After the Battle: 7 Health Problems Facing Veterans: Psychological, Psychosocial and Physical

By Maureen Salamon, MyHealthNewsDaily Contributor

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The wounds of war can go far beyond what meets the eye. From mental health issues to pain and illness that persist long after they’ve left the battlefield, veterans face a multitude of health troubles either unique to their service or more frequent among them than the general population.

“Folks returning from combat have a constellation of health concerns, including physical issues, psychological issues and psychosocial issues concerning things like work and family,” said Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative.

“This is a population that has unique health care needs that need to be addressed,” added Hunt, who is based in Seattle. “It’s something that really needs to be done by a team. We can’t do it without the collaboration of other providers, and the knowledge and presence of the community.”

Some of the most common physical complaints of returning soldiers cannot be classified into a single disorder, Hunt said. They include nonspecific symptoms such as fatigue, pain and cognitive disturbances such as memory and concentration problems.

“The interesting thing is, we see this after all wars,” he said. “We think it’s a reflection of the duress and intensity of the situation. They’re worn out, hurting and it’s kind of hard to think straight.”

Here are seven health conditions confronting veterans:

Musculoskeletal injuries and pain

Just over half of all veterans’ post-deployment health visits address lingering pain in their backs, necks, knees or shoulders, Hunt said. And according to an August study in the Journal of Pain, about 100,000 veterans of the Gulf War nearly 20 years ago have reported chronic muscle pain. Previous research indicated that regular, sustained exercise can help reduce that pain, which doctors encourage to help avoid disability.

Mental health issues

While post-traumatic stress disorder (PTSD) among soldiers has been well publicized, other mental woes can also result from the trauma of war. A June study in the journal Archives of General Psychiatry found that one in 10 Iraq war vets develop serious mental problems, including violent behavior, depression and alcohol abuse. The study found that PTSD or depression seriously impaired daily functioning in 8.5 percent to 14 percent of these vets.

Disabling on its own, PTSD is also linked to the development of physical illnesses for veterans as years pass. Researchers from Walter Reed Army Medical Center in Washington, D.C., reported this year that 54 percent of veterans with PTSD also had sleep apnea, compared with 20 percent of PTSD patients in the general population. PTSD in vets is also associated with a greater risk of developing dementia, according to a June study in Archives of General Psychiatry.

Chemical exposure

Research by the American Heart Association found that exposure to nerve agents such as sarin— which can trigger convulsions and death on the battlefield— may cause long-term heart damage in Gulf War veterans. The damage can include an enlarged left ventricle, heart rhythm abnormalities or a reduction in the pumping strength of the heart.

“Environmental agents and toxic chemicals are very common in combat theaters,” Hunt said, “and we need to watch [these vets] closely.”

Infectious diseases

As a rule, all military personnel are given routine vaccinations before deployment. Yet veterans suffer disproportionately from certain infections that civilians almost never experience for which vaccines are not available, according to the U.S. Department of Veterans Affairs. They include bacterial infections such as brucellosis, which may persist for years; campylobacter jejuni, which causes abdominal pain, fever and diarrhea; and Coxiella burnetii, which in chronic cases can inflame the heart.

Leishmaniasis, a parasitic disease caused by the bite of a sand fly native to the Middle East, is a particularly brutal condition veterans experience. Those infected suffer weight loss, fevers, headaches, muscle pain and weakness, anemia, and enlargement of the spleen and liver. It can be fatal if untreated, according to the VA.

Noise and vibration exposure

Hearing loss and impairment — including persistent ringing and buzzing in the ears — are common effects of harmful noise from gunfire, heavy weapons, noisy engine rooms and aircraft, Hunt said. Additionally, vets who regularly worked with machinery can suffer vibration exposure, which can prompt irreversible lower back pain or numbness and pain in the hands and fingers, according to the VA.

Traumatic Brain Injury (TBI)

TBI, often brought on by a blow or jolt to the head, disrupts brain function and has been called the signature wound of the fighting in Iraq and Afghanistan, according to the National Academy of Sciences. Blast exposures and other combat-related activities put service members at greater risk for sustaining a TBI compared to their civilian counterparts, according to the Defense and Veterans Brain Injury Center.

Common effects of TBIs include cognitive issues such as shorter attention span, language disabilities, and an inability to process information. Vets can also suffer from lack of motivation, irritability, anxiety and depression, headaches, memory loss and PTSD.

“Between 70 and 80 percent of combat deaths are from blast-related exposure,” Hunt said, “and of survivors, 20 percent report that they may have had an event that resulted in a mild concussion. Whether there will be any long-term effects is difficult to ascertain.”

