Kamila U. Pollin’s research while affiliated with Washington DC VA Medical Center and other places

Background The shift toward a patient-centered and whole health care model offers a promising approach for the management of symptoms among veterans with chronic multisymptom illness (CMI). A behavioral intervention aimed at reducing cognitive control dysregulation which is a component of impairments common among veterans with CMI may be helpful. Therefore, a pilot study was conducted to explore the feasibility, safety, and acceptability of a telehealth mental and physical (MAP) training intervention among veterans with CMI. Methods Utilizing a two-arm randomized trial, participants were either randomized to 8 weeks of a directed MAP training protocol (dMAP) that received weekly guidance via text messaging or 8 weeks of self-guided MAP training (sgMAP) which did not receive guidance aside from the intervention goals. The MAP intervention was the same for both groups except for the delivery and consisted of two MAP training sessions and one telephone health coaching session per week. The primary aim of the study was to evaluate the feasibility (e.g., recruitment, retention, and adherence rates; amount of missing data), safety (e.g., adverse events), and acceptability (e.g., satisfaction) of a telehealth MAP intervention. Results Out of 44 potentially eligible veterans, 26 were randomized to either the dMAP group (n = 13) or the sgMAP group (n = 13), resulting in a recruitment rate of 59% (26/44 patients). Two participants withdrew after randomization, resulting in 24 participants used for analyses. The retention rates at endpoint and 3-month follow-up were 79.2% (19/24; dMAP:sgMAP = 9:10) and 62.5% (15/24; dMAP:sgMAP = 7:8), respectively. Participants completed an average of 48.2% of the MAP sessions (7.7/16 sessions; dMAP:sgMAP = 7.9:7.5 sessions) and 82.8% of the health coaching sessions (6.6/8 sessions; dMAP:sgMAP = 7.2:6.2 sessions). Missing data was minimal, and no adverse events related to the study were reported. Acceptability was high as veterans were satisfied with the wearables and valued the health coaching support. Conclusions This pilot study provides insights into the feasibility of a large-scale randomized control trial that promotes meditation and physical activity to augment cognitive control to facilitate self-regulation. Future efforts should expand recruitment strategies and add internal data quality monitoring. Trial registration NCT04164667, retrospectively registered November 12, 2019, https://clinicaltrials.gov/study/NCT04164667

Introduction: Military exposure summarization is critical for Veterans with complex environmental, occupational, or toxic exposures. Existing methods are limited by technical language, incompatible data formats, and difficulty in prioritizing information. Clinicians require concise, standardized, and easily interpretable exposure summaries to facilitate rapid assessment. This report is part of a broader programmatic effort to collate military exposure information from established, as well as new sources of data to improve VA exposure-informed healthcare. Methods: In a collaborative effort, VA clinicians from multiple specialties participated in a structured clinical needs assessment interview to identify the most clinically useful information to be included in the Health Exposure Records and Occupations (HERO) summary. The interviews covered summary length, exposure prioritization, demographics, military occupational history, features characterizing exposure, resilience factors, health outcomes, and impact on clinical practice. Results: Consensus recommendations prescribed a concise summary with clear language, basic military demographics, and critical military exposures that prioritize exposures that require further investigation. Based on recommendations, the HERO summary also includes types of exposure, proximity, route, symptoms at the time of exposure, exposure period, duration, frequency, and protective controls used. Conclusion: This perspective piece not only assesses the clinical need for exposure summarization and the optimal format for the HERO summary, but also highlights its potential impact. The HERO summary, as a tool, offers improved time efficiency, consistency in exposure-informed care across the VA, enhances communication between Veterans and providers, and improves understanding of the association between military exposures and health outcomes, potentially transforming the VA healthcare system.

