Alcohol use disorder prevalent among Veterans

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(05/04/2022)
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)

Genetic testing could protect against adverse drug interactions

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(05/04/2022)
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)

Post-concussive symptoms linked to suicide risk

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(05/04/2022)
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)

Pain in non-amputated arm common in Veterans with arm amputation

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(04/27/2022)
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)

Older and underweight Veterans at higher risk of death from COVID-19

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(04/27/2022)
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)

Transgender Veterans more likely to be prescribed opioids

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(04/27/2022)
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)

Using genetic tests to assess disease risk

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(04/22/2022)
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)

Standing wheelchair performs well in testing

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(04/22/2022)
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)

Veterans’ health worsens over time after leaving military

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(04/22/2022)
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)

Military sexual trauma linked to multiple health problems

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(04/13/2022)
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)

Seizure drug may help treat posttraumatic irritability

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(04/13/2022)
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)

Mindfulness program could lower opioid misuse

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(04/13/2022)
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)

Post-surgery opioid use increases opioid use disorder and overdose risk

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(04/07/2022)
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)

VA depression screening leads to treatment, but improvements needed

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(04/07/2022)
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)

Behavioral health provider burnout

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(04/07/2022)
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)

COVID-19 increases diabetes risk

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(03/31/2022)
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)

Stem cells could speed up wound healing

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(03/31/2022)
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)

Racial disparities in menopause management

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(03/31/2022)
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)

COVID-19 vaccines largely effective over long-term

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(03/23/2022)
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)

Strengths, weaknesses of housing-first homelessness program

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(03/23/2022)
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)

Suicide rate increasing in American Indian and Alaska Native Veterans

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(03/23/2022)
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)

Small shifts in VA colon cancer screening during pandemic

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(03/16/2022)
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)

Stigma makes Veterans less likely to disclose suicidal behavior

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(03/16/2022)
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)

Diabetes drug could help treat flu

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(03/16/2022)
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)

Integrated mental health care may improve physical health

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(03/09/2022)
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)

Self-directed care program helps older Veterans live independently

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(03/09/2022)
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)

Alcohol and drug use severity affect PTSD differently

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(03/09/2022)
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)

Electronic appointment reminders improve VA wait times

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(03/01/2022)
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)

Horse riding could help Veterans with addiction

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(03/01/2022)
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)

Gene strands linked to cognitive decline identified

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(03/01/2022)
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)

COVID-19 increases mental health risks

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(02/24/2022)
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)

Biomarkers may predict depression in pregnancy

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(02/24/2022)
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)

Automated wheelchair system to travel over curbs

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(02/24/2022)
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)

COVID-19 increases cardiovascular risk

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(02/15/2022)
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)

Problem drinking patterns after traumatic brain injury

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(02/15/2022)
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)

Veterans with and without mental illness equally likely to get COVID-19 vaccine

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(02/15/2022)
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)

Digital app could improve loneliness and quality of life

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(02/10/2022)
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)

Possible new biomarker for antidepressant effectiveness

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(02/10/2022)
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)

Brain structure changes linked to impairment after stroke

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(02/10/2022)
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)

Gene variants increase COVID-19 kidney risk in patients with African ancestry

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(02/01/2022)
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)

Depression may be linked to genetic cause of Alzheimer’s

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(02/01/2022)
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)

Sound waves could help treat musculoskeletal injury

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(02/01/2022)
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)

Telehealth may be best method to deliver PTSD therapy

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(01/25/2022)
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)

Moral injury increases Veterans’ suicide risk

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(01/25/2022)
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)

Oxytocin may improve opioid use disorder treatment adherence

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(01/25/2022)
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)

Study identifies gene variant that may protect against severe COVID-19

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(01/19/2022)
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)

VA patients may receive better diabetes care than non-VA patients

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(01/19/2022)
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)

Women Veterans less likely than men to be prescribed statins

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(01/19/2022)
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)

Group cohesion an important part of suicide prevention group therapy

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(01/12/2022)
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)

Less racial disparity in VA than non-VA care for bladder cancer

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(01/12/2022)
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)

Lower risk of death from surgery in VA hospitals than outside facilities

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(01/12/2022)
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)

Potential new treatment for cocaine use disorder

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(12/27/2021)
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)

Crowded psychiatric units may increase suicide risk

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(12/27/2021)
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)

Phone app may help treat insomnia

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(12/27/2021)
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)

Risk factors for Veteran suicide

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(12/27/2021)
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)

COVID-19 antibodies decline after six months in nursing home residents

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(12/27/2021)
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)

Drug may help prevent cardiovascular complications of kidney disease

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(12/27/2021)
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)

Psychotherapy an effective treatment for anger

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(12/15/2021)
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)

Genetic mutations linked to esophageal cancer identified in African American patients

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(12/15/2021)
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)

Lithium can stabilize circadian rhythm in bipolar disorder

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(12/15/2021)
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)

Diabetes drug metformin may lower liver cancer risk in diabetic patients

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(12/03/2021)
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)

Combination antibiotics may effectively treat drug-resistant bacteria

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(12/03/2021)
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)

Asthma drug may reduce lung cancer risk

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(12/03/2021)
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)

Lithium does not appear to improve suicide risk

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(11/24/2021)
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)

Telemedicine could help reduce emergency department overcrowding

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(11/24/2021)
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)

Smartphone app aims to help prevent Veteran suicide

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(11/24/2021)
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)

Daily fasting could improve metabolic health, suggests mouse study

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(11/17/2021)
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)

Homelessness, justice involvement linked to mental health difficulties

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(11/17/2021)
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)

Solar activity may be linked to high blood pressure in elderly men

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(11/17/2021)
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)

COVID-19 vaccine effectiveness wanes, but remains high against death

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(11/10/2021)
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)

E-cigarettes may increase inflammation, disease risk

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(11/10/2021)
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)

PTSD medication disparities between rural and urban VA patients mostly eliminated

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(11/10/2021)
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)

Tau protein linked to traumatic brain injury, processing problems

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(11/02/2021)
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)

Pregnancy-related anxiety linked to postpartum depression

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(11/02/2021)
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)

Transcranial magnetic stimulation can improve depression, PTSD

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(11/02/2021)
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)

Low-value prostate cancer screening common in VA

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(10/26/2021)
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)

Mild traumatic brain injury linked to prolonged health problems

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(10/26/2021)
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)

Statin use may increase diabetes progression

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(10/26/2021)
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)

Biological pathways of suicide risk identified

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(10/21/2021)
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)

Statin use disparities

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(10/21/2021)
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)

Many VA health care enrollees purchase outside insurance

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(10/21/2021)
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)

Military sexual trauma independently increased suicide risk

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(10/21/2021)
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)

Legal involvement increases risk of opioid overdose death

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(10/21/2021)
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)

Poor diet quality in older Veterans with PTSD

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(10/21/2021)
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)

Severe obesity a risk factor for death from COVID-19

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(10/06/2021)
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)

Disability compensation may affect PTSD treatment response

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(10/06/2021)
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)

Transcranial magnetic stimulation safe for patients with alcohol use disorder

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(10/06/2021)
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)

Heart rate variability as a biomarker of PTSD treatment response

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(09/29/2021)
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)

Cough medicine may reduce flu hospitalizations

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(09/29/2021)
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)

Gender-based health care disparities

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(09/29/2021)
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)

Primary care employment support helps Veterans with psychiatric disorders

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(09/22/2021)
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)

Gulf War chemical exposure could cause cell dysfunction

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(09/22/2021)
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)

Differentiating between Veterans who think about and attempt suicide

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(09/22/2021)
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)

Review: No link between cinnamon and lower cardiovascular risk

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(09/16/2021)
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)

High altitude may negatively affect brain chemistry

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(09/16/2021)
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)

PTSD and traumatic brain injury alter brain connectivity

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(09/16/2021)
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)

COVID-19 pandemic has not increased suicide risk in Veterans

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(08/30/2021)
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)

PTSD treatment improves sleep

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(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)

Testosterone treatment not associated with cardiovascular events

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(08/30/2021)
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)

New tool to predict suicide risk

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(08/26/2021)
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)

Smoking, alcohol use tied to lower mortality risk in COVID-19 patients

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(08/26/2021)
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)

Treating vitamin D deficiencies could lower risk of heart attack, death

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(08/26/2021)
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)

Racial gaps in PTSD treatment outcomes

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(08/18/2021)
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)

Convalescent plasma treatment did not affect COVID-19 mortality

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(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)

Toxic exposure increases Gulf War illness likelihood in women Veterans

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(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)

Chronic pain may disrupt nervous system, lead to walking problems

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(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)

Gulf War illness symptoms persist 25 years later

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(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)

TBI and PTSD affect coping skills and self-efficacy differently

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(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)

Equal access to VA COVID-19 testing among racial groups

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(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)

Gulf War toxic exposure may be linked to damaging gene expression changes

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(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)

Knee replacement surgery at VA facilities leads to fewer complications than community surgeries

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(08/04/2021)
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)

Shorter antibiotic treatments effective at treating UTIs in men

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(07/28/2021)
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)

Program could prevent suicide after psychiatric hospitalization

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(07/28/2021)
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)

Factors associated with homelessness

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(07/28/2021)
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)

Nasal swab COVID-19 test less sensitive, easier than sinus swab

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(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)

Remdesivir linked to longer hospital stays for COVID-19 patients

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(07/21/2021)
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)

Eating disorder symptoms linked to trouble at work

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(07/21/2021)
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)

Telehealth increases specialty pain care use

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(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)

Brief intimate partner violence counseling program shows promise

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(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)

Transportation a barrier to colon cancer care

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(07/14/2021)
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)

Race more important than rural-urban residency in suicide risk

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(07/06/2021)
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)

Public transportation, high Veteran population increase VA health care use

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(07/06/2021)
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)

A1c variability linked to increased risk of death in diabetes patients

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(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)

Social and behavioral risk factors did not increase COVID-19 mortality risk in Veterans

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(06/29/2021)
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)

Psychiatric issues increase risk of multiple suicide attempts

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(06/29/2021)
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)

High-performance brain-to-text communication

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(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)

Predictors of response to PTSD treatment

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(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)

Phone intervention can relieve PTSD caregiver burden

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(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)

Discussing firearms storage safety in primary care

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(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)

Trauma-sensitive yoga effective treatment for PTSD

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(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)

Chronic pain linked to cognitive processing problems in Gulf War Veterans

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(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)

Soldiers with chronic pain likely to use VA health care

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(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)

Alzheimer’s screening tool highly effective in Mexican American patients

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(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)

Diabetes linked to worse COVID-19 outcomes

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(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)

Some VA therapists more effective than others at treating PTSD

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(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)

COVID-19 vaccines largely effective in inflammatory bowel disease patients taking immunosuppressants

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(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)

Depression and other conditions often co-occur

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(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)

Affordable Care Act reduced catastrophic health costs for young Veterans

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(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)

Most adult COVID-19 patients develop antibodies

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(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)

PTSD treatment more effective in patients with specific brain traits

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(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)

Veterans more likely to use community care in rural areas

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(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)

Brain connectivity disruption may explain poor social connection in PTSD patients

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(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)

Cognitive behavioral therapy beneficial for dementia patients

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(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)

High blood pressure could cause peripheral artery disease

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(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)

Comparing different forms of transcranial magnetic stimulation

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(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)

Gene therapy could prevent learning and memory loss from Alzheimer’s disease

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(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)

Cannabis use disorder linked to aggression

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(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)

Combined PTSD, substance use disorder lead to worse social well-being

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(04/27/2021)
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)

Cognitive and motor performance linked in stroke recovery

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(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)

Transportation an important barrier to colorectal cancer care

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(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)

COVID-19 ‘long-haulers’ face increased risk of death and many other health problems

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(04/26/2021)
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)

Inflammation linked to Alzheimer’s disease risk

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(04/21/2021)
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)

Non-suicidal self-injury linked to suicide attempts

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(04/21/2021)
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)

Older adults show low physical activity in and out of nursing facilities

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(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)

Higher risk of suicidal thoughts in American Indian, Alaska Native Veterans

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(04/14/2021)
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)

Veterans open to firearms safety discussions in primary care to prevent suicides

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(04/14/2021)
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)

PTSD symptoms linked to unhealthy diet

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(04/14/2021)
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)

Feelings of anger often lead to self-injury

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(04/06/2021)
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)

Stem cell therapy offers potential treatment for ischemia

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(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)

Peer-led program leads to better Veteran engagement and well-being

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(04/06/2021)
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)

Black patients face credibility bias

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(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)

Challenges of providing telehealth care

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(03/31/2021)
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)

Process behind kidney stone formation

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(03/31/2021)
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)

Mild traumatic brain injury and PTSD frequently occur together

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(03/23/2021)
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)

Morphine could improve heart function in diabetic patients

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(03/23/2021)
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)

Addiction possibly linked to brain asymmetry

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(03/23/2021)
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)

Increasing physical distance in schools not linked to fewer COVID-19 cases

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(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)

Moral injury increases Veteran suicide risk

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(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)

Rural Veterans may have less access to lung cancer screenings

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(03/17/2021)
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)

Meditation program may reduce nursing burnout

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(03/09/2021)
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)

Traumatic brain injury increases sleep disorder risk

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(03/09/2021)
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)

MRI could help detect early Alzheimer’s

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(03/09/2021)
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)

Height loss linked to higher hip fracture risk in older men

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(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)

Simulating feeling in amputated feet

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(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)

Kidney transplant patients have lower risk of death when receiving VA care

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(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)

Quitting smoking linked to less pain

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(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)

Transgender Veterans at high risk of suicide

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(02/23/2021)
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)

Secure messaging changes how Veterans access health care

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(02/23/2021)
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)

Anticoagulants could lower COVID-19 mortality risk

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(02/16/2021)
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)

Recovery needs after suicide attempt vary by gender

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(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)

Temporary financial assistance helps homeless Veterans find stable housing

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(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)

Unexpected or morally questionable combat experiences increase suicide risk

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(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)

Back and neck pain common after upper-limb amputation

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(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)

Bacteria immunization may improve stress response

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(02/10/2021)
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)

Veterans with ALS at high suicide risk

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(02/02/2021)
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)

Technology-based physical activity therapy for COPD cost-effective

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(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)

Study: Shock waves can cause structural brain damage

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(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)

Identifying chronic cough with natural language processing

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(01/26/2021)
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)

Timed muscle stimulation makes wheelchair use easier

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(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)

Stepped care treatment model improves knee osteoarthritis

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(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)

Potential new medication for treating COVID-19

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(01/21/2021)
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)

Sleep coach program improves insomnia

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(01/21/2021)
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)

Cognitive impairment common in homeless adults

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(01/21/2021)
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)

Frailty increases the risk of death after surgery

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(01/14/2021)
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)

Patients with kidney disease have mixed results on blood thinners

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(01/14/2021)
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)

Brain volume abnormalities linked to impulsive suicide attempts

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(01/14/2021)
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)

Disadvantaged patients less likely to receive flu shots

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(01/06/2021)
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)

Nerve stimulation may improve cognitive performance

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(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)

Higher suicide risk in sexual minority Veterans

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(01/06/2021)
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)

Lab study sheds light on insomnia caused by alcohol withdrawal

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(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)

Veterans homeless services use reduces death by suicide

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(12/22/2020)
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)

Higher rates of drug use disorder among transgender patients

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(12/22/2020)
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)

Nurses at higher risk of COVID-19 than other health care workers

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(12/16/2020)
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)

Number of concussions does not affect cognitive treatment response

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(12/16/2020)
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)

Psychiatric conditions not linked to worse nicotine withdrawal

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(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)

Race-based COVID-19 disparities

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(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)

Post-traumatic headaches are often more complex than non-traumatic headaches

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(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)

New technique could improve wound healing

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(12/10/2020)
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)

Elevated immune response leads to more severe COVID-19

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(12/02/2020)
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)

Blood pressure medications not linked to worse COVID-19

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(12/02/2020)
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)

Phone-based diabetic kidney disease care effective for African American patients

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(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)

Inflammation may cause motor slowing in patients with schizophrenia

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(11/23/2020)
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)

Walking program improves diabetes control

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(11/23/2020)
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)

Perceived discrimination linked to worse arthritis outcomes

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(11/23/2020)
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)

Stroke survivor mental deficits negatively affect caregiver well-being

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(11/19/2020)
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)

Program helps lower self-stigma from PTSD

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(11/19/2020)
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)

Exercise alleviates sleep problems caused by nicotine withdrawal

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(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)

Gene variant increases risk of blast-induced memory problems

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(11/12/2020)
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)

Involuntary opioid dose reduction does not lead to more chronic pain

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(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)

Toxic exposure linked to rheumatoid arthritis-related antibodies

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(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)

Molecular DNA changes linked to depression

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(11/06/2020)
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)

Cannabis use linked to psychiatric problems

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(11/06/2020)
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)

Risk factors for COVID-19 death

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(11/06/2020)
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)

Cigarette smoke makes lung infection bacteria more dangerous

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(10/28/2020)
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)

Transcranial magnetic stimulation reduces PTSD-linked anger

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(10/28/2020)
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)

Identity disruption linked to Veteran reintegration trouble

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(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)

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)

Immunotherapy improves cancer survival

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(10/21/2020)
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)

TBI increases risk of dementia to different degrees based on race

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(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)

Many Veterans with suicidal thoughts not receiving mental health care

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(10/14/2020)
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)

Novel risk factors for heart attack in younger patients

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(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)

Yoga a cost-effective treatment for back pain

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(10/14/2020)
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)

Head and neck cancer rates increasing

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(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)

Air pollution linked to stroke risk in atrial fibrillation patients

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(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)

