The impact of killing on mental health symptoms in Gulf War veterans.

This study examined the impact of killing on posttraumatic stress symptomatology (PTSS), depression, and alcohol use among 317 U.S. Gulf War veterans. Participants were obtained via a national registry of Gulf War veterans and were mailed a survey assessing deployment experiences and postdeployment mental health. Overall, 11% of veterans reported killing during their deployment. Those who reported killing were more likely to be younger and male than those who did not kill. After controlling for perceived danger, exposure to death and dying, and witnessing killing of fellow soldiers, killing was a significant predictor of PTSS, frequency and quantity of alcohol use, and problem alcohol use. Military personnel returning from modern deployments are at risk of adverse mental health symptoms related to killing in war. Postdeployment mental health assessment and treatment should address reactions to killing in order to optimize readjustment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War.

Confirmatory factor analysis was used to compare 6 models of posttraumatic stress disorder (PTSD) symptoms, ranging from 1 to 4 factors, in a sample of 3,695 deployed Gulf War veterans (N = 1,896) and nondeployed controls (N = 1,799). The 4 correlated factors-intrusions, avoidance, hyperarousal, and dysphoria-provided the best fit. The dysphoria factor combined traditional markers of numbing and hyperarousal. Model superiority was cross-validated in multiple subsamples, including a subset of deployed participants who were exposed to traumatic combat stressors. Moreover, convergent and discriminant validity correlations suggested that intrusions may be relatively specific to PTSD, whereas dysphoria may represent a nonspecific component of many disorders. Results are discussed in the context of hierarchical models of anxiety and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Course and predictors of posttraumatic stress disorder among Gulf War veterans: A prospective analysis.

Rates and predictors of posttraumatic stress disorder (PTSD) over time are not well understood. This study is the first to look at the rates of PTSD immediately following war and 2 years later using a large cohort (N?=?2,949) of Gulf War veterans. Using a cut score to indicate presumptive PTSD, 3% of participants exceeded the cutoff at Time 1 compared with 8% at Time 2. Those who exceeded the cutpoint at Time 1 were up to 20 times more likely to exceed the cutpoint at Time 2 than those who did not exceed the cutpoint at Time 1. Women and those with high levels of combat exposure were at increased risk for PTSD at both times. Being young, being single, and having previous combat experience were associated with increased risk at Time 1 only, whereas reservists and enlisted personnel were at increased risk at Time 2 only. These findings indicate that, although low initially, rates of PTSD increased substantially over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in immune parameters seen in Gulf War veterans but not in civilians with chronic fatigue syndrome

Primary cultures of rat cerebral cortical cells and cerebellar granule cells die by an apoptotic mechanism after more than 2 weeks in cultures in the absence of medium change and glucose supplement, a process termed age-induced apoptosis of cultured neurons. Our preliminary study has shown that age-induced apoptosis of cerebellar granule cells is protected by pretreatment with tetrahydroaminoacridine (THA), an antidementia drug. In this study, we systematically compared the neuroprotective effects of THA with those of (S)-1-[N-(4-chlorobenzyl)succinamoyl]pyrrolidine-2-carbaldehyde (ONO-1603), a novel prolyl endopeptidase inhibitor and potential antidementia drug. Both ONO-1603 and THA effectively delay age-induced apoptosis of cerebral and cerebellar neurons, as demonstrated morphologically with toluidine blue and fluorescein diacetate/propidium iodide staining or biochemically by DNA laddering analysis on agarose gels. ONO-1603 is about 300 times more potent than THA, with a maximal protective effect at 0.03 and 10 microM, respectively. ONO-1603 shows a wide protective range of 0.03 to 1 microM in contrast to a narrow effective range of 3 to 10 microM for THA. Moreover, ONO-1603 is nontoxic to neurons, even at the high concentration of 100 microM, whereas THA elicits severe neurotoxicity at a dose of >/=30 microM. Both ONO-1603 and THA robustly suppress overexpression of glyceraldehyde-3-phosphate dehydrogenase (GAPDH; EC 1.2.1.12) mRNA and accumulation of GAPDH protein in a particulate fraction of cultured neurons undergoing age-induced apoptosis. Because we documented that GAPDH overexpression participates in neuronal apoptosis induced by various insults, we conclude that the neuroprotective actions of ONO-1603 and THA appear to be mediated by suppression of this protein overexpression.     