Objective To examine the association between actigraphy-based sleep parameters and neuropsychological health in Veterans with Gulf War Illness (GWI). Methods Objective sleep data was obtained from 85 GW Veterans (Mage = 54.2, 79% Male) using an actigraphy monitor (Phillips Respironics Actiwatch-2) worn for 24 hours/day for seven consecutive days. Actigraphy data was manually scored to define time in bed (TIB), and total sleep time (TST), wake after sleep onset (WASO), number of awakenings (NWAK), and motor activity counts (MAC) during sleep were derived using the device software. Participants completed a battery of questionnaires: Patient Health Questionnaire (PHQ-9), Posttraumatic Symptom Checklist (PCL-5), and Pittsburgh Sleep Quality Index (PSQI). Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Correlation analysis was conducted to discover associations between sleep parameters, self-reported measures, and cognitive function. Results MAC was positively correlated with elevated scores on PSQI (r = 0.35, p < 0.01), PHQ-9 (r = 0.26, p < 0.05), and PCL-5 (r = 0.26, p < 0.05), and negatively correlated with RBANS Total Index score (r = −0.27, p < 0.05). WASO was also positively correlated with PSQI scores (r = 0.29, p < 0.01). TIB and TST were positively correlated with age (r = 0.25, r = 0.28; all p < 0.05). Conclusion Objective parameters of disrupted sleep – nocturnal MAC and WASO – were associated with greater self-reported sleep disturbance. MAC was additionally correlated with increased self-reported symptoms of depression and PTSD, as well as lower performance on a measure of objective cognitive function. This study identifies aspects of sleep disruption as potential sleep intervention targets related to both mood and cognitive symptoms.

Introduction Military exposures may present a cumulative load and increased individual susceptibility to negative health outcomes. Currently, there are no comprehensive and validated environmental exposure assessment tools covering the full spectrum of occupational and environmental exposures for Veterans. The Veterans Affairs (VA) War Related Illness and Injury Study Center in Washington, DC, developed the Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT) to establish a structured, comprehensive self-report tool that captures military and non-military occupational and environmental exposures. The VMOAT is clinically insightful, modular, and flexible for adding novel exposures, meeting the needs of modern evolving threats and exposures in both clinical and research settings. This manuscript reviews the ongoing development and validation plans for the VMOAT. Materials and Methods The VMOAT is a self-reported structured questionnaire, and VMOAT 1.0 was developed to cover an individual’s 3 life phases (pre, during, post-military service); 5 exposure domains (chemical, physical, biological, injuries including ergonomic, and psychological stress exposures, plus military preventive health measures); and 64 specific exposures nested within exposure categories. VMOAT 1.0 addresses exposure dose (frequency, duration, proximity, route), and can be administered online via VA approved Qualtrics survey software. VMOAT 1.0 to 2.0 updates began in December 2022 with changes focused on readability, streamlining the exposure history, refining the exposure metrics, and improving the skip logic embedded within the survey design. Results The initial VMOAT 1.0 development included face and construct validation with expert internal and external academic and military collaborators, undergoing an iterative 5-cycle review as well as sample testing among a small group of Veterans. The VMOAT 1.0 was used in Institutional Review Board (IRB)-approved longitudinal study, which has been examined preliminarily to compare the VMOAT 1.0 with other exposure assessments and to compare responses of Explosive Ordnance Disposal Veterans, a high occupational exposure cohort, to non-Explosive Ordnance Disposal Veterans. Ongoing VMOAT 2.0 updates will include integration of experiences from piloting the VMOAT 1.0 as well as additional face and content validation and survey cognitive testing with Veterans. VMOAT 2.0 data will improve the development of exposure-informed models using composite survey data to create scored- and scale-based exposure metrics for specific exposures and exposure domains. These data will highlight the effectiveness of the VMOAT as a structured comprehensive occupational and environmental exposure assessment instrument. Conclusions VMOAT development supports the 2022 Promise to Address Comprehensive Toxics Act and fits into the existing VA exposure assessment approach as a standardized, comprehensive self-reported exposure assessment tool. It can be utilized as a stand-alone instrument or supplemented by clinician interviews in research or specialty evaluation programs. The collected VMOAT self-report information on military occupational and environmental exposures will allow direct evaluation with objective measures of exposure and health outcomes. These data outcomes have a high potential to guide the DoD and VA environmental exposure risk mitigation and risk communication efforts.

