019)
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Mindfulness program could curb suicide among Veterans
 Photo for illustrative purposes only. ©iStock/electravk (01/16/2020)
Mindfulness-based cognitive therapy shows promise for reducing suicide among Veterans, found a VA New Jersey study. Researchers evaluated 140 Veterans at high risk for suicide. Veterans received either Mindfulness-Based Cognitive Therapy adapted for Suicide (MBCT-S) or VA treatment as usual. MBCT-S combines mindfulness therapy with suicide safety planning. Patients receiving MBCT-S along with usual treatment made fewer suicide attempts within 100 days of treatment. Five of the MBCT-S group attempted suicide, compared with 13 from the control group. MBCT-S patients also showed greater distress tolerance over time. MBCT-S was especially effective in participants who also received VA residential care. No participants receiving both MBCT-S and residential care attempted suicide during the study period. Patients receiving both also had significantly greater improvement on depression, hopelessness, distress tolerance, and suicide-related coping, compared with controls. MBCT-S could be a useful intervention for patients at-risk for suicide, according to the researchers. It can be integrated within existing VA programs, they say. (International Academy of Suicide Research, Oct. 29, 2019)
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Study probes link between exercise-induced breathing problems and military exposures
 Photo by Senior Airman Julianne Showalter, USAF (01/16/2020)
Findings on the link between military exposures and exercise-induced breathing problems were mixed in a VA New Jersey study. Exposure to fine particulate matter in the air can lead to breathing problems. Service members in Iraq and Afghanistan were regularly exposed to dust and sand, smoke from burn pits, vehicle exhaust, and regional air pollution. Researchers tested the breathing of 24 Veterans without asthma who were not currently seeking treatment for breathing problems. After an exercise challenge, 17% tested positive for bronchial constriction. This rate is similar to the prevalence in the general population. However, a further 42% of the participants had a probable constriction response that did not meet the full diagnostic criteria. Many of the participants reported persistent cough, wheeze, and shortness of breath at the time of testing. The researchers urge continued monitoring of respiratory symptoms in this population. (Military Medicine, Dec. 31, 2019)
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Study: End-of-life care for Vets with hearing and vision loss is up to par
 Photo for illustrative purposes only. ©iStock/seb_ra (01/16/2020)
Older Veterans with hearing and vision loss receive similar end-of-life care in VA as those without sensory loss, found a Corporal Michael J. Crescenz VA Medical Center study. Researchers looked at data on more than 42,000 Veterans at 145 VA medical centers. They found that end-of-life care quality indicators were similar between patients with and without sensory loss. Patients with hearing loss had slightly lower pain management scores and less satisfaction with communication. Patients with vision loss were less likely to have received a palliative care consult or contact with a chaplain. Patients with vision loss were also less likely to report excellent overall care and satisfaction with emotional support, but most care outcomes were similar to those of patients without vision loss. (Journal of the American Geriatrics Society, Dec. 30, 2019)
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Complicated grief may make PTSD treatment less effective
 Photo for illustrative purposes only. ©iStock/fizkes (01/16/2020)
Patients with complicated grief have poorer responses to PTSD treatment, found a VA study. Complicated grief refers to feelings of loss after the death of someone close that are debilitating and do not improve with time. It often occurs with PTSD in military personnel. Researchers analyzed outcomes from Veterans being treated with prolonged exposure therapy and medication for combat-related PTSD. They found that those who also had complicated grief had lower response to PTSD treatment than those with PTSD only. Those with complicated grief had greater PTSD severity and trauma-related guilt both before and after treatment. They were also more likely to have suicidal thoughts during the study than patients with PTSD only. The results suggest that screening for complicated grief as well as PTSD may be needed, say the researchers. (Depression and Anxiety, January 2020)
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Gene mutation linked to ALS
 Photo: ©iStock/koto_feja (12/19/2019)
A large genetic study including a VA researcher identified a gene linked to ALS. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects nerve cells. People with ALS progressively lose control of the body’s muscles, which eventually leads to death. Researchers studies the genomes of more than 20,000 patients with ALS and almost 60,000 without to look for genetic causes of the disease. They found that a specific mutation of the gene KIF5A is linked with developing ALS. Mutations to this gene previously have been linked to two other neurodegenerative diseases: hereditary spastic paraplegia and Charcot-Marie-Tooth type 2. However, ALS appears to be linked to a different mutation to gene KIF5A than the other two diseases. The discovery will add to scientists’ understanding of the causes and progression of ALS. (Neuron, March 21, 2018; available in PubMed Central in March 2019)
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Post-exertion malaise symptom inconsistent in Vets with Gulf War illness
 Photo for illustrative purposes only. ©iStock/ClarkandCompany (12/19/2019)
Although many Veterans with Gulf War illness experience post-exertional malaise, the causes and patterns of the condition remain unknown, found a VA study. Post-exertional malaise refers to increased pain, fatigue, and cognitive problems after physical or mental exertion. It is a common symptom of GWI. Researchers compared symptoms of 39 Gulf War Veterans with and 28 without GWI after exercise. Some participants with GWI perceived exercise as more painful and fatiguing, compared with a control group. However, not all participants with GWI reported post-exertional malaise. The results show that post-exertional malaise is not always a symptom of GWI, say the researchers, and more research is needed on the condition. (International Journal of Psychophysiology, Nov. 28, 2019)
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Opioids negatively affect pain relief from antidepressant
 Photo: ©iStock/chesiireCat (12/19/2019)
Patients prescribed both opioids and the antidepressant venlafaxine for low back pain had reduced pain relief, in a study including a VA Pittsburgh researcher. Venlafaxine (sold as Effexor) is an antidepressant commonly given to people with chronic pain along with opioids. Because chronic pain and depression are related in a complex way, antidepressant treatment can also reduce pain. The researchers looked at pain relief in older adults with chronic low back pain and depression. They found that patients taking both opioids and venlafaxine had less pain reduction in response to venlafaxine, compared with those not taking opioids. Depression symptoms were not altered by the drug interaction. The study suggests that clinicians may want to reconsider prescribing the two medication together. (Pain Medicine, Oct. 21, 2019)
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Drug use treatment up for urban and rural Vets in recent years
 Photo for illustrative purposes only. ©iStock/Viktoriia Hnatiuk (12/12/2019)
Substance use disorder treatment has increased in recent years for both urban and rural Veterans, found an Iowa City VA study. Researchers looked at admissions data from non-VA treatment centers between 2011 and 2016. The study included data on more than 90,000 Veterans. Both urban and rural Veterans had similar rates of treatment for SUD. Rural Veterans had slightly higher rates of admission for injectable and opiate drug use. Admissions for opioid, heroin, and injectable drug use increased between 2011 and 2016 for both groups. The study shows that monitoring Veteran care outside VA is crucial to understanding and combating drug use in Veterans, say the researchers. (Journal of Rural Health, Dec. 6, 2019)
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Sense of purpose appears to ward off cognitive decline
 Photo for illustrative purposes only. ©iStock/Image Source (12/12/2019)
Greater purpose in life is linked with lower cognitive decline in middle age, according to an Atlanta VA and Emory University study. Researchers used a machine learning algorithm to assess how purpose in live affects perceived cognitive function. Purpose in life refers to a tendency to derive meanings and purpose from life events. Average participant age was 63. Researchers tested cognitive function with a questionnaire that assesses perceived functional problems that may not yet rise to clinical impairment. Those with greater purpose in life had less perceived cognitive decline. This result held true even after considering other factors that affect cognitive decline, such as activity level and depression. The results suggest that purpose in life is a robust protective factor of cognitive decline in middle age. (Journal of Affective Disorders, February 2020)
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Low-vision intervention helps, but challenges remain
 Photo by Jerry Daliege (12/12/2019)
Low-vision services improved visual ability for patients with macular disease, but patients still lost reading ability, in a study of 255 VA patients. Researchers compared outcomes after patients were given either low-vision assistive devices alone or devices along with therapist rehabilitation. Both groups showed significant improvement in visual ability one year later. However, both groups lost visual reading ability during the study period. This loss in reading ability reduced the benefits gained from the low-vision services provided, according to the researchers. They recommend yearly low-vision follow-ups to assess disease progression and modify treatment. (Optometry and Vision Science, October 2019)
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CPAP compliance lowers diabetic retinopathy risk
 Photo for illustrative purposes only. ©iStock/Darunechka (12/04/2019)
Using prescribed CPAP machines reduces diabetic retinopathy, found a VA Maine Health Care System study. Obstructive sleep apnea has been linked to diabetic retinopathy. Diabetes can cause damage to the blood vessels in the eyes, a condition called retinopathy. It can eventually lead to blindness. Researchers looked at the rates of retinopathy in patients with diabetes who had been prescribed continuous positive airway pressure (CPAP) therapy to treat sleep apnea. Those who used their CPAP machines regularly were significantly less likely to have retinopathy than those who were not compliant with their treatment. The results show that improving CPAP compliance could lower risk of diabetic retinopathy, say the researchers. (Optometry and Vision Science, November 2019)
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Present-centered therapy eases PTSD, but not as much as cognitive behavioral therapy
 Photo: ©iStock/Pornpak Khunatorn (12/04/2019)
Present-centered therapy can reduce PTSD symptoms, but is less effective than cognitive behavioral therapy, according to a review by VA National Center for PTSD researchers and colleagues. Present-centered therapy (PCT) focuses on the patient’s current life and how to cope with PTSD symptoms. It does not directly confront trauma memories as cognitive behavioral therapy (CBT) does. The review found that PCT reduces PTSD severity, compared with no treatment. However, studies show that CBT is more effective than PCT. Because PCT has a lower treatment dropout rate than CBT, it could be a useful PTSD treatment when patients are resistant to CBT, say the researchers. (Cochrane Database of Systematic Reviews, Nov. 18, 2019)
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Amino acid may protect against kidney damage
 Photo: ©iStock/cdascher (12/04/2019)
Researchers with the Washington DC VA Medical Center have identified an amino acid that may help reverse kidney damage. They tested the effects of the amino acid L-ornithine on proximal tubular cells, the most common type of cells in the kidney. They found that the amino acid activated a protein called calcium-sensing receptor, which protected the kidney cells from harmful chemicals called reactive oxygen species. When ornithine activates the calcium-sensing receptors, they stop reactive oxygen species from being produced. The results show that ornithine could be useful in reversing kidney diseases involving proximal tubular cell damage, according to the researchers. (Cellular Signalling, Nov. 23, 2019)
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Excess medication supply potentially a problem for many Vets
 Photo for illustrative purposes only. ©iStock/Burlingham (11/27/2019)
Excess medication supply was high among VA health care users, in a study by the VA Center for Healthcare Organization and Implementation Research. Excess medication was defined as having more doses of a prescription than needed to treat a condition. It can occur for a number of reasons, including being prescribed two different formulations of the same drug. Experts consider this a problem because it can increase the risk of overdose and other harms. In a study of almost 5 million Veterans with prescriptions through VA, 64% had at least one duplicated medication. Excess medication was more likely for Veterans with both VA and non-VA health care and with more medical conditions. Patients who had a copay for medication were less likely to have excess medication. The results show that further efforts are needed to make sure patients receive the right amount of medication, say the researchers. (Medical Care, November 2019)
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Insulin overtreatment common in VA nursing homes
 Photo: ©iStock/Maya23K (11/27/2019)
Diabetes insulin overtreatment is common in VA nursing homes, found a San Francisco VA Medical Center study. Researchers looked at data on more than 5,000 patients with Type 2 diabetes in VA nursing homes. They found that 14% patients showed signs of overtreatment, based on their HbA1c levels. Only 1.4% showed likely undertreatment. The results suggest that insulin regimens that were appropriate when patients were healthier and living in the community may be too intensive when they get older and transition into nursing homes, say the researchers. Nursing home admission may be a good time to reevaluate diabetes treatment, they conclude. (Journal of Internal Medicine, Nov. 8, 2019)
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Study suggests a more accurate approach to diabetes diagnosis
 Photo: ©iStock/ftwitty (11/27/2019)
Using HbA1c levels alone can lead to both over- and under-diagnosis of diabetes, according to Atlanta VA researchers and colleagues. HbA1c blood tests determine glucose levels over the previous two to three months. It is the most common test to diagnose diabetes and assess how well patients are controlling their blood sugar. However, for some people the HbA1c test is inaccurate. Some may have higher or lower HbA1c readings than would be expected based on actual glucose levels. The researchers gave participants with diabetes oral glucose tolerance tests, which compare fasting glucose levels with levels after the person is given oral glucose. They found that using HbA1c alone led to under-diagnosis of diabetes for people who had lower HbA1c mismatches, and over-diagnoses for people with mismatches in the other direction. The results suggest oral glucose tests should be used along with HbA1c to ensure a proper diagnosis, say the researchers. ( Diabetic Medicine, Nov. 13, 2019)
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Swimming may help protect against knee arthritis
 Photo: ©iStock/microgen (11/18/2019)
A study including a Houston VA researcher found that swimming may help protect against knee arthritis. Researchers surveyed more than 2,000 people about their exercise history and knee health. Participants with a history of swimming for exercise had a modestly lower rate of knee osteoarthritis, compared to those who did not swim. Participants who reported swimming at a younger age (between 12 and 34) were less likely to have osteoarthritis than those who swam when older. Swimmers had slightly lower rates of knee pain than non-swimmers, although the results were not statistically significant. The researchers note the possibility that participants with less arthritis led healthier, more active lifestyles in general and the effects seen were not just from swimming. However, a previous study by the same group showed that people who ran for exercise had lower rates of symptomatic arthritis but not radiographic arthritis, suggesting the benefits in the new study were specific to swimming. They also found that people who played football had higher rates of knee arthritis. Swimming is often recommended for patients with osteoarthritis because it is a non-weight bearing exercise that is easy on the joints. But more study is needed to confirm the benefits of swimming on knee health, say the researchers. (Physical Medicine and Rehabilitation, Oct. 19, 2019)
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Studies lacking on women with TBI
 Photo for illustrative purposes only. ©iStock/SDI Productions (11/18/2019)
Female Veterans and service members are not well-represented in traumatic brain injury research, according to a Washington DC VA Medical Center review. Using several databases, the researchers found 29 studies on TBI in Veterans that included women. They found that few studies focused on gender, and most that did had only a small number of female participants. Most guidelines on TBI care are not differentiated based on gender, most likely due to lack of research. Limited evidence suggests that female Veterans with mild TBI report more neurobehavioral symptoms and use more outpatient health services than male Veterans. Studies also show that female Veterans with TBI are more often diagnosed with depression. More research is needed on how TBI specifically affects female Veterans and service members, say the researchers. (Physical Medicine and Rehabilitation, Aug. 10, 2019)
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E-cigarettes may make it harder for the body to fight off infection
 Photo: ©iStock/danchooalex (11/18/2019)
Electronic cigarettes weaken the body’s ability to fight infection by affecting immune cells called neutrophils, found a study by VA San Diego and University of California San Diego researchers. Neutrophils are white blood cells that help control infections. Researchers exposed human cells to e-cigarette vapor in a lab. Exposure to the vapor interfered with neutrophils’ ability to respond to the presence of bacteria. The vapor hindered the neutrophils’ ability both to move to the site of bacteria and to produce infection-fighting substances. The neutrophils were affected even when nicotine was not present in the vapor, meaning that e-cigarette ingredients other than nicotine may be harmful. The researchers also found that mice exposed to e-cigarette vapor were less able to fight off bacterial infections than control mice. The results suggest that using e-cigarettes could change the immune response and make people more susceptible to infections, according to the researchers. (American Journal of Physiology, Oct. 30, 2019)
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Mantram therapy curbs PTSD hyperarousal
 Photo for illustrative purposes only. ©iStock/electravk (11/06/2019)
Mantram repetition therapy may reduce hyperarousal in patients with PTSD, found a VA San Diego study. Hyperarousal, a common PTSD symptom, is a heightened state of anxiety. Common PTSD treatments are less effective at treating hyperarousal than other PTSD symptoms. In the study, researchers had Veterans practice mantram repetition to deal with hyperarousal. Mantram therapy is a type of meditation that employs repeated phrases to train attention and regulate emotions. Those using mantram repetition had greater reductions in hyperarousal, compared with patients using standard psychotherapy only. Those with reduced hyperarousal had greater overall PTSD symptom reduction. The results show that mantram treatment that focuses specifically on hyperarousal could lead to lower PTSD symptoms more generally, according to the researchers. (European Journal of Psychotraumatology, Sept. 30, 2019)
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Does frequent switching of reminder signs help hand hygiene in hospitals?
