VIENNA -- Blood concentrations of some antioxidative micronutrients were positively associated with executive function and visuopractical skills, researchers reported here.
Among healthy patients, plasma concentrations of non-provitamin A were positively and significantly associated with executive function, before and after adjustment for body mass index (BMI), smoking status, diabetes, hypertension, and cardiac disease (Beta=0.086, P<0.05), according to Abhijit Sen, MSc, of the Medical University Graz in Austria, and colleagues.
Additionally, concentrations of provitamin A were positively and significantly associated with visuopractical skills (Beta=0.066, P<0.05) before and after adjustment, Sen said at an oral presentation during the World Congress of Neurology meeting.
However, these studies have not based results on actual plasma concentration of the micronutrients potentially associated with healthier minds, Sen said during his presentation.
The investigators analyzed plasma concentrations of 10 antioxidative micronutrients in a cohort of 767 healthy older patients (mean age 66) who were enrolled in the Austrian Stroke Prevention Study and assessed the nutrients' relation to five global and domain-specific realms of cognitive function, as well as whether relationships were mediated by white matter lesions and brain atrophy.
The study population was mostly female (58%), mostly hypertensive (71%), and had a mean BMI of 26. Additionally, 11% of patients had diabetes, 40% had cardiac disease, 19% were carriers of the e4 allele, 28% had smoked previously, and 11% were current smokers at the time of the study. They did not have a history of neuropsychiatric disease.
Plasma was analyzed for concentrations of alpha-carotene, beta-carotene, beta-crytoxanthin, canthaxanthin, lutein and zeaxanthin, lycopene, alpha-tocopherol, gamma-tocopherol, and vitamin C through reverse phase chromatography. These were transformed into a z-score, then put into subgroups based on chemical properties, which included:
Provitamin A: a construct of alpha-carotene, beta-carotene, beta-crytoxanthin, and retinol
Non-provitamin A: a construct of lutein and zeaxanthin, lycopene, and canthaxanthin
Vitamin E: a construct of alpha-tocopherol and gamma-tocopherol
The authors compared concentrations of these vitamin groups with outcomes in tests for memory, executive function, attention speed, visuopractical skills, and general cognitive ability. White matter lesions and brain volume were assessed via MRI.
Linear regression of the association with nutrient concentration with cognitive outcomes were computed in two models. In one, scores were adjusted for age, sex, education, and ApoE genotype. The second included those, as well as BMI, smoking status, hypertension, diabetes, and cardiac disease.
Although associations were seen with cognitive function and provitamin A and non-provitamin A, there were no other associations seen with other micronutrients. There was also no mediation in the association seen between brain atrophy or brain lesions.
Sen noted two possible mechanisms of action were "regulation of all trans-retinoic acid that may modulate synaptic plasticity and cognitive function via the retinoic acid signalling pathway," and possible modulation of synaptic plasticity by lutein and zeaxanthin, as prior research has suggested.
Session moderator Jagjit Chophrah, PhD, FRCP, of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, noted that the association was interesting, but that the study population was small and limited to healthy individuals. The study needed confirmation with an extension to a less limited population, he told MedPage Today.
On the other hand, there is insufficient evidence to say surgery has any benefit and, given its risks, it "should not be used as initial treatment," according to the guidelines published in the Oct. 1 issue ofAnnals of Internal Medicine.
Obstructive sleep apnea is an increasing issue, "probably because of escalating obesity rates," the guidelines noted, so that more and more people are likely to seek treatment.
To assess the evidence, researchers led by Amir Qaseem, MD, PhD, of the ACP in Philadelphia, used a systematic review of available English-language literature from 1966 to September 2010, conducted by Tufts researcher Ethan Balk, MD. He also reviewed information turned up in a supplemental search for studies published through October 2012.
The first recommendation of the guideline committee was that all overweight and obese patients who have obstructive sleep apnea should be encouraged to lose weight.
The investigators concluded that the evidence showed that "some intensive weight-loss programs may effectively reduce signs and symptoms of (obstructive sleep apnea) in obese patients with or without diabetes."
But in cases where patients are not overweight or where weight-loss interventions fail, the next line of defense should be CPAP, which is the most intensely studied therapy, the committee argued.
The evidence shows that CPAP reduces daytime sleepiness, cuts the AHI and arousal index scores, and increases quality of life, although it has not been shown to improve the latter, they reported.
There was insufficient evidence to say anything about the effect of CPAP on cardiovascular disease, hypertension, and type 2 diabetes, the guidelines committee found.
