Groundbreaking test for PTSD developed
March 12, 2019
Science Daily/Indiana University
Researchers have developed a groundbreaking blood test that could help more accurately diagnose those suffering from post-traumatic stress disorder.
A cutting-edge blood test discovered by Indiana University School of Medicine researchers could help more accurately diagnose military veterans and other people experiencing post-traumatic stress disorder, and potentially provide more precise treatments and prevention.
A study led by psychiatry professor Alexander Niculescu, MD, PhD, and published this week in the high-impact SpringerNature journal Molecular Psychiatry, tracked more than 250 veterans in over 600 visits at the Richard L. Roudebush VA Medical Center in Indianapolis to identify molecules in the blood that can help track stress intensity. According to Niculescu's findings, the blood test can accurately identify people who are at risk of stress disorders or are experiencing them severely.
"PTSD is a disorder that affects a lot of veterans, especially those involved in combat. It's also an underappreciated and underdiagnosed disorder among the civilian population, whether it be the result of abuse, rape, violence or accidents" said Niculescu, who worked with other Department of Psychiatry and VA researchers on the study, as well as collaborators at The Scripps Research Institute and University of California Irvine. "Countless people are underdiagnosed with stress disorders, which may manifest themselves by drinking more, other addictions, suicide or violence. Our research has broader relevance for not just veterans but the general public."
The decade-long study looked at the expression of genes in the blood, starting with the entire genome, which has over 20,000 genes. Over the course of multiple visits, researchers tested participants in both low- and high-stress states -- their blood analyzed for detectable changes in expression of genes between those two different states that could serve as biological markers (biomarkers) for stress. Researchers were able to narrow the study's focus down to 285 individual biomarkers (related to 269 genes) that can objectively help diagnose patients with PTSD, as well as determine the severity of their stress and predict future hospitalizations.
They also compared these biomarkers with other well-known markers of stress and aging, such as telomer length. The biomarker signature helped identify new potential medications and natural substances to treat stress disorders that could be paired in a personalized way with individuals.
"There are similar tests like this in other fields, like cancer, where a physician can biopsy the affected part of the body to determine the stage of disease. But when it comes to mental health, biopsying the brain isn't an option," Niculescu said "Our research is applying similar concepts from other areas of medicine, but we're engineering new ways that will allow us to track mental symptoms objectively, including stress, using blood, or so-called 'liquid biopsies.'"
Much like with his recent breakthrough in developing a blood test to measure pain, and his past work on suicide, Niculescu said this research could be life-changing for individuals who have been exposed to or are about to enter high-stress environments. Such biomarkers will allow doctors to classify people in terms of their current severity or risk for future stress disorders, which can guide career choices as well as treatment options. Additionally, the biomarkers could measure response to treatment in an objective, quantifiable manner.
"Untreated pain and stress can lead to suicide, that's how we became interested in these disorders, and decided to move upstream and see if we can better understand, treat and prevent them," Niculescu said. "We think that one of the key uses of our research would be to test people before they have symptoms of an illness to see who's at risk and possibly treat them early. It's much better to prevent things for the person, and for the health care system, than to treat somebody who is in an acute crisis."
With this study, Niculescu said the ultimate goal is prevention -- pairing the ability to better predict those predisposed to PTSD with a more targeted approach to medicating those suffering from its affects. It's preventive medicine done in a precise way, which aligns with the IU Grand Challenge Precision Health Initiative launched in 2016.
"We want to prevent the needless tragedy and suffering in people's lives. By understanding in a biological way a patient's illnesses and their mental health challenges, we could treat what they have better, preventing future episodes," Niculescu said. "I have an excellent team and group of collaborators, and we are excited to partner with other groups of experts and people who can carry this forward. There is a lot of good work being done in the field right now."
The study was supported by an NIH Director's New Innovator Award and a VA Merit Award. Moving forward, Niculescu's group looks to secure more funding through grants and private donations, as well collaborate with other institutions and organizations to advance these studies -- with the hope that ultimately the cutting-edge tests developed at IU School of Medicine be implemented in clinical settings.
"If you treat a medical disorder in general, you improve someone's quality of life; sometimes you save lives. But if you treat a mental health disorder, you can change somebody's destiny," said Niculescu, who is also a practicing psychiatrist. "You can help change someone from being a person who suffers, is unhappy, is unemployed -- maybe goes down the route of addiction, violence or suicide -- to somebody who can become a happy, well adjusted, productive member of society. That's the challenge and the privilege -- we can really change people's destinies if we do our job."
https://www.sciencedaily.com/releases/2019/03/190312092510.htm
Exposure to trauma impacts ability to squash bad memories
March 4, 2019
Science Daily/Boston University School of Medicine
People exposed to trauma are less able to suppress unwanted emotional memories due to neural and behavioral disruptions in their brain that may contribute to the development of post-traumatic stress disorder (PTSD).
PTSD is characterized by intense reliving of the trauma that is repetitive, intrusive and incapacitating. The intrusive nature of these hallmark symptoms suggests that the inability to suppress unwanted memories may be a strong contributor to the behavioral manifestation of PTSD.
Previous work has shown that healthy individuals can actively suppress emotional memories while individuals with PTSD frequently experience unwanted memories of their traumatic experiences, even when making explicit efforts to avoid them. However, little is known regarding the behavioral and neural effects of memory suppression among individuals with PTSD.
Using functional magnetic resonance imaging, the researchers examined memory suppression in three groups: those with PTSD; those who experienced trauma without PTSD and controls with no trauma exposure or PTSD. They found trauma-exposed participants (regardless of PTSD status) were less likely to successfully suppress memory than non-trauma-exposed controls.
"Neuroimaging data revealed that trauma-exposed individuals showed reduced activation in the right middle frontal gyrus, a critical region for memory suppression, during a memory suppression task and were less likely to successfully suppress memory compared to non-trauma exposed individuals. These results suggest that trauma exposure is associated with neural and behavioral disruptions in memory suppression and point to the possibility that difficulty in active suppression of memories may be just one of several likely factors contributing to the development of PTSD," explained lead author Danielle R. Sullivan, PhD, affiliated with Boston University School of Medicine and the National Center for PTSD, VA Boston Healthcare System.
These findings appear in the Journal of Psychiatric Research.
https://www.sciencedaily.com/releases/2019/03/190304105445.htm
How to treat depression in prison -- and why it matters
February 21, 2019
Science Daily/Michigan State University
The first randomized study of its kind reveals effective treatment for prisoners suffering from mental illness.
Of the 4 million prisoners released each year, 23 percent have suffered from major depressive disorder. Due to resource shortages, many go without adequate treatment while in prison. Oftentimes they rejoin society in worse mental shape than before their incarceration -- which could be prevented with the right care. A team led by Michigan State University has found a cost-effective way to improve mental health in prisons.
The research, published in Journal of Consulting and Clinical Psychology, tested the effectiveness of interpersonal psychotherapy for inmates battling major depressive disorder, or MDD, as a strategy to bring affordable treatment into a prison setting. It is the first large randomized trial of any treatment for MDD, including therapy or medications, in any incarcerated population.
About 15 million people touch the criminal justice system each year in the United States," said Jennifer Johnson, lead author and professor of public health in MSU's College of Human Medicine. "Most of us have friends, family or neighbors who have been through this system. The fact we've waited until 2019 to conduct a trial like this means we've understudied and underserved a huge population."
About 2.3 million people are incarcerated every day, and if they too suffer from depression, addiction or other disorders, they often do not get the help they need. Prison funding for mental health care is determined by state legislatures, which often leaves them understaffed and under-resourced, Johnson explained. Voters may be unsympathetic, which creates a deficit for mental health treatment in the prison system -- which houses many people with untreated mental illnesses.
To address the issues of care and cost, Johnson and colleagues trained a team to treat 181 inmates through interpersonal psychotherapy, or IPT. The team included master's level health therapists working in the prisons and bachelor's level re-entry counselors. This allowed the researchers to keep costs down by extending the reach of counselors and care without having to hire new mental health professionals.
Johnson explained that IPT is one of the most-effective forms of therapy because it addresses difficult life events, which consistently burden prison populations. She explained that traumatic and challenging experiences -- such as assault, abuse, poverty, death of loved ones and loss of family members, children and friends -- are overwhelmingly present with those incarcerated.
"When practicing IPT, you go back to when someone's depressed mood began and talk about what was going on in their life at that time," Johnson said. "IPT deals with relationships, feelings, conflicts with others, life changes and grief. Using this therapy, you're helping people feel and express emotions, and problem-solve with them in ways to improve communications or improve relationships that address the original problem."
Counselors worked in a group-setting with inmates twice a week for 10 weeks, which reduced the cost of treatment. Inmates were individually assessed at the beginning of the trial, after the trial ended and then three months later to see if the therapy had a lasting impact.
"As compared to the usual treatment prisons offer, IPT reduced depressive symptoms, hopelessness and PTSD symptoms and was better at ending cases of major depression," Johnson said.
Using IPT proved a low-cost intervention as well. Once counselors are trained and supervision is no longer needed, the cost per patient would be $575 -- significantly less than treatment options outside of prison, she said.
"This is the first large randomized study for major depression ever conducted for an incarcerated population, one that found an effective and cost-effective solution," Johnson said. "This method could drastically improve the mental well-being of people while in prison -- and when they re-enter the world."
Moving forward, Johnson will continue researching ways to treat inmates by conducting the first large randomized suicide prevention trial for people leaving the criminal justice system.
https://www.sciencedaily.com/releases/2019/02/190221115909.htm
It doesn't take much for soldiers to feel cared for
Researchers conduct randomized controlled trial of caring texts
Science Daily/February 14, 2019
University of Washington Health Sciences/UW Medicine
Caring texts sent to active-duty military had important findings in reducing suicide.
A soldier named Jerome Motto received caring letters from home in World War II. They helped boost his spirits and later led to one of the nation's first successful suicide interventions.
Today, with military personnel being more mobile, researchers tested out the effectiveness of caring texts sent to active-duty military.
The study of 658 randomized participants at three military installations was led by Kate Comtois, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. The results were published Feb. 13 in JAMA Psychiatry along with a podcast with the researchers.
Comtois said the most significant finding was that the caring contacts reduced the odds of a suicide attempt. The contacts lowered the risk from 15 percent to 9 percent.
"Caring contacts is an entirely different way to engage and take care of suicidal individuals," she said. "It can both prevent suicidal behavior and provide support over periods of stress and transition."
As for the primary aims -- reducing current suicidal ideation and suicide risk incidents, such as hospitalizations or medical evacuation -- the study was inconclusive. But the study did have impactful findings and secondary outcomes as well as clinical implications.
The study recruited Army and Marine Corps personnel identified as being at risk of suicide at three bases in the United States. The control group was given 11 text messages from a clinician, who engaged with the service members, including calling them on the phone if they were feeling urgent distress.
This simple intervention builds on the work of Jerome Motto, a World War II soldier who became a psychiatrist and researcher. He used caring letters to conduct the first successful clinical trial to reduce suicide deaths.
Military personnel historically have had a lower rate of suicide than the general population, Today, however, veterans have a 50 percent higher incidence of suicide than the general population, according to the Department of Veteran Affairs Suicide Data Report, 2006-2016. In 2018, the U.S. military experienced the highest number of suicides among active-duty personnel in at least six years. A total of 321 active-duty members took their lives during the year (57 Marines, 68 sailors, 58 airmen, and 138 soldiers), according to Military . com.
In this study, just under 14 percent of text responses mentioned difficulty and adversity, but after a few exchanges with a clinician, the service member felt better, said Amanda Kerbrat, a research scientist with the UW Department of Psychiatry and Behavioral Sciences.
"Most people didn't seem to need much to get the message that someone cared and was looking out for them," she said.
During the study, which took place from April 2013 to September 2016, five service members indicated they were suicidal and were called by a clinician immediately, said Kerbrat.
Two accompanying editorials in JAMA Psychiatry addressed the research by Comtois and colleagues.
"Comtois et al have confirmed that is possible to conduct high-value suicide prevention research in the active-duty military," wrote three researchers at University of California, San Diego, Harvard Medical School and the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Charles Hoge, with the Center for Psychiatry and Neurosciences at the Walter Reed Army Institute of Research in Silver Spring, Maryland, called the study a "hallmark clinical trial from the DoD [Department of Defense] portfolio." Hoge, however, said the study joins other intervention trials in delivering primarily null or inconclusive findings in military and veteran populations. He noted that only 30 percent of veterans are engaged in Veterans Affairs care, and he laid out what needs to be understood and implemented to prevent more suicides.
For the researchers, caring texts is something that can be implemented with some guidelines.
"The intervention is ready for prime time," said Comtois, noting that healthcare systems still need to sort out issues such how as who will be delivering the messages and guidelines for what they will include. She and colleagues are working on a free toolkit for healthcare providers.
https://www.sciencedaily.com/releases/2019/02/190214174237.htm
Stimulating the vagus nerve in the neck might help ease pain associated with PTSD
February 13, 2019
Science Daily/University of California - San Diego
In a randomized, controlled pilot trial, researchers found that participants pre-treated with noninvasive vagus nerve stimulation experienced less pain after heat stimulus than mock-treated participants.
Post-traumatic stress disorder, or PTSD, is a mental condition caused by a traumatic event. People with PTSD may experience intrusive memories, negative thoughts, anxiety and chronic pain. The condition is typically treated with a combination of psychotherapy, anti-depressants and anti-anxiety medications.
It's this connection between mental health and pain that interests Imanuel Lerman, MD, associate professor at University of California San Diego School of Medicine, Jacobs School of Engineering and Qualcomm Institute, and a pain management specialist at UC San Diego Health and Veterans Affairs San Diego Healthcare System.
Lerman especially wants to know how the emotional pain experience may be influenced by the vagus nerve, which runs down both sides of our necks from the brainstem to the abdomen. The vagus nerve also plays a critical role in maintaining heart rate, breathing rate, digestive tract movement and many other basic body functions.
In a study published February 13, 2019 in PLOS ONE, Lerman and colleagues tested noninvasive vagus nerve stimulation as a method for dampening the sensation of pain.
"It's thought that people with certain differences in how their bodies -- their autonomic and sympathetic nervous systems -- process pain may be more susceptible to PTSD," Lerman said. "And so we wanted to know if we might be able to re-write this 'mis-firing' as a means to manage pain, especially for people with PTSD." Lerman led the study with Alan N. Simmons, PhD, director of the fMRI Research Laboratory at Veterans Affairs San Diego Healthcare System and associate professor of psychiatry at UC San Diego School of Medicine.
The team used functional magnetic resonance imaging (fMRI) to get a look at the brains of 30 healthy study participants after a painful heat stimulus was applied to their legs. To determine how the body's sympathetic nervous system responds to pain, they also measured the sweat on the skin of participants before the heat was applied, and at several points as the heat increased.
Half the participants were treated with noninvasive vagus nerve stimulation for two minutes -- via electrodes placed on the neck -- approximately 10 minutes before the heat stimulus. The other half received a mock stimulation.
Lerman and colleagues report three main findings from this study. First, vagus nerve stimulation blunted peak response to heat stimulus in several areas of the brain known to be important for sensory and discriminative pain processing, as well as in emotional pain centers. The treatment also delayed the pain response in these brain regions -- pain-related brain regions were activated ten seconds later in participants pre-treated with vagus nerve stimulation than in sham-treated participants.
Second, the sweat measurements revealed that vagus nerve stimulation altered autonomic responses to painful heat stimulus. For participants pre-treated with vagus nerve stimulation, the sweat response decreased over time, in contrast to the sham-treatment group.
Third, vagus nerve stimulation dampened the usual brainstem centers critical for the fight-or-flight-type responses, which are also known to control the sweat response to pain.
"Not everyone is the same -- some people may need more vagus nerve stimulation than others to achieve the same outcomes and the necessary frequencies might change over time -- so we'll need to personalize this approach," Lerman said. "But we are hopeful and looking forward to the next steps in moving this approach toward the clinic."
Next, Lerman and colleagues will launch a Veterans Affairs Healthcare System-funded clinical trial in San Diego with military veterans, with and without PTSD. They want to determine if at-home vagus nerve stimulation can reduce emotional pain and underlying neural inflammation associated with PTSD. To learn how to participate, please call 858-552-8585.
Vagus nerve stimulation is a form of neuromodulation, an approach to pain management that also includes spinal cord and dorsal root ganglion (DRG) stimulation. The U.S. Food and Drug Administration (FDA) has approved noninvasive vagus nerve stimulator for the treatment of episodic and chronic cluster headache and acute migraine, as well as an implantable device for epilepsy. An implanted vagus nerve stimulator is now being tested in a clinical trial for the treatment of rheumatoid arthritis. Side effects of implanted vagus nerve stimulation can include hoarseness, shortness of breath and nausea.
https://www.sciencedaily.com/releases/2019/02/190213142700.htm
PTSD alone didn't increase heart disease risk in veterans with PTSD
February 13, 2019
Science Daily/American Heart Association
Coexisting medical conditions, psychiatric disorders, heavy smoking and illicit drug use may explain the increased risk for heart disease among veterans with PTSD.
Post-traumatic stress disorder (PTSD) by itself does not explain the increased risk of cardiovascular disease in veterans with this condition. A combination of physical disorders, psychiatric disorders and smoking, that are more common in patients with PTSD, may explain the association, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.
Researchers examined whether one, or a combination of heart disease risk factors common in those with PTSD, can explain the association between PTSD and cardiovascular disease. They reviewed electronic health records of 2,519 Veterans Affairs (VA) patients diagnosed with PTSD and 1,659 without PTSD. Participants were aged 30-70 (87 percent male; 60 percent white), had no cardiovascular disease diagnoses for 12 months prior and were followed for at least three years.
Researchers found:
Among VA patients, those diagnosed with PTSD were 41 percent more likely to develop circulatory and heart disease than those without PTSD.
Smoking, depression, other anxiety disorders, sleep disorders, Type 2 diabetes, obesity, high blood pressure, and cholesterol, were significantly more prevalent among patients with PTSD than those without.
No single comorbid condition explained the association between PTSD and incident cardiovascular disease, after adjusting for a combination of physical and psychiatric disorders, smoking, sleep disorder, substance use disorders, PTSD was not associated with new cases of cardiovascular disease.
"This suggests there is no single comorbidity or behavior that explains the link between PTSD and cardiovascular disease," said study lead author Jeffrey Scherrer, Ph.D., professor and director, Division of Research in the Department of Family and Community Medicine at the Saint Louis University School of Medicine in Missouri. "Instead, a combination of physical disorders, psychiatric disorders and smoking -- that are more common in patients with PTSD versus without PTSD -- appear to explain the association between PTSD and developing cardiovascular disease."
Researchers cautioned that the results may not be generalized to patients older than 70 or to non-veteran populations. In addition, the study did not measure lifetime cardiovascular disease risk; therefore, the association between PTSD and risk of cardiovascular disease over many decades may differ from the present results.
"For veterans, and likely non-veterans, heart disease prevention efforts should focus on helping patients reduce weight, control high blood pressure, cholesterol, Type 2 diabetes, depression, anxiety disorders, sleep problems, substance abuse and smoking," Scherrer said. "That is a long list, and for patients with many of these conditions it is challenging yet important to manage all of them."
"Recognizing that PTSD does not preordain cardiovascular disease may empower patients to seek care to prevent and/or manage CVD risk factors," Scherrer said.
https://www.sciencedaily.com/releases/2019/02/190213081642.htm
Brain wave stimulation may improve Alzheimer's symptoms
Noninvasive treatment improves memory and reduces amyloid plaques in mice
March 14, 2019
Science Daily/Massachusetts Institute of Technology
By exposing mice to a unique combination of light and sound, neuroscientists have shown they can improve cognitive and memory impairments similar to those seen in Alzheimer's patients.
This noninvasive treatment, which works by inducing brain waves known as gamma oscillations, also greatly reduced the number of amyloid plaques found in the brains of these mice. Plaques were cleared in large swaths of the brain, including areas critical for cognitive functions such as learning and memory.
"When we combine visual and auditory stimulation for a week, we see the engagement of the prefrontal cortex and a very dramatic reduction of amyloid," says Li-Huei Tsai, director of MIT's Picower Institute for Learning and Memory and the senior author of the study.
Further study will be needed, she says, to determine if this type of treatment will work in human patients. The researchers have already performed some preliminary safety tests of this type of stimulation in healthy human subjects.
MIT graduate student Anthony Martorell and Georgia Tech graduate student Abigail Paulson are the lead authors of the study, which appears in the March 14 issue of Cell.
Memory improvement
The brain's neurons generate electrical signals that synchronize to form brain waves in several different frequency ranges. Previous studies have suggested that Alzheimer's patients have impairments of their gamma-frequency oscillations, which range from 25 to 80 hertz (cycles per second) and are believed to contribute to brain functions such as attention, perception, and memory.
In 2016, Tsai and her colleagues first reported the beneficial effects of restoring gamma oscillations in the brains of mice that are genetically predisposed to develop Alzheimer's symptoms. In that study, the researchers used light flickering at 40 hertz, delivered for one hour a day. They found that this treatment reduced levels of beta amyloid plaques and another Alzheimer's-related pathogenic marker, phosphorylated tau protein. The treatment also stimulated the activity of debris-clearing immune cells known as microglia.
In that study, the improvements generated by flickering light were limited to the visual cortex. In their new study, the researchers set out to explore whether they could reach other brain regions, such as those needed for learning and memory, using sound stimuli. They found that exposure to one hour of 40-hertz tones per day, for seven days, dramatically reduced the amount of beta amyloid in the auditory cortex (which processes sound) as well as the hippocampus, a key memory site that is located near the auditory cortex.
"What we have demonstrated here is that we can use a totally different sensory modality to induce gamma oscillations in the brain. And secondly, this auditory-stimulation-induced gamma can reduce amyloid and Tau pathology in not just the sensory cortex but also in the hippocampus," says Tsai, who is a founding member of MIT's Aging Brain Initiative.
The researchers also tested the effect of auditory stimulation on the mice's cognitive abilities. They found that after one week of treatment, the mice performed much better when navigating a maze requiring them to remember key landmarks. They were also better able to recognize objects they had previously encountered.
They also found that auditory treatment induced changes in not only microglia, but also the blood vessels, possibly facilitating the clearance of amyloid.
Dramatic effect
The researchers then decided to try combining the visual and auditory stimulation, and to their surprise, they found that this dual treatment had an even greater effect than either one alone. Amyloid plaques were reduced throughout a much greater portion of the brain, including the prefrontal cortex, where higher cognitive functions take place. The microglia response was also much stronger.
"These microglia just pile on top of one another around the plaques," Tsai says. "It's very dramatic."
The researchers found that if they treated the mice for one week, then waited another week to perform the tests, many of the positive effects had faded, suggesting that the treatment would need to be given continually to maintain the benefits.
In an ongoing study, the researchers are now analyzing how gamma oscillations affect specific brain cell types, in hopes of discovering the molecular mechanisms behind the phenomena they have observed. Tsai says she also hopes to explore why the specific frequency they use, 40 hertz, has such a profound impact.
The combined visual and auditory treatment has already been tested in healthy volunteers, to assess its safety, and the researchers are now beginning to enroll patients with early-stage Alzheimer's to study its possible effects on the disease.
The research was funded, in part, by the Robert and Renee Belfer Family Foundation, the Halis Family Foundation, the JPB Foundation, the National Institutes of Health and the MIT Aging Brain Initiative.
https://www.sciencedaily.com/releases/2019/03/190314111004.htm
Traumatic brain injury and kids: New treatment guidelines issued
March 1, 2019
Science Daily/Oregon Health & Science University
To help promote the highest standards of care, and improve the overall rates of survival and recovery following TBI, a panel of pediatric critical care, neurosurgery and other pediatric experts today issued the third edition of the Brain Trauma Foundation Guidelines for the Management of Pediatric Severe TBI.
Each year in the United States, more than 600,000 children are seen in emergency rooms due to traumatic brain injury, a disruption to the normal function of the brain caused by a bump, blow or jolt to the head. Severe TBI results in approximately 7,000 childhood deaths annually, while survivors of the condition may suffer from long-term health conditions such as seizures, learning difficulty and communication disorders.
To help promote the highest standards of care, and improve the overall rates of survival and recovery following TBI, a panel of pediatric critical care, neurosurgery and other pediatric experts today issued the 3rd edition of the Brain Trauma Foundation Guidelines for the Management of Pediatric Severe TBI.
The updated guidelines reflect the addition of nearly 50 research studies, and include eight new, or revised, treatment recommendations for health care providers that range from the use of intracranial monitoring to the use of hypertonic saline to reduce acute brain swelling.
An executive summary of the guidelines published in the journals Pediatric Critical Care Medicine and Neurosurgery; the full guidelines are available via Pediatric Critical Care Medicine, an official journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
"These guidelines are vital to the proper care and treatment of children with serious brain injury," said co-author and clinical investigator Nathan Selden, M.D., Ph.D., Campagna Professor and Chair of the Department of Neurological Surgery at the OHSU School of Medicine in Portland, Oregon. "Now, health care providers around the world will have access to the best medical evidence and recommendations to help save and improve countless lives."
An associated manuscript, also published in Pediatric Critical Care Medicine, describes an algorithm designed to guide first and second tier therapies for infants and children with severe TBI. The tool for bedside use by caregivers, which supplements evidence-based recommendations in the updated guidelines, was created using a validated, consensus-based expert opinion process.
