Postconcussive Symptoms, PTSD, and Medical Disease Burden in Treatment-Seeking OEF/OIF/OND Veterans

Introduction: The most common psychological and cognitive sequelae associated with deployments to Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) are mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). High rates of PTSD are often observed among Veterans with a history of mTBI, and persistent postconcussive symptoms commonly endorsed after mTBI are known to be associated with PTSD. Therefore, this study examined whether PTSD mediates relations between postconcussive symptoms and 2 indices of medical disease burden: 1) the number of disease categories positive for a diagnosis, or system disease burden, and 2) total number of physical diagnoses, or cumulative disease burden. Materials and Methods: Participants were 91 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans seeking treatment at a Veterans Affairs Medical Center who screened positive for mTBI and later attended a follow-up Polytrauma clinic evaluation for neuropsychiatric assessment. Medical records were reviewed for a history of mTBI, postconcussive symptoms, and physician diagnoses, which were used to derive system and cumulative disease burden variables. Mediation was tested using bootstrapping procedures. Participants provided written informed consent and all study procedures were approved by both the VA and university institutional review boards. Results: Postconcussive symptoms (r = 0.53) and PTSD symptoms (r = 0.32) were both associated with cumulative disease burden. Only postconcussive symptoms were associated with system disease burden (r = 0.32). Results of our follow-up mediation analysis suggest that PTSD did not mediate relations between postconcussive symptoms and cumulative disease burden (bootstrap coefficient = −0.02, 95% confidence interval [−0.05 to 0.01]). Conclusion: These findings join an emerging body of literature suggesting that postconcussive symptoms have a direct impact on Veterans’ health above and beyond the effects of PTSD. Strengths of this study include the use of objective, clinician-diagnosed medical conditions as an indicator of health, whereas limitations include the use of self-report measures to assess postconcussive and PTSD symptoms. This study underscores the need for more original research on the impact of mTBI on the long-term health and readjustment of returning Veterans. Furthermore, this study highlights the need for additional research on the psychosocial and pathophysiological mechanisms underlying the link between mTBI and poor health

Postconcussive symptoms, PTSD, and medical disease burden in treatment-seeking OEF/OIF/OND veterans

Introduction: The most common psychological and cognitive sequelae associated with deployments to Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) are mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD). High rates of PTSD are often observed among Veterans with a history of mTBI, and persistent postconcussive symptoms commonly endorsed after mTBI are known to be associated with PTSD. Therefore, this study examined whether PTSD mediates relations between postconcussive symptoms and 2 indices of medical disease burden: 1) the number of disease categories positive for a diagnosis, or system disease burden, and 2) total number of physical diagnoses, or cumulative disease burden. Materials and Methods: Participants were 91 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans seeking treatment at a Veterans Affairs Medical Center who screened positive for mTBI and later attended a follow-up Polytrauma clinic evaluation for neuropsychiatric assessment. Medical records were reviewed for a history of mTBI, postconcussive symptoms, and physician diagnoses, which were used to derive system and cumulative disease burden variables. Mediation was tested using bootstrapping procedures. Participants provided written informed consent and all study procedures were approved by both the VA and university institutional review boards. Results: Postconcussive symptoms (r = 0.53) and PTSD symptoms (r = 0.32) were both associated with cumulative disease burden. Only postconcussive symptoms were associated with system disease burden (r = 0.32). Results of our follow-up mediation analysis suggest that PTSD did not mediate relations between postconcussive symptoms and cumulative disease burden (bootstrap coefficient = −0.02, 95% confidence interval [−0.05 to 0.01]). Conclusion: These findings join an emerging body of literature suggesting that postconcussive symptoms have a direct impact on Veterans’ health above and beyond the effects of PTSD. Strengths of this study include the use of objective, clinician-diagnosed medical conditions as an indicator of health, whereas limitations include the use of self-report measures to assess postconcussive and PTSD symptoms. This study underscores the need for more original research on the impact of mTBI on the long-term health and readjustment of returning Veterans. Furthermore, this study highlights the need for additional research on the psychosocial and pathophysiological mechanisms underlying the link between mTBI and poor health

Deployment risk factors and postdeployment health profiles associated with traumatic brain injury in heavy drinking Veterans

Along with post-traumatic stress disorder (PTSD), mild traumatic brain injury (mTBI) is considered one of the signature wounds of combat operations in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]), but the role of mTBI in the clinical profiles of Veterans with other comorbid forms of postdeployment psychopathology is poorly understood. The current study explored the deployment risk and postdeployment health profiles of heavy drinking OIF and OEF Veterans as a function of mTBI. Sixty-nine heavy-drinking OIF/OEF Veterans were recruited through a Veterans\u27 Affairs Medical Center and completed questionnaires and structured interviews assessing war-zone experiences, postdeployment drinking patterns, and PTSD symptoms. Veterans with positive mTBI screens and confirmed mTBI diagnoses endorsed higher rates of combat experiences, including direct and indirect killing, and met criteria for PTSD at a higher rate than Veterans without a history of mTBI. Both PTSD and combat experiences independently predicted screening positive for mTBI, whereas only combat experiences predicted receiving a confirmed mTBI diagnosis. mTBI was not associated with any dimension of alcohol use. These results support a growing body of literature linking mTBI with PTSD. © Association of Military Surgeons of the U.S. All rights reserved

Deployment Risk Factors and Postdeployment Health Profiles Associated With Traumatic Brain Injury in Heavy Drinking Veterans

Along with post-traumatic stress disorder (PTSD), mild traumatic brain injury (mTBI) is considered one of the “signature wounds” of combat operations in Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]), but the role of mTBI in the clinical profiles of Veterans with other comorbid forms of postdeployment psychopathology is poorly understood. The current study explored the deployment risk and postdeployment health profiles of heavy drinking OIF and OEF Veterans as a function of mTBI. Sixty-nine heavy-drinking OIF/OEF Veterans were recruited through a Veterans’ Affairs Medical Center and completed questionnaires and structured interviews assessing war-zone experiences, postdeployment drinking patterns, and PTSD symptoms. Veterans with positive mTBI screens and confirmed mTBI diagnoses endorsed higher rates of combat experiences, including direct and indirect killing, and met criteria for PTSD at a higher rate than Veterans without a history of mTBI. Both PTSD and combat experiences independently predicted screening positive for mTBI, whereas only combat experiences predicted receiving a confirmed mTBI diagnosis. mTBI was not associated with any dimension of alcohol use. These results support a growing body of literature linking mTBI with PTSD

Fenofibrate-associated changes in renal function and relationship to clinical outcomes among individuals with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) experience

AIMS/HYPOTHESIS: Fenofibrate has been noted to cause an elevation in serum creatinine in some individuals. Participants in the Action to Control Cardiovascular Risk in Diabetes Lipid Study were studied to better characterise who is at risk of an increase in creatinine level and to determine whether those with creatinine elevation have a differential risk of adverse renal or cardiovascular outcomes. METHODS: A fenofibrate-associated creatinine increase (FACI) was defined as an increase in serum creatinine of at least 20% from baseline to month 4 in participants assigned to fenofibrate. Baseline patient characteristics, and baseline and 4-month drug, clinical, laboratory characteristics and study outcomes were examined by FACI status. RESULTS: Of the sample, 48% of those randomised to receive fenofibrate had at least a 20% increase in serum creatinine within 4 months. In multivariable analysis, participants who were older, male, used an ACE inhibitor at baseline, used a thiazolidinedione (TZD) at 4 months post-randomisation, had baseline CVD, and had lower baseline serum creatinine and LDL-cholesterol levels were all more likely to meet the criteria for FACI. Participants in the FACI group were also more likely to have a decrease in their serum triacylglycerol level from baseline to 4 months. No differences in study outcomes were seen by FACI criteria. CONCLUSIONS/INTERPRETATION: Several characteristics predict a rapid rise in serum creatinine upon starting fenofibrate. Participants who met the criteria for FACI also had a greater change in triacylglycerol levels. In the setting of careful renal function surveillance and reduction of fenofibrate dose as indicated, no increase in renal disease or cardiovascular outcome was seen in those individuals demonstrating FACI