 Illustration: ©iStock/Victor_Brave (11/06/2019)
Frequently changing reminder signs did not increase hand hygiene adherence in a study at nine VA medical centers. Proper hand hygiene by health care workers during direct patient contact reduces hospital-acquired infections. But adherence in hospitals to hand-washing guidelines is low. Researchers tested whether increasing the frequency with which hand-hygiene visual reminders were changed would boost adherence. Signs next to antibacterial hand soap dispensers were changed either weekly or monthly to make them more noticeable, or were left the same. Over six months, , hand-washing rates remained nearly the same in all three groups. The researchers concluded that frequently changing signs had no effect on hand hygiene, possibly because of the abundance of other notices in the acute-care setting. (JAMA Network Open, Oct. 2, 2019)
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New genetic risk factors for PTSD identified
 Illustration: ©iStock/poba (11/06/2019)
A large genome study identified new genetic risk factors for PTSD. The international study included multiple VA researchers. It examined the genomes of over 30,000 participants with PTSD and 170,000 controls without PTSD. The researchers estimate that 5 to 20% of PTSD risk can be attributed to inherited genes, with heritability higher in women than men. The analysis identified three new locations on the genome where gene variations affect a person’s risk for PTSD. Two of these were found only in people of European ancestry and one was only in people of African ancestry. Three other gene locations related to PTSD risk were identified in men only. The study also found that a gene previously linked to Parkinson’s disease is also associated with PTSD. The findings advance the understanding of the genetic basis of PTSD, say the researchers. (Nature Communications, Oct. 8, 2019)
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Mouse study explores benefits of calorie restriction
 Photo: ©iStock/Eduard Lysenko (11/01/2019)
A VA mouse study has challenged the understanding of how calorie restriction improves health. Limiting calories is known to improve health in mammals, including humans. Prior thought was that this is achieved through improved insulin sensitivity. Researchers at the Madison, Wisconsin, VA tested the effects of calorie restriction on mice with insulin resistance. Calorie-restricted mice had improved fitness and longevity compared to control mice. Calorie rest riction led to similar improvements in both insulin-resistant and non-insulin-resistant mice. The results show that the health benefits of calorie restriction are not solely based on insulin sensitivity, say the researchers. (Cell Reports, Oct. 1, 2019)
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Opioids overused in dental care
 Photo for illustrative purposes only. ©iStock/tommaso79 (11/01/2019)
U.S. dentists prescribe far more opioids than dentists in other countries, found a review that included a Edward Hines, Jr. VA Hospital researcher. For example, 22.3% of U.S. dental prescriptions in 2016 were for opioids, while only 0.6% were for opioids in the United Kingdom. Dentists are among the most frequent prescribers of opioids. Two large reviews cited by the study also showed that other types of pain medication are at least as effective as opioids for controlling dental pain. Because of the risk of opioid addiction, there is clear patient benefit to avoiding opioids for dental pain, say the researchers. (Journal of the American Dental Association, October 2019)
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Serious mental illness no barrier to hepatitis C treatment
 Photo: ©iStock/Gligatron (11/01/2019)
Serious mental illness such as schizophrenia doesn’t affect access to hepatitis C treatment in VA, found a VA Capitol Healthcare Network study. Researchers looked at data on more than 4,000 VA patients with hepatitis C in a two-year period. About 30% of patients began treatment with the hepatitis drug sofosbuvir, one of the newer medications responsible for dramatically high cure rates. There was no difference in treatment rates between patients with and without serious mental illness. The results suggest that VA efforts to expand treatment using the new hepatitis C drugs have extended equally to those with serious mental illness, a group that has traditionally experienced barriers to optimal health care. (Psychiatric Services, Oct. 16, 2019)
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Dietary oils could help with diabetic nerve damage
 Photo: ©iStock/mescioglu (10/28/2019)
A rat study has shown that dietary oils could be an effective treatment for nerve damage caused by diabetes. Researchers from the VA Iowa City Health Care System and University of Iowa simulated diabetes by giving rats a high-fat diet. They then replaced the fat in the rats’ diets (from lard) with unsaturated fats from several dietary oils. Rats given fish oil and flaxseed oil showed improvement in peripheral nerve damage. Enriched fish oil also led to the greatest improvements in vascular dysfunction and cognitive activity. The other dietary oils tested—olive oil, safflower oil, and evening primrose oil—provided no or only small improvements. The results show that dietary fat modification, especially with fish oil, could be a useful treatment for vascular and nerve problems caused by diabetes, say the researchers. (Journal of Diabetes Research, Aug. 7, 2019)
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Researchers identify genes related to schizophrenia
 Illustration: ©iStock/Lars Neumann (10/28/2019)
A team including VA researchers identified several regions on the genome related to schizophrenia risk. The team sequenced the DNA of more than 1,500 patients with schizophrenia. They found seven regions of the genome that appear to relate to neurological dysfunction in schizophrenia. The analysis also confirmed multiple schizophrenia-related regions identified in previous studies. The results help explain the biological processes of schizophrenia and could lead to new targeted treatments, according to the researchers. (JAMA Psychiatry, Oct. 9, 2019)
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Smoking linked to higher prostate cancer mortality
 Photo: ©iStock/sanjagrujic (10/28/2019)
Smoking is linked to a higher risk of dying from prostate cancer, found a VA San Diego Health Care System study. Researchers looked at more than 73,000 VA patients diagnosed with prostate cancer. The rate of death from prostate cancer was 5.2% for currents smokers within 10 years of their diagnosis. Past smokers had a 4.8% mortality rate, while those who never smoked had a rate of 4.5%. The study shows that prostate cancer diagnosis may be an important opportunity to discuss quitting smoking. (Prostate Cancer and Prostate Diseases, Oct. 17, 2019)
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Diabetic Veterans find peer mentors valuable
 Photo for illustrative purposes only. ©iStock/Kali9 (10/17/2019)
Veterans with diabetes found value in a peer mentor program aimed at improving self-care. Veterans at the Corporal Michael J. Crescenz VA Medical Center who had trouble controlling their diabetes were paired with other Veterans who had gotten their blood sugar under control. Mentors called mentees daily to offer encouragement and advice. The researchers interviewed both groups after a six-month period. Participants described several benefits of the program, including accessible support, improved self-confidence, and increased accountability. Some participants faced barriers to the experience, such as scheduling problems and interpersonal conflicts. The more successful mentees said they had a strong connection to their mentor. The study shows that a low-cost peer mentor program can offer support to patients with diabetes that may improve their self-care. (Diabetes Educator, Oct. 9, 2019)
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Alcohol withdrawal in VA hospital patients
 Photo: ©iStock/ZzzVuk (10/17/2019)
Alcohol withdrawal syndrome affected nearly 6% of Veterans hospitalized in VA in 2013, found a VA Puget Sound study. Heavy drinkers may go through withdrawal when they suddenly stop drinking. Withdrawal symptoms include trembling, headache, and even hallucinations and seizures. Researchers looked at data on almost half a million VA hospitalizations. Of those, 5.8% of patients had documented AWS. The prevalence varied widely based on location, facility, admitting specialty, and diagnosis. Psychiatric admissions had a higher rate of AWS than medical or surgical. AWS was especially common during hospitalizations for other alcohol-related disorders, substance use disorders, attempted suicide, and liver injury. (Journal of Addiction Medicine, Oct. 11, 2019)
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Tinnitus rates going up in active duty service members
 Photo by Spc. Anthony Zendejas/USA (10/17/2019)
Tinnitus rates in active duty service members have increased significantly in recent years, according to a study by South Texas VA Health Care System and University of Texas at San Antonio researchers. They studied the health records of more than 85,000 active duty service members. Between 2001 and 2015, the rate of tinnitus more than tripled. Tinnitus refers to a ringing or buzzing in the ears. It is often caused by blast exposure. This was the first study to assess tinnitus rates in active duty rather than in Veterans. Further studies are needed on how hearing damage impacts active duty service members, say the researchers. (American Journal of Audiology, Oct. 16, 2019)
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Early deployment could increase suicide risk
 U.S. Army photo by Maj. Thomas Cieslak (10/02/2019)
Early first deployment may increase the risk of suicide attempt, according to a study of U.S. enlisted soldiers. VA San Diego researchers and colleagues looked at data on a large number of soldiers, including 1,700 who attempted suicide. Soldiers who deployed within 12 months of beginning their Army service were 70% more likely to attempt suicide, compared with soldiers who deployed later. The early deployers’ risk was elevated both during and after deployment. More study is needed to understand how training and preparedness affect suicidal behavior, say the researchers. (Suicide & Life-Threatening Behavior, Sept. 23, 2019)
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Supported employment boosts functional outcomes in PTSD
 Photo: ©iStock/shironosov (10/02/2019)
Supported employment improves overall PTSD-related functioning, found a VA study. Individual Placement and Support is a VA program to help Veterans with PTSD find jobs. It uses individual-centered job development and employment specialists. Past studies have showed that IPS is more effective than transitional work programs at helping Veterans find sustained employment. The new study of 512 Veterans shows that IPS also improves PTSD-related functions in other areas. In addition to greater work functioning, Veterans given IPS had greater improvement in school, relationship, and lifestyle functioning, compared with those given transitional work. The results show that IPS has benefits beyond helping Veterans with PTSD find work. (Psychiatric Rehabilitation Journal, September 2019)
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Brain structures account for transcranial magnetic stimulation effectiveness
(10/02/2019)
A team including Providence VA Medical Center researchers identified brain structures that influence the effectiveness of transcranial magnetic stimulation for PTSD and depression. In TMS, magnets are placed on the outside of the head to affect electrical signals in the brain. The therapy has emerged in recent studies as a promising treatment for PTSD. Researchers used MRI to study the pre-TMS brain structure of 20 patients. Those with greater connectivity in the anterior thalamic radiation (fiber pathways in the white matter) had greater symptom relief after TMS. The results suggest that this brain area could be a good target for TMS treatment, according to the researchers. (Depression and Anxiety, Sept. 2, 2019)
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Metformin, versus sulfonylureas, linked to fewer heart issues for diabetes patients with weakened kidneys
 Photo: ©iStock/ljubaphoto (09/26/2019)
The diabetes drug metformin is more effective than sulfonylureas, a separate class of commonly used diabetes drugs, at preventing cardiovascular events in patients with reduced kidney function, according to a Tennessee Valley VA Health Care System study. Past studies showed that metformin is more effective at treating diabetes than sulfonylureas. However, worries over possible kidney damage led the FDA to warn against metformin for people with reduced kidney function. In 2016, the FDA revised its recommendation to say metformin was safe for people with kidney disease. To test metformin’s effectiveness in this population, the researchers studied data on nearly 175,000 VA patients. They found that diabetic patients on metformin had significantly fewer cardiovascular events (such as heart attack or stroke) than those on sulfonylureas. (JAMA, Sept. 19, 2019)
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Mouse study: Potential stroke treatment only effective in males
 Photo: ©iStock/D-Keine (09/26/2019)
In a mouse study, a potential stroke therapy was found to be effective in males but not females. A team of VA Portland Health Care System researchers and colleagues gave stroke-affected mice a drug called anti-PDL2. An inflammatory immune response can lead to brain tissue death during stroke. Anti-PDL2 potentially block this immune response. The team found that giving anti-PDL2 significantly reduced the amount of brain cell death, but only in male mice. It had no protective effects in female mice. The difference may be due to changes in cell production in the spleen that occurred in males but not females. The results suggest that anti-PDL2’s potential as a stroke treatment may be limited to men, say the researchers. (Metabolic Brain Disease, Aug. 13, 2019)
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No link found between herbicide exposure and restrictive pulmonary disease
 Photo for illustrative purposes only. Courtesy of Cincinnati VAMC (09/26/2019)
A study by the VA Office of Patient Care Services did not find a link between herbicide exposure in Vietnam and restrictive pulmonary disease. Researchers tested Veterans using a spirometer, which measures lung volume. While participants who sprayed herbicides during their service showed more lung restriction than those who did not, the difference was not statistically significant. Race and waist circumference were much more predictive of restrictive pulmonary disease. Previous studies have shown race and weight to be risk factors for the disease. Black participants were three times more likely than white participants to have restricted breathing. Those with a larger waist circumference were 2.5 times more likely to have restricted breathing than those with a smaller waist. More research is needed on how chemical exposure may affect breathing in Veterans, according to the researchers. (International Journal of Environmental Research and Public Health, Aug. 28, 2019)
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Gene linked to thinner cortex in PTSD patients
 Photo: ©iStock/Denes Farkas (09/19/2019)
Researchers at the VA Boston Healthcare System found evidence that gene variants are linked to reduced cortical thickness in people with PTSD. Past research has shown that PTSD is connected to reduced thickness in the cortex, the outer layer of the brain. By testing the genomes of 240 Veterans with PTSD, the researchers found that participants with specific variants of the gene PPM1F had reduced cortical thickness. The results suggest that people with these gene variants may be susceptible to greater PTSD severity from changes in brain structure, say the researchers. (Journal of Affective Disorders, Aug. 19, 2019)
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Many VA providers unaware of corticosteroid risks
