Military history of patients with inflammatory bowel disease: an epidemiological study among U.S. veterans

OBJECTIVES: The military history of patients with inflammatory bowel disease (IBD) contains types of exposure that are not available through other sources and may provide clues about the as-yet unknown etiology of IBD. We therefore sought to describe the epidemiology of IBD among veterans, with particular emphasis on their military history. METHODS: A case-control study compared 10,544 IBD patients and 42,026 controls with respect to age, gender, ethnicity, time period of military service, military duty in Vietnam, status as prisoner of war, and exposure to Agent Orange. RESULTS: Subjects with Crohn's disease were younger than those with ulcerative colitis or without IBD (odds ratio: 0.85; 95% confidence interval [CI]: 0.83-0.87). Both types of IBD affected female veterans significantly more often than male veterans, the relative female predominance being more pronounced in Crohn's disease than ulcerative colitis (0.70; 0.61-0.81 vs 0.83; 0.71-0.96). Whites were more prone to develop both types of IBD than nonwhites (2.46; 2.27-2.68 vs 2.11; 1.95-2.27). Military duty in Vietnam and a status as prisoner of war both exerted a protective influence against Crohn's disease (0.84; 0.75-0.96 and 0.60; 0.41-0.87, respectively), but not ulcerative colitis. CONCLUSIONS: The results are consistent with the hypothesis that exposure to poor sanitation decreases the future risk of developing Crohn's disease.     

Study of the bioequivalence of a new isosorbide dinitrate tablet formulation compared with the standard preparation

Army Chemical Corps personnel who served in Vietnam were among those service personnel with the greatest potential for exposure to herbicides. An earlier evaluation of the mortality experience of 894 Army Chemical Corps Vietnam veterans found a statistically significant excess risk of dying from digestive disease, primarily due to cirrhosis of the liver, and from motor vehicle accidents. That study was expanded to include 2,872 Vietnam veterans who served with the Army Chemical Corps and a comparison cohort of 2,737 veterans who never served in Southeast Asia but who did serve in the same occupational category. The results of the analysis comparing the Vietnam cohort to the non-Vietnam cohort support the earlier finding of a significant excess of deaths from digestive diseases (adjusted relative risk (RR) = 3.88, 95% C.I. = 1.12-13.45) primarily due to liver cirrhosis. Non-significant elevated relative risks were observed for all cancers combined, digestive and respiratory systems cancers, skin cancer, lymphopoietic cancers, and respiratory system diseases. Compared to the mortality rates in the general population, the non-Vietnam Army Chemical Corps veterans had a statistically significant deficit in mortality from all causes combined, which is consistent with a 'healthy selection bias' seen among military populations (SMR = 0.79, 95% C.I. = 0.66-0.94). For the Vietnam veterans, patterns of elevated but nonsignificant SMRs persisted for diseases of the digestive and respiratory systems and for selected cancer sites.     

Posttraumatic stress disorder, exposure to combat, and lower plasma cortisol among Vietnam veterans: Findings and clinical implications.

Several clinical studies suggest that individuals with posttraumatic stress disorder (PTSD) experience neuroendocrine system alterations, resulting in significantly lower plasma cortisol. To test this hypothesis, morning serum cortisol was compared among a national sample of Vietnam "theater" veterans (n?=?2,490) and a sample of Vietnam "era" veterans (n?=?1,972) without service in Vietnam. Analysis of covariance was used to compare cortisol concentrations after adjusting for 9 covariates (education, income, race, age, smoking status, alcohol use, illicit drug use, medication use, and body mass index ). Adjusted cortisol was lower among theater veterans with current PTSD but not era or theater veterans with lifetime PTSD. Among theater veterans, cortisol was inversely related to combat exposure, with veterans exposed to heavy combat having the lowest concentrations. Analysis of plasma cortisol, together with other clinical data, may be instrumental in the future diagnosis and treatment of stress disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive potentials in children with learning disabilities