In patients who are unable or unwilling to use CPAP, mandibular advancement devices can be an alternative to CPAP, they said.
The devices move the lower jaw forward slightly during sleep to tighten the soft tissues of the airway and prevent apnea. The committee noted that evidence shows the devices are better than no treatment in improving AHI scores, arousal index scores, and minimum oxygen saturation.
But the evidence also shows that CPAP does a better job, they found.
Drug therapy has been tried, using a range of medications including such mirtazapine (Remeron), xylometazoline, and fluticasone (Flonase), but evidence was insufficient to conclude that any of them worked.
Seven studies evaluated surgical interventions but each assessed a different approach and outcomes were inconsistent, "making it difficult to ascertain the benefit of surgery," the committee reported.
Support for the development of this guideline came from the operating budget of the American College of Physicians. The systematic evidence review was sponsored by the Agency for Healthcare Research and Quality. Qaseem and co-authors reported no conflicts of interest.
Written by Anthony Hardie, 91outcomes.com (91outcomes.com - Sep. 27, 2013) - A new survey of sleep issues among a representative cross-section of combat and non-combat U.S. military veterans has uncovered an extremely high prevalence of chronic insomnia, with significant negative impact on the veterans' during their waking hours. The survey found that more than three-quarters of veterans don't get enough enough sleep due to an extraordinarily high prevalence of sleep disorders, but these disorders may be amendable to treatment.
The purpose of the survey, conducted by a partnership of the Johns Hopkins School of Medicine's Center of Behavior and Health and VetAdvisor®, LLC was, "to help researchers understand the causes of veteran sleep disorders, enhance overall understanding of these disorders, and determine the potential benefits of behavioral sleep coaching and consumer sleep monitoring devices in their treatment."
Among the survey's important findings:
The average amount of veteran participant sleep was 5.6 hours.
76% of veterans report that they do not typically get enough sleep.
Even more alarming, 91% of the veterans surveyed reported often feeling tired, fatigued or sleepy during the day.
“Having trouble falling or staying asleep” was by far the most frequent reason cited by veterans as a cause of not getting enough sleep (70%).
Other common reasons included: “sleep is poor quality” (53%), “being too busy with work or family responsibilities” (13%), “being a night owl” (12%), and “liking to watch television late at night” (8%).
Perhaps most significantly, according to the survey, "74.3% of respondents reported meeting general clinical criteria for insomnia (i.e., trouble falling asleep or staying asleep, 3 or more nights per week for at least a month with at least some significant sleep-related daytime symptoms)."
This rate of insomnia is much greater than in the non-veteran population, where the surveyors report that, in the general population, the prevalence of chronic insomnia is 10-15%."
And according to the survey, "veterans who had actively engaged in combat were also more likely to report insomnia than those who had not actively engaged in combat (78.7% vs. 69.2%)." "Factors associated with trauma such as nightmares or feeling the need to be “on guard” were much higher in the active combat engagement group."
For those actively engaged in combat (53% of those surveyed), the top 3 reasons for difficulty falling or staying asleep were:
Mental alertness/thoughts won’t slow down (15.7%)
For those not engaging in combat (47% of those surveyed), the top three reasons were:
Mental alertness/thoughts won’t slow down (15.3%)
Worrying about daily concerns (6.9%).
The representative survey included almost 3,000 volunteers -- all U.S. military veterans -- ranging from age 18 to 96. Diversity by race, sex, and military branch of service was generally reflective of veteran population demographics. About 72 percent were combat zone veterans, with about 53 percent reporting combat experiences.
Some Gulf War veterans deal with PTSD. Others deal with anxiety or depression, often in conjunction with or as the result of debilitating physical disability. And many deal with debilitating chronic pain. And, dealing with chronic illness can be a stressor in and of itself.
For these veterans, the following list of smartphone apps might be of interest. There's even an app for suicide prevention. -A.H.
If you’re looking for good mental health apps, those selected here are all solid. But the really great thing about the apps on this list?
Not only are they useful for your personal mental health mobile toolkit, and for referring to clients, they’re all free.
Keep up with the latest mental health information with the PsychCentral app. It’s free too!
A great tool for anxiety available on iPhone and Andoid, developed by Anxiety BC. It teaches relaxation skills, develops new thinking, and suggests healthy activities. Designed for youth but useful to anyone.
2. PTSD Coach
Helpful for symptoms of combat-related post-traumatic stress, this trusted military app has been downloaded over 100,000 times foriPhone and Android. Featuring versions in French-Canadian and more.
