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Ly MT, Adler J, Ton Loy AF, Edmonds EC, Bondi MW, Delano-Wood L. Comparing neuropsychological, typical, and ADNI criteria for the diagnosis of mild cognitive impairment in Vietnam-era veterans. J Int Neuropsychol Soc 2024; 30:439-447. [PMID: 38263745 DOI: 10.1017/s135561772301144x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Neuropsychological criteria for mild cognitive impairment (MCI) more accurately predict progression to Alzheimer's disease (AD) and are more strongly associated with AD biomarkers and neuroimaging profiles than ADNI criteria. However, research to date has been conducted in relatively healthy samples with few comorbidities. Given that history of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are risk factors for AD and common in Veterans, we compared neuropsychological, typical (Petersen/Winblad), and ADNI criteria for MCI in Vietnam-era Veterans with histories of TBI or PTSD. METHOD 267 Veterans (mean age = 69.8) from the DOD-ADNI study were evaluated for MCI using neuropsychological, typical, and ADNI criteria. Linear regressions adjusting for age and education assessed associations between MCI status and AD biomarker levels (cerebrospinal fluid [CSF] p-tau181, t-tau, and Aβ42) by diagnostic criteria. Logistic regressions adjusting for age and education assessed the effects of TBI severity and PTSD symptom severity simultaneously on MCI classification by each criteria. RESULTS Agreement between criteria was poor. Neuropsychological criteria identified more Veterans with MCI than typical or ADNI criteria, and were associated with higher CSF p-tau181 and t-tau. Typical and ADNI criteria were not associated with CSF biomarkers. PTSD symptom severity predicted MCI diagnosis by neuropsychological and ADNI criteria. History of moderate/severe TBI predicted MCI by typical and ADNI criteria. CONCLUSIONS MCI diagnosis using sensitive neuropsychological criteria is more strongly associated with AD biomarkers than conventional diagnostic methods. MCI diagnostics in Veterans would benefit from incorporation of comprehensive neuropsychological methods and consideration of the impact of PTSD.
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Affiliation(s)
- Monica T Ly
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | - Jennifer Adler
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | - Adan F Ton Loy
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Emily C Edmonds
- Banner Alzheimer's Institute, Tucson, AZ, USA
- Departments of Neurology and Psychology, University of Arizona, Tucson, AZ, USA
| | - Mark W Bondi
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego Health, La Jolla, CA, USA
- Center for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA
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Kovnick MO, Young Y, Tran N, Teerawichitchainan B, Tran TK, Korinek K. The Impact of Early Life War Exposure on Mental Health among Older Adults in Northern and Central Vietnam. J Health Soc Behav 2021; 62:526-544. [PMID: 34622692 PMCID: PMC8633195 DOI: 10.1177/00221465211039239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Most Vietnamese young adults who experienced the American War were exposed to war-related violence, which can exert a lifelong impact. We analyze survey data collected among northern and central Vietnamese older adults in the 2018 Vietnam Health and Aging Study (N = 2,447) to examine the association between various war traumas, psychological distress, and suicidal ideation. Informed by life course and stress process perspectives, we use structural equation models with multiple mediators to analyze the relationship between mental health outcomes and five types of wartime stress exposure: loss of family and friends, witnessing death, malevolent living conditions, life threat, and moral injury. Our findings reveal enduring mental health impacts of war among survivors. Wartime stress exposure's influence on mental health is mediated by recent comorbidities and stressful life events. Loss of family members, witnessing death, and malevolent living conditions during war are particularly salient risks for psychological distress.
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Affiliation(s)
| | | | - Nhung Tran
- University of Utah, Salt Lake City, UT, USA
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Hong P, Song YG, Paek S. Possible effects of agent orange and posttraumatic stress disorder on hyperglycemia in Korean veterans from the US-Vietnam war. Medicine (Baltimore) 2021; 100:e26508. [PMID: 34160471 PMCID: PMC8238358 DOI: 10.1097/md.0000000000026508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/12/2021] [Indexed: 01/04/2023] Open
Abstract
This study was conducted to examine whether Korean veterans from the US-Vietnam War who had a diagnosis of type II diabetes mellitus (T2DM) as well as past history of exposure to agent orange (AO) are vulnerable to hyperglycemia when receiving intra-articular corticosteroid injection (IACI) for pain relief.The current study included a total of 49 patients (n = 49) who received an injection of triamcinolone 20 or 40 mg to the shoulder under sonographic guidance or did that of dexamethasone 10 mg or triamcinolone 40 mg combined with dexamethasone 20 mg to the spine under fluoroscopic guidance. Their 7-day fasting blood glucose (FBG) levels were measured and then averaged, serving as baseline levels. This is followed by measurement of FBG levels for 14 days of IACI. Respective measurements were compared with baseline levels. The patients were also evaluated for whether there are increases in FBG levels depending on insulin therapy as well as HbA1c ≥ 7% or HbA1c < 7%.Overall, there were significant increases in FBG levels by 64.7 ± 42.5 mg/dL at 1 day of IACI from baseline (P < .05). HbA1c ≥ 7% and HbA1c < 7% showed increases in FBG levels by 106.1 ± 49.0 mg/dL and 46.5 ± 3.8 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). In the presence and absence of insulin therapy, there were significant increases in them by 122.6 ± 48.7 mg/dL and 48.0 ± 20.4 mg/dL, respectively, at 1 day of IACI from baseline (P < .05). But there were decreases in them to baseline levels at 2 days of IACI.Clinicians should consider the possibility of hyperglycemia when using corticosteroids for relief of musculoskeletal pain in Korean veterans from the US-Vietnam War who had a history of exposure to AO.
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Affiliation(s)
- Pa Hong
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Yun Gyu Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Sungwoo Paek
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea
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Rytel MR, Butler R, Eliot M, Braun JM, Houseman EA, Kelsey KT. DNA methylation in the adipose tissue and whole blood of Agent Orange-exposed Operation Ranch Hand veterans: a pilot study. Environ Health 2021; 20:43. [PMID: 33849548 PMCID: PMC8045317 DOI: 10.1186/s12940-021-00717-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/08/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Between 1962 and 1971, the US Air Force sprayed Agent Orange across Vietnam, exposing many soldiers to this dioxin-containing herbicide. Several negative health outcomes have been linked to Agent Orange exposure, but data is lacking on the effects this chemical has on the genome. Therefore, we sought to characterize the impact of Agent Orange exposure on DNA methylation in the whole blood and adipose tissue of veterans enrolled in the Air Force Health Study (AFHS). METHODS We received adipose tissue (n = 37) and whole blood (n = 42) from veterans in the AFHS. Study participants were grouped as having low, moderate, or high TCDD body burden based on their previously measured serum levels of dioxin. DNA methylation was assessed using the Illumina 450 K platform. RESULTS Epigenome-wide analysis indicated that there were no FDR-significantly methylated CpGs in either tissue with TCDD burden. However, 3 CpGs in the adipose tissue (contained within SLC9A3, LYNX1, and TNRC18) were marginally significantly (q < 0.1) hypomethylated, and 1 CpG in whole blood (contained within PTPRN2) was marginally significantly (q < 0.1) hypermethylated with high TCDD burden. Analysis for differentially methylated DNA regions yielded SLC9A3, among other regions in adipose tissue, to be significantly differentially methylated with higher TCDD burden. Comparing whole blood data to a study of dioxin exposed adults from Alabama identified a CpG within the gene SMO that was hypomethylated with dioxin exposure in both studies. CONCLUSION We found limited evidence of dioxin associated DNA methylation in adipose tissue and whole blood in this pilot study of Vietnam War veterans. Nevertheless, loci in the genes of SLC9A3 in adipose tissue, and PTPRN2 and SMO in whole blood, should be included in future exposure analyses.
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Affiliation(s)
- Matthew R. Rytel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
| | - Rondi Butler
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Pathology and Laboratory Medicine, Brown University School of Public Health, Providence, RI 02912 USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
| | - Joseph M. Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
| | - E. Andres Houseman
- Statistical Bioinformatics, GlaxoSmithKline, 1250 S Collegeville Rd, Collegeville, PA 19426 USA
| | - Karl T. Kelsey
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Pathology and Laboratory Medicine, Brown University School of Public Health, Providence, RI 02912 USA
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Oh JS, Lee CH, Park JI, Park HK, Hwang JK. Hypertension-Mediated Organ Damage and Long-term Cardiovascular Outcomes in Asian Hypertensive Patients without Prior Cardiovascular Disease. J Korean Med Sci 2020; 35:e400. [PMID: 33316856 PMCID: PMC7735919 DOI: 10.3346/jkms.2020.35.e400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/27/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hypertension-mediated organ damage (HMOD), comprising structural and functional changes in arteries or end organs, is a marker of cardiovascular (CV) disease. However, there are limited data on evaluation of risk of CV disease regarding HMOD, especially in Asians. We sought to investigate the association between CV events and HMOD, and we tried to determine the most important diagnostic marker among the component of HMOD for prevention of mortality and CV events in treated Korean hypertensive patients. METHODS From January 2008 to December 2010, a total of 35,000 hypertensive Vietnamese War veterans who consecutively visited our hospital for medical check-up were reviewed, and 6,158 patients without established CV disease were enrolled. The patients were divided into two groups as follows: HMOD group (n = 766) and non-HMOD group (n = 5,392). The primary outcome was all-cause death. RESULTS Median age was 63.3 years (interquartile range [IQR], 61.4-65.4), and median follow-up was 6.6 years (IQR, 5.9-7.2). Patients with old age, diabetes, and chronic kidney disease were more prevalent in the HMOD group than in the non-HMOD group (all P < 0.05). The lipid profiles were not significantly different between the two groups. Nephropathy was the most prevalent (54.7%) organ damage in the HMOD group. The 6-year incidence of all-cause death was higher in the HMOD group than in the non-HMOD group (22.5% vs. 9.0%; adjusted hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.01-2.00; P = 0.04). The incidence of cardiac death, ischemic heart disease, and ischemic and hemorrhagic stroke were also significantly higher in the HMOD group than in the non-HMOD group (P < 0.05, respectively). In multivariate analysis, proteinuria (adjusted HR, 2.21; 95% CI, 1.52-3.20; P < 0.001) was the most powerful independent risk factor to predict all-cause death among components of HMOD. As the degree of proteinuria increased, the rate of all-cause death also increased (long-rank P < 0.001). CONCLUSION HMOD was associated with increased risk of mortality and CV events. Proteinuria was the most powerful independent risk factor for all-cause death, and the degree of proteinuria and mortality rate were proportional. Our data suggest that monitoring of the proteinuria is important to predict long-term CV events in hypertensive patients.
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Affiliation(s)
- Jung Sun Oh
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Chang Hoon Lee
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Joong Il Park
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hoon Ki Park
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Jin Kyung Hwang
- Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea.
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Abshire M. Caring for Our Heroes: On Guns, War, Depression, and Pain. J Psychosoc Nurs Ment Health Serv 2020; 58:2. [PMID: 32853388 DOI: 10.3928/02793695-20200616-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Olson MD. The Influence of Social Exclusion on Posttraumatic Stress Reactions in Older Adult Veterans. Soc Work 2020; 65:123-130. [PMID: 32211796 DOI: 10.1093/sw/swaa008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 06/10/2023]
Abstract
The relationship between social exclusion and posttraumatic stress reactions in aging veterans is a particularly timely issue, warranting greater attention in the social work literature. Research with military veterans indicates that the social marginalization resulting from racial and ethnic discrimination can exacerbate posttraumatic stress symptoms. This marginalization suggests an increased potential for emergent or recurrent trauma reactions in aging military veterans, as previous research has documented older adults' unique risk for social exclusion. The issue takes on greater relevance as increased numbers of Vietnam veterans enter older adulthood. Professionals working with military veterans should be aware of the social and cultural factors that play a critical role in posttrauma response and recovery.
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Kelsey KT, Rytel M, Dere E, Butler R, Eliot M, Huse SM, Houseman EA, Koestler DC, Boekelheide K. Serum dioxin and DNA methylation in the sperm of operation ranch hand veterans exposed to Agent Orange. Environ Health 2019; 18:91. [PMID: 31665024 PMCID: PMC6819394 DOI: 10.1186/s12940-019-0533-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/01/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Exposure to the herbicide Agent Orange during the Vietnam War was widespread and is associated with numerous adverse health outcomes. A continuing concern of veterans is the possibility that exposure to the dioxin-containing herbicide might induce adverse reproductive outcomes. We sought to assess whether exposure to Agent Orange in Vietnam was associated with changes in DNA methylation in sperm in a subset of Vietnam veterans who participated in the Air Force Health Study (AFHS). METHODS We studied 37 members of the AFHS chosen to have no, low, medium or high exposure to Agent Orange, based upon serum dioxin levels obtained during a series of examinations. DNA from stored semen was extracted and DNA methylation assessed on the Illumina 450 K platform. RESULTS Initial epigenome-wide analysis returned no loci that survived control for false discovery. However, the TEAD3 gene had four different CpG sites that showed loss of DNA methylation associated with dioxin exposure. Analysis assessing regional DNA methylation changes revealed 36 gene regions, including the region of the imprinted gene H19 to have altered DNA methylation associated with high exposure compared to the low exposure group. Additional comparison of our data with sperm DNA methylation data from Russian boys exposed to dioxin found an additional 5 loci that were altered in both studies and exhibited a consistent direction of association. CONCLUSIONS Studying a small number of sperm samples from veterans enrolled in the AFHS, we did not find evidence of significant epigenome-wide alterations associated with exposure to Agent Orange. However, additional analysis showed that the H19 gene region is altered in the sperm of Agent Orange-exposed Ranch Hand veterans. Our study also replicated several findings of a prior study of dioxin-exposed Russian boys. These results provide additional candidate loci for further investigation and may have implications for the reproductive health of dioxin-exposed individuals.
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Affiliation(s)
- Karl T. Kelsey
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Pathology and Laboratory Medicine, Brown University School of Public Health, Providence, RI 02912 USA
| | - Matthew Rytel
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
| | - Edward Dere
- Department of Pathology and Laboratory Medicine, Brown University School of Public Health, Providence, RI 02912 USA
| | - Rondi Butler
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Pathology and Laboratory Medicine, Brown University School of Public Health, Providence, RI 02912 USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI 02912 USA
| | - Susan M. Huse
- NIAID Collaborative Bioinformatics Resource, Frederick National Laboratory for Cancer Research, Frederick, MD 21701 USA
| | | | - Devin C. Koestler
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66160 USA
| | - Kim Boekelheide
- Department of Pathology and Laboratory Medicine, Brown University School of Public Health, Providence, RI 02912 USA
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Korinek K, Teerawichitchainan B, Zimmer Z, Brindle E, Nguyen TKC, Nguyen HM, Tran KT. Design and measurement in a study of war exposure, health, and aging: protocol for the Vietnam health and aging study. BMC Public Health 2019; 19:1351. [PMID: 31646987 PMCID: PMC6806496 DOI: 10.1186/s12889-019-7680-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survivors of war throughout the world experience illnesses and injuries that are crucial to understand, given the ongoing treatment and adaptation they demand. In developing countries like Vietnam, where population aging and chronic disease burdens are rapidly rising, aging populations have seen a disproportionate share of armed conflict and related casualties. This paper describes the Vietnam Health and Aging Study (VHAS), a unique resource for investigating mechanisms of association between diverse exposures to armed conflict during the Vietnam War and multiple dimensions of older adult health among survivors of that war. METHODS The VHAS utilizes a longitudinal design, the first wave of data collection conducted in 2018 among 2447 older adults. A second wave of follow-up data collection, scheduled to take place in 2021, will examine life course, social relational and health and mortality transitions. The VHAS was conducted in four northern Vietnamese districts purposively selected to represent a spectrum of war exposure as indicated by intensity of bombings. Additionally, VHAS uses random sampling within gender and military service subdomains to permit unique gender-specific analyses of military service, trauma exposure and health. The VHAS' face-to-face interviews include modules detailing war and military service experiences; warzone stressors; and multiple dimensions of health such as chronic disease, functional limitation, disability, health behaviors, cognition and psychological health. Biomarker data collected for the full VHAS sample includes anthropometric and functional tests such as grip strength and blood pressure, hair samples for cortisol assay, and capillary blood samples to assay C-reactive protein, cholesterol, HbA1c, and other markers of interest for cardiovascular and other disease risks and for testing the impact of early life stressors on later life health. Blood samples will also permit epigenetic analysis of biological aging. DISCUSSION Future VHAS investigations will examine dynamic linkages between war exposure, mortality and morbidity, while taking into account the selective nature of each of these processes. Longitudinal analyses will examine late-life health transitions and war-related resiliency.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, 380 S 1530 E, Room 301, Salt Lake City, Utah, USA.
| | | | | | | | | | - Huu Minh Nguyen
- Vietnam Institute for Family and Gender Studies, Hanoi, Vietnam
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Schmidt EM, Magruder K, Kilbourne AM, Stock EM, Cypel Y, El Burai Félix S, Serpi T, Kimerling R, Cohen B, Spiro A, Furey J, Huang GD, Frayne SM. Four Decades after War: Incident Diabetes among Women Vietnam-Era Veterans in the HealthViEWS Study. Womens Health Issues 2019; 29:471-479. [PMID: 31519465 DOI: 10.1016/j.whi.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We analyzed long-term differences in incident diabetes associated with military service in a warzone among women who served during the Vietnam War era. METHODS For HealthViEWS, the largest later-life study of women Vietnam War-era U.S. veterans, a population-based retrospective cohort who served during 1965-1973 completed a health interview in 2011-2012. This cohort included women deployed to Vietnam, near Vietnam, or who served primarily in the United States. We hypothesized a warzone exposure gradient: Vietnam (highest exposure), near Vietnam, and the United States (lowest exposure). We used an extended Cox regression to test for differences in incident diabetes by location of wartime service. RESULTS Of 4,503 women in the analysis, 17.7% developed diabetes. Adjusting for demographics and military service characteristics, hazard of incident diabetes was significantly lower initially in the Vietnam group compared with the U.S. group (hazard ratio, 0.33; 95% confidence interval, 0.15-0.69). However, lower diabetes hazard in the Vietnam group was not constant over time; rather, hazard accumulated faster over time in the Vietnam group compared with the U.S. group (hazard ratio, 1.38; 95% confidence interval, 1.11-1.72). No significant difference in diabetes hazard was found between the near Vietnam and U.S. groups. Older age during military service, minority race/ethnicity, and lower military rank were associated with a higher diabetes hazard. CONCLUSIONS Women deployed to a warzone might have protective health factors that lower risk for diabetes early in their military career, but delivery systems for long-term health should consider that a lower risk for chronic diseases like diabetes can wane quickly in the decades that follow warzone service.
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Affiliation(s)
- Eric M Schmidt
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; Program Evaluation Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Central Office, Menlo Park, California.
| | - Kathryn Magruder
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Amy M Kilbourne
- Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Eileen M Stock
- Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Yasmin Cypel
- Epidemiology Program Post-Deployment Health Services, Office of Patient Care Services, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Suad El Burai Félix
- Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Tracey Serpi
- Perry Point/Baltimore Coordinating Center, Cooperative Studies Program, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, Maryland
| | - Rachel Kimerling
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, California
| | - Beth Cohen
- General Internal Medicine, San Francisco VA Medical Center, San Francisco, California; School of Medicine, University of California, San Francisco, California
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Health Care System, Boston, Massachusetts; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts; Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts
| | | | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, District of Columbia
| | - Susan M Frayne
- Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California
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11
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Marini CM, Fiori KL, Wilmoth JM, Pless Kaiser A, Martire LM. Psychological Adjustment of Aging Vietnam Veterans: The Role of Social Network Ties in Reengaging with Wartime Memories. Gerontology 2019; 66:138-148. [PMID: 32079014 PMCID: PMC7056538 DOI: 10.1159/000502340] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
It is projected that by 2020 there will be 8.7 million veterans over the age of 65 years, more than half (64%) of whom served during the Vietnam War. The effects of military service on mental health and well-being may be more pronounced later in life among those who served in Vietnam than prior cohorts of veterans. Many veterans confront and rework their wartime memories later in life in an attempt to find meaning and coherence, engaging in a process referred to as Later-Adulthood Trauma Reengagement (LATR). LATR often occurs in the context of other stressors that are a normative part of aging, such as role transitions (e.g., retirement), declines in physical health, and the death of close others (e.g., spouses), perhaps because these events trigger reminiscence. Importantly, LATR may result in either positive (e.g., acceptance) or negative (e.g., distress) psychological outcomes. It has been suggested that the presence of social/environmental resources, including socioemotional support, may aid veterans in successfully navigating LATR. We, therefore, review relevant areas of research to delineate the role that various layers of social context may play in -helping - or hindering - aging Vietnam veterans as they navigate LATR in the context of normative late-life stressors. We conclude by offering fruitful directions for future research and applied implications for intervention efforts.
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Affiliation(s)
- Christina M Marini
- Department of Psychology, The Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA,
| | - Katherine L Fiori
- Department of Psychology, The Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Janet M Wilmoth
- Department of Sociology, Aging Studies Institute, Syracuse University, Syracuse, New York, USA
| | - Anica Pless Kaiser
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lynn M Martire
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, Pennsylvania, USA
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Walsh K. Volunteer Service From American Physicians During the Vietnam War. AMA J Ethics 2019; 21:E806-E812. [PMID: 31550230 DOI: 10.1001/amajethics.2019.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article draws on resources from the American Medical Association Archives on the Volunteer Physicians for Vietnam Program (1966-1973) to consider benefits and costs of immersion opportunities in medical education. Selected images and reports illuminate how such programs can influence both physicians-in-training and the environments in which they are immersed.
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Affiliation(s)
- Kelsey Walsh
- The program administrator in the American Medical Association's Department of Records Management and Archives in Chicago, Illinois
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Abstract
Music can influence clinicians' and patients' mental states and emotions via the capacity of rhythm and tone to entrain. Entrainment can facilitate relaxation and distraction from pain and has a role to play in experiences with and in health care. In this article, we discuss the benefits of music from the perspectives of a physician and a veteran.
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Affiliation(s)
- Doug Bradley
- A distinguished lecturer emeritus at the University of Wisconsin-Madison
| | - Omar Viswanath
- An anesthesiologist and interventional pain medicine physician who practices in Phoenix, Arizona, and a clinical assistant professor of anesthesiology at Creighton University School of Medicine and the University of Arizona College of Medicine-Phoenix
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Voisey J, Lawford B, Bruenig D, Harvey W, Morris CP, Young RM, Mehta D. Differential BDNF methylation in combat exposed veterans and the association with exercise. Gene 2019; 698:107-112. [PMID: 30831210 DOI: 10.1016/j.gene.2019.02.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 01/24/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) gene is associated with increased risk of posttraumatic stress disorder (PTSD) and plays a role in neuroplasticity, cognition and memory. BDNF has strong potential as a therapeutic target as studies have shown that antidepressants, electroconvulsive treatment and exercise modulate BDNF expression and methylation. In this study we examined the role of BDNF methylation and expression in PTSD and the implications of exercise in mediating these effects. BDNF DNA methylation and gene expression analysis was performed in a sample of 96 male Vietnam veterans. Cases were combat-exposed veterans with current PTSD (n = 48) and controls were combat exposed veterans with no past or current PTSD diagnosis (n = 48). No association between BDNF mRNA and PTSD was identified. PTSD was associated with decreased methylation at three BDNF CpG sites (cg01546433 P = 0.004835; cg24650785 P = 0.000259 and cg002298481 P = 0.000672). Differential BDNF methylation was associated with exercise, with active exercise associated with lower methylation levels at three CpG sites (cg04481212 P = 0.005; cg01546433 P = 0.025 and cg00298481 P = 0.035). Given that exercise mediates BDNF action on cognitive plasticity, exercise may be a non-invasive, drug free option in the treatment of PTSD.
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Affiliation(s)
- Joanne Voisey
- Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, 60 Musk Avenue, Queensland University of Technology Kelvin Grove, Queensland 4059, Australia.
| | - Bruce Lawford
- Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, 60 Musk Avenue, Queensland University of Technology Kelvin Grove, Queensland 4059, Australia
| | - Dagmar Bruenig
- Institute of Health and Biomedical Innovation (IHBI), School of Psychological and Counselling, 60 Musk Avenue, Queensland University of Technology Kelvin Grove, Queensland 4059, Australia; Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street Greenslopes, Queensland 4120, Australia
| | - Wendy Harvey
- Gallipoli Medical Research Institute, Greenslopes Private Hospital, Newdegate Street Greenslopes, Queensland 4120, Australia
| | - Charles P Morris
- Institute of Health and Biomedical Innovation (IHBI), School of Biomedical Sciences, 60 Musk Avenue, Queensland University of Technology Kelvin Grove, Queensland 4059, Australia
| | - Ross McD Young
- Institute of Health and Biomedical Innovation (IHBI), School of Psychological and Counselling, 60 Musk Avenue, Queensland University of Technology Kelvin Grove, Queensland 4059, Australia
| | - Divya Mehta
- Institute of Health and Biomedical Innovation (IHBI), School of Psychological and Counselling, 60 Musk Avenue, Queensland University of Technology Kelvin Grove, Queensland 4059, Australia
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Brown T. Noam Chomsky (1928-), Fierce and Formidable Critic of the Vietnam War. Am J Public Health 2018; 108:1025. [PMID: 29995472 PMCID: PMC6050830 DOI: 10.2105/ajph.2018.304465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2018] [Indexed: 03/29/2024]
Affiliation(s)
- Theodore Brown
- Theodore M. Brown is with the Departments of History and Public Health Sciences, University of Rochester, Rochester, NY
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16
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Baird T, McLeay S, Harvey W, Theal R, Law D, O'Sullivan R. Sleep Disturbances in Australian Vietnam Veterans With and Without Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:745-752. [PMID: 29734981 PMCID: PMC5940424 DOI: 10.5664/jcsm.7096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Posttraumatic stress disorder (PTSD) is a condition that may develop after a traumatic event, particularly combat-related trauma. Although sleep disturbance is a hallmark of PTSD, the prevalence of sleep disturbances in Australian veterans with PTSD remains uncertain. This study aimed to subjectively compare the prevalence of sleep disturbances in Australian Vietnam veterans with and without PTSD. METHODS A cross-sectional cohort study compared trauma-exposed Australian Vietnam veterans with and without PTSD. PTSD diagnosis was confirmed using the Clinician Administered PTSD Scale for DSM-5. Sleep information was evaluated using supervised structured questionnaires, including Epworth Sleepiness Scale (ESS) and Berlin and Mayo Questionnaires. RESULTS Two hundred fourteen male Vietnam veterans (108 with PTSD) were included. Participants with PTSD had higher body mass index (30.3 versus 29 kg/m2; P < .05), higher ESS score (9.2 versus 7.6; P < .05), and increased alcohol or medication use to assist with sleep (19% versus 6%; P < .01; and 44% versus 14%; P < .01). Those with PTSD were less likely to sleep well (32% versus 72%; P < .01) and reported higher rates of restless legs (45% versus 25%; P < .01), nightmares (91% versus 29%; P < .01), nocturnal screaming (73% versus 18%; P < .01), sleep terrors (61% versus 13%; P < .01) and dream enactment (78% versus 11.8%; P < .01). The PTSD group had higher rates of diagnosed OSA (42% versus 21%; P < .01) and an increased risk of OSA on the Berlin Questionnaire (69% versus 43%; P < .01). CONCLUSIONS Compared to trauma-exposed controls, Australian Vietnam veterans with PTSD demonstrated an increased prevalence of a wide range of sleep disturbances, including OSA. In veterans with PTSD, detailed sleep assessment, including consideration of polysomnography, is paramount.
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Affiliation(s)
| | - Sarah McLeay
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Wendy Harvey
- Greenslopes Private Hospital, Brisbane, Australia
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Rebecca Theal
- Gallipoli Medical Research Institute, Brisbane, Australia
| | - Dayna Law
- Greenslopes Private Hospital, Brisbane, Australia
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17
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Fried DA, Rajan M, Tseng CL, Helmer D. Impact of presumed service-connected diagnosis on the Department of Veterans Affairs healthcare utilization patterns of Vietnam-Theater Veterans: A cross-sectional study. Medicine (Baltimore) 2018; 97:e0662. [PