"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/行动的退伍军人新黎明 （OEF/OIF/OND）擦除是面临前所未有的障碍的独特人群；超过30％的人与 多发性毛发，通常是脑损伤（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疾病导致重返社会不良， 以高失业率，3,4个深层内在的污名，5,6和健康状况不佳的特征。7,8这些 残疾也是粮食不安全的重要贡献者；能够在 足够数量满足人们感知的营养需求。9研究是新生的，但初步数据 建议超过25％的OEF/OIF/OND退伍军人是不安全的。10历史上被视为一种经济 关注的是，现在理解粮食不安全受到一系列社会心理决定者的影响。11,12 具体而言，在康复和恢复的背景下，人们对营养有一种新兴的了解 一个多因素概念，可以增强物理，社会心理和环境因素 塑造一个人与食物的关系。即使国际功能分类（ICF）优先 身体功能（例如自喂养），研究人员呼吁康复服务以扩大其 除了物理流动性或敏感性外，接近13,14，尽管如此，完成粮食安全的结构， 迄今称为“营养功能”，尚未进行操作或系统测量。 VHA的Polytrauma护理系统为成千上万的退伍军人提供康复服务。15 此外，自2014年以来，综合健康协调中心领导了整个实施 健康护理模型，16，提供综合健康（IH）多发性伤害的方式。17重要的是， 在整个健康模型中，“食物和饮料”是核心元素。鉴于此，IH和Polytrauma既 设置是操作和创建“营养功能”的理想位置，可以 用于评估受伤的退伍军人使用和获取食物的使用，确定“差距”进行干预，并作为 随机临床试验的结果。 在OEF/OIF/ONF退伍军人中运行营养功能，并开发一个 测量封装了这一概念的，可以在临床环境中进行验证，我建议： 目标1：进行定性访谈，以进一步运营营养功能的组成部分 OEF/OIF/OND退伍军人，具有多头性的历史。使用ICF框架评估潜在的其他 成分以及与营养功能相关的障碍/促进因子。面试VHA提供者评估 关于营养功能的看法。 AIM 2：使用AIM 1中运行的组件来开发和试行营养功能的测量。使用。 专家面板输入以评估内容有效性和临床实用程序，并在样本中进行测量 OEF/OIF/OND退伍军人，带有多重曲子。结合探索性因素和Rasch模型分析以评估 维度，规模适当和项目级别特征，以告知测量改进。 目标3：对OEF/OIF/OND退伍军人的营养功能的精制测量进行验证研究 在有和/或没有polytrauma的情况下，参加了IH和/或Polytrauma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 统计数据以进一步完善测量，并将其开发为将来用作营养的结果度量 在多发性的人中起作用。 该提案解决了通过专注于应用的RR＆D最大化功能恢复的目标 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 在跨学科环境中的营养方法中，衡量开发和干预设计。

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.