 Photo for illustrative purposes only. ©iStock/RgStudio (09/19/2019)
Many providers are unaware of guidelines on corticosteroid use for COPD, according to a survey of VA primary care providers. Inhaled corticosteroids are recommended for chronic obstructive pulmonary disease (COPD) only in severe cases. Their use can lead to pneumonia, fracture risk, cataracts, and poor diabetes control. However, more than 50% of COPD patients in VA are prescribed the drugs. According to the survey, many providers are not aware of the current evidence and recommendations regarding corticosteroids. For example, 46% were unaware of the risk of pneumonia. Participants said it was hard to keep up with current guidelines because of the broad scope of primary practice. Many were also reluctant to change prescriptions made by other providers. More efforts are needed to limit the use of this potentially harmful drug class in VA, say the researchers. (Journal of General Internal Medicine, Aug 8, 2019)
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Diabetes risk over time for women Vets of Vietnam era
 Photo by CPT George Clemmons/USAF (09/19/2019)
A VA study tracked the diabetes risk of women who served during the Vietnam War. Researchers interviewed 4,500 women who served between 1965 and 1973. Those who served in the warzone in Vietnam had a three-times lower diabetes risk at the start of their service, compared with women serving stateside. However, diabetes risk increased 38% faster in that Vietnam group than in the U.S. group in the decades after service. The researchers speculate that the lower initial risk could be due to the physical and mental fitness standards for service members in warzones. These standards are often not maintained when Veterans separate from service. Diabetes risk did not differ between women serving near but not in Vietnam and those serving in the U.S. The results show that factors related to warzone service that may lower diabetes risk can quickly wane as Veterans age. (Women’s Health Issues, Sept. 10, 2019)
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VA relatively free of disparities in colorectal cancer screening
 (Photo illustration by Michael Escalante) (09/11/2019)
Many demographic disparities in colorectal cancer screening seen in the general population do not exist in VA. That is the main finding from a study by VA Greater Los Angeles Healthcare System researchers. In the database study, the overall colorectal screening rate for VA patients ages 50 to 75 was 82%. Rates were lowest among American Indians/Alaska Natives, those with a history of serious mental illness or substance abuse, and those with the lowest socioeconomic status. However, screening rates even for these groups topped 75%. Older age, Hispanic ethnicity, black race, Asian race, and co-occurring illnesses were all predictors of higher screening rates. Although screening disparities are relatively rare in VA, groups with lower rates might benefit from targeted efforts to increase uptake, say the researchers. (Medical Care, Aug. 14, 2019)
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Menopause linked to more opioid prescribing
 Photo for illustrative purposes only. ©iStock/BakiBG (09/11/2019)
VA researchers in San Francisco looked at prescribing data from over 100,000 mid-life women Veterans with chronic pain. They found that menopause symptoms were linked with higher opioid prescribing. Women with symptoms had higher odds of being prescribed long-term opioids, high-dose opioids, and opioids co-prescribed with central nervous system depressants such as sedatives or muscle relaxants, compared with symptom-free women. Another study by the team found that women with menopause symptoms were twice as likely to have chronic pain than those without symptoms. The researchers say more awareness of the links between menopause and pain could help curb risky prescribing. (Journal of General Internal Medicine, Aug. 14, 2019)
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Cardiology visits linked with more statin use
 Photo: ©iStock/South_agency (09/11/2019)
Houston VA researchers and their colleagues found that cardiology visits lead to more statin use and adherence in patients with cardiovascular disease. Statin drugs lower cholesterol and help ward off heart attacks and strokes. The team studied data on more than a million VA patients with cardiovascular disease. Patients who had visited a cardiologist had greater odds of being on a statin and staying with the treatment, compared with those who had seen only a primary care provider. More cardiology visits were linked with greater statin use and adherence. Referrals to cardiologists may be among the strategies needed to boost appropriate statin use, say the researchers. (American Journal of Cardiology, July 25, 2019)
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Traumatic loss tied to poorer response to PTSD treatment
 Photo: ©iStock/fizkes (09/11/2019)
In a study that included several VA researchers, service members with PTSD stemming from traumatic losses—such as the death of buddies—were less responsive to treatment than those with PTSD related to other causes. Past studies have shown that combat-related PTSD is less responsive to treatment than PTSD among civilians. The traumatic death of a close friend or colleague is a common deployment experience. The study showed that service members with traumatic loss-related PTSD recovered less from depression than those who experienced other traumatic events. Less recovery from depression predicted less recovery from PTSD. The results suggest that PTSD therapists should take into account loss and grief in military populations. Therapy could be tailored to focus on feelings of grief and guilt, say the researchers. (Journal of Traumatic Stress, Aug. 28, 2019)
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Veterans in rural areas do not face longer kidney transplant wait times
 Photo: ©iStock/uchar (09/05/2019)
Rural and urban Veterans have similar wait times for kidney transplant, according to an Iowa City VA Medical Center study. Prior research has shown that VA patients in need of new kidneys have lower rates of transplant than non-Veterans. Rural residents also have lower transplant rates than urban residents in the general population. A higher proportion of Veterans live in rural areas, compared with non-Veterans. To see whether these factors affected transplant rates, researchers looked at data on more than 3,000 Veterans participating in VHA's transplant programs. Veterans living in urban areas spent a longer time on dialysis than rural Veterans before registering for the transplant waitlist. But once on the waitlist, rural and urban Veterans did not have a significant difference in how long they waited for a kidney transplant. More research is needed to determine why transplant rates differ between Veterans and non-Veterans, the researchers write. (Transplantation, September 2019)
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Controlled blast exposure top predictor of service-connected disability
 Photo by Lance Cpl. Immanuel Johnson/USMC (09/05/2019)
Exposure to blasts from controlled detonations was the most common predictor of service-connected disability, in a study of post-9/11 Veterans. The number of controlled blasts experienced was the top predictor of a service-connected disability rating of 50% or greater. Breachers—personnel who use explosives to create entries to buildings—often have repeated exposure to low-level blasts, both in combat and training. The second highest predictor of high service-connected disability was exposure to uncontrolled blasts, such as from improvised explosive devices in combat. The results suggest that military calculations on the minimum safe distance from blasts may be inaccurate, say the researchers. (Military Health System Research Symposium, Aug. 22, 2019)
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Low-value prostate cancer screening prevalent in VA
 Photo: ©iStock/jarun011 (09/05/2019)
Low-value prostate cancer screening remains prevalent in the VA health system, found a VA Pittsburgh Healthcare System study. Prior research has shown that screening for prostate-specific antigen—a biomarker of prostate cancer in the blood—does not improve survival of men 70 and older. The screening can lead to anxiety about diagnosis and overly aggressive treatment. Out of more than 200,000 male Veterans 75 or older, 18% underwent prostate-specific antigen screening in the study year. The rates of screening for this age group of men varied across VA medical centers, ranging from 3% to 38%. The results show that more efforts are needed to reduce low-value tests in VA, say the researchers. (Journal of the American Geriatrics Society, July 5, 2019)
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Boosting addiction treatment for opioid misuse
 Photo: ©iStock/KatarzynaBialasiewicz (08/28/2019)
Recommending addiction treatment may increase patients’ interest in and use of treatment for opioid misuse, according to VA New Jersey Health Care System researchers. They surveyed 567 patients taking opioids for chronic pain. A majority (63%) screened positive for opioid misuse. Health care providers had recommended addiction treatment to nearly a third of those misusing opioids. Almost the same number of patients took advantage of the treatment. In the survey, patients who had been offered treatment were more likely to say they were interested in the option, and, not surprisingly, were far more likely to report actually having undergone treatment, compared with those who were misusing but had not received a recommendation. More research is needed on barriers to providers’ recommending addiction treatment for patients taking opioids for chronic pain, write the researchers. (American Psychological Association 2019 convention, Aug. 8, 2019)
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Telephone goal-setting may ease depression in diabetic patients
 Photo: ©iStock/MartinPrescott (08/28/2019)
Telephone-delivered collaborative goal-setting can help reduce depression in patients with diabetes, found a Michael E. DeBakey VA Medical Center study. One in three patients with diabetes also have depression symptoms. Patients with both uncontrolled diabetes and clinical depression were enrolled in the Healthy Outcomes Through Patient Empowerment (HOPE) program. HOPE includes nine telephone sessions with health care professionals, focusing on collaborative goal-setting to improve health and behavior. Twelve months after participating in HOPE, patients had lower depression symptom scores, compared with patients receiving usual care. HOPE did not lead to improved diabetes control, as measured by HbA1c levels. The results show that HOPE has potential to improve depression in patients with diabetes, say the researchers. (JAMA Network Open, Aug. 2, 2019)
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Financial incentives fail to boost colorectal screening rates
 Photo: ©iStock/JoKMedia (08/28/2019)
Small financial incentives did not increase colorectal cancer screening participation, in a study including a VA San Diego Healthcare System researcher. Patients were mailed a fecal immunochemical test annually for three years. Some patients were also offered either a $5 or $10 incentive to complete the test. Response rates were similar for patients given outreach only and for both incentive levels. While previous research has shown that financial incentives may improve short-term health behaviors, the results suggest that they may not be effective for longer-term periodic testing, according to the researchers. (Cancer Epidemiology, Biomarkers & Prevention, Aug. 6, 2019)
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New insight on the genetic basis of psychological resilience
 U.S. Army photo by Spc. Jeffery (08/22/2019)
A genetic study of U.S. soldiers has shown that psychological resilience may have a genetic basis. The study team, which included researchers from the VA San Diego and Connecticut health care systems, used genome mapping and survey data from more than 11,000 new recruits and deployed soldiers of European ancestry. They measured resilience both subjectively, as self-assessed ability to handle stress, and objectively, using mental disorder diagnoses. Two genes—DCLK2 and KLHL36—were linked with self-assessed resilience. Preliminary results on a smaller group of soldiers who had experienced high levels of combat stress suggest that another gene, SLC15A5, may influence objectively measured resilience. The results offer new insights into the possible biological bases for resilience to stressors, say the researchers. (American Journal of Medical Genetics, July 2019)
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After smokers quit, heart risk declines, but slowly
 Photo: ©iStock/Suriyawut Suriya (08/22/2019)
Former heavy smokers had lower risk of cardiovascular disease five years after quitting but were still at greater risk than people who had never smoked, in a study including VA Tennessee Valley Healthcare System researchers. The study followed nearly 9,000 people for several decades. Heavy smokers who had quit about half the risk of cardiovascular disease five years after they stopped smoking, compared with current smokers. However, they were still at significantly higher risk than people who had never smoked. Former smokers had about the same cardiovascular risk as nonsmokers 10 to 15 years after quitting. The results show that while quitting smoking lowers risk of cardiovascular disease, it may take a decade or more for the risk caused by smoking to totally decline. (JAMA, Aug. 20, 2019)
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Pre-treatment level of protein could predict cancer drug’s effects
 Photo: ©iStock/Alexey_ds (08/22/2019)
A phase 2 clinical trial that included VA researchers in Miami suggests that measuring a certain protein before treatment could predict whether a second-line cancer drug will be effective. The study added to the evidence that pembrolizumab (sold as Keytruda) may help slow or stop liver cancer progression for some patients. The drug, used for multiple types of cancer, has been given accelerated approval as a second-line treatment for liver cancer, but has not received full approval. The researchers tested the blood of nearly 30 liver cancer patients given intravenous pembrolizumab for three weeks. Tumor progression slowed or stopped in about a third of patients. Blood tests showed that a high level of TBF-beta—a protein involved in cell growth—before treatment was associated with poorer outcomes. The majority of adverse side effects were manageable—such as rash, fatigue, and diarrhea. While more testing is needed on the drug’s effects, it would be reasonable to combine pembrolizumab with first-line treatments to improve response, say the researchers, adding that TGF-beta “could be a predictive biomarker.” (Cancer, June 28, 2019)
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Mouse study probes nicotine addiction from e-cigarettes
 Photo: ©iStock/sestovic (08/15/2019)
Daily use of electronic cigarettes may lead to nicotine addiction due to similar biological changes as are seen with regular cigarettes, suggests a mouse study by VA San Diego Healthcare System researchers and colleagues. E-cigarettes produce an aerosol that contains nicotine, as an alternative to smoking. To test whether using e-cigarettes (also known as “vaping”) affects the same addiction pathway as conventional cigarettes, researchers exposed mice to nicotine vapor daily, comparable to a chronic e-cigarette use. They found that six months of exposure decreased dopamine concentrations in the striatum area of the brain. Concentrations of the neurotransmitter GABA decreased in the frontal cortex. Concentrations of the neurotransmitters glutamate and glutamine were increased. Changes in glutamate and dopamine levels are known to be involved in drug dependence, including in nicotine addiction. This imbalance of neurotransmitters could drive nicotine addiction from e-cigarettes, say the researchers. (Frontiers in Pharmacology, Aug. 12, 2019)
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Do more blood pressure drugs pay off for nursing home residents?