3. BellyBio Interactive Breathing
Wonderful biofeedback device that monitors your breathing and plays sounds reminiscent of ocean waves when you relax. Great for anxiety and stress. iPhone only.
4. Positive Activity Jackpot
A unique augmented reality tool that uses the functionality of a smartphone in an innovative way. Combines a professional behavioral health therapy for depression called pleasant event scheduling (PES) with activities available in the user’s location, mapped with GPS. For Android only.
An assessment tool that allows users to check for symptoms of depression, anxiety, relationship issues, drug and alcohol issues, and other problems and makes recommendations for action. iPhone only.
7. Operation Reach Out
This lifesaving app for iPhone and Android was developed by the military to prevent suicide. Recorded videos and menu options help users assess their thinking and reach out for help in crisis.
9. T2 Mood Tracker
Tracks symptoms of depression, anxiety, PTSD, traumatic brain injury, stress and general well-being. Useful to share with clinicians and chart recovery. Another excellent app developed by the Department of Defense National Center for Telehealth and Technology (see their complete list), for Android and iPhone.
The article below was published by the American Legion following a contentious hearing before the House Veterans' Affairs Subcommittee on Oversight & Investigations (HVAC-O&I), chaired by Rep. Mike Coffman (R-Colo.), himself a 1991 Gulf War veteran.
VA official Joan Mooney evaded many questions at a Sept. 19 congressional hearing that focused on the Department of Veterans’ Affairs consistent lack of response to committee members’ requests for information.
Mooney, assistant secretary for congressional and legislative affairs for the Department of Veterans Affairs (VA), was the sole witness at the House Committee on Veterans’ Affairs hearing attended by The American Legion.
Rep. Mike Coffman, R-Colo., called Mooney a "very smart political operative" who would "like us to believe today that you are just incredibly incompetent." Coffman accused Mooney of "systematically covering up information" that is embarrassing to VA. He complained that VA has yet to provide him with results of an internal mental-health survey that were requested last February. He asked Mooney why the survey results weren’t provided.
"I think I will go back and check on that, and find out the status of it," Mooney said. When asked another question about when a VA report on medical facilities in South Carolina would be provided (it was requested last March), Mooney said, "Congressman, I will look into that request for you."
Coffman said it was an "affront to the men and women who have sacrificed so much for this country, who have worn the uniform for this country, that you’re in this position. It’s also, in my view, an embarrassment to (VA Secretary) Shinseki – who has served this country honorably for over 30 years in the United States Army – to have a political operative like you in this critical position engaging in this systematic cover-up on information that is embarrassing to the VA, about the mistreatment of the veterans who serve this country. I just think it’s extraordinary.
"And you are not who you appear to be today, this bumbling idiot, this incompetent manager. I know what you’re engaged in, and it’s wrong."
Rep. Tim Huelskamp, R-Kans., was also clearly irritated by Mooney.
"How do you decide which information requests to simply ignore?," Huelskamp asked Mooney, who replied, "Requests are not ignored, Congressman."
Huelskamp then asked for an explanation as to why he has been waiting 52 weeks for VA to answer a request for information on how much money was spent on the 2011 Golden Games. "Congressman, I know that issue, that correspondence, is being worked with in the agency and there will be a response forthcoming," Mooney said.
Pressing Mooney for an explanation as to why it takes 52 weeks to answer a simple question, Huelskamp said, "I’m just trying to get some insight of why you will ignore a very basic budget question.... I just wish you’d admit to the committee why you’re refusing to answer that question."
It has been 100 days since the committee asked VA several questions about the security of the department’s data, a circumstance that led to the following exchange:
Huelskamp: "Is that something you can ignore for a hundred days?"
Mooney: "Congressman, we will work to get you a response to your request. I understand and hear your frustration."
Huelskamp: "Do you not know the reason why you waited a hundred days? Or you’re just not willing to share that with the entire committee? I not only want a response, I want to know why you’re ignoring the issue. Twenty million veterans have their private health-care information breached ... and no response. No answer. My constituents want to know. They are shocked and outraged by this occurrence, and it continues to grow.... So your response is ‘We’ll get to you … we’ll get to that’?"
Mooney: "Congressman, we will get you an answer to your...."
Huelskamp: "But can you explain why you won’t answer the question, for a hundred days or 52 weeks? We’ve been trying to talk about, ‘What’s the reason for this?’ I don’t understand how you can be in charge of a shop that can wait 52 weeks on something – basic budget matters – or a hundred days on something as critical as private, personal, medical information breached by potentially nine foreign agents in numerous countries. And no response. Do you know the answer to that and just can’t share that here?
