Search Results (170)

Military personnel deployed to Iraq and Afghanistan were exposed to emissions from open-air burn pits, where plastics, metals, and medical waste were incinerated. These exposures have been linked to deployment-related respiratory diseases (DRRD) and may also impact neurological health via the lung–brain axis. To investigate molecular mechanisms, adult male rats were exposed to filtered air, naphthalene (a representative volatile organic compound), or a combination of naphthalene and carbon black (surrogate for particulate matter; CBN) via whole-body inhalation (six hours/day, three consecutive days). Lung, brain, and plasma samples were collected 24 h after the final exposure. Pro-inflammatory biomarkers were assessed using multiplex electrochemiluminescence and western blot. Differentially expressed genes (DEGs) were identified by RNA sequencing, and elastic net modeling was used to define exposure-predictive gene signatures. CBN exposure altered inflammatory biomarkers across tissues, with activation of nuclear factor kappa B (NF-κB) signaling. In the lung, gene set enrichment revealed activated pathways related to proliferation and inflammation, while epithelial–mesenchymal transition (EMT) and oxidative phosphorylation were suppressed. In the brain, EMT, inflammation, and senescence pathways were activated, while ribosomal function and oxidative metabolism were downregulated. Elastic net modeling identified a lung gene signature predictive of CBN exposure, including Kcnq3, Tgfbr1, and Tm4sf19. These findings demonstrate that inhalation of a surrogate burn pit mixture induces inflammatory and metabolic gene expression changes in both lung and brain tissues, supporting the utility of this animal model for understanding systemic effects of airborne military toxicants and for identifying potential biomarkers relevant to DRRD and Veteran health. Full article

Background: The number of women veterans has been rising steadily since the Gulf War and many assume the functions of their male counterparts. Women face unique obstacles in their service, and it is imperative that differences in physiology not be overlooked so as to provide better and appropriate care to our women in uniform. Despite this influx and incorporation of female talent, dedicated reports contrasting female and male veterans are rare, outside of specific psychological studies. We therefore attempt to contrast gut constituents, absorption, innate immune system, and nutritional differences to provide a comprehensive account of similarities and differences between female and male veterans, from our single-center perspective, as this has not been carried out previously. Herein, we obtained a detailed roster of commonly used biomedical tests and some novel entities to detect differences between female and male veterans. The objective of this study was to detect differences in the innate immune system and other ancillary test results to seek differences that may impact the health of female and male veterans differently. Methods: To contrast biochemical and sociomedical parameters in female and male veterans, we studied the data collected on 450 female veterans and contrasted them to a group of approximately 1642 males, sequentially from 1995 to 2022, all selected because of above-average risk for CRC. As part of this colorectal cancer (CRC) screening cross-sectional and longitudinal study, we also collected stool, urine, saliva, and serum specimens. We used ELISA testing to detect stool p87 shedding by the Adnab-9 monoclonal and urinary organ-specific antigen using the BAC18.1 monoclonal. We used the FERAD ratio (blood ferritin/fecal p87), a measure of the innate immune system to gauge the activity of the innate immune system (InImS) by dividing the denominator p87 (10% N-linked glycoprotein detected by ELISA) into the ferritin level (the enumerator, a common lab test to assess anemia). FERAD ratios have not been performed elsewhere despite past Adnab-9 commercial availability so we have had to auto-cite our published data where appropriate. Results: Many differences between female and males were detected. The most impressive differences were those of the InImS where males clearly had the higher numbers (54,957 ± 120,095) in contrast to a much lower level in females (28,621 ± 66,869), which was highly significantly different (p < 0.004). Mortality was higher in males than females (49.4% vs. 24.1%; OR 3.08 [2.40–3.94]; p < 0.0001). Stool p87, which is secreted by Paneth cells and may have a protective function, was lower in males (0.044 ± 0.083) but higher in females (0.063 ± 0.116; p < 0.031). Immunohistochemistry of the Paneth cell-fixed p87 antigen was also higher in females (in the descending colon and rectum). In contrast, male ferritin levels were significantly higher (206.3 ± 255.9 vs. 141.1 ± 211.00 ng/mL; p < 0.0006). Females were less likely to be diabetic (29.4 vs. 37.3%; OR 0.7 [0.55–0.90]; p < 0.006). Females were also more likely to use NSAIDs (14.7 vs. 10.7%, OR 1.08 [1.08–2.00]; p < 0.015). Females also had borderline less GI bleeding by fecal immune tests (FITs), with 13.2% as opposed to 18.2% in males (OR 0.68 [0.46–1.01]; p = 0.057), but were less inclined to have available flexible sigmoidoscopy (OR 0.68 [0.53–0.89]; p < 0.004). Females also had more GI symptomatology, a higher rate of smoking, and were significantly younger than their male counterparts. Conclusions: This study shows significant differences with multiple parameters in female and male veterans. Full article