American Indian/Alaskan Native Veterans have higher risk of death

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(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)

Risk factors for lower-limb re-amputation

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(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)

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)

One-day mental health workshop helps rural Veterans in distress

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(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)

Nondrug therapy use for chronic pain common

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(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)

Exploring gene expression in prostate cancer

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(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)

Cause of light sensitivity the same in multiple conditions

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(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)

Understanding prostate cancer molecular processes

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(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)

Opioid misuse linked to emotion dysregulation

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(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)

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)

3D-printed masks can be decontaminated of coronavirus using standard methods

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(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)

Educational program increases Veterans’ confidence in suicide crisis hotline

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(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)

Testing for virus presence after COVID-19 infection

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(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)

Veterans Choice Program did not reduce appointment wait times

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(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)

HIV drug may increase kidney disease, fractures

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(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)

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)

Lower weight, diabetes increase risk of death from pulmonary hypertension

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(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)

Neurostimulation could prevent wheelchair falls

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(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)

Racial/ethnic disparities exist in diabetes control

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(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)

Treatment for depression linked to apathy

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(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)

Many patients receive potentially dangerous medication combinations from dentists

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(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)

Keeping women Veterans in PTSD therapy

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(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)

Potential new migraine medication developed

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(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)

Acid reflux may accelerate COPD progression

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(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)

Veterans with unstable housing at greater risk of death

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(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)

Copper-impregnated hospital surfaces may reduce microbial contamination

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(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)

Implanted electrical stimulation device for paralysis safe and effective

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(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)

New assessment for pulmonary hypertension

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(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)

Measuring brain connectivity after magnetic stimulation

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(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)

Alcohol use changes linked to HIV medication non-adherence

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(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)

History of sexual assault linked to increased emergency department use

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(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)

Efforts to change sexual orientation increases suicidal thoughts, actions

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(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)

Medical record notes often inaccurate

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(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)

Possible molecular link between nonalcoholic fatty liver disease and cancer

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(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)

Increased blood flow in the brain linked to blast exposure

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(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)

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)

Racial disparity in sleep apnea treatment adherence

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(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)

Cirrhosis hospitalizations decline due to COVID-19

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(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)

Trauma exposure worsens work-related outcomes in women Veterans

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(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)

Telehealth adherence in patients with heart failure

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(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)

Statin use linked to lower risk of death in older patients

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(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)

Treadmill training helps correct walking problems in prosthetic users

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(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)

Hormone biomarkers give insight into PTSD treatment response

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(07/06/2020)
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)

Frailty linked to low bone mineral density in men

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(07/06/2020)
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)

Opioid misuse common in older adults

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(06/23/2020)
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)

Exercise training reduces protein linked to muscle pain

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(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)

Less sleep time may predict higher chance of dementia

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(06/23/2020)
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)

Mental health treatment improves lung cancer outcomes

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(06/16/2020)
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)

Prolonged exposure therapy reduces trauma-related guilt

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(06/16/2020)
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)

Patient-aligned care teams help keep patients in VA care

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(06/16/2020)
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)

Psychotic symptoms linked to solitary confinement in incarcerated individuals

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(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)

Secure messaging from clinicians improves diabetes patient self-management

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(06/03/2020)
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)

Blood thinner linked to higher fracture risk

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(06/03/2020)
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)

Blood pressure variability linked to heart failure risk

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(05/28/2020)
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)

Parkinson’s patients with sleep disorder have poorer mental function

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(05/28/2020)
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)

HIV linked to lung impairment

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(05/28/2020)
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)

PTSD suppresses the brain’s immune system

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(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)

Veterans from lower ranks less likely to use mental health care

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(05/21/2020)
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)

Adding social workers to primary care teams reduces emergency room visits

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(05/21/2020)
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)

PTSD may increase risk of autoimmune diseases

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(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)

PTSD and alcohol use disorder feed into each other

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(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)

Migraine genetically linked to other health conditions

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(05/13/2020)
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)

Elective percutaneous coronary interventions in VA largely appropriate

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(05/06/2020)
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)

Many Veterans prefer virtual health care visits

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(05/06/2020)
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)

Survey: Majority of women Veterans feel welcome at VA

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(05/06/2020)
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)

High-dose folic acid may improve diabetic foot ulcer healing

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(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)

Shifting risk factors for cirrhosis

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(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)

High-dose flu vaccine may improve response in rheumatoid arthritis patients

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(04/29/2020)
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)

PTSD increases women Veterans’ risk of heart disease

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(04/23/2020)
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)

Opioid agonist therapy infrequent in VA

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(04/23/2020)
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)

Brain activity relation to emotions could predict PTSD treatment response

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(04/23/2020)
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)

Editorial: Pandemic could increase suicide risk

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(04/16/2020)
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)

Prolonged exposure therapy could improve sexual desire problems

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(04/16/2020)
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)

Spiritual difficulties may increase suicidal thoughts

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(04/16/2020)
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)

Study: Patient outcomes similar with nurse practitioners or physicians

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(04/10/2020)
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)

Mind-body skills intervention improves PTSD symptoms

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(04/10/2020)
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)

Stem cells accelerate diabetic wound healing in mouse model

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(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)

Patient hassles lead to delayed or skipped care

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(04/02/2020)
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)

Gender differences in newly separated Veterans’ health care use

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(04/02/2020)
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)

Infectious disease specialist consultation improves long-term S. aureus outcomes

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(04/02/2020)
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)

Trust of electronic health records sharing differs by race

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(03/19/2020)
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)

Hoarding treatment shows promise

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(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)

Many providers unaware of COPD treatment guidelines

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(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)

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)

Antimicrobial hospital curtains fall short in curbing contamination

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(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)

Exercise boosts quality of life after liver transplant

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(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)

Quality of life improvements for PTSD patients differ by gender

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(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)

Neurofeedback has potential as schizophrenia treatment

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(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)

Possible biomarkers of traumatic brain injury identified

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(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)

Study finds unexpected relationship between social connectedness, depression

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(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)

Online therapy with peer support useful for depression

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(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)

Telehealth PTSD treatment as effective as in-person care, but has higher drop-out

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(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)

Study: Increased opioid dose not linked to improved chronic pain

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(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)

VA patient portal leads to fewer duplicate lab tests

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(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)

Mixed results from peer specialists for formerly homeless Veterans

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(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)

Insight on how subtle cognitive difficulties predict decline

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(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)

Sense of purpose may protect against cognitive decline

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(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)

Benefits of testosterone therapy limited; more research needed

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(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)

Pet ownership linked to lower risk of high blood pressure

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(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)

Study points to shortcomings in VA outcomes for joint replacement surgery

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(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)

Toilet flushing may increase bacteria contamination in hospitals

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(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)

Sexual dysfunction linked to suicidal thoughts in Veterans with PTSD

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(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)

Training program leads to less unnecessary antibiotic prescribing

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(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)

Understanding chemotherapy-resistant lung cancer

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(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)

More study needed on best C. difficile prevention practices

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(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)

Primary care visits linked to better statin adherence

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(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)

Genetics linked to cognitive impairment

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(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)

Mindfulness program could curb suicide among Veterans

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(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)

Study probes link between exercise-induced breathing problems and military exposures

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(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)

Study: End-of-life care for Vets with hearing and vision loss is up to par

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(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)

Complicated grief may make PTSD treatment less effective

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(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)

Gene mutation linked to ALS

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(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)

Post-exertion malaise symptom inconsistent in Vets with Gulf War illness

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(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)

Opioids negatively affect pain relief from antidepressant

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(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)

Drug use treatment up for urban and rural Vets in recent years

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(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)

Sense of purpose appears to ward off cognitive decline

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(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)

Low-vision intervention helps, but challenges remain

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(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)

CPAP compliance lowers diabetic retinopathy risk

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(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)

Present-centered therapy eases PTSD, but not as much as cognitive behavioral therapy

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(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)

Amino acid may protect against kidney damage

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(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)

Excess medication supply potentially a problem for many Vets

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(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)

Insulin overtreatment common in VA nursing homes

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(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)

Study suggests a more accurate approach to diabetes diagnosis

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(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)

Swimming may help protect against knee arthritis

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(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)

Studies lacking on women with TBI

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(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)

E-cigarettes may make it harder for the body to fight off infection

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(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)

Mantram therapy curbs PTSD hyperarousal

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(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)

Does frequent switching of reminder signs help hand hygiene in hospitals?

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(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)

New genetic risk factors for PTSD identified

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(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)

Mouse study explores benefits of calorie restriction

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(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)

Opioids overused in dental care

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(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)

Serious mental illness no barrier to hepatitis C treatment

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(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)

Dietary oils could help with diabetic nerve damage

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(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)

Researchers identify genes related to schizophrenia

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(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)

Smoking linked to higher prostate cancer mortality

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(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)

Diabetic Veterans find peer mentors valuable

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(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)

Alcohol withdrawal in VA hospital patients

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(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)

Tinnitus rates going up in active duty service members

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(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)

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)

Supported employment boosts functional outcomes in PTSD

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(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)

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)

Metformin, versus sulfonylureas, linked to fewer heart issues for diabetes patients with weakened kidneys

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(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)

Mouse study: Potential stroke treatment only effective in males

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(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)

No link found between herbicide exposure and restrictive pulmonary disease

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(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)

Gene linked to thinner cortex in PTSD patients

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(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)

Many VA providers unaware of corticosteroid risks

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(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)

Diabetes risk over time for women Vets of Vietnam era

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(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)

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)

Menopause linked to more opioid prescribing

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(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)

Cardiology visits linked with more statin use

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(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)

Traumatic loss tied to poorer response to PTSD treatment

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(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)

Veterans in rural areas do not face longer kidney transplant wait times

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(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)

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)

Low-value prostate cancer screening prevalent in VA

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(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)

Boosting addiction treatment for opioid misuse

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(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)

Telephone goal-setting may ease depression in diabetic patients

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(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)

Financial incentives fail to boost colorectal screening rates

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(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)

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)

After smokers quit, heart risk declines, but slowly

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(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)

Pre-treatment level of protein could predict cancer drug’s effects

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(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)

Mouse study probes nicotine addiction from e-cigarettes

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(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)

Do more blood pressure drugs pay off for nursing home residents?

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(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)

The formula for effective rapid response in hospitals

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(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)

Women and men differ in understanding of harassment

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(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)

Improving ‘affirming care’ for LGBT Veterans

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(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)

Pre-deployment TBI increases odds of post-deployment alcohol misuse

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(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)

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)

Diabetes and Alzheimer’s risk factors together linked to greater cognitive decline

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(08/01/2019)
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)

Substance use disorder treatment low for both HIV-infected and uninfected Veterans

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(08/01/2019)
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)

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)

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)

Combined VA, Medicare Part D prescription use increases unsafe medication risk

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(07/25/2019)
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)

How aspirin helps against cancer

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(07/17/2019)
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)

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)

Diet quality affects gut microbiome

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(07/17/2019)
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)

Telehealth helps with HIV management

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(07/10/2019)
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)

Care cost lower for diabetes patients primarily seeing NPs or PAs rather than physicians

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(07/10/2019)
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)

Newer hepatitis C drugs pose advantage for diabetes risk

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(07/10/2019)
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)

Continuity of care linked to better outcomes in inflammatory bowel disease

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(07/09/2019)
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)

Complementary and integrative health use linked to lower costs

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(07/09/2019)
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)

Three psychotherapies for depression reduce suicidal thoughts

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(07/09/2019)
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)

Liver cancer risk remains after successful hepatitis C treatment

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(07/09/2019)
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)

Collaborative care plus self-management of chronic pain and mood symptoms leads to best results

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(06/27/2019)
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)

New insight on role of hippocampus in memory

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(06/27/2019)
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)

Rat study: Single injection protects against TBI damage in short term

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(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)

Diabetes drug equally effective across groups

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(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)

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)

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)

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)

Lipid testing boosts statin adherence

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(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)

Study: Almost all VA patients would benefit from gene tests to guide drug choice

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(06/13/2019)
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)

New insight into how cancer spreads

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(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)

CPAP machines and insomnia

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(06/04/2019)
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)

Overuse of antibiotics in dental care

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(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)

Rural Veterans have higher per-capita opioid use

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(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)

Tinnitus frequently occurs with mental health disorders

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(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)

Pinpointing genetic targets for meth addiction

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(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)

Alert to curb antibiotic overuse

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(05/29/2019)
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)

When to change the PTSD treatment plan

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(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)

Men, women respond differently to 'acceptance and commitment therapy'

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(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)

H. pylori treatment may raise risk of autoimmune disease

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(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)

Brain injuries in women after intimate partner violence

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(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)

Residents and attending physicians provide similar care

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(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)

Study: Fewer hospitalizations for diabetes patients using both VA and Medicare

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(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)

Brain study ties proteins to ‘cognitive trajectory’ in aging

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(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)

Tinnitus characteristics do not affect impact

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(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)

Algorithm for identifying PTSD in electronic health records

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(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)

Osteoporosis drug treatment studies show both effectiveness and risk

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(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)

Evidence lacking on use of massage for pain

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(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)

Treating alcohol problems: Does patient motivation matter?

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(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)

Use of cardiac stress tests varies widely in VA

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(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)

Families give high marks to polytrauma care

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(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)

Stress inoculation training shows promise for PTSD

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(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)

Brain thickness measure linked to better attention

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(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)

Mixed reports from women Veterans on their family-planning experiences

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(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)

Weight management boosts quality of life in serious mental illness

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(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

Researchers grow axons in lab

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(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

Parkinson’s patients more likely to get recommended care with new model

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(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)

Molecular delivery system takes arthritis drugs directly to joints

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(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)

Racial mortality disparities in VA

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(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)

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)

Tailored medical homes provide better experience to homeless Vets

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(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)

Sedative prevents neuron cell growth after TBI

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(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)

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)

The link between TBI and dementia

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(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)

Gene variant interacts with stress to accelerate aging

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(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)

Higher rates of insomnia drug overprescribing in women Veterans

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(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)

Study finds low adherence to hormone therapy guidelines

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(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)

Women’s health care expenses rise after death of a spouse

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(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)

Long-term posttraumatic stress tied to changes in brain structure

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(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)

TBI and PTSD increase tinnitus risk

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(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)

Study sheds light on pesticides-Alzheimer’s link

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(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)

Testosterone replacement with exercise boosts muscle mass after spinal injury

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(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)

Cheese may increase prostate cancer risk for men with gene variant

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(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. (12^th Annual Multi-Institutional Prostate Cancer Program Retreat, March 3, 2019)

Understanding a cause of aortic aneurysm

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(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)

Sleep habits predict mortality

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(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)

For those with chronic illness, brief cognitive behavioral therapy reduces suicidal thought

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(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)

Loved ones’ support helps keep Veterans in PTSD treatment

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(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)

Early palliative care may help avert unhelpful chemotherapy

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(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)

Educational tool helps patient understand electronic health records

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(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)

Androgen deprivation therapy may increase depression risk

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(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)

Rat study: Brain injury can cause PTSD without psychological stressors

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(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 months after the exposure, even though they had been spared significant psychological stress because of the anesthesia. Exposing the rats to predator scent stress months after the blast exposure also caused a PTSD response. This showed the researchers that mild TBI may make the brain more sensitive to future psychological stress. The researchers also found that a specific experimental compound reversed PTSD-related behaviors in the blast-exposed mice, suggesting that it could one day be used to treat such injuries in humans. (Neuropharmacology, February 2019)

‘Next-step’ depression treatment medications are cost-effective

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(02/14/2019)
Adding a second drug to standard depression treatment is cost-effective, according to a VA Palo Alto Health Care System study. Researchers compared three common alternate treatments for depression: standard antidepressant therapy plus aripiprazole, standard therapy plus bupropion, and switching to bupropion from a different antidepressant. Aripiprazole, sold as Abilify and other brands, is commonly used to treat schizophrenia and bipolar disorder. Bupropion, sold as Wellbutrin or Zyban, is an antidepressant and smoking-cessation aid. Health care costs were similar between treatment groups. The aripiprazole group had the highest depression remission rate. The group that supplemented treatment with bupropion had a higher remission rate than the bupropion-only group. The results show that augmenting standard depression therapy with a “next-step” treatment is cost-effective and could be useful, say the researchers. (Journal of Clinical Psychiatry, Dec. 18, 2018)

Many patients taking PPIs concerned about adverse effects

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(02/14/2019)
Concern about proton pump inhibitors is common and leads to attempts to discontinue the medication, found a VA Ann Arbor Healthcare System study. Researchers surveyed 755 patients with gastroesophageal reflux disease who took PPIs. PPIs—brands such as Prilosec, Prevacid, and Nexium—are a class of drugs that reduces stomach acid production. Thirty-three percent of patients were slightly concerned, 32 percent were somewhat concerned, and 14 percent were extremely concerned about adverse effects of PPIs. Of the 39 percent of patients who attempted to stop taking their PPI, 83 percent did so without a doctor’s recommendation. Patients more concerned about adverse effects were more likely to stop taking their PPIs. The results show that doctors should proactively discuss the risks and benefits of PPIs with patients to avoid unwise care decisions, say the researchers. (American Journal of Gastroenterology, February 2019)

Harassment of women Veterans by male Veterans common at VA medical centers

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(02/06/2019)
Harassment of women Veterans by male Veterans at VA medical centers is prevalent, found a VA Greater Los Angeles Health Care System study. Researchers surveyed more than 1,000 women Veterans who used VA health care at any one of 12 facilities. One in four women said they experienced inappropriate or unwanted comments or behavior from male Veterans on VA grounds. The negative interactions included catcalls, sexual remarks, and denigration of Veteran status. Reports of harassment were more common among women with histories of military sexual trauma; other trauma exposure; anxiety, depression, or PTSD; and poorer health. Not surprisingly, women experiencing harassment were significantly less likely to feel welcome at VA and were more likely to not feel safe. Importantly, they were also more likely to delay or miss care. More efforts are needed to make VA health care facilities more inclusive, welcoming, and respectful of women Veterans, say the researchers. (Women’s Health Issues, Jan. 24, 2019)