Mooney: "Congressman, I think as I mentioned earlier, my office does not manage correspondence. I am happy to take your request back."
Huelskamp: "This is an information request. It came from the committee, it’s on the website, the public – the world knows you’re ignoring the question.... It’s the same old denial, and how can we work together? I mean, that’s your responsibility, the answer to these questions. And I guess you were sent here today to say, ‘We’ll get back to you on that’.... Can you tell me when you might answer those questions?"
Mooney: "Congressman, I understand. I hear your frustration. I’ll take back your concerns and we will get you a response."
Huelskamp: "So you don’t know the answer? I don’t care if you care about my frustrations. I really don’t care about that. I want an answer. Americans want answers. Will you answer that question today? Just say yes or no."
Mooney: "I’m sorry. I think I said, Congressman, we will get you a response to your questions."
Huelskamp: "When, is the question."
Mooney: "Soon. I will work to get it soon."
Huelskamp: "The answer is, no answer."
Mooney also faced a question from Committee Chairman Rep. Jeff Miller, R-Fla., about the deadly outbreak of Legionella bacteria at the VA medical center in Pittsburgh. On Jan. 18, the committee requested details of that outbreak from VA, but the media got answers to their questions before the committee did. Miller said that no emails had been received by VA on the Pittsburgh matter, and he asked Mooney if she knew why.
"I can say, in the case of Pittsburgh and the email documents, the request came in," Mooney said. "It was a rather large-scale data pull. The goal was to focus and scope down search terms, et cetera, with the committee – which we did – and the work is in process and ongoing, and the results should be forthcoming very soon."
Miller suggested that a search for the words "Legionella" and "death" would be "two pretty specific words that you could search pretty quickly." He told Mooney that his committee doesn’t request information for itself. "We’re asking on behalf of the veterans of this country. And every obstacle that the agency puts up in front of us prevents us from doing our job on oversight."
Earlier in the hearing, Rep. Mike Michaud, D-Maine, said the hearing "should send a clear signal that the status quo is unacceptable." While Mooney’s office must respond to a large number of information requests from Congress, the "high workload is not an excuse for the current situation, which has gone on since 2009 and which simply must change," he said.
The relationship between Congress and VA, Michaud said, must be built around three goals: customer service, timeliness and access.
Miller pointed out to Mooney that VA has delivered testimony to the committee in a timely manner (48 hours in advance) for only 11 of 21 hearings since April. "It seems that timely receipt of testimony is completely arbitrary."
(91outcomes.com - Sep. 26, 2013) -Living with an illness can be challenging, but living with
multiple illnesses can feel like pure hell. Twenty-plus years is a long time
with little relief. Each day gets harder. Rolling out of bed slower, taking
longer to get coherent, until one day, you just wish you could roll out of bed.
Now, not only are Gulf War veterans ill, but employment
capabilities become a thing of the past. Who is going to compensate lost income
while you wait for claims to be processed? Who will help care for you?
You become faced with a whole new set of problems to be
concerned with. You can no longer drive.
You need help completing basic tasks.
Your spouse left their job to care for you and as a result, no longer
has medical insurance.
There is no money left over for your children’s dental or vision
needs. Is your home going into foreclosure or your vehicle being
repossessed? Our families should not
have to worry about where our next meal is coming from.
My name is Rebecca
McCamick. I’m married to a veteran of the 1991 Gulf War and we're very
familiar with the lack of recognition and services provided to Gulf War
veterans. Like many, we have fought our way through the cumbersome VA system
and often times have run into a brick wall. I'm tired of watching veterans and
their families suffer needlessly because of VA bureaucracy.
Today, I’m advocating for all veterans who served prior to 9/11.
The U.S. Department of Veterans Affairs (VA) has a program that would help meet
most of the needs listed above. It’s called the VA Caregiver program.
As a veteran, if you have an inability to perform one or more
activities of daily living, need supervision or protection based on symptoms of
neurological or other impairment, you would meet the program’s criteria for
eligibility. In addition, you do not need to be a combat veteran or have a 100%
rating to be eligible as it is intended to cover all service-connected disabled
veterans who qualify.
The VA Caregiver program would provide the caregiver of your
choice with training, ongoing support, counseling, CHAMPVA health insurance,
respite care, reimbursement for lodging and travel, and a monthly stipend
ranging from $600-$2,000.