Objectives: To investigate the relationship between serum magnesium levels, prescribed oral magnesium replacement, and major adverse cardiovascular events (MACE) in type-2 diabetes mellitus (T2D). Research design and methods: This nationwide retrospective study analyzed 1,284,940 US Veterans (≥18 years) with T2D who had outpatient serum magnesium testing between 1999–2021 in the Veterans Health Administration. The relationship between serum magnesium levels and MACE (hospitalizations for acute myocardial infarction, heart failure, ischemic stroke, or all-cause mortality) was determined using multivariable-adjusted Cox-regression models. Using a new-user-design and propensity-score-matching approach, we further related the use of prescribed oral magnesium and MACE among patients with hypomagnesemia (serum magnesium <1.8 mg/dL) and normomagnesemia (serum magnesium 1.8–2.3 mg/dL). Results: Of 1,284,940 patients with T2D, 229,210 (17.8%) patients had hypomagnesemia, and 117,674 (9.2%) patients had hypermagnesemia (serum magnesium >2.3 mg/dL). Compared to patients with normomagnesemia (serum magnesium 1.8–2.3 mg/dL), those with either hypomagnesemia or hypermagnesemia had elevated hazards for MACE. The risk increased with the severity of serum magnesium abnormalities in both directions—low (hazard ratios [HRs] 1.11–1.20) and high (HRs 1.04–1.39)—in a parabolic pattern. Oral magnesium was prescribed to 9.7% and 0.7% of patients with hypomagnesemia and normomagnesemia, respectively. After propensity-score-matching balanced across 64 baseline characteristics, oral magnesium was associated with a lower MACE risk in 40,766 matched patients with hypomagnesemia (HR 0.89; 95% confidence interval [CI], 0.84–0.93), especially those on proton-pump-inhibitors or thiazides. Oral magnesium was not related to MACE in 11,838 matched patients with normomagnesemia (HR 1.07; 95% CI, 0.97–1.17). Conclusions: In patients with T2D, both hypomagnesemia and hypermagnesemia were associated with higher one-year MACE risks compared to normomagnesemia. Prescribed oral magnesium was associated with a reduced MACE risk in hypomagnesemia but not in normomagnesemia. Full article

Background/Objectives: Veterans differ in sociodemographic composition and experience higher frequencies of disability than non-Veterans of the same age. Yet the epidemiology of the long-term care needs of Veterans, specifically activities of daily living (ADLs) and instrumental activities of daily living (IADLs), remains an important gap in the literature. The objectives of this study were to (1) characterize Veterans across levels of hierarchy of ADL and IADL support needs; (2) compare Veterans across the degree of need for help, from those who can still “self-manage” to those with an “unmet need”; and (3) identify the types and prevalence of ADL and IADL need combination patterns. Methods: This study used cross-sectional data from the 2021 administration of the HERO CARE survey. We included Veterans ages 65+ in our analyses (N = 7424). We calculated the overall weighted descriptive statistics across a hierarchy of ADL and IADL problems and the degree of need for help. One-way ANOVA for continuous variables and Rao–Scott chi-square tests for categorical variables were conducted to examine associations between groups, followed by post hoc pairwise comparisons, as appropriate. Results: Veteran respondents mean age was 82.3 (SD: 8.2 years), and most were male, non-Hispanic White, and married. In weighted analyses, more Veterans with both ADL and IADL problems compared to only ADL problems reported food insecurity, missed appointments, low health literacy, and depression. Among Veterans with ADL or IADL problems, 32.3% reported an unmet need for help. Almost a quarter of Veterans with ADL problems reported difficulties performing all eight ADLs (23.9%), and over a quarter of Veterans with IADL problems reported difficulties performing all seven IADLs (31.3%). Conclusions: Our findings show that Veterans are demographically and clinically different based on their hierarchy of impairment and degree of need for help. Identifying the patterns and prevalence of ADL and IADL needs among Veterans provides valuable information to align the Veterans Affairs (VA) programs and services with Veterans’ needs. Full article