Mechanism behind COPD lung damage

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(02/06/2019)
Researchers with the Birmingham VA Medical Center and colleagues have shown a possible mechanism for how lung damage occurs in chronic obstructive pulmonary disease (COPD). The researchers showed that inflammatory cells in the lung produce specific proteins that can damage specific critical structural proteins in lung tissue. Particles related to a type of white blood cell bind to and cause damage to the extracellular matrix of the lungs. The neutrophils were found in the lungs of patients with COPD, but not healthy patients. The finding points to a number of approaches for therapies to reduce the progression of lung damage in Veterans with COPD, according to the researchers. (Cell, Jan. 10, 2018)

Melamine promotes kidney stone formation

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(02/06/2019)
Researchers with the Washington DC VA Medical Center explored how melamine can contribute to the formation of kidney stones. Melamine is a type of plastic that can sometimes find its way into the body through products such as plastic tableware. The researchers showed that melamine can promote the forming of crystals of calcium phosphate and calcium oxalate—two substances that commonly make up kidney stones—through chemical reactions. The results will add to the knowledge of how kidney stones form and help scientists understand how melamine acts as an environmental toxin, say the researchers. (Scientific Reports, Jan. 29, 2019)

Neuropathy drives balance problems in HIV

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(02/01/2019)
Neuropathy (nerve damage) can cause balance problems in older people with HIV, according to a study by VA San Diego Healthcare System researchers. Looking at more than 3,000 patients, the researchers found that patients with HIV were more than twice as likely than HIV-negative patients to have had balance problems within the last 10 years. In both groups, patients with diagnosed chronic distal sensory polyneuropathy (cDSPN)—loss of feeling in the toes and feet—had more balance problems than those without. The results show that balance problems caused by neuropathy were more frequent in HIV-positive patients. Older patients with HIV should be assessed for cDSPN to prevent falls, say the researchers. (Journal of Acquired Immune Deficiency Syndromes, Jan. 3, 2019)

Chronic hypoxia a risk factor for suicide

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(02/01/2019)
Chronic hypoxia is a risk factor for suicide, found a White River Junction VA Medical Center study. Hypoxia is when the body does not get enough oxygen. The researchers looked at data on more than 9 million patients, a little over 22,000 of whom died by suicide. They assessed three causes of chronic hypoxia: altitude, smoking, and chronic obstructive pulmonary disease (COPD). Patients who had at least one of the three hypoxia conditions had a significantly increased risk of suicide. Current smokers had nearly two-times greater odds of dying by suicide than those who never smoked. Suicide risk increased as the elevation where a person lives increased. Having multiple hypoxia conditions greatly raised odds of suicide. Patients with all three conditions were nearly four times more likely to die by suicide than patients with no conditions. Patients with these risk factors may need specialized treatments to prevent suicide, say the researchers. (Psychiatry Research, Jan. 12, 2019)

Compounds emerge as potent tools against toxoplasmosis and malaria

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(02/01/2019)
VA Portland Health Care System researchers identified highly effective chemical compounds for fighting toxoplasmosis and malaria. Toxoplasmosis is a disease that can cause vision loss, neurological problems, and death. It is caused by the microscopic parasite Toxoplasma gondii. The researchers tested chemical compounds called endochin-like quinolones (ELQs). They found that the ELQs can stop T. gondii proliferation, even when the parasite is drug-resistant. These compounds may also be effective against malaria, which is caused by a parasite similar to T. gondii. Understanding the chemical interactions involved with these compounds could lead to safer and more effective treatment for toxoplasmosis and malaria. (ACS Infectious Diseases, Nov. 9, 2018)

Therapeutic horseback riding can lower PTSD symptoms

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(01/24/2019)
Therapeutic horseback riding could effectively lower PTSD symptoms in Veterans, found a study by Harry S. Truman Memorial Veterans’ Hospital researchers and colleagues. After three weeks of a horseback riding program, participants had a 67 percent greater chance of having lower PTSD symptoms, compared to a waitlisted group. The likelihood of lower symptoms was 88 percent greater after six weeks. The results show that longer participation leads to better results in self-efficacy and emotion regulation. The study also identified several steps that could make therapeutic horseback riding programs more effective, such as providing transportation to the riding center and child care during classes. (Military Medical Research, Jan. 19, 2018)

Research limited on electrical brain modulation for PTSD

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(01/24/2019)
Evidence is limited on the effectiveness of neuromodulation strategies to treat PTSD, according to a review led by a VA Greater Los Angeles Healthcare System researcher. In neuromodulation, electric currents or fields are applied to the head to influence brain circuits. The researchers looked for published studies on multiple techniques: electroconvulsive therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation, trigeminal nerve stimulation, and deep brain stimulation. While these techniques have had some success in treating other neurological disorders—such as depression and schizophrenia—not much evidence has been gathered related to PTSD. More studies are needed to improve the understanding of how neurocircuitry affects PTSD, say the researchers. (Progress in Neuro-psychopharmacology & Biological Psychiatry, Jan. 11, 2019)

Rates of wrong-site spinal surgery in VA

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(01/24/2019)
The VA National Center for Patient Safety investigated the rates of wrong-site spinal surgery in the Veterans Health Administration. Surgery on the wrong region of the spinal cord is one of the most commonly reported surgical mistakes. The researchers found 32 cases of wrong-site spinal surgery over an 18-year period in the VHA. This equates to an error in 2.66 of every 10,000 spinal surgeries, a rate comparable to that seen nationally outside VA. The most common cause was a problem with the X-ray, such as image quality. Error rates in spinal surgery were steady during the 18-year study period, even though error rates in other types of surgeries declined. New methods to optimize X-ray image quality and interpretation may be needed to correct this problem, say the researchers. (Clinical Spine Surgery, Jan. 11, 2019)

ADHD drug may help in Parkinson’s

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(01/24/2019)
The medication atomoxetine shows potential for treating executive dysfunction caused by Parkinson’s disease, found a Durham VA Health Care System review. Atomoxetine (sold as Strattera) is commonly used to treat ADHD. Executive functioning refers to cognitive processes involved in planning, organizing, and completing tasks. Several studies showed that atomoxetine improves markers of executive dysfunction—such as impulsivity, risk-taking, and global cognition—in Parkinson’s patients. The drug was well-tolerated in most studies, with a few reports of gastrointestinal problems or insomnia. The results show that atomoxetine should continue to be explored to treat Parkinson’s disease, according to the researchers. (Journal of Clinical Psychopharmacology, December 2018)

Chronic kidney disease care varies widely in VA system

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(01/16/2019)
Chronic kidney disease treatment in VA facilities varied widely and was often suboptimal, found a study including Michael E. DeBakey VA Medical Center researchers. The study looked at nearly 300,000 patients with both CKD and diabetes receiving care in 130 VA facilities. They found that rates of laboratory test ordering and nephrology referral scheduling varied widely. Only 13 percent of patients met all outcomes measuring recommended care for chronic kidney disease. The results show that further efforts are needed to standardize CKD care within VA, say the researchers. They did note in an interview with the health website Healio.com that “these rates are similar [to, if not better than those of] other health care systems.” (Clinical Journal of the American Society of Nephrology, Dec. 7, 2018)

Hybrid treatment proves effective for Veterans with PTSD and TBI

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(01/16/2019)
A new hybrid treatment called SMART-CPT led to improvement in PTSD symptoms and cognitive functioning in patients with PTSD and traumatic brain injury, in a VA San Diego Healthcare System study. Researchers combined two treatments to create SMART-CPT. Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) aims to improve memory and function through brain training—such as list memorization and problem-solving drills—after a brain injury. Cognitive processing therapy (CPT)—a widely used PTSD treatment—is talk therapy that helps patients change their thinking about traumatic events. In the study, Veterans with PTSD and TBI were given either CPT only or SMART-CPT. Patients in both groups had lower PTSD and postconcussive symptoms after treatment. Those in SMART-CPT also had additional improvements in attention/working memory, verbal learning/memory, and novel problem-solving. The results show that SMART-CPT can have benefits beyond CPT alone. (Journal of Neurology, Neurosurgery, and Psychiatry, Dec. 15, 2018)

Improving prediction of Alzheimer’s disease

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(01/16/2019)
Changing the criteria for mild cognitive impairment diagnosis to include two separate memory tests allows for better prediction of future Alzheimer’s disease, according to a study including a VA San Diego Healthcare System researcher. The study looked at patients diagnosed with MCI by Alzheimer’s Disease Neuroimaging Initiative (ADNI) criteria who also took a second memory test, the Rey Auditory Verbal Learning Test (AVLT). Patients who showed MCI on both memory tests had consistently higher levels of biomarkers for Alzheimer’s disease, compared with patients diagnosed with MCI by the ADNI but not the AVLT, and cognitively normal patients. Catching Alzheimer’s early gives patients more time to prepare, and medications are more effective in early stages of the disease. Using a single MCI test often yields false positives or negatives, according to the researchers. They concluded that changing the requirement for MCI diagnosis to include two different memory tests could improve prediction of progression to Alzheimer’s disease. (Brain Imaging and Behavior, Dec. 4, 2018)

Racial disparities in electroconvulsive therapy

Illustration: National Institute of Mental Health

(01/14/2019)
Racial disparities exist in the use of electroconvulsive therapy to treat depression in older adults, found a study including a Houston VA health Care System researcher. ECT involves applying electrical current to the brain to treat mood disorders. It has proven effective in treating major depressive disorder when medication does not work. The researchers looked at nearly 700,000 patients older than 65 in a national health care database. They found that black and Hispanic patients were nearly half as likely to receive ECT, compared with white patients. While the research team acknowledges that patient preference may have played some role, they assert that efforts are needed in any case to ensure that minority groups have equal access to care. (American Journal of Geriatric Psychiatry, Nov. 29, 2018)

Barriers to medication treatment for opioid use disorder

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(01/14/2019)
VA Palo Alto Health Care System researchers explored the barriers to using medication to treat opioid use disorder within VA. Evidence shows that medications such as methadone, buprenorphine, and naltrexone care be effective at treating opioid use disorder. However, only 21 percent of patients with the disorder in VA residential treatment are on these medications. According to patient and staff surveys, barriers to this type of treatment include program philosophy against medication use, lack of coordination with other treatment settings, and perceived low patient interest. Having prescribers on staff, education and support for patients and staff, and support from leadership would help facilitate medication treatment, according to survey responses. (Journal of Studies on Alcohol and Drugs, November 2018)

Survey: Most Vets OK with curbing gun access during times of high suicide risk

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(01/14/2019)
Veterans receiving mental health care were in favor of voluntary programs to reduce firearm access during high-risk periods for suicide, in a VA Ann Arbor Health Care System survey. Veterans in mental health care have high rates of firearm-related suicide. Of Veterans surveyed receiving mental health care at one VA facility, 93 percent were in favor of health system interventions to limit firearm access. Of those, 75 percent were in favor of substantially limiting firearm access during times of crisis. While Veterans with household firearms were less likely to be in favor of interventions, 50 percent of the group that owns firearms still said they would participate in an intervention to limit firearm access during high-risk periods. The results suggest that VA and other health systems should consider more intensive efforts to voluntarily limit firearm access during high-risk periods, say the researchers. (General Hospital Psychiatry, Nov.-Dec. 2018)

Risk factors for transition from suicidal thoughts to attempts

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(01/03/2019)
A team co-led by a VA San Diego Healthcare System researcher identified characteristics that differed between service members who contemplated suicide and those who went on to make a suicide attempt. As part of the Army STARRS study, researchers surveyed more than 10,000 soldiers. They found that, compared with soldiers without suicidal thoughts, those with suicidal thoughts had higher rates of interpersonal violence, relationship problems, major depressive disorder, PTSD, and substance use disorder. Soldiers with combat trauma in the past 12 months, intermittent explosive disorder, or any college education were less likely to have suicidal thoughts. Of those with suicidal thoughts in the past 30 days, those with PTSD had higher risk of suicide attempt. Those with intermittent explosive disorder or some college education were less likely to have attempted suicide. The results show that PTSD, intermittent explosive disorder, and education should be considered when studying what makes suicidal ideation transition into suicide attempts. (Depression and Anxiety, Dec. 14, 2018)

Carpal tunnel syndrome treatment varies widely in VA

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(01/03/2019)
Nonsurgical therapy use for carpal tunnel syndrome varies widely within the Veterans Health Administration, according to a study by VA Ann Arbor and Palo Alto researchers. Of nearly 80,000 patients diagnosed with carpal tunnel syndrome, 8 percent had surgery. Across different facilities, between 0 and 93 percent of surgical patients received physical therapy, occupational therapy, or an orthotic. Between 1 and 67 percent of nonsurgical patients received these types of therapy. Between 0 and 100 percent of surgical patients had electrodiagnostic studies (such as X-rays or CT scans), while between 0 and 55 percent of nonsurgical patients had diagnostic scans. The results suggest that clinical practice guidelines are needed to improve the uniformity and efficiency of carpal tunnel care, say the researchers. (Journal of Hand Surgery, Dec. 19, 2018)

Probing the evidence for probiotics

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(01/03/2019)
Evidence suggests that several probiotics are effective to treat various conditions, found a study by an Edward Hines, Jr. VA Hospital researcher and colleagues. Probiotics are live bacteria and yeast that promote a healthy microorganism balance in the digestive tract. While many probiotics are on the market, evidence is lacking on their effectiveness. Researchers reviewed the current medical literature and consulted experts in the field about which probiotics have been shown to be effective. They found enough evidence to suggest that 22 different types of probiotics are effective at treating different conditions. Some probiotics had strong evidence for treatment of conditions such as antibiotic-associated diarrhea, pediatric acute diarrhea, and inflammatory bowel disease. The researchers stress that it is important to pick the correct strain, formulation, and dose of a probiotic to match a specific disease. (PLoS One, Dec. 26, 2018)

Intimate relationships may buffer against suicide

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(12/26/2018)
Strong intimate relationships could help protect service members from suicide, according to a VA Ann Arbor Health Care System study. Researchers surveyed 712 National Guard members after they returned home from deployment. The found that lower relationship satisfaction and more depressive symptoms at six months after deployment were linked to greater risk of suicide 12 months after deployment. Couple satisfaction was related to suicide risk for service members with PTSD, depression, and anxiety. The results show that the strength of an intimate relationship could serve as a buffer against suicide for patients who have these conditions, say the researchers. (Suicide and Life-Threatening Behavior, Dec. 3, 2018)

Molecular brain damage after blast exposure

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(12/26/2018)
A team including researchers from the Bedford VA Medical Center in Massachusetts have shown molecular changes in brain cells that occur after a mild traumatic brain injury. The researchers used a mouse model to simulate exposure to low-intensity blasts, analogous to those experienced by many service members. They found changes in interactions within cells for more than 2,000 different proteins. The brain cells showed mitochondrial dysfunction, as well as other structural damage. This damage negatively affected cell growth, development, and other functions. Understanding what molecular changes occur after mild traumatic brain injury could help scientists better identify and treat brain injuries. (Journal of Neurotrauma, Nov. 28, 2018)

Adding fish oil to a statin did not lead to better cardiovascular health in Veteran study

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(12/26/2018)
Adding fish oil to statin treatment did not improve cardiovascular outcomes in a Fargo VA Health Care System database study that included nearly 1,000 patients. Statins are the standard drugs prescribed for high cholesterol. Past research has shown that fish oil could help prevent major coronary events in patients with high cholesterol. The researchers looked at data for Veterans prescribed either a statin alone or statins and fish oil together. They did not find any difference between the group in number of cardiovascular events—such as heart attack or stroke—or in rates of any-cause death. The results suggest that adding fish oil to statin treatment does not lower the risk of cardiovascular problems. (Federal Practitioner, October 2018)

Lowering of blood pressure medication linked to fewer falls in long-term care

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(12/20/2018)
Deintensification, or lowering, of blood pressure medication could lead to fewer falls in older adults in nursing homes, found a study by researchers from several VA facilities. Researchers looked at data on more than 2,000 VA nursing home residents whose records suggested evidence of overly aggressive blood pressure treatment. Eleven percent of patients had had their medication lowered prior to the study. Those whose medication levels were lowered had a significantly lower risk of recurrent falls than other patients. The results suggest that steps should be taken to deintensify overly aggressive treatment for high blood pressure, say the researchers. (Health Services Research, December 2018)

Lab study suggests heart benefits from widely used diabetes drug

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(12/20/2018)
An international lab study that included a VA San Diego Healthcare System researcher showed that congenital heart disease (CHD) and obesity can lead to heart failure, but treatment with metformin, a widely used diabetes drug, can prevent the condition. CHD is the most frequent birth defect worldwide. Researchers found that the combination of CHD and a high-fat diet in mice led to heart failure. Giving mice the drug metformin prevented this heart dysfunction. Early treatment with metformin may prevent or delay the onset of heart failure in patients with CHD, say the researchers. (Molecular Metabolism, Nov. 15, 2018)

Prolonged exposure therapy, medication equally effective at treating PTSD in new study

