Injured Veterans Research Articles

Impact of TBI on caregivers of veterans with TBI: Burden and interventions

ABSTRACTObjectives: Describe State-of-the-Art in practice and research in caregiving with individuals, specifically, Veterans with traumatic brain injury (TBI) and the implications for current practice and future research. Sources: Professional literature and personal experience of review panel.Main Outcomes: Unpaid caregiving for individuals with TBI is most often provided by a spouse, parent or other blood relative; the majority of caregivers are women. Although caregiving can be rewarding, it also may create financial burden and psychological stress. Depression among family caregivers occurs four times more frequently than in the general population. Positive coping can help reduce the impact of stress, and Department of Veterans Affairs (VA) programmes are available to ease financial burden. Group interventions show promise in reinforcing and improving positive coping for both family caregivers and Veterans with TBI.Conclusions: Identifying the specific needs of caregivers and families of Veterans with TBI and other traumatic injuries, including post-traumatic stress syndrome (PTSD), will require further longitudinal research. Currently available group interventions and programmes appear to benefit injured Veterans and their family caregivers financially and psychologically. Increased understanding of characteristics of quality family caregiving and its long term costs and benefits is likely to lead to additional improvements in these interventions and programmes.

Compassionate Corps: creating access to IVF medications for injured veterans

Implement program to assist wounded Veterans with IVF medications for family building where no coverage or assistance existed. More than 2,000 people who have served in the military have been diagnosed with infertility after suffering from major injuries. However, when active members of the U.S. military and U.S. veterans injured during service are faced with infertility, they become an underserved population. According to law, the Department of Veterans Affairs is prohibited from covering in vitro fertilization treatments for injured veterans, therefore creating a gap in coverage for their fertility benefits and significant cost barriers. In July of 2014 Compassionate Corps launched to raise awareness of fertility coverage gaps and to help alleviate these cost barriers by developing a program tailored for injured U.S. veterans. Compassionate Corps provides IVF stimulation medications at no charge for up to 2 cycles for qualifying applicants. Compassionate Corps is the first patient assistance program to completely eliminate the cost [AD1] of[AD2] fertility medications (Gonal-f, Cetrotide, & Ovidrel) for eligible U.S. Veterans who are infertile due to a service-related injury. • Patient Attested • Patient confirms that he/she/spouse is a medically retired member of the military • Patient submits his/her/spouse's DD-214 and any medical information and records proving the service-related injury • Patient confirms that he/she/spouse has no insurance coverage for the infertility treatments or related medications needed • Physician Attested • Physician confirms that the patient has service-related injuries that have caused infertility • Physician confirms that IUI/OI would be suboptimal or impossible • Physician submits a valid prescription for an eligible drug • Medications Provided • Program is valid for a maximum of 2 cycles per calendar year • Medications are shipped to IVF clinic. To date, more than 80 U.S. veterans have attained access to medications for in vitro fertilization and advanced reproductive technology through the Compassionate Corps program. The Compassionate Corps program was designed and implemented to create access for injured U.S. Veterans who required IVF due to injuries sustained while actively serving in the military. The coverage gap that currently exists creates tremendous financial burdens and barriers to treatment for this very deserving population. The 80 approved applicants were given a chance to build a family because of Compassionate Corps when no other program existed and no legislation had been mandated to protect our heroes who bravely served their country.

Evaluation of Sleep Disorders in Wartime Chemically Injured Veterans with Sleep-Related Complaints: Self-Report vs. Polysomnographic Measures