Post-traumatic stress disorder (PTSD) is a complex, debilitating condition prevalent among military personnel exposed to traumatic events, necessitating biomarkers for early detection and intervention. Using data from the Millennium Cohort Study, the largest and longest-running military health study initiated in 2001, our objective was to identify specific microRNA (miRNA) expression patterns associated with distinct PTSD symptom trajectories among service members and veterans and assess their potential for predicting resilience and symptom severity. We analyzed 1052 serum samples obtained from the Department of Defense Serum Repository and linked with survey data collected at baseline and across three follow-up waves (2001–2011), using miRNA sequencing and statistical modeling. Our analysis identified five PTSD trajectories—resilient, pre-existing, new-onset moderate, new-onset severe, and adaptive—and revealed significant dysregulation of three key miRNAs (miR-182-5p, miR-9-5p, miR-204-5p) in participants with PTSD compared to resilient individuals. These miRNAs, which inhibit brain-derived neurotrophic factor (BDNF) and target pathways like NFκB, Notch, and TGF-alpha, were associated with neuronal plasticity, inflammation, and tissue repair, reflecting PTSD pathophysiology. These findings suggest that miRNA profiles could serve as biomarkers for early identification of PTSD risk and resilience, guiding targeted interventions to improve long-term health outcomes for military personnel. Full article

Objective: Although there has been substantial research on post-traumatic stress disorder and its commonly comorbid conditions, the unique associations among these mental health symptoms and relationship adjustment have not been investigated. The purpose of this paper is to extend understanding of the associations among PTSD and relationship adjustment for female and male veterans, as well as to account for the impact of comorbid symptoms of depression and problematic alcohol use in a large sample. Method: Participants were 2325 (n = 1122 men and 1203 women) veterans of the wars in Iraq and Afghanistan from a larger study exploring wartime experiences and post-deployment adjustment. Chi-square analyses and regressions tested the associations among mental health symptoms (PTSD symptom severity, depressive symptoms, and problematic alcohol use) and relationship status and adjustment. Results: For both men and women, those with probable PTSD were less likely to be in an intimate relationship than those without probable PTSD, and those in intimate relationships had lower PTSD symptom severity compared with those not in intimate relationships. However, when accounting for PTSD, depression, and problematic alcohol use simultaneously, only depression emerged as a significant negative predictor of relationship adjustment. Conclusions: Shared variance among these common post-traumatic mental health conditions comorbidities may be most responsible for PTSD’s negative association with relationship adjustment. Unique remaining variance of depression is also negatively associated with relationship adjustment. Treatment implications of these findings for individual and couple therapy post-trauma are provided. Full article