Fear-potentiated startle conditioning to explicit and contextual cues in Gulf War veterans with posttraumatic stress disorder.

Aversive conditioning to explicit and contextual cues was examined in Gulf War veterans with and without posttraumatic stress disorder (PTSD) by use of the startle reflex methodology. Veterans participated in a differential aversive conditioning experiment consisting of 2 sessions separated by 4 or 5 days. Each session comprised two startle habituation periods, a preconditioning phase, a conditioning phase, and a postconditioning extinction test. In contrast to the non-PTSD group, the PTSD group showed a lack of differential startle response in the presence of a conditioned stimulus with or without an unconditioned stimulus in Session 1 and an increase in the baseline startle response during Session 2. The PTSD group also exhibited normal differential conditioning following reconditioning in Session 2. These data suggest that individuals with PTSD tend to generalize fear across stimuli and are sensitized by stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musculoskeletal manifestations, pain, and quality of life in Persian Gulf War veterans referred for rheumatologic evaluation

OBJECTIVE: Pain in the joints and other areas has been a frequent complaint among veterans of Operation Desert Storm who are experiencing unexplained illness. We characterized the rheumatic manifestations of a group of veterans of the Persian Gulf War who were referred to a rheumatology clinic. METHODS: Consecutive South Texas veterans of the Persian Gulf War who were referred for evaluation of rheumatic manifestations underwent a comprehensive evaluation of their musculoskeletal symptoms, pain, and health related quality of life. RESULTS: Of 928 veterans evaluated in a screening clinic for unexplained symptoms, 145 had rheumatic manifestations (15.6%) and were referred to a rheumatology clinic. The most common diagnosis was fibromyalgia, present in 49 patients (33.8%), followed by various soft tissue problems in 25 (17.2%), nonspecific arthralgias in 14 (9.6%), and clinical or radiographic osteoarthritis in 16 (11.0%). In 39 patients (26.9%), no symptoms were present at the time of the evaluation, a careful musculoskeletal examination and laboratory tests were normal, and no diagnosis was possible. Two patients had Reiter's syndrome. Four had a positive rheumatoid factor and 3 had antinuclear antibodies, but none of these had clinical evidence of rheumatoid arthritis or systemic lupus erythematosus. Pain was present in nearly all patients and was widely distributed, with no body area spared in this group of patients. The most frequent painful areas were the knees in > 65%, the lower back in > 60%, the shoulders in 50%, and the hands and wrists in 35%. Widespread body pain was present in 65.1% of the veterans. Average values of all 8 scales measured by the SF-36 health survey were below the 25th percentile of published national norms, with pain and the number of nonarticular rheumatic symptoms explaining most of the decreased health related quality of life in the veterans we evaluated. CONCLUSION: No specific rheumatic diagnosis is characteristic of Gulf War veterans with unexplained illness referred to a rheumatology clinic. However, pain is common and widespread in these patients, and their health related quality of life is poor. Further research is necessary to determine the cause of the symptoms of veterans of the Gulf War.     

Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: A prospective analysis.

