Combat Deployment and Mental Health in Military Dependents

Operations in Iraq and Afghanistan have involved the frequent and extended deployment of U.S. military personnel, many of whom are married, have children, or both. The effect of deployment on mental health problems in military spouses and children is largely unstudied. Research is needed to inform assessment and allocation of military mental health resources. This study characterized outpatient mental health diagnoses among the family members of U.S. military personnel associated with deployment in support of Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF). The risk and rate of mental health diagnoses associated with prolonged ([greater than or equal to] 7 months) OIF and OEF deployment between January 1, 2003 and December 31, 2006 were compared using electronic medical record data for spouses (n=267,126) and dependent children (n=348,012) of active duty U.S. Army personnel. After adjusting for sociodemographic characteristics and the family member's mental health history, the excess of mental health cases attributable to longer spousal deployment was 34.7 per thousand (95% CI: 29.7-39.6). It was greater for disorders of depression (22.7 cases; 95% CI: 18.4-29.9), sleep (15.8 cases; 95% CI: 12.9-18.6), stress (15.2 cases; 95% CI: 11.7-18.8), and anxiety (13.2 cases; 95% CI: 9.8-16.6), with diagnosis rates 11 to 24 percent higher for these same conditions. Excess mental health cases among children attributable to prolonged parental deployment were 14.1 per thousand (95% CI: 10.6-17.6), and were greater for depression (3.6 cases; 95% CI: 1.6-5.6), stress (9.0 cases; 95% CI: 6.5-11.5), and pediatric behavioral disorders (4.7 cases; 95% CI: 2.9-6.4), with diagnosis rates 12 to 39 percent higher for these same conditions, as well as bipolar disorder. Excess cases and rates varied for male and female children, and by military installation for all family members. This is the first large-scale study examining the effects of deployment on mental health problems in military families. Findings indicate prolonged periods of deployment are associated with increased occurrence and rates of mental health diagnoses, and have relevance for informing prevention efforts and service provision at locations with substantial troop deployment

Zebulon, Wake County : a community diagnosis including secondary data analysis and qualitative data collection

This document was created to identify and clarify points of interest and concern that are of significance to community members of Zebulon, North Carolina. The document is divided into two main sections. The first is a compilation of secondary data collected for Zebulon, and when possible, for Wake County and the State of North Carolina to use as comparisons. The second section addresses various topics brought to light during interviews with both community members and service providers within the Town. In essence, this document examines the congruence and differences between secondary data and the community’s perceptions concerning various topics of interest. Over the course of the interviewing process, many members of the Zebulon community shared their thoughts, beliefs, and experiences to help illuminate the most salient issues. The subsequent characteristics were identified as some of the most important, and hence, contributed greatly to the completion of this document: Community Characteristics: The small town of Zebulon is known as “The Town of Friendly People” and does a great deal to live up to its name. Many of the Town residents have lived there for a long period of time. Consequently, many residents enjoy familiarity with one another, close family ties, and a sense of history and community in the area. There is widespread community support within the Town from both individuals and community organizations such as churches, civic groups, and service agencies. Although Zebulon is a rural town, it now faces some issues more typical of urban centers. These issues are rapid and expansive growth, ethnic and language diversity within the population, public housing, increased crime and drugs, and growing industry and commercialization. The rapid change and growth that Zebulon has experienced in the last several years brings with it many needs and challenges, many demanding the attention of the Town and County governments. There is significant interest among residents and Town officials in handling the change and growth in Zebulon, especially concerning meeting the needs of the community through the provision, improvement, and assurance of services. Directions and Challenges: Zebulon is in the midst of a period of growth and change that the Town never before experienced. The recent annexation of Wakefield is an example of the community’s expansion, and one that illustrates some of the concerns facing Town Hall. The addition of more people means an increase in need for existing services and perhaps the development of new services. While growth is a welcomed sight for some members of Zebulon, many see it as a movement away from the traditionally held values and familiarity that come from living in a small town. The adjustment period has already started for some individuals in the community, but many steps have yet to be taken to make the Town accessible to everyone who calls it home. Several of the churches and civic organizations have offered their services to help new members to the community feel welcome, namely the growing Hispanic population. In addition, the new police chief has made a commitment to actively involving the police department in the community, thus showing one example of how the Town and its residents can work together to make Zebulon a better place for everyone. As continued growth and change face the Town, community members and service providers are preparing to address the challenges these bring. Many of the people interviewed have strong feelings and opinions about their Town and the direction in which it is moving. The greatest endeavor for Zebulon may focus on communication among Town officials, services providers, and community members to ensure a future that benefits all living and working within Zebulon.Master of Public Healt

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Brain network decoupling with increased serum neurofilament and reduced cognitive function in Alzheimer’s disease

Neurofilament light chain, a putative measure of neuronal damage, is measurable in blood and cerebrospinal fluid and is predictive of cognitive function in individuals with Alzheimer Disease. There has been limited prior work linking neurofilament light and functional connectivity and no prior work has investigated neurofilament light associations with functional connectivity in autosomal dominant Alzheimer Disease. Here we assessed relationships between blood neurofilament light, cognition, and functional connectivity in a cross-sectional sample of 106 autosomal dominant Alzheimer Disease mutation carriers and 76 non-carriers. We employed an innovative network-level enrichment analysis approach in order to assess connectome-wide associations with neurofilament light. Neurofilament light was positively correlated with deterioration of functional connectivity within the default mode network and negatively correlated with connectivity between default mode network and executive control networks including the cingulo-opercular, salience, and dorsal attention networks. Further, reduced connectivity within the default mode network and between the default mode network and executive control networks was associated with reduced cognitive function. Hierarchical regression analysis revealed that neurofilament levels and functional connectivity within the default mode network and between the default mode network and the dorsal attention network explained significant variance in cognitive composite scores when controlling for age, sex, and education. A mediation analysis demonstrated that functional connectivity within the default mode network and between the default mode network and dorsal attention network partially mediated the relationship between blood neurofilament light levels and cognitive function. Our novel results indicate that blood estimates of neurofilament levels correspond to direct measurements of brain dysfunction, shedding new light on the underlying biological processes of Alzheimer Disease. Further, we demonstrate how variation within key brain systems can partially mediate the negative effects of heighted total serum neurofilament levels, suggesting potential regions for targeted interventions. Finally, our results lend further evidence that low-cost and minimally invasive blood measurements of neurofilament may be a useful marker of brain functional connectivity and cognitive decline in Alzheimer disease