Publications by authors named "Mary Pugh"
Objective: Traumatic brain injury (TBI) is a significant risk factor for epilepsy, but little work has explored whether risk of epilepsy after TBI may operate through intermediary mechanisms. The objective of this study was to statistically screen for potentially mediating effects among 64 comorbidities for epilepsy risk following TBI among Post-9/11 U.S.
View Article and Find Full Text PDFIdentifying historical mild traumatic brain injury (TBI) is important for many clinical care reasons; however, diagnosing mild TBI is inherently challenging and utility of screening is unknown. This study compares a standardized research process to an established clinical process for screening and diagnosis of historical mild TBI during combat deployment in a military/Veteran cohort. Using validated instruments, the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study (PLS) screens for all potential concussive events (PCEs) and conducts structured concussion diagnostic interviews for each PCE.
View Article and Find Full Text PDFArticle Synopsis
- Researchers developed prediction models to estimate the risk of posttraumatic epilepsy (PTE) in individuals who experienced moderate-to-severe traumatic brain injuries (TBI) during a two-year recovery period.
- The study utilized data from over 6,000 participants in the TBI Model Systems National Database, performing analyses to create models that account for various factors influencing seizure risk post-injury.
- Key findings indicated that Model 3, which focused on predicting new or recurrent seizures in the second year, had the highest sensitivity (86.63%) and effectiveness, with factors like cranial surgeries and traumatic hemorrhages being significant risk predictors across all models.
Importance: Blast-related mild traumatic brain injuries (TBIs), the "signature injury" of post-9/11 conflicts, are associated with clinically relevant, long-term cognitive, psychological, and behavioral dysfunction and disability; however, the underlying neural mechanisms remain unclear.
Objective: To investigate associations between a history of remote blast-related mild TBI and regional brain volume in a sample of US veterans and active duty service members.
Design, Setting, And Participants: Prospective cohort study of US veterans and active duty service members from the Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC), which enrolled more than 1500 participants at 5 sites used in this analysis between 2014 and 2023.
Article Synopsis
- Women veterans and non-veteran women both have comparable caregiving rates, with roughly 23% in each group providing care.
- Women veterans who are caregivers tend to have higher rates of chronic health conditions, disabilities, and mental distress compared to their non-veteran counterparts.
- Younger women veterans (ages 18-44) experience significantly more mental distress, highlighting the need for targeted support and mental health services for this group.
Objective: To investigate phenotypes of comorbidity before and after an epilepsy diagnosis in a national cohort of post-9/11 Service Members and Veterans and explore phenotypic associations with mortality.
Methods: Among a longitudinal cohort of Service Members and Veterans receiving care in the Veterans Health Administration (VHA) from 2002 to 2018, annual diagnoses for 26 conditions associated with epilepsy were collected over 5 years, ranging from 2 years prior to 2 years after the year of first epilepsy diagnosis. Latent class analysis (LCA) was used to identify probabilistic comorbidity phenotypes with distinct health trajectories.
Article Synopsis
- Chronic headaches are a common issue for military Veterans after experiencing traumatic brain injuries (TBI), and their treatment is often complicated and costly.
- A study of 141,125 Veterans post-9/11 revealed that those with specific types of headache combinations, especially post-TBI migraines, faced significantly higher healthcare costs.
- There's a need for further research to understand if the high costs correlate with better treatment results or indicate persistent, harder-to-treat headaches.
Article Synopsis
- The StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) is a key player in helping the Department of Veterans Affairs meet the Evidence Act requirements by providing evidence and evaluation support for federal funding requests.
- SALIENT focuses on optimizing policies and programs for veterans, improving health outcomes, advancing dissemination science, and expanding the workforce in implementation science through collaborative evaluations.
- Using a Lean Sprint methodology, SALIENT collaborates with veterans and stakeholders to develop strategic evaluation plans, ensuring effective communication of results and implementation of evidence-based practices.
Objective: Demonstrate how patient-level traumatic brain injury (TBI) data from studies in the Federal Interagency Traumatic Brain Injury Research (FITBIR) Informatics System can be harmonized and pooled to examine relationships between TBI and cognitive functioning.
Method: We harmonized and pooled data across studies and analyzed rates of probable cognitive functioning deficits by TBI history and severity.
Results: Four publicly available FITBIR studies with 3,445 participants included data on cognitive dysfunction, though only one included comparison groups (mild TBI vs.
Background: Traumatic brain injury (TBI) is associated with a variety of adverse long-term outcomes and increases sympathetic nervous system activation, which could increase the risk of arrhythmias including atrial fibrillation or atrial flutter (AF/AFL).
Objective: We examined episodes of TBI and subsequent AF/AFL in a large cohort of post-9/11 servicemembers and veterans.
Methods: The variable of interest was TBI, stratified by severity (mild, moderate/severe, and penetrating).
Background: We aimed to identify combinations of long-term services and supports (LTSS) Veterans use, describe transitions between groups, and identify factors influencing transition.
Methods: We explored LTSS across a continuum from home to institutional care. Analyses included 104,837 Veterans Health Administration (VHA) patients 66 years and older at high-risk of long-term institutional care (LTIC).
Article Synopsis
- The study investigates the relationship between the timing of traumatic brain injury (TBI) and mortality in veterans with epilepsy, finding that TBI increases mortality risk, especially when it occurs shortly after epilepsy onset.