Syndromic surveillance has evolved into a vital public health tool, providing near real-time data to detect and respond to health threats. While states administer syndromic surveillance systems, Tribal Epidemiology Centers (TECs) serve American Indian and Alaska Native (AIAN) communities across multistate regions, often encountering significant barriers to data access and utilization. This manuscript explores how TECs access and use syndromic surveillance data to address health disparities in AIAN populations, highlighting successes, innovations, and ongoing challenges. The Alaska Native Epidemiology Center (ANEC), Great Plains Tribal Epidemiology Center (GPTEC), and Northwest Tribal Epidemiology Center (NWTEC) provide insights into their syndromic surveillance practices. This includes data access methods, the creation of dashboards and reports, technical assistance for Tribal Health Organizations (THOs), and strategies for overcoming jurisdictional and data-sharing barriers. TECs have successfully leveraged syndromic surveillance to monitor critical health issues, including respiratory illnesses, substance misuse, behavioral health, and maternal care. Collaborative efforts have addressed race misclassification and data gaps, enabling targeted interventions such as air purifier distribution and improving health care delivery for tribal veterans. However, TECs can face restrictive data use agreements, jurisdictional misalignments, and limited access to granular data, hindering their ability to serve AIAN communities comprehensively. Syndromic surveillance offers transformative potential for improving public health in AIAN communities. To fully realize this potential, systemic changes are needed to streamline data-sharing agreements and improve data accuracy. These efforts, along with strong collaborations between TECs and state health departments, are critical to advancing health equity, respecting tribal sovereignty, and ensuring timely, actionable insights for AIAN populations. Full article

Introduction: Social sustainability is deeply connected to the well-being of marginalized groups, and it is important to highlight how mental health impacts the social inclusion of homeless individuals, particularly veterans. Homelessness is a growing global issue, disproportionately affecting U.S. veterans, with mental health challenges playing a significant role in its onset and perpetuation. Purpose: This study aims to compare the sociodemographic and clinical characteristics of homeless veterans and non-veterans in the U.S. Method: Using public data (N = 6295), this quantitative study applies descriptive and inferential statistical analyses. Results: Homeless veterans are more likely than non-veterans to be older, male, and identify as Caucasian or African American. They are more frequently high school graduates or have higher education, and report being divorced, widowed, married, or in varied employment statuses (full-time, part-time, or unemployed). Veterans exhibit higher rates of severe mental illnesses, schizophrenia, trauma- and stressor-related disorders, ADHD, bipolar disorder, personality disorders, depression, anxiety, and substance or alcohol use disorders. However, they are less likely than non-veterans to report substance-induced disorders, intoxication, dependence, or abuse involving cocaine, cannabis, opioids, and other substances. Conclusions: Psychosocial interventions for homeless veterans should prioritize mental health-related concerns, whereas efforts for homeless non-veterans should focus on addressing substance use. Future research should develop tailored interventions, explore the sociodemographic factors influencing homelessness, and investigate the interplay between trauma, mental health, and substance use. Addressing these issues can contribute to a more resilient, inclusive, and sustainable society by providing long-term support and integration opportunities for those most affected. The novelty of this study lies in distinguishing between mental health issues prevalent in veterans and substance use disorders more common in non-veterans, offering insights for tailored interventions. It also connects these findings to social sustainability, suggesting that addressing these issues can promote a more inclusive and resilient society. Full article

Disempowering experiences of military service and transition for women veterans exist within an established, dominant, masculinised culture, in which their presence is highly visible, challenged, and often subject to institutional prejudice. Sexual abuse of women in the military, in particular, is a persistent finding in contemporary international research and national inquiries into military culture in countries such as Australia, the United Kingdom (UK), the United States (US), and Canada. This study sought to understand military service, transition to civilian life, and post-military experiences of Australian women veterans, specifically their experiences of discrimination, military sexual harassment and assault, and consequent military sexual trauma (MST). In-depth qualitative interviews were undertaken with 22 Australian women veterans that examined how women veterans manage their identity as women in the military. Issues included gender-based challenges in conforming to a masculinised culture, experiences of misogyny, sexual harassment and assault, systemic failures to recognize women’s specific health needs, and experiences of separation from the military and transition, including help-seeking and engagement with services to address their experiences of MST. Women veterans’ adverse experiences largely stemmed from an entrenched masculinised military culture, in which military sexual assault was enabled, ignored, and condoned. Military and veteran support services have been slow to recognize, acknowledge, and address this significant issue. Full article

