"Nutritional Functioning" in OEF/OIF/OND Veterans with Polytraumatic Injuries: Developing a New Approach

患有多发性损伤的 OEF/OIF/OND 退伍军人的“营养功能”：开发新方法

• 批准号: 10649423
• 负责人: Diana Brostow
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649423
• 关键词: Address; Affect; Anxiety; Awareness; Behavior; Belief; Caring; Characteristics; Classification; Clinical; Clinical Trials; Complex; Country; Data; Development; Dimensions; Economics; Elements; Encapsulated; Enrollment; Environmental Risk Factor; Face; Food; Freedom; Future; Goals; Health; Health Status; Healthcare; Impairment; Income; Individual; Injury; Integrative Medicine; International; Intervention; Interview; Investigation; Knowledge; Learning; Life; Literature; Location; Maintenance; Measurement; Measures; Medical center; Meditation; Mental Depression; Methods; Modality; Modeling; Multiple Trauma; Nutritional; Outcome; Outcome Measure; Perception; Personal Communication; Persons; Physical Capacity; Physical Function; Physical Rehabilitation; Population; Post-Traumatic Stress Disorders; Poverty; Process; Property; Provider; Psychometrics; Psychosocial Factor; Recording of previous events; Recovery; Recovery of Function; Rehabilitation therapy; Reporting; Research; Research Personnel; Restaurants; Risk; Risk Factors; Role; Sampling; Services; Shapes; Social Functioning; Societies; Stigmatization; Substance abuse problem; Suggestion; Suicide; Symptoms; Training; Traumatic Brain Injury; Unemployment; Validation; Veterans; Veterans Health Administration; Work; care providers; care systems; chronic pain; cognitive capacity; cohort; combat; community reintegration; dexterity; disability; experience; feeding; food insecurity; food security; functional disability; health care model; improved; injured; innovation; internalized stigma; mental function; mindfulness-based stress reduction; novel strategies; nutrition; operation; poor health outcome; psychologic; psychological distress; psychosocial; randomized, clinical trials; rehabilitation service; rehabilitative care; statistics; substance use; suicidal behavior; therapy design; validation studies; whole health

Veterans of the Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) era are a unique population facing unprecedented obstacles; over 30% struggle with polytrauma, often a combination of traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and psychological distress.1,2 The resulting physical and psychosocial disabilities contribute to poor reintegration, characterized by high unemployment,3,4 deeply internalized stigma,5,6 and poor health status.7,8 These disabilities are also significant contributors to food insecurity; being able to access/make use of food in sufficient quantities to meet one’s perceived nutritional needs.9 Research is nascent, but preliminary data suggest that over 25% of OEF/OIF/OND Veterans are food insecure.10 Historically viewed as an economic concern, food insecurity is now understood to be influenced by a range of psychosocial determinants.11,12 Specifically, in the context of rehabilitation and recovery, there is an emerging understanding of nutrition as a multifactorial concept, one which encompasses the physical, psychosocial, and environmental factors that shape one’s relationship with food. Even as the International Classification of Functioning (ICF) prioritizes physical functions, (e.g. self-feeding), researchers have called for rehabilitation services to expand their approach beyond physical mobility or dexterity13,14 Nevertheless, the constructs that comprise food security, heretofore termed “nutritional functioning”, have yet to be operationalized or systematically measured. The VHA’s Polytrauma System of Care provides rehabilitation services to thousands of Veterans.15 In addition, since 2014, the Integrative Health Coordinating Center has led the implementation of the Whole Health model of care,16 which offers integrative health (IH) modalities for polytraumatic injuries.17 Importantly, within the Whole Health model, “Food and Drink” are core elements. Given this, both IH and polytrauma settings are ideal locations for operationalizing and creating a measure of “nutritional functioning,” one that can be used to evaluate injured Veterans’ use of and access to food, identify ‘gaps’ in for intervention, and serve as an outcome for randomized clinical trials. To operationalize nutritional functioning in OEF/OIF/ONF Veterans with polytrauma, and to develop a measure which encapsulates this concept, and can be validated in clinical settings, I propose to: Aim 1: Conduct qualitative interviews to further operationalize the components of nutritional functioning in OEF/OIF/OND Veterans with a history of polytrauma. Use the ICF framework to assess potential additional components, and associated barriers/facilitators to nutritional functioning. Interview VHA providers to assess perceptions regarding nutritional functioning. Aim 2: Develop and pilot a measure of nutritional functioning using components operationalized in Aim 1. Use expert panel input to evaluate content validity and clinical utility, and pilot the measure in a sample of OEF/OIF/OND Veterans with polytrauma. Combine exploratory factor and Rasch model analyses to evaluate dimensionality, scale appropriateness, and item level characteristics to inform measure refinements. Aim 3: Conduct a validation study of the refined measure of nutritional functioning in OEF/OIF/OND Veterans with and without polytrauma enrolled in IH and/or polytrauma rehabilitation services. Evaluate psychometric properties - reliability, validity (construct, known-groups and convergent validity) and Rasch measurement statistics to refine the measure further, and to develop it for future use as an outcome measure of nutritional functioning among those with polytrauma. This proposal addresses the RR&D goal of maximizing functional recovery by focusing on applied physical rehabilitation and psychological recovery. I will accomplish the proposed aims by seeking training in nutritional methods in interdisciplinary settings, measure development, and intervention design.

持久自由行动/伊拉克自由行动/新黎明行动的退伍军人 （OEF/OIF/OND）时代是一个独特的人群面临前所未有的障碍；超过30%的人在挣扎 多发伤，通常是创伤性脑损伤 (TBI)、创伤后应激障碍 (PTSD) 和 心理困扰。1,2 由此产生的身体和社会心理残疾导致难以重新融入社会， 其特点是高失业率、3,4 根深蒂固的耻辱感、5,6 和健康状况不佳。7,8 这些 残疾也是造成粮食不安全的重要因素；能够获取/利用食物 足够的数量来满足一个人感知的营养需求。9 研究刚刚起步，但初步数据 表明超过 25% 的 OEF/OIF/OND 退伍军人粮食不安全。10 历史上被视为经济 令人担忧的是，粮食不安全现在被认为受到一系列心理社会决定因素的影响。11,12 具体而言，在康复和恢复的背景下，人们对营养有了新的认识： 一个多因素的概念，包括身体、心理和环境因素 塑造一个人与食物的关系。即使国际功能分类 (ICF) 优先考虑 研究人员呼吁康复服务扩大其身体功能（例如自我进食） 超越身体移动性或灵巧性的方法13,14 然而，构成粮食安全的结构、 迄今为止被称为“营养功能”的概念尚未得到实施或系统测量。 VHA 的多发伤护理系统为数千名退伍军人提供康复服务。 15 此外，自2014年以来，综合健康协调中心牵头实施了“整体健康”计划。 健康护理模式，16 为多发性损伤提供综合健康 (IH) 模式。 17 重要的是， 在整体健康模式中，“食物和饮料”是核心要素。鉴于此，IH 和多发伤 环境是实施和创建“营养功能”衡量标准的理想场所，该衡量标准可以 用于评估受伤退伍军人对食物的使用和获取情况，确定干预措施的“差距”，并作为 随机临床试验的结果。 使患有多发伤的 OEF/OIF/ONF 退伍军人的营养功能发挥作用，并制定 概括这一概念并且可以在临床环境中验证的措施，我建议： 目标 1：进行定性访谈，以进一步落实营养功能的组成部分 OEF/OIF/OND 有多发伤史的退伍军人。使用 ICF 框架来评估潜在的额外 成分以及营养功能的相关障碍/促进因素。采访 VHA 提供商进行评估 关于营养功能的看法。 目标 2：使用目标 1 中实施的组件开发并试点营养功能测量。 使用 专家小组输入评估内容有效性和临床实用性，并在样本中试点该措施 OEF/OIF/OND 患有多发伤的退伍军人。结合探索性因素和 Rasch 模型分析进行评估 维度、尺度适当性和项目级别特征，以通知测量细化。 目标 3：对 OEF/OIF/OND 退伍军人营养功能的精细测量进行验证研究 有或没有多发伤参加 IH 和/或多发伤康复服务。评估心理测量 属性 - 可靠性、有效性（构造、已知组和收敛有效性）和 Rasch 测量 进一步完善该衡量标准，并将其发展为未来用作营养结果衡量标准的统计数据 在患有多发伤的人中发挥作用。 该提案通过关注应用来解决最大程度地实现功能恢复的 RR&D 目标 身体康复和心理康复。我将通过寻求培训来实现拟议的目标 跨学科环境中的营养方法、测量开发和干预设计。

项目成果

Food Insecurity and Food Worries During the COVID-19 Pandemic: A Point-In-Time Study of Injured United States Veterans.

COVID-19 大流行期间的粮食不安全和粮食担忧：对受伤的美国退伍军人的时间点研究。

• DOI: 10.1080/19320248.2022.2118564
• 发表时间: 2022-09-04
• 期刊: JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION
• 影响因子: 1.6
• 作者: Brostow, Diana P.;Smith, Alexandra A.;Bahraini, Nazanin H.;Besterman-Dahan, Karen;Forster, Jeri E.;Brenner, Lisa A.
• 通讯作者: Brenner, Lisa A.