Understanding Racial Disparities in Dementia Prevalence Among Veterans.

Background: Black and Hispanic older adults have greater incidence of Alzheimer's disease and related dementias relative to White adults, but factors underlying these disparities are not well understood, limiting the ability to address them. Objective: To determine the impact of demographics, cardiovascular disease (CVD) and risk factors, social determinants of health (SDOH), and neuropsychiatric risk factors on racial/ethnic disparities in dementia risk among Veterans. Methods: We examined a random sample of 1,579,919 older Veterans (age ≥55) without dementia who received care from the VHA from October 1, 1999 to September 30, 2021. All variables were extracted from national VHA data. We used Cox proportional hazard regression models to examine change in variance in risk of dementia across racial/ethnic groups. Results: During follow up (mean 11.1 years), 13% of Veterans developed dementia. Relative to White Veterans, the adjusted hazard ratios (AHRs) for developing dementia in sex-adjusted models with age as timescale were 1.65 (95% CI, 1.63-1.67) for Black Veterans and 1.50 (95% CI, 1.44-1.56) for Hispanic Veterans. In the model examining CVD and risk factors, AHRs were 1.53 (95% CI, 1.50-1.55) for Black Veterans and 1.38 (95% CI, 1.33-1.44) for Hispanic Veterans. In the model examining SDOH, AHRs were 1.46 (95% CI, 1.43-1.49) for Black Veterans and 1.34 (95% CI, 1.29-1.40) for Hispanic Veterans. Conclusions: SDOH and CVD and risk factors accounted for the greatest amount of variance in racial/ethnic disparities in dementia risk. Cardiovascular disease and SDOH are strong possible targets for interventions designed to reduce these disparities.

Comparing Trauma Treatment Outcomes Between Homeless and Housed Veterans in a VA PTSD Clinical Program.

Homeless veterans are likely to experience Post Traumatic Stress Disorder (PTSD). Homelessness itself is traumatic, and PTSD may exacerbate homelessness risk for veterans. Often, PTSD goes untreated in this subpopulation of veterans. Our study examined trauma-focused treatment (TFT) and non-TFT initiation and completion in a sample of housed and homeless veterans being served by a PTSD clinical team in Washington, DC. Findings included a high percentage of veterans who experienced homelessness in the sample and lower treatment completion rates among homeless veterans compared to housed veterans. This difference was no longer significant when comparing only those veterans who engaged in treatment, reinforcing the critical role of treatment engagement in successful treatment completion across populations.

Parental Views of Social Worker and Chaplain Involvement in Care and Decision Making for Critically Ill Children with Cancer.

BACKGROUND: Social workers (SWs) and chaplains are trained to support families facing challenges associated with critical illness and potential end-of-life issues. Little is known about how parents view SW/chaplain involvement in care for critically ill children with cancer. METHODS: We studied parent perceptions of SW/chaplain involvement in care for pediatric intensive care unit (PICU) patients with cancer or who had a hematopoietic cell transplant. English- and Spanish-speaking parents completed surveys within 7 days of PICU admission and at discharge. Some parents participated in an optional interview. RESULTS: Twenty-four parents of 18 patients completed both surveys, and six parents were interviewed. Of the survey respondents, 66.7% and 75% interacted with SWs or chaplains, respectively. Most parents described SW/chaplain interactions as helpful (81.3% and 72.2%, respectively), but few reported their help with decision making (18.8% and 12.4%, respectively). Parents described SW/chaplain roles related to emotional, spiritual, instrumental, and holistic support. Few parents expressed awareness about SW/chaplain interactions with other healthcare team members. CONCLUSIONS: Future work is needed to determine SWs'/chaplains' contributions to and impact on parental decision making, improve parent awareness about SW/chaplain roles and engagement with the healthcare team, and understand why some PICU parents do not interact with SWs/chaplains.

Unique and Transdiagnostic Dimensions of Reward Functioning in Attention-Deficit/Hyperactivity Disorder and Alcohol Use Disorder Symptoms.

