John D. Sorkin

Background: Adverse health events have been reported among US service members who served at Karshi-Khanabad (K2) Air Base, Uzbekistan, but prior studies of cancer risk had key limitations. Methods: A nested case-control study to assess the association between K2 deployment and cancer outcomes among military personnel deployed between 2001 and 2005. Eight malignant outcomes (brain, colorectal, liver, urinary tract, pancreatic, prostate, leukemia, non-Hodgkin’s lymphoma [NHL]) were identified via health records from the Department of Defense and Veterans Administration through 2022. Cases were matched to controls (1:100) on age, sex, and health system usage. Covariate-adjusted conditional logistic regression models estimated outcome likelihood by exposure surrogates without and with lagging. Results: Among 619 403 service members, 15 031 (2.3%) were deployed at least once to K2 (median duration 130 days). We identified cancer cases (count; cumulative incidence per 10 000) for brain (450; 7.3), colorectal (1542; 25.0), liver (113; 1.8), urinary tract (1831; 29.7), pancreatic (417; 6.8), prostate (5165; 83.6), leukemia (707; 11.5), and NHL (1700; 27.5). Across 7 of 8 outcomes, there were no associations between deployment and case status. In contrast, each additional month of deployment increased the odds of NHL by 13% (95% CI = 4% to 23%) and deployment >180 days was associated with higher odds (OR = 1.78; 95% CI = 1.08 to 2.94). When lagging exposure by 12-15 years, these associations strengthened (range: OR=2.38 [95% CI = 1.17 to 4.82] to OR=3.09 [95% CI = 1.73 to 5.52]). Conclusions: Long-term K2 deployment was associated with increased likelihood of non-Hodgkin’s lymphoma. Careful clinical monitoring and continued follow-up of this cohort for cancer and other outcomes are warranted.

Background: Antipsychotic medication (APM) can cause weight gain, insulin resistance, dyslipidemias, and an increased risk of developing type-2 diabetes and cardiovascular disease among youth. The study sought to increase water consumption, reduce sugar-sweetened beverage (SSB) intake, and prevent unhealthy weight gain via a healthy lifestyle intervention among youth newly started on a second-generation APM for psychiatric treatment. Methods: This randomized controlled trial enrolled 148 Medicaid-insured youth (ages 8–17) recently starting APM. The treatment group received both a biweekly home-delivery of bottled water and parental phone support from a family navigator. In-home visits conducted at baseline, three months, and six months assessed the participants’ height/weight and dietary intake. All participants received basic healthy lifestyle education emphasizing increased water intake and decreased SSB consumption. Longitudinal linear mixed models were conducted to examine between-group and within-group changes in BMI z-scores, and water/SSB intake. Results: No significant between-group differences in BMI z-score were found at three (p = 0.908) and six months (p = 0.919). However, the within-group increase in BMI z-score in the control group was significant from baseline to three months (p = 0.029). A between-group comparison found the treatment group significantly increased their water intake at three (p = 0.006) and six months (p = 0.002). No between-group differences were identified at three and six months for the reduction in SSB, although the treatment group did demonstrate a decrease from baseline to three months (p = 0.004). Conclusions: Neither group experienced unhealthy increases (>0.5%) in BMI z-score over the six months. Providing a safe/free water supply showed a superior improvement in water consumption in the treatment group, and an initial decrease in SSB. Further studies are needed to identify feasible, effective, and sustainable lifestyle interventions tailored to this at-risk population.