"We believe a combination of research findings and real-life experience will further advance the bedside care of infants and children with severe TBI, especially in treatment scenarios where scientific and clinical research is lacking," said first author Patrick Kochanek, M.D., Grenvik Professor and Vice Chairman of Critical Care Medicine and Director of the Safar Center for Resuscitation Research at the University of Pittsburgh. "This algorithm will also help to identify key research priorities to help ensure the ongoing momentum of consistent, high-quality care for patients across the globe."
The original Brain Trauma Foundation Guidelines published in 2003 and were last updated in 2012. The 3rd edition was developed as part of the Brain Trauma Evidence-based Consortium based at the Stanford University School of Medicine. The Pacific Northwest Evidence-based Practice Center at OHSU managed the effort, which included experts from OHSU, the University of Pittsburgh, Boston Children's Hospital, Phoenix Children's Hospital, Children's National Medical Center, Seattle Children's Hospital, the University of Utah, the University of British Columbia, and Duke University.
https://www.sciencedaily.com/releases/2019/03/190301192651.htm
Mesothelioma & Veterans
© 2019 by Asbestos.com and The Mesothelioma Center
Veterans file nearly 30 percent of all mesothelioma lawsuits in the United States. All branches of the military relied on asbestos in the past, and builders overseas still do. As a result, veterans are more likely than others to develop asbestos-related diseases.
Veterans of the U.S. armed forces played an important role in building America into the great nation it is today. These brave men and women made incredible sacrifices to protect our country, and we owe them respect and gratitude.
Many servicemen and servicewomen gave their lives to defend our country. Others came home and died decades later from mesothelioma, a cancer caused by exposure to the mineral asbestos.
The armed forces used the mineral extensively from 1935 to 1975. The military certainly had the safety of service members in mind when it first embraced asbestos as a fireproofing material. But the use of the toxic mineral continued well after medical evidence first proved the harmful effects of inhaling it. Today, veterans account for nearly a third of all mesothelioma lawsuits in the U.S.
Veterans and Asbestos Exposure
Members of the armed forces who develop mesothelioma and other asbestos-related conditions after exposure to the mineral in the military qualify for special financial benefits from the U.S. Department of Veterans Affairs (VA). These include disability compensation, special monthly compensation and service-connected death benefits for surviving family members.
An approved mesothelioma VA claim provides much-needed help for servicepersons. You’ll get access to treatment at any facility in the VA network. Free travel is available for veterans who want to visit the Boston VA Healthcare System and the VA Greater Los Angeles Healthcare System. These are two of the leading facilities offering the best mesothelioma treatments.
Overview of Asbestos in the Military
Asbestos was once highly regarded for its heat resistance and fireproofing capabilities. Nearly all branches of the military used the mineral from the 1900s to the mid-1970s. This put veterans who specialized in many military occupations at risk for mesothelioma.
All modes of military transportation contained products contaminated with asbestos. All aircraft, vehicles, tanks and naval ships contained asbestos. Common products included thermal insulation, electric wiring insulation, brake pads and clutch pads. Barracks and other buildings on military bases were constructed with asbestos cement pipes and a variety of other asbestos-containing materials.
Help with VA Claims and Other Benefits for Veterans
Every member of the military discharged “under conditions other than dishonorable” has a right to VA benefits. These benefits include health care, monthly disability compensation and survivor benefits for their loved ones.
The Veterans Department at The Mesothelioma Center specializes in getting VA claims approved for veterans. U.S. Army Capt. Aaron Munz, director of the Veterans Department, is well versed in helping people navigate the complicated VA claims process. He has the knowledge and resources to guide you each step along the way.
The VA recognizes mesothelioma as a service-connected medical condition. We can help you gather evidence to prove your disease is asbestos-related. We can help you explore other potential avenues of compensation. We’ll also answer frequently asked questions you might have regarding claims and benefits.
For additional information please visit: https://www.asbestos.com/veterans/
Drug & Alcohol Addiction Support Groups
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Support groups for all types of addictions allow people to join together with others who share similar experiences, backgrounds, and struggles. Drug and alcohol substance abuse groups are helpful whether you are interested in a support group as a first step in your journey to recovery from a drug or alcohol addiction or if you want to participate in a group to remain sober and help newer members.
There are hundreds of support groups full of compassionate members around the United States for you to consider. People who live in rural areas or prefer to not leave home to get help from peers have the option of joining many online communities that will be happy to welcome you as a member. There are general groups for any kind of addiction, for specific substance recoveries, for people who are religious or non-religious, and more, so no matter your circumstances and background, there is a community waiting to help you live a happy, healthy, sober life.
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This hotline is available 24/7 every day of the year. Compassionate staff will help you find the resources you need to start your journey to recovery.
Your Life Your Voice Hotline
In addition to their main hoteline, Your Life Your Voice from Boys Town also offers text (available 12pm to 12am CST), chat (available Monday through Friday, 6pm to 12am CST), and email support (available anytime for responses within 48 hours) for pre-teens, teenagers, and young adults.
800-448-3000 | Text VOICE to 20121 | Chat | Website | Email Contact Form
Online Drug & Alcohol Addiction Support Groups
5th Dimension Online Alcoholics Anonymous Group
An online Alcoholics Anonymous meeting specifically for teens and young people that meets Monday and Wednesday evenings. The Wednesday meetings are translated by an ASL interpreter. They also have a secret Facebook group where you can interact with other members.
Find an Online Meeting | Email
Al-Anon: Sharing Experience Strength & Hope Yahoo Group
An Al-Anon Yahoo Group for people who want to share their experiences with others who are in recovery.
Alcoholics Anonymous Online Intergroup
An Alcoholics Anonymous directory that lists general online Alcoholics Anonymous meetings as well as specialized meetings such as men only, women only, LGBT, veterans, atheists and agnostics, and more.
Alcohol Support Group at SupportGroups.com
An active online community for people who have struggled or are struggling with alcohol addiction.
Alcoholism Support Group at DailyStrength.org
A community of people who connect with each other online to provide support to others and get help for alcohol addiction or alcohol abuse.
Cocaine Anonymous Online
The online sector of Cocaine Anonymous, featuring email meetings and phone meetings via Skype.
Find a Meeting | Email | Phone
Cocaine Support Group at DailyStrength.org
An online community for recovery from cocaine abuse where people can share their experiences, receive guidance, and help others on their path to sobriety.
Cocaine Support Group at SupportGroups.com
An online network for people with a cocaine addiction to communicate with each other about any issues, struggles, victories, and more.
The Daily Pledge
An online recovery community for people who have been affected personally by addiction or know someone who has been affected by substance abuse.
Drug/Alcohol Addiction Support Facebook Group
A Facebook group for people looking to become sober or maintain their recovery from drug or alcohol addiction.
Drug Support Group at SupportGroups.com
A general drug use community that allows members to give and receive help for many different substance abuse problems.
In The Rooms
An online social network for people who are struggling with addiction, in recovery, and their friends and family members who have been affected by a loved one’s substance dependence.
Lifering Secular Recovery
In addition to face-to-face meetings, Lifering has 24/7 online meetings and dedicated communities for people looking to connect with others in a secular environment.
Online Meetings | Email Group | Email | Phone
Marijuana Anonymous
The headquarters of Marijuana Anonymous, an organization that helps people struggling with marijuana use and their families find help.
Online Meetings | Phone Meetings | Contact | Phone
Marijuana Support Group at DailyStrength.org
For people struggling with marijuana addiction, this online community comprised of members with similar issues can be accessed from any internet connected device.
Men’s One Day At A Time Al-Anon Yahoo Group
An Alcoholics Anonymous online-only Yahoo Group just for men with a small community of very active members.
Meth Support Group at SupportGroups.com
SupportGroups.com offers this online community specifically for people who want to overcome or maintain sobriety from a meth addiction.
Methadone Support Group at SupportGroups.com
It can often be difficult to find in-person, local methadone help, but you can access this community of like-minded people who will support you during your journey no matter where you are located.
My Recovery
As an online support community, My Recovery offers a social recovery network, online journal, forums, and more. Online AA and NA dedicated meetings are scheduled regularly.
Prescription & Synthetic Drug Support Group at DailyStrength.org
A more general community for people who have abused prescription or synthetic drugs and are looking toward recovery.
Recoveries Anonymous
This network of smaller communities for people with any problem or troubling behavior is focused on “sanity recovery” instead of full abstinence.
Secular Alcoholics Anonymous
An AA community for people who wish to participate in the 12 steps without the religious belief component with meetings online and in person across the USA.
Find an Online Meeting | Contact
SMART Recovery Teen & Youth Support Program
The Teen & Youth SMART (Self Management and Recovery Training) Recovery program utilizes a 4-point program to help people with addictions to any substance or activity. Online meetings specifically for teens and youth are held regularly.
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Drug & Alcohol Addiction Support Groups with In-Person Meetings
All Addictions Anonymous
Similar to AA, this twelve step program is based on healing from all addictions, no matter the type.
Celebrate Recovery
The headquarters for Celebrate Recovery, a network with an annual rally and individual meetings in many locations throughout the country. Specific subsects for students, veterans, pastors, Native Americans, bikers, and more are also available.
Chemically Dependent Anonymous
CDA is a community for people who are or have been addicted to drugs or alcohol.
Find a Meeting | Contact | Phone
Learn to Cope
The national headquarters of Learn to Cope, a recovery network for people who are struggling with or in recovery from an addiction to opiates or other drugs.
Moderation Management
Created for problem drinkers, not necessarily people with alcohol addictions, Moderation Management (MM) focuses on limiting and controlling the amount of alcohol people consume instead of abstinence.
Recoveries Anonymous
This network of communities for people with any problem or troubling behavior is focused on “sanity recovery” instead of full abstinence.
SMART Recovery
SMART (Self Management and Recovery Training) Recovery utilizes a 4-point program to help people with addictions to any substance or activity. SMART places an emphasis on evidence-based and scientifically-backed recovery techniques.
Substance Abuse and Mental Health Services Administration
Government resources for recovery from drug and alcohol addictions.
The Phoenix
The headquarters of The Phoenix, a national organization that encourages people to live a fulfilling life in sobriety.
Find a Meeting | Contact | Phone
Men’s Drug & Alcohol Addiction Support Groups
AAmen Online Group
An online Alcoholics Anonymous community for men from anywhere in the world that meets through email.
Men’s One Day At A Time Al-Anon Yahoo Group
An Alcoholics Anonymous online-only Yahoo group for men with a small community of very active members.
Men’s Online Serenity Alcoholics Anonymous Group
A weekly audio & video men’s only meeting that discusses an assigned reading each meeting.
Women’s Drug & Alcohol Addiction Support Groups
Alcoholics Anonymous Serenity Online Group
An AA group just for women that meets through email and discusses the twelve steps, offers newcomer meetings, and more.
AAChatcorner@Topica.com Online Group
An online-only women’s AA group that applies traditional AA topics to women’s issues.
KISS Group Alcoholics Anonymous Online Group
Keep It Simple Sisters (KISS) is an online email meeting for women only.
Ladies Alcoholics Anonymous Meeting Online Group
The Ladies AA Meeting is an online support community just for women where they can discuss sobriety from alcohol and other issues as they pertain to women.
Sisters in Sobriety (SIS) Alcoholics Anonymous Online Group
A community just for women who meet virtually each week to discuss a pre-selected topic.
Sober She Devils Alcoholics Anonymous Online Group
A secular, women-only meeting for women around the world.
Women for Sobriety
In addition to face-to-face meetings, Lifering has 24/7 online meetings and dedicated groups for people looking to connect with others in a secular environment.
Find a Meeting | Email | Phone
Women in the Solution (WITS) Alcoholics Anonymous Online Group
A community that meets via email each week to discuss two topics for women only.
Women’s Sober Living Alcoholics Anonymous Online Group
A telephone meeting for women who wish to share and hear about AA literature.
LGBT Drug & Alcohol Addiction Support Groups
A Safe Place Online Alcoholics Anonymous Meeting
An AA meeting that provides a welcoming environment full of people who identify as LGBT.
AA4gaymen Online Group
An Alcoholics Anonymous online-only group for gay men to help each other through their recoveries from alcohol addiction.
Alcoholics Anonymous Lesbian 3 Online Group
A small group of alcoholic lesbians who discuss topics each week through email.
LGBTQ Friendly Open Discussion Alcoholics Anonymous Online Group
An exclusively online Alcoholics Anonymous group where LGBTQ people can reach out to each other.
Rainbow Serenity Alcoholics Anonymous Online Group
Online group for LGBT members that discuss a select topic each week but sharing anything else is encouraged.
TG-AA Alcoholics Anonymous Online Group
An online Alcoholics Anonymous group for transgender people looking to connect and help other members through their recovery.
Teen Drug & Alcohol Addiction Support Groups
Most support groups meant specifically for teens and young people are area-specific, so please navigate to your state to see more detailed results.
5th Dimension Online Alcoholics Anonymous Group
An online Alcoholics Anonymous meeting specifically for teens and young people that meets Monday and Wednesday evenings. The Wednesday meetings are translated by an ASL interpreter. They also have a secret Facebook group where you can interact with other members.