Urologic injuries

Penetrating injuries to the groin area during battle are often treated only after life-threatening injuries have been dealt with, said Dr. Arthur Smith, a Medical College of Georgia urologist who spoke at the Warrior Health Symposium last month. Injuries to the bladder, ureters, kidneys and genitalia usually require complex surgery, Smith said, but complications often arise because treatment must be put off.

This article was provided by MyHealthNewsDaily, a sister site to LiveScience.

Screening Test Validated For Depression In Adolescents

Primary-care clinicians know teen depression is common, but they’ve lacked a reliable screening test for it. Now researchers at the University of Washington (UW), Seattle Children’s, and Group Health report the PHQ-9 (Patient Health Questionnaire – 9 item) is a good screening test for major depression in adolescents.

Led by Laura P. Richardson, MD, MPH, the team tested the PHQ-9 as a screening tool for depression in 442 teenage patients, age 13-17, at Group Health. The test is brief, available free of charge, easy to score and understand, and proven to find major depression (meeting DSM-IV criteria) in adults. This study, the first to assess it in teens, is in the November 2010 Pediatrics.

“This is important not only because depression is relatively common among adolescents, but also because we have effective treatment for them,” said Dr. Richardson. She is an associate professor of pediatrics at the UW, an adolescent medicine specialist at Seattle Children’s, and an affiliate investigator at Group Health Research Institute. “Primary care clinicians are advised to screen teens for depression,” she said, “and they need a convenient tool like this.”

The team compared the PHQ-9 to the more labor-intensive gold standard, an independent structured mental health interview (the Child Diagnostic Interview Schedule, DISC-IV)-and to published data on use of the screening test in adults. They found the best cut point for maximizing the PHQ-9 screening test’s sensitivity without losing specificity (11) is higher among teens than in adults. But its sensitivity (89.5%) and specificity (77.5%) in teens are similar to those in adults. So the team concluded that the PHQ-9 is an excellent choice for providers and researchers who want to screen for depression in teens in primary care.

Source:
Rebecca Hughes
Group Health Research Institute

Childhood Sexual Abuse May Be a Risk Factor for Later Psychotic Illness

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ScienceDaily (Nov. 3, 2010) — An Australian study suggests that children who are sexually abused, especially if it involves penetration, appear to be at higher risk for developing schizophrenia and other psychotic disorders, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Previous studies have established that abused children are more likely to develop depression, anxiety, substance abuse, borderline personality disorders, posttraumatic stress disorder and suicidal behavior, according to background information in the article. “The possibility of a link between childhood sexual abuse and later psychotic disorders, however, remains unresolved despite the claims of some that a causal link has been established to schizophrenia,” the authors write

Margaret C. Cutajar, D.Psych., M.A.P.S., of Monash University, Victoria, Australia, and colleagues linked data from police and medical examinations of sexual abuse cases to a statewide register of psychiatric cases. Rates of psychiatric disorders among 2,759 individuals who had been sexually abused when younger than age 16 were compared with those among 4,938 individuals in a comparison group drawn from electoral records.

Over a 30-year period, individuals who had experienced childhood sexual abuse had significantly higher rates than those in the comparison group of psychosis overall (2.8 percent vs. 1.4 percent) and schizophrenia disorders (1.9 percent vs. 0.7 percent). Participants experienced abuse at an average age of 10.2, and 1,732 (63 percent) of cases involved penetration of a bodily orifice by a penis, finger or other object. Those exposed to this type of abuse had higher rates of psychosis (3.4 percent) and schizophrenia (2.4 percent).

“The risks of subsequently developing a schizophrenic syndrome were greatest in victims subjected to penetrative abuse in the peripubertal and postpubertal years from 12 to 16 years and among those abused by more than one perpetrator,” the authors write. “Children raped in early adolescence by more than one perpetrator had a risk of developing psychotic syndromes 15 times greater than for the general population.”

The results establish childhood sexual abuse as a risk factor for psychotic illness, but do not necessarily translate into abuse causing or increasing the risk of developing such a disease, the authors note. Many cases of childhood sexual abuse never come to light, and the overall population of abused children maybe significantly different from those whose abuse is detected by officials.

“Establishing that severe childhood sexual abuse is a risk factor for schizophrenia does have important clinical implications irrespective of questions of causality and irrespective of whether those whose abuse is revealed are typical,” the authors conclude. “Children who come to attention following childhood sexual abuse involving penetration, particularly in the peripubertal and postpubertal period, should receive ongoing clinical and social support in the knowledge that they are at greater risk of developing a psychotic illness.”

