Quality Of Life In Veterans Research Articles

SOCIAL POLICY REGARDING VETERANS, PEOPLE WITH DISABILITIES AND OTHER VULNERABLE POPULATION GROUPS

The study focuses on evaluating and analyzing social policies designed to enhance the quality of life for veterans, disabled individuals, and other vulnerable population groups. Emphasis is placed on the effectiveness and adaptability of existing programs and initiatives, along with identifying potential directions for further development of social support for the mentioned citizen categories. The research adopts a comprehensive approach, incorporating the analysis of legislative frameworks, examination of statistical data, and conducting empirical investigations. Comparative analysis methods, surveys, and interviews with representatives of vulnerable groups and experts in social policy are employed. The social policy directed towards veterans, people with disabilities, and other vulnerable population groups is an integral component of the structure of modern society. Providing support to these categories of citizens holds significant humanitarian importance, as it reflects universal values and contributes to addressing issues of social justice. Systematic efforts to create equal opportunities for vulnerable groups foster inclusive development, promoting the construction of a more just and balanced society. The work not only addresses existing challenges in the realm of social support for veterans, disabled individuals, and other vulnerable groups but also proposes specific recommendations for improving assistance programs. This includes exploring opportunities to enhance the accessibility of social services and stimulate the integration of these groups into society. The findings of the research underscore the necessity for actively implementing innovative approaches in social policy, taking into account the individual needs and capabilities of vulnerable groups. The proposed recommendations can serve as a foundation for future policy decisions and improvements in the social support system for relevant population categories. Special attention is given to the development of professional rehabilitation and training programs aimed at integrating individuals into the workforce. In the context of vulnerable population groups, there is a highlighted necessity to expand social protection for the elderly, single parents, and individuals with disabilities. The recommendations also aim to improve mechanisms of civic participation and partnerships between the government, civil society, and businesses to ensure the effectiveness and sustainability of social programs. Overall, the study emphasizes the importance of revisiting and improving social policy in response to contemporary challenges and the diverse needs of different population groups. The developed recommendations can serve as a basis for strategic planning and enhancing the overall social system.

IMPLEMENTATION OF VIRTUAL REALITY TO IMPROVE QUALITY OF LIFE FOR VETERANS IN HOSPICE AND PALLIATIVE CARE

Abstract Virtual Reality (VR) is a safe and effective adjunctive care option with multiple clinical applications. An interdisciplinary VR program aimed at improving quality of life for veterans receiving inpatient hospice and palliative care was implemented at the VA Bedford Health Care System. Principles from the 4Ms of Geriatrics (Mentation, Mobility, Medications, and Matters Most) guided evaluation and outcomes. Implementation involved decision-making around hardware and software, learning about processes at other facilities, financing, and creating policies and procedures. Project development began in 2021 and data collection began in March 2023. Veteran residents enrolled in inpatient hospice and palliative care were invited to participate. As of August 2023, 22 VR visits were conducted with 13 veterans. Preliminary data suggests VR can be used with a wide range of individuals receiving hospice and palliative care. Analysis of pre-post measures indicate improvement in mood (62%) and overall day (81%), and reduced pain. Barriers to engagement include staffing (e.g., availability), technology (e.g., VR technical issues), hospital procedures/policies (e.g., infection control, COVID-19), and patient factors (e.g., interest, symptoms). Facilitators include hospital support, interdisciplinary collaboration, and understanding of the setting and patient preferences/ needs. Although conception to implementation took two years, a VR program to improve quality of life for veterans enrolled in hospice and palliative care appears to be feasible and clinically beneficial. Experience has shown that flexibility, adaptability, and an individualized approach facilitate engagement. Best practices in the application of VR within the hospice and palliative care setting will continue to be evaluated and honed.

Exploring Interactions Between Traumatic Brain Injury History and Gender on Medical Comorbidities in Military Veterans: An Epidemiological Analysis in the VA Million Veteran Program.