Find an Online Meeting | Email
SMART Recovery Teen & Youth Support Program
The Teen & Youth SMART (Self Management and Recovery Training) Recovery program utilizes a 4-point program to help people with addictions to any substance or activity. Online meetings specifically for teens and youth are held regularly.
Find an Online Meeting | Contact
Veteran Drug & Alcohol Addiction Support Groups
Alcoholics Anonymous Online Intergroup
An Alcoholics Anonymous directory that lists general online Alcoholics Anonymous meetings as well as specialized meetings such as men only, women only, LGBT, veterans, atheists and agnostics, and more.
Celebrate Recovery
The headquarters for Celebrate Recovery, a support network with an annual rally and individual meetings in many locations throughout the country. Specific meetings for students, veterans, pastors, Native Americans, bikers, and more are also available.
Religious Drug & Alcohol Addiction Support Groups
Alcoholics for Christ
A non-denominational Christian community with chapters across the nation for people with substance abuse problems, their family members, and their adult children.
Find a Meeting | Email | Phone
Alcoholics Victorious
Alcoholics Victorious is a Christian faith recovery community that has local meetings in many states.
Buddhist Recovery Network
A network of communities that are guided by Buddhist principles. Meetings are open to people of any faith, background, and recovery path.
The Calix Society
The Calix Society provides help for Catholics who are already well along the path to recovery and are currently maintaining their sobriety from alcohol.
Indigenous Sobriety Alcoholics Anonymous Online Group
An online-only Alcoholics Anonymous community for Indigenous and Aboriginal people who want to interact with and help others through their sobriety.
Millati Islami
The main website for Millati Islami, a community for Muslims recovering from substance abuse.
re:generation
The main headquarters of a network of Christian faith recovery groups that are based on biblical principles.
Find a Meeting | Email | Phone
White Bison
A recovery community created for and by the Native Americans and Alaska Native communities.
Secular Drug & Alcohol Addiction Support Groups
A Spiritual Recovery Online Alcoholics Anonymous Meeting
A Spiritual Recovery caters to people such as freethinkers, atheists, and agnostics who prefer an approach to sobriety that doesn’t contain more traditional religious aspects of AA.
Alcoholics Anonymous Atheists and Agnostics Online Meeting
An Alcoholics Anonymous online community where people are accepting of non-belief in God. Members can participate from anywhere in the world through Google Groups.
Alcoholics Anonymous Freethinkers Group Online Meeting
An online Alcoholics Anonymous community for freethinkers that meets through Yahoo groups.
Atheist-Alcoholics Anonymous Online Meeting
An online Alcoholics Anonymous community specifically for Atheists, who often struggle with some of the spiritual concepts of traditional AA, that meets through Google Groups.
Alcoholics Anonymous
With thousands of recovery support networks across the United States, AA can be easily accessed no matter your location.
Alcoholics Anonymous Online Intergroup
An Alcoholics Anonymous directory that lists general online Alcoholics Anonymous meetings as well as specialized meetings such as men only, women only, LGBT, veterans, atheists and agnostics, and more.
Lifering Secular Recovery
Lifering offers meetings across the United States for people who prefer a non-religious approach to sobriety.
Secular Alcoholics Anonymous
An AA community for people who wish to participate in the 12 steps without the religious belief component with meetings online and in person across the USA.
Secular Organizations for Sobriety (S.O.S)
The national head of SOS which offers general information and connections to local SOS meetings.
Find a Meeting | Email | Phone
Alcohol Addiction Support Groups
5th Dimension Online Alcoholics Anonymous Group
An online Alcoholics Anonymous meeting specifically for teens and young people that meets Monday and Wednesday evenings. The Wednesday meetings are translated by an ASL interpreter. They also have a secret Facebook group where you can interact with other members.
Find an Online Meeting | Email
Alcoholics Anonymous
With thousands of recovery support networks across the United States, AA can be easily accessed no matter your location.
Alcoholics Anonymous Online Intergroup
An Alcoholics Anonymous directory that lists general online Alcoholics Anonymous meetings as well as specialized meetings such as men only, women only, LGBT, veterans, atheists and agnostics, and more.
Alcoholics for Christ
A non-denominational Christian support community with chapters across the nation for people with substance abuse problems, their family members, and their adult children.
Find a Meeting | Email | Phone
Alcoholics Victorious
Alcoholics Victorious is a Christian faith recovery support community that has local meetings in many states.
A Spiritual Recovery Online Alcoholics Anonymous Meeting
A Spiritual Recovery caters to people such as freethinkers, atheists, and agnostics who prefer an approach to sobriety that doesn’t contain more traditional religious aspects of AA.
Alcoholics Anonymous Atheists and Agnostics Online Meeting
An Alcoholics Anonymous online community where people are accepting of non-belief in God. Members can participate from anywhere in the world through Google Groups.
Alcoholics Anonymous Freethinkers Group Online Meeting
An online Alcoholics Anonymous community for freethinkers that meets through Yahoo Groups.
Atheist-Alcoholics Anonymous Online Meeting
An online Alcoholics Anonymous community specifically for Atheists, who often struggle with some of the spiritual concepts of traditional AA, that meets through Google Groups.
AAChatcorner@Topica.com Online Group
An online-only women’s AA community that applies traditional AA topics to women’s issues.
AAmen Online Group
An online Alcoholics Anonymous community for men from anywhere in the world that meets through email.
Al-Anon: Sharing Experience Strength & Hope Yahoo Group
A Yahoo group for people who want to share their experiences with others who are in recovery.
Alcoholics Anonymous Online Intergroup
An Alcoholics Anonymous directory that lists general online Alcoholics Anonymous meetings as well as specialized meetings such as men only, women only, LGBT, veterans, atheists and agnostics, and more.
A Safe Place Online Alcoholics Anonymous Meeting
An AA meeting that provides a welcoming environment full of people who identify as LGBT.
AA4gaymen Online Group
An Alcoholics Anonymous online-only community for gay men to help each other through their recoveries from alcohol addiction.
Alcoholics Anonymous Lesbian 3 Online Group
A small community of alcoholic lesbians who discuss topics each week through email.
Alcoholics Anonymous Serenity Online Group
An AA community just for women that meets through email and discusses the twelve steps, offers newcomer meetings, and more.
Alcohol Support Group at SupportGroups.com
An active online community for people who have struggled with alcohol addiction.
Alcoholism Support Group at DailyStrength.org
A community of people who connect with each other online to provide support to others and get help for alcohol addiction or alcohol abuse.
Drug/Alcohol Addiction Support Facebook Group
A Facebook group for people looking to become sober or maintain their recovery from drug or alcohol addiction.
Indigenous Sobriety Alcoholics Anonymous Online Group
An online-only Alcoholics Anonymous community for Indigenous and Aboriginal people who want to interact with and help others through their sobriety.
KISS Group Alcoholics Anonymous Online Group
Keep It Simple Sisters (KISS) is an online email group for women only.
Ladies Alcoholics Anonymous Meeting Online Group
The Ladies AA Meeting is an online community just for women where they can discuss sobriety from alcohol and other issues as they pertain to women.
LGBTQ Friendly Open Discussion Alcoholics Anonymous Online Group
An exclusively online Alcoholics Anonymous community where LGBTQ people can help each other.
Men’s One Day At A Time Al-Anon Yahoo Group
An Alcoholics Anonymous online-only Yahoo community for men with a small community of very active members.
Men’s Online Serenity Alcoholics Anonymous Group
A weekly audio & video men’s only meeting that discusses an assigned reading each meeting.
Moderation Management
Created for problem drinkers, not necessarily people with alcohol addictions, Moderation Management (MM) focuses on limiting and controlling the amount of alcohol people consume instead of abstinence.
Rainbow Serenity Alcoholics Anonymous Online Group
Online community for LGBT members that discuss a select topic each week but sharing anything else is encouraged.
Secular Alcoholics Anonymous
An AA community for people who wish to participate in the 12 steps without the religious belief component with meetings online and in person across the USA.
Find an Online Meeting | Contact
Sisters in Sobriety (SIS) Alcoholics Anonymous Online Group
A community just for women who meet virtually each week to discuss a pre-selected topic.
Sober She Devils Alcoholics Anonymous Online Group
A secular, women-only meeting for women around the world.
TG-AA Alcoholics Anonymous Online Group
An online Alcoholics Anonymous community for transgender people looking to connect and help other members through their recovery.
Women for Sobriety
In addition to face-to-face meetings, Lifering has 24/7 online meetings for people looking to connect with others in a secular environment.
Find a Meeting | Email | Phone
Women in the Solution (WITS) Alcoholics Anonymous Online Group
A community that meets via email each week to discuss two topics for women only.
Women’s Sober Living Alcoholics Anonymous Online Group
A telephone meeting for women who wish to share and hear about AA literature.
Cocaine & Crack Addiction Support Groups
Cocaine Anonymous
World headquarters of Cocaine Anonymous with resources and links to local, in-person meetings.
Cocaine Anonymous Online
The online sector of Cocaine Anonymous, featuring email meetings and phone meetings via Skype.
Find a Meeting | Email | Phone
Cocaine Support Group at DailyStrength.org
An online community for recovery from cocaine abuse where people can share their experiences and help others on their path to sobriety.
Cocaine Support Group at SupportGroups.com
The Cocaine Support Group is an online network that helps people with a cocaine addiction.
Heroin & Opiates Addiction Support Groups
Narcotics Anonymous
The main headquarters of Narcotics Anonymous which provides resources and a list of local meetings.
Opiates Anonymous World Services
Find meetings around the entire country using the world services website of Opiates Anonymous.
Marijuana Addiction Support Groups
Marijuana Anonymous
The headquarters of Marijuana Anonymous, an organization that helps people struggling with marijuana use and their families find help.
Online Meetings | Phone Meetings | Contact| Phone
Marijuana Support Group at DailyStrength.org
For people struggling with marijuana addiction, this online community comprised of members with similar issues can be accessed from any internet connected device.
Leaves Subreddit
AAn online space with over 70,000 subscribers on Reddit for people who have, would like to, or are quitting the use of marijuana to discuss their journey anonymously.
Meth & Crystal Meth Addiction Support Groups
Crystal Meth Anonymous
The main website of Crystal Meth Anonymous, an organization that has literature, resources, and can connect people with local meetings.
Meth Support Group at SupportGroups.com
SupportGroups.com offers this online community specifically for people who want to overcome or maintain sobriety from a meth addiction.
Methadone Support Group at SupportGroups.com
It can often be difficult to find in-person, local methadone recovery help, but you can access this community of like-minded people who will help you during your journey no matter where you are located.
Prescription Drug Addiction Support Groups
Nar-Anon
The world services of Narcotics Anonymous which provides resources and a list of local meetings.
Find a Meeting | Contact | Phone
Pills Anonymous
Pills Anonymous offers support for people who are recovering from prescription medication addictions.
Prescription & Synthetic Drug Support Group at DailyStrength.org
A more general group for people who have abused prescription or synthetic drugs and are looking toward recovery.
Concussion treatment: Adolescent athletes 'prescribed' aerobic exercise recovered faster
Study is the first randomized clinical trial on treatment of acute concussion
Science Daily/February 4, 2019
University at Buffalo
Adolescent athletes who sustained concussions while playing a sport recovered more quickly when they underwent a supervised, aerobic exercise regimen.
The study, by University at Buffalo researchers and colleagues, is the first randomized clinical trial of a treatment in the acute phase after a sport-related concussion. The goal was to evaluate prescribed, progressive sub-symptom threshold exercise as a treatment within the first week of a concussion in adolescents after a few days of rest. Sub-symptom threshold exercise is physical activity that doesn't exacerbate symptoms.
The researchers followed 103 participants ages 13-18, with nearly the same number of males and females. All were seen within 10 days after sustaining a sport-related concussion at one of the UBMD Orthopaedics and Sports Medicine clinics in Western New York or at the Pan Am Clinic in Winnipeg.
Patients who followed the aerobic exercise program took on average 13 days to recover while those in the control group, who performed stretching exercises, took 17 days. In addition, fewer patients in the exercise program took longer than four weeks to recover than did patients in the control group.
"This research provides the strongest evidence yet that a prescribed, individualized aerobic exercise program that keeps the heart rate below the point where symptoms worsen is the best way to treat concussion in adolescents," said John J. Leddy, MD, first author, clinical professor of orthopaedics in the Jacobs School of Medicine and Biomedical Sciences at UB, and director of the UB Concussion Management Clinic at UBMD Orthopaedics and Sports Medicine.
The researchers plan to investigate if the treatment is also effective in adults with concussion.
No proven treatment
The researchers noted that there is no proven treatment for concussion, especially among adolescents, who typically take the longest to recover.
"Until now, nothing else has been proven in any way effective for treating concussion," said Barry S. Willer, PhD, senior author, director of research in the UB Concussion Management Clinic and professor of psychiatry in the Jacobs School. "This is the best evidence so far for a treatment that works."