“Such treatment in our opinion should focus on improving their current functioning and adaptation to the demands of the transition from adolescent to adult roles rather than primarily on the abuse experience itself. Such an approach should benefit all victims, irrespective of whether they have the potential to develop a psychotic illness.”

Editor’s Note: This article is not intended to provide medical advice, diagnosis or treatment.

Can Meditation Change Your Brain? Contemplative neuroscientists believe it can

From CNN’s Dan Gilgoff:

Can people strengthen the brain circuits associated with happiness and positive behavior,  just as we’re able to strengthen muscles with exercise?

Richard Davidson, who for decades has practiced Buddhist-style meditation – a form of mental exercise, he says – insists that we can.

And Davidson, who has been meditating since visiting India as a Harvard grad student in the 1970s, has credibility on the subject beyond his own experience.

A trained psychologist based at the University of Wisconsin, Madison, he has become the leader of a relatively new field called contemplative neuroscience – the brain science of meditation.

Over the last decade, Davidson and his colleagues have produced scientific evidence for the theory that meditation – the ancient eastern practice of sitting, usually accompanied by focusing on certain objects – permanently changes the brain for the better.

“We all know that if you engage in certain kinds of exercise on a regular basis you can strengthen certain muscle groups in predictable ways,” Davidson says in his office at the University of Wisconsin, where his research team has hosted scores of Buddhist monks and other meditators for brain scans.

“Strengthening neural systems is not fundamentally different,” he says. “It’s basically replacing certain habits of mind with other habits.”

Contemplative neuroscientists say that making a habit of meditation can strengthen brain circuits responsible for maintaining concentration and generating empathy.

One recent study by Davidson’s team found that novice meditators stimulated their limbic systems – the brain’s emotional network – during the practice of compassion meditation, an ancient Tibetan Buddhist practice.

That’s no great surprise, given that compassion meditation aims to produce a specific emotional state of intense empathy, sometimes call “loving-kindness.”

But the study also found that expert meditators – monks with more than 10,000 hours of practice – showed significantly greater activation of their limbic systems. The monks appeared to have permanently changed their brains to be more empathetic.

An earlier study by some of the same researchers found that committed meditators experienced sustained changes in baseline brain function, meaning that they had changed the way their brains operated even outside of meditation.

These changes included ramped-up activation of a brain region thought to be responsible for generating positive emotions, called the left-sided anterior region. The researchers found this change in novice meditators who’d enrolled in a course in mindfulness meditation – a technique that borrows heavily from Buddhism – that lasted just eight weeks.

But most brain research around meditation is still preliminary, waiting to be corroborated by other scientists. Meditation’s psychological benefits and its use in treatments for conditions as diverse as depression and chronic pain are more widely acknowledged.

Serious brain science around meditation has emerged only in about the last decade, since the birth of functional MRI allowed scientists to begin watching the brain and monitoring its changes in relatively real time.

Beginning in the late 1990s, a University of Pennsylvania-based researcher named Andrew Newberg said that his brain scans of experienced meditators showed the prefrontal cortex – the area of the brain that houses attention – surging into overdrive during meditation while the brain region governing our orientation in time and space, called the superior parietal lobe, went dark. (One of his scans is pictured, above.)

Newberg said his findings explained why meditators are able to cultivate intense concentration while also describing feelings of transcendence during meditation.

But some scientists said Newberg was over-interpreting his brain scans. Others said he failed to specify the kind of meditation he was studying, making his studies impossible to reproduce. His popular books, like Why God Won’t Go Away, caused more eye-rolling among neuroscientists, who said he hyped his findings to goose sales.

“It caused mainstream scientists to say that the only work that has been done in the field is of terrible quality,” says Alasdair Coles, a lecturer in neurology at England’s University of Cambridge.

Newberg, now at Thomas Jefferson University and Hospital in Philadelphia, stands by his research.

And contemplative neuroscience had gained more credibility in the scientific community since his early scans.

One sign of that is increased funding from the National Institutes of Health, which has helped establish new contemplative science research centers at Stanford University, Emory University, and the University of Wisconsin, where the world’s first brain imaging lab with a meditation room next door is now under construction.

The NIH could not provide numbers on how much it gives specifically to meditation brain research but its grants in complementary and alternative medicine – which encompass many meditation studies – have risen from around $300 million in 2007 to an estimated $541 million in 2011.

“The original investigations by people like Davidson in the 1990s were seen as intriguing, but it took some time to be convinced that brain processes were really changing during meditation,” says Josephine Briggs, Director of the NIH’s National Center for Complementary and Alternative Medicine.