Epidemiological studies of medical comorbidities and possible gender differences associated with traumatic brain injury (TBI) are limited, especially among military veterans. The purpose of this study was to examine relationships between TBI history and a wide range of medical conditions in a large, national sample of veterans, and to explore interactions with gender. Participants of this cross-sectional epidemiological study included 491,604 veterans (9.9% TBI cases; 8.3% women) who enrolled in the VA Million Veteran Program (MVP). Outcomes of interest were medical comorbidities (i.e., neurological, mental health, circulatory, and other medical conditions) assessed using the MVP Baseline Survey, a self-report questionnaire. Logistic regression models adjusting for age and gender showed that veterans with TBI history consistently had significantly higher rates of medical comorbidities than controls, with the greatest differences observed across mental health (odds ratios [ORs] = 2.10-3.61) and neurological (ORs = 1.57-6.08) conditions. Similar patterns were found when evaluating men and women separately. Additionally, significant TBI-by-gender interactions were observed, particularly for mental health and neurological comorbidities, such that men with a history of TBI had greater odds of having several of these conditions than women with a history of TBI. These findings highlight the array of medical comorbidities experienced by veterans with a history of TBI, and illustrate that clinical outcomes differ for men and women with TBI history. Although these results are clinically informative, more research is needed to better understand the role of gender on health conditions in the context of TBI and how gender interacts with other social and cultural factors to influence clinical trajectories following TBI. Ultimately, understanding the biological, psychological, and social mechanisms underlying these comorbidities may help with tailoring TBI treatment by gender and improve quality of life for veterans with TBI history.

0836 Chronic Pain worsens Daytime Sleepiness, Insomnia and Quality of Life in Veterans with Obstructive Sleep Apnea

Abstract Introduction Chronic noncancer pain (CP) commonly co-occurs with obstructive sleep apnea (OSA) and may contribute to greater symptom burden. The study aim was to examine differences in sleepiness (Epworth Sleepiness Scale, ESS), insomnia symptoms (Insomnia Severity Index [ISI]), and quality of life (Short Form Health Survey 20, SF-20) in veterans with OSA with or without pre-existing CP. Methods An observational, cross-sectional, study of veterans with newly diagnosed, untreated OSA was conducted. Unadjusted between-group comparisons (i.e., OSA-only versus OSA + CP) were conducted using the Welch’s t-test and Pearson Chi-Square. Regression analyses were performed to determine the influence of self-reported CP on sleep-related symptoms and quality of life while controlling for potential confounders (i.e., age, sex, OSA severity, body mass index, percentage of total sleep time spent with SpO2 < 90%, and presence of psychiatric/mental health comorbidities). The Hochberg (step-up) method was used to control for the family-wise error rate at 5%. Results The final sample included N=111 participants with complete survey responses. Compared to the group with OSA-only (n=40), veterans with comorbid OSA and CP (n=71) experienced significantly higher ESS (12.7 ± 5.5 vs 10.2 ± 5.2; p = .021) and ISI scores (18.1 ± 6.2 vs. 13.7 ± 7.4; p = .002), and worse quality of life across all SF-20 domains. Of note, clinically significant insomnia (ISI score > 15) was most common among veterans with comorbid OSA and CP (68.7% vs. 45.5%, p = .010). In adjusted analyses, CP diagnosis was significantly associated with higher ESS (adjusted mean difference [95% CI] = 2.72 [0.55, 4.88], p = .014) and ISI scores (adjusted mean difference [95% CI] = 3.82 [1.27, 6.37], p =.004). Conclusion There is a high prevalence of CP among veterans with OSA and symptom burden is higher in patients with OSA and CP. Future investigations should address symptom response and burden to OSA treatment in comorbid OSA and CP to guide outcome expectancies and residual OSA symptom treatment plans. Support (if any) SRSF Small Research Grant Award: 05-SRG-20. University of Pennsylvania School of Nursing, Office of Nursing Research.

Acute influence of an adaptive sporting event on quality of life in veterans with disabilities.

Veterans with disabilities can experience poor quality of life following military service due to the associated negative physical and psychological ramifications. However, participation in physical activities has shown to induce both physical and mental benefits and improve the quality of life of this population. Adaptive sports, an innovative approach to address the unique physical and psychosocial needs of veterans with disabilities, are becoming more widely used as a rehabilitation tool to improve the quality of life for these veterans. This study aimed to determine the acute influence of participation in a single-day, veteran-based, adaptive kayaking and sailing event on the perceived overall health, quality of life, and quality of social life of veterans with varying disabilities. It was hypothesized that all three categories and the sum score of quality of life would reflect a positive acute response after participation in the community-based physical activity event. Veterans responded to three quality of life-related questions using a 5-point Likert scale before and directly after participating in the event. Findings indicated that an adaptive sporting event can have an acute positive influence on the quality of life of veteran participants, with improvements observed in all three categories of perceived quality of life. Therefore, it is advantageous for the whole-health rehabilitation of veterans with disabilities for the Department of Veterans Affairs to continue to provide opportunities for veterans to participate in non-traditional, community-based activities.