The findings directly contradict the conventional approach to concussion, which often consists of nearly total rest, eliminating most physical and mental activities, including schoolwork.
"Telling a teenager to go home and basically do nothing is depressing," said Willer. "It can actually increase their physical and psychological symptoms, and we see that particularly among girls. But with our approach, you're saying, sure, you can return to school and you should start doing these exercises. Their chins are up, Mom and Dad are happy and so is the student."
The fact that all states have now passed laws requiring schools to make accommodations for students who have sustained concussions is also helpful, said Willer, so that the student can opt out of some activities during the school day, if necessary.
The proper 'dose' of exercise
To determine how much exercise each patient could sustain without exacerbating symptoms, the researchers had each one undergo the Buffalo Concussion Treadmill Test, developed by Leddy and Willer, to determine at what level their symptoms worsen. As the patient walks on a treadmill, the incline is gradually increased and the heart rate is recorded at the point where concussion symptoms intensify.
"We prescribed exercise at 80 percent of that threshold," Leddy explained, "so each patient's exercise 'dose' was individually tailored."
Patients were randomly assigned to the aerobic exercise group (52) or to a stretching group (51). Patients in both groups were sent home with a heart rate monitor so they could make sure they stayed below the threshold while exercising.
Both groups performed their assigned exercise for about 20 minutes each day and were required to report compliance and daily symptoms online. Those in the aerobic group either walked on a treadmill, rode a stationary bike, or walked either inside or out. Aside from the prescribed exercise, patients were advised to refrain from contact sports, gym class or team practice. They were given advice about getting schoolwork done and told to avoid excessive use of electronic devices, since that can also aggravate symptoms.
Each patient's condition was re-evaluated weekly and as symptoms improved, the "dose" of exercise or stretching was increased, according to the weekly treadmill test results.
Recovery was rigorously defined, requiring agreement among three independent criteria: the patient's reporting a normal (minimal) level of symptoms, a normal physical examination by a medical doctor, and the return of normal exercise tolerance on the Buffalo Concussion Treadmill Test. The physicians were blinded as to the group assignment of each participant.
One surprising finding was that only two participants out of 52 (4 percent) in the aerobic exercise group took longer than four weeks to recover compared to seven out of 51 (14 percent) in the stretching group. This did not reach statistical significance, but the scientific literature suggests, by contrast, that between 15 and 25 percent of adolescents who do not receive any treatment will be symptomatic past four weeks.
"Reducing the number of concussed adolescents who have delayed recovery has major implications," Willer said, noting that delayed recovery creates more difficulty with schoolwork, can lead to depression and puts additional demands on the health care system and its costs.
Expanding capacity for medically supervised exercise treatment
Michael J. Ellis, MD, co-author and medical director of the Pan Am Concussion Program in the Department of Surgery and Pediatrics at the University of Manitoba, said that for years, his clinic has been successfully using the Buffalo Concussion Treadmill Test and a medically supervised sub-symptom-threshold aerobic exercise program to treat professional, collegiate and elite adolescent athletes.
Expanding access to this treatment is now critical, he said.
"The results of this study suggest that we must build greater capacity within our health care systems to allow patients access to multidisciplinary concussion programs and clinics that have the medical expertise to carry out early targeted rehabilitation of acute concussion," he said.
Leddy and Willer are internationally known for their research into the best ways to diagnose and treat concussion, especially among adolescents, who are the most vulnerable age group for concussions and take the longest time to recover. They have led the emerging body of research findings that show that a patient's degree of exercise intolerance in the first week after injury, i.e., the lower the threshold of activity at which symptoms increase, is a key clinical indicator of how severe the concussion may be.
https://www.sciencedaily.com/releases/2019/02/190204114615.htm
Mental health disorders common following mild head injury
Risk factors for neuropsychiatric conditions after concussion
January 30, 2019
Science Daily/NIH/National Institute of Neurological Disorders and Stroke
A new study reveals that approximately 1 in 5 individuals may experience mental health symptoms up to six months after mild traumatic brain injury (mTBI), suggesting the importance of follow-up care for these patients. Scientists also identified factors that may increase the risk of developing post-traumatic stress disorder (PTSD) and/or major depressive disorder following mild mTBI or concussion through analysis of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study cohort.
"Mental health disorders after concussion have been studied primarily in military populations, and not much is known about these outcomes in civilians," said Patrick Bellgowan, Ph.D., NINDS program director. "These results may help guide follow-up care and suggest that doctors may need to pay particular attention to the mental state of patients many months after injury."
In the study, Murray B. Stein, M.D., M.P.H., professor at the University of California San Diego, and his colleagues investigated mental health outcomes in 1,155 people who had experienced a mild TBI and were treated in the emergency department. At three, six, and 12 months after injury, study participants completed various questionnaires related to PTSD and major depressive disorder. For a comparison group, the researchers also surveyed individuals who had experienced orthopedic traumatic injuries, such as broken legs, but did not have head injury.
The results showed that at three and six months following injury, people who had experienced mTBI were more likely than orthopedic trauma patients to report symptoms of PTSD and/or major depressive disorder. For example, three months after injury, 20 percent of mTBI patients reported mental health symptoms compared to 8.7 percent of orthopedic trauma patients. At six months after injury, mental health symptoms were reported by 21.2 percent of people who had experienced head injury and 12.1 percent of orthopedic trauma patients.
Dr. Stein and his team also used the data to determine risk factors for PTSD and major depressive disorder after mTBI. The findings revealed that lower levels of education, self-identifying as African-American, and having a history of mental illness increased risk. In addition, if the head injury was caused by an assault or other violent attack, that increased the risk of developing PTSD, but not major depressive disorder. However, risk of mental health symptoms was not associated with other injury-related occurrences such as duration of loss of consciousness or posttraumatic amnesia.
"Contrary to common assumptions, mild head injuries can cause long-term effects. These findings suggest that follow-up care after head injury, even for mild cases, is crucial, especially for patients showing risk factors for PTSD or depression," said Dr. Stein.
This study is part of the NIH-funded TRACK-TBI initiative, which is a large, long-term study of patients treated in the emergency department for mTBI. The goal of the study is to improve understanding of the effects of concussions by establishing a comprehensive database of clinical measures including brain images, blood samples, and outcome data for 3,000 individuals, which may help identify biomarkers of TBI, risk factors for various outcomes, and improve our ability to identify and prevent adverse outcomes of head injury. To date, more than 2,700 individuals have enrolled in TRACK-TBI.
A recent study coming out of TRACK-TBI suggested that many TBI patients were not receiving recommended follow-up care.
"TRACK-TBI is overturning many of our long-held beliefs around mTBI, particularly in what happens with patients after they leave the emergency department. We are seeing more evidence about the need to monitor these individuals for many months after their injury to help them achieve the best recovery possible," said Geoff Manley, M.D., professor at the University of California San Francisco, senior author of the current study and principal investigator of TRACK-TBI.
Future research studies will help identify mental health conditions, other than PTSD and major depressive disorder, that may arise following mTBI. In addition, more research is needed to understand the biological mechanisms that lead from mTBI to mental health problems and other adverse outcomes, such as neurological and cognitive difficulties.
https://www.sciencedaily.com/releases/2019/01/190130112717.htm
PTSD symptoms improve when patient chooses form of treatment
October 19, 2018
Science Daily/University of Washington
A new study is the first large-scale trial of hundreds of PTSD patients, including veterans and survivors of sexual assault, to measure whether patient preference in the course of treatment impacts the effectiveness of a type of cognitive behavioral therapy and use of selective serotonin reuptake inhibitors, a type of antidepressant often prescribed for PTSD.
The study, led by the University of Washington and Case Western Reserve University, was conducted at outpatient clinics in Seattle and Cleveland. It found that both a medication -- Sertraline, marketed as Zoloft -- and a specific form a therapy known as prolonged exposure were effective in reducing PTSD symptoms during the course of treatment, with improvements maintained at least two years later. But patients who received their choice between the two possible treatments showed greater reduction in symptoms, were more apt to stick to their treatment program and even lost their PTSD diagnosis over time.
The study, published Oct. 19 in the American Journal of Psychiatry, is the first large-scale trial of hundreds of PTSD patients, including veterans and survivors of sexual assault, to measure whether patient preference in the course of treatment impacts the effectiveness of a type of cognitive behavioral therapy and use of selective serotonin reuptake inhibitors, a type of antidepressant often prescribed for PTSD.
"In any form of health care, when receiving a recommendation from a provider, patients may or may not be given a choice of approaches to address their problems," said the study's lead author, Lori Zoellner, a UW professor of psychology and director of the Center for Anxiety & Traumatic Stress. "This research suggests that prolonged exposure and Sertraline are both good, evidence-based options for PTSD treatment -- and that providing information to make an informed choice enhances long-term outcomes."
The 200 subjects in the study, all adults, had been diagnosed with chronic PTSD. At the start of the study, all participants expressed a treatment preference between two options -- medication or 10 weeks of therapy -- at the outset of the trial. The study was doubly randomized, meaning that participants were randomly assigned to a group in which they received their preferred treatment, or to a group in which they were also randomly assigned to one treatment program or the other. All participants were evaluated by clinicians for PTSD symptoms, along with the patients' own reports of feelings and behaviors, before, immediately after, and at three, six, 12 and 24 months later.
In this study, 61 percent of participants expressed a preference for prolonged exposure therapy. This form of counseling is often used to treat PTSD because it encourages patients to talk about what happened to them, learn coping strategies and explore their thoughts and feelings through repeatedly approaching the trauma memory and reminders of the trauma.
Of those participants who received prolonged exposure therapy, nearly 70 percent were determined to be free of their PTSD diagnosis two years after the therapy ended, compared with 55 percent of those who had taken and stayed on Sertraline through the follow-up.
Comparing medication to psychotherapy is rare in a clinical trial because it is time- and labor-intensive, Zoellner explained. In this case, both treatments had positive effects, though therapy demonstrated a slight edge. "When both interventions reduce symptoms, it is often difficult to detect a difference because of patients' varying responses -- some get a lot better, some do not. This study showed both prolonged exposure and Sertraline provide generally large and clinically meaningful effects to reduce PTSD and related symptoms," she said. "Prolonged exposure psychotherapy for PTSD is as good as Sertraline, if not better, for the treatment of PTSD."
When treatment preference is taken into account, results are more dramatic. Of those who wanted and received therapy, 74 percent had lost their PTSD diagnosis two years later; of those who preferred therapy but received medication instead, only 37 percent were PTSD-free after two years.
Whether patients received their choice of treatment appeared to directly affect their commitment: Nearly 75 percent of those who were "matched" with their preferred method completed their full treatment program, while more than half of those who were "mismatched" with a treatment method did not complete that course of treatment.
Though PTSD is commonly associated with combat veterans, more than half the participants in the study were diagnosed with chronic PTSD due to a sexual assault, in either childhood or adulthood. Three-quarters of participants were women.
Not all survivors of sexual assault have PTSD or depression, Zoellner pointed out, but those who do may not know that short-term therapy or a medication can yield significant long-term benefits.
"Sexual assault often has a long-term impact on the trauma survivor, but for many it need not be in the form of chronic psychiatric problems," she said. "Survivors should know good, short options exist and need not suffer in silence."
Cost-effectiveness information from the trial, released in 2014, showed that patient choice in treatment also saved money, in the form of fewer emergency department visits, hospitalizations and other care, as well as indirect savings such as fewer lost work hours.
Overall, the trial indicates the importance of tailoring PTSD treatment to the patient, said study co-author Norah Feeny, a psychology professor at Case Western Reserve University.
"Dr. Zoellner and our team showed that we've got two effective, very different interventions for chronic PTSD and associated difficulties," Feeny said. "Given this, and the fact that getting a treatment you prefer confers significant benefit, we are now able to move toward better personalized treatment for those suffering after trauma. These findings have significant public health impact and should inform practice."
https://www.sciencedaily.com/releases/2018/10/181019131515.htm
Mitigating stress, PTSD risk in warfighters
September 27, 2018
Science Daily/U.S. Army Research Laboratory
Researchers have developed a technique that has the potential to provide measures that facilitate the development of procedures to mitigate stress and the onset of conditions such as post-traumatic stress disorder in warfighters.
A U.S. Army Research Laboratory scientist has collaborated with a team of researchers from the University of North Texas to develop a new data processing technique that uses electroencephalogram, or EEG, time series variability as a measure of the state of the brain.
The researchers say such a technique has the potential to provide measures that facilitate the development of procedures to mitigate stress and the onset of conditions such as Post-Traumatic Stress Disorder in warfighters.
"The human brain is considered by many to be the most complex organ in existence, with over a billion neurons and having in excess of a trillion interconnections," said Dr. Bruce West, senior scientist of mathematics and information science at the U.S. Army Research Office and ARL Fellow.