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(12/20/2018)
PTSD treatment with prolonged exposure therapy and with the anti-anxiety drug sertraline (sold as Zoloft) showed similar effectiveness, in a study including several VA researchers. Researchers treated 223 Veterans with PTSD with one of three treatments: prolonged exposure therapy plus a placebo, prolonged exposure therapy plus sertraline, or sertraline plus a medication management program. After 24 weeks, patients in all three groups had significantly decreased PTSD symptoms. No significant symptom differences existed between groups. Prolonged exposure therapy, a type of psychotherapy, is a preferred PTSD treatment within VA. The researchers expected that therapy and sertraline together would prove the most effective. The results suggest that adding medication to prolonged exposure therapy does not further improve PTSD symptoms, according to the researchers, although they say more study is necessary. (JAMA Psychiatry, Dec. 5, 2018)

Robotic heart procedure shown to be safe and effective

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(12/12/2018)
Robotic percutaneous coronary intervention is as safe and effective as manual PCI, found a study including VA San Diego Healthcare System researchers. In PCI, surgeons use a catheter to place a stent in blood vessels in the heart. Manual PCI procedures can expose the surgeon to radiation from the X-ray machine, as well as other occupational hazards. Using a robotic platform can protect surgeons from these hazards. To see how well robotic PCI works compared with manual procedures, researchers looked at outcomes from 108 robotic and 226 manual PCIs. They found no differences between the procedures in adverse cardiovascular events after six and 12 months. The results show that robotic PCI can be similarly effective to manual PCI while offering protection to the surgeons. (Catheterizations and Cardiovascular Interventions, Nov. 19, 2018)

Two DNA sites linked to PTSD risk

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(12/12/2018)
A team including a VA San Diego Healthcare System researcher identified two genome sites that may influence a person’s risk for PTSD. While trauma exposure often leads to PTSD, not everyone who experiences trauma develops PTSD. To explore why that is, researchers looked at the genomes of trauma-exposed people with and without PTSD. They found that those with PTSD had more methylation at two specific genome sites: NRG1 and NGS. Methylation is when a chemical compound (methyl) attaches to the DNA molecule. It can change how the DNA segment acts. Future research should focus on whether this DNA activity existed prior to trauma, making it a risk factor for PTSD, or whether PTSD causes the activity, say the researchers. (Epigenomics, Nov. 20, 2018)

Cisplatin superior to cetuximab for cancer treatment

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(12/12/2018)
The drug cisplatin was superior to cetuximab in treating head and neck cancer along with radiation therapy, in a study by researchers from the Michael J Crescenz and James J. Peters VA medical centers. Both cisplatin and cetuximab are commonly given along with radiation therapy to treat head and neck squamous cell carcinoma. The researchers looked at 4,520 cancer patients over a period of three years. They found that those on cetuximab had significantly inferior overall survival, compared with patients taking cisplatin. The results suggest that cisplatin is the most appropriate drug partner for radiation therapy, say the researchers. (Cancer, Oct. 20, 2018)

Large genome study leads to better understanding of high blood pressure

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(12/04/2018)
A large international genetic study that included several VA researchers has identified more than 500 new gene locations that affect blood pressure. The project is the largest genetic study of blood pressure to date, involving more than 1 million participants. It included data from VA’s Million Veteran Program. By comparing participants’ genetic data, researchers identified 535 new locations on the human genome that influence blood pressure. The researchers calculate that the new findings increase the knowledge of inheritable blood pressure traits by 27 percent. They call the findings “an important step forward” in understanding how genes affect blood pressure. (Nature Genetics, October 2018)

Program improved staff interactions with residents

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(12/04/2018)
A training program improved interactions between staff and VA community living center residents, in a study by researchers at several VA facilities. The intervention centered on observations, huddles, and a focus on the positive. Researchers surveyed 62 residents and 308 staff members after the staff behavioral change program. Results showed increased communication and decreased negative staff intervention with residents after the training. Staff members credited the program with helping them to understand the importance of engagement and improving the quality of their interactions with residents. (Gerontologist, July 13, 2018)

White matter damage could explain chronic headaches after TBI

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(12/04/2018)
Researchers with the VA San Diego Healthcare System have identified white matter abnormalities in the brains of patients with mild traumatic brain injury that may help explain their chronic headaches. The study used brain imaging data from 12 patients with TBI and chronic headache, compared with healthy controls. The TBI patients had abnormalities of the white matter in two brain tracts: the left superior longitudinal fasciculus, and the right anterior thalamic radiation. These tracts link different parts of the brain. This disruption of communication within the brain could be partly responsible for chronic headaches often experienced by patients with TBI, say the researchers. (Molecular Pain, Oct. 16, 2018)

Mouse study: Aspirin may slow multiple sclerosis

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(11/29/2018)
Low-dose aspirin could suppress multiple sclerosis symptoms and slow the disease, according to a mouse study by Jesse Brown VA Medical Center researchers. Mice with a condition similar to MS were given small doses of aspirin orally. Mice given aspirin show reduced symptoms for both relapsing-remitting and chronic forms of the disease. The aspirin also seems to have prevented destruction to the myelin sheath in the spinal cord caused by destructive T-cells. The researchers found that aspirin reversed the depletion of regulatory T-cells that occurs in MS, which may have helped stop other T-cells from attacking nerve fibers. While more study is needed, the results suggest that low-dose aspirin regimens could help patients with MS, say the researchers. (Science Signaling, Nov. 27, 2018)

Rural, urban ICUs perform similarly in VA system

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(11/29/2018)
Rural intensive care units (ICUs) in VA facilities perform similarly to their urban counterparts, found an Iowa City VA Health Care System study. Researchers looked at data on nearly 10,000 rural patients and almost 66,000 urban patients. They found that patients treated at rural ICUs had similar mortality rates, despite rural locations having lower-complexity facilities. Rural patients were less likely to have respiratory illnesses and more likely to have sepsis than urban patients, and they had higher illness severity scores. Rural patients also had fewer inter-hospital transfers and shorter ICU length of stay. The results indicate that being part of a national health care system may have benefits for rural facilities that should be explored outside the VA system, according to the researchers. (Journal of Critical Care, Oct. 19, 2018)

Study explains gene mutation’s link to ALS

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(11/29/2018)
Researchers at the VA Lexington Medical Center and University of Kentucky have shown how a gene mutation may contribute to the development of amyotrophic lateral sclerosis (ALS). Mutation to a gene called fused in sarcoma (FUS) are known to contribute to some cases of inherited ALS. The researchers showed that this mutation can suppress protein translation and interfere with how RNA functions in the body. The mutated proteins generated by the FUS gene disrupt an RNA quality-control pathway, which damages neuronal maintenance and function. Because this mutation suppresses how proteins are translated within cells and disrupts how RNA regulates cell activity, it likely contributes to the motor cell death seen in ALS. According to the researchers, the results will add to the understanding of both how this specific mutation can lead to inherited ALS, and more generally how ALS develops. (Proceedings of the National Academy of Sciences, Nov. 19, 2018)

Patients more likely to use psychotropic medication in suicide attempts when they have a prescription

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(11/21/2018)
People at high risk for suicide who had a psychotropic medication prescription were more likely to use that type of drug in suicide attempts than those without a prescription, found a study including a Rocky Mountain Regional VA Medical Center researcher. The study looked at health insurance data for nearly 23,000 people who had attempted suicide. Those who had prescription access to a psychotropic drug were 1.7 times more likely to use that drug to attempt suicide than those without a prescription. People with antipsychotic or mood stabilizer prescriptions had the highest odds of using their prescription drug in a suicide attempt. Antianxiety drugs were the most common class of drugs used, regardless of prescription status, accounting for 59 percent of overdose attempts. The results show that people at risk for suicide with psychotropic prescriptions should be targeted for safety interventions, say the researchers. (Journal of Clinical Psychiatry, Nov. 6, 2018)

High cholesterol linked to lower risk of death in chronic kidney disease patients

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(11/21/2018)
High cholesterol was linked to lower risk of death in chronic kidney disease patients, but higher risk of death in other patients, in a VA Long Beach Healthcare System study. Researchers looked at data on more than 2 million Veterans. They found that, in patients with chronic kidney disease, patients with cholesterol levels higher than 200 mg/dL had lower risk of all-cause death. However, patients without chronic kidney disease had a higher risk of death from cardiovascular conditions when their cholesterol was above 200 mg/dL. More research is needed to explore the seemingly paradoxical relationship between chronic kidney disease and cholesterol, according to the researchers. (American Heart Association Scientific Sessions, Nov. 10, 2018)

Reasons for trauma-focused therapy drop-out

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(11/21/2018)
Minneapolis VA Healthcare System researchers explored why some Veterans with PTSD drop out of prolonged exposure and cognitive processing therapy, the two main forms of psychotherapy that VA uses to treat the condition. About one-third of Veterans who begin prolonged exposure and cognitive processing therapy do not complete treatment. Researchers interviewed 60 patients who completed treatment and 68 who did not to look for differences. They found differences between the groups in the strength of the working relationship between patient and therapist, patients’ ability to cope with increased distress, and internal motivation. Treatment buy-in, logistical factors such as transportation, and beliefs about treatment did not appear to influence the drop-out rate. (Annual Meeting of the International Society for Traumatic Stress Studies, Nov. 9, 2018)

Diabetes prevention program equally effective online and in person

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(11/14/2018)
Diabetes prevention programs delivered in person and online can be similarly effective for both older and younger Veterans, found a VA Ann Arbor Healthcare System study. Researchers looked at data from 378 Veterans enrolled in a weight management program either in-person or online. Over 70 percent of participants completed eight or more sessions within six months. A higher percentage of the online group completed at least eight sessions. Both online and in-person groups saw similar weight loss. Weight loss was the same for both younger participants and participants 65 or older. The results show that online programs may be an good way for diabetes prevention programs to reach older adults, say the researchers. (Diabetes Care, Oct. 30, 2018)

Benzodiazepine use linked to greater hospitalization, suicide risk in those with PTSD

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(11/14/2018)
Patients with PTSD who were prescribed benzodiazepines, such as Valium or Xanax, had higher health care utilization and suicide risk than similar patients not given the drugs, in a study by VA Salt Lake City Health Care System researchers. They looked at data on more than 240,000 Veterans with PTSD. About 7 percent of those were prescribed benzodiazepines during the 14 years examined in the study. Patients prescribed benzodiazepines had more hospitalizations, as well as outpatient and mental health visits, than those not on the drug. Benzodiazepines users had a significantly greater risk of death from suicide, and were more likely to have suicide attempts or suicidal thoughts. The study strengthens the evidence against use of the drugs in Veterans with PTSD, according to the researchers. (Journal of Clinical Psychiatry, Oct. 23, 2018)

Household paints likely to contain rash-causing allergen

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(11/14/2018)
Household paints frequently contain isothiazolinones, despite claims on safety data sheets, according to a study featuring Minneapolis VA Medical Center researchers. Isothiazolinones are commonly used as preservatives in household products, but can cause allergic reactions. The researchers tested 47 common paints. All 47 contained at least one isothiazolinone. Concentration varied based on the type of isothiazolinone present. Isothiazolinones were present even in paint specifically advertised as being preservative-free. Safety data sheets, which are supposed to disclose potential allergens, were inaccurate and insufficient to warn against possible contact dermatitis, say the researchers. (Dermatitis, Oct. 20, 2018)

Omega-3 fatty acids boost neurological health after stroke in mice

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(11/07/2018)
Omega-3 fatty acids were shown to improve neurological health after stroke, in a mouse study by VA Pittsburgh Health Care System researchers. The researchers gave mice food supplements of omega-3 polyunsaturated fatty acids, including from fish oil, for 35 days after a stroke. Mice given omega-3 had better cognitive function and neurovascular healing than those not on the supplements. Omega-3 was not as effective at improving cognitive function in older animals as in younger animals, although older animals did improve some. The results suggest that omega-3 fatty acid could be a promising therapy after stroke, say the researchers. (Neurobiology of Disease, Sept. 12, 2018)

Battlefield acupuncture effective in both groups and individually

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(11/07/2018)
Battlefield acupuncture was effective in treating back pain in both group and individual settings, in a West Haven VA Medical Center study. In battlefield acupuncture, needles are placed in specific sites in the ear to influence the nervous system. The researchers treated 284 Veterans with back pain in either a group or individual setting, for a total of close to 800 treatment sessions. Patients self-reported a decrease in pain after 82 percent of treatments. Patients reported no change after 10 percent of treatments, and reported increased pain after 8 percent of the sessions. Both group and individual treatment had similar rates of effectiveness. The results confirm that battlefield acupuncture could be a useful treatment to relieve pain, whether administered in a group or individually. (Medical Acupuncture, Oct. 1, 2018)

Study reveals how lungs protect against damage from cigarette smoke

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(11/07/2018)
A study by VA Pittsburgh Healthcare System researchers explored mechanisms that protect the lungs from oxidants and how smoking can damage these processes. The researchers looked at two parts of the lungs’ defense system: an enzyme called GPx3 and a hormone receptor called PPAR-gamma. They found that GPx3 expression was decreased in the lungs of patients with chronic obstructive pulmonary disease (COPD). The study showed that PPAR-gamma responds to oxidative stress from cigarette smoke by increasing GPx3 production, which helps protect the lungs from damage. However, the researchers also found that cigarette smoke makes the relationship between GPx3 and PPAR-gamma less effective. They believe that the results could be useful in the development of more effective treatments for COPD. (Free Radical Biology and Medicine, October 2018)

Small molecule has potential as non-opioid pain drug

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(11/02/2018)
A team featuring several VA researchers have discovered a non-narcotic drug that has potential to reduce neuropathic pain. The team designed and synthesized a small molecule that disrupts protein exchange in calcium channels in nerves. Calcium channels control the flow of molecules between nerve membranes, and have been shown to affect how pain is perceived. The channel targeted by the new molecule is important for the release of pain neurotransmitters in the spinal cord. When given to rodents, the molecule lowered their neuropathic pain response. This discovery has potential to be developed into a non-opioid pain medication, according to the researchers. (Proceedings of the National Academy of Sciences, Oct. 24, 2018)

Brain stimulation technique no better than sham version in depression study

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(11/02/2018)
In a trial sponsored by VA’s Cooperative Studies Program, Veterans receiving repetitive transcranial magnetic stimulation for major depression did not show greater signs of remission than those not undergoing the treatment. In TMS, an electromagnetic coil is placed on the head to stimulate a specific brain region. The researchers treated 164 Veterans with treatment-resistant major depression with either TMS or sham treatment. Of those receiving TMS, 41 percent saw remission of depressive symptoms. In the sham group, 37 percent saw remission. The difference was not statistically significant, say the researchers. The results do not support previous studies in civilians showing TMS to be effective for major depression. In fact, the FDA has approved TMS to treat depression that doesn’t respond to other treatments. The VA researchers believe the difference could be that Veterans often have multiple mental health conditions, making treatment more complex. They point to the fact that patients in the TMS group without PTSD were more likely that those with PTSD to achieve remission in the study. The researchers also note that the remission rate for both the TMS and sham groups was higher than seen in previous studies. They say this could be because Veterans had higher expectations of recovery and because their medications and other treatments were closely monitored. (JAMA Psychiatry, Sept. 1, 2018)

Study explores alcohol counseling for Vets in non-VA care

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(11/02/2018)
Veterans were more likely than non-Veterans to be screened by doctors for heavy drinking, found a study by VA Pittsburgh and Puget Sound health care system researchers. While past research has shown that Veterans receiving care through VA have high rates of alcohol screening and intervention, less than 50 percent of Veterans in the U.S. use VA health care. The researchers looked at data on more than 92,000 people who had visited a non-VA doctor for a routine checkup within the last two years, 14 percent of whom were Veterans. The Veterans were more likely to be screened for alcohol quantity and heavy episodic drinking than non-Veterans. They were also more likely to receive advice about alcohol’s harmful effects. However, Veterans were not more likely to receive advice to reduce or abstain from drinking. The results point to some gaps in the delivery of recommended alcohol-related care, especially for vulnerable populations such as women Veterans, say the researchers. (Journal of Substance Abuse Treatment, Sept. 8, 2018)

Food environment can alter weight management effectiveness in men

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(10/25/2018)
The food environment in people’s neighborhoods slightly affects how effective VA’s MOVE! weight management program is, at least among men, found a study by VA Great Lakes Health Care System researchers and their colleagues. MOVE! is a VA program designed to help Veterans eat healthier, be more physically active, and achieve weight loss goals. Researchers studied data on MOVE! patients and community locations for a seven-year period. They found that the program was slightly less effective for men living near fast food restaurants or convenience stores. The food environment did not change the program’s effectiveness among women. The results highlight the importance of considering environmental and community factors in weight loss, say the researchers. (Health Services Research, Sept. 23, 2018)

More research needed on stem cell therapy for diabetic foot ulcers

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(10/25/2018)
Studies suggest that stem cell therapy could be an effective treatment for diabetic foot ulcers, but more research is needed on best techniques, according to a review by a team including a VA Connecticut Healthcare System researcher. Multiple studies have shown that stem cell therapy for diabetic foot ulcers is both safe and effective. However, studies varied widely on what stem cell type they used and how the treatment was delivered. Many different study designs were used, making it difficult to compare techniques. Because of these differences, the researchers emphasize the need for new studies to reach consensus on the best ways to test and deliver stem cell therapy for this condition. (Stem Cell Research & Therapy, July 11, 2018)

Studies teases out impact on kidneys of intensive blood pressure lowering

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(10/25/2018)
Two studies featuring several VA researchers found that intensive blood pressure lowering led to a decline in estimated glomerular filtration rate (eGFR), but not other signs of kidney damage. Doctors commonly use eGFR as a measure of kidney function. Previous research has suggested that intensive blood pressure control can lead to kidney injury. One study (ACCORD-BP) examined blood pressure risk in patients with diabetes. The other (SPRINT) looked at patients with high blood pressure who also had chronic kidney disease. Each study checked eGFR levels, as well as other biomarkers of kidney damage, in different groups of patients undergoing intensive blood pressure lowering treatment. Both found that intensive blood pressure lowering was linked with reductions in eGFR. However, neither study detected increases of biomarkers in the urine that usually indicate kidney damage. Both studies concluded that declines in eGFR may reflect hemodynamic changes—changes to blood flow—rather than actual kidney injury. (American Journal of Kidney Disease, Sept. 28, 2018)