Feasibility and Effectiveness of a Multi-Micronutrient Intervention as a Palliative Care Therapy in Patients With Congestive Heart Failure

ObjectivesVeterans with HF are at risk of micronutrient depletion due to combined systemic disease and drug induced altered nutrient disposition. This pilot aimed to test feasibility and effectiveness of a MMI to improve micronutrient status, cardiac function and quality of life in Veterans with HF. MethodsA pre/post repeated measures design was used. Veterans with stable HF stage B-D, left ventricular ejection fraction (LVEF) ≤45%, from ischemic cardiomyopathy with systolic dysfunction were recruited. The 6-month MMI was 3 tabs daily providing thiamin (B1) 100 mg, 50 mg each of riboflavin, niacin, pantothenic acid, pyridoxine (B6), inositol, 25 mg phosphatidyl choline, 400 mcg folic acid, and 50 mcg each of B12 and biotin, and 50 mg elemental zinc (Zn). Ergocalciferol was given as 50,000 IU weekly for 2 months then every 2 weeks for 4 months. Micronutrient status and LVEF (echocardiogram) were determined as least-squares mean (± standard error, SE) estimated from general linear mixed effect models fitted to micronutrient measurements adjusting for age (18–65 Vs. > 65); feasibility of MMI assessed as % consumed. ResultsThis abstract focuses on the nutrient status at baseline, feasibility of the MMI, and change in nutrient status following MMI. Twenty-two male Veterans (86% Caucasian), median 64 years (59–75 interquartile range, IQR) started MMI; 20 completed. At baseline, median (IQR) dietary intake was 1639 (1472–1838) calories, 36 (28–41) % fat, 13 (10–15) % saturated fat, 2981 (2067–3534) mg sodium while following the American Heart Association diet with 2 gm sodium restriction. Micronutrient intake was 1.2 (0.9–1.4) mg B1, 1.2 (1.0–1.8) mg B6, 49 (38–166) IU Vitamin D, and 7 (5–10) mg zinc. Median % compliance with MMI at 3 and 6 months was ≥ 92 and ≥94, respectively. Baseline and changes in blood measures of micronutrients were: B1, 119 (SE 13) and 96 (SE 20, p< 0.0001) nmol/L; B6, 11.4 (SE 6.3) and 57.3 (SE 9.2, p< 0.0001) ng/mL; total 25-OH Vitamin D, 31.2 (SE 2.3) and 6.5 (SE 3.4, p = 0.057) ng/mL; Zn, 81.4 (SE 5.1) and 13.8 (7.6, p = 0.07) mcg/dL. LVEF at baseline and 6 months were 28.9 (SE 1.6) % and 30.0 (SE 1.7) %, respectively (p = 0.64). ConclusionsThe feasibility of adding MMI to complex pharmaceutical regimens in male Veterans with stable HF was high. MMI was effective in improving micronutrient status and preserved LVEF. Funding SourcesDepartment of Veterans Affairs

Safety, Acceptability, and Proof of Concept Efficacy of Telerehabilitation on Sleepiness and Quality of Life in Veterans with End-Stage Pulmonary Disease (RP519)

Safety, Acceptability, and Proof of Concept Efficacy of Telerehabilitation on Sleepiness and Quality of Life in Veterans with End-Stage Pulmonary Disease (RP519)