- Among almost 1 million veterans, those with epilepsy had a significantly higher mortality rate compared to controls, with the most severe risk observed in those with TBI within 6 months of epilepsy diagnosis.
- Results indicate that the timing of TBI in relation to epilepsy is crucial, highlighting a need for targeted care for veterans experiencing these conditions.
Although family caregivers are increasingly recognized for their essential role in helping vulnerable adults live in the community for as long as possible, their priorities and perspectives have not been well-integrated into quality assessments of home- and community-based services (HCBS). Our overall goal was to identify measurement gaps to guide monitoring and improve HCBS. Caregiver-specific measurement priorities were identified during a multi-level stakeholder engagement process that included 34 Veterans, 24 caregivers, and 39 facility leaders, clinicians, and staff across four VA healthcare systems.
View Article and Find Full Text PDFDeficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15-90. The effects of dementia, mild cognitive impairment, Parkinson's disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals.
View Article and Find Full Text PDFBackground: A partnered evaluation project with Veterans Health Administration Physical Medicine and Rehabilitation program office uses a partner-engaged approach to characterize and evaluate the national implementation of traumatic brain injury (TBI)Intensive Evaluation and Treatment Program (IETP).
Objective: This paper illustrates a partner-engaged approach to contextualizing the IETP within an implementation research logic model (IRLM) to inform program sustainment and spread.
Setting: The project was conducted at five IETP sites: Tampa, Richmond, San Antonio, Palo Alto, and Minneapolis.
Article Synopsis
- The study aims to systematically review existing data to better understand how long it typically takes for post-traumatic epilepsy (PTE) to develop after a mild traumatic brain injury (mTBI) like a concussion.
- Researchers will conduct a thorough search of medical literature, assess the risk of bias in the studies, and combine their findings using meta-analysis techniques to draw clearer conclusions about incidence and latency.
- This research aims to enhance early detection and intervention strategies for PTE, ultimately improving patient care and quality of life for individuals affected by mTBI.
Article Synopsis
- The study aimed to understand lifetime exposure to mild traumatic brain injuries (TBIs) among U.S. military service members and Veterans, focusing on differences between male and female participants.
- It involved analyzing data from a large longitudinal study, measuring various characteristics of mild TBIs through structured interviews.
- Results indicated that female service members reported fewer TBIs overall and during deployment compared to males, highlighting significant sex-related differences in injury patterns prior to and during military service.
Article Synopsis
- This study explores the connection between white matter hyperintensities (WMHs), mild traumatic brain injury (mTBI), age, and cognitive performance in a group of combat-exposed Veterans and Service Members.
- The research involved 1,011 participants, revealing that both groups had similar rates of WMHs; however, older individuals with mTBI showed a higher count of WMHs compared to those without.
- Significant relationships were found linking increased WMHs with cognitive impairments in memory and processing speed, suggesting the need for further investigation on the long-term effects of WMHs in mTBI cases.
Aging Veterans face complex needs across multiple domains. However, the needs of older female Veterans and the degree to which unmet needs differ by sex are unknown. We analyzed responses to the HERO CARE survey from 7,955 Veterans aged 55 years and older (weighted = 490,148), 93.
View Article and Find Full Text PDFThis study investigated influence of biological sex on postconcussive symptoms (PCS) following concussion using the Federal Interagency Traumatic Brain Injury Research (FITBIR) database. All studies with publicly released data as of 4/7/21 that included both males and females, enough information to determine severity of injury consistent with concussion, a measure of PCS, and objective measures of neurocognitive functioning were used. This resulted in 6 studies with a total of 9890 participants (3206 females, 6684 males); 815 participants completed the Neurobehavioral Symptom Inventory (NSI), 471 completed the Rivermead Post-Concussion Symptoms Questionnaire (RPSQ), and 8604 completed the Sport Concussion Assessment Tool-3rd Edition (SCAT 3).
View Article and Find Full Text PDFU.S. Service members and Veterans (SM/V) experience elevated rates of traumatic brain injury (TBI), chronic pain, and other non-pain symptoms.
View Article and Find Full Text PDFBackground And Objectives: Traumatic brain injury (TBI) is a concern for US service members and veterans (SMV), leading to heterogeneous psychological and cognitive outcomes. We sought to identify neuropsychological profiles of mild TBI (mTBI) and posttraumatic stress disorder (PTSD) among the largest SMV sample to date.
Methods: We analyzed cross-sectional baseline data from SMV with prior combat deployments enrolled in the ongoing Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study.
Article Synopsis
- The study examines the use of VA-purchased care among post-9/11 veterans with traumatic brain injury (TBI), highlighting their increased health-related complexities compared to other veterans.
- Findings show that 51% of veterans with TBI utilized VA-purchased care, and almost all of these individuals (99%) also received VA-delivered outpatient care.
- Factors such as the severity of TBI, health risk scores, and mental health conditions (like PTSD and depression) significantly influenced the likelihood of these veterans using VA-purchased care from 2016 to 2019.
Introduction: The extent of racial/ethnic disparities and whether they are attenuated in the Veteran population compared to the total US population is not well understood. We aimed to assess racial/ethnic mortality disparities from all-cause, cardiovascular (CVD) and cancer among post-9/11 military Veterans with and without exposure to TBI, compared to the total US population.
Methods: This cohort study included 2,502,101 US military Veterans (18,932,083 person-years) who served after 09/11/2001 with 3 or more years of care in the Military Health System (MHS); or had 3 or more years of care in the MHS and 2 or more years of care in the Veterans Health Administration.