According to West, it is the operation of this extraordinary complex network of neurons that hosts human thinking, and through the central nervous system, enables the functioning of most, if not all, of the physiologic networks, such as the respiratory, motor control and cardiovascular.
However, according to the researchers, even with this central role the brain plays in enabling our existence, remarkably little is known about how it does what it does.
Consequently, measures for how well the brain carries out its various functions are critical surrogates for understanding, particularly for maintaining the health and wellbeing of military personnel.
A small but measureable electrical signal generated by the mammalian brain was captured in the electrocardiogram of small animals by Caton in 1875 and in human brains by Berger in 1925.
Norbert Wiener, a half century later, provided the mathematical tools believed necessary to penetrate the mysterious relations between the brain waves in EEG time series and the functioning of the brain.
According to West, progress along this path has been slow, and after over a century of data collection and analysis, there is no taxonomy of EEG patterns that delineates the correspondence between those patterns and brain activity....until now!
The technique developed by West and his academic partners generalizes Evolutionary Game Theory, a mathematical technique historically used in the formulation of decision making in war gaming.
Their findings are reported in a paper published in the August edition of Frontiers in Physiology.
In the paper, titled "Bridging Waves and Crucial Events in the Dynamics of the Brain," West, along with Gyanendra Bohara and Paolo Grigolini of the University of North Texas, propose and successfully test a new model for the collective behavior within the brain, which bridges the gap between waves and random fluctuations in EEG data.
"The work horse of decision making within the military has historically been Game Theory, in which players cooperate or defect, and with pairwise interactions receive various payoffs so that under given conditions certain strategies always win," West said. "When the game is extended to groups in which individual strategy choices are made sequentially and can change over time, the situation evolves offering a richer variety of outcomes including the formation of collective states in which everyone is a cooperator or a defector, resulting in a collective state."
It turns out, West said, that the technique developed to process EEG data, the self-organized time criticality method, or SOTC method, incorporates a strategy that is an extension of Evolutionary Game Theory directly into the modeling of the brain's dynamics.
"The collective, or critical, state of the neural network is reached spontaneously by the internal dynamics of the brain and as with all critical phenomena its emergent properties are determined by the macroscale independently of the microscale dynamics," West said.
This macroscale can be directly accessed by the EEG spectrum.
The EEG spectrum, obtained by the SOTC method, decays like Brownian motion at high frequencies, has a peak at an intermediate frequency (alpha wave) and at low frequencies has an inverse power law.
In the case of the brain, the inverse power law has revealed that there is a broad range of time scales over which the brain is able to respond to the demands placed on it.
This spectrum suggests a flexibility in response, reflecting a potential range from concentrating on a single task for hours to rapidly countering a physical assault.
"This means that in the foreseeable future the physical training of warriors, along with the necessary monitoring of progress associated with that training, will be expanded to include the brain," West said. "The reliable processing of brain activity, along with the interpretation of the processed EEG signal, will guide the development of reliable techniques to reduce stress, enhance situational awareness and increase the ability to deal with uncertainty, both on and off the battlefield."
West said that the research team even speculates that such understanding of brain dynamics may provide the insight necessary to mitigate the onset of PTSD by early detection and intervention, as is routinely done for more obvious maladies.
According to West, going forward with this research can proceed in at least two ways.
"One way is to apply these promising results to data sets of interest to the Army," West said. "For example, quantify how the EEG records of warriors with PTSD differ from a control group of warriors and how this measure changes under different therapy and medication protocols. The other way is to refine the technique, for example, locate where on the scalp it is the most robust, while retaining sensitivity."
However this research proceeds, these Army scientists are focused on bringing the technology to fruition to help the Soldier of the future succeed in an ever-changing world and battlefield.
Earlier this year, the research team published on work that look at the processing heart rate data and how heart rate was indirectly influenced by meditation through the dynamics of the brain. That work examined how the brain influences the operation of the body by directly measuring how the physiologic system (cardiovascular in this case) responds to changes in the brain (by means of meditation).
This current work focuses on processing EEG data and directly interpreting the dynamics of the brain; it examines how the rhythmic behavior of brain waves (alpha, beta, gamma, etc. waves) can be understood to be compatible with the fluctuations in brain wave data.
Both papers are part of an ongoing ARL-University of North Texas study to determine if the fluctuations in all the physiological systems are produced by a previously unidentified mechanism that we call crucial events.
https://www.sciencedaily.com/releases/2018/09/180927091010.htm
K9s For Warriors - Because Together We Stand
Scott Smith
Sep 14, 2018
Soldier, take me from this shelter’s cage.
Give me back my life. In return, I’ll cover your back.
I’ll be your canine warrior, your sixth sense.
I’ll stand guard into the night and chase the demons away,
the uninvited, cloaked in night sweats and darkness.
I will help you open your cage of solitude
then walk tall by your side into the light of day.
Together, our faith will rise as tall as your soldier’s pride.
We are now family in this post-911 world.
Because together, we stand.
-Bridget Cassidy
MEET JAMES AND DUNKIN
James Rutland is a 12-year Army veteran who served a tour of duty in Iraq in 2004, followed by two more tours in South Korea. He left the military in 2014, suffering from multiple medical conditions related to his service, including mild traumatic brain injury (TBI), sleep apnea, and hearing loss, to name a few.
Most importantly, he suffered from depression and often thought about suicide. Thinking he could do it alone, Rutland tried healing from the trauma on his own. That wasn’t working. “If you do what you’ve always done, you’ll get what you always got,” says Rutland.
What Life Without Dunkin?
- James Rutland of K9s For Warriors
In 2016, Rutland finally rounded the bend of recovery when he was paired with his service dog, Dunkin. “I started focusing on "we instead of "me”, says Rutland.
He has a semi-colon tattoo on his right wrist, a known symbol of taking a pause when thinking about suicide. Unlike a “period” which ends a sentence, the semicolon creates a pause, for the reader, then continues the story. Rutland wears it proudly. "It's a great conversation starter," Rutland says.
He goes on to explain that breathing, family, friends, and the program that gave him Dunkin are what keeps him going.
THE PROGRAM: K9S FOR WARRIORS
K9s For Warriors is a BBB accredited charity organization located in Ponte Vedra, Florida, that has been pairing rescue dogs with traumatized soldiers since 2011. The dogs are trained to be service dogs, specifically performing tasks to quiet the symptoms of war trauma disabilities in soldiers.
“The skillsets our dogs learn help these warriors with anxiety, isolation, depression, and nightmares,” says Shari Duval, the founder of K9s For Warriors. “So, the warriors can function again in public.”
Specifically, the dogs are trained to deal with symptoms of Post-traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), or military sexual trauma (MST), as a result of military service on or after 9/11.
K9s For Warriors sees it as two battles: fighting the past of the dog and fighting the past of the warrior. We’re saving two lives here.
-Brett Simon
K9s For Warriors veterans walking with their service dogs
Duval started the program after watching her son Brett Simon suffer from PTSD after he returned from Iraq. Simon did two tours, developing PTSD during the first one. Watching her son suffer from the debilitating condition motivated Duval to research alternative treatments to the standard talk therapy and medication, neither of which worked for her son.
“On average, soldiers take 14 meds a day to treat PTSD, TBI, or MST,” says Duval. If treatment is not working, she says veterans are prescribed more and more drugs. “I even knew one soldier who was taking 44 meds per day.”
After two years of researching alternative PTSD treatments, Duval came upon a program that paired service dogs to alleviate their PTSD symptoms in veterans.
According to Simon, “Mom was the one that suggested I use a service dog to deal with my PTSD when nothing else worked.” Duval saw her son’s symptoms begin to improve. She then wanted to help other veterans do the same.
Thus, the K9s For Warrior program was born. With her son’s background in training dogs, including 13 years as a canine police officer, Duval convinced Simon to start the nonprofit together.
To date, the program has rescued more than 850 dogs and 440 military service members, with an astounding 99% program success rate.
Based on a recent Purdue study, the organization’s mission seems to be making a difference in the lives of warriors.
WHAT IS PTSD?
PTSD is classified as a mental disorder that develops after a person experiences severe trauma as a result of a traumatic event such as warfare, sexual assault, auto accident, or other severely traumatic events. PTSD symptoms are re-experiencing, avoidance, arousal, and negative changes in beliefs and feelings. The disability manifests itself in depression, anxiety, night terrors, and social embarrassment resulting in isolation. Many individuals have initial symptoms while others can worsen, requiring treatment.
According to the Department of Veterans Affairs (VA), it is common to have reactions such as upsetting memories of an event, increased anxiety, or trouble sleeping after experiencing a traumatic event. If these reactions do not go away or worsen, then the individual may have PTSD.
Along with TBI and MST, PTSD is recognized under the American Veterans Aid (AVA), the Department of Justice through the American Disabilities Act (ADA), and the Veteran’s Association of America (VA). The Department of Defense (DoD) is also strongly committed to providing service members and families with access to quality mental health care and resources for all mental health conditions including PTSD.
I appreciated the willingness of K9s for Warriors to open their doors to research and science.
-Dr. Maggie O'Haire
PILOT STUDY AFFIRMS ANTICIPATED OUTCOME
K9s For Warriors recently partnered with Purdue University College of Veterinary Medicine on a pilot study testing the effectiveness of service dogs as a complementary treatment for military members and veterans who suffer from PTSD. Dr. Maggie O'Haire, assistant professor of human-animal interaction, along with Kerri E. Rodriguez, research assistant, conducted the study and published the findings earlier this year.
The study had a total of 141 participants from the K9s For Warriors’ program or individuals on the program’s waiting list. Half of the program's participants had service dogs; the other half did not.
The study found that PTSD symptoms were significantly lower in veterans with service dogs, demonstrating that service dogs are associated with lower PTSD symptoms among war veterans. “The initial findings showed lower depression, lower PTSD symptoms, lower levels of anxiety, and lower absenteeism from work due to health issues,” says Dr. O'Haire.
Each morning, she measured levels of cortisol - a stress hormone, in each participant; an increase of the hormone in the morning is indicative of a healthy level or curve. We tend to see a rise in cortisol immediately after waking up. “We call it the morning rise”, says Dr. O'Haire.
Dr. Anantha Shekhar, Director of Indiana Clinical and Translational Sciences Institute, and professor at Indiana University School of Medicine was the lead researcher on the grant at the university. "Service dogs are a great resource for veterans to modulate their own reactions and to cope better with symptoms of PTSD,” says Dr. Shekhar.
Dr. Timothy Hsiao, a Yale graduate, as well as the Program Director of the National Center for Advancing Translational Sciences (NCATS) at the National Institute of Health (NIH) awarded the NCATS award to Dr. O’Haire as a KL2 Scholar under the CTSA Career Development Award.
“This is an innovative approach to a serious medical issue,” said Dr. Hsiao. “This study highlights the unique skills that the CTSA Program Hubs and their KL2 Scholars bring to address difficult conditions like PTSD.”
Other key findings (in a related study) included a significant reduction in suicidal thoughts, required medication (not suggested by K9s For Warriors), night terrors, and an increase of three to four more hours of sleep per night. That is, in part, due to the fact that the service dogs are trained to wake up the warriors when experiencing night terrors. Purdue University is currently studying this behavior and although it hasn't been substantiated scientifically, it has been reported by K9s For Warriors anecdotally.
Dr. O’Haire has been granted additional funding from NIH to perform a large-scale study on the efficacy of service dogs as a complementary treatment of PTSD symptoms in military members and veterans. The study is scheduled to be completed in 2019.
THEY RESCUED EACH OTHER
Her senses were always up, in a constant state of fight or flight, ever since that day in May of 2012. Tiffany Baker, an Army National Guard soldier, was traveling in a Mine-Resistant Ambush Protected (MRAP) vehicle while stationed in Afghanistan when it hit a 250-pound IED. The bomb was so powerful, it rolled the heavily-enforced vehicle.
Baker sustained major physical injuries, requiring four hip surgeries the next year. She also suffered a traumatic brain injury because of the attack. “I was taking 17 medications between being overseas and then coming back,” says Baker. She was frequently going to the VA, seeing a counselor, psychiatrists, and psychologists. “They were constantly giving me medications.” She was feeling more and more isolated.
In February 2015, Baker medically retired, saying goodbye to her unit, the 1157 Transportation Company. That same year, she met Buddy through K9s For Warriors.
Buddy had been badly abused and neglected by his owner. Before being rescued, he was found tied to a tree without any food or water. “K9s For Warriors is great at pairing the dog with veterans,” says Baker. She explains that Buddy always covers her back. He’s "got her 6", and he creates a safe barrier between her and other people, allowing her to function in public.
Just as Buddy is my service dog, I am Buddy's service human.
-Tiffany Baker, K9s For Warrior graduate and advocate
Baker was so taken with Buddy and the K9s For Warriors program that she got involved in supporting the PAWS (Puppies Assisting Wounded Service Members) Act of 2017 that got the VA on board with service dogs helping veterans. The bill directs the VA to carry out a five-year pilot program, providing grant funding to qualifying nonprofits that provide service dogs to military members or veterans who suffer from PTSD after they finalize other traditional treatments.