COACH: Caring for Older Adults and Caregivers at Home

Dementia is a major cause of disability and dependency in older adults and it has a physical, psychological, social, and economic impact on the affected individual as well as their caregivers. Most Americans with dementia receive care from their family members, and friends2. Care giving is associated with an increased level of psychological distress and lower subjective well-being and physical health2; caregiver support groups have been found to reduce angry and depressive feelings, improve caregiver's skills, maintain favorable health behaviors and quality of life, and increase social support and satisfaction for caregivers3. There is often a strong preference to keep the affected individual at home for as long as possible; however, significant behavioral challenges and caregiver strain lead to placement in a long-term care facility4. COACH is an innovative, longitudinal, home-based dementia care program serving veterans with dementia and their caregivers. The program originated as a clinical demonstration project by the Geriatric, Research, Education and Clinical Center at the Durham VA Health Care System (DVAHCS) in 2010. It became a fully established, permanent program in 2012 and expanded to rural Eastern North Carolina in 2014. COACH is designed to improve quality of life for veterans with dementia and their caregivers, with the goal of helping veterans remain at home for as long as possible. The criteria for COACH include veterans enrolled in VAHCS who are 65 or more years of age with moderate to severe cognitive impairment and who have a live-in caregiver. Enrolled veterans cannot be in another home-based program and must live within 50 miles from the COACH team's home clinic. The process begins with a consult to the COACH program from any health care provider. Once the veteran and their care giver are screened and found eligible, a LCSW and a RN conduct a comprehensive assessment. This includes psychosocial assessment; home safety assessment; evaluation of patient's cognitive and functional abilities; evaluation of patient's behaviors; medication review; and evaluation of care giver stress, knowledge of dementia, coping abilities, screening for depression and family resources. RN and LCSW consult with an interdisciplinary team of a geriatrician, a geriatric psychiatrist, and a geriatric pharmacist weekly to develop a comprehensive treatment plan integrating best evidence-based practices. After the initial assessment, LCSW and RN conduct follow ups via home visits or video and telephone contact at one, three, and six months. Home visits continue every six months with quarterly follow-ups via video or telephone, and additional ad-hoc home visits as recommended by the interdisciplinary team or needed by the caregiver. The team provides ongoing support and education to caregivers in five major areas of care. 1. Behavioral symptoms management: focuses on non-pharmacological approaches like communication skills, reminiscence and validation techniques, behavioral activation 2. Safety: addresses any safety hazards that may affect the veteran like driving or falls. 3. Advance care planning: offers anticipatory guidance and education on advance directives and end of life care preferences. 4. Caregiver burden: offers ongoing support to caregivers, emphasizes self-care. 5. Dementia related medical concerns: Offers pharmacological recommendations for safety, appropriateness, and compliance; guidance on strategies to maintain functioning, assistance with activities of daily living, and cover needs for durable medical equipment in the home. To augment the educational interventions, the program offers weekly caregiver support groups and monthly educational series talks on dementia. In the last in the last ten years, the program has served nearly 1,200 veterans, with about 100 new veterans enrolled each year. It has demonstrated ability to improve dementia care at home, delay long-term care facility placement6, reduce caregiver burden, and improve safety at home5. COACH exceeds all national dementia performance measures5.

Impact of the Post Deployment Assessment and Treatment Residential Rehabilitation Program on Quality of Life in Veterans with Multiple Medical and Psychiatric Comorbidities

<h3>Research Objectives</h3> To evaluate the impact of a residential psychological rehabilitation program on quality of life of veterans with comorbid mental health, substance use, and neurological conditions (e.g. traumatic brain injury). <h3>Design</h3> Before-and-after trial of a novel neurorehabilitation program for Veterans with complex postdeployment needs. <h3>Setting</h3> Interdisciplinary residential inpatient rehabilitation program in a Veteran's Administration hospital. <h3>Participants</h3> Participants were 48 male residents (24 to 61 years of age, M = 36.85 (SD = 9.50)), 68.8% were non-Hispanic Caucasian, 8.3% Asian/Pacific Islander, 4.2% African-American, 8.3% Hispanic, 10.4% Native-American/Alaskan Native, mean education was 13.00 years (SD = 1.39, range = 9 to 19). Mean months deployed was 14.61 (SD = 8.80, range = 0 to 42). The three most common mental health diagnoses were sleep-wake disorder, trauma and stress-related disorder, and anxiety disorders. A total of 43.8%, n = 21, of participants experienced problems with alcohol abuse. Assessment was completed immediately prior to and up to two weeks after discharge. <h3>Interventions</h3> Participants received intensive individual and group therapies from an interdisciplinary team with an emphasis on community re-integration. The length of treatment varied from two weeks to sixty weeks. <h3>Main Outcome Measures</h3> World Health Organization Quality of Life-Brief (WHOQOL-BREF), a well-validated 26-item measure of quality of life within four domains (physical health, psychological well-being, social relationships, and environment). <h3>Results</h3> Results showed significant change on all four WHOQOL-BREF domains after program participation, t's = 4.15 to 6.20, all p's <.001. Number of military deployments was marginally negatively associated with degree of improvement on the physical health domain (r = -.28, p < .10). Nondeployment during military service was marginally positively associated with increases on the social relationship domain (p < .10, t = -1.83). <h3>Conclusions</h3> Findings support the benefit of the Post Deployment Assessment and Treatment residential rehabilitation intervention for improvement of quality of life. Comprehensive rehabilitation efforts are important and can be helpful with Veterans who experience multiple comorbities. <h3>Author(s) Disclosures</h3> The authors report no relevant disclosures.