 Photo: ©iStock/Creative-Family (08/15/2019)
Nursing home residents with high blood pressure do not get significant added benefit from multiple blood pressure medications, found a study by VA researchers from several systems. Researchers studied data from more than U.S. 250,000 nursing home residents with high blood pressure. They found small increases in hospitalization rates in residents whose blood pressure medication intensity had been increased. On the other hand, these patients had a slightly smaller decline in their activity level, compared with peers on fewer blood pressure medications. Intensity of blood pressure treatment did not affect mortality. On balance, the researchers concluded that the benefits from more intense blood pressure treatment were not significant, especially in light of the increased risk for side effects such as falls and incontinence. (Journal of the American Geriatrics Society, July 22, 2019)
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The formula for effective rapid response in hospitals
 Photo for illustrative purposes only. ©iStock/stockstudioX (08/15/2019)
A team including VA Ann Arbor Healthcare System and Iowa City VA Medical Center researchers evaluated the factors linked to high performance in rapid response teams for in-hospital cardiac arrest. They interviewed 158 clinicians and staff at nine different hospitals. At top-performing hospitals, rapid response teams were typically staffed by dedicated team members without competing responsibilities. They collaborated with bedside nurses before, during, and after rapid response events. Bedside nurses at top-performing hospitals were empowered to activate rapid responses based on their own judgment. At lower-performing hospitals, rapid response teams often had competing responsibilities and were less engaged with bedside nurses. Nurses at lower-performing hospitals were concerned about potential consequences from activating a rapid response. The findings can provide insights on the best way to handle in-hospital cardiac arrests, say the researchers. (JAMA Internal Medicine, July 29, 2019)
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Women and men differ in understanding of harassment
 Photo: ©iStock/asiandelight (08/07/2019)
Women and men have different perceptions of stranger harassment on VA facility grounds, found a VA Greater Los Angeles Healthcare System study. Stranger harassment refers to unwanted comments and attention—such as cat-calls and sexual comments. One in four women VA health care users has experienced harassment at VA facilities, according to a recent VA study, usually from male Veterans. In follow-up, researchers held group discussions at four VA medical centers to get patient perspectives on the problem. Women, on the whole, had clear understandings and experiences of what behaviors constituted harassment. Many men, however, expressed confusion about the difference between harassment and acceptable behavior, such as general friendliness and “harmless flirting.” Men said women should set boundaries with men, while women indicated it was not their responsibility to “train” men about acceptable behavior. Both men and women said that VA staff are primarily responsible for preventing harassment. Participating Veterans recommended educating male Veterans on the issue, as well as training staff to address the problem. (Women’s Health Issues, June 25, 2019)
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Improving ‘affirming care’ for LGBT Veterans
 Photo for illustrative purposes only. ©iStock/asiseeit (08/07/2019)
Researchers with the VA Boston Healthcare System and Michael E. DeBakey VA Medical Center reported on the facilitators and barriers in a program to improve LGBT services for VA patients. The program, launched in 2016, requires every VHA facility to appoint an LGBT Veteran Care Coordinator to support affirming care. Affirming care includes providing LGBT patients with a welcoming environment and addressing their specific health care needs. Researchers surveyed 79 care coordinators to see how well the program has been implemented. The highest positive facilitator to the program was leadership engagement, reported by 53% of coordinators. The largest barrier was insufficient availability of resources, reported by 66% of coordinators. The survey results will help VHA improve the program in the future, say the researchers. (Psychological Services, July 25, 2019)
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Pre-deployment TBI increases odds of post-deployment alcohol misuse
 iStock/South_agency (08/07/2019)
Traumatic brain injury prior to deployment could lead to problem drinking in soldiers after deployment, according to a study based on the Army STARRS survey. Soldiers who had a TBI that included loss of consciousness prior to deploying to Afghanistan had increased odds of binge drinking (five or more drinks at once) and heavy drinking (weekly binge drinking) three months after deployment. The connection between TBI and drinking appears more pronounced when the TBI occurred prior to age 13. Those who experienced both a prior TBI and a deployment-related TBI had even higher odds of heavy drinking nine months after deployment. The results suggest that routine screening for pre-deployment TBIs may help target efforts to prevent alcohol misuse in military members, say the researchers. (Journal of Head Trauma Rehabilitation, July 29, 2019)
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Post-TBI symptoms linked to suicide attempts in soldiers
 Photo for illustrative purposes only. By Ensign Haraz Ghanbari/USN (08/01/2019)
Having traumatic brain injury symptoms before deployment was linked to post-deployment suicide attempts in soldiers deployed to Afghanistan, found a study including a VA San Diego Healthcare System researcher. Using the Army STARRS survey, the researchers studied data on 7,677 soldiers deployed to Afghanistan in 2012. Of those, 103 made a suicide attempt. Soldiers who had post-concussive/post-TBI symptoms before deployment had a higher risk of a suicide attempt than those without TBI symptoms. The results show that detecting post-TBI symptoms could help target suicide prevention programs, say the researchers. (Journal of Head Trauma Rehabilitation, July 11, 2019)
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Diabetes and Alzheimer’s risk factors together linked to greater cognitive decline
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Patients with both diabetes and Alzheimer’s disease risk factors showed greater cognitive decline than those with one or the other, in a VA San Diego Healthcare System study. Researchers followed the cognitive functioning of patients for five years. Patients with both diabetes and at least one Alzheimer’s risk factor showed the most cognitive decline, greater than those with only diabetes, only Alzheimer’s risk factors, or neither. Alzheimer’s risk factors included subtle cognitive decline, genetic risk, and three biomarkers found in the spinal fluid. The results suggest that diabetes interacts with Alzheimer’s risk factors to increase cognitive decline, according to the researchers. (Alzheimer’s Disease and Associated Disorders, July 10, 2019)
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Substance use disorder treatment low for both HIV-infected and uninfected Veterans
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Substance use disorder treatment was low for Veterans both with and without HIV, in a study of more than 160,000 Veterans. Researchers studied how HIV status affected patients’ use of treatment for substance use disorders, considering SUDs are common in patients with HIV. Patients with HIV were slightly more likely than those without to have an SUD. Fewer than 17% of patients with an SUD engaged in treatment in both the HIV and non-HIV groups. Patients with HIV were more likely to stay in SUD treatment for six months, but the difference was small. While the percentage of VA patients with SUDs who receive treatment is higher than SUD treatment rates in the general population, the researchers still say efforts are needed to get more Veterans to engage in SUD treatment, regardless of HIV status.-
- (Journal of Substance Abuse Treatment, August 2019)
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Aspirin may help cancer patients live longer
(07/25/2019)
Aspirin use was linked with better survival in patients with head and neck cancer, in a study of patients at the Washington DC VA Medical Center. Studies have shown that long-term aspirin use can reduce the risk of developing several types of cancer, but its effects after cancer diagnosis are unknown. Researchers looked at the medical charts of 584 Veterans treated for cancers of the head and neck over a 20-year period. About 26% were prescribed long-term aspirin use. Aspirin users were significantly more likely to survive for at least three years after diagnosis. Overall survival was 79% for aspirin users and 56% for those not taking aspirin. While the study was not designed to show direct cause and effect, the results do suggest that aspirin may be a useful addition to treatment for head and neck cancer, say the researchers. (Head and Neck, May 2019)
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Blast exposure linked to decreased sound tolerance
 DoD photo by Lance Cpl. Immanuel Johnson (07/25/2019)
Blast exposure increases the likelihood of decreased sound tolerance in Veterans and service members, according to a VA Portland Health Care System study. People with decreased sound tolerance often experience negative physical or psychological reactions to everyday sounds, such as being uncomfortable or overwhelmed from the background noise of a public place. Researchers looked at data on 426 Veterans and service members who participated in a study on hearing. They found that, of those with blast exposure, 33% of service members and 48% of Veterans had decreased sound tolerance. For who had not been exposed to blasts, 28% of service members and 34% of Veterans had decreased sound tolerance. The researchers say more study is needed to understand the connection between blast exposure and sound tolerance, and to examine whether related auditory injuries are going undetected. (Scientific Reports, July 15, 2019)
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Combined VA, Medicare Part D prescription use increases unsafe medication risk
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Older Veterans who use both VA and Medicare Part D are at increased risk of receiving unsafe medication, according to a study by VA researchers from several VA locations. Almost all Veterans 65 and older with prescription benefits from VA are also eligible for Medicare Part D. To see whether dual use of prescription sources increases seniors’ risk of unsafe medication use, the researchers looked at data for nearly 280,000 Veterans. They found that dual-use patients had a nearly twofold increase in the odds of receiving potentially unsafe medication. The results show that policies to expand Veterans’ access to non-VA providers must ensure patient information is shared to avoid dangerous prescribing, say the researchers. (JAMA Internal Medicine, July 22, 2019)
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How aspirin helps against cancer
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A Michael E. DeBakey VA Medical Center researcher and a colleague have identified the possible mechanism behind aspirin’s anticancer activity. Low-dose aspirin has been found to both help stop many forms of cancer from forming and also block cancer’s ability to spread when taken after diagnosis. The researchers found evidence that aspirin’s ability to inhibit platelet cyclooxygenase-1—an enzyme related to inflammation—is the key mechanism behind this. Platelet levels are often elevated in the later stages of cancer. They are known to promote cancer growth. Past research by the VA and University of Texas team has shown that low-dose aspirin can block the pro-cancer action of platelets, but until now the way this interaction worked was unknown. (Cancer Research, March 7, 2019)
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Traumatic brain injury linked to higher psychiatric risk and symptoms
 Illustration: ©iStock/Lamenko (07/17/2019)
Service members and Veterans with a history of traumatic brain injury have higher rates and severity of psychiatric conditions, found a Minneapolis VA Health Care System review. Researchers analyzed studies on TBI and psychiatric disorders conducted over a 17-year period, and found 33 relevant studies. The review shows that service members and Veterans with TBIs had higher rates of PTSD, depressive disorder, substance use disorder, and anxiety disorder, compared to those without TBI. One study showed higher rates of suicide attempts in people with TBI. Geographically diverse studies linked TBI to greater symptom severity of PTSD. Results of TBI’s effect on depression and substance use disorder symptom severity were mixed. According to the researchers, the results support a need for increased emphasis on evaluation of psychiatric conditions in service members and Veterans with a history of TBI. (Journal of Head Trauma Rehabilitation, April 25, 2019)
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Diet quality affects gut microbiome
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Quality of diet affects the microbiome in the digestive tract, found a Michael E. DeBakey VA Medical Center study. Researchers studied the types of bacteria present in the colon of patients undergoing a colonoscopy. They found that patients who reported eating a good-quality diet—one high in fruits, vegetable, and whole grains and low in sugar, alcohol, and fats—had higher levels of beneficial bacteria, such as those with anti-inflammatory properties. Those with a poor-quality diet, by comparison, had more potentially harmful bacteria, such as bacteria linked to colorectal cancer. The study suggests that the microbiome of the colon can be modified through diet, which could help reduce the risk of chronic diseases, say the researchers. (American Journal of Clinical Nutrition, July 10, 2019)
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Telehealth helps with HIV management
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Telehealth availability improves viral suppression in HIV patients, found a VA Office of Rural Health study. Patients who previously traveled long distances to HIV specialty clinics were offered telehealth visits in nearby primary care clinics. The researchers compared outcomes of patients living in areas where telehealth was available to those of patients in areas without telehealth. In the areas where telehealth was available, 13% of patients used the option. Small average improvements in viral suppression were seen in patients offered telehealth visits compared with patients not offered telehealth, regardless of whether patients took advantage of telehealth or not. Patients who actually used telehealth had large improvements in viral suppression. The results show that HIV clinics should offer telehealth visits for patients facing travel burdens, say the researchers. (Open Forum Infectious Diseases, May 10, 2019)
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Care cost lower for diabetes patients primarily seeing NPs or PAs rather than physicians
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Use of nurse practitioners and physician assistants could lead to lower health care costs for diabetes care, according to a Durham VA Health Care System study. Researchers looked at a year of VA data on medically complex patients with diabetes. They found that patients whose primary care provider was a nurse practitioner or physician assistant had 6–7% lower average total care costs than patients with a physician as the primary care provider. The difference was mainly due to more use of emergency and inpatients services by the physician group. The study suggests that nurse practitioners and physician assistants can effectively manage primary care for complex patients with diabetes without increasing care costs. (Health Affairs, June 2019)
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Newer hepatitis C drugs pose advantage for diabetes risk
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Hepatitis C patients treated with directly acting antiviral agents had lower risk of diabetes than patients treated with interferon, in a VA Pittsburgh Healthcare System study. Hepatitis C infection is linked to higher risk of diabetes. Results from previous research were mixed on whether treatment with interferon—an older treatment for hepatitis C—affects diabetes risk. To test how newer directly acting antiviral agent treatment affects diabetes risk, researchers studied data on more than 240,000 people with chronic hepatitis C. For both untreated patients and patients treated with interferon, about 2% developed diabetes. Only 0.1% of patients treated with directly acting antiviral agents developed diabetes after treatment. Patients with more advanced liver fibrosis had even larger diabetes risk reduction. The results show that the new antiviral agents may be better than older treatments at controlling hepatitis C complications, say the researchers. (Clinical Infectious Diseases, April 12, 2019)