Hearing loss is one of the most common sensory impairments acquired with aging. This condition causes communication difficulties, leading to social isolation, dependence on others, and a reduced quality of life. However, less is known about the influence of environmental factors on the experiences of older adults with hearing loss. This study utilized three waves of the National Health and Aging Trends Study (2011–2013), analyzing data from 3950 community-dwelling older adults. Survey-weighted random intercept models were used to investigate whether hearing loss is associated with social isolation over the three waves and whether this relationship is moderated by neighborhood disorder and perceived neighborhood social cohesion. The study found that older adults with hearing loss were significantly less socially isolated, while the perceived social cohesion significantly moderated the effect of hearing loss on social isolation. Given that hearing function deteriorates with age and hearing aids or other devices are rarely covered by third-party payers, except for some state Medicaid plans or rehabilitation services for veterans, addressing modifiable neighborhood factors may be the most effective way to help individuals remain socially engaged and avoid isolation. Full article

Background/Objectives: Suicides among U.S. military veterans are alarmingly high, driven by factors such as mental health issues, combat exposure, and history of mild traumatic brain injury (mTBI)/concussion. This study aims to examine the relationship between concussion history, combat experience, and their effects on mental health issues and suicide ideation among military veterans. Additionally, this study investigates the impact of post-traumatic stress disorder (PTSD) on these variables. Methods: A total of 78 veterans (62 males, 16 females) participated in this study. Participants completed a demographic survey and the Global Well-being Index (GWI) to assess concussion history and residual symptoms. A licensed social worker interviewed the veterans using the 9-Item Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder survey (7 Items) (GAD-7) for anxiety, and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide ideation. A 2 × 2 cross-tabulation analysis examined the relationships between concussion history, combat experience, and outcomes of anxiety, depression, and suicide ideation. PTSD was also assessed as both a predictor and an outcome. Statistical analyses yielded odds ratios (OR) with 95% confidence intervals (CI), Chi-square, and Cramer’s V (V) correlations along with associated p-values. Results: The combination of concussion history and combat experience strongly predicted either anxiety, depression, or suicide ideation (OR = 7.97, 95% CI: 1.70, 37.44; V = 0.334, (p = 0.003)), more than either factor alone. Combat experience was the strongest predictor of PTSD (OR = 11.12, 95% CI: 3.30, 37.47; V = 0.485, p ≤ 0.001), both individually and when combined with concussion history. PTSD strongly influenced mental health issues and suicide ideation (OR = 8.16, 95% CI: 1.74, 38.25; V = 0.339, p = 0.003). Stratification by PTSD status (positive or negative) affected the relationships between independent and dependent variables. Small cell counts resulted in a wide 95% CI for some ORs, though some statistically significant Fisher’s Exact Test results were observed. Credibility analysis using the critical prior interval (CPI) metric confirmed the intrinsic credibility of the results. Conclusions: This study provides insights into the relationships between concussion history, combat experience, and their impacts on mental health issues and suicide ideation among military veterans. Full article

Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry’s role in misrepresenting opioid risks—leading to over USD 50 billion in legal settlements—has included targeted marketing to vulnerable populations. This study examines Janssen Pharmaceuticals’ “Imagine the Possibilities Pain Coalition” (IPPC), which aimed to increase opioid use among veterans with chronic non-cancer pain. Insights from this public health industry document analysis offer guidance for military medicine and healthcare policymaking. Methods: Using the Opioid Industry Document Archive (OIDA), housed at Johns Hopkins University and the University of California, San Francisco, researchers conducted retrospective content analysis. Documents referencing veterans were identified through keyword searches on Johns Hopkins’ SciServer portal and reviewed using CoCounsel, an AI-based legal document platform using a human-in-the-loop approach. Relevant documents were examined by the authors to extract material aligned with the research focus. Results: The IPPC employed strategies to influence opioid prescribing for veterans. These included educational materials that minimized addiction risks and exaggerated long-term benefits and empathy-driven narratives prioritizing immediate pain relief over potential harms. Ghostwriting ensured favorable perspectives on opioids in scientific literature, aligning with broader industry strategies to promote opioids for chronic pain. Conclusions: The targeted marketing of opioids to veterans has exacerbated the opioid crisis, as documented in government reports and litigation. Rigorous oversight of industry-funded coalitions and evidence-based practices are critical to insulating military healthcare from corporate influence and addressing the opioid crisis among veterans. Full article