Understanding the health outcomes of military exposures is of critical importance for Veterans, their health care team, and national leaders. Approximately 43% of Veterans report military exposure concerns to their VA providers. Understanding the causal influences of environmental exposures on health is a complex exposure science task and often requires interpreting multiple data sources; particularly when exposure pathways and multi-exposure interactions are ill-defined, as is the case for complex and emerging military service exposures. Thus, there is a need to standardize clinically meaningful exposure metrics from different data sources to guide clinicians and researchers with a consistent model for investigating and communicating exposure risk profiles. The Linked Exposures Across Databases (LEAD) framework provides a unifying model for characterizing exposures from different exposure databases with a focus on providing clinically relevant exposure metrics. Application of LEAD is demonstrated through comparison of different military exposure data sources: Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT), Individual Longitudinal Exposure Record (ILER) database, and a military incident report database, the Explosive Ordnance Disposal Information Management System (EODIMS). This cohesive method for evaluating military exposures leverages established information with new sources of data and has the potential to influence how military exposure data is integrated into exposure health care and investigational models.

PURPOSE: Gulf War Illness (GWI) is a poorly understood illness that impacts about a third of Veterans who were deployed to the Gulf Region during the 1990-1991 Gulf War (GW). GW Veterans have twice the odds of having depression compared to non-deployed Veterans. Depression and sleep quality are associated with impaired physical function, which is notable since physical activity is a modifiable health behavior that can be an effective method to reduce mild to moderate depressive symptoms and improve sleep. We hypothesize that Veterans categorized with GWI and with high physical function scores will have fewer depressive symptoms and better sleep quality compared to those with low physical function. Evaluating the connection between physical and mental health in Veterans with GWI could support behavioral health interventions intended to improve symptom management. Methods: GW Veterans were enrolled in an ongoing VA multi-site remote clinical research study and completed web-based questionnaires: the Modified Kansas questionnaire, short-form 36 (SF-36), Patient Reported Outcomes Measurement Information System (PROMIS)-Emotional Distress Anxiety and Depression, and the Pittsburgh Sleep Quality Index (PSQI). The modified Kansas was used to designate GWI based on 6 self-reported symptom domains. Symptom onset was also required within 5 years of deployment. The SF-36 assessed eight functional domains, including physical functioning measuring mobility disability. GW Ill Veterans were grouped based on the SF-36 physical function score such that those with ≤70 were considered in the poor physical function group (low) and >70 were in the high physical function group (high). The PROMIS Anxiety assessed anxiety and PROMIS Depression assessed negative mood and decreased positive affect. The PSQI global score assessed sleep quality over a one-month period and ranges from 0-21 where a greater score reflects poorer sleep quality. Data were analyzed using student t-tests and linear regressions using Graphpad Prism 9. RESULTS: 63 Veterans (low group: 12 females/35 males, 60±4 years old; high group: 3 females/13 males, 59±5 years old) completed the web-based questionnaires. Anxiety and depression scores were greater in the low vs high group (Anxiety= low: 70.0±29; high: 45.4±14.0, P=0.001; Depression= low: 64.2.0±34.5; high: 41.3±14.7, P=0.01). Sleep quality (low: 12.8±4.0; high: 11.9±4.7, P=0.44) was not different between the groups. Anxiety scores (R ² =0.19, P=0.0004) and depression scores (R ² =0.11, P=0.007) were related to physical function, thus greater physical function was associated with lower (better) mental health scores. Sleep quality (R ² =0.07, P=0.03) was related to physical function, so greater physical function was associated with better sleep quality. CONCLUSIONS: Gulf War Illness is a chronic multi-symptom condition that can be debilitating. Insight about physical function, depression and sleep symptoms could guide therapeutic approaches. The SF-36 is recommended as a core data element in GWI research and as such can provide information on the physical aspects of health. These findings suggest that depression and anxiety differ in those with low versus high physical function and that physical function is related to mental health and sleep quality. Future research should examine how GW Veterans are able to maintain their physical function to improve overall health. VA CSR&D. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Understanding the health outcomes of military exposures is a critical effort for Veterans, their health care team, and national leaders. Veterans Affairs providers receive reports of military exposure related concerns from 43% of Veterans. Understanding the causal influences of environmental exposures on health is a complex task advancement in exposure science and may require interpreting multiple data sources; particularly when exposure pathways and multi-exposure interactions are ill-defined, as is the case for complex and emerging military service-related exposures. Thus, there is a need to standardize clinically meaningful exposure metrics from different data sources to guide clinicians and researchers with a consistent model for investigating and communicating exposure risk profiles. The Linked Exposures Across Databases (LEAD) framework provides a unifying model for characterizing exposure from different exposure datatypes and databases with a focus on providing clinically relevant exposure metrics. Application of LEAD is demonstrated through comparison of different military exposure data sources: Veteran Military Occupational and Environmental Exposure Assessment Tool (VMOAT), Individual Longitudinal Exposure Record (ILER) database and a military incident report database, the Explosive Ordnance Disposal Information Management System (EODIMS). This cohesive method for evaluating military exposures leverages established information with new sources of data and has the potential to influence how military exposure data is integrated into exposure health care and investigational models.