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Continuity of care linked to better outcomes in inflammatory bowel disease
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Greater continuity of care leads to better outcomes for patients with inflammatory bowel disease, according to a VA Ann Arbor Healthcare System study. Researchers looked at more than 46,000 patients with inflammatory bowel disease—that is, either Crohn’s disease or ulcerative colitis—who received care through VA. Average continuity of care (meaning patients saw the same provider for outpatient visits) was only 23%. Patients with lower care continuity had more flare ups, need for medication, hospitalizations, and surgery than those with more continuity. More research is needed on how to improve continuity of care and how team-based care may affect patient outcomes, say the researchers. (Digestive Disease Week, May 17, 2019)
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Complementary and integrative health use linked to lower costs
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Using complementary and integrative health (CIH) approaches for chronic musculoskeletal pain led to lower health care costs and pain in younger Veterans, found a study by VA researchers from several systems. CIH refers to practices not currently part of mainstream, conventional medical practice, such as acupuncture, chiropractic care, and massage. Researchers looked at data on more than 30,000 Veterans who used CIH and nearly 200,000 who did not. They found that CIH use was linked with lower health care costs and less pain from chronic musculoskeletal conditions, compared with one year before patients began CIH. However, the CIH group had slightly higher opioid use than those who did not use CIH. The researchers theorize that the slightly higher opioid use could reflect the fact that many patients turn to CIH treatments as a last resort after trying other pain treatments such as opioids. The results show that use of CIH is cost-effective and can even be cost-saving, they say. (PLoS One, June 5, 2019)
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Three psychotherapies for depression reduce suicidal thoughts
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A VA Office of Mental Health and Suicide Prevention study looked at the effectiveness of three psychotherapies for depression at reducing suicidal thoughts. The researchers studied treatment data on interpersonal psychotherapy, cognitive-behavioral therapy, and acceptance and commitment therapy. The analysis showed that all three treatments reduced suicidal thoughts, especially in women Veterans. For male Veterans, decreases in suicidal thoughts were significantly greater in interpersonal psychotherapy and cognitive-behavioral therapy, compared with acceptance and commitment therapy. The results show that all three therapies are effective treatments for suicidal thoughts and depression, say the researchers. They suggest that more research be done on how gender influences the effectiveness of these treatments. (Women’s Health Issues, June 25, 2019)
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Liver cancer risk remains after successful hepatitis C treatment
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Patients treated with direct-acting antiviral agents for hepatitis C remained at risk for liver cancer after several years, found a Michael E. DeBakey VA Medical Center study. Hepatitis C increases the risk of liver cancer. Direct-acting antivirals are a new form of medication that are more effective than interferon—an older treatment—at treating hepatitis C. But their long-term effect on cancer risk is unknown. Researchers followed more than 18,000 patients at VA medical centers who had achieved sustained virologic response (meaning that no hepatitis C viruses were found in blood samples) with these new medications. They found that three years later these patients, while having lower cancer risk than people with active hepatitis C infection, still had risk levels that warrant monitoring. The risk was particularly high in patients with cirrhosis. The researchers recommend that hepatitis C patients treated with antivirals continue to be monitored for liver cancer. (Hepatology, June 20, 2019)
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Collaborative care plus self-management of chronic pain and mood symptoms leads to best results
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Adding collaborative care by nurses and doctors to an automated self-management program improves outcomes for Veterans with chronic musculoskeletal pain and mood disorders. That is the main finding from a study at the Roudebush VA Medical Center in Indiana. Nearly 300 patients with both chronic pain and depression or anxiety were treated for 12 months. In addition to standard primary care—including medication as needed—one group received automated monitoring and web-based self-management modules. The other group received self-management along with collaborative care by a team of nurses and physicians, who were responsible for regular phone contact and optimized medication management. While both groups showed a trend toward symptom decline, the collaborative care group were more likely to report overall improvement and less likely to have worsening symptoms. (Journal of General Internal Medicine, June 21, 2019)
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New insight on role of hippocampus in memory
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A study including researchers from the VA Boston Healthcare System found that the hippocampus is involved in consolidation of memory even when it is not involved in the initial learning. The hippocampus is a part of the brain involved in spatial memory and navigation. During sleep, the hippocampus helps convert short-term memories to long-term memories for tasks it was initially involved in. To test whether the hippocampus plays a role in other instances of memory formation, the researchers taught a simple motor task to people with hippocampal amnesia (meaning they couldn’t form long-term memories), and to control patients. While both groups showed similar initial learning, only the control group showed memory consolidation overnight, meaning they learned the task over the longer term. In the words of the researchers, “These results demonstrate that the hippocampus can be required for normal consolidation of a task without being required for its acquisition.” The results suggest that the hippocampus plays a broader role than previously thought in memory, they say. (Hippocampus, June 3, 2019)
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Rat study: Single injection protects against TBI damage in short term
 Photo: iStock/gorodenkoff (06/27/2019)
In a rat study by VA Pittsburgh Healthcare System researchers, a single shot of the drug memantine protected against neurodegeneration caused by traumatic brain injury (TBI), although the effects did not last. Within hours of a TBI, levels of the neurotransmitter glutamate rise in the brain. This can cause cell damage and long-term neurological deficits. To counter this, the researchers gave brain-injured rats a single injection of memantine one hour after injury. Memantine, sold as Nemenda, blocks glutamate receptors in the brain, and is used to treat Alzheimer’s disease. The shot protected cortical tissue and reduced neuronal degradation one day after injury. It also protected the hippocampus from damage seven days after injury. Higher doses of memantine were more effective than smaller doses. Researchers did not see any adverse side effects from the drug in the rats. However, the benefits did not remain past five weeks. While memantine injections have potential to protect the brain from degradation after TBI, a single dose may not be enough for long-term benefits, say the researchers. (Restorative Neurology and Neuroscience, 2019)
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Diabetes drug equally effective across groups
 Photo for illustrative purposes only. ©iStock/Jelena Danilovic (06/20/2019)
The diabetes medication empagliflozin reduces blood sugar levels for people with diabetes across a variety of demographics, found a VA Palo Alto Health Care System. Empagliflozin, sold as Jardiance, is a medication for reducing A1c (blood glucose) levels. Researchers looked at data on nearly 8,000 VA patients with Type 2 diabetes taking the drug. They found patients had an average of 0.7% reduction in A1c levels after six months on empagliflozin. Black and white patients had similar A1c reductions. Those with and without cardiovascular disease also had similar reductions. Patients with the highest A1c levels at baseline had the largest A1c reductions after six months. Patients also taking insulin had lower A1c reductions than those not taking insulin. (American Diabetes Association, June 9, 2019)
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More study needed on TBI’s effect of psychiatric treatment
 Illustration ©iStock/laramenko (06/20/2019)
Evidence is lacking on how mild traumatic brain injury (TBI) affects treatment for psychiatric conditions, according to Minneapolis VA Health Care System researchers. The researchers conducted a literature review for studies on patients with mild TBI and several other conditions: PTSD, depression, substance use disorders, suicidal thoughts or attempts, and anxiety disorders. They found seven studies looking at mild TBI occurring with these conditions. None of the studies looked at treatment effectiveness for substance use disorder or suicidal thoughts. For the other conditions, TBI history did not affect treatment outcomes. However, the studies that were analyzed did not use control groups or a randomized trial design, making it hard to assess the strength of the evidence. More studies are needed on how TBI affects treatment for other psychiatric conditions, say the researchers. (Journal of Affective Disorders, June 1, 2019)
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Breast cancer screening guidance
 Photo by Robin DeMark (06/20/2019)
The American College of Physicians released four guidance statements on breast cancer screening for average-risk women. A researcher from the Minneapolis VA Medical Center was part of the guideline committee. First, they recommend that clinician discuss whether or not to screen for breast cancer with women below age 50 since potential harms often outweigh the benefits in this age group. Second, for women 50 to 74, they recommend offering mammogram screening every other year. Third, they recommend discontinuing breast cancer screening for women age 75 or older, or for those with a life expectancy of 10 years or less. Fourth, for all age groups they say that clinicians should not use clinical breast examination to screen for breast cancer. (Annals of Internal Medicine, April 9, 2019)
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Gene variants linked to habitual alcohol use
 Photo by Mitch Mirkin (06/13/2019)
Researchers with the VA Connecticut and Boston health care systems found five new locations on the human genome related to habitual alcohol use. Using VA’s Million Veteran Program, the researchers studied the genomes of 126,936 European American Veterans and 17,029 African American Veterans. They found habitual alcohol use—which could lead to alcohol dependence—was linked to gene variants at specific locations on the genome for both groups. One gene, ADH1B, is already known to influence alcohol dependence. Five other gene locations (the most significant of which is called CRHR1) also showed a link to increased habitual alcohol use. These five gene locations have not previously been associated with alcohol use. The results provide new insight into how genetics could affect harmful alcohol use, say the researchers. (Biological Psychiatry, April 8, 2019)
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Lipid testing boosts statin adherence
 Photo: ©iStock/PongMoji (06/13/2019)
Routine lipid testing can lead to Veterans taking their statin medication more regularly, found a study by Michael E. DeBakey VA Medical Center researchers. The study looked at data on patients receiving care through VA for atherosclerotic cardiovascular disease. Researchers looked at medication refill data to see whether patients were taking prescribed statins. Patients with at least one lipid panel over a one-year period had a 66% chance of adhering to their medication, while those without a lipid panel had a 61% chance. Among new statin users, 68% adhered to their medication when they had a lipid panel within 4–12 weeks of beginning treatment. For those without a lipid panel, adherence was 59%. While the difference is modest, routine statin testing can significantly increase patient’s statin adherence, according to the researchers. (American Journal of Medicine, May 16, 2019)
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Study: Almost all VA patients would benefit from gene tests to guide drug choice
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Almost all Veterans would benefit from genetic testing to see how they would react to various medications, according to a study of data from nearly 8 million Veterans. Specific gene variants affect how people respond to different drugs. The researchers looked at pharmacy and demographic data on 7.7 million Veterans who used VA pharmacies over a six-year period. They projected, based on the Veterans’ demographics, that 99% would have at least one gene variant that could affect their response to commonly used drugs. Common prescriptions in VA that could be affected by gene variation included simvastatin (sold as Zocor) for high cholesterol, tramadol (sold as Ultram) for pain, and warfarin (sold as Coumadin) for high blood pressure. Genetic testing could influence prescribing decisions for many Veterans, concluded the researchers. (JAMA Network Open, June 5, 2019)
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New insight into how cancer spreads
 Illustration: ©iStock/Mohammed Haneefa Nizmudeen (06/04/2019)
An international study led by a researcher at the VA San Diego Healthcare System yielded new insight into how cancer spreads. The study focused on a protein known as Caveolin-1, or Cav-1, which scientists have found plays a role in cancer cell migration from a primary tumor into other areas of the body. The new study tested whether a particular part of this protein, called the caveolin scaffolding domain, or CSD, is critical in this process. The team engineered cancer cell lines into three categories. One over-expressed the entire Cav-1 protein. The second over-expressed the protein but without a working CSD. The third over-expressed green fluorescent protein, as a control. The researchers found that cancer cell migration was inhibited in the first group of cells, but increased in the second group, the cells without the CSD. The finding supports their theory that Cav-1 thwarts cell migration through its CSD. They write, “Modulating the CSD and targeting specific proteins may offer potential new therapies in the treatment of cancer metastasis.” Besides VA and a few other U.S. institutions, the work involved collaborators in Japan, Scotland, and Pakistan. (Cell Cycle, online May 22, 2019)
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CPAP machines and insomnia
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Many people with sleep apnea—a potentially dangerous condition in which breathing repeatedly stops and starts during sleep—use a continuous positive airway (CPAP) device, which pumps air through the nose. VA researchers in Pittsburgh and colleagues looked at how CPAP therapy affected insomnia among patients with Type 2 diabetes and sleep apnea. Not surprisingly, they found that greater use of CPAP was associated with improvements in insomnia overall. Specifically, the therapy helped with difficulty staying asleep, and with early waking. However, CPAP use did not appear to help difficulty falling asleep. The researchers say it’s important to delve into the specific type of insomnia patients experience, and to understand the potential pros and limitations of CPAP for each type. (American Thoracic Society meeting, May 20, 2019)
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Overuse of antibiotics in dental care
 Photo: iStock/sturti (06/04/2019)