This study investigated factors predicting help-seeking from the Department of Veterans' Affairs (DVA) by Vietnam veterans. Data used were from a national Australian survey of Vietnam veterans' health (n = 641) conducted between July 1990 and April 1993. The survey involved current clinical assessments and retrospective questionnaires, supplemented with health and service records retrieved from the DVA and Army personnel files. Measures included the 1989-90 Australian Bureau of Statistics Health Survey questionnaire, and mental health, sociodemographic and operational deployment history questionnaires. For both current and lifetime diagnoses of post-traumatic stress disorder, a third of the veterans with the disorder had never obtained any health care entitlement from the DVA. Other than physical and mental problems, which accounted for the greatest proportion of the help-seeking odds, significant factors predicting help-seeking included factors such as: predeployment personality, combat exposure, the veterans' own attitudes towards their deployment, experiences during deployment, experiences during repatriation and membership of ex-service organisations. These findings on how post-traumatic stress disorder and other health problems relate to help-seeking patterns could help in developing prevention and care programs for stress disorder.     

Postservice mortality of US Air Force veterans occupationally exposed to herbicides in Vietnam: 15-year follow-up

The US Air Force continues to assess the mortality of veterans of Operation Ranch Hand, the unit responsible for aerially spraying herbicides in Vietnam. The authors of this study found that the cumulative all-cause mortality experience of these veterans was not different from that expected (standardized mortality ratio (SMR) = 1.0). Overall, cause-specific mortality did not differ from that expected regarding deaths from accidents, cancer, or circulatory system diseases, but the authors found that there was an increased number of deaths due to digestive diseases (SMR = 1.7, 95% confidence interval (CI) 0.9-3.2). When analyzing by military occupation, they found an increase in the number of deaths caused by circulatory system diseases (SMR = 1.5, 95% CI 1.0-2.2) among enlisted ground personnel, the subgroup with the highest dioxin levels. Most of the increase in the number of deaths from digestive diseases was caused by chronic liver disease and cirrhosis, and more than half of the increase in the number of deaths from circulatory system diseases was a result of atherosclerotic heart disease. In the subgroup of Ranch Hand veterans who had survived more than 20 years since their military service in Southeast Asia, the authors found no significant increase in the risk of death due to cancer at all sites (SMR = 1.1) and a nonsignificant increase in the number of deaths due to cancers of the bronchus and lung (SMR = 1.3).     

Environmental tobacco smoke and lung cancer

In a case-control study of 1,004 lung cancer cases and 1,004 population controls, all nonsmokers (71 cases, 236 controls) were interviewed for their exposure to environmental tobacco smoke. On the basis of indices of duration, we separated intermediate and high exposures from low or no exposure. The odds ratio for high exposure was 2.09 (95% confidence interval = 1.02-4.28). Exposure from the spouse was only weakly associated with lung cancer risk. We found little association for exposure during childhood. High exposure at the work place showed an odds ratio of 1.91. There was little indication of confounding by dietary habits.     

Post-traumatic stress disorder and functioning and quality of life outcomes in female Vietnam veterans

OBJECTIVE: This investigation assessed whether current post-traumatic stress disorder (PTSD) was associated with impaired functioning in a nationally representative sample of female Vietnam veterans. METHODS: Logistic models were used to determine the association between PTSD and outcome while adjusting for demographic characteristics and medical and psychiatric co-morbidities. RESULTS: PTSD was associated with significantly elevated odds of poorer functioning in five of the six outcome domains; only the association between perpetration of violence in the past year and PTSD did not achieve statistical significance. After adjusting for demographics and medical and psychiatric co-morbidities, PTSD remained associated with significantly elevated odds of bed days, poorer physical health, and currently not working. CONCLUSIONS: Among female Vietnam veterans PTSD is associated with a broad profile of functional impairment. The significantly increased odds of impaired functioning and diminished quality of life suggest that PTSD may be the core problem of the set of problems afflicting female Vietnam veterans.     

Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care

OBJECTIVE: Epidemiologic studies have linked exposure to severe environmental stress, such as natural disasters and combat operations, to the onset of specific psychiatric disorders. Some research also suggests that these exposures may be associated with the onset of chronic diseases as well. However, these chronic disease outcome studies often have been obscured by bias and confounding. METHOD: The medical histories of 1399 male Vietnam veterans approximately 20 years after combat exposure (mean years = 17) were analyzed by lifetime posttraumatic stress disorder (PTSD) status (lifetime PTSD = 332 cases). These men were included in a national, random in-person study of United States Army veterans of the Vietnam War (study completion rate = 65%). RESULTS: After controlling for preservice, in-service, and postservice factors (including intelligence, race, region of birth, enlistment status, volunteer status, Army marital status, Army medical profile, hypochondriasis, age, smoking history, substance abuse, education, and income), associations were found for reported circulatory [odds ratio (OR) = 1.62, p = .007], digestive (OR = 1.47, p = .036), musculoskeletal (OR = 1.78, p = .008), endocrine-nutritional-metabolic (OR = 1.58, p = .10), nervous system (OR = 2.47, p < .001), respiratory (OR = 1.54, p = .042), and nonsexually transmitted infectious diseases (OR = 2.14, p < .004) after military service. CONCLUSION: Although this study has some limitations, it suggests that there is a direct link between severe stress exposures and a broad spectrum of human diseases. In the future, medical researchers and clinicians should focus more on the medical consequences of exposure to severe environmental stress and seek to better integrate psychobiologic models of disease pathogenesis.     

Stress-disorder symptoms in Vietnam and Korean War veterans.

Compared the incidences of stress-disorder and non-stress-disorder "control" symptoms in the records of 58 Vietnam and Korean War veterans (mean age 25.15 yrs) hospitalized for psychiatric problems between 9 and 36 mo after return from their respective war zones. No significant difference in the percentages of symptoms observed in the 2 groups that fell into the stress-disorder category were found. The percentages of Vietnam veterans who qualified or nearly qualified for stress-disorder diagnoses under criteria from the DSM-III were not larger than the percentages of their Korean War counterparts. Results suggest that stress disorder is neither unique to nor inordinately common among Vietnam veteran psychiatric patients. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of mental and physical health service utilization among Vietnam veterans.

This study investigated predictors of mental and physical health care service utilization among 1,632 male (n = 1,200) and female (n = 432) Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. Using Anderson's theory as a model (Anderson & Bartkus, 1973), the authors examined both direct and mediated relationships among predisposing factors (i.e., age, marital status, and combat exposure), enabling factors (e.g., household income and insurance), and need factors (e.g., medical and psychological symptomatology) and physical and mental health care utilization outcomes. Need factors were the most consistent and strongest mediators of predisposing variables for both physical and mental health care service utilization, although there were differences between male and female veterans. For men, combat exposure indirectly predicted mental health care utilization through the need variables (with the effects of posttraumatic stress disorder being greatest). For women, physical health problems mediated the relationship between combat exposure and physical health outpatient care utilization. These findings have implications for screening and outreach efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder among Army Nurse Corps Vietnam veterans.

Extended an examination conducted by the 1st author (1984) of posttraumatic stress disorder (PTSD) among active-duty and reserve US Army Vietnam veterans to 361 US Army nurses (mean age 41.5 yrs) who had served in Vietnam and 351 Vietnam-era US Army nurses (mean age 38.7 yrs) who had not served in Vietnam. Analysis of questionnaire data obtained from Ss revealed a current PTSD rate for Vietnam veteran nurses of 3.3%. This rate was comparable to that found among nonnurse active-duty Army Vietnam veterans (5.1%) in the earlier study and was much lower than estimates (18–54%) for civilian Vietnam veterans. Results suggest that danger and exposure to violence may be responsible for stress reactions such as PTSD among noncombatants. Additional results indicate that social support is an important moderator in the attenuation of PTSD. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Australian Vietnam Veterans Health Study: II. self-reported health of veterans compared with the Australian population