The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N?=?2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region and 18–24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat–Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Followup models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-reported chemical sensitivity and wartime chemical exposures in Gulf War veterans with and without decreased global health ratings

BACKGROUND: The appetite-suppressant drug fenfluramine, usually given in combination with phentermine, has been reported to be associated with cardiac valvular regurgitation. Concern has been raised that the d-enantiomer of fenfluramine, dexfenfluramine, may also cause this problem. We were able to study the question by modifying an ongoing trial comparing dexfenfluramine with regular dexfenfluramine and placebo. METHODS: We modified our randomized, double-blind, placebo-controlled study of dexfenfluramine to include echocardiographic examinations of 1072 overweight patients within a median of one month after the discontinuation of treatment. The patients (approximately 80 percent of whom were women) had been randomly assigned to receive dexfenfluramine (366 patients), investigational sustained-release dexfenfluramine (352 patients), or placebo (354 patients). The average duration of treatment was 71 to 72 days in each of the three groups. Echocardiograms were assessed in a blinded fashion. RESULTS: When all degrees of valvular regurgitation were considered and when the two dexfenfluramine groups were combined, there was a higher prevalence of any degree of aortic regurgitation (17.0 percent vs. 11.8 percent, P=0.03) and any degree of mitral regurgitation (61.4 percent vs. 54.4 percent, P=0.01) in the active-treatment groups than in the placebo group. These differences were primarily due to a higher prevalence of physiologic, trace, or mild regurgitation. Analyses that used the criteria of the Food and Drug Administration for aortic regurgitation of mild or greater severity and mitral regurgitation of moderate or greater severity found no statistically significant difference among the groups (P=0.14 to 0.75). These analyses showed that aortic regurgitation of mild or greater severity occurred in 5.0 percent of the patients in the dexfenfluramine group, 5.8 percent of those in the sustained-release dexfenfluramine group, 5.4 percent of those in the two active-treatment groups combined, and 3.6 percent of those in the placebo group. Mitral regurgitation of moderate or greater severity occurred in 1.7, 1.8, 1.8, and 1.2 percent, respectively. Aortic regurgitation of mild or greater severity, mitral regurgitation of moderate or greater severity, or both occurred in 6.5 percent, 7.3 percent, 6.9 percent, and 4.5 percent, respectively. CONCLUSIONS: The increased prevalence of aortic and mitral regurgitation in patients treated with dexfenfluramine was small, and the degree of regurgitation was usually classified as physiologic, trace, or mild. However, the duration of therapy was short, and whether therapy of longer duration would yield the same or different results is not known.     

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).     

Horsemen of the Apocalypse: lessons from the Gulf War

War is a major global threat to human health, not only in the immediate effects of death and injury to the people, but also in the damage to infrastructures such as food, water, and power supplies and to social structures that support families, economies, and governments. Iraq's devastating aftershocks from the Gulf War include the physical and psychologic effects of displacement, poverty, famine, disease, and environmental destruction. Early nursing leaders vocally opposed World War I, and contemporary nurses should consider becoming activists in the primary and secondary prevention of this major global health problem.     

Assessment of posttraumatic stress disorder in World War II veterans.

Four posttraumatic stress disorder (PTSD) scales were compared in a community sample of 330 American former prisoners of war and combat veterans of World War II. The Mississippi Scale for Combat-Related PTSD (M-PTSD), the MMPI-2 Pk PTSD scale, and the Impact of Event Scale (IES) all demonstrated moderate relationships with PTSD as defined by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). Comparative validities were similar to those observed in Vietnam veteran samples. Confirmatory factor analysis indicated that the 3 scales loaded significantly on 1 factor. The impact of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PTSD criteria changes was examined and found to be minimal. Implications for the use of the M-PTSD, Pk, and IES in combat-related PTSD assessment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical evaluation of Persian Gulf veterans with fatigue and/or chemical sensitivity

The purpose of this study was to determine if Gulf War veterans with complaints of severe fatigue and/or chemical sensitivity (n = 72) fulfill case definitions for chronic fatigue syndrome (CFS) and/or multiple chemical sensitivity (MCS) and to compare the characteristics of those veterans who received a diagnosis of CFS (n = 24) to a group of non-veterans diagnosed with CFS (n = 95). Thirty-three veterans received a diagnosis of CFS with 14 having MCS concurrently; an additional six had MCS but did not fulfill a case definition for CFS. The group of fatigued veterans receiving a diagnosis of CFS was comprised of significantly fewer women and fewer Caucasians than the civilian group, and significantly fewer veterans reported a sudden onset to their illness. Veterans with CFS had a milder form of the illness than their civilian counterparts based on medical examiner assessment of the severity of the symptoms, reported days of reduced activity, and ability to work. Since CFS in veterans seems less severe than that seen in civilians, the prognosis for recovery of veterans with this disorder may be better.     