A study led by investigators at VA’s Center of Innovation for Complex Chronic Healthcare found that the great majority of preventive antibiotic prescriptions written by dentists in the U.S. are not in accord with clinical guidelines, and are unnecessary. The team analyzed more than 168,000 dental visits involving more than 91,000 U.S. patients using commercial dental health plans. Per current guidelines, only patients with cardiac conditions who are at high risk for endocarditis, in which germs from other parts of the body, such as the mouth, spread to the heart, should receive prophylactic antibiotic treatment before invasive dental procedures. The study found that dentists, on the whole, operated well outside the guideline, and that 8 in 10 preventive antibiotic prescriptions were unnecessary. The researchers called the finding “worrisome,” in light of the ongoing crisis stemming from antibiotic overuse and the proliferation of drug-resistant bacteria. Though their data were from 2011–2015, and they note the situation has been “slowly improving,” they still called for better antibiotic stewardship in dentistry. (JAMA Network Open, May 3, 2019)
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Rural Veterans have higher per-capita opioid use
 Photo: iStock/sassy1902 (06/04/2019)
Rural Veterans receive over 30% more opioids than their urban counterparts, found a study by VA’s Iowa-based Center for Comprehensive Access and Delivery Research and Evaluation. Using national data, the team examined how opioid prescribing varies by region in VA, and whether there are differences based on rural vs. urban status. They used a measure called “morphine milligram equivalents.” The average per-person use for VA patients in 2016 was 1,038 MME. The lowest use was in the Northeast: 894 MME. The highest was in the West, at 1,368 MME. Urban residents averaged 988 MME, compared with 1,306 for those in rural areas. Most of the difference was explained by more long-term opioid use by rural Veterans. Short-term use of the pain medications was similar. The researchers say the reasons for the disparity need to be studied further. It’s possible, they say, that rural Veterans don’t have equal access to non-drug pain treatment for chronic pain. (Military Medicine, May 21, 2019)
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Tinnitus frequently occurs with mental health disorders
 Photo for illustrative purposes only. ©iStock/Ridofranz (05/29/2019)
A study of VA health care users found that nearly 4% met the diagnostic criteria for tinnitus, the perception of ringing, buzzing, or other noises in the ears. The prevalence estimate is based on a random, representative sample of more than 600,00 Veterans who received care in VA between 2011 and 2016. The study found that tinnitus was often co-diagnosed with hearing loss and traumatic brain injury. Tinnitus was also associated with mental health diagnoses, including anxiety, depression, and substance use disorders. While the study wasn’t designed to show cause-and-effect relationships between tinnitus and mental health, the researchers did stress the need for coordinated care between the two areas. A team at VA’s National Center for Rehabilitative Auditory Research led the study. (American Journal of Audiology, April 22, 2019)
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Pinpointing genetic targets for meth addiction
 Photo: ©iStock/JTSorrell (05/29/2019)
Researchers at the Portland VA Medical Center and Oregon Health & Science University are working to understand genetic risk for methamphetamine addiction. In a recent experiment, they used mice that were genetically bred to crave methamphetamine. The researchers first identified two proteins that appear at higher-than-normal levels in the brains of those animals. One is a receptor for glutamate, the most abundant neurotransmitter in the brain, and is known as mGluR5. The other is a scaffolding protein known as Homer2a/b. There are no known drugs that target the latter protein, but there are several that target mGluR5. The next step was to test drugs known to bind to mGluR5 and make it less active. Those drugs, however, appeared to have little effect on the mice’s meth appetite. The researchers concluded that targeting mGluR5 may not be an adequate strategy, and that scientists will need to better understand the role of Homer2a/b in addiction. (International Behavioural and Neural Genetics Society meeting, May 2019)
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Alert to curb antibiotic overuse
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Researchers at the VA Western New York Healthcare System developed a new strategy for reducing inappropriate use of antibiotics. While antibiotics are critical life-saving drugs, their overuse has fueled drug-resistant strains of bacteria. Focusing on outpatient care, which accounts for the majority of antibiotic use, the researchers found that 4 in 10 patients among their sample of more than 1,000 Veterans received an inappropriate prescription. The drug that accounted for the most unnecessary prescriptions was azithromycin. More than half of the prescriptions for this antibiotic were deemed unnecessary. Respiratory infections were the most common conditions for which the drug was used inappropriately. This drug along with three others accounted for 80% of inappropriate prescriptions. The researchers designed an electronic alert, triggered when providers sign a prescription, that allows for real-time intervention to adjust the prescription before the patient leaves the office. They say focusing on the four drugs they identified, to start, will allow for maximum impact. They also recommend patient education to lessen the pressure that prescribers sometimes feel to “appease” the patient with an antibiotic. (American Journal of Infection Control, online March 9, 2019)
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When to change the PTSD treatment plan
 Photo for illustrative purposes only. ©iStock/Wavebreakmedia (05/29/2019)
VA uses two main psychotherapies to treat PTSD—prolonged exposure, and cognitive processing therapy—and they are usually delivered in 8 to 12 weekly sessions. But a new study suggests that Veterans not seeing “meaningful” improvement after eight sessions are unlikely to do so in the remaining weeks of therapy. That’s the main finding from a study led by VA authors in Ann Arbor and Atlanta. The researchers examined the records of more than 2,200 Veterans. All of them had completed at least eight sessions of one evidence-based, trauma-focused psychotherapy or the other, as well as two self-report assessments, in which they answered questions about their PTSD symptoms. Those who reported at least 20% symptom reduction by session eight were twice as likely to go on to achieve “meaningful change”—defined by the researchers as a 50% reduction—in further sessions, compared with all those who continued treatment. For those not seeing meaningful change after eight weeks, the researchers recommend that clinicians consider changing the type or intensity of treatment. (Behavior Therapy, online May 18, 2019)
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Men, women respond differently to 'acceptance and commitment therapy'
 Photo for illustrative purposes only. ©iStock/electravk (05/23/2019)
Men and women Veterans may respond differently to acceptance and commitment therapy (ACT) for emotional distress, according to a VA San Diego Healthcare System study. In ACT, patients are taught not to avoid negative emotions and experiences and learn abilities to help them act in a way that is in line with their values. ACT led to a greater decrease in PTSD symptom severity in women compared to present-centered therapy, whereas the two therapies had similar results in men. A similar trend was seen in changes in general emotional distress, although to a lesser extent than in PTSD. Women were more likely than men to recommend the treatment to a friend. The results underscore that gender differences in coping skills and reactions to stress should be taken into consideration when prescribing psychotherapy, according to the researchers. If future research confirms that women respond better to ACT, it could be important guidance for how to treat women Veterans with PTSD, they say. (Women’s Health Issues, May 3, 2019)
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H. pylori treatment may raise risk of autoimmune disease
 Photo: ©iStock/iLexx (05/23/2019)
Drug treatment for H. pylori infection was linked to an increased risk of autoimmune disease, in a study including a VA Ann Arbor Healthcare System researcher. H. pylori is a type of bacteria that infects the digestive tract. It can cause ulcers and stomach cancer. About two-thirds of the world’s population has the bacteria in their bodies; most people don’t experience problems. Working with data on nearly 80,000 Taiwanese patients, the researchers found that patients treated to eradicate H. pylori infection had a significant increase in risk for autoimmune disease, including irritable bowel disease. The increased risk was not the result of general antibiotic treatment, since patients treated with antibiotics for urinary tract infections had lower autoimmune risk than H. pylori patients. The results suggest that H. pylori colonization could have immune system benefits, say the researchers. The study was published in the journal Clinical Gastroenterology and Hepatology last year, and more recently presented at a meeting. (Digestive Disease Week, May 21, 2019)
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Brain injuries in women after intimate partner violence
 Photo: ©iStock/lolostock (05/23/2019)
A team including a VA Boston Healthcare System researcher summarized the research available on traumatic brain injuries (TBIs) in women as a result of intimate partner violence. They found that intimate partner violence-related TBIs are common, and women in these circumstances often have repetitive TBIs. These injuries are linked with a range of mental health problems, such as anxiety and depression, and with structural and functional brain damage. The authors make several recommendations for future research and clinical practice to address this issue, including using trauma screening tools and risk assessment. (Journal of Aggression, Maltreatment, & Trauma, March 12, 2019)
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Residents and attending physicians provide similar care
 Photo: ©iStock/digitalskillet (05/15/2019)
Resident physicians and attending physicians provide equal quality of care in VA hospitals, found a VA Portland Health Care System study. Residents are doctors who are under the supervision of a more experienced attending physician. Researchers studied data on diabetes quality of care for more than 76,000 patients in 10 VA facilities across the country. Of those patients, 25% were cared for by a resident, while 75% were cared for by an attending physician. Quality-of-care measures were similar between both groups. While attending physicians have more experience, the results show that residents provide an important role in caring for patients, often caring for new patients and those from vulnerable populations. (JAMA Internal Medicine, April 1, 2019)
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Study: Fewer hospitalizations for diabetes patients using both VA and Medicare
 Photo: ©iStock/EXTREME-PHOTOGRAPHER (05/15/2019)
Diabetes patients who used only VA medical care or Medicare rather than both systems together were more likely to have been hospitalized, in a study by researchers from the VA Greater Los Angeles and New Jersey health care systems. Researchers looked at data from 2007-2010 on more than 200,000 Medicare-eligible Veterans with diabetes. Patients who used both VA and Medicare for either primary or supplementary care were less likely to have a hospitalization during the study period. The study population was primarily older and had multiple complications related to diabetes. The results suggest that hospitalized older patients with diabetes may be so medically complex that they benefit from having more providers involved in their care, say the researchers. This need may outweigh the risk of care fragmentation that comes with using two different health care systems. (Medical Care, April 29, 2019)
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Brain study ties proteins to ‘cognitive trajectory’ in aging
 Photo: ©iStock/malgorzata tatarynowicz (05/15/2019)
A group including Atlanta VA Medical Center researchers has identified protein markers in the brain that affect aging-related cognitive decline. The researchers followed 143 patients for up to 14 years to track whether they had any cognitive decline as they aged. Upon patients’ death, the researchers studied the donated brains. They found 579 proteins to be associated with cognitive trajectory. Specifically, patients who showed greater cognitive stability had increased levels of proteins involved with mitochondrial activities or synaptic function. These findings show markers that affect cognitive decline that have not been previously considered in cognitive status and Alzheimer’s disease diagnoses. The results suggest promising targets for future research on how cognitive ability changes as people age, say the researchers. (Nature Communications, April 8, 2019)
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Tinnitus characteristics do not affect impact
 Photo for illustrative purposes only. ©iStock/Westbury (05/08/2019)
Perceived loudness and pitch do not change the impact of tinnitus, according to a VA Portland Health Care System study. Tinnitus is a sound—such as ringing or buzzing—in the ears when no outside sound is present. It is the No. 1 disability affecting Veterans. Researchers surveyed 223 participants on how they perceived tinnitus. They found that how loud the sound seemed to participants and the pitch of the noise was not related to how bothersome the tinnitus was. The results suggest that how patients react to tinnitus has a greater impact on their quality of life than how they perceive the sound, in terms of loudness, pitch, or other sound qualities. (American Journal of Audiology, April 22, 2019)
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Algorithm for identifying PTSD in electronic health records
 Photo: ©iStock/Laurence Dutton (05/08/2019)
Researchers with VA’s Million Veteran Program have designed a computer algorithm to identify PTSD in electronic health records. Although PTSD may be noted in a patient’s electronic health record, researchers would need to read individual records to pick out patients with the condition for studies. The algorithm searches records for diagnoses and symptoms to classify patients as likely PTSD, possible PTSD, and likely not PTSD. The algorithm had high accuracy when compared with manual chart review. The algorithm could be useful for research and quality improvement endeavors within VA, say the researchers. A quick way to identify thousands of cases using electronic health records would help recruiting for large genome-wide association studies of PTSD. (Journal of Traumatic Stress, April 2019)
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Osteoporosis drug treatment studies show both effectiveness and risk
 Photo for illustrative purposes only. ©iStock/Steve Debenport (05/08/2019)
Minneapolis VA Health Care System researchers reviewed the existing evidence on long-term drug therapy to prevent fractures in patients with osteoporosis. They surveyed 35 trials and 13 observational studies of various osteoporosis drugs. The literature shows that long-term treatment with alendronate acid or zoledronic acid, two drugs known as bisphosphonates, reduces fracture risk in women with osteoporosis. Long-term bisphosphonate treatment may increase risk for rare adverse events, but continuing this treatment beyond three to five years may reduce the risk of vertebral fractures. Another osteoporosis treatment, long-term hormone therapy, reduces hip fracture risks but has serious side effects, according to the literature. One limitation of the review is that the researchers did not find any studies involving male patients. (Annals of Internal Medicine, April 23, 2019)
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Evidence lacking on use of massage for pain
 Photo: ©iStock/skynesher (05/01/2019)
A literature review by West Los Angeles VA Medical Center researchers found some evidence that massage is beneficial for pain, but the evidence was weak. The literature search turned up 32 high-quality systematic reviews on massage and pain. These studies showed potential benefits of massage for a wide variety of pain, including low back, neck, and cancer pain. However, the evidence was low-strength (meaning researchers were unable to confidently draw conclusions). Factors affecting the usefulness of massage included style, provider, duration, and other treatments used. Too few studies and not enough details are available to draw conclusions about the usefulness of massage for treating pain, according to the researchers. (Journal of Alternative and Complementary Medicine, March 20, 2019)
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Treating alcohol problems: Does patient motivation matter?