Baker actually spoke at a press conference in support of the act. “Going into the public was very difficult,” says Baker. “I’m always watching over my back.”
But Buddy has helped Baker to get back out into the public. Tiffany graduated this past May from Waukesha County Technical College with a degree in business management, and an emphasis in social media marketing. As Baker puts it, she is like every other broken person whose service dog keeps them going. She says, “I need to get out of bed to take care of him.”
The two rescued each other.
Service dog gazing up at veteran
WAR TRAUMA: THE MONSTER IN THE ROOM
Seventeen years at war with a volunteer military has resulted in U.S. soldiers being deployed multiple times more than any other time in modern history. According to a recent Rand Corporation report, 2.77 million service members have been deployed on 5.4 million deployments since 9/11, with around 225,000 Army soldiers having been deployed at least three times or more.
The DoD reported that between 2000 and September 2017, about 173,000 active-duty service members were diagnosed with PTSD in the military health system, with about 139,000 of those being diagnosed following a deployment of 30 days or more.
According to the DoD, PTSD is treatable, and many service members will recover with appropriate treatment. However, many do not.
It is invisible and causes panic attacks, survivor guilt, anger, etc.
-Brett Simon
Dr. Andrea Roberts, Research Scientist with the T.H. Chan School of Public Health at Harvard University says PTSD is common in civilian life. “Most PTSD goes untreated,” says Roberts. “Individuals suffering from PTSD have higher tendencies for cardiovascular disease, high-blood pressure, and autoimmune disease (Lupus).”
Roberts went on to explain there are effective treatments for PTSD, including talk therapy or exposure therapy (where a patient is led through the trauma to understand that the event is part of the past and not in the present). Another treatment is prescription medication on its own or in combination with talk or psychotherapy.
HOW K9S FOR WARRIORS IS SAVING LIVES
Take Me from the Shelter’s Cage
According to the American Society for the Prevention of Cruelty to Animals (ASPCA), 670,000 dogs are euthanized each year in the United States. “We take shelter or rescue dogs and turn them into warriors,” says Duval. K9s For Warriors rescues dogs from animal shelters across the United States, particularly local ones including the Alachua County Humane Society, Putnam County Shelter, and Lake City County Shelter.
It takes K9s For Warrior six months to train a dog. They train a total of 120 dogs per year. They rescue most breeds except full-bred Pitbulls, Dobermans, Chow Chows, Rottweilers, or Dalmatians due to insurance restrictions or state sanctions. The service dogs have full public access (with papers) but are not emotional support dogs or pets.
Once the dogs are fully trained, they are ready to be paired with their warrior. As Duval says, “When the dog's healthy, the warrior is healthy.”
As of May 2018, K9s has rescued 870 dogs with 434 dogs becoming service dogs, and the remaining rescues placed for adoption with loving families.
I Got Your 6
The K9s For Warriors program trains rescue or shelter dogs to perform four specific tasks: averting panic attacks, waking warriors from nightmares, creating personal space comfort zones in public situations by standing in front of the veteran (barrier) and reminding warriors to take their medications.
Dogs also learn two other commands: brace and cover. Many warriors suffer physical disabilities as well, so the brace command prepares the dog to assist the warrior with standing, sitting or kneeling. The cover command is used to cover the warrior’s back.
Many soldiers with PTSD do not like people coming up from behind them. In the field, soldiers say to one another, “I got your back” or “I got your 6.” The cover command does just that. The service dog literally becomes the warrior’s sixth sense, by sitting and facing the opposite way the warrior is facing. When someone approaches from behind, the dog wags its tail.
According to Moira Smith of the ASPCA, service animals can also boost the handler’s social and emotional life, in addition to providing safety and autonomy in public. “The dog acts as a bridge for social interaction,” says Smith. She explains that most Americans can’t relate to war experiences, but they are familiar with taking care of a dog as a pet. “It also adds another dimension to their identity.”
Dogs and Warriors Together: Let the Healing Begin
The three-week program is open to veterans or military members who became disabled while serving in the U.S. Armed Forces on or after 9/11. The program costs $27,000 per participant but at no cost to the warrior. If one cannot cover travel costs, K9s pays for travel to and from the facility. To Duval, every military member or veteran who walks through her door is family and is treated with honor and respect. “We bring the warrior home to heal, to a place to regroup, to hit the reset button,” says Duval.
To qualify, a warrior must submit an application and have a verified clinical diagnosis of PTSD, TBI, or MST. All applications go through a full vetting process that takes 2-4 weeks to complete. During that time, a trained service dog is identified that matches the applicant’s specific situation and needs. The organization stays in constant contact with applicants throughout the entire application process, including after approval or while a warrior is put on the waiting list. The waiting period is currently one year.
The dog doesn’t know or care about their diagnoses - they love the handler unconditionally.
-Moira Smith of the ASPCA
If accepted into the program, the warrior must reside at Camp K9, the organization’s Florida facility, for three weeks. There is one program per month with 12 warriors in attendance. Warriors arrive on a Sunday and are introduced to their canine warriors within 24 hours. “After that, you go nowhere without your dog,” says Simon.
K9s For Warriors believes their program is unique. In addition to matching warriors with service dogs and providing training, certifications, seminars, legal instruction, and housing, they also offer what Duval calls “wrap-around services.” These include lifelong health care and food for the service dogs and ongoing unconditional love and support of the warrior pair.
The program includes grooming, health care, and command classes, among others. Public access classes take warriors out in public with their dogs, to Costco, to the Jacksonville Zoo, to downtown St. Augustine or a restaurant. “They go to places in a high-stress environment to force them to use their dogs,” says Simon. At the end of the program, warriors and their dogs go to a local park and practice all the commands. Before graduating, the pairs take a Public Access test regulated by the Assistance Dogs International (ADI).
ADI sets the standards for training guide, hearing, and service dogs. Sheila O’Brien, the President of the North America Chapter, says, “This is a rigorous process, holding organizations to the highest standards.” According to O’Brien, the committee was formed (with ADI) nine years ago to look at programs that are placing dogs with vets and persons with PTSD to develop best practices.
She went on to explain that the initial purpose of ADI was to meet the physical needs of veterans. “After speaking with vets, we understood they could handle the physical disabilities, but it was the PTSD that was with them 24/7, and that’s where the service dogs provided the most value.”
There are now 72 ADI-accredited programs throughout North America with a total of 17,502 service dog teams formed from accredited programs. Each team must be recertified every five years.
We Are Family
Duval is all about family and serving those she vehemently sees as our nation’s greatest asset: our country’s military members.
Each month, a new family is formed when a warrior takes his or her first step onto the grounds at Camp K9 in Florida. In addition to meeting their dog and dog trainer, warriors meet the “Housemoms,” volunteers who stay in the facility day and night and talk with the warriors about everyday things instead of their military service.
The Housemoms run errands, grocery shop, and take warriors on outings. After graduation, Housemoms continue to stay in touch with the warriors by phone and on social media.
Apart from the Housemoms, K9s For Warriors relies heavily on its volunteers, local businesses, and support from Florida's veteran community. Many of the meals donated to the program come from local restaurants, neighbors, and organizations. Whether it be offering emotional aid to our veterans or helping with kennel enrichment, K9s is readily available to accept new Volunteer Ambassadors.
Service dogs are prescriptions on four legs
-Shari Duval
At the start, K9s For Warriors operated out of two houses with the dogs in the garages and vets sleeping on couches. "Then our humble beginnings were transformed by Summit Contracting. They believed in our program and built us a beautiful 17,000 square foot facility on nine acres. It was the most incredible gift in the world" said Simon.
In 2017, Steve Gold and family, gifted The Gold Family Campus to K9s For Warriors. The campus is a 67-acre property featuring a 9-bedroom and 7-bath house. It will be powered by solar panels (worth $1 million), making the campus energy-independent. The facility is currently under construction and will be operational in 2019.
It will allow four more veterans to attend each monthly program, bringing the total number of warriors graduating per month to 16. The campus will also function as the primary facility for female military members and veterans.
An additional facility means more space for Duval and Simon to save lives.
STANDING TOGETHER FOR A BETTER TOMORROW
There are good things in K9s For Warriors’ future.
As previously stated, Dr. O’Haire is partnering again with K9s For Warriors on a more extensive study funded by NIH. The findings will be published in 2019.
The VA is also running a Congressionally-mandated PTSD service dog study that will be completed in 2019. A total of 180 veterans have received either a service dog or an emotional support dog as part of the study. According to a VA spokesperson, after peer reviews, the VA will submit the study and results to the National Academy of Sciences for review, as required by the authorizing legislation (Section 1077 of the 2010 National Defense Authorization Act).
On the legislative side, Simon is working to secure public access identification from Service Dog Credentials, so K9s For Warriors’ service dogs will be recognized by airlines, hotels, and restaurants, bypassing the need for the warriors to provide paperwork or visit the disability office.
The future for K9s For Warriors looks promising as Duval and Simon continue to fight to save lives, both of soldiers and their canine warriors.
Because together, they stand.
https://www.consumersadvocate.org/features/k9s-for-warriors
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For more information on PTSD treatment options, visit the U.S. Department of Veterans Affairs, PTSD: National Center for PTSD or the DoD, which encourages service members to ask for help by affirming that seeking help is actually a sign of strength.
Co-Author Bridget Cassidy, Associated Editor
PTSD rate among prison employees equals that of war veterans
July 16, 2018
Science Daily/Washington State University
Prison employees experience PTSD on par with Iraq and Afghanistan war veterans, a new study from a Washington State University College of Nursing researcher found.
Working conditions in a prison can include regular exposure to violence and trauma, and threats of harm to the workers and their families. Previous studies have shown that prison workers have some of the highest rates of mental illness, sleep disorders and physical health issues of all U.S. workers. But the rate of PTSD among prison workers isn't well understood.
The new study, "Prison employment and post-traumatic stress disorder: Risk and protective factors," was conducted by lead investigator Lois James, Ph.D., assistant professor at the WSU College of Nursing, and co-investigator Natalie Todak, assistant professor at the University of Alabama at Birmingham.
It recently was published in the American Journal of Industrial Medicine and excerpted in Force Science News.
"Prison employees can face some of the toughest working conditions of U.S. workers," said James, "yet limited evidence exists on the specific risk and protective factors to inform targeted interventions."
Among the study's findings:
· Prison employees work under an almost constant state of threat to their personal safety, and about a quarter of them routinely experience serious threats to themselves or their families.
· Almost half have witnessed co-workers being seriously injured by inmates.
· More than half have seen an inmate die or have encountered an inmate who recently died.
· The vast majority have dealt with inmates who were recently beaten and/or sexually assaulted.
PTSD rates were higher among women, black employees, and employees with more than 10 years of experience. PTSD scores, using criteria from the Diagnostic and Statistical Manual of Mental Disorders, didn't differ based on where the employee worked, such as a minimum versus maximum security facility.
James and Todak note that the research included a small sample of 355 employees of one labor union at the Washington State Department of Corrections, and recommended further study of the issue.
Still, they said their findings suggest the corrections profession could benefit from specific training to promote resilience. They also said issues common to nearly every workplace also can protect prison employees from PTSD, such as having good relationships with supervisors and coworkers, and liking their work assignments.
https://www.sciencedaily.com/releases/2018/07/180716091509.htm
Teens with concussion may benefit from earlier physical therapy
June 27, 2018
Science Daily/Wolters Kluwer Health
For adolescents with symptoms following a concussion, starting physical therapy (PT) earlier -- within less than three weeks after the injury -- provides outcomes similar to those of later PT.
"Multimodal PT interventions administered by licensed physical therapists may be feasible and safe even within the first few weeks after injury to help facilitate prompt recovery and mitigate the onset of secondary effects from delayed treatment," write Catherine Quatman-Yates, DPT, PhD, of The Ohio State University, Columbus, and colleagues. The study is part of a JNPT special issue on "Rehabilitation Management of Concussion," highlighting research-driven changes geared toward promoting return to activity in young patients with concussion.
Similar Outcomes for Teens with Concussion Undergoing Earlier or Later PT
The researchers looked how the timing of PT affected the course of concussion-related symptoms in 120 adolescents: 78 females and 42 males, median age 14 years. Physical therapy was classified as early (beginning 0 to 20 days after concussion) in 27.5 percent of patients, middle (21 to 41 days) in 32.5 percent, and late (42 days or after) in 40 percent.
The PT program consisted of progressive exercise; vestibular/oculomotor training (targeting inner ear/balance and visual symptoms); and cervical spine manual therapy, stretching, and strengthening exercises. This multimodal treatment was delivered by licensed physical therapists with special training in concussion treatment.
Whether started earlier or later, PT led to similar reductions in concussion-related symptoms. The number of sessions and duration of PT care were similar across groups. There was a low rate of adverse events, most of which were unrelated to PT.
Symptoms worsened in a few patients, more commonly in the late PT group. Some of these patients may have had concussion-related impairments not directly addressed by PT, such as anxiety, depression, or sleep problems.
Recent research has led to new insights into medical management of concussion in children and adolescents. Past guidelines recommended complete physical and cognitive (mental) rest after concussion, until symptoms resolved. But recent studies have suggested that resting for more than a day or two has limited benefits, and may even be linked to increased concussive symptoms.
Today, concussion management is shifting toward a shorter period of rest, followed by gradual return to usual activities, guided by the patient's symptoms. Physical therapy has been recommended for adolescents with persistent symptoms of concussion, generally after three weeks.
The new study provides evidence that starting PT earlier is a safe and feasible approach for adolescents after concussion, with improved symptoms regardless of the timing of the intervention. "Introducing PT earlier in the recovery process may be beneficial in minimizing the potential burden of longer recovery trajectories," Dr. Quatman-Yates and coauthors write. They emphasize the need for further research to determine PT's role in the "optimal plan of care" for young patients with concussion.
Other articles in the special issue include a neuroscience perspective on the role of rest versus physical activity in recovery for young people with concussion, along with new research on changes in vestibular/oculomotor function and the role of balance testing after concussion.
Physical therapists can play a critical role in evaluating and choosing targeted interventions most likely to result in the best outcomes for patients with concussion, according to a Guest Editorial by Karen L. McCulloch, PT, PhD, NCS, and Kathleen Gill-Body, PT, DPT, MS, NCS, FAPTA. They write, "We are in an ideal position to continue our process of returning people to activities and roles that they care about...because it is what we do."
https://www.sciencedaily.com/releases/2018/06/180627160258.htm
Certain PTSD therapies prove effective long after patients stop treatment
Reducing severity of PTSD symptoms long-term holds significant public-health and economic implications
April 19, 2018
Science Daily/Case Western Reserve University
Reducing severity of PTSD symptoms long-term holds significant public-health and economic implications.
Both civilians and military veterans with post-traumatic stress disorder (PTSD) reap long-term benefits from psychotherapies used for short-term treatment, according to a new study from Case Western Reserve University.
The findings suggest effective and lasting approaches for symptoms of PTSD-a debilitating and typically chronic disorder that rarely diminishes spontaneously and is associated with significant distress, impairment and considerable economic costs.
For U.S.-based military veterans alone, lost productivity, health-care and other costs are estimated to be in the billions of dollars, according to recent peer-reviewed research.
The paper, published in the journal Clinical Psychology Review, was based on a meta-analysis of 32 PTSD-related studies-involving 72 treatment conditions-that followed up with patients at least six months, and up to nearly two years, after treatment ended.
Patients displayed less-intense symptoms up to two years after treatment ended, compared to six months post-therapy, according to the study.
"It is possible that the longer time between post-treatment and follow-up assessments may provide a better opportunity for new skills to be practiced and reinforced, and for treatment gains to crystallize," said Alex Kline, a co-author of the study and a PhD student in adult clinical psychology in the Department of Psychological Sciences at Case Western Reserve.
PTSD treatments effective in both the short- and long-term include trauma-focused cognitive behavioral therapy and exposure therapy. Both are relatively common in veterans' facilities yet are inconsistently available elsewhere-a major barrier to access and effective treatment, Kline said.
"It's important to get a better understanding of who responds to what and why," Kline said. "Showing that PTSD treatment gains are being maintained is meaningful for health-care providers choosing how to improve patient outcomes and drive down costs of ineffectual care."
Broadly, cognitive behavioral therapy reduces symptoms by changing patient behavior and addressing maladaptive thoughts. In particular, exposure therapy-considered the current standard for PTSD treatment-exposes patients to feared stimuli under deliberate, controlled, safe conditions.
While some PTSD patients do not respond to current treatments, most do-across a range of populations, settings and trauma types.
PTSD often co-occurs with depression, but the findings run counter to a recent similar study of long-term depression outcomes, where effectiveness decreased with longer follow-up periods. That was noteworthy, Kline said, given the diagnostic overlap between PTSD and depression and high rates of co-occurrence between the two disorders.
"Eventually, our findings and others could optimize treatments," he said. "The goal is to match patients with what's best for them."
https://www.sciencedaily.com/releases/2018/04/180419131133.htm
How chronic early-life stress raises PTSD vulnerability
Persistent stress in adolescence appears to increase vulnerability through elevated ghrelin levels in rat model and in humans
April 11, 2018
Science Daily/Massachusetts General Hospital
A collaboration between investigators at Massachusetts General Hospital and Khyber Medical University in Pakistan may have discovered how chronic stress experienced early in life increases vulnerability to post-traumatic stress disorder (PTSD) later in life. In their report published in Translational Psychiatry the researchers describe finding that chronic stress induces a persistent increase in the hormone ghrelin, both in a rat model and in human adolescents. Rats with stress-induced ghrelin elevations were more vulnerable to an excessive fear response long after the stressful experience, a vulnerability that was eliminated by long-term blockade of ghrelin signaling.
"Ghrelin is called the 'hunger hormone,' and while it does play an important role in appetite, it has many other effects," says Ki Goosens, PhD, of the MassGeneral Institute for Neurodegenerative Disease, who led the study. "Several teams have shown that repeated stress exposure increases circulating ghrelin levels in many organisms, but those studies examined ghrelin shortly after the stressor exposure ended. Ours is the first to show that traumatic stress increases ghrelin in humans -- specifically in adolescent humans -- and the first to look at ghrelin elevation over long time periods after the end of the stressor."
Considerable evidence supports the impact of early-life stress on brain function and on other health outcomes in human adults. Adolescents are known to have increased emotional reactions to their experiences, and stress may enhance that reactivity, increasing vulnerability to several mental health disorders. Since areas of the brain such as the prefrontal cortex that regulate fear-responsive structures including the amygdala continue to develop during adolescence, stress-induced disruption of the developmental process during adolescence could interfere with those regulatory circuits.
To investigate the potential long-term impact of chronic stress on ghrelin levels, the researchers conducted a series of experiments. Chronic stress was induced in a group of adolescent rats by immobilizing them inside their cages daily for two weeks. A control group was handled daily by research team members over the same time period. Not only were ghrelin levels in the stress-exposed rats significantly higher 24 hours after the last stress exposure, as previously reported, they also remained elevated 130 days later, roughly equivalent to 12 years in human lifespan.
To investigate whether long-term stress produced similar persistent ghrelin elevation in humans, the researcher enrolled 88 children from the Khyber Pukhtunkhwa province of Pakistan, an area affected by more than a decade of terrorist activity. The participants averaged around age 14 at the time of study, and some had either experienced a personal injury or lost a family member in a terrorist attack around four years prior to entering the study. The control group consisted of children who had not experienced those specific types of trauma.
Blood tests revealed that circulating ghrelin levels in the trauma-affected children were around twice those of the control group. Based on interviews with the children and their parents, trauma-affected children also had differences in their sleep, emotional regulation and social isolation, compared with the control group. And while all participants had a body mass index (BMI) within the normal range, the BMIs of trauma-exposed children were significantly lower than those of the control group.
To test the long-term impact of stress-induced ghrelin elevation in the rat model, the research team exposed two other groups of animals to 14 days of either chronic stress induction or daily handling. Two weeks later both groups went through a standard behavioral protocol called fear conditioning, which trained them to expect an unpleasant sensation -- a mild but not painful foot shock -- when they heard a specific sound. After they learn that association, animals will typically 'freeze' in expectation of the shock when they hear that sound. Compared to the control animals, the chronic-stress-exposed rats showed a stronger fear memory by freezing longer during the sound when it was not paired with a shock.
To test whether blocking ghrelin signaling could reduce the stress-enhanced fear response, the researchers administered a drug that blocks the ghrelin receptor to groups of rats over three different schedules -- throughout both the two-week chronic stress induction period and the two weeks prior to fear conditioning, during the stress induction period only or during only the two weeks between stress induction and fear conditioning. While blocking the ghrelin receptor for the full four weeks did eliminate the stress-induced enhanced fear response, blocking ghrelin signaling either only during or only after stress induction did not prevent the enhanced response.
"It appears that blocking the ghrelin receptor throughout the entire period of ghrelin elevation -- both during and after stress -- prevents fear enhancement when the animals subsequently encounter a traumatic event," says Goosens. "But only blocking the receptor during stress, when ghrelin is initially elevated, or after stress, when it remains elevated, does not prevent the fear-enhanced, PTSD-like response."
She adds, "Previous work from my lab shows that exposing brain cells to high levels of ghrelin reduces their sensitivity to the hormone, which we call 'ghrelin resistance.' We've also shown that ghrelin inhibits fear in unstressed individuals, and we believe that stress-induced ghrelin resistance interferes with that inhibition. Finding a way to reverse ghrelin resistance could have important therapeutic implications. The ability to identify individuals who are more vulnerable to the detrimental effects of stress, as well as the 'tipping point' when they become vulnerable, could enable early intervention with either therapy or medication."
https://www.sciencedaily.com/releases/2018/04/180411220806.htm
Severe war injuries and PTSD can impact hypertension risk
March 19, 2018
Science Daily/American Heart Association
US service members severely injured in the Iraq or Afghanistan wars or diagnosed with PTSD (posttraumatic stress disorder) face a greater risk of high blood pressure. Injury severity and PTSD were each independently associated with an increased risk of high blood pressure.
PTSD, a mental health disorder that stems from a traumatic or life-threatening event, has been previously linked to risk of high blood pressure and other issues, including substance abuse, obesity, coronary artery disease, and suicide.
The new study reviewed records of 3,846 U.S. service members in the Iraq and Afghanistan wars who received intensive care for combat injuries sustained from February 2002 until February 2011. Their average age when they were wounded was 26. More than 14 percent of combatants developed high blood pressure at least 90 days after being wounded. How severe initial injuries were, and how frequently PTSD was noted in medical records after the wounding, separately affected later risk of hypertension, the study found.
"What we found surprised us. PTSD does appear to increase the risk of hypertension," said Maj. Ian J. Stewart, M.D., the study's senior author, who works from the David Grant U.S. Air Force Medical Center at Travis Air Force Base in California. "But we thought that hypertension risk from the injury would depend on the presence of PTSD. Instead, increased hypertension risk is additive to the injury itself," said Stewart.
The study incorporated each service member's Injury Severity Score, a scale ranging from 1 to 75 that gauges the total impact of multiple injuries, based on assessment of six body regions.
For instance, a third-degree burn covering 20 percent of the skin's surface, plus a concussion and minor scalp cut, would yield a score of 11. A traumatic amputation at the hip would be scored at 16, and a 60 percent third-degree burn plus six rib fractures would be scored at 41.
The study found that for every five-point increase in Injury Severity Score, overall risk of high blood pressure rose 5 percent. Patients with an Injury Severity Score of 25 or lower and no recorded PTSD diagnosis had the lowest hypertension risk.
Compared with patients who had no record of a PTSD diagnosis, those with 1 to 15 PTSD notations in their files had an 85 percent higher risk of hypertension. Those who had PTSD noted more than 15 times -- suggesting the condition was more chronic -- had 114 percent increase in the risk of high blood pressure, the study found.
As in other studies, this research found that age, acute kidney injury and race were associated with risk of developing high blood pressure. Risk increased about 5 percent for every year older a veteran was, and was 69 percent higher for African-Americans, compared with whites. Suffering acute injury to the kidneys, which play a key role in regulating blood pressure, also was linked to a higher risk for hypertension.
It's important for policy makers to better understand Iraq and Afghanistan veterans' long-term potential health-related risks and costs, Stewart said. He cited a report from Harvard Kennedy School estimating those could total about $970 billion, including almost $288 billion in direct medical costs, over the next 40 years.
"Veterans suffer long after wars end and wounds heal," he said. "Our society will be paying the price for years to come."
The study included up to 10 years' worth of records following each wounded service member, reflecting care in both Department of Defense health facilities and medical visits through the TRICARE program, a health care program of the U.S. Department of Defense Military Health System.
Stewart and his colleagues suspect that development of high blood pressure and other chronic medical conditions after combat injury might generally be traced through three routes:
through PTSD or other mental health conditions that arise, such as depression or anxiety;
through physiological changes, including inflammatory or metabolic responses,
or due to lifestyle changes such as smoking or gaining weight. More research into these areas is needed, the authors note.
High blood pressure is defined as blood pressure readings 130/80 mm Hg and above. Untreated, it can lead to stroke, heart and kidney disease, vision loss and sexual dysfunction.
Strengths of the study include the high number of medical visits recorded for each patient, and the use of Department of Defense databases that allowed researchers to track patients over time rather than rely on individuals' own accounts. However, the study did not follow patients in real time, and couldn't control for differences in how blood pressure readings were taken. The study also lacked biological data such as measurements of inflammatory markers, and information about behaviors such as smoking that impact future health.
https://www.sciencedaily.com/releases/2018/03/180319090719.htm