BACKGROUND: Self-reported physical health status of Australian Vietnam veterans was determined 20-25 years after the war and its relation to combat was investigated. METHOD: An epidemiological cohort study of a simple random sample of Army veterans posted to Vietnam between 1964 and 1972 was conducted with personal interviews using the Australian Bureau of Statistics Health Interview Survey questionnaire to compare veterans with the Australian population and a 21-item combat exposure index used to measure the relationship of combat to physical health. RESULTS: Veterans reported greater health service usage and more recent health actions than population expectations. They also reported excess health problems in almost all recent illness disease categories except endocrine conditions and cardiovascular conditions; only 6 of 37 chronic disease groups were not elevated compared to the population. Adjustment for non-response changed estimates only slightly. Combat exposure was significantly related to reports of recent and chronic mental disorders, recent hernia and chronic ulcer, recent eczema and chronic rash, deafness, chronic infective and parasitic disease, chronic back disorders and symptoms, signs and ill-defined conditions. CONCLUSION: Combat exposure may have significantly increased reports of only some health problems. A general position to complain as a result of psychological conditions due to combat is not consistent with the lack of relationship between combat and reports of physical conditions.     

Protection by endoscopy against death from colorectal cancer. A case-control study among veterans

BACKGROUND: Although several clinical and epidemiologic studies suggest that timely diagnostic procedures of the large bowel may reduce mortality from colorectal cancer, the evidence for this relationship is primarily circumstantial. METHODS: A case-control study was conducted among hospitalized US military veterans to investigate whether diagnostic procedures of the large bowel were performed in the period preceding the diagnosis of colorectal cancer less frequently in patients dying of colorectal cancer than in control patients. Data files of a total of 4411 veterans dying of colorectal cancer between 1988 and 1992 were extracted from the records of the US Department of Veterans Affairs, Washington, DC. Data of four living control patients and four dead control patients without colorectal cancer were matched by age, sex, and race to each case patient. The case and the two control populations were compared by conditional logistic regression, calculating odds ratios, and their 95% confidence interval. RESULTS: Diagnostic procedures of the large bowel reduced mortality from colorectal cancer, the odds ratio being 0.41 (range, 0.33 to 0.50) for the comparison with living control patients. The protective effects of proctosigmoidoscopy, colonoscopy, and polypectomy lasted for 5 years. The procedures were protective against death from cancer of the colon, as well as cancer of the rectum. The most protective influence was associated with removal of tissue through biopsy, fulguration, and polypectomy. Similar influences were found comparing case patients with dead control patients. CONCLUSION: Removal of tissue represents the most effective means to reduce mortality from cancers of the large bowel. It retains its efficacy over a time period of 5 years.     

Lipid lowering in a multidisciplinary clinic compared with primary physician management

OBJECTIVE: This study analyzed questionnaire items that address complaints about sleep from the National Vietnam Veterans Readjustment Study, a nationally representative sample of the 3.1 million men and women who served in Vietnam. This study compared the frequency of nightmares and difficulties with sleep onset and sleep maintenance in male Vietnam theater veterans with male Vietnam era veteran and male civilian comparison subjects. It focused on the role of combat exposure, nonsleep posttraumatic stress disorder (PTSD) symptoms, comorbid psychiatric and medical disorder, and substance abuse in accounting for different domains of sleep disturbance. METHOD: The authors undertook an archival analysis of the National Vietnam Veterans Readjustment Study database using correlations and linear statistical models. RESULTS: Frequent nightmares were found exclusively in subjects diagnosed with current PTSD at the time of the survey (15.0%). In the sample of veterans who served in Vietnam (N = 1,167), combat exposure was strongly correlated with frequency of nightmares, moderately correlated with sleep onset insomnia, and weakly correlated with disrupted sleep maintenance. A hierarchical multiple regression analysis showed that in Vietnam theater veterans, 57% of the variance in the frequency of nightmares was accounted for by war zone exposure and non-sleep-related PTSD symptoms. Alcohol abuse, chronic medical illnesses, panic disorder, major depression, and mania did not predict the frequency of nightmares after control for nonsleep PTSD symptoms. CONCLUSIONS: Frequent nightmares appear to be virtually specific for PTSD. The nightmare is the domain of sleep disturbance most related to exposure to war zone traumatic stress.     