 Photo for illustrative purposes only: ©iStock/sturti (05/01/2019)
Whether a Veteran receives alcohol use disorder treatment voluntarily or involuntarily does not affect treatment outcome, found a St. Cloud VA Health Care System study. Researchers looked at 120 Veterans being treated for alcohol use disorder in a residential rehabilitation treatment program. Half were admitted under recommendation by a court order. The others were admitted voluntarily. The researchers found no differences between groups in how long participants remained sober after they were discharged. The results show that patients’ motivation for treatment may not be a good predictor of treatment outcomes, say the researchers. (Journal of Addictions Nursing, Jan./March 2019)
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Use of cardiac stress tests varies widely in VA
 Photo: ©iStock/SerafinoMozzo (05/01/2019)
The use of cardiac stress tests for ischemic heart disease patients varies widely across VA facilities, found a Michael E. DeBakey VA Medical Center study. Researchers studied treatment data on nearly 1 million Veterans with ischemic heart disease. The use of cardiac stress tests—such as treadmill exercise and stress echocardiography—varied by as much as 40%, depending on where treatment was received. Use ranged from 2 to 32 tests per 100 patients at different VA medical centers. The cause of this variation is not yet known. The results could suggest that some facilities are overusing this type of test, say the researchers. (JACC. Cardiovascular and Imaging, April 10, 2019)
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Families give high marks to polytrauma care
 Photo: ©iStock/spxChrome (04/25/2019)
A majority of caregivers were satisfied with the inpatient care their loved ones received from VA, in a study of caregivers of Veterans in a VA Polytrauma Rehabilitation Center. Of the 524 caregivers surveyed, 75% were mostly or very satisfied with their loved ones’ inpatient care. Higher satisfaction was linked with greater caregiver social support, receipt of training from VA, and perceptions of being valued by VA. The authors say the results suggest that “supporting a strong social network for caregivers, providing caregiver training, and employing practices that communicate that family caregiving is valued by providers and healthcare organizations are promising avenues for improving caregiver satisfaction.” (PLoS One, March 15, 2019)
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Stress inoculation training shows promise for PTSD
 Photo for illustrative purposes only. ©iStock/asiseeit (04/25/2019)
Stress inoculation training can reduce PTSD and depression symptoms in patients with PTSD and traumatic brain injury, found a VA Northern California Health Care System study. Stress inoculation training is a psychotherapy that teaches patients to prepare themselves in advance to handle stressful events. In the study of 56 Veterans, the majority had significant reductions in PTSD and depression symptoms, better perceived stress tolerance, and improved social and occupational functioning. Eighty-eight percent followed through with recommended follow-up treatment. Stress inoculation training could be a useful treatment for patients who do not want to participate in trauma-focused therapies such as prolonged exposure, according to the researchers. (Psychological Trauma, March 21, 2019)
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Brain thickness measure linked to better attention
 Illustration: ©iStock/Lars Neumann (04/25/2019)
Cortical thickness is linked with sustained attention, according to a study by VA Boston Healthcare System researchers. The cortex is the outer layer of the brain, and is divided into different sections related to various functions. The researchers took high-resolution MRI scans of the brains of 125 participants. The participants then took performance tests to measure how well they could maintain attention. Better attention was linked to more thickness in the visual, somatomotor, frontal, and parietal cortices of the brain, especially in the right hemisphere. Different regions of the cortex also connect and work together to form networks for specific functions. Several networks of brain regions—including two known to be linked to attention—were thicker in participants with better sustained attention. The results show that structural MRI could help explain differences in cognition, say the researchers. (Human Brain Mapping, April 13, 2019)
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Mixed reports from women Veterans on their family-planning experiences
 Photo for illustrative purposes only. ©iStock/PeopleImages (04/24/2019)
Women Veterans had both negative and positive experiences with family planning in the military and VA, in a study by VA Puget Sound and Pittsburgh health care system researchers. Researchers interviewed 32 women Veterans about their family planning care. Nearly all described negative experiences in military or VA health care. These included perceived gender-based discrimination and pressure to choose certain contraceptive methods, judgment of reproductive choices, and lack of continuity with providers. Some women also reported positive family planning experiences in VA. These included feeling respected, receiving comprehensive information about options, and having their perspectives and concerns considered. Women preferred counseling that included providers initiating and validating family planning discussions. Establishing trust and avoiding judgment, asking women’s individual preferences, and engaging them as equal decision-making partners were also important. The results provide key insights that could improve family planning care in VA, say the researchers. (Women’s Health Issues, April 10, 2019)
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Weight management boosts quality of life in serious mental illness
 Photo: ©iStock/emesilva (04/24/2019)
Both in-person and web-based weight management programs improved quality of life for patients with serious mental illness, in a study by Baltimore VA Medical Center researchers. Patients with serious mental illness are often at greater risk for obesity. Researchers analyzed outcomes for patients participating in the in-person MOVE! weight management program or the online version, WebMOVE. Participants in the in-person program showed decreases in loneliness, compared with normal care, after six months. Those in WebMOVE had increases in weight-related self-esteem after six months. Both groups had significant increases in health-related quality of life, compared with patients in usual care. The results show that both in-person and web-based weight management counseling can promote “holistic” recovery for patients with serious mental illness, according to the researchers. (Society of Behavioral Medicine Annual Meeting, March 7, 2019
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Researchers grow axons in lab
 Photo: ©iStock/Henrik5000w (04/24/2019)
A team including a Corporal Michael J. Crescenz VA Medical Center researcher have found a way to create brain axons in the lab. Axons are long, slender fibers projecting from neurons that conduct electrical impulses. Brain damage to the white matter often leads to permanent neurological problems because axons are not known to regenerate much. The researchers used stem cells to generate cortical neurons. Using a technique called axon stretch growth, they were able to grow axon tracts at a rate of one millimeter per day. The technique could potentially make it possible to transplant axons into the brain after injury, say the researchers. (Tissue Engineering Part A, March 29, 2019
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Parkinson’s patients more likely to get recommended care with new model
 Photo: ©iStock/noipornpan (04/11/2019)
A new method of disease management led to improved care processes for Parkinson’s patients, in a study by VA Greater Los Angeles Healthcare System researchers. The study recruited 328 Veterans with Parkinson’s disease at five VA medical centers in California. Half were treated using a nurse-led chronic model called CHAPS. The rest received usual care. The CHAPS group had substantially higher adherence to quality of care indicators, such as assessment of symptoms, counseling, and palliative care. The only patient-centered difference was improvements on a depression screen in the CHAPS group. While this care model shows potential to improve Parkinson’s disease treatment, more refinement is needed to improve patient-centered outcomes, say the researchers. (Neurology, March 22, 2019)
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Molecular delivery system takes arthritis drugs directly to joints
 Photo: ©iStock/Tharakorn (04/11/2019)
Baltimore VA Medical Center researchers developed a technique to deliver arthritis medication directly to the joints. Rheumatoid arthritis drugs can cause bad reactions when healthy organs are exposed. The researchers developed a molecular substance (a peptide ligand called ART-2) that could home in on inflamed joints. A molecular structure called a liposome is coated in ART-2, with the arthritis drug inside. When injected into the body, the drugs go directly to inflamed joints, meaning that other organs are not exposed. When given to rats, the therapy was more effective at stopping arthritis than injection of the same drug without the ART-2. This type of treatment could have many advantages over conventional arthritis therapy, according to the researchers. (Nanomedicine (London), April 2, 2019)
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Racial mortality disparities in VA
 Photo: ©iStock/Andresr (04/11/2019)
VA has reduced many racial disparities in mortality, but differences in risk of death based on race still exist in some areas, found a VA Portland Health Care System study. Racial and ethnic health disparities have been a major problem in U.S. health care, both in the private sector and in VA. A literature review found that black and white Veterans receiving care through VA have similar overall rates of mortality. This could be due to VA’s commitment to equal access to care, according to the researchers. However, black Veterans did have higher mortality from certain conditions: chronic kidney disease, colon cancer, diabetes, HIV, rectal cancer, and stroke. American Indian and Alaska Native Veterans undergoing noncardiac major surgery had higher mortality rates than other groups. Some studies also showed Hispanic Veterans with HIV or traumatic brain injury having higher mortality. Because most studies compare black and white Veterans, more research is needed on health care disparities for other racial and ethnic groups, say the researchers. (American Journal of Public Health, March 2018)
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Post-9/11 Veterans less likely to delay mental health care
 (Photo for illustrative purposes only. DoD/Navy Petty Officer 1st Class Daniel Barker) (04/05/2019)
Post-9/11 Veterans were less likely than others to delay treatment for common psychiatric conditions, according to a study by VA Puget Sound Health Care System researchers. In a study of almost 15,000 people, post-9/11 Veterans were less likely to delay treatment for PTSD and depression than pre-9/11 Veterans or civilians. No differences in treatment time existed between groups for alcohol use disorder. Post-9/11 Veterans with health care coverage from VA in the past year tended to seek out depression treatment earlier than post-9/11 Veterans without VA coverage, pre-9/11 Veterans, and civilians. The results may reflect efforts to engage recent Veterans in mental health care, say the researchers. (Psychiatric Services, March 7, 2019)
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Tailored medical homes provide better experience to homeless Vets
 Photo: ©iStock/Solange_Z (04/05/2019)
Patient-centered medical homes offer a better care experience to homeless Veterans compared with standard primary care, found a study of more than 11,000 patients. In 2012, select VA facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams. Researchers surveyed patients enrolled in H-PACTs, along with those receiving standard care at facilities both with and without H-PACTs. H-PACT patients were more likely than standard-care patients at the same facility to report positive experiences in five domains: access, communication, office staff, provider ratings, and comprehensiveness. Standard-care patients at facilities with H-PACT programs were more likely to report positive experiences with communication and self-management support, compared with patients at facilities without H-PACT. The lessons learned from the program can be applied throughout the VA system to improve care, according to the researchers. (Medical Care, April 2019)
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Sedative prevents neuron cell growth after TBI
Photo: ©iStock/Henrik5000w (04/05/2019)
The sedative diazepam prevented neurogenesis after a traumatic brain injury, in a mouse study by Portland VA Health Care System and Oregon Health & Science University researchers. The growth of new neuron cells in the hippocampus increases significantly after TBI. This can be positive and lead to recovery. It can also be negative and lead to conditions such as epilepsy if the cells do not form correctly. The researchers found that diazepam almost completely prevented the TBI-induced increase in hippocampal neurogenesis in brain-injured mice. While limiting this cell growth could lead to some cognitive impairment, it also prevented aberrant cell growth that causes problems after TBI. According to the researchers, more study is needed on how benzodiazepines such as diazepam could help or hinder recovery from TBI. (Journal of Neurotrauma, Feb. 22, 2019)
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Increased cleaning time may not improve hospital room disinfection
 Photo by Mitch Mirkin (03/27/2019)
More time spent cleaning patient rooms in a hospital may not improve disinfection, found a Central Texas Veterans Healthcare System study. Researchers measured the infectious bacteria count on five room surfaces in a VA medical center—bedrail, tray table, call button, toilet seat, and bathroom handrail—after cleaning in between patients. For some rooms, cleaning time was limited to 25 minutes, while for others cleaning time was unlimited. Longer time spent cleaning did not lead to fewer infectious organisms on surfaces. The results suggest that time spent cleaning beyond 25 minutes may not be necessary to properly disinfect a hospital room, as long as appropriate disinfectants are used and staff is properly trained, say the researchers. (Infection Control and Hospital Epidemiology, March 25, 2019)
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The link between TBI and dementia
 Photo: ©iStock/gorodenko (03/27/2019)
Portland VA Health Care System researchers examined the existing evidence on the link between traumatic brain injury and dementia. Evidence suggest that dementia rates are similar between Veterans and non-Veterans age 65 and older. Multiple studies link TBI with increased risk of dementia in both Veterans and the general population. In Veterans, studies suggest that dementia risk grows progressively larger with higher levels of TBI severity. The researchers identified several evidence gaps where more study is needed. Not many studies have directly compared dementia rates in Veterans and non-Veterans. More research is also needed into the link between TBI and early-onset dementia, as well as into the mechanisms of how TBI raises dementia risk. (VA Evidence Synthesis Program, February 2019)
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Gene variant interacts with stress to accelerate aging
 Photo: ©iStock/zmeel (03/27/2019)
Psychological stress was linked with advanced cellular aging in people with a specific gene variant, in a VA Boston Healthcare System study. Researchers looked at the genotypes of 309 Veterans to see how variants of the longevity gene klotho affected biomarkers of epigenetic age. Epigenetic age refers to how much DNA methylation (a process in which methyl molecules attach to DNA molecules, which can hamper DNA transcription) has occurred, and can be used as a biomarker of how much cells have aged. In some people, epigenetic age can exceed chronological age, which can predict higher mortality risk. They found that a specific form of the gene (rs9315202) interacted with PTSD, sleep disturbances, and pain to predict accelerated epigenetic age. This gene variant also interacted with PTSD to predict inflammation and lower white-matter neural integrity. A different form of the same gene (rs9527025) predicted a slowed epigenetic age. The results suggest that enhancement of the protein produced by the klotho gene could be a treatment target for patients with this gene variant, say the researchers. (Brain, Behavior, and Immunity, March 11, 2019)