The digital delivery of mental health services became increasingly common following the onset of the COVID-19 pandemic. There is still much to learn regarding tailoring interventions for trauma-affected populations (military members, Veterans, public safety personnel). Through the current pilot study, we explored the perceptions of digitally delivered psychotherapies utilized for trauma-affected populations, as reported by Canadian military members, Veterans, and public safety personnel who completed such interventions. Quantitative data were collected from 11 Canadian clients (military members, Veterans, and public safety personnel with posttraumatic stress injury). Survey questions were based on the Alberta Quality Matrix of Health and the Unified Theory of Acceptance and Use of Technology model. As a follow-up, clients were invited to partake in a semi-structured interview to further explore their perspectives on digitally delivered trauma-focused and adjunct therapies. Four clients participated in an interview. The client participants reported that digitally delivered trauma and adjunct therapies offered similar treatment effectiveness to in-person delivery while also improving treatment access. The participants indicated several unique advantages of digital delivery, including the increased accessibility of treatment, cost-effectiveness, and more efficient use of resources, although the small sample size limits the generalizability of our findings. Further research with a larger, more diverse population is required to corroborate our results and identify other avenues in which psychotherapies utilized for trauma-affected populations can be engaged with and improved upon. Full article

Background: Access to healthcare is a significant challenge for rural veterans, especially those with chronic conditions; yet, research on their specific barriers remains limited. This study had three objectives: (1) to develop and validate the Rural Access to Care and Services Scale (RACSS) as a simple tool to assess access to physical, mental, and social care and services; (2) to examine whether minority veterans face greater barriers to care; and (3) to test whether RACSS scores are associated with psychosocial outcomes as theoretically expected. Methods: Data were collected from 500 rural veterans in the U.S. through a survey assessing demographic information, service-connected disability status, clinical conditions, and access to healthcare. First, the RACSS was developed and validated using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Second, to assess the reliability of the RACSS, internal consistency was evaluated using Cronbach’s alpha. Finally, independent sample t-tests were conducted to explore the relationships between access to healthcare and services and participants’ minority status. Results: The scale demonstrated a one-factor structure with excellent model fit indices and high internal consistency (α = 0.89). Veterans from minoritized racial and ethnic groups reported significantly higher difficulties in accessing healthcare and services. Conclusions: The RACCS provides a reliable tool to measure access to healthcare and services among rural veterans. The findings highlight the critical need for targeted interventions to improve access to healthcare and services, especially for veterans from minoritized racial and ethnic groups. Enhancing healthcare and service delivery in rural areas is essential to reducing disparities and improving health outcomes for this underserved population. Full article

Older adults with serious mental illness (SMI) (i.e., schizophrenia, schizoaffective disorder, bipolar disorder) have compromised physical function that adversely affects their quality of life. Exercise is an effective intervention to improve function in older persons; however, older people with SMI experience barriers to exercise engagement. This study sought to obtain feedback on an exercise program in development for older people with SMI that comprised home-based exercise delivery, individualized exercise prescription, and motivational health coaching calls. Individual interviews and focus groups were conducted with older Veterans with SMI (n = 3) and clinical staff serving this population (directors: n = 3; clinicians: n = 15, k = 3) to elicit feedback on the perceived feasibility and acceptability of the preliminary program and recommendations for modifications to the program. Rapid analysis was used to summarize transcripts of audio-recorded interviews and focus groups. Results indicated a strong perceived feasibility and acceptability of the preliminary intervention because of how the individualized exercise prescription component (i.e., exercise plan) would be personalized to the Veteran’s preferences and abilities. Clinical staff participants expressed concerns about how the lack of real-time supervision would negatively affect exercise completion. Participants recommended tailoring the home-based exercise delivery and motivational health coaching calls components to each Veteran’s unique context. Full article