PTSD not tied to asthma in Veteran study

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(10/17/2018)
PTSD was not linked to bronchodilator response, a marker of asthma, in a VA New Jersey Health Care System study. Past research has suggested that PTSD may be linked to symptoms of asthma in combat Veterans. To test this association, researchers looked at the breathing and PTSD symptoms of 188 Veterans of Iraq or Afghanistan. They found that responses to a bronchodilator—a drug that opens the airways, used to treat asthma—were not different between participants with and without PTSD symptoms. The researchers specifically looked at three symptoms of PTSD—re-experiencing, avoidance, and arousal—and did not find any link between any symptom and participants’ breathing. (Canadian Institute for Veteran and Military Health Research, Oct. 16, 2018)

The role of fatty acids in diabetic neuropathy

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(10/17/2018)
Unsaturated fatty acids have potential for treating diabetic neuropathy, according to a review by a VA Iowa City Health Care System researcher. Diabetic neuropathy refers to nerve damage caused by diabetes. Multiple studies show that a diet high in saturated fat slows nerve function in rodents. Other studies with rodents suggest that unsaturated fats like omega-6 or omega-3 fatty acids could improve or even reverse vascular and neural problems. Studies show that resolvins, a type of unsaturated fatty acid, can promote neuron cell growth in diabetic mice. Omega-3 polyunsaturated fatty acids derived from fish oil have anti-inflammatory properties and could help with diabetic neuropathy, says the researcher. Clinical trials would be needed to test whether these substances would help people with diabetes. (Current Diabetes Reports, Aug. 25, 2018)

3D modeling of brain cells reveals protein changes linked to Alzheimer’s

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(10/17/2018)
Researchers from the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts, found protein alterations in neurons of Alzheimer’s disease patients by using a new technique. Studying neurons in a two-dimensional slide under a microscope, the usual way they are analyzed, does not give a full picture. The researchers created “neuro-spheroids,” 3D neuron cultures, using stem cells derived from patients’ blood cells. Using this technique, they found a number of alterations to proteins in the neurons of Alzheimer’s patients that would lead to dysfunction. When compared with postmortem brain tissue taken from Alzheimer’s patients, the 3D neurons showed similar dysfunction. The results show this type of 3D modeling could help find Alzheimer’s disease markers. The identified proteins could have important implications for the progression of the disease, say the researchers. (Journal of Proteomics, June 30, 2018)

Nursing home quality of care linked to cost

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(10/10/2018)
Higher quality of nursing home care was linked to higher cost, in a study of 132 VA community living centers. Researchers looked at data from two years for all community living centers in the VA system. They measured quality of care by looking at rates of adverse health events (such as falls). Fewer adverse events were linked to higher predicted cost, suggesting that greater resources allocated to quality lead to better care. However, higher costs were not driven by higher nurse staffing levels. According to the researchers, more studies are needed to determine what precisely drives the relationship between quality and cost. (PLoS One, Sept. 19, 2018)

Evidence lacking on outcomes of genetic testing for statin resistance

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(10/10/2018)
Information is lacking on patient outcomes for statin-associated muscle symptoms (SAMS) after testing for the SLCO1B1 gene, according to a VA Boston Healthcare System literature review. SAMS refers to muscle pain and weakness sometimes caused by statin medication used to treat cardiovascular disease. Previous studies have shown that people with the SLCO1B1 gene are more likely to get SAMS. The researchers looked at 37 studies for evidence that testing for SLCO1B1 could lead to treatment changes and improved cholesterol levels in statin-intolerant patients. They found very few reports of patient outcomes after SLCO1B1 testing. More studies are needed to explore whether this type of genomic testing can lead to improvements in care, say the researchers. (Clinical Pharmacology and Therapeutics, Aug. 23, 2018)

Study suggests adverse health impact on sexual minorities from religious freedom law

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(10/10/2018)
A team including a VA researcher found that “unhealthy days” increased for Indiana residents identifying as sexual minorities after that state passed a religious freedom restoration act (RFRA). Statewide religious freedom restoration laws aim to protect the free exercise of religion by ensuring that any government interference must be for “compelling” interests, and must employ the “least restrictive means” possible. Some legal scholars have argued that RFRAs could potentially expose sexual minorities to more discrimination. And past research has shown that stigma and discrimination could worsen physical and mental health for sexual minority individuals. The researchers surveyed sexual-minority individuals in 21 states with RFRAs in 2015. They found the number of people reporting more than 14 “unhealthy days” per month increased quarterly in Indiana following the passing of an RFRA there. Unhealthy days did not increase for heterosexual people. This trend did not occur in other states. Indiana was the only state to pass and enact an RFRA in the time frame of the study. Other states already had RFRAs in place or had passed an RFRA but not put it into practice. Indiana also differed from other states in that its law applies to cases between private parties, not just those involving government. (American Journal of Orthopsychiatry, Sept. 24, 2018)

Telehealth a viable way to improve antimicrobial stewardship

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(10/04/2018)
A pilot telehealth program shows promise in improving infectious disease control at rural medical centers, according to a Louis Stokes Cleveland VA Medical Center study. Staff at two rural VA medical centers used videoconferencing to work with infectious disease physicians at other facilities. These videoconference antimicrobial stewardship teams (VASTs) held weekly meetings to discuss ways to combat antimicrobial resistance on a patient-by-patient basis. After a year of the program, one site accepted VAST recommendations in 73 percent of cases presented, and the other accepted 65 percent of the recommendations. Participants felt that the sessions improved their antimicrobial stewardship efforts and patient care. (Infection Control and Hospital Epidemiology, Sept. 6, 2018)

Mental health disorders linked with more unintended pregnancy

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(10/04/2018)
Women Veterans with mental health disorders are more likely to have experienced unintended pregnancy than those without, found a study by VA Pittsburgh Health Care System researchers and colleagues. They surveyed almost 3,000 women Veterans by phone. Sixty percent of women with at least one mental health disorder reported having an unintended pregnancy, while 51 percent of women without a mental health disorder said they had had an unintended pregnancy. Mental health disorders were linked to a greater number of unintended pregnancies. Multiple mental health disorders were also connected to a greater number of unintended pregnancies. More research is needed on how to improve reproductive health outcomes for women with mental health disorders, say the researchers. (Journal of General Internal Medicine, Sept. 5, 2018)

Opioids not linked to better sleep for chronic pain patients

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(10/04/2018)
Opioid use did not improve insomnia or fatigue for patients with chronic pain, in a Minneapolis VA Health Care System study. Insomnia is a common problem related to chronic pain. Researchers studied data on medication dosage and sleep disturbance for patients taking opioids or non-opioid medication for chronic pain. Over a year of treatment, neither group showed improvements in insomnia or fatigue despite improvements in pain severity. Medication dosage increased over the course of the trial. Patients with chronic pain commonly take extra opioid medication to sleep, but this increase did not lead to improved sleep. The results suggest that patients should be encouraged to used evidence-based behavioral sleep interventions to manage their insomnia, according to the researchers. (International Association for the Study of Pain, Sept. 13, 2018)

Early nonadherence to diabetes drugs leads to more heart attacks and strokes

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(09/27/2018)
Patients who did not adhere early on to their medication treatment for type 2 diabetes were more likely to have poor health outcomes, found a study by VA Mid South Health Care Network researchers and their colleagues. Researchers looked at data for more than 159,000 Veterans with type 2 diabetes over an 11-year period. They measured patients’ adherence to oral diabetes medication by how often patients filled prescriptions in the first year of treatment. Patients who did not take their medication as prescribed were 14 percent more likely to have a heart attack in the five years after starting treatment, compared with those who took their medication. Those not regularly taking their medication were 22 percent more likely to have a stroke. The less compliant patients were to their medication regimen, the higher their chances were of having a heart attack or stroke. Those not adhering to treatment were also more likely to have died. The results underscore the need to help patients understand the importance of taking their oral antidiabetes medication regularly, say the researchers. (Diabetes Medicine, July 6, 2018)

Blood test could predict effectiveness of NSAID treatment in Alzheimer’s patients

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(09/27/2018)
Blood tests could identify which Alzheimer’s disease patients will respond to non-steroid anti-inflammatory drug (NSAID) therapy, according to a study including a VA San Diego Healthcare System study. Previous research has shown the potential of NSAIDs to improve outcomes in Alzheimer’s patients because the disease has been linked to inflammation. An earlier study treated Alzheimer’s patients with two NSAIDs, rofecoxib and naproxen. In it, some patients improved and some declined in both groups as well as in controls. For the new study, researchers tested blood samples from these patients for four specific proteins that have been identified as inflammation biomarkers. They found that they could identify which patients in the rofecoxib group had cognitive improvements with 98 percent accuracy. They also predicted improvements in the naproxen group with 97 percent accuracy. The results show that a precision-medicine approach could identify which treatments will be most effective for specific patients with Alzheimer’s, according to the researchers. (Journal of Alzheimer’s Disease, Sept. 4, 2018)

Benzodiazepine prescribing higher than evidence warrants in older adults

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(09/27/2018)
Prescribing of benzodiazepines may be higher than appropriate in older adults, according to a study that included several VA researchers. The team looked at use of the drugs across various health systems, not just in VA. Benzodiazepines are sedative drugs commonly prescribed for conditions such as insomnia, anxiety disorders, and behavioral and psychological symptoms of dementia. However, evidence suggest that these drugs could be dangerous for elderly patients. The researchers looked at 31 studies on the effects of benzodiazepines in patients over age 50 with the above three conditions. They found 21 studies that demonstrated improved insomnia outcomes. Only one study showed a benefit of the drugs for patients with anxiety disorder. They also found only a single study that showed improvements in behavioral disturbances in patients with dementia. The results suggest that benzodiazepine prescribing in older adults is higher than what is supported by evidence, according to the researchers. Studies are needed on how to reduce use of this type of drug in older patients, they say. (Harvard Review of Psychiatry, Sept/Oct 2018)

Brain peptide implicated in migraine pain

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(09/20/2018)
VA and University of Iowa researchers may have identified one of the sources of migraine pain. Researchers injected mice with calcitonin gene-relate peptide (CGRP), a substance naturally found in the brain that is believed to be related to nerve hypersensitivity and photosensitivity in migraine. They found that CGRP caused spontaneous pain in the mice, regardless of whether they were in light or darkness. When the researchers gave the mice an antibody that blocks CGRP receptors, the pain went away. They also found that the nonsteroidal anti-inflammatory drug meloxicam did not block the effects of CGRP. The antimigraine drug sumatriptan partially blocked CGRP response in male mice, but not females. (Pain, Sept. 1, 2018)

Suicide risk common in patients with anxiety

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(09/20/2018)
A high number of patients with anxiety could be at risk for suicide, found a Syracuse VA Medical Center study. Researchers surveyed 182 primary care patients who had anxiety symptoms but were not in psychotherapy specialty care. Forty percent had elevated suicide risk, based on a standard assessment. Suicide risk was more common in patients who also had depression (51 percent) than in those who had anxiety alone (27 percent). The severity of anxiety symptoms did not affect patients’ suicide risk. The results suggest that primary care providers should assess suicide risk in patients with anxiety, even when patients are not seeking mental health treatment or when their anxiety symptoms do not rise to the level of an anxiety disorder, say the researchers. (Family Practice, Sept. 14, 2018)

Oxytocin fails to boost social cognition in schizophrenia trial

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(09/20/2018)
Oxytocin did not improve social cognition in patients with schizophrenia, in a study by VA San Diego Healthcare System researchers and their colleagues. Social cognition refers to how a person deals with other people, including aspects like social knowledge and emotional processing. People with schizophrenia often have impaired social cognition. The researchers prescribed schizophrenic patients oxytocin—a drug that has been shown to improve social cognition in the general population—over 24 weeks, along with cognitive-behavioral training. Patients taking oxytocin showed no improvements in social cognition over the course of the study, compared with patients taking placebo. The results add to growing literature suggesting that oxytocin may not be effective in this population. (Psychological Medicine, Sept. 6, 2018)

Herbicide-related COPD rates differ between self-report and lung tests

U.S. Army, via Wikimedia Commons

(09/14/2018)
Herbicide exposure during the Vietnam War was linked to self-reported chronic obstructive pulmonary disease (COPD), but the link was not supported by lung tests, in a study by VA's Office of Patient Care Services. Researchers surveyed more than 3,000 Veterans of the U.S. Army Chemical Corps who served in Vietnam. Those who had actively sprayed herbicides during their service were nearly twice as likely to say they had been told by a doctor that they had COPD, compared with non-sprayers. However, when the survey respondents were examined with spirometry—a common test of lung function—people in the spraying group were not more likely to have COPD than the non-spraying group. The difference may be due to physicians diagnosing COPD based on symptoms rather than spirometry, according to the researchers. Spirometry is underutilized by physicians, they say. (American Journal of Industrial Medicine, Aug. 29, 2018)

PTSD may disrupt parasympathetic nervous system during sleep

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(09/14/2018)
Patients with PTSD had blunted parasympathetic nervous system modulation during sleep, found a Durham VA Health Care System study. The parasympathetic nervous system is the part of the nervous system that regulates rest and digestion. Heart-rate variability can be used to assess how well the parasympathetic system is working. Researchers studied the sleep of 62 post-9/11 Veterans and service members. They found that, for those with PTSD, high-frequency heart rate variability was lower during the non-rapid eye movement sleep phase, compared with those without PTSD. Impaired parasympathetic nervous system function increases the risk of cardiovascular events. This parasympathetic modulation could be one reason for the increased rates of cardiovascular disease among Veterans with PTSD, suggest the researchers. Patients with PTSD had blunted parasympathetic nervous system modulation during sleep, found a Durham VA Health Care System study. The parasympathetic nervous system is the part of the nervous system that regulates rest and digestion. Heart-rate variability can be used to assess how well the parasympathetic system is working. Researchers studied the sleep of 62 post-9/11 Veterans and service members. They found that, for those with PTSD, high-frequency heart rate variability was lower during the non-rapid eye movement sleep phase, compared with those without PTSD. Impaired parasympathetic nervous system function increases the risk of cardiovascular events. This parasympathetic modulation could be one reason for the increased rates of cardiovascular disease among Veterans with PTSD, suggest the researchers. (Sleep, Aug. 29, 2018)

Development of a new non-addictive pain drug

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(09/14/2018)
A team including a researcher from the W.G. Hefner VA Medical Center in Salisbury, North Carolina, is working on a pain medication that could potentially work as well as opioids without being addictive. They developed a new compound, AT-121, that works on the mu opioid receptor, a protein that opioids interact with to block pain. AT-121 also activates the nociceptin receptor, which blocks the addictive side effects of opioids. Using non-human primates, the researchers showed that AT-121 gave the same level of pain relief as opioids without the risk of addiction that comes with opioids. The results suggest that this new drug could have potential to both safely and effectively relieve pain, and also treat prescription opioid abuse. More studies will be needed before AT-121 can be tested in humans. (Science Translational Medicine, Aug. 29, 2018)

Circadian rhythm disruption linked to cognitive decline in older men

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(09/14/2018)
Disruptions in circadian rhythm are linked to greater cognitive decline in older men, according to a study including a Minneapolis VA Health Care System researcher. Circadian rhythm refers to the body's natural sleeping and waking patterns. Over multiple follow-up visits during an average period of three years, the researchers found that men with disrupted rest-activity circadian rhythm had greater cognitive decline, as measured by a standard cognition test, compared with those without disrupted circadian rhythms. Rest-activity circadian rhythm was measured using an accelerometer that recorded any time a patient's wrist moved. Aging is often associated with altered rest-activity circadian rhythm. The results add to growing evidence that age-related disruptions to sleep pattern are connected to cognitive decline, say the researchers. (Journal of the American Geriatric Society, Aug. 23, 2018)

Complex relationship between alcohol consumption and psychiatric distress

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(09/06/2018)
Hazardous drinking was linked to higher likelihood of psychiatric symptoms, while results of moderate drinking were mixed, in a study by Durham VA Health Care System researchers and colleagues. Previous studies have linked heavy drinking with increased depression and anxiety, but the it is not clear what cause-and-effect relationships, if any, may exist. The researchers collected data on alcohol use and psychiatric conditions for 3,003 Veterans. They found that hazardous drinkers were more likely to have PTSD, depression, and suicidality, compared with moderate drinkers. For men, moderate drinkers were less likely than nondrinkers to have depression and suicidality. However, this relationship disappeared when nondrinkers with past alcohol use disorder were removed from the calculations. Women moderate drinkers had lower rates of PTSD than nondrinkers and light drinkers, even when those with past AUD were removed. More research is needed on the possible protective effects of moderate drinking, say the researchers. Also, patients with a history of AUD may benefit from mental health screening and treatment, they say. (Journal of Studies on Alcohol and Drugs, July 2018)