AIMS: Contemporary theories of attention-deficit/hyperactivity disorder (ADHD) and alcohol use disorder (AUD) emphasize core dysfunctions in reward-related processes and behaviors as pathognomonic characteristics. However, to date, it is unclear which domains of reward functioning are unique to ADHD versus AUD symptom dimensions, and which represent underlying shared correlates. METHODS: The current study employed secondary data analyses from a large community sample of emerging adults (N = 602; 57.3% female) and novel transdiagnostic modeling (i.e. bi-factor confirmatory factor analyses and structural equation modeling) of ADHD, AUD and shared symptom dimensions to identify unique and common reward-related dimensions: environmental suppressors, reward probability, hedonic capacity, proportionate substance-related reinforcement and delay discounting. RESULTS: The presence of environmental suppressors was the only reward-related construct that correlated with the underlying ADHD-AUD shared dimension. The AUD symptom dimension was uniquely associated with proportionate substance-related reinforcement, whereas the ADHD symptom dimension was uniquely associated with limited reward probability. No significant associations were found for delay discounting or hedonic capacity. CONCLUSIONS: These novel findings highlight specific aspects of reward-related functioning in ADHD, AUD and shared symptom dimensions. In so doing, this work meaningfully advances theoretical conceptualizations of these two commonly co-occurring presentations and suggests future directions for research on transdiagnostic correlates. Future longitudinal studies should include clinical samples with diagnoses of AUD and ADHD to further identify underlying correlates over time.

Social support, social network size, and suicidal ideation: A nine-year longitudinal analysis from the Mind Your Heart Study.

Substantial research has investigated the impact of social support on the development and course of suicidal thoughts and behaviors. However, its measurement has been inconsistent, and different facets of social support may have differential effects on suicidal ideation (SI). The present study used data from 743 veterans recruited between 2008 and 2010 as part of the Mind Your Heart Study to investigate the relationship between two aspects of social support (social network size and perceived social support) and SI over 9 years. Using the 9th item of the PHQ-9, we created two composite scores: (1, chronicity) the proportion of years the participant endorsed SI and (2, severity) the severity of SI across the follow-up period. We found that, when modeled individually, both larger social network size and greater perceived social support predicted lower SI chronicity (ß=-.16, ß = -0.19 respectively; ps < .001) and lower SI severity (ß=-0.15 and ß = -0.19, respectively; ps < .001). However, when modeled together and controlling for PTSD and depression symptoms, increased social network size but not perceived social support predicted lower SI chronicity (ß=-0.09, p = .01 and ß = 0.02, p = .48, respectively) and SI severity (ß=-0.07, p = .045 and ß = 0.01, p = .71, respectively). These findings suggest that social network size may be an important target for intervention, and that future work is needed to better delineate the effect of different features of social support on risk for suicide.

Predictors of multiple domains of functioning in Veterans with posttraumatic stress disorder: Results from the Mind Your Heart Study.

BACKGROUND: Those with posttraumatic stress disorder (PTSD) have lower overall functioning than healthy controls. However, this population is not homogenous, and those with PTSD have a wide range of functional outcomes. To our knowledge, only one other study has evaluated the predictors of better functioning within patients with PTSD. METHODS: We examined 254 veterans with likely PTSD, using the Clinician-Administered PTSD Scale to assess PTSD symptom severity, and the SF-36 and single-item question to assess aspects of current functioning and quality of life. RESULTS: In fully adjusted models (controlling for age, gender, and PTSD score, and including all significant psychosocial predictors of the outcome of interest), greater sleep quality (p = .03), lower C-reactive protein (p < .01), and lower erythrocyte sedimentation rate (p = 0.04) were associated with greater physical functioning; lower depression (p < .01) and greater perceived social support (p = .05) were associated with greater social functioning; lower depression (p = .02) was associated with greater occupational functioning; and greater combat exposure (p = .04), greater optimism (p < .01) and greater perceived social support (p = .05) were associated with greater quality of life. CONCLUSIONS: These findings highlight the differential impact of psychosocial predictors on multiple functional outcomes. As such, they provide important information for clinicians about aspects of veterans' lives that can be targeted during the treatment to improve specific types of functioning.

A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences.

BACKGROUND: Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs). OBJECTIVE: Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs. DESIGN: Observational study. SETTING/SUBJECTS: University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs. MEASUREMENTS: We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements. RESULTS: DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%). CONCLUSIONS: In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.

Posttraumatic stress disorder, depression, and suicidal ideation in veterans: Results from the mind your heart study.

