Scatterbrained is overrated - being focused on CVD and cerebrovascular health for military populations worldwide

 

Copyists and imitations, a high form of echo flattery, should be appreciated as opportunity. We should build off one another’s work and words, bridging the best of scientific collaboration worldwide for real-time cardiovascular and cerebrovascular health in military and veteran populations

1. Future work should incorporate evidence in specific deployment science that does not point to increased CVD and cerebrovascular risk

2.  Future work should incorporate specialty science evidence that considers CVD and cerebrovascular risks, such as blood lipid work, toxin exposure and other unknowns. Future work should incorporate chronic conditions, such as obesity and diabetes.

3.  Future work should incorporate TBI and neurological trauma, including PTSD, into science around strokes, cardiology and distinctions.

4. Future work should use stroke science to bridge international cooperation in cardiovascular and cerebrovascular considerations for military populations.

 

Somethings to incorporate and build from:

 

Something in the way we stick around and let commitment show

Epidemiology and research that focuses on disabled populations does not account for the large population on veterans in various occupations. These populations are reachable, new occupational hazards are important and they should be incorporated. Veterans across manufacturing, transportation, service and consumer industries each have important contributions to the cardiovascular science. Veterans in intelligence, security, policing, first response and bureaus of investigation should be incorporate into cohorts, and something in the way the epidemiology is conducted must consider access and need. Blood, biological and neuroimaging science should not miss the greater population, globally. Through occupational inclusion that considers health access, outstanding needs and physicals as a component to CVD, stroke and cerbrovascular science, we can stick around and let commitment show.

 

Something about believing and how

CVD and cerebrovascular risks associated with OEF/OIF/OND veterans will continue to be studied, with elevated risk noted. We should advance data aggregation, epidemiological design, account for veterans’ new employers variables and offer proactive interventions (teleclass, tech assistance with healthy lifestyle, social support, accountability in decreasing consumer stress) as part of lifelong commitment. Military and veterans need to know and believe the risks as well as risk reduction.

Words for echo consideration: https://psycnet.apa.org/record/2020-05909-001

 

 

Something about blood lipid science that requires international effort

Lipids and blood science will continue to be considered. Why not coordinate international efforts around obvious trends in military personnel and dyslipidemia:

Words for echo consideration: https://www.researchgate.net/profile/Laurel_Wentz/publication/305598350_Correlations_between_Vitamin_D_Concentrations_and_Lipid_Panels_in_Active_Duty_and_Veteran_Military_Personnel/links/5794c67608aed51475cf2235/Correlations-between-Vitamin-D-Concentrations-and-Lipid-Panels-in-Active-Duty-and-Veteran-Military-Personnel.pdf

 

Why not coordinate international alignment on tools used for lipid science? For starters, laboratory ranges used by the US Army Medical Department (AMEDD) standards of care may differ across continents. Aligning it now serves the future of deployment science.

Words for echo consideration: https://www.nature.com/articles/s41588-018-0222-9?_ga=2.262964300.1528897282.1539475200-515434739.1539475200

 

Something in neuroscience

Neuroimaging has demonstrated some reliability in distinguishing PTSD from TBI. How does neuroimaging assist with cerebrovascular and cardiovascular science for those affected, and how is it offered to this population?

Words to echo: https://link.springer.com/article/10.1007/s11682-015-9385-5

 

Something in the way we define the obesity comorbidities

If BMI is to continue as an indicator for overweight and obesity definitions, including for risk factors and associated morbidities, what is being done in the field of muscle mass and science? What is being done to study and address musculoskeletal science and weight alongside cardiovascular science?  Military personnel classified as overweight, though muscular, should understand trajectories and science behind the issue. Risks, prevention and intervention in cardiovascular and cerebrovascular science can benefit with stronger insight.

Words to echo: https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21513

 

Something about prevention science

Educational guides for stroke prevention in veteran populations focus on self-management. Why not require or incentivize healthcare delivery as a partner in management? Telehealth, wellness check in, virtual classes, occupational stress reduction and other considerations should be considered.

Words for echo: https://www.ahajournals.org/doi/abs/10.1161/str.44.suppl_1.AWP338

 

Consideration for opportunities to include ischemic stroke science in TBI, proteinopathy and dementia work, for efficiency in science should be maximized.

Words for echo: https://content.iospress.com/articles/journal-of-alzheimers-disease/jad181039

What is being done for cardiovascular care policy? What is being done to incorporate exposures into cardiovascular considerations in primary care? 