Written exposure therapy effective as PTSD treatment

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(09/06/2018)
Written exposure therapy (WET) could be as effective as cognitive processing therapy in treating PTSD, according to a VA Boston Healthcare System study. WET involves five weekly sessions in which patients write for 30 minutes in detail about a single traumatic event associated with their PTSD. Cognitive processing therapy (CPT), a common PTSD treatment, involves learning how to evaluate and change upsetting thoughts. WET is shorter than CPT, which usually lasts for 12 sessions and includes homework between each session. Patients in both a WET and CPT group showed similar improvement of PTSD symptoms when assessed 60 weeks later. Both treatments significantly reduced depressive symptoms, although the CPT group did have a more rapid decrease in symptoms. WET takes a similar approach to prolonged exposure therapy, another common psychological PTSD treatment, in that both focus on directly confronting memories of trauma. Prolonged exposure is usually based on talking with a therapist, and generally involves more sessions than WET. The results show that WET could be a short and long-lasting treatment for PTSD. (Depression and Anxiety, Aug. 24, 2018)

Study shows two genes may be linked to suicide attempts

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(09/06/2018)
Durham VA Medical Center researchers have identified two genes that may be related to suicidal behavior. They conducted a genome-wide association study, in which they compared the genomes of a large number of Veterans to look for variations common among those with history of suicidal behavior. The researchers found an association between a gene called KCNMB2 and suicide attempts. This gene plays a key role in neuronal excitability. They also found evidence that may link another gene, ABI3BP, to both suicide attempts and suicidal thoughts. While the results are interesting, the researchers caution that they are preliminary and need replication in further studies. (Psychiatry Research, July 17, 2018)

Group treatment program curbs intimate partner violence

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(08/29/2018)
The Strength at Home program can successfully reduce intimate partner violence use, found a study by Central Texas and Boston VA health care system researchers. SAH is a 12-week cognitive-behavioral and trauma-informed group treatment designed to reduce and end IPV use among military and Veteran populations. The pilot program is part of a national program within VA to help Veterans who use or experience IPV. It was implemented at 10 VA medical centers over a year. Seventy percent of sites successfully launched the program in the first year. Results from 51 Veterans who participated in the program showed a significant reduction in the number who exhibited violence toward a partner. The participants also showed reduced PTSD symptoms. While the pilot program showed overall successful implementation, more work is needed to reduce the time between initial training and the start of group treatment, according to the researchers. (BMC Health Services Research, July 24, 2018)

Repeated ketamine infusions may ease PTSD and depression

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(08/29/2018)
Repeated ketamine infusions may improve PTSD and depression symptoms, according to a Minneapolis VA Health Care System study. Researchers gave 15 people with both PTSD and major depressive disorder six intravenous infusions of ketamine—a medication used mainly for anesthesia—over two weeks. Eighty percent had remission of PTSD symptoms immediately after treatment. The remission lasted a median of 41 days. For major depressive disorder, 93 percent experienced remission of symptoms, which lasted a median of 20 days. The results suggest that repeated ketamine treatments are safe and may be an effective treatment for people with both PTSD and major depressive disorder, say the researchers. (Journal of Clinical Psychiatry, May/June 2018)

Review study: Mind-body treatments show promise for PTSD

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(08/29/2018)
Studies show that mind-body treatments are promising for treating PTSD, found a literature review by VA Boston Healthcare System researchers. The researchers looked at 22 randomized controlled trials on mind-body techniques. Nine mindfulness and six yoga studies showed significant improvements in PTSD symptoms, compared with control groups. Seven studies showed large symptom improvements from relaxation interventions, even though relaxation was used as the control condition in these studies. While many studies on mind-body interventions have methodology weaknesses, the researchers found increased scientific rigor in recent studies. The results overall show increasing evidence on the benefits of mindfulness, yoga, and relaxation for PTSD. (Journal of Clinical Psychology, May 10, 2018)

Depression drives nursing home placement in older women

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(08/23/2018)
More severe depression symptoms led to higher rates of nursing home placement in women, found a study by San Francisco and Minneapolis VA health care systems. Researchers looked at data for more than 9,000 older women over a 20-year period. They found that women with low or moderate depressive symptom burden were twice as likely to move from community living to a nursing home, compared with women with minimal burden. Those with high burden were three times as likely. Antidepressant use only slightly affected this relationship. The results show the importance of improving recognition, monitoring, and treatment of depression early to reduce or delay nursing home placement, say the researchers. (Journal of the American Geriatric Society, Aug. 9, 2018)

Postconcussive symptoms predict opioid prescriptions

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(08/23/2018)
Traumatic brain injury symptoms predicted opioid prescriptions for chronic pain for Veterans, in a San Francisco VA Health Care System study. Opioids are not recommended for patients with neuropsychological impairment from traumatic brain injury. However, clinical guidelines are not always adhered to in actual practice. Researchers studied the records of 53,124 Iraq and Afghanistan Veterans with chronic pain diagnoses from VA providers during a nine-year period. Self-reported severe and very severe postconcussive symptoms predicted starting long-term or short-term opioid use for chronic pain. The results indicate a need to educate prescribers and make non-opioid pain management options more available for Veterans, according to the researchers. (Brain Injury, July 9, 2018)

Mild ozone exposure can cause breathing problems

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(08/23/2018)
Low-level ozone exposure causes breathing problems and lung damage in older people, according to a study led by a San Francisco VA Medical Center researcher. Ozone, a gas commonly found in the upper atmosphere, is considered a pollutant when present in lower levels of the atmosphere. Researchers exposed healthy adults to low concentrations of ozone for three hours, with intermittent exercise. Tests showed worse lung function after exposure to ozone, with higher ozone concentration linked to worse function. This decreased lung function was still noticeable 22 hours later. The results show that ozone can decrease lung function and cause airway injury and inflammation in older adults. The U.S. Environmental Protection Agency suggests regularly checking air-quality reports for levels of ozone and other irritants, especially for people with conditions such as asthma. (American Journal of Respiratory and Critical Care Medicine, May 15, 2018)

New approach to target drug treatment to painful joints

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(08/15/2018)
Baltimore VA Medical Center researchers have designed a method that could more effectively deliver drugs directly to the joints to treat rheumatoid arthritis. Arthritis medications can cause damage to other organs because they affect the whole body rather than just the joints. Researchers used a liposome (a sphere of molecules surrounding another material, such as a medication) containing the peptide ART-1 to target medication to joint cells. A peptide is a chain of amino acids. ART-1 has been shown to bind to the endothelial cells in joints. Researchers injected this compound into rats with arthritis. They found that the injection containing ART-1 suppressed the disease better than a control that did not have ART-1. The ART-1 liposome also appeared to be safer than liposomes not directed by the peptide, which interacted with more parts of the body than the joints. The results show that ART-1 could be used to home in on the joints to treat rheumatoid arthritis. (Journal of Controlled Release, Aug. 4, 2018)

Patient perspectives on opioids

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(08/15/2018)
Iowa City VA Healthcare System researchers interviewed 19 hospitalized Veterans about their chronic pain to get their perspective on opioids and other care. Patients were not asked about opioids specifically. Most patients brought up opioids themselves. Interviewees expressed views that other patients were the problem, meaning they thought opioid access was limited because other people were misusing opioids. They had empathy for providers, whom they saw as working under prescribing constraints. Most also viewed opioids as a last resort for treating pain. The results show that engaging hospitalized patients in conversations about opioids and alternative pain management would be useful, and that providers would benefit from increased awareness of chronic pain, say the researchers. (Pain Medicine, July 17, 2018)

Sailing therapy helpful in substance use disorders

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(08/15/2018)
Sailing adventure therapy may be a positive and calming activity for Veterans with substance use disorder, according to a George E. Wahlen VA Medical Center study. Twenty-two Veterans participated in the pilot study. In the therapy, participants sailed on a reservoir with an instructor for three hours, including instructional time. Each participant went to three sessions, once per month. They manned various positions on the sail boat, helped rig the sails, and watched out for other boats. After each trip, they took turns describing what the experience had been like for them personally and were encouraged to share whether they had learned anything about themselves from the experience. The activity did not increase anxiety or negatively affect the participants. Results show that this therapy may increase psychological flexibility and enhance treatment response, based on questionnaires given after the therapy. The results suggest that sailing adventure therapy could be a low-risk intervention for Veterans with substance use disorder, according to the researchers. (Complementary Therapies in Medicine, October 2018)

Urine biomarkers may warn of kidney damage from ventilation

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(08/08/2018)
Novel urine biomarkers could give an early warning on kidney injury caused by mechanical ventilation, say VA San Diego Health Care System and University of California San Diego researchers. Previous research has linked mechanical ventilation to acute kidney injury. This link may be due to damage to the lungs and circulatory system, or blood flow changes to the kidney. Low-tidal volume—when less air is taken into the lungs with each breath—could help prevent this kidney injury. Several biomarkers (such as mitochondrial byproducts) have recently been found to show kidney dysfunction before permanent injury. By testing for these biomarkers in the urine, clinicians may be able to time when ventilation needs to be adjusted to prevent kidney injury, according to the researchers. (Nephron, July 11, 2018)

Battlefield acupuncture may reduce opioid use after surgery

Photo by Robert Turtil, for illustrative purposes only.

(08/08/2018)
Battlefield acupuncture may reduce the need for opioid use after surgery, found a John D. Dingell VA Medical Center study. In battlefield acupuncture, needles are placed in and around the ear to influence how the central nervous system processes pain. In a study of 39 patients, those who had this treatment after general surgery had significantly lower opioid use in the following 24 hours, compared to those not given acupuncture. Patients in the acupuncture group also had 15 percent less post-operative nausea and vomiting. Previous studies have shown that this type of acupuncture can reduce the stress response after surgery, aiding in recovery. The results suggest that battlefield acupuncture could be a low-cost, effective, safe, and easy to implement means of reducing post-operative pain, say the researchers. (2018 World Congress on Regional Anesthesia & Pain Medicine, April 19, 2018)

Health care performance measures may not be accurate for older patients

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(08/08/2018)
Standard measures of health care quality may not accurately rate care for higher risk patients, according to a VA Greater Los Angeles Healthcare System study. Measures based on processes of care—such as breast cancer screenings—are frequently used to compare health care performance. To see whether these measures are biased against older and sicker patients, researchers looked at national data on mortality risk from a 14-year period. They found that providers serving high-risk patients rated significantly worse (67 percent performance score) than for low-risk patients (74 percent). Clinicians may choose not to use recommended processes based on limited prognosis, patient preference, or potential adverse effects when patients are older and have more illnesses. The resulting poor performance scores may lead to financial penalties or excessive administrative work. The results suggest that process of care ratings may not be the best fit to evaluate all situations. (Journal of the American Geriatric Society, Aug. 6, 2018)

Lab study suggests novel RNA treatment could improve brain function after TBI

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(08/01/2018)
James A. Haley Veterans Hospital and University of South Florida researchers showed that injections of a type of RNA could improve brain function after a traumatic brain injury, in rats. The researchers injected injured rats with cell structures called exosomes, which they got from stem cells in human fat tissue. The exosomes contain MALAT1, a type of RNA (a form of genetic material). The rats injected with exosomes showed significant recovery of function of motor behavior, as well as a reduction in cortical brain injury. Analysis of the brain and spleen showed that MALAT1 could ease brain inflammation at a genomic level. The spleen is involved in protective substances such as white blood cells entering the blood stream after injury. The results show that using exosomes containing MALAT1 has "tremendous" potential for treatment of TBI, say the researchers. (Journal of Neuroinflammation, July 12, 2018)

Algorithm can identify urine-test results showing cannabis use

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(08/01/2018)
VA Portland Health Care System researchers have developed an algorithm to identify cannabis urine drug test results in electronic health records. Although VA does not prescribe cannabis, in accordance with federal law, many states now allow medical cannabis use. Many patients are now using medical cannabis, particularly for chronic pain. While it may be important for doctors to know of this use, how the results of drug tests are reported varies widely. The researchers created a computer algorithm to identify the results of urine tests within the VA electronic health records. They tested the algorithm on a sample of VA patients who were prescribed long-term opioid therapy for chronic pain. The algorithm correctly identified cannabis-positive results for 99 percent of patients who used cannabis. It identified cannabis-negative results with 100 percent accuracy. The findings suggest that this algorithm is an effective way to identify urine test results for cannabis use within the electronic health record, despite inconsistent reporting practices. (Journal of Medical Systems, July 24, 2018)

VA emergency departments vary widely in opioid prescribing

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(08/01/2018)
Opioid prescribing rates vary widely in VA emergency departments (EDs), found a study by the VA Pharmacy Benefits Management program. The researchers looked at data on opioid prescribing for pain in 118 VA EDs between January and March 2017. The percentage of patients prescribed an opioid ranged from 1 percent to 24 percent, depending on facility. For individual clinicians, opioid prescribing rate varied between 0.2 percent and 57 percent. While nationwide interventions to promote safe opioid prescribing have resulted in lower overall opioid prescriptions in VA since 2011, much variation still remains based on geographic area and individual behavior. Targeting interventions for providers may be more effective than general prescribing guidelines at changing how opioids are prescribed in VA EDs, say the researchers. (Journal of General Internal Medicine, July 23, 2018)

Availability of non-VA health care lacking for rural Veterans, despite Veterans Choice Act

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(07/27/2018)
The Veterans Choice Act may not significantly improve rural Veterans' access to health care due to a shortage of non-VA providers, according to an Iowa City VA Medical Center study. Under the Veterans Choice Act, VA will pay for medical care from non-VA providers for Veterans who live more than 40 miles from a VA facility. Pending legislation is set to expand on the Veterans Choice Act and replace it. To see how the existing act or future versions could affect Veterans' access to care, researchers looked at data on both where rural Veterans live and what health care is available in those areas. They found that 16 percent of rural Veterans live in an area with primary care shortages, and 70 percent in mental health care shortage areas. Most rural Veterans lived in counties that lacked specialized care such as cardiologists and neurologists. In fact, VA played a greater role in delivering health care in areas where Veterans were eligible for the Veterans Choice Act, compared with less rural areas. The results show that programs such as telehealth are needed to supplement non-VA health care in rural areas, which may be lacking, say the researchers. (BMC Health Care Services, May 29, 2018)

Mouse study questions whether tau protein leads to brain degeneration after TBI

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(07/27/2018)
A mouse study suggests that the build-up of a protein in the brain is not a cause of traumatic encephalopathy following a traumatic brain injury, counter to evidence from previous studies. James A. Haley Veterans Hospital researchers and their colleagues studied the build-up of tau proteins in the brain matter of mice after traumatic brain injury. Other research has documented increased tau protein in patients with chronic traumatic encephalopathy, a degenerative brain disease linked to dementia. Researchers on the new study found modest increases in tau protein in the brain after both a single and repetitive mild TBI. However, in both cases the protein was reabsorbed by the brain within 12 months after injury, with no evidence of excess build-up. Moreover, increased tau protein in the brain was not linked to worse cognitive performance in the mice. The results may mean that while there may be short-term tau protein build-up after TBI, this condition is not likely to directly cause post-TBI cognitive problems. (Journal of Neurotrauma, June 11, 2018)

Acquired stuttering after TBI and PTSD could be linked to medications

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(07/27/2018)
Veterans with both traumatic brain injury and PTSD were more likely to be diagnosed with acquired stuttering, and the condition could be linked to medications they were prescribed, found a South Texas Veterans Health Care System study. Researchers looked at data on more than 300,000 Iraq and Afghanistan Veterans. They found that 235 were diagnosed with acquired stuttering after their deployment. Of those, 43 percent had both TBI and PTSD. These patients had a greater likelihood of stuttering than those with only one or neither condition. Furthermore, over 66 percent of patients with stuttering were prescribed a medication that affects speech fluency, such as antidepressants and antiepileptic drugs. Based on the results, the researchers suggest that clinicians treating Veterans with complex conditions should consider the impact of medications on speech fluency. (Military Medicine, April 18, 2018)

Mantram meditation more effective than present-centered therapy at reducing PTSD symptoms

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(07/19/2018)
Mantram therapy was more effective than present-centered therapy at reducing PTSD symptoms, in a VA San Diego and New England Health Care System study. Patients with PTSD underwent eight weekly one-hour session of either mantram or present-centered therapy. In mantram meditation therapy, patients repeat a word or phrase with spiritual meaning to slow down thoughts and focus attention. Present-centered therapy focuses on currently stressful events and problem-solving skills. Those in the mantram group had significantly lower scores on a PTSD symptom scale after treatment and two months later. The mantram group also had lower self-reported PTSD symptoms and less insomnia. The results show that non-trauma focused complementary approaches such as mantram therapy can help alleviate PTSD symptoms, say the researchers. (American Journal of Psychiatry, June 20, 2018)

Intensive management outpatient program has similar cost to usual care

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(07/19/2018)
High-risk patients received more outpatient care with no increase in total cost from an intensive management program, found a study at five VA medical centers. More than 2,000 patients with an average of seven chronic conditions were given either intensive outpatient management or usual care for one year. Intensive management involves care coordination, goals assessment, health coaching, medication reconciliation, and home visits through an interdisciplinary team. Those in the intensive management had an average of $2,164 lower inpatient costs than the usual care group. The intensive management had an average of $2,636 more in outpatient costs. Average total costs were similar for both groups. The results show that intensive management has potential, but room exists to improve the program and make it more efficient, according to the researchers. (Annals of Internal Medicine, June 19, 2018)

Possible mechanism behind TBI-related sleep-wake disturbances

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(07/19/2018)
Researchers with the VA Portland Health Care System may have demonstrated how traumatic brain injury affects the sleep-wake pattern of the brain, using a mouse model. TBI often causes sleep-wake disturbances, such as excessive daytime sleepiness. Researchers have hypothesized that this is because of damage to neurons that make orexin, a hormone that regulates sleep. By studying the brains of mice with TBI, the researchers found that decreased density of the amino acid glutamate—which helps neurons function—could be responsible for problems with the orexin neurons. They also found that giving the mice branched-chain amino acid supplements through their food helped restore glutamate density and orexin neuron function. The results open up a path to potential therapy for sleep-wake disturbances caused by TBI. (Sleep, March 1, 2018)