Veterans with PTSD or depression are at increased risk for suicidal ideation. However, few studies have examined that risk in those with comorbid PTSD and depression, instead focusing on these disorders individually. This study investigates the association of suicidal ideation with comorbid PTSD and depression and examines the role of military and psychosocial covariates. We evaluated 746 veterans using the CAPS to assess PTSD and the PHQ-9 to measure depression and suicidal ideation. Covariates were assessed via validated self-report measures. 49% of veterans with comorbid PTSD and depression endorsed suicidal ideation, making them more likely to do so than those with depression alone (34%), PTSD alone (11%), or neither (2%). In multivariate logistic regression models, this association remained significant after controlling for demographics and symptom severity. Anger, hostility, anxiety, alcohol use, optimism and social support did not explain the elevated risk of suicidal ideation in the comorbid group in fully adjusted models. As suicidal ideation is a known risk factor for suicide attempts and completions, veterans with comorbid PTSD and depression represent a vulnerable group who may need more intensive monitoring and treatment to reduce risk of suicide.

A search algorithm for identifying likely users and non-users of marijuana from the free text of the electronic medical record.

BACKGROUND: The harmful effects of marijuana on health and in particular cardiovascular health are understudied. To develop such knowledge, an efficient method of developing an informative cohort of marijuana users and non-users is needed. METHODS: We identified patients with a diagnosis of coronary artery disease using ICD-9 codes who were seen in the San Francisco VA in 2015. We imported these patients' medical record notes into an informatics platform that facilitated text searches. We categorized patients into those with evidence of marijuana use in the past 12 months and patients with no such evidence, using the following text strings: "marijuana", "mjx", and "cannabis". We randomly selected 51 users and 51 non-users based on this preliminary classification, and sent a recruitment letter to 97 of these patients who had contact information available. Patients were interviewed on marijuana use and domains related to cardiovascular health. Data on marijuana use collected from the medical record was compared to data collected as part of the interview. RESULTS: The interview completion rate was 71%. Among the 35 patients identified by text strings as having used marijuana in the previous year, 15 had used marijuana in the past 30 days (positive predictive value = 42.9%). The probability of use in the past month increased from 8.8% to 42.9% in people who have these keywords in their medical record compared to those who did not have these terms in their medical record. CONCLUSION: Methods that combine text search strategies for participant recruitment with health interviews provide an efficient approach to developing prospective cohorts that can be used to study the health effects of marijuana.

Anthropocentric by Default? Attribution of Familiar and Novel Properties to Living Things.

Humans naturally and effortlessly use a set of cognitive tools to reason about biological entities and phenomena. Two such tools, essentialist thinking and teleological thinking, appear to be early developmental cognitive defaults, used extensively in childhood and under limited circumstances in adulthood, but prone to reemerge under time pressure or cognitive load. We examine the nature of another such tool: anthropocentric thinking. In four experiments, we examined patterns of property attribution to a wide range of living and non-living objects, manipulating time pressure, response type, and property (either novel or familiar) in a total of 471 participants. Results showed no tendency toward increased similarity-based attribution patterns indicative of anthropocentric thinking under time pressure. However, anthropocentric thinking was consistently observed for unfamiliar properties. These findings suggest that anthropocentric thinking is not a developmentally persistent cognitive default, but rather a cognitive strategy deliberately employed in situations of uncertainty.

Intuitive biological thought: Developmental changes and effects of biology education in late adolescence.

A large body of cognitive research has shown that people intuitively and effortlessly reason about the biological world in complex and systematic ways. We addressed two questions about the nature of intuitive biological reasoning: How does intuitive biological thinking change during adolescence and early adulthood? How does increasing biology education influence intuitive biological thinking? To do so, we developed a battery of measures to systematically test three components of intuitive biological thought: anthropocentric thinking, teleological thinking and essentialist thinking, and tested 8th graders and university students (both biology majors, and non-biology majors). Results reveal clear evidence of persistent intuitive reasoning among all populations studied, consistent but surprisingly small differences between 8th graders and college students on measures of intuitive biological thought, and consistent but again surprisingly small influence of increasing biology education on intuitive biological reasoning. Results speak to the persistence of intuitive reasoning, the importance of taking intuitive knowledge into account in science classrooms, and the necessity of interdisciplinary research to advance biology education. Further studies are necessary to investigate how cultural context and continued acquisition of expertise impact intuitive biology thinking.

The Process and Impact of Stakeholder Engagement in Developing a Pediatric Intensive Care Unit Communication and Decision-Making Intervention.

Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.