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Higher rates of insomnia drug overprescribing in women Veterans
 Photo: ©iStock/Martin Dimitrov (03/20/2019)
Women are more likely than men to be inappropriately prescribed the insomnia drug zolpidem (sold as Ambien) within VA, found a Bedford VA Medical Center study. Researchers looked at prescribing data for more than 500,000 Veterans taking zolpidem. They found that 30 percent of female Veterans taking the drug received an inappropriately high dose of zolpidem, compared with only 0.1 percent of male Veterans. Nearly 19 percent of those women had a prescription to both zolpidem and benzodiazepine, while 14 percent of men did. Benzodiazepine is another insomnia drug that is also used to treat other conditions such as anxiety and seizures. Drug interactions between zolpidem and benzodiazepine are linked with increased hospitalizations. Younger women and those with substance use disorders were more likely to receive too-high doses of zolpidem. Women with anxiety or schizophrenia and men with cancer, anxiety, or schizophrenia were more likely to have overlapping prescriptions. Guidelines recommend lower doses of zolpidem for women than men because of metabolism differences, but many women may still be prescribed similar doses to men. The results show that more attention is needed to gender-specific dosing, say the researchers. (American Journal of Managed Care, March 1, 2019)
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Study finds low adherence to hormone therapy guidelines
 Photo for illustrative purposes only.©iStock/Highwaystarz-Photography (03/20/2019)
Adherence to prescribing guidelines for systemic hormone therapy for menopausal symptoms was low among VA providers, in a VA Greater Los Angeles Healthcare System study. Systemic hormone therapy with estrogen is effective in treating menopausal symptoms such as hot flashes and insomnia. Researchers looked at prescribing in four VA facilities across three states to see how well dosage guidelines were followed. Average guideline adherence was 58 percent. Adherence was highest with new prescriptions, at 74 percent. An inappropriately high dose was used in new prescriptions more than half the time. Most renewals were at a high dose, and only 16 percent had a documented rationale for the dosing. Among 116 prescriptions for systemic estrogen, progesterone was not prescribed in eight cases. Failure to co-prescribe progesterone puts women at increased risk for endometrial cancer. Intervention is urgently needed to improve guideline adherence, say the researchers. They also suggest similar studies should be done in community settings to see how widespread the problem is. (Journal of Healthcare Quality, March/April 2019)
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Women’s health care expenses rise after death of a spouse
 Photo for illustrative purposes only. ©iStock/Tinpixels (03/20/2019)
Bereavement is linked with increased health care spending for women, according to a study by Boston VA Healthcare System researchers and colleagues. The researchers looked at Medicare spending of older adults for the two years before an after their partners’ death. Women increased their health care spending by an average of $625 per quarter after the death of a spouse. There was no significant increase for males who survived their spouses. The increase for women may be because they pay more attention to their own health once they are no longer acting as caregivers for their spouses, according to the researchers. More study is needed to find out why men and women have different patterns of health care spending after the death of a spouse, they say. (PharmacoEconomics, March 13, 2019)
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Long-term posttraumatic stress tied to changes in brain structure
 Photo: ©iStock/Utah778 (03/13/2019)
Posttraumatic stress symptoms can persist decades after trauma exposure and are linked to lower hippocampal volume, according to a study featuring VA San Diego Healthcare System researchers. The study assessed PTSD symptoms in 247 men at two times: when each man was an average age of 38, and again when they were an average age of 62. Participants were Veterans who served during the Vietnam era and had experienced trauma before the first assessment. At the first time point, 8 percent of participants met criteria for presumptive PTSD. At the second time point, 6 percent did, showing that PTSD symptoms remained mostly stable over the 24-year period. Posttraumatic stress symptoms at both times were linked to lower volume of the hippocampus and other brain regions. Participants who had worse symptoms at time 2 had smaller hippocampal volume than they had at time 1. The study confirms what other research has shown, that posttraumatic stress symptoms are present years after trauma, even in the absence of a PTSD diagnosis. The results show that this symptom persistence is highly related to changes in brain structure, say the researchers. (Brain Imaging and Behavior, March 4, 2019)
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TBI and PTSD increase tinnitus risk
 Photo for illustrative purposes only. ©iStock/Westbury (03/13/2019)
Traumatic brain injury and PTSD increase the risk for tinnitus, found a VA San Diego Healthcare System study. Tinnitus refers to hearing sound—such as ringing in the ears—when no external sound is present. Researchers assessed the hearing of 2,600 Marines before and after combat deployment. They found that both PTSD and TBI, particularly blast TBI, were linked to worsening tinnitus. Tinnitus progression also increased with hearing loss. Pre-deployment tinnitus was also likely to continue or worsen after deployment. Screening for PTSD, TBI, and hearing loss may allow for more focused treatment for tinnitus, say the researchers. (Military Medicine, Feb. 22, 2019)
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Study sheds light on pesticides-Alzheimer’s link
 Photo: ©iStock/SVproduction (03/13/2019)
A team including two VA researchers have found a possible mechanism for how exposure to pesticides increases the risk of Alzheimer’s disease. Occupational exposure to organophosphate pesticides—such as experienced by agricultural workers—has been shown to increase the risk of Alzheimer’s disease. The researchers exposed rats to the chemical chlorpyrifos to simulate this pesticide exposure. Exposure resulted in dysregulation of microglial cells (a type of cell involved in the immune defense of the brain and spinal cord). Exposed rats showed accelerated neurodegeneration. The neurodegeneration was more severe in male rats, and only male rats showed cognitive impairment over 20 months. The results suggest that future treatments to preserve or restore the microglia could help prevent Alzheimer’s disease in people exposed to pesticides, according to the researchers. (NPG Aging and Mechanism of Disease, Jan. 22, 2019)
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Testosterone replacement with exercise boosts muscle mass after spinal injury
 Photo: ©iStock/vadimguzhva (03/08/2019)
Low-dose testosterone replacement therapy paired with resistance training can lead to improved muscle mass and health in spinal-cord-injured patients, according to a Hunter Holmes McGuire VA Medical Center study. Loss of muscle mass is often a problem in patients with spinal cord injury. Patients underwent twice-weekly resistance training for 16 weeks, using ankle weights and electrical stimulation to activate the paralyzed muscles in their legs. They were also given testosterone replacement therapy via a patch. Patients receiving both testosterone and resistance training had improved body lean mass, muscle mass, and knee extensor strength. The patients also showed trends in less body fat, increased metabolic rate, glucose effectiveness, and inflammatory response. The results suggest that low-dose testosterone replacement therapy could ease the negative muscle and metabolic effects of spinal cord injury. (Journal of Neurotrauma, Feb. 22, 2019)
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Cheese may increase prostate cancer risk for men with gene variant
 Photo: ©iStock/lechatnoir (03/08/2019)
The amount of cheese eaten may interact with specific gene variants to greatly increase the risk of prostate cancer, found a VA Portland Health Care System study. Researchers studied the genomes of 187 patients with prostate cancer and 306 controls without cancer. They looked at how 31 different dietary factors interacted with six genes known to be related to prostate cancer risk. They found that, for patients with a specific variant of one of the genes, each additional daily serving of cheese increased the risk of prostate cancer 16-fold. Past research has linked dairy to prostate cancer risk. In the new study, prostate cancer risk decreased by 37 percent per daily serving of fruits in the same group. The results suggest that patients’ diet and genetic variation can interact to affect their risk of prostate cancer, say the researchers. (12th Annual Multi-Institutional Prostate Cancer Program Retreat, March 3, 2019)
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Understanding a cause of aortic aneurysm
 Illustration: ©iStock/mr.suphachai praserdumrongchai (03/08/2019)
A team including a researcher from the Harry S. Truman Memorial Veterans’ Hospital used a mouse model to explore the underlying causes of abdominal aortic aneurysm. An aortic aneurysm is when the aorta (the largest artery in the body, which carries blood from the heart to the rest of the body) becomes enlarged. This can cause it to rupture, leading to death. The researchers found that a deficiency of a protein called IL12p40 can lead to aortic aneurysm. It does this by leading to a build-up of M2 macrophages—white blood cells that decrease inflammation. This can lead to aortic stiffness and damage to the cellular matrix. The results suggest that, for aortic health, balance is needed between M2 macrophages and M1 macrophages—white blood cells that promote inflammation. (Arteriosclerosis, Thrombosis, and Vascular Biology, February 2019)
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Sleep habits predict mortality
 Photo for illustrative purposes only. ©iStock/monkeybusinessimages (02/28/2019)
Sleep quality and duration are useful in predicting mortality, according to a study including a Minneapolis VA Health Care System researcher. Researchers looked at health data on more than 8,000 older adults, covering an average of 13 years. Using machine learning programs, they found that a multidimensional set of sleep factors was a significant predictor for all-cause and cardiovascular mortality. The most predictive sleep characteristics were time spent in bed, time to bed, wake-up time, and napping habits. Sleep was less predictive of all-cause mortality than factors such as demographics, physical health, or medication but more predictive than health behaviors such as smoking or drinking alcohol. The results suggest that developing comprehensive tools to measure sleep quality and habits could help predict mortality risk, say the researchers. They add that such tools could also aid in working with patients to improve their sleep habits. (Journal of Gerontology, Feb. 18, 2019)
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For those with chronic illness, brief cognitive behavioral therapy reduces suicidal thought
 Photo for illustrative purposes only. ©iStock/asiseeit (02/28/2019)
Brief cognitive behavioral therapy (bCBT) can reduce suicidal thoughts, found a Michael E. DeBakey VA Medical Center study. Cognitive behavioral therapy is a psychotherapy that focuses on changing thoughts and behaviors that contribute to emotional distress. Patients with congestive heart failure or chronic obstructive pulmonary disease who also had depression and anxiety symptoms received four months of bCBT. Those who received bCBT were less likely to have suicidal thoughts after treatment, compared with patients who received usual care. They were also less likely to have suicidal thoughts four, eight, and 12 months after treatment. The results suggest that bCBT delivered in primary care can reduce suicidal ideation, even when the therapy does not directly target suicide. (General Hospital Psychiatry, Feb. 8, 2019)
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Loved ones’ support helps keep Veterans in PTSD treatment
 Photo: ©iStock/PeopleImages (02/28/2019)
Support of loved ones is important to keeping Veterans from dropping out of PTSD treatment, found a Minneapolis VA Health Care System study. Researchers interviewed Veterans undergoing prolonged exposure therapy or cognitive processing therapy—two forms of psychotherapy considered the gold standard for PTSD care—at four VA medical centers. They found that Veterans whose loved ones encouraged them to participate in treatment and face distress were twice as likely to remain in PTSD treatment, compared with those without such support. The researchers concluded that providers should routinely assess how much support for treatment Veterans are getting at home. (Journal of Consulting and Clinical Psychology, March 2019)
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Early palliative care may help avert unhelpful chemotherapy
 Photo: ©iStock/Pornpak Khunatorn (02/20/2019)
Early palliative care led to less receipt of unhelpful chemotherapy in patients with advanced lung cancer, in a study by VA Portland Health Care System researchers. Chemotherapy is not recommended for patients with advanced lung cancer because it is unlikely to be helpful. However, many patients continue to receive it anyway. Researchers studied more than 23,000 patients with late-stage lung cancer over a seven-year period. Of those, 37 percent received palliative care within 90 days of cancer diagnosis. Forty-five percent of the total group received chemotherapy. Thirty-four percent of patients who received early palliative care also received chemotherapy, compared with 51 percent who did not receive early palliative care. Those who received early palliative care also had lower rates of high-intensity chemotherapy. According to the researchers, early palliative care may optimize patient selection for chemotherapy. This could lead to less use of high-intensity therapy, promoting a focus on quality of life in accordance with patients’ performance, preferences, and care goals, they say. (Journal of Thoracic Oncology, February 2019)
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Educational tool helps patient understand electronic health records
 Photo for illustrative purposes only. ©iStock/shapecharge (02/20/2019)
A resource called NoteAid led to better patient understanding of medical notes within their electronic health records, found a study headed by a Bedford VA Medical Center researcher. NoteAid is a freely available Web-based tool to help patients learn more about a diseases and conditions mentioned in their electronic health records. The system identifies medical concepts within doctor notes and provides links to lay definitions and resources. Patients given access to NoteAid scored higher on a test of comprehension for medical notes within their records, compared with a baseline group and patients given a passive educational resource. The results show that tools such as NoteAid can help patients better understand their own electronic health records. (Journal of Medical Internet Research, Jan. 16, 2019)
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Androgen deprivation therapy may increase depression risk
 Photo: ©iStock/Luso (02/20/2019)
Androgen deprivation therapy was linked to an increased risk of depression in men with prostate cancer, in a VA San Diego Health Care System study. Prostate cancer cells require androgen hormones (such as testosterone) to grow. Reducing the level of these hormones can prevent the cancer cells from growing. Researchers looked at nearly 40,000 Veterans with prostate cancer who were treated with radiation therapy. Those also treated with androgen deprivation therapy had higher rates of new depression diagnoses and outpatient psychiatric services, compared with those not given the therapy. This group did not have higher rates of inpatient psychiatric use or suicide. The results may provide further evidence for the long-term risks of androgen deprivation therapy, say the researchers. (Cancer, Feb. 12, 2019)
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Rat study: Brain injury can cause PTSD without psychological stressors
 Photo: ©iStock/fotografixx (02/14/2019)
A mouse study by James J. Peters VA Medical Center researchers found that PTSD can occur after a traumatic brain injury even without a corresponding psychological trauma. PTSD and TBI often occur together in Veterans, but it is difficult to separate their effects. The researchers exposed rats to repetitive low-level blasts while the rodents were under anesthesia. The rats showed anxiety and PTSD-like behavior for at least nine |