Most studies so far have examined so-called focused-attention meditation, in which the practitioner concentrates on a particular subject, such as the breath. The meditator monitors the quality of attention and, when it drifts, returns attention to the object.

Over time, practitioners are supposed to find it easier to sustain attention during and outside of meditation.

In a 2007 study, Davidson compared the attentional abilities of novice meditators to experts in the Tibetan Buddhist tradition. Participants in both groups were asked to practice focused-attention meditation on a fixed dot on a screen while researchers ran fMRI scans of their brains.

To challenge the participants’ attentional abilities, the scientists interrupted the meditations with distracting sounds.

The brain scans found that both experienced and novice meditators activated a network of attention-related regions of the brain during meditation. But the experienced meditators showed more activation in some of those regions.

The inexperienced meditators, meanwhile, showed increased activation in brain regions that have been shown to negatively correlate with sustaining attention. Experienced meditators were better able to activate their attentional networks to maintain concentration on the dot. They had, the study suggested, changed their brains.

The fMRI scans also showed that experienced meditators had less neural response to the distracting noises that interrupted the meditation.

In fact, the more hours of experience a meditator had, the scans found, the less active his or her emotional networks were during the distracting sounds, which meant the easier it was to focus.

More recently, contemplative neuroscience has turned toward compassion meditation, which involves generating empathy through objectless awareness; practitioners call it non-referential compassion meditation.

New neuroscientific interest in the practice comes largely at the urging of the Dalai Lama, the spiritual and political leader of Tibetan Buddhists, for whom compassion meditation is a time-worn tradition.

The Dalai Lama has arranged for Tibetan monks to travel to American universities for brain scans and has spoken at the annual meeting of the Society for Neuroscience, the world’s largest gathering of brain scientists.

A religious leader, the Dalai Lama has said he supports contemplative neuroscience even though scientists are stripping meditation of its Buddhist roots, treating it purely as a mental exercise that more or less anyone can do.

“This is not a project about religion,” says Davidson. “Meditation is mental activity that could be understood in secular terms.”

Still, the nascent field faces challenges. Scientists have scanned just a few hundred brains on meditation do date, which makes for a pretty small research sample. And some scientists say researchers are over eager to use brain science to prove the that meditation “works.”

“This is a field that has been populated by true believers,” says Emory University scientist Charles Raison, who has studied meditation’s effect on the immune system. “Many of the people doing this research are trying to prove scientifically what they already know from experience, which is a major flaw.”

But Davidson says that other types of scientists also have deep personal interest in what they’re studying. And he argues that that’s a good thing.

“There’s a cadre of grad students and post docs who’ve found personal value in meditation and have been inspired to study it scientifically,” Davidson says. “These are people at the very best universities and they want to do this for a career.

“In ten years,” he says, “we’ll find that meditation research has become mainstream.”

Originally Posted at: http://www.huffingtonpost.com/2010/10/26/can-meditation-change-you_0_n_774105.html?utm_source=chrome

Bullying: Physical and Cyber Equally Dangerous

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A telephone survey conducted by Rasumussen Reports found 69 percent of adult respondents said physical and cyber-bullying are equally dangerous. The same percentage believe cyber-bullying should be a punishable crime. Twenty-one percent said physical bullying is more damaging than the online version, but seven percent said they believe cyber-bullying to be worse than physical.

Eighty-five percent of adults are somewhat concerned about bullying in schools, while 57 percent are very concerned. Just three percent are not at all concerned. Fifty percent of the adults surveyed thought parents are the ones who should deal with bullying. Thirty-seven percent said they thought schools should be responsible for dealing with the problem. Only five percent said police are the ones who should be used for bullying problems.

Sixty-one percent of adults surveyed said bullying is more of a problem today than it has been in the past. The Rassmasuen Reports survey included 1,000 adults. You can see how their surveys are conducted here.

Cyber-bullying was the number-one fear of parents in a Care.com telephone survey of 384 American adult parents. Other parental fears scored for the survey were kidnapping, terrorism, and suicide. Cyber-bullying was selected by 3o percent of the respondents, while kidnapping was close behind at 27 percent.

A Harris Interactive poll found 9 percent of 13-15 year-olds surveyed had experienced bullying often or always, to the degree it made them feel very sad, angry or upset. Twenty-eight percent said they are sometimes bullied to the point of those feelings.

A news article from Flagler College stated one third of American teens have experienced cyber-bullying. A number of U.S. states have passed laws to punish cyber bullying and to raise awareness about the damage it can do. They were spurred to do so in part, by the tragic suicide of a thirteen-year old girl in Missouri.

Article was originally printed at: http://www.care2.com/greenliving/bullying-cyber-and-physical-equally-dangerous.html