Study shows safety of brain stimulation together with exposure therapy for PTSD

Image courtesy of Dr. Albert Leung

(07/11/2018)
Transcranial magnetic stimulation (TMS) along with prolonged exposure therapy may be beneficial for patients with PTSD, according to a Ralph H. Johnson VA Medical Center study. Eight patients with PTSD undergoing prolonged exposure therapy received either weekly repetitive TMS for five weeks or a control adjunct treatment. In TMS, a magnet is applied to the outside of the head to affect the electrical fields in the brain. Patients in the TMS group showed a trend toward improvement of PTSD symptoms, although the change was not statistically significant. The study demonstrates that TMS is safe to be delivered to PTSD patients while they are receiving prolonged exposure therapy. Larger studies are needed to see if this technique can be an effective treatment, say the researchers. (Journal of Electroconvulsive Therapy, June 26, 2018)

Movement-based therapies yield multiple benefits for patients with chronic conditions

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(07/11/2018)
Patients saw improvements in a number of areas as a result of movement-based therapies, in a VA New England Healthcare System study. Researchers surveyed a focus group of 31 patients enrolled in yoga and qi gong programs for chronic conditions at two VA medical centers. The participants described improved physical and mental health, reduced opiate and psychotropic use, enhanced emotional well-being, and better social relationships as a result of the treatment. They attributed these changes to physical improvements, development of coping skills, and increased self-awareness. The researchers suggest health care providers consider referring patients with chronic conditions to movement-based complementary and integrative health therapies alongside usual care. (Chronic Illness, Jan. 1, 2018)

New drug-resistant form of E. coli rapidly spreading

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(07/11/2018)
A team including a Minneapolis VA Healthcare System researcher tracked the spread of a new drug-resistant strain of E. coli. The team gathered data on more than 6,000 E. coli infections at nine hospitals, including at the Minneapolis VA Medical Center. Twenty-one percent of the infections were resistant to fluoroquinolones, a common antibiotic. The most common strain of drug-resistant strain of E. coli was H30. The prevalence of this strain—which has been known since the 1990s—did not increase from the study years of 2016 to 2016. The second most common type of E. coli was ST1193. This strain is newer than H30, and its prevalence increased sevenfold between 2016 and 2017. It is more likely to occur in younger patients. The results show that the ST1193 of drug-resistant E. coli is on the rise, say the researchers, and more studies are needed on how to limit its spread. (Clinical Infectious Diseases, June 29, 2018)

Irregular discharges tied to higher suicide risk

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(07/05/2018)
Patients are at an increased suicide risk after irregular hospital discharges, according to VA researchers in New England and Ann Arbor. Irregular hospital discharges include a patient leaving the hospital against medical advice and other unplanned discharges. The researchers looked at data on more than 5 million inpatient discharges from VA facilities between 2001 and 2014. About 2 percent were irregular. Patients with an irregular discharge from a general medical ward had three times higher risk of suicide than those discharged normally a year after their discharge. Patients with an irregular discharge from psychiatric care did not have higher suicide risk based on discharge type. The findings give important information on patient populations that may need to be targeted for suicide prevention, say the researchers. (Psychiatric Services, June 1, 2018)

Dialysis patients have lower mortality in VA vs. non-VA centers

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(07/05/2018)
Patients who initiated dialysis at VA facilities had lower mortality than patients who used non-VA dialysis centers, found a study of nearly 70,000 VA patients. Researchers looked at Veterans with end-stage kidney disease who began dialysis between 2007 and 2014. Ten percent used VA dialysis centers. Those in VA facilities were 13 percent less likely to die in the 12 months after they began dialysis. Along with that, patients in VA facilities were more likely than those in outside centers to be hospitalized at some point in the following year. The researchers suggest that the better outcomes may relate to VA's integrated health care system. Most VA dialysis centers are located within larger VA facilities. VA's integrated system may mean that patients are receiving more intense care addressing their health problems and have an easier transfer to hospital admission, say the researchers. (Clinical Journal of the American Society of Nephrology, June 14, 2018)

ICU telemedicine lowers hospital transfers

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(07/05/2018)
Intensive-care unit (ICU) telemedicine was linked to decreased interhospital transfers in an Iowa City VA Health Care System study. In ICU telemedicine, intensivist doctors can provide remote care to patients at regional facilities that may lack specialized personnel. The researchers looked at data for more than 550,000 admissions at 306 VA ICUs during a five-year period. Transfers to other hospitals decreased by 42 percent in hospitals with telemedicine programs, compared with a decrease of 7 percent in non-telemedicine hospitals during the same time period. The results may show that telemedicine allows hospitals to better evaluate when patients may effectively be treated locally, say the researchers. While ICU telemedicine did not reduce mortality in the study, past research suggests that limiting interhospital transfers lowers costs and improves patient, family, and staff satisfaction. (Chest, June 5, 2018)

Electrical signal change may explain link between combat exposure and psychiatric disorders

Photo by Jerry Daliege

(06/27/2018)
Increased error-related negativity (ERN) may help explain why combat exposure increases the risk of psychiatric disorders, found a Jesse Brown VA Medical Center and University of Illinois at Chicago study. ERN refers to a change in electrical signals in the brain as a result of making a mistake in a motor or cognitive task. Past research has linked it to various psychiatric disorders, such as anxiety and alcohol use disorders. In a study of 62 Veterans, the researchers used electroencephalography to show that those with greater combat exposure had greater ERN. This effect held true even after adjusting for anxiety and PTSD symptoms. The level of ERN was not associated with other life stressors before or after deployment, suggesting that this effect is specific to combat exposure. The results suggest that ERN may be one mechanism for how combat exposure increases the risk of psychiatric disorders, say the researchers, and could be a valuable screening tool for psychiatric disorder risk. (International Journal of Psychopsychology, July 2018)

Increased travel reimbursement leads to more VA health care use

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(06/27/2018)
Increased reimbursement for travel led to more VA outpatient use, found a VA Salt Lake City Health Care System study. A recent VA policy change increased how much Veterans can be reimbursed for travel expenses to receive VA health care. To study the effects of this change, researchers looked at data for 110,007 Veterans nationwide. They found that the number of VA outpatient visits increased by more than 30 percent after the rule change. The greatest increase was in Veterans living in rural areas. The number of non-VA outpatient care visits for rural Veterans also significantly decreased. A 2014 policy allows eligible Veterans to use their VA-provided health care at non-VA facilities. The results indicate how health care utilization may be affected by future policy changes. (Medical Care, July 2018)

Mental health service use remains stable after PTSD disability rating

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(06/27/2018)
Use of VA mental health services largely remains stable after receipt of a service-connected disability for PTSD, according to a study by VA researchers in Ann Arbor and Boston. Some concern exists that Veterans will stop using mental health services after receiving service-connected disability benefits for PTSD, but actual usage patterns are not well-understood. Researchers looked at mental health service utilization for more than 22,000 Veterans one year before and after they received service-connected disability ratings for PTSD. They found that use remained stable for 80 percent of patients. Nine percent increased their use, and 11 percent decreased their use. While disability rating largely did not alter mental health service usage patterns, the researchers did find generally low utilization of these services. Opportunities exist to enhance outreach for Veterans with PTSD-related disability benefits, they conclude. (Health Services Research, April 17, 2018)

Review: Childhood sexual abuse can lead to sexual dysfunction in women

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(06/21/2018)
A review by Doris Miller VA Medical Center and University of Texas at Austin researchers confirmed that women with childhood sexual abuse histories had higher rates of sexual dysfunction, compared with women without a history of abuse. Lack of positive emotions related to sexuality appears to be the most relevant factor in sexual dysfunction. Lack of positive emotions was more common than direct negative emotions connected to sexuality. Studies show that mindfulness-based sex therapy and expressive writing treatments are effective for this group. More studies are needed on exactly how childhood sexual abuse can lead to sexual dysfunction, say the researchers. (Sexual Medical Reviews, April 2018)

If taller people are 'smarter,’ why is that? Brain study offers insight

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(06/21/2018)
Cortical surface area may explain the connection between height and cognitive ability, found a study including a VA San Diego Healthcare System researcher. Previous studies have shown that greater height is correlated with greater general cognitive ability. But the reason for this relationship is not well-understood. The researchers looked at data from 515 participants of the Vietnam Era Twin Study of Aging. General cognitive ability was based on the Armed Forces Qualification Test, a measure similar to IQ. The researchers found that cortical surface area (brain size, taking into account the folds and layers of brain matter) is positively linked to cognitive ability. Taller people tend to have larger brains, and larger brains are linked to higher cognitive ability. Cortical thickness (total thickness of all brain layers) was not linked to cognitive ability. (Brain Structure & Function, May 11, 2018)

Suicidal behavior common with schizophrenia and bipolar disorder

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(06/21/2018)
A recent study confirmed that suicidal behavior is common among Veterans with schizophrenia or bipolar disorder. Researchers from the Bruce W. Carter VA Medical Center and VA Connecticut Healthcare System collected data on 3,942 Veterans with schizophrenia and 5,414 with bipolar disorder. They found that 70 percent of Veterans with schizophrenia had a history of suicidal thoughts or behavior. Of those with bipolar disorder, 82 percent had a history of suicidal thoughts or behavior. Veterans with more than one psychiatric condition were at the highest risk of suicide. The results underscore the need for continuous monitoring for suicidal behavior in patients with severe mental illness. (Journal of Psychiatric Research, April 21, 2018)

Homeless Veterans are more satisfied with specially tailored care teams

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(06/14/2018)
Homeless Veterans at VHA facilities with tailored primary care teams had better care experiences than non-homeless Veterans, according to a National Center on Homelessness Among Veterans study. Researchers surveyed more than 340,000 Veterans receiving care through VHA nationwide. About 4 percent were homeless. In facilities without homeless-tailored teams, homeless patients had more negative and fewer positive experiences than non-homeless patients. In facilities with Homeless Patient Aligned Care Teams (HPACTs), this pattern was reversed. HPACTs appear to offer homeless Veterans a better primary care experience than that received by non-homeless Veterans. (Medical Care, May 12, 2018)

Fluorouracil cream may lower treatment cost for those at high risk for skin cancer

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(06/14/2018)
Treating patients at high risk for two skin cancer conditions with topical fluorouracil cream can provide cost savings, found a VA Palo Alto Health Care System study. Previous research shows that fluorouracil reduces incidence of keratinocyte carcinoma (nonmelanoma skin cancer) and actinic keratosis (a precancerous skin condition). Patients at high risk for the conditions applied either the fluorouracil or a placebo cream to their faces and ears for four weeks. After one year, those not using fluorouracil had more treatment visits for squamous cell carcinoma than those using it. Over three years, patients using fluorouracil had average treatment costs of $771 less per patient. (Journal of the American Academy of Dermatology, March 2, 2018)

Photodynamic therapy may effectively treat bladder cancer

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(06/14/2018)
A group including a VA Northern California Health Care System researcher showed that a photodynamic therapy technique could effectively treat bladder cancer. In photodynamic therapy, medication that is activated by light and heat is injected into the body. The cancer site can then be exposed to light, which allows the cancer cells to be closely targeted. This process has significantly fewer side effects than treatments such as chemotherapy. The researchers used the drug 17AAG to target bladder cancer in animal models. They combined 17AAG with the organic compound nanoporphyrin. 17AAG is not very water-soluble. Combining it with nanoporphyrin allows it to be absorbed by cells more easily. The results show that the NP-AAG was effectively accumulated in cancer cells. A single intravenous injection followed by multiple light treatments over seven days effectively eradicated the tumors. This technique could dramatically improve bladder cancer management with minimal toxicity, say the researchers. (Nanomedicine, April 2018)

Gender-tailored alcohol screening improves detection among women

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(06/06/2018)
Gender-tailored binge-drinking screens may improve detection of women's unhealthy alcohol use, according to a study by researchers from several VA systems. Women and men have different patterns of alcohol consumption. But the usual screens for binge drinking are based on men's drinking patterns. Researchers adjusted the AUDIT-C assessment to specifically address women's drinking patterns. In a survey of more than 1,000 women Veterans, 6 percent screened positive for unhealthy alcohol use on the standard assessment. When a gender-tailored binge-drinking question was added (asking how often participants had four or more drinks on one occasion, as opposed to six or more on the unaltered AUDIT-C), 10 percent screened positive. When researchers lowered the threshold score for what was considered unhealthy alcohol use, 21 percent of women screened positive. Using both the tailored question and lowered threshold, 25 percent screened positive for unhealthy alcohol use. Using gender-tailored screening could improve alcohol screening in women, say the researchers. (American Journal of Addictions, March 2018)

Longer ‘dwell time’ linked to fewer PTSD symptoms

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(06/06/2018)
Longer time home between deployments, or “dwell time,” is linked to fewer long-term PTSD symptoms in Veterans, found a Central Texas Veterans Health Care System study. Researchers looked at data for 278 Veterans of Iraq and Afghanistan three years after discharge. They found that those with time between deployments less than 12 months had the highest long-term PTSD symptoms. Consistent with other studies, combat exposure was linked to more PTSD symptoms. Average length of deployment and number of deployments did not significantly affect long-term PTSD symptoms; intensity of combat exposure had a much bigger effect than either. The researchers conclude that “in addition to combat exposure, time between deployments warrants clinical attention as an important deployment characteristic for predicting long-term PTSD symptoms.” (Journal of Clinical Psychology, April 2018)

Acceptance and commitment therapy prior to surgery may help pain outcomes

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(06/06/2018)
Acceptance and commitment therapy led to a quicker end to pain and opioid use after surgery, in an Iowa City VA Medical Center study of 88 patients. High levels of pain, anxiety, and depressive symptoms before surgery put patients at elevated risk of chronic pain and prolonged opioid use following surgery. Patients scheduled for orthopedic surgery attended a one-day acceptance and commitment therapy workshop prior to surgery. The workshop focused on pain acceptance and values-based behavior. Three months following surgery, patients who attended the workshop achieved pain reduction and opioid cessation sooner than those who had treatment as usual. The benefits of the therapy were greatest for patients with post-operative complications. The results suggest that pre-operative pain management may help prevent chronic pain after surgery. (Journal of Pain, May 16, 2018)

Cannabis use disorder linked to self-injury

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(06/01/2018)
Cannabis use disorder was linked to greater odds of self-injury, in a study by Durham VA Medical Center and Central Texas VA Health Care System researchers. The researchers interviewed 292 Iraq and Afghanistan Veterans. Of those, 13 percent had engaged in either suicidal or non-suicidal self-injury. Fourteen percent of Veterans interviewed had cannabis use disorder—defined as continued use of marijuana despite impairment and dependence. Participants with cannabis use disorder had three times higher odds of any type of self-injury, compared to those without the disorder. The odds of non-suicidal self-injury were higher than the odds of suicide attempts for participants with cannabis use disorder. While the results may show that cannabis use disorder increases the risk of self-injury, the basis for this link is not yet clear, caution the researchers. (Suicide and Life-Threatening Behavior, April 9, 2018

New insight to guide dialysis decisions

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(06/01/2018)
For patients with chronic kidney disease, the level of kidney function at which dialysis improves survival varies by age, according to a study by VA Palo Alto Health Care System and Stanford University researchers. Using data from more than 70,000 Veterans with chronic kidney disease, the researchers compared survival rates of patients on dialysis with those of patients treated without dialysis. They looked at patients' eGFR levels when they were on dialysis. eGFR is a measure of waste products in the blood, and is used to test kidney function. Higher scores mean better kidney function. For patients 75 or older, risk of death was lower than with medical management for eGFR levels of 6-9 or lower. For those age 65-74, risk of death was lower at eGFR below 6. For those younger than 65, the eGFR level at which dialysis improved survival compared with medical management was 6-9. The results show that age should be taken into consideration when deciding to put patients on dialysis. (Journal of the American Society of Nephrology, May 22, 2018

Alcohol-related treatment low in hepatitis C patients

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(06/01/2018)
Many patients with hepatitis C do not receive recommended alcohol-related care, found VA Puget Sound Health Care System researchers. Alcohol use increases the risks associated with hepatitis C. More than 30,000 VA patients with both hepatitis C and unhealthy alcohol use were studied over a four-year period. Seventy-two percent had a brief alcohol intervention, 13 percent pad specialty addiction treatment, and only 3 percent had drug treatment for problematic alcohol use. For those with alcohol use disorder, 27 percent used specialty addiction treatment and 6 percent used drug treatment. Strategies are needed to increase alcohol-related care and pharmacotherapy for alcohol use disorder in patient with hepatitis C, say the researchers. (Drug and Alcohol Dependence, May 8, 2018

Review study: Exercise helps lungs even in those with chronic lung disease

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(05/17/2018)
Studies show that whole-body exercise training improves pulmonary function in adults with chronic lung disease, according to a VA New Jersey Health Care System review. The general consensus was that exercise does not stimulate and improve lung function in this population. The researchers looked at 21 randomized controlled trials to see if this assumption was supported by evidence. They found that exercise training resulted in small but significant improvements in measures of pulmonary function for patients with chronic lung disease. The findings suggest that pulmonary treatment should include exercise to improve lung function, in addition to care to reduce symptom burden. (Archives of Physical Medicine and Rehabilitation, April 17, 2018)