Sleep disorders, daytime symptoms, and quality of life in veterans with multiple sclerosis: preliminary findings.

Multiple sclerosis (MS) is an autoimmune disease impacting the central nervous system. A hallmark symptom of MS is fatigue, which impairs daytime function and quality of life (QOL). Sleep disorders and disturbances are common in persons with MS and exacerbate fatigue. We evaluated relationships between sleep-disordered breathing (SDB), insomnia symptoms, sleep quality, and daytime functioning in veterans with MS participating in a larger study. Twenty-five veterans with clinically diagnosed MS were included (average age = 57 ± 11, 80% male). One had a co-occurring thoracic spinal cord injury. Twenty-four participants completed in-laboratory polysomnography (PSG) to measure apnea-hypopnea index (AHI) and sleep efficiency (PSG-SE). Insomnia Severity Index (ISI) and Pittsburg Sleep Quality Index (PSQI) were used to measure sleep subjectively. The Flinders Fatigue Scale (FFS), Epworth Sleepiness Scale (ESS), PHQ-9 depression scale, and GAD-7 anxiety scale assessed daytime symptoms. The World Health Organization Quality of Life (WHOQOL) was used to assess quality of life. Relationships between sleep (AHI, PSG-SE, ISI, PSQI), daytime symptoms (ESS, FFS, PHQ-9, and GAD-7), and quality of life (WHOQOL) were evaluated with bivariate correlations. Higher ISI (r = 0.78, 95% CI = [0.54, 0.90], p < .001), higher PSQI (r = 0.51, 95% CI = [0.10, 0.77], p = .017), and lower PSG-SE (r = -0.45, 95% CI = [-0.74, -0.02], p = .041) were associated with worse fatigue (FFS). Higher ISI was also associated with worse WHOQOL (Physical Domain; r = -0.64, 95% CI = [-0.82, -0.32], p = .001). There were no other significant relationships. In veterans with MS, more severe insomnia and worse sleep quality may be associated with more fatigue and lower quality of life. Recognition and management of insomnia should be considered in future studies of sleep in MS.

Complementary and Integrative Health Interventions for Insomnia in Veterans and Military Populations.

Insomnia can be a serious problem diminishing quality of life for Veterans and military populations with and without posttraumatic stress disorder (PTSD). Sleep disturbances are one of the symptoms of PTSD but even after evidence-based PTSD treatments, insomnia symptoms often remain. The primary approaches for treating insomnia are cognitive behavioral therapy for insomnia (CBT-I) and pharmacotherapy. However, each of these treatments has drawbacks. Complementary and Integrative Health (CIH) approaches such as mindfulness meditation, mantram meditation, yoga, and tai chi may provide alternative treatments for insomnia in military populations. This paper provides a brief review of studies on CIH interventions for sleep disturbances in Veterans. It also proposes possible mechanisms by which CIH practices may be effective, including increasing hippocampal volume and gamma-aminobutyric acid acid (GABA). Finally, the acceptability of CIH approaches among Veterans is discussed.

Role of Particulate Matter from Afghanistan and Iraq in Deployment-Related Lung Disease.

