Military-Related Exposures, Social Determinants of Health, and Dysbiosis: The United States-Veteran Microbiome Project (US-VMP)

Significant effort has been put forth to increase understanding regarding the role of the human microbiome in health- and disease-related processes. In turn, the United States (US) Veteran Microbiome Project (US-VMP) was conceptualized as a means by which to serially collect microbiome and health-related data from those seeking care within the Veterans Health Administration (VHA). In this manuscript, exposures related to military experiences, as well as conditions and health-related factors among patients seen in VHA clinical settings are discussed in relation to common psychological and physical outcomes. Upon enrollment in the study, Veterans complete psychometrically sound (i.e., reliable and valid) measures regarding their past and current medical history. Participants also provide skin, oral, and gut microbiome samples, and permission to track their health status via the VHA electronic medical record. To date, data collection efforts have been cross-diagnostic. Within this manuscript, we describe current data collection practices and procedures, as well as highlight demographic, military, and psychiatric characteristics of the first 188 Veterans enrolled in the study. Based on these findings, we assert that this cohort is unique as compared to those enrolled in recent large-scale studies of the microbiome. To increase understanding regarding disease and health among diverse cohorts, efforts such as the US-VMP are vital. Ongoing barriers and facilitators to data collection are discussed, as well as future research directions, with an emphasis on the importance of shifting current thinking regarding the microbiome from a focus on normalcy and dysbiosis to health promotion and disease prevention

Military-Related Exposures, Social Determinants of Health, and Dysbiosis: The United States-Veteran Microbiome Project (US-VMP)

Significant effort has been put forth to increase understanding regarding the role of the human microbiome in health- and disease-related processes. In turn, the United States (US) Veteran Microbiome Project (US-VMP) was conceptualized as a means by which to serially collect microbiome and health-related data from those seeking care within the Veterans Health Administration (VHA). In this manuscript, exposures related to military experiences, as well as conditions and health-related factors among patients seen in VHA clinical settings are discussed in relation to common psychological and physical outcomes. Upon enrollment in the study, Veterans complete psychometrically sound (i.e., reliable and valid) measures regarding their past and current medical history. Participants also provide skin, oral, and gut microbiome samples, and permission to track their health status via the VHA electronic medical record. To date, data collection efforts have been cross-diagnostic. Within this manuscript, we describe current data collection practices and procedures, as well as highlight demographic, military, and psychiatric characteristics of the first 188 Veterans enrolled in the study. Based on these findings, we assert that this cohort is unique as compared to those enrolled in recent large-scale studies of the microbiome. To increase understanding regarding disease and health among diverse cohorts, efforts such as the US-VMP are vital. Ongoing barriers and facilitators to data collection are discussed, as well as future research directions, with an emphasis on the importance of shifting current thinking regarding the microbiome from a focus on normalcy and dysbiosis to health promotion and disease prevention

Military-Related Exposures, Social Determinants of Health, and Dysbiosis: The United States-Veteran Microbiome Project (US-VMP)

Significant effort has been put forth to increase understanding regarding the role of the human microbiome in health- and disease-related processes. In turn, the United States (US) Veteran Microbiome Project (US-VMP) was conceptualized as a means by which to serially collect microbiome and health-related data from those seeking care within the Veterans Health Administration (VHA). In this manuscript, exposures related to military experiences, as well as conditions and health-related factors among patients seen in VHA clinical settings are discussed in relation to common psychological and physical outcomes. Upon enrollment in the study, Veterans complete psychometrically sound (i.e., reliable and valid) measures regarding their past and current medical history. Participants also provide skin, oral, and gut microbiome samples, and permission to track their health status via the VHA electronic medical record. To date, data collection efforts have been cross-diagnostic. Within this manuscript, we describe current data collection practices and procedures, as well as highlight demographic, military, and psychiatric characteristics of the first 188 Veterans enrolled in the study. Based on these findings, we assert that this cohort is unique as compared to those enrolled in recent large-scale studies of the microbiome. To increase understanding regarding disease and health among diverse cohorts, efforts such as the US-VMP are vital. Ongoing barriers and facilitators to data collection are discussed, as well as future research directions, with an emphasis on the importance of shifting current thinking regarding the microbiome from a focus on normalcy and dysbiosis to health promotion and disease prevention

Rationale, design, and methods: A randomized placebo-controlled trial of an immunomodulatory probiotic intervention for Veterans with PTSD