Frequent hospital urine cultures lead to unnecessary antibiotic use

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(05/17/2018)
Patients with a urine culture taken on the first day of hospital admission receive more days of antibiotics and have longer hospital stays than patients who do not have a urine culture, found a Michael E. DeBakey VA Medical Center study. The researchers looked at data for nearly 90,000 patients in 230 U.S. hospitals admitted for any reason. They found that patients who had their urine tested for bacterial infection had more days of inpatient antibiotic use. Those tested had an average of 2.1 percent longer hospital length of stay. Positive urine cultures often lead providers to give patients antibiotics even when they do not need them. In many cases, antibiotics are not necessary even when bacteria is found in the urine if the patient does not have symptoms of an infection. Unnecessary antibiotic use contributes to antibiotic resistance and is a threat to public health, write the researchers. Steps should be taken to limit unnecessary urine cultures, they say. (Infection Control and Hospital Eipdemiology, May 2018)

Therapeutic horseback riding may reduce PTSD symptoms

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(05/17/2018)
A therapeutic horseback riding program reduced PTSD symptoms in a small study of 29 Veterans. The study team included a Harry S. Truman Memorial Veterans' Hospital researcher. Half the Veterans took a six-week horseback riding program, while the others were put on a wait-list. Those who rode had a 67 percent likelihood of a lower PTSD symptom score after three weeks. The likelihood increased to 88 percent after six weeks. Participants showed improvement in self-efficacy and emotion regulation. The results show that therapeutic horseback riding may be an effective way to alleviate PTSD symptoms for some Veterans. (Military Medical Research, Jan. 19, 2018)

Possible biological effect of cognitive behavioral therapy

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(05/11/2018)
Researchers with the South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio may have identified a biological explanation for how psychotherapies improve stress-related psychiatric illness. Cognitive behavioral therapies have been shown to improve symptoms in PTSD and depression, but the mechanism is unknown. Researchers used a drug to block activity in the ventral medial prefrontal cortex of rats. Fear extinction therapy, which usually reverses stress-induced cognitive dysfunction in rats, did not work when rats were on the drug. The study also showed that chronic stress decreased this brain region’s response to stimulation. This tells the researchers that activity in the prefrontal cortex may underlie the benefits of cognitive behavioral therapy. The results support the idea that modulating activity in the prefrontal cortex, for example, through a medication, could boost the effectiveness of cognitive behavioral therapies for PTSD and other mental disorders. (Journal of Neuroscience, Feb. 7, 2018)

PTSD from military sexual trauma, versus other causes, may have stronger link to suicidal thoughts

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(05/11/2018)
Female Veterans with PTSD as a result of military sexual trauma were twice as likely to have suicidal thoughts as those with PTSD from any other cause, found a Denver VA Medical Center study. Researchers surveyed more than 300 female Veterans who had experienced military sexual trauma. Of those, 29 percent said they have current suicidal thoughts, and 72 percent said military sexual trauma was the source of their PTSD symptoms. Women who identified military sexual trauma as the source of their PTSD were at least three times as likely to have suicidal thoughts as those who said their PTSD was specifically related to combat or deployment. The study shows the importance of addressing PTSD specifically related to military sexual trauma, say the researchers. (Suicide and Life-Threatening Behavior, April 20, 2018)

Stimulant use increases mortality risk for HIV-infected men

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(05/11/2018)
Stimulant use increases mortality risk for HIV-infected men Stimulant use increases mortality risk for men with HIV, but cannabis use does not, according to the Veterans Aging Cohort Study. Researchers surveyed more than 3,000 men with HIV. At baseline, 15 percent of participants used cannabis, or marijuana; and 24 percent used stimulants, such as cocaine and methamphetamines. Cannabis was not linked to increased mortality risk based on the VACS Index, a measure of the risk of all-cause mortality. Those using stimulants, however, scored five points higher on the risk scale, compared with cannabis and alcohol users. Participants who used stimulants were also more likely to have unhealthy alcohol and opioid use. This was not true for those who used cannabis. The results suggest that efforts to reduce stimulant use in this population may reduce mortality. The researchers do note that demographic factors—such as age, race, and education—seem to impact mortality risk more than alcohol, cannabis, or stimulant use. (AIDS and Behavior, April 2018) 

Pulsed xenon ultraviolet leads to better disinfection

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(05/03/2018)
Pulsed xenon ultraviolet devices disinfect more effectively than manual cleaning, found a study by researchers at multiple VA centers. The devices use bulbs that contain xenon, a gas, to emit short bursts of high-energy ultraviolet light. Researchers tested surfaces in two hospital rooms cleaned using pulsed xenon ultraviolet and two cleaned with manual disinfection. Staphylococcus aureus counts were reduced by 75 percent in the UV rooms, compared with pre-cleaning counts. Aerobic bacteria colony counts were reduced by 84 percent in the UV rooms. Manual disinfection reduced bacteria counts only by 25 to 30 percent. The researchers recommend that this technology be integrated into daily hospital operations. (American Journal of Infection Control, April 11, 2018)

Caloric restriction changes liver metabolism, shows primate study

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(05/03/2018)
Restricting calories may delay the onset of age-related disorders and extend the lifespan by changing how the liver metabolizes various molecules, according to a study led by a William S. Middleton Memorial Veterans Hospital researcher. Caloric restriction has been shown to ward off disease and extend life in many species. To look for a possible molecular explanation, the researchers put male rhesus monkeys on a diet that was 30 percent lighter in calories than a standard diet, for two years. They then took liver biopsies and conducted high-resolution molecular profiling of the tissue. The team found that caloric restriction changes gene expression relating to liver metabolism. Their report describes the changes in detail, with a focus on RNA processing. They say the work represents a “comprehensive, integrated account of the molecules and pathways recruited by [caloric restriction] that may underlie the longevity benefits.” (Cell Metabolism, March 6, 2018)

Researchers report technical breakthrough for brain-computer systems

Adapted from JN article

(05/03/2018)
A team that included researchers from the Providence VA Medical Center showed how “local field potentials”— the total electrical current flowing to a small section of nervous tissue in the brain—may be a more robust, stable signal for brain-computer systems than neuronal action potentials, which represent the activity of individual brain cells. The study involved one person with ALS and another with locked-in syndrome due to a stroke. In locked-in syndrome, the person is mentally engaged but unable to speak or move his or her limbs. The two participants were able to type messages and emails for 138 and 76 days, respectively, without needing re-calibration of their brain-computer systems. Past studies in which the decoding of brain signals was based on neuronal action potentials had required far more frequent re-calibration. The researchers say they have achieved a “new benchmark” for stability, using local field potentials. “This study is a step towards a reliable and robust [brain-computer interface] that will allow people with [locked-in syndrome] to communicate independently and, therefore, provide greater and more extensive interactions with their friends, family, and caregivers.” (Journal of Neurophysiology, April 25, 2018)

Up to nine months between doctor's visits do not worsen viral load for HIV patients

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(04/25/2018)
Gaps up to nine months between HIV primary care visits do not worsen viral load, found a study including a Michael E. DeBakey VA Medical Center researcher. Current guidelines say that HIV patients should visit their doctors every six months for viral monitoring. Looking at more than 6,000 patients with HIV, researchers found that patients who went up to nine months between doctor's visits did not have significant increases in viral load. Patients with visit gaps greater than 12 months were much more likely to have lost viral suppression. The results show that primary care visit intervals between six and nine months may be appropriate for HIV patients, say the researchers. (AIDS Patient Care and STDs, April 2018)

Probiotic reduces S. aureus infection odds in GI tract

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(04/25/2018)
Probiotics can reduce Staphylococcus aureus infection in the gastrointestinal tract, according to a William S. Middleton VA Medical Center study. Patients with S. aureus infection were given either the probiotic Lactobacillus rhamnosus HN001 or a placebo for four weeks. Those taking the probiotic had 83 percent reduced odds of S. aureus presence in their GI tract after treatment, compared with the placebo group. However, those with S. aureus infection somewhere other than the GI tract only had 15 percent lower S. aureus colonization. The results show that oral L. rhamnosus could be a useful treatment for S. aureus infection in the GI tract. (BMC Infectious Disease, March 14, 2018)

Possible explanation for how melatonin promotes sleep

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(04/25/2018)
Researchers at the Harry S Truman Memorial VA Hospital have identified a possible mechanism that explains how melatonin promotes sleep. Melatonin, sold in supplement form, is widely prescribed nowadays as a sleep aid, but how exactly it works is unclear. Researchers studied how the brains of mice responded to melatonin. They found that orexin neurons in the brain expressed MT1, a melatonin receptor protein. When the researchers infused melatonin into the brain, the mice showed increased REM sleep and reduced wakefulness. Melatonin infusion inhibited orexin neurons. The results show that melatonin may act via the MT1 receptors to inhibit orexin neurons and promote sleep. The researchers point out that while the finding helps explain an existing treatment, it also may lead to new ones.  (Journal of Pineal Research, April 14, 2018)

Certain psychotropic drugs increase risk of QT prolongation in PTSD patients

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(04/25/2018)
Certain drugs used to treat PTSD could lead to dangerous heart conditions, found researchers from several VA systems. Several psychotropic drugs used to treat depression and sometimes given for PTSD have recently been linked to QT prolongation. QT prolongation is an abnormal heart rhythm that can cause fainting, seizures, and even sudden death. The researchers looked at administrative data of VA patients with PTSD. They found that patients on the antipsychotic drug ziprasidone (sold under the brand name Geodon, among others) and the anti-anxiety drug buspirone (sold as Buspar) had increased risk of QT prolongation, while those on the SSRI antidepressants citalopram (sold as Celexa and other brands) and fluoxetine (Prozac and other brands) did not. The researchers also found that patients with QT prolongation had a higher risk of death than those without. They recommend that prescribers and patients consider these risks when deciding on treatments for PTSD. (Annals of Pharmacotherapy, April 1, 2018)

Telemental health useful for women Veterans

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(04/19/2018)
Telemental health is seen as a good fit to address the needs of women Veterans, according to a survey by the VA Center for the Study of Healthcare Innovation, Implementation and Policy. Researchers interviewed 40 VA leadership and clinical employees. Respondents believed that telemental health could increase access to care, especially for rural women and those with other barriers to care. Telemedicine was seen as particularly useful for women with responsibilities related to child care, spousal care, and elder care. The findings could help guide gender-tailored expansion of telemedicine. (Women's Health Issues, March-April 2018)

Self-report survey data improves violence risk prediction in soldiers

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(04/19/2018)
Data from the Army STARRS New Soldier Survey can improve the accuracy of interpersonal violence risk prediction, found a study that included a VA Eastern Colorado Health Care System researcher. The survey was given to more than 21,000 Army recruits. When using both survey and administrative data, researchers were able to predict soldiers’ involvement in physical or sexual violence with greater accuracy than with administrative data alone. The greatest change was in predicting whether women soldiers would be victims of sexual violence. Overall accuracy increased to 29 percent, up from 18 percent with administrative data only. The researchers believe that the increased accuracy might offset the survey costs. (BMC Psychiatry, April 3, 2018)

Blood cancer patients with cognitive impairment may have worse survival

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(04/19/2018)
Cognitive impairment was linked to worse survival rates in patients with blood cancers, in a study that included VA Boston Healthcare System researchers. They looked at 341 elderly patients with leukemia, myeloma, or lymphoma. Of those, 127 had executive dysfunction and 62 had impaired working memory. Those with impaired working memory had lower median survival, regardless of treatment type. Executive dysfunction was linked with worse survival only for those undergoing intensive treatment. While age is the main cause of cognitive impairment, some cancer-fighting drugs may further impair cognition. Other cancer treatments, as well, may worsen existing health conditions. The results show that targeted interventions are needed for cancer patients with cognitive impairment, say the researchers. (JAMA Oncology, March 1, 2018)

Increased exercise may improve cognitive function shortly after breast cancer surgery

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(04/11/2018)
An exercise program improved cognitive functioning in patients diagnosed with breast cancer within the past two years, in a study including a VA San Diego Healthcare System researcher. Increased physical activity has been shown to improve cognition in both healthy and cognitively impaired adults. This study aimed to see how exercise specifically benefitted cancer survivors. Patients within two years post-surgery scored better on a test of processing speed after a 12-week exercise program, compared with those not in the exercise program. However, patients who had surgery more than two years previously did not show faster processing. The results suggest that early implementation of an exercise intervention could have benefits for breast cancer survivors, say the researchers. (Cancer, Jan. 1, 2018)

High BMI linked with early, but not later, survival after hospitalization

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(04/11/2018)
Overweight or obese BMI is linked with improved survival after hospitalization, but only in the short term, found a study by VA Ann Arbor Healthcare System and NYU School of Medicine researchers. The study looked at survival rates for older patients hospitalized for congestive heart failure, pneumonia, and heart attack. Patients with overweight or obese BMI had lower mortality one year after hospitalization. However, after one year these patients did not have better survival rates than those with lower BMI. While previous studies have shown the link between higher BMI and lower risk of death after hospitalization in the short term, less data are available on the effects long-term. While obesity may be protective in the short term, this connection is a source of debate. Obesity may be protective against in-hospital mortality, but still hazardous for longer-term mortality, according to the researchers. (BMC Geriatrics, Feb. 6, 2018)

Accepting hepatitis C-positive liver transplants could improve life expectancy

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(04/11/2018)
Patient without hepatitis C needing a liver transplant may have increased life expectancy if they are willing to accept a donated liver that is positive for the hepatitis C virus, according to a mathematical model. A team including a researcher from the Michael E. DeBakey VA Medical Center used data from published studies to create a simulated trial. They found that accepting any liver regardless of hepatitis C status resulted in increased life expectancy over waiting for a liver free of the hepatitis C virus. Although infected livers could have adverse outcomes, the virus can now be treated very effectively post-transplant using direct-acting antivirals. (Hepatology, Dec. 9, 2017)

Detecting coronary heart disease using genetic data

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(04/04/2018)
A team including an Iowa City VA Healthcare System researcher used machine learning to detect coronary heart disease by combining genetic and epigenetic data. Epigenetics is the study of what causes genes to be expressed—basically, to get translated into proteins or other molecules that effect changes in the body. The program was able to classify heart disease with 78 percent accuracy, in a group of 142 patients. A comparison test using conventional heart disease risk factors—such as age, cholesterol level, and smoking status—was only 65 percent accurate. The results show that using computer algorithms with genetic data could lead to better ways to detect coronary heart disease, say the researchers. (PLoS One, Jan. 2, 2018)

‘Autonomy support’ linked to better diabetes control

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(04/04/2018)

Autonomy support from family or friends may help people better control their diabetes by relieving diabetes distress, according to a study by the VA Center for Clinical Management Research. Autonomy support is social support that encourages patients to control their own care. Many people with diabetes experience emotional distress from diabetes symptoms, the stress of keeping up with care regimens, and fear of complications from the disease. Studying 308 Veterans with diabetes, researchers found that high diabetes distress was linked to poor glycemic control. Those with greater autonomy support had greater glycemic control than those without. (Diabetes Care, March 29, 2018)

Low systolic blood pressure linked to worse outcomes for heart failure patients

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(04/04/2018)
Low systolic blood pressure is linked to worse outcomes in patients with heart failure with preserved ejection fraction, found Washington DC VA Medical Center researchers. Heart failure with preserved ejection fraction involves increased stiffness of the heart's left ventricle and less relaxation of the ventricle when filling with blood before the next beat. Out of more than 1,800 patients hospitalized with this condition, 10 percent of patients with systolic blood pressure less than 120 mm Hg at discharge died within 30 days, compared with 5 percent of those with systolic blood pressure higher than 120 mm Hg. Those with lower blood pressure also had higher risk of death one year after hospitalization. The researchers conclude that future studies should look at optimal systolic blood pressure treatment goals for patients with this condition. (JAMA Cardiology, Feb. 14, 2018)

Site mentoring can improve clinical trial recruitment

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(03/28/2018)

A site mentoring model improved recruitment for clinical trial participation, in a VA Cooperative Studies Program study. As part of the CONFIRM trial, which studies colorectal cancer, teams with expertise in managing multi-site clinical trials worked one-on-one with low-enrolling CONFIRM sites to identify and overcome barriers to recruitment. Sites being mentored had an average improvement of five participants per month. A majority of sites had improved participant recruitment and participant screening for eligibility three months after the mentoring. The success of this pilot program shows that a site mentoring model could help improve recruitment for future clinical trials, according to the researchers. (Contemporary Clinical Trials Communications, March 2018)

Outpatient medical care linked to lower drug use in rural patients

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(03/28/2018)
Use of outpatient medical care is linked to reductions in illicit drug use over time in rural areas, found a study by Central Arkansas VA Healthcare System researchers and their colleagues. The researchers looked at how outpatient medical care for other issues affected substance use in 710 stimulant users in rural areas of Arkansas, Kentucky, and Ohio. They found that patients with at least one outpatient medical care visit over a three-year period had lower alcohol, crack cocaine, and methamphetamine use over time, compared with patients who did not have any outpatient visits. The findings highlight the importance of medical care contact in addressing unhealthy substance use, say the researchers. (American Journal of Drug and Alcohol Abuse, 2018)

Gene variant, mild traumatic brain injury combination lead to greater risk of Alzheimer's

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(03/28/2018)
Mild traumatic brain injury may be connected to lower hippocampal volume in people with a gene variant linked to Alzheimer's disease risk, according to a VA Boston Healthcare System study. Lower volume of the hippocampus (a region of the brain) has been shown to be a sign of Alzheimer's disease. Previous research has shown that severe TBI can lead to hippocampus atrophy, but less evidence of this exists for mild TBI. The researchers looked at the genes of 165 Veterans with at least one mild TBI. They found that a combination of a specific gene variant previously linked to Alzheimer's and mild TBI was a good predictor of hippocampal volume. The results suggest that people with this gene variant are at greater risk for neurodegeneration after exposure to a mild TBI. (Genes, Brain, Behavior, Feb. 2018)

Apalutamide could delay metastasis of prostate cancer