Approximately 3 million United States military personnel and contractors were deployed to Southwest Asia and Afghanistan over the past two decades. After returning to the United States, many developed persistent respiratory symptoms, including those due to asthma, rhinosinusitis, bronchiolitis, and others, which we collectively refer to as deployment-related lung diseases (DRLD). The mechanisms of different DRLD have not been well defined. Limited studies from us and others suggest that multiple factors and biological signaling pathways contribute to the onset of DRLD. These include, but are not limited to, exposures to high levels of particulate matter (PM) from sandstorms, burn pit combustion products, improvised explosive devices, and diesel exhaust particles. Once inhaled, these hazardous substances can activate lung immune and structural cells to initiate numerous cell-signaling pathways such as oxidative stress, Toll-like receptors, and cytokine-driven cell injury (e.g., interleukin-33). These biological events may lead to a pro-inflammatory response and airway hyperresponsiveness. Additionally, exposures to PM and other environmental hazards may predispose military personnel and contractors to more severe disease due to the interactions of those hazardous materials with subsequent exposures to allergens and cigarette smoke. Understanding how airborne exposures during deployment contribute to DRLD may identify effective targets to alleviate respiratory diseases and improve quality of life in veterans and active duty military personnel.

Mission Reconnect: Exploring the Mobile and Web Based Complementary and Integrative Health Program Experience for Veterans with Chronic Pain and PTSD and Their Partners

<h3>Research Objectives</h3> There is a global trend in healthcare towards non-pharmacological and complementary and integrative approaches to health (CIH). The primary objective of this poster is to present the experience of veterans with chronic pain and PTSD and their partners with a remotely delivered CIH education program. <h3>Design</h3> A parent four year, mixed methods randomized control trial proposed to conduct telephone interviews with a subsample of veteran and partner intervention dyads. Transcripts were analyzed using a content analysis. Data in this poster represent preliminary findings from 13 dyads that have been interviewed to date. <h3>Setting</h3> Three Veterans Administration Medical Centers recruited participants from surrounding areas, resulting in recruitment from 12 states. <h3>Participants</h3> Veterans with chronic pain and PTSD, and their selected partners (e.g., spouse, child). <h3>Interventions</h3> The Mission Reconnect program is a partnered, self-directed intervention which teaches CIH skills (e.g., meditation, partnered massage) remotely using mobile and web-based mediums. <h3>Main Outcome Measure(s)</h3> Main outcomes are physical and mental, overall quality of life for veterans; and social relationship with partners. <h3>Results</h3> Participants reported improvements in physical, mental, overall quality of life for veterans; and social relationship with partners. Veterans reported improvements in sleep quality, pain management, and anxiety and PTSD symptoms. For veterans and partners, respondents reported improvements in quality of life, including feeling energized, refreshed, centered, and relaxed; and enhanced relationships, including increase in quality time spent together, and expression of affection. <h3>Conclusions</h3> Veterans and their partners reported Mission Reconnect is an effective approach to "reconnecting with life." Online and mobile CIH approaches should be considered for other diverse patient populations and partners, who will benefit from ongoing self-care management. Future research should examine cost-effectiveness of such approaches and broadscale implementation. <h3>Author Disclosures</h3> None disclosed.

Elevated Neuropsychological Intraindividual Variability Predicts Poorer Health-Related Quality of Life in Veterans with a History of Mild Traumatic Brain Injury.

We examined the association between cognitive functioning and health-related quality of life (HR-QOL) in military veterans with a history of mild traumatic brain injury (mTBI) using two methods to assess cognition: mean performance on cognitive composite scores and across-test intraindividual variability (IIV). The sample included 73 veterans (84.9% male; age, mean = 32.47 years) who completed neuropsychological testing and self-report questionnaires ∼7 years post-injury. Three cognitive composite scores representing mean performance were computed, including memory, attention/processing speed (A/PS), and executive functioning (EF). Three IIV indices were also calculated reflecting degree of dispersion across the same cognitive domains: memory-IIV, A/PS-IIV, and EF-IIV. The Posttraumatic Stress Disorder (PTSD) Checklist-Military Version (PCL-M) was used to assess current PTSD symptoms, and the World Health Organization Quality of Life Short Version Physical Health domain was used to assess HR-QOL. Hierarchical linear regressions adjusting for PTSD symptoms demonstrated that IIV indices, but not mean cognitive composite scores, significantly predicted HR-QOL. Specifically, memory-IIV, A/PS-IIV, and EF-IIV, when taken together, made an independent and significant contribution to the prediction of HR-QOL. Examination of the standardized coefficients showed that the A/PS-IIV index was uniquely associated with HR-QOL, such that higher A/PS-IIV scores significantly predicted poorer HR-QOL. Our results are the first to show that, in veterans with remote mTBI histories, greater fluctuations in cognitive performance significantly contribute to poorer HR-QOL, even after accounting for PTSD symptom severity. Moreover, findings suggest that, compared to traditional mean cognitive performance scores, measures of IIV may represent more sensitive indicators of clinical outcome and better align with subjective experiences of distress.