United States military Veterans from recent conflicts are experiencing symptoms related to posttraumatic stress disorder (PTSD). Many Veterans are resistant to conventional health and mental health interventions (e.g., medication, psychotherapy). Alternative treatment approaches are needed. An underlying feature of PTSD is exaggerated inflammation, both peripherally and in the central nervous system. This inflammation is thought to play an important role in the vulnerability to, aggravation of, and persistence of PTSD symptoms. Therefore, an innovative intervention strategy would be the use of immunoregulatory/anti-inflammatory probiotics to reduce inflammation. Here we describe the rationale, design, and methods of a randomized placebo-controlled trial (RCT) of Lactobacillus rhamnosus GG (LGG; ATCC 53103) for posttraumatic stress disorder (PTSD). &nbsp;</p

Military-Related Exposures, Social Determinants of Health, and Dysbiosis: The United States-Veteran Microbiome Project (US-VMP)

Significant effort has been put forth to increase understanding regarding the role of the human microbiome in health- and disease-related processes. In turn, the United States (US) Veteran Microbiome Project (US-VMP) was conceptualized as a means by which to serially collect microbiome and health-related data from those seeking care within the Veterans Health Administration (VHA). In this manuscript, exposures related to military experiences, as well as conditions and health-related factors among patients seen in VHA clinical settings are discussed in relation to common psychological and physical outcomes. Upon enrollment in the study, Veterans complete psychometrically sound (i.e., reliable and valid) measures regarding their past and current medical history. Participants also provide skin, oral, and gut microbiome samples, and permission to track their health status via the VHA electronic medical record. To date, data collection efforts have been cross-diagnostic. Within this manuscript, we describe current data collection practices and procedures, as well as highlight demographic, military, and psychiatric characteristics of the first 188 Veterans enrolled in the study. Based on these findings, we assert that this cohort is unique as compared to those enrolled in recent large-scale studies of the microbiome. To increase understanding regarding disease and health among diverse cohorts, efforts such as the US-VMP are vital. Ongoing barriers and facilitators to data collection are discussed, as well as future research directions, with an emphasis on the importance of shifting current thinking regarding the microbiome from a focus on normalcy and dysbiosis to health promotion and disease prevention

Examination of Sleep Disturbances in Children with Down Syndrome and Multiple Comorbidities in New York State

Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Community and Preventive Medicine, 2012.Background Down syndrome (DS) is a neurodevelopmental disorder characterized by multiple comorbidities. Sleep disorders are recognized to be common among children with DS and can cause significant distress for families. Therefore, their identification and treatment may substantially improve health and quality of life. However, there is a paucity of research describing sleep problems and correlates in large population-based samples of DS. Accordingly, we aimed to describe sleep behavior among children with DS and its relationship with medical conditions, autism, and emotionalbehavioral disturbances (EBD) in this population. Methods We conducted a population-based cross-sectional study of sleep disturbances in 116 children and adolescents with DS (7-17 years old) previously evaluated for autism (2006-2008). We assessed a broad range of sleep problems using caregiverreport on two validated screening tools; the Childhood Sleep Habits Questionnaire (CSHQ) and the Pediatric Sleep Questionnaire (PSQ). The prevalence and severity of sleep problems were compared in children with and without various health conditions, autism (Autism Diagnostic Interview-Revised), and EBD (Childhood Behavior Checklist) using multivariable regression techniques. Results 67% of children screened positive on the CSHQ for significant sleep problems in the past month, but their parents often did not report a recognized sleep problem. On the PSQ, 47% of the sample screened positive for sleep-related breathing disorders (SRBD), and 24% screened positive for sleep-related movement disorders. Children with asthma, autism, EBD, and a history of enlarged adenoids or tonsils had more reported and more severe sleep problems than children without these comorbidities. SRBD were independently associated with a history of enlarged adenoids or tonsils, regardless of removal, and sleep movement disorders were associated with autism. Conclusions Sleep problems, especially breathing and movement disorders, are common in children with DS, but appear to be under-recognized by parents. In a large sample of children with DS, we found that parentally-reported sleep problems correlated with numerous comorbidities. Current practice guidelines may not fully inform optimal physician monitoring and assessment activities to evaluate sleep problems within the DS population. Findings from this study are preliminary, however, and require replication with more comprehensive assessment methods to better inform revisions of existing guidelines

Strengths and vulnerabilities: Comparing post-9/11 U.S. veterans' and non-veterans' perceptions of health and broader well-being.