<p><strong>BACKGROUND:</strong> Sleep disorders are among the most common problems experienced by chemically injured veterans, affecting their quality of life and their general health. Therefore, we aimed to compare Polysomnography indices with data derived from the PSQI in chemically injured veterans in Iran in order to study the relationship between or independence of subjective complaints (self-reports) and objective data.</p><p><strong>METHODS:</strong> In this study, 70 veterans were selected among chemically injured veterans who had referred to our clinic during 2012-2013 using the convenience sampling method. Objective and subjective sleep qualities were measured using the in-laboratory diagnostic Polysomnography method and the Pittsburg Sleep Quality Index (PSQI), respectively. The two measured were then compared.</p><p><strong>RESULTS:</strong> All the 70 assessed veterans in this study were male with a mean±SD age of 50.2±9.97. The mean±SD total score for the PSQI was 12.38±4.34. We found no significant relationship between the total PSQI score and age (r=-0.045, P=0.80), marital status (r=0.14, P=0.437), and occupational status (r=0.242, P=0.175). However, a negative significant relationship was found between the total PSQI score and educational status (r=-0.464, P=0.007). Moreover, we found a significant relationship between sleep quality according to Polysomnography and age (r=0.254, P=0.039). However, no such relationship was found with respect to marital status (r=0.2, P=0.1), occupational status (r=0.02, P=0.863), and educational status (r=0.047, P=0.71). We found no significant relationship between any of the parameters measured by Polysomnography with the scores obtained in the 7 subscales of the PSQI or its total score.</p><p><strong>CONCLUSION:</strong> An individual’s dissatisfaction with sleep quality does not necessarily indicate an objective sleep disorder. Objective evaluations alongside reports provided by friends and relatives play a key role in the correct diagnosis of sleep disorders in chemically injured veterans.</p>

The Influence of the Two World Wars on the Development of Rehabilitation for Spinal Cord Injuries in the United States and Great Britain.

During World War I, physical and occupational therapies became important adjuncts to surgical practice, particularly for orthopedic casualties, but there was little progress in the management of severe brain and spinal cord injuries (SCIs), largely because of the very high mortality of such injuries at that time. During World War II (WWII), rehabilitation was greatly expanded into an integrated, comprehensive multidisciplinary program in the U.S. military, largely because of the efforts of Howard Rusk (1901-1989), initially in the Army Air Corps and later across all of the services. With Bernard Baruch's (1870-1965) assistance, Rusk was also successful in swaying President Franklin Delano Roosevelt (1882-1945) to support rehabilitation for injured veterans and to give official standing to rehabilitation medicine in the military and the Veterans Administration after WWII. Such WWII developments in rehabilitation medicine had a profound effect on the care, functional outcomes, and survival of veterans with SCIs. Neurosurgeon Donald Munro's (1898-1978) prototype SCI unit at Boston City Hospital in 1936 influenced the U.S. Army to establish several SCI centers during WWII and influenced urologist Ernest Bors (1900-1990) to pioneer SCI care in Veterans Administration medical centers after WWII. In Britain, the organizational leadership of George Riddoch (1888-1947) led to the development of SCI units that saw their greatest development by Ludwig Guttmann (1899-1980) at Stoke-Mandeville Hospital in Aylesbury, near London. These SCI centers provided a comprehensive spectrum of care, including medical, neurological, and surgical management; psychological counseling; and rehabilitation focused on improving self-care, mobility, and re-assimilation into society. After WWII, military developments in comprehensive rehabilitation were promulgated to and developed in the revitalized Veterans Administration and then disseminated to civilian populations.

Protective and Vulnerability Factors Contributing to Resilience in Post-9/11 Veterans With Service-Related Injuries in Postsecondary Education.

To examine differences in psychosocial protective factors (social support, meaningful occupation, and academic self-efficacy) and health-related vulnerability factors (posttraumatic stress, depression, and somatic symptoms) contributing to resilience in post-9/11 veterans with service-related injuries and nonveterans in postsecondary education. A cross-sectional, matched-participants design using propensity score matching was used to test differences in mean levels of protective and vulnerability factors between injured veterans (n = 26) and nonveterans (n = 19); zero-order correlations explored relationships among study variables. The veteran sample demonstrated lower levels of psychosocial protective factors and higher levels of health-related vulnerability factors compared with nonveterans (|0.49| to |1.56|). Psychosocial protective factors were consistently negatively associated with health-related vulnerability factors (-.27 to -.63). Post-9/11 veterans with service-related injuries are at a substantial disadvantage in terms of resilience; lower protective factors and elevated vulnerability factors may increase their risk for poor campus integration and impede academic achievement.

Exploring discourse surrounding therapeutic enhancement of veterans and soldiers with injuries.