Interpretive algorithms for the symptom-limited exercise test: assessing dyspnea in Persian Gulf war veterans

The mechanisms by which respiratory syncytial virus (RSV) infection induces bronchiolitis and airway disease are unclear. The presence of large numbers of polymorphonuclear leukocytes (PMN) in the airways of infants with RSV infection suggests a potential role of PMN in airway injury associated with RSV infection. To investigate the potential role of neutrophils in RSV bronchiolitis, human alveolar type II cells (A549 cells) were infected with different doses of RSV for 6-48 h. A 51Cr-releasing assay was used to measure PMN-induced damage and image analysis was used to determine PMN adhesion and detachment of epithelial cells. The results showed that RSV infection of epithelial cells enhanced PMN adherence in a dose- and time-dependent pattern, RSV infection alone could damage and detach epithelial cells to a limited extent and PMN significantly augmented RSV infection-induced damage and detachment of epithelial cells. These data suggest that respiratory syncytial virus infection of respiratory epithelial cells enhances neutrophil adhesion to the epithelium and that activated neutrophils augment the damage and detachment of epithelium infected with the virus. Polymorphonuclear leukocytes may contribute to the pathogenesis of respiratory syncytial virus airway disease by inducing epithelial damage and cell loss.     

海湾战争与美国世界新秩序构想的实践

20世纪80年代末,世界形势发生了显著的变化,冷战时期美苏双方紧张对峙的局面不复存在,于是美国为了维护自身世界惟一的超级大国地位,迅速借助1990年8月爆发的海湾危机提出了建立世界新秩序的构想.在后来的海湾战争中美国将建立世界新秩序的构想予以实践,显示了争夺战争中的领导地位、维护地区利益和分担战争责任以及防止武器扩散等方面的特点.海湾战争结束后,美国在战争中的辉煌胜利更加推动了这一构想的丰富与发展.     

海湾战争与美国世界新秩序构想的实践

20世纪80年代末,世界形势发生了显著的变化,冷战时期美苏双方紧张对峙的局面不复存在,于是美国为了维护自身世界惟一的超级大国地位,迅速借助1990年8月爆发的海湾危机提出了建立世界新秩序的构想。在后来的海湾战争中美国将建立世界新秩序的构想予以实践,显示了争夺战争中的领导地位、维护地区利益和分担战争责任以及防止武器扩散等方面的特点。海湾战争结束后,美国在战争中的辉煌胜利更加推动了这一构想的丰富与发展。     

Caregiver burden in partners of Vietnam War veterans with posttraumatic stress disorder.

Caregiver burden in 58 partners of Vietnam War veterans with posttraumatic stress disorder (PTSD) was examined. The relationship between patient PTSD severity and caregiver burden, as well as the effect of several caregiver and patient variables on caregiver psychological status, was evaluated twice, an average of 8 months apart. Patient symptom severity was positively correlated with caregiver burden. Time 1 cross-sectional analysis indicated that greater caregiver burden was associated with greater caregiver psychological distress, dysphoria, and anxiety. Patient symptom severity also contributed to caregiver psychological distress; financial stress contributed to caregiver dysphoria and trait anxiety. Time 2 cross-sectional analyses essentially replicated the Time 1 findings. A third set of analyses examining change scores indicated that changes in caregiver burden for individuals in the sample positively predicted individual changes in caregiver psychological distress, dysphoria, and state anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)