Posttraumatic stress disorder among U.S. Army Reserve Vietnam and Vietnam-era veterans.

Analysis of questionnaire data collected in the spring of 1982 from 935 randomly selected Vietnam and Vietnam-era veterans (mean age 36.7 yrs) assigned to US Army Reserve troops units nationwide revealed a posttraumatic stress disorder (PTSD) rate for Vietnam veteran reservists of 10.9%, which is midrange between estimates for civilian (18–54%) and active duty Army (5.1%) Vietnam veterans. Results suggest that the quality of social support received during Vietnam duty and the 1st yr back may serve to either moderate or exacerbate PTSD symptomatology associated with combat experience. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorders in Vietnam veterans: Selected bibliographical addendum to Fairbank et al., Silver, and Arnold.

J. A. Fairbank et al (see record 1982-12226-001), presented a selected bibliography on contributions relevant to posttraumatic stress disorder (PTSD) in Vietnam veterans. Their selection included research and clinical reports found in psychological and medical journals, books and government publications, which were pertinent to epidemiology, etiology, symptomatology, and treatment of PTSD in Vietnam veterans, plus narratives by Vietnam veterans and research germane to PTSD from other conflicts. S. M. Silver (see record 1983-03626-001) updated Fairbank et al., with 171 since-published articles, reports, and other references. A. Arnold's (1987) bibliograpy contains over 1,000 clinical references, as well as accounts of the Vietnam War. This addendum is an attempt to update the enormous body of PTSD literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological effects of military service in Vietnam: A meta-analysis.

To integrate research on the psychological status of Vietnam veterans, we conducted a meta-analysis of 67 studies appearing in the literature from 1972 through 1985. Mean effect size, representing the comparison between Vietnam veterans and others on a variety of mental health indicators, was a significant –0.53. There was a tendency for larger effect sizes in studies that appeared later, were published by researchers affiliated with the Veterans Administration, documented combat history, but did not incorporate a comparison group. Vietnam veterans were significantly different from both Vietnam-era veterans and nonveterans, with the pattern of differences indicating a "Vietnam effect." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder

This study used quantitative volumetric magnetic resonance imaging techniques to explore the neuroanatomic correlates of chronic, combat-related posttraumatic stress disorder (PTSD) in seven Vietnam veterans with PTSD compared with seven nonPTSD combat veterans and eight normal nonveterans. Both left and right hippocampi were significantly smaller in the PTSD subjects compared to the Combat Control and Normal subjects, even after adjusting for age, whole brain volume, and lifetime alcohol consumption. There were no statistically significant group differences in intracranial cavity, whole brain, ventricles, ventricle:brain ratio, or amygdala. Subarachnoidal cerebrospinal fluid was increased in both veteran groups. Our finding of decreased hippocampal volume in PTSD subjects is consistent with results of other investigations which utilized only trauma-unexposed control groups. Hippocampal volume was directly correlated with combat exposure, which suggests that traumatic stress may damage the hippocampus. Alternatively, smaller hippocampi volume may be a pre-existing risk factor for combat exposure and/or the development of PTSD upon combat exposure.     

Interpersonal problem solving and coping reactions of Vietnam veterans with posttraumatic stress disorder.

In order to assess the relation between posttraumatic stress disorder (PTSD) and interpersonal problem solving and coping, 43 Vietnam veterans were assigned to the following four groups: (a) combat veterans with PTSD, (b) combat veterans with severe adjustment problems but not PTSD-diagnosable (AP), (c) combat veterans who were well adjusted (WA), and (d) veterans with little or no combat exposure who served during the Vietnam era (ERA). Multivariate analyses of variance indicated that both the PTSD and AP groups reported less effective coping reactions and poorer problem solving than both the WA and ERA groups. The PTSD subjects also reported less effective problem solving and less problem-focused coping reactions than the AP veterans. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)