Background: Foot ulcers are a common complication of diabetes, often resulting from peripheral neuropathy and inadvertent trauma. Poor healing is exacerbated by peripheral arterial disease and poor glycemic control. Off-loading, a key treatment, leads to prolonged immobility. Patients rarely regain baseline mobility. Mobility is crucial to improve glycemia, promote vascular health, and improve immobility as it leads to nursing home admissions. There is limited research on exercise during ulcer remission. Objective: This pilot study will assess the feasibility and acceptability of a home-based exercise regimen aimed at safely increasing mobility and function, focusing on improving lower extremity strength, tissue perfusion, and glycemic control. Methods: Veterans aged ≥50 years with a recently healed diabetic plantar foot ulcer receiving care in the US Department of Veterans Affairs (VA) Maryland Health Care System and enrolled in a remote temperature-sensing mat program will be eligible. Potential participants will be identified via administrative codes used for the Prevention of Amputation in Veterans Everywhere directive, as well as using the VA’s Podimetrics SmartMat dashboard. In this pilot study, 25 veterans will be randomized (in a 3:1 ratio) to a 12-week home-based exercise regimen or standard of care. Participants will undergo tests for gait speed, knee extension strength, cutaneous perfusion, and community mobility. The intervention group will participate in internet-based videoconference exercise classes twice a week led by the study team and home cycling 3 times a week. The control group will receive standard-of-care guidance. Outcome measures will include feasibility; acceptability; and changes in gait speed, physical activity levels, and strength. Results: This study was funded on July 1, 2024, with data collection planned from October 1, 2024, to March 31, 2026. The protocol was approved by the University of Maryland Institutional Review Board on May 13, 2024, and by the Baltimore VA Research and Development Committee on June 13, 2024. As of June 12, 2025, 12 participants have been enrolled in the study, and 6 (50%) participants have been randomized. Recruitment is expected to continue through December 2025. Conclusions: This project has potential for clinical rehabilitation translation. If it is found to be feasible and acceptable, the exercise intervention will be tested in a future multisite randomized clinical trial to assess its impact on mobility, cardiovascular events, and ulcer recurrence. Trial Registration: ClinicalTrials.gov NCT06312579; https://clinicaltrials.gov/ct2/show/NCT06312579 International Registered Report Identifier (IRRID): DERR1-10.2196/71237

Objectives: The Numerical Rating Scale is widely used for patient-reported appraisals of pain intensity; however, scale properties have limited utility for assessing chronic pain. Specifically, single pain ratings demonstrate high intraindividual variability. We propose an efficient alternative, termed hurdle analysis, separately analyzing zero and nonzero pain ratings. Methods: This retrospective study of 23,480 US Veterans diagnosed with low back pain (LBP) included 2.1 million unique pain ratings. Marginal distributions comprised of all pain ratings for each individual were parametrized with usual and hurdle analysis methods to holistically assess scale utilization. Results: The population was 87% male and 13% female; 41% Black, 38% White, and 2% Hispanic; modal age range was 65 years to 84 years (45 years–64 years) for men (women). Focusing on statistically informative records, ie, those with ≥100 pain ratings (22% of the total), the median [interquartile range] pain rating was 3.5 [2.3–4.7] (4.0 [3.0–5.1]) for men (women). Marginal distributions were non-normal, with zero being the modal value in 79% (73%) of men (women). In hurdle analysis, the average proportion of zeroes was 0.39 (0.31) for men (women); the average nonzero pain rating was 5.9 [5.1–6.6] (6.0 [5.3–6.7]) for men (women). The nonzero averages, in contrast to standard averages, were normally distributed for the population and compared with data showed less bias and variance. Conclusion: Analysis of clinical pain ratings from Veterans with LBP with hurdle analysis yielded improved estimates of pain when-pain-is-present (ie, nonzero pain) and also demonstrated the variable presence of pain in this population. Further study of this approach appears warranted.

Background/Objectives: Long COVID-19 is characterized by persistent symptoms lasting three months or more following SARS-CoV-2 infection. Nutrition has emerged as a modifiable factor influencing recovery trajectories and symptom burden; however, existing evidence remains fragmented across diverse study designs and populations. This scoping review synthesized global evidence on the role of diet and nutrition in managing long COVID-19 symptoms and supporting recovery. Methods: Following PRISMA-ScR and Joanna Briggs Institute guidelines for scoping reviews, we searched major biomedical databases for studies published between 2020 and 2025. Eligible studies examined dietary intake, nutritional status, or nutrition-related interventions in adults with long COVID-19. Results: After duplicates were removed, 1808 records were screened, resulting in 50 studies that met the inclusion criteria—27 intervention studies and 23 observational studies. Nutritional exposures included micronutrients (e.g., vitamins D, K₂), amino acids (e.g., L-arginine), multinutrient formulations, microbiota-targeted therapies (e.g., probiotics, synbiotics), nutritional status, diet quality, and whole-diet patterns (e.g., the Mediterranean diet). Approximately 76% of studies reported improvements in long COVID-19-related symptoms such as fatigue, mood disturbances, physical function, and markers of inflammation. Conclusions: Diet and nutrition may support long COVID-19 recovery by targeting inflammation and the gut microbiome to alleviate symptoms and improve functional outcomes. Well-powered trials of whole-diet approaches, combined with targeted supplementation, are needed to confirm their potential as scalable, accessible tools for post-COVID-19 recovery and management.