BackgroundPrior research has examined how the post-military health and well-being of both the larger veteran population and earlier veteran cohorts differs from non-veterans. However, no study has yet to provide a holistic examination of how the health, vocational, financial, and social well-being of the newest generation of post-9/11 U.S. military veterans compares with their non-veteran peers. This is a significant oversight, as accurate knowledge of the strengths and vulnerabilities of post-9/11 veterans is required to ensure that the needs of this population are adequately addressed, as well as to counter inaccurate veteran stereotypes.MethodsPost-9/11 U.S. veterans' (N&nbsp;=&nbsp;15,160) and non-veterans' (N&nbsp;=&nbsp;4,533) reported on their health and broader well-being as part of a confidential web-based survey in 2018. Participants were drawn from probability-based sampling frames, and sex-stratified weighted logistic regressions were conducted to examine differences in veterans' and non-veterans' reports of health, vocational, financial, and social outcomes.ResultsAlthough both men and women post-9/11 veterans endorsed poorer health status than non-veterans, they reported greater engagement in a number of positive health behaviors (healthy eating and exercise) and were more likely to indicate having access to health care. Veterans also endorsed greater social well-being than non-veterans on several outcomes, whereas few differences were observed in vocational and financial well-being.ConclusionDespite their greater vulnerability to experiencing health conditions, the newest generation of post-9/11 U.S. veterans report experiencing similar or better outcomes than non-veterans in many aspects of their lives. Findings underscore the value of examining a wider range of health and well-being outcomes in veteran research and highlight a number of important directions for intervention, public health education, policy, and research related to the reintegration of military veterans within broader civilian society

Differences in Childhood Adversity, Suicidal Ideation, and Suicide Attempt Among Veterans and Nonveterans

Adverse childhood experiences (ACEs) are robustly associated with physical and mental health problems over the life span. Relatively limited research has examined the breadth of ACEs among military veteran populations, for whom ACEs may be premilitary traumas associated with suicidal ideation and attempt. Using data from the Comparative Health Assessment Interview Research Study, a large national survey sponsored by the U.S. Department of Veterans Affairs, this investigation examined the prevalence of 22 self-reported potentially traumatic experiences before the age of 18 (i.e., ACEs) among veterans and nonveterans and estimated the association of ACEs with suicidal ideation and attempt at age 18 or older. All analyses were weighted to account for complex sampling design and stratified by gender. The study sample included 9,571 veteran men, 3,143 nonveteran men, 5,543 veteran women, and 1,364 nonveteran women. Veteran men reported greater average frequency of ACEs than nonveteran men (2.7 ACEs vs. 2.3 ACEs, respectively, p &lt; .001); 11.1% of veteran men indicated &gt;6 ACEs compared with 7.3% of nonveteran men (p &lt; .001). Veteran women reported greater average frequency of ACEs than nonveteran women (3.1 ACEs vs. 2.4 ACEs, respectively, p &lt; .001). Among women, more veterans than nonveterans reported &gt;6 ACEs (14.9% vs. 8.6%, respectively, p &lt; .001). The strongest correlate of suicide attempt at age 18 or older for veteran men was having &gt;6 ACEs (adjusted odds ratio, aOR = 4.20, 95%CI = 2.72-6.49); for veteran women, the strongest correlate was suicidal ideation or attempt before age 18 (aOR = 5.37, 95%CI = 4.11-7.03). Suicide prevention research, policy, and practice should address ACEs among veterans as salient premilitary risk factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Time-dependent suicide rates among Army soldiers returning from an Afghanistan/Iraq deployment, by military rank and component

Abstract Background To date, knowledge is limited regarding time-dependent suicide risk in the years following return from deployment and whether such rates vary by military rank (i.e., enlisted, officer) or component (i.e., active duty, National Guard, reserve). To address these gaps in knowledge, the objectives of this study were to determine and compare postdeployment suicide rates and trends (percent change over time), and hazard rates for Army soldiers, by rank and component (measured at the end of the deployment). Methods Longitudinal cohort study of 860,930 Army soldiers returning from Afghanistan/Iraq deployment in fiscal years 2008–2014 from the Substance Use and Psychological Injury Combat study. Death by suicide was observed from the end of the first deployment in the study period through 2018 (i.e., the most recently available mortality data) for up to 11 years of follow-up. Analyses were conducted in 2021–2022. Results Adjusting for age, lowest-ranking Junior Enlisted (E1–E4) soldiers had a suicide rate 1.58 times higher than Senior Enlisted (E5–E9)/Warrant Officers (95% CI [1.24, 2.01]) and 2.41 times higher than Officers (95% CI [1.78, 3.29]). Suicide rates among lower-ranking enlisted soldiers remained elevated for 11 years postdeployment. Overall and annual postdeployment suicide rates did not differ significantly across components. Comparisons across rank and component for females were generally consistent with the full cohort results. Conclusions Lower-ranking enlisted soldiers had the highest rate of suicide, underscoring the importance of understanding rank as it relates to social determinants of health. For over a decade following Afghanistan/Iraq deployment, lower-enlisted rank during deployment was associated with an elevated rate of suicide; thereby suggesting that postdeployment prevention interventions targeting lower-ranking military members are warranted