Words for echo: https://www.ahajournals.org/doi/10.1161/JAHA.118.009056

Something about the theatre receipts

How is greater healthcare working with militaries around acute deployment care, records, TBI therapeutics and long-term cardiovascular and cerebrovascular science? Where are the quality metrics, agreed upon globally, for therapeutics, treatment and follow up during deployment operations?

Words for echo, infection prevention for stroke TBI: https://academic.oup.com/milmed/article/176/4/364/4345310

 

Something in quality to methodology in statistical analysis for CVD research

Cox regression is a staple in CVD work and could be a starting point in research quality checks. There should be alignment between Cox methodology, acceptable conclusions and a secondary epidemiological check.  Even if Cox variable work is not directed for detailed variable conclusion, agreement on methodology consistency is important. Integrity to the research should accompany Cox at all times, just in case, with publication requirements and notations in military systematic reviews.

Words for echo: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641800/

https://content.sciendo.com/configurable/contentpage/journals$002fslgr$002f43$002f1$002farticle-p33.xml

https://www.aaimedicine.org/AnnualMeetingPresentations/docs/concurrent-sessions/monday-oct-15/mortality-research---uses-&-limitations-of-cox-roc-&-other-statistics.pdf

Something in the way we consider populations

Comparative work between veterans of different wars has examined stroke incidence.  Where is the cardiovascular, TBI and stroke science in recent theatre deployments, comparative across countries, accounting for post-stroke management quality indicators?

Words to echo: https://www.sciencedirect.com/science/article/abs/pii/S1047279709003433

https://www.sciencedirect.com/science/article/abs/pii/S1052305796800061

Significant risk to cardiovascular health, and sometimes cerebrovascular health, may occur with neurological and mental health therapies. Where are the guidelines, metrics and risk reduction strategies for growing populations at risk?

 

Something in substance abuse science and international efforts

Substance abuse is an issue for US active duty and veteran populations, and this is an issue for other military populations as well. General population science in other countries could also detail populations by military status, pulling strong cardiovascular and stroke insight.

Words to echo:

https://www.tandfonline.com/doi/abs/10.1080/00325481.2020.1805945  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0173704

https://link.springer.com/article/10.1186/s12916-016-0721-4

 

As alcohol and other substance abuse is linked to ischemic stroke, cerebrovascular and cardiovascular diseases, and as the greater population has not solved nor successfully collaborated to address military-related substance abuse and mental health, why not put in extra interventions for this population? Why not automatically fund extra prevention, primary care guidance, physical fitness stipends, healthy eating incentives or other motivators for active duty and veteran populations?  Why not accept what we haven't yet solved as well as put extra buffers in to help the population affected? 

Words to echo:

https://www.rand.org/pubs/research_reports/RR4354.html

https://pubmed.ncbi.nlm.nih.gov/27881167/

https://www.rand.org/pubs/research_reports/RR1542.html

https://www.rand.org/blog/2020/09/ptsd-and-substance-use-disorders-are-a-vicious-cycle.html

Something in the way we move them

How can greater healthcare quality oversight, both nationally and internationally, move the dial on quality expectations for cardiovascular and cerebrovascular care in military health systems? We can start by moving heart health and stroke care quality, which is already structured. From here, we can begin to expand in cardiovascular and cerebrovascular health. There shouldn’t be so many quality reporting systems that are incompatible to comparison, locally, nationally and internationally. Stroke science is global, cardiovascular science is global, TBI science is becoming more global, quality to care should be just as cohesive.

Words to echo, for coordination between military and greater healthcare alignment:

https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Patient-Portal-for-MHS-Quality-Patient-Safety-and-Access-Information/See-How-Were-Doing/Navy/NMC-SAN-DIEGO?DmisId=0029

Words that could be echoed in VA stroke care assessment for greater veteran population (outside of the VA) insight: https://www.strokejournal.org/article/S1052-3057(18)30194-0/pdf  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6368016/  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707641/

Words to echo greater public should be tailored for military specifics: https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000173

https://www.ahajournals.org/doi/full/10.1161/STR.0000000000000114 

Words to echo international work in stroke care improvement should consider who among the population has military experience:

https://www.sciencedirect.com/science/article/abs/pii/S1052305717304238   https://www.sciencedirect.com/science/article/pii/S2468266718300306 

 

Written work and current operations have been initiated for CVD and cerebrovascular disease in active duty and veteran populations. This work should be significantly expanded with concepts in imitation, a highest form of communicated kinship. It all comes down to international alignment in helping active duty, veteran and general populations know that we are thinking of military cardiovascular and cerebrovascular health.

Let mockingbirds be heard.