Background: Nearly half of all veterans are 65 years and older, and they have a higher prevalence of functional disabilities compared to the nonveteran population. Balance impairments resulting in injurious falls are a leading cause of morbidity and mortality in older adults. Instability or fear of falling can significantly reduce physical activity and social participation, even in the absence of falls. Dysmobility is a leading factor in long-care admissions, and therefore, maintenance of mobility throughout aging is crucial. Recent evidence indicates lower extremity muscle weakness as a key risk factor for falls, with lower limb muscle strength and quality being critical for balance recovery. The primary hip abductors, the gluteus maximus, medius, and minimus, are particularly essential for balance recovery. Objective: This study aims to test the hypothesis that adding neuromuscular electrical stimulation (NMES) to a multimodality balance intervention (MMBI) will yield greater reductions in fall risk and improvements in muscle and mobility function compared with MMBI alone. Methods: This randomized controlled trial will enroll 80 veterans aged 55 years and older at risk for falls (defined by a four-square step test [FSST] time >12 seconds, history of falls, or fear of falling). Participants will be randomized to receive either NMES + MMBI or MMBI alone. The 12-week outpatient center–based intervention will include 3 sessions per week, focusing on hip abductor strength, balance, and mobility. Assessments will occur at baseline, postintervention, and at 6- and 12-month follow-ups. Primary outcomes include fall risk and dynamic balance, measured by FSST and hip abductor strength using a Biodex dynamometer. Secondary outcomes will examine muscle composition through computed tomography (CT) scans and assess gait variability parameters. Results: This study was funded on January 1, 2022, with a data collection period from April 1, 2022, to December 31, 2026. As of March 2025, we have screened 100 potential participants and excluded 38. Out of the 61 participants enrolled to date, 21 have completed the 12-month follow-up, 32 have completed the 6-month follow-up, and 41 have completed the posttesting. A total of 4 participants are currently in the intervention phase; 1 has just completed the baseline testing, while 15 have been dropped from the study. Conclusions: This trial will be the first large, randomized controlled trial to evaluate NMES as an adjunct to an MMBI for fall prevention in older veterans. If successful, NMES combined with hip abductor strengthening and balance training could provide a low-cost, scalable solution to reduce falls, improve balance and mobility, and decrease health care costs related to falls in older adults. This study will address a critical gap in knowledge about the effectiveness of NMES in enhancing rehabilitation outcomes for fall prevention. Trial Registration: ClinicalTrials.gov NCT04969094; https://clinicaltrials.gov/study/NCT04969094 International Registered Report Identifier (IRRID): DERR1-10.2196/68082

Background: The COVID-19 pandemic has had a profound impact on older adults, particularly those with existing comorbidities. To inform targeted healthcare strategies for this heterogeneous group, this study seeks to analyze and compare mortality trends among various geriatric age groups within the Veterans Affairs healthcare system, both during the COVID-19 era and the pre-COVID era, while accounting for demographic and clinical factors such as age, gender, race, and comorbidities. Methods: In this retrospective cohort study using Veterans Affairs Informatics and Computing Infrastructure data, two samples were analyzed: Veterans alive during the pre-COVID era (January 2019—December 2019) and during the COVID era (January 2020—December 2020). Propensity score matching was used to control for age, sex, race, body mass index, and comorbidities. Results: The primary outcome was mortality. Odds ratios (ORs) and 95% confidence intervals were calculated to compare mortality across age groups. Unmatched analyses, adjusted for age, sex, race, body mass index, and comorbidities, showed that mortality significantly increased during the COVID era for age groups 70–79 (OR 1.38), 80–89 (OR 1.14), and 90–99 (OR 1.20), all with p values < 0.0001. No significant increase was observed in centenarians (OR 1.10, 95% confidence interval 0.90–1.35, p = .345). Matched analysis confirmed these findings. Conclusions: In a large cohort of older Veterans, COVID-19 had a significant impact on mortality in older adults aged 70–99, highlighting the need for targeted public health interventions. The lack of significant increase in mortality for centenarians is notable and warrants further study to identify possible protective factors in this unique population.