Human enhancement (the enhancement of the abilities of a normative person beyond the norm) of soldiers has been debated for some time. However, therapeutic enhancement of soldiers and veterans with injuries (the enhancement of the abilities of a sub-normative labeled person beyond the norm) is much less discussed. This article discusses 1) historical examples of policies and views linked to soldiers and veterans that have been injured in the Americas, and perception of injured veterans and soldiers; 2) the science and technology of the therapeutic enhancement landscape and 3) views of veterans on therapeutic enhancements. Three methods were used: a) historical search of policy documents; b) content analysis of the New York Times and c) online delivered exploratory non-probability survey using the Survey Monkey platform. Researchers found that veterans played a special role in policy developments in the United States, such as disability pension plans, and that veterans who were injured were portrayed more positively than other people with disabilities in the NYT from 1851-2010. However, within the current public discourse around the use of enhancement enabling therapeutic assistive devices, the voices of injured soldiers and veterans are not visible. Therapeutic enhancements, especially of injured soldiers and veterans, are an under researched area with various open ethical questions in need of more coverage.

The lifelong struggle of Finnish World War II veterans

Objectives: In many countries veterans from World War II are growing old. Research has shown that war experiences continue to impact those who have been involved in war for a long time. The present study targets old injured war veterans from World War II in Finland. The aim of this study was to produce knowledge of the impact of war experiences and injuries on the lifespan of Finnish war veterans.Method: The method used was grounded theory. Data were collected by interviewing 20 aged war veterans in their homes.Results: The analysis resulted in four categories, with also subcategories: (1) lost childhood and youth; (2) war traumas impacting life; (3) starting life from scratch; and (4) finding one's own place. A substantive theory of war veterans’ lifelong struggle for freedom throughout the lifespan was outlined.Conclusion: The war overshadowed the whole lifespan of the veterans, but in old age they finally felt free. Since war experiences vary depending on historical context, a formal theory would require additional research.

Clinical considerations for morally injured veterans: Response to Dr. Brad Johnson.

Clinical considerations for morally injured veterans: Response to Dr. Brad Johnson.

Assessing the relationship of paraoxonase-1 Q192R polymorphisms and the severity of lung disease in SM-exposed patients

Late respiratory complications in patients suffering from pulmonary lesions due to sulfur mustard (SM) gas are asthma, chronic obstructive pulmonary disease and bronchiectasis. Recently PON1 antioxidant activity draws attention as the enzyme which prevents the oxidation of lipoproteins during oxidative stress. In this study we aimed to investigate PON1 192 polymorphisms and paraoxonase and arylesterase activity in the serum of SM-exposed lung disease patients. Also, we examined the detection of PON1 and apoA1 proteins in BAL fluid. 101 male patients were included who were categorized to three groups of mild, moderate and severe suffering from pulmonary lesions due to SM. Significant reduction in paraoxonase activity [Healthy: 412.46 ± 89.1 U/L, Severe: 89.66 ± 20.7 U/L] (p < 0.0001) and arylesterase activity [Healthy: 25826.4 ± 4425.23 U/L, Severe: 16760.43 ± 3814.9 U/L] (p < 0.0001) with increase in severity of disease was demonstrated statistically. With respect to the distribution of the PON1 polymorphism, the RR genotype was more frequent in severe patients [37.2%] than healthy group [10%] (p < 0.05) and no significant regression was found between genotype and PON1 activity. On the other hand, the results of PON1 and apoA1 detection illustrated that only apoA1 protein was found in BAL fluid. According to our findings it seems that increase in the stress oxidative in chemical injured veterans with pulmonary complications comes with reduction in PON1 enzyme activity and appearance of RR genotype rises up with the increase in disease severity. Since a significant correlation between enzyme activity and genotype was not observed altering these two variables with each other requires more studies.

Impacts of mustard gas exposure on veterans mental health: A study on the role of education

Background:The mustard gas (MG) exposure can impair physical health and therefore increase the probability of the posttraumatic stress disorder (PTSD) and psychological disorders.Aim:The aim of this study was to investigate long-term effects of MG exposure on veterans’ mental health.Materials and Methods:This was a cross-sectional study. In order to assess prevalence of mental health and PTSD of 100 MG victims 25 years after the exposure to MG in Iran-Iraq conflict, the general health questionnaire (GHQ-28) and Impact of Event Scale-Revised, respectively was administered.Results:The mean (±standard deviation (SD)) age of participants was 40.63 (±5.86) years. The mean GHQ-28 (47.34) of the study group was higher compared to standardized cutoff point (23) of the Iranian community. Also, it was found that 38 participants (38%) suffer from PTSD. The results of this study showed that academic education in the PTSD group was less than that in the non-PTSD group (P=0.03). In addition, in multivariate analysis it was found that only education level of the veterans and their wives were effective on the mental health score (adjusted P=0.036 and 0.041, respectively). The mean score of depression and psychosocial activity subscale in patients at higher education level was lower than patients at lower education level (P<0.05).Conclusion:This study found that sulfur mustard (SM) exposure can be effect on mental health even 25 years after exposure. Therefore, the psychological state should be more considered in chemical injured veterans and it is important that providing more mental health centers for this community.

Psychological assessment of chemical injured war veterans compared to non‐chemical injured war veterans

AbstractIntroductionChemical weapons induce various and long‐lasting physical complications that can affect mental health. We assessed the psychiatric status of chemical and non‐chemical injured war veterans.MethodsWe conducted a cross‐sectional study on chemical and non‐chemical war injured veterans. The Persian version of the Beck Depressive Inventory, Social Anxiety Scale and both the PTSD Checklist‐Military and Impact of Event Scale‐Revised were used for evaluation of psychiatric condition. Data were analyzed and compared using SPSS version 16 and P &lt; 0.05 was considered statistically significant.ResultsThe prevalence of clinical depression was 47.5% and 48.3%, for anxiety it was 11.3% and 7.9%, and for post‐traumatic stress disorder (PTSD) it was 40% and 28.1% in chemical and non‐chemical injured veterans, respectively. Depression, anxiety and PTSD prevalence and scales did not show any significant difference between chemical and non‐chemical war injured veterans (P &lt; 0.05). There was a relationship between these variables and some factors, such as type of soldier dispatch by military organizations (P &lt; 0.05) and their occupations (P &lt; 0.05), but there was no relationship between these and accident time, literacy, and type of chemical agents (P &gt; 0.05).DiscussionIn the literature, the mental health of civilians who have been exposed to chemical agents could be affected because of long‐term adverse consequences, but in the present study psychological condition did not show any difference between chemical and non‐chemical war injured veterans. Further investigation on veterans is necessary.

"Living Ice": Rediscovery of the Poles in an Era of Climate Crisis

Discovery or uncovering) has to do with what already existSj actually or virtually) it was therefore to happen sooner or later. - Gilles Deleuze^ Bergsonism Polar explorers, primarily known for symbolic acts of imperial derringdo, are reliable and safe, nonconfrontational heroes for confusing times.1 Perhaps this was all quite clear to Prince Harry of Britain, who joined a February 2011 trek to the North Pole as a member of Walking with the Wounded, a group raising money for injured veterans. Once the mythic zones of European heroism, the poles today are more associated with concerns over Native rights, oil company drilling and privatization, the destruction of habitats and species, and most of all climate change. So the prince, in bright red survival gear posing (for G Q, and other fashion venues), is only the most recent recuperation of myths of British heroic martyrdom - John Franklins lost North Polar expedition of 1845 and Robert Scott s 1912 disaster at the South Pole are other examples.2 I'm not really interested in flogging the prince s adventure on ice as a remilitarization of a newly contested region. The desire to discover the ends of the earth and to make use of them had been predicted in literature and scientific imagining long before men finally arrived at the ends of the earth. It was, in Gilles Deleuze s protest against imperial geoteleology, certain to happen, sooner or later, and surely it is still happening, on and on and by many different types of people for myriad causes and beliefs. Preceding Prince Harrys latest remasculinization and following in the footsteps of the Heroic Age of Polar Exploration and the 1959 establishment of the international Antarctic Treaty System, women, non-Europeans, southern hemispherics, and people of color have performed physical survival in an extreme environment.3 Whether by direct representatives of governments, private adventurers, tourists, or more likely, associates of national science programs, polar ice has become ever more filled in, storied. Ice has become a sublime incitement. If everyone now travels to the poles, everyone can be a hero, too. The more people trek to the poles the more they empty the ice of its own materiality or liveliness. They leave footprints, tell stories and take pictures, build stations, and change a landscape from a self-contained and perhaps incomprehensible one into a metaphor of human survival, a trace of past failure for which the only point seems to be to have arrived and to have survived. And yet most people travel to, say, to Antarctica, the only continent on earth lacking human natives, not to find evidence of human history alone. They go also to encounter the ice directly. I am concerned here to consider this backdrop itself - the ice - not as a proving ground for humanity, not as a homeland as it is for many Arctic Natives, not merely as potential territory. How can the ice be discovered outside historical determination? What would ice become on its own? While the draw to approach the polar regions and to pose and retread heroic histories, to remilitarize and reassert imperial intentions of human time has not ceased, a new feature has emerged. The ice itself is under threat. It is no longer the enemy or the implacable outside force to be conquered. Nor is it an uncomplicated pure wilderness. It is no longer exactly a blank backdrop for imperial posturing. Rather, the ice is fragile, melting, ever shifting - in need of rescue. The controversy about climate change, and especially the computer-modeled projections of melting Antarctic ice sheets and inundated cities that were the centerpiece of Al Gore's 2005 documentary An Inconvenient Truth, has shifted Antarctica from a blank backdrop for empire or even a zone of purity to a becoming another part of a war-torn and environmentally endangered planet. Especially as a sentimental object of anthropo centric panic - the ice is melting and were all going to diel - Antarctica's ruin now prefigures and announces a more universal ruin. …

From an unlicensed philosopher: reflections on brain, mind, society, culture—each other's environments with equal “ontologic standing”

Philosophic conclusions drawn from work with psychologically and morally injured combat veterans include that brain, mind, society, and culture "co-evolved." The four encompass the complete human phenomenon, but not all are reducible to the physical brain. None of the four are "ontologically prior" to the others, when viewed over the entire lifecycle. All four are what I call "each other's environments," with obligatory cross-boundary flows--each with each in both directions. Rigorous, but nonreductionist interdisciplinary research, in the vein of "evo-devo" in embryology, is called for in the study of the human phenomena. On the basis of these conclusions, I offer a few practical comments on clinical work with psychologically and morally injured combat veterans.

Unruly Bodies: The Rhetorical Domestication of Twenty-First-Century Veterans of War

Veterans of wars in Afghanistan and Iraq with visually identifiable injuries possess “unruly” bodies that render the story of war in efficient, emotional terms. The injured veteran's explicit connection of war with injury motivates state and mainstream news discourse that domesticates veterans’ bodies, managing representations of injured veterans through three dominant strategies. First, dominant discourses invoke veterans’ bodies as metonymy of the nation-state at war—bodily well-being operates as a metonym for both the nation's health and for the condition of the war. Second, veterans are domesticated by strategic placement in contexts that regulate their range of movement, especially amputees, who are often framed as having already overcome any limitations imposed by their war injuries. Third, dominant visual discourse domesticates veterans’ bodies by ascribing a strategic telos to them, shifting the meaning of the injuries away from their origins in state policy and toward wholeness and “normalcy.” Representations of whole-bodied and injured veterans tame the harshness of war and erode the argumentative grounds for questioning it.

Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records

Valid and efficient methods of identifying the etiology of treated injuries are critical for characterizing patient populations and developing prevention and rehabilitation strategies. We examined the accuracy of external cause-of-injury codes (E-codes) in Veterans Health Administration (VHA) administrative data for a population of injured patients. Chart notes and E-codes were extracted for 566 patients treated at any one of four VHA Polytrauma Rehabilitation Center sites between 2001 and 2006. Two expert coders, blinded to VHA E-codes, used chart notes to assign "gold standard" E-codes to injured patients. The accuracy of VHA E-coding was examined based on these gold standard E-codes. Only 382 of 517 (74%) injured patients were assigned E-codes in VHA records. Sensitivity of VHA E-codes varied significantly by site (range: 59%-91%, p < 0.001). Sensitivity was highest for combat-related injuries (81%) and lowest for fall-related injuries (60%). Overall specificity of E-codes was high (92%). E-coding accuracy was markedly higher when we restricted analyses to records that had been assigned VHA E-codes. E-codes may not be valid for ascertaining source-of-injury data for all injuries among VHA rehabilitation inpatients at this time. Enhanced training and policies may ensure more widespread, standardized use and accuracy of E-codes for injured veterans treated in the VHA.