Introduction: Females typically exhibit smaller blood pressure (BP) responses during exercise than males. However, recent findings indicate that adjusting for maximal strength attenuates sex differences in BP during isometric handgrip (HG) exercise and post-exercise ischemia (PEI; metaboreflex isolation). Additionally, body size is associated with HG strength but its contribution to sex differences in exercising BP is less appreciated. Therefore, the purpose of this study was to determine whether adjusting for strength and body size would attenuate sex differences in BP during HG and PEI. Methods: We obtained beat-to-beat BP in 110 participants (36 females, 74 males) who completed two minutes of isometric HG exercise at 40% of their maximal voluntary contraction followed by three minutes of PEI. In a subset (11 females, 17 males), we collected muscle sympathetic nerve activity (MSNA). Statistical analyses included independent t-tests and mixed models (sex by time) with covariate adjustment for 40% HG force, height2, and body surface area. Results: Females exhibited a lower absolute 40% HG force than male participants (ps<0.001). Females exhibited lower Δsystolic, Δdiastolic, and Δmean BP during HG and PEI than males (e.g., PEI Δsystolic BP: 15±11 vs. 23±14; p=0.004). After covariate adjustment, sex differences in BP responses were attenuated. There were no sex differences in MSNA. In a smaller strength-matched cohort there were no sex by time interactions for BP responses (e.g., PEI systolic BP: p=0.539; diastolic BP: p=0.758). Conclusion: Our data indicate that sex differences in exercising BP responses are attenuated after adjusting for muscle strength and body size.

Purpose: High salt consumption increases blood pressure (BP) and cardiovascular disease risk by altering autonomic function and increasing inflammation. However, it is unclear whether salt manipulation alters resting and exercising heart rate variability (HRV), a noninvasive measure of autonomic function in healthy young adults. The purpose of this investigation was to determine whether short-term high salt intake 1) alters HRV at rest, during exercise, or exercise recovery, and 2) increases the circulating concentration of the inflammatory biomarker monocyte chemoattractant protein 1 (MCP-1). Methods: Using a randomized, placebo-controlled, crossover study, 20 participants (9 females; 24±4 years old, 110±10/64 ± 8mmHg) consumed high salt (3.9g sodium) or placebo capsules for 10 days each separated by ≥ two weeks. We assessed HRV during 10 minutes of baseline rest, 50 minutes of cycling (60%VO2max), and recovery. We quantified HRV using the standard deviation of normal-to-normal RR intervals, the root mean square of successive differences (RMSSD), and additional time and frequency domain metrics of HRV. Plasma samples were collected to assess MCP-1. Results: No main effect of high salt or condition x activity interaction was observed for HRV metrics. However, acute exercise reduced HRV (e.g., LnRMSSD time: p=0.005, condition: p=0.142, interaction: p=0.954). High salt elevated MCP-1 (72.4±12.5 vs. 78.14±14.7pg/mL; p=0.010). Irrespective of condition, MCP-1 was moderately associated (ps<0.05) with systolic (r =0.32) and mean BP (r =0.33) CONCLUSIONS: Short-term high salt consumption does not affect HRV, however, it increases MCP-1 which may influence BP in young adults.