A Heuristic Evaluation of Usability for Environmental Control Units’ Eye-Tracking Interfaces at Veterans Affairs Spinal Cord Injuries and Disorders Centers

Heuristic evaluation is a valid method for assessing interface usability. Results derived from these methods are useful in identifying the most impactful design elements influencing usability and user experience of a system. By establishing the features in need of most improvement, designers can more effortful consider their approaches for iterative efforts to improve usability and user experience. This work used established design principles (i.e., Shneiderman’s Golden Rules and Nielsen’s Heuristics) to analyze the inpatient environmental control units deployed at VA Spinal Cord Injuries and Disorders (SCI/D) Centers to assist with task completion, foster independence, and improve the quality of life in veterans with spinal cord injuries and disorders. Analyses revealed many usability issues in the current interface, varying in severity from minor to catastrophic. Specific design recommendations to address these issues are provided.

Associations between adverse childhood experiences and weight, weight control behaviors and quality of life in Veterans seeking weight management services

IntroductionA neglected area of trauma research with Veterans is the study of Adverse Childhood Experiences (ACEs). The present study aimed to examine the prevalence of ACEs, and to explore relationships between ACEs and measures of weight, eating behaviors and quality of life in weight loss seeking Veterans. MethodsParticipants were 191 Veterans [mean age 58.9 (SD = 12.8), mean Body Mass Index (BMI) 35.4 (SD = 6.1), 86.9% male, 33.7% racial/ethnic minority] receiving care at VA Connecticut Healthcare System (VA CT) who attended an orientation session of VA's behavioral weight management program. Participants completed a measure of ACEs and measures related to weight, eating and health. ResultsAmong completers, 68.6% endorsed at least one ACE. The average number of reported ACEs was 2.2 (SD = 2.5), with 48.7% of Veterans reporting more than one type of ACE. Women were more likely to report any ACE (88.0% vs. 65.6%, p = .025) and reported significantly more ACEs compared to males (4.2 vs. 1.9, p < .001). ACEs were associated with lower physical activity (p = .05), lower quality of life (p's < 0.05), and lower weight-related quality of life (p < .01), but not weight, weight control strategies, binge eating, or alcohol use. ConclusionACEs are common among weight loss seeking Veterans, particularly among female Veterans. Findings suggest that there is a high rate of ACEs in Veterans, which are associated with exercise and quality of life outcomes, but not diet and weight outcomes.

The Role of Perceived Social Support in Assessing Posttraumatic Stress Disorder and Mental Health-Related Quality of Life in Veterans.

This study aims to establish the effect of self-perceived social support on the intensity of Post-Traumatic Stress Disorder (PTSD) symptoms and Mental Health-Related Quality of Life (MHRQoL) in veterans more than two decades after exposure to trauma in the Homeland War in Croatia, which took place from 1990 to 1995. The sample comprised 259 Croatian Homeland War veterans diagnosed with PTSD, with at least 6 months of combat experience. Among them, 90 subjects had also experienced imprisonment in enemy prison camps (at least 1 month of captivity). The subjects were evaluated using the questionnaire on self-perceived social support, sociodemographic questionnaire, PTSD self-report checklist (PCL-5) and Short Form (SF-36) Health Survey questionnaire. A general regression model analysis was performed to determine whether social support affected patients’ MHRQoL and intensity of the PTSD symptoms. The obtained results showed that veterans who had a more positive perception of social support after the events of the war had less intense PTSD symptoms and better MHRQoL. Furthermore, captivity and socioeconomic status were shown to be important predictors of PTSD and MHRQoL. The nonimprisoned veteran group was more likely to develop more severe PTSD symptoms and have poorer MHRQoL compared to the group of former prisoners of war (ex-POWs). This could be due to better post-war care and social support, which ex-POWs received after their release from captivity.