Sounds too good to be true? Well, for
veterans whose service was prior to 9/11, unfortunately, it currently is! Although a permanent program, the current
program was also used as a pilot program which the VA tested on post-9/11 era
veterans, and Congress funded for the last 2 years. The VA has since reported
back to Congress that the program was successful and therefore should be
expanded to other era veterans.
The Caregiver and Improvement Act of
2013 (S. 851) is currently being reviewed in the U.S. Senate. If passed into
law, this bill would help expand the current Caregiver program to all eras of
veterans who need caregiver support, not just those with post-9/11 service.
Your help is urgently needed to ensure this program becomes available to
veterans whose service was prior to 9/11. All it takes is a phone call to the
House Committee on Veterans Affairs, at (202) 225-3527, asking them to pass
legislation mirroring the Senate’s Caregiver bill, S.851.
In other words, the Senate already has this bill but the House does not. This
is what our charge is: to make this an all-inclusive program.
Everyone needs to call, email, or write their Senators and ask them to
co-sponsor and support the Caregiver bill, S. 851. And everyone needs to call, email, or write
their Congressperson to ask that they help pass legislation in the House that
mirrors the Senate’s Caregiver bill, S. 851.
Without your help the bill will most likely die and veterans who desperately
need the support of caregivers, but whose service was prior to 9/11, will
continue to be excluded from this critically important program to support their
As the spouse of a Gulf War veteran, I’m urging you to please contact Congress
today to support our service-disabled veterans who need caregiver support.
A Washington Post article this week, below, highlights an important new report from the American Legion about federal government PTSD and TBI treatment efforts. It's conclusions are critically important. In short, veterans with PTSD and TBI are being failed by VA and DoD, which are providing palliative treatments to adjust symptoms but failing to address the underlying conditions. This is eerily similar to the experience of hundreds of thousands of Gulf War veterans with Gulf War Illness. Led by pseudo-scientists like Dr. Kelley Brix, government offices including DoD's misnamed Force Health Protection unit and VA's Office of Public Health spin science to their own interests, as testimony by top VA researcher-turned-whistleblower Dr. Steve Coughlin showed at a March 13, 2013 Congressional hearing. Instead of real treatment aimed at cures, hundreds of thousands of veterans of multiple wars suffer the lasting effects of their post-deployment health issues, with VA and DoD failure to develop real treatments for health conditions ranging from TBI to Gulf War Illness to burn pit exposure illnesses and more. VA and DoD can and must do better. The Obama Administration must be directed by Congress to clean house of people in DoD's misnamed Force Health Protection unit and VA's Office of Public Health who are most interested in shaping "research" to deny there's anything wrong, or minimize the seriousness of the post-deployment health issues than to find treatment solutions. Congress must defund these entities and help ensure these people never find positions of authority again. And we as a nation must ensure that our warriors are much better taken care of when they come home, not met with brick walls and band-aids to merely mask the awful symptoms of untreated underlying conditions. -A.H. Full Legion report here: http://legion.org/documents/legion/pdf/american-legion-war-within.pdf
The departments of Defense and Veterans Affairs provide “limited and inadequate” treatment for post traumatic stress disorder and traumatic brain injury , according to a new report issued by the American Legion.
(Photo: Robert Skidmore)
The report, called “The War Within,”was based on two years of research by a Legion committee that visited military, VA and private medical facilities. It is being distributed to members of Congress, the Obama administration and VA officials.
The Legion said in a statement Thursday that the two departments “have no well-defined approach to the treatment of TBI; providers are merely treating the symptoms.”
William Detweiler, the past national commander of the Legion who chaired the committee, said the departments have relied on traditional medical treatments for TBI and PTSD cases.
“They have not done a lot of research on alternative methods,” he said in the statement. “There’s no simple answer to what works as far as PTSD or TBI is concerned, but we found that the (DoD and VA) medical profession shied away from certain things which they considered to be alternative medicine.”
The report says the departments have not adequately researched treatments such as virtual reality therapy, hyperbaric oxygen therapy and other alternative medicine therapies.
The report recommends that Congress provide oversight and funding to VA and DoD for innovative TBI and PTSD research currently used in the private sector.
Steve Vogel covers the federal workforce, with an emphasis on issues involving veterans and the military. He has reported extensively on defense issues, writing the Military Matters column and covering military operations in Somalia, Rwanda, the Balkans, Afghanistan and Iraq. He is the author of The Pentagon – A History and Through the Perilous Fight.