Background: Plant-based diets are associated with various health benefits; however, their impact on physical performance in aging populations remains unclear. Objectives: To investigate the associations between adherence to plant-based diets and physical performance, focusing on their potential protective effects against age-related declines in function. Methods: Data were obtained from men and women aged 40 years or older in the Baltimore Longitudinal Study of Aging (BLSA) (mean ± SD age: 68 ± 13 years at the first dietary visit; n = 1389). Dietary intake was assessed using a food frequency questionnaire (FFQ). Plant-based diets, calculated from 18 food groups, were categorized as overall (PDI), healthful (hPDI), or unhealthful (uPDI), and their tertiles across visits were analyzed. Multivariable linear mixed-effects models were used to examine the association between repeated measurements of three physical performance outcomes—Short Physical Performance Battery (SPPB), grip strength (kg), and gait speed (m/s)—and adherence to each plant-based diet. Results: In fully adjusted models, SPPB and grip strength were significantly associated with both hPDI and uPDI, but not with PDI. For hPDI, the intermediate tertile showed the greatest benefit, with SPPB scores 0.5 points higher (β_T2vs.T1 = 0.50, 95% CI: 0.30–0.70, p < 0.001) over the follow-up period. In contrast, for uPDI, a 0.27-point lower SPPB score was seen (β_T3vs.T1 = −0.27, 95% CI: −0.48 to −0.07, p = 0.009). Longitudinally, grip strength was positively associated with hPDI (β_T3vs.T1 = 1.14, 95% CI: 0.24–2.05, p = 0.0013). Similar results were observed in older adults aged ≥65 years. Conclusions: Adherence to hPDI may benefit lower body function and muscle strength, while uPDI appears to have adverse effects. This suggests that the quality of plant-based foods is essential for maintaining functional well-being in older adults. Further research is needed to confirm these findings, explore underlying mechanisms, and identify strategies to optimize plant-based dietary patterns for aging populations.

BACKGROUND Nearly half of all veterans are 65 years and older, and they have a higher prevalence of functional disabilities compared to the nonveteran population. Balance impairments resulting in injurious falls are a leading cause of morbidity and mortality in older adults. Instability or fear of falling can significantly reduce physical activity and social participation, even in the absence of falls. Dysmobility is a leading factor in long-care admissions, and therefore, maintenance of mobility throughout aging is crucial. Recent evidence indicates lower extremity muscle weakness as a key risk factor for falls, with lower limb muscle strength and quality being critical for balance recovery. The primary hip abductors, the gluteus maximus, medius, and minimus, are particularly essential for balance recovery. OBJECTIVE This study aims to test the hypothesis that adding neuromuscular electrical stimulation (NMES) to a multimodality balance intervention (MMBI) will yield greater reductions in fall risk and improvements in muscle and mobility function compared with MMBI alone. METHODS This randomized controlled trial will enroll 80 veterans aged 55 years and older at risk for falls (defined by a four-square step test [FSST] time >12 seconds, history of falls, or fear of falling). Participants will be randomized to receive either NMES + MMBI or MMBI alone. The 12-week outpatient center–based intervention will include 3 sessions per week, focusing on hip abductor strength, balance, and mobility. Assessments will occur at baseline, postintervention, and at 6- and 12-month follow-ups. Primary outcomes include fall risk and dynamic balance, measured by FSST and hip abductor strength using a Biodex dynamometer. Secondary outcomes will examine muscle composition through computed tomography (CT) scans and assess gait variability parameters. RESULTS This study was funded on January 1, 2022, with a data collection period from April 1, 2022, to December 31, 2026. As of March 2025, we have screened 100 potential participants and excluded 38. Out of the 61 participants enrolled to date, 21 have completed the 12-month follow-up, 32 have completed the 6-month follow-up, and 41 have completed the posttesting. A total of 4 participants are currently in the intervention phase; 1 has just completed the baseline testing, while 15 have been dropped from the study. CONCLUSIONS This trial will be the first large, randomized controlled trial to evaluate NMES as an adjunct to an MMBI for fall prevention in older veterans. If successful, NMES combined with hip abductor strengthening and balance training could provide a low-cost, scalable solution to reduce falls, improve balance and mobility, and decrease health care costs related to falls in older adults. This study will address a critical gap in knowledge about the effectiveness of NMES in enhancing rehabilitation outcomes for fall prevention. CLINICALTRIAL ClinicalTrials.gov NCT04969094; https://clinicaltrials.gov/study/NCT04969094 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/68082