Pain intensity and mental health quality of life in veterans with mental illnesses: the intermediary role of physical health and the ability to participate in activities.

PurposeThe purpose of this study was to examine the intermediary role of physical health quality of life and ability to participate social roles and activities in the relationship between pain intensity and mental health quality of life in veterans with mental illnesses.MethodsThis is a cross-sectional correlational design study. Our participants are 156 veterans with self-reported mental illness (Mage = 37.85; SDage = 10.74). Descriptive, correlation, and mediation analyses were conducted for the current study.ResultsPain intensity was negatively correlated with physical health QOL, ability to participate in social roles and activities, and mental health QOL. Physical health QOL and ability to participate in social roles and activities were positively associated with mental health QOL, respectively. Physical health QOL was positively correlated with a ability to participate in social roles and activities. Study results indicate that the effect of pain intensity on mental health QOL can be explained by physical health QOL and ability to participate.ConclusionsSpecific recommendations for practitioners include implementing treatment goals that simultaneously focus on physical health and ability to participate in social roles and activities for clients who present with both physical pain and low mental health QOL.

Relationships between chronic pain and mood symptoms among veterans with bipolar disorder

BackgroundChronic pain is highly prevalent among individuals with mood disorders. While much is known about the relationship between pain and unipolar depression, little is known about pain experiences among people with bipolar disorder. This pilot study addresses this gap by examining pain and its relationship to mood and functioning in a sample of US military veterans with bipolar disorder. MethodsQualitative interviews were conducted with 15 veterans with bipolar disorder and chronic pain who were recruited from outpatient services within a Veterans Affairs medical center. ResultsVeterans reported a bidirectional relationship between pain and bipolar depression. When discussing manic episodes, individuals’ experiences varied between notable reductions in pain (usually in euphoric states), increases in pain (usually in angry/irritable states), and feeling disconnected from pain. Many reported that increased activity when manic contributed to worse pain after an episode. Veterans clearly articulated how these connections negatively affected their functioning and quality of life. LimitationsThis was a small, retrospective study that included a non-random sample of veteran participants from one VA medical center. All veterans were engaged in outpatient mental health care, so the majority reported that their mood has been well-stabilized through medications and/or psychotherapy. ConclusionsChronic pain experiences appear to be related to depressive and manic mood states and significantly affects functioning and quality of life in Veterans with bipolar disorder. This study highlights the need to assess chronic pain among veterans with bipolar disorder, as changes in mood could have significant implications for functioning and pain management.

Feasibility and Acceptability of Heart Rate Variability Biofeedback in a Group of Veterans with Fibromyalgia.

Objectives: To determine the feasibility and acceptability of a heart rate variability biofeedback (HRVB) protocol in a focus group of Veterans with fibromyalgia (FM). Design: A multimethod feasibility and acceptability study. Settings/location: A Veterans Health outpatient pain medicine clinic in the southern United States. Subjects: The researcher enrolled seven women and three men between the ages of 33 and 68 years with a diagnosis of FM. Interventions: Participants practiced HRVB on the emWave2 at home for 20 min twice daily for 7 weeks. Outcome measures: Feasibility to adhere to the HRVB protocol was measured using the practice frequency and time (minutes) data collected from the emWave2. The author compared the individual reports from participants with the Credibility/Expectancy Questionnaire to measure the acceptability of the intervention. In addition, the principal investigator evaluated data from the Short-form McGill Pain Questionnaire (SFMQ) and the Revised Fibromyalgia Impact Questionnaire (FIQR) at the baseline and weekly study visits for a signal of efficacy for pain control, functional status, and quality of life (QOL). Results: The majority of participants (80%) expected 50% or more improvement in their pain, and (70%) felt HRVB would reduce their FM-related pain by 50%-80%. The mean daily practice frequency rate was 0.80. The mean practice duration was 19.36 min. Pain score differences from the SFMQ were insignificant preintervention and postintervention. The mean total FIQR scores postintervention improved by 18.1 points. Conclusions: Findings suggest twice-daily HRVB practice protocol is not feasible. However, 20-min HRVB sessions were feasible and acceptable. Improved FIQR scores post-treatment suggest HRVB may be an effective strategy to improve functional status and QOL for Veterans with FM. ClinicalTrials.gov ID: Pro00079144.