Assessing and treating veterans with traumatic brain injury

Conflicts in Iraq and Afghanistan have resulted in greater proportions of service members with traumatic brain injury than in prior conflicts. These brain injuries range from the mild (concussion) to severe, and have enormous implications for clinical practice with these soldiers. The highly stressful and dangerous context in which these injuries are sustained set them apart in significant ways from brain injuries seen in civilian settings. The associated emotional toll of the environment and comorbid injuries, often resulting from blast exposure, complicates the clinical picture. In this article, the authors describe the complex presentations in this population of traumatically brain injured combat veterans and illustrate with case vignettes.

The dream contents in veterans of Iraq-Iran war suffering from chronic PTSD

Background:Iraq-Iran war lasted 8 years and ended approximately 20 years ago. It left many mentally injured veterans suffering from chronic post-traumatic stress disorder (PTSD). In this research we tried to evaluate the most frequent dream contents.Material & Method:Fifty patients with chronic PTSD and fifty matched healthy individuals were included in the study. Patient's demographic data, status of depression and anxiety and severity of PTSD were valuated. Frequent dreams in the past 6 months were recorded, using a checklist which was designed based on Hall/Van de Castle test.Results:The mean±SD of age was 38.08 years four most frequent dreams were threatening situations (rather then war events), natural disasters, death and falling down. There was no relation between the level of depression and anxiety and contents of dreams. Patients with more sever PTSD had more dreams including theme of death (P<0.0001).Conclusion:Frequent dreams in patients with chronic PTSD were not related to war experiences .We suggested dissociation as a defense mechanism is a more important factor shaping dreams than war experiences per se.

Drug use and abuse in an urban veteran spinal cord injured population.

Substance abuse in the spinal cord injured (SCI) population has been addressed in a few controlled studies. These reports have led to the belief that many SCI patients were illicit drug users prior to their injury and that their drug abuse was a contributing cause of their accidents. One large study determined from answers obtained on a questionnaire that drug abuse, other than alcohol, was prevalent among injured veterans. Our study uses urine toxicology to determine the frequency of drug use and abuse, excluding alcohol, in 72 inpatients and 81 outpatients associated with an urban Veterans Affairs Medical Center. In a blinded experiment, urinary concentrations of opiates, barbiturates, amphetamines, methadone, benzodiazepines, and cocaine were determined with Syva reagents on an Abbott VP. Urinary cannabinoids were determined using Abbott TDX and the FPIA method. The use of illicit (unprescribed) drugs was surprisingly low (< or = 13 percent) for an urban medical center. Outpatient cannabinoid abuse was significantly more frequent than inpatient usage (p < 0.01). Barbiturates were not found in any patient. Benzodiazepines were taken most commonly (29 percent). Since benzodiazepine usage is the direct result of physician prescription, wide-spread usage of this agent is avoidable. Physicians should pay attention to the probable deleterious consequences of benzodiazepine addiction related to depressive effects on the central nervous system caused by its chronic use.

Rehabilitation of the Amputee and Orthopedic Surgery

This short article is author's experiences during the war on the rehabilitation of the amputees from the viewpoint of orthopedic surgery.The author first deals with amputees' training in the use of the prosthesis and then describes the importance of proper guidance and encouragement. Long hospitalization without any fixed scheme and activity and to let the will to work remain dormant, is far more harmful to the patient than the amputation itself. The stronger the will power to work and for recovery, the quicker is the resumption of activitey and the development of the compensatory function of extremities. In such case the speed of attaining vocational skill is phenomenal too and he will soon resume his activity in the community to which he once belonged.According to the author's investigation on 409 war injured veterans, he found among them 12%, whose will for labor is very insufficient.The causes of this lack are classified as follows:1. site of amputation 51.9%2. character 48.7%3. short stump 13.4%4. severity of the disability 13.4%5. bad fitting of. prosthesis 30.8%6. insufficient vocational guidance 44.2%According to the author's investigation on 652 war injured veterans in 1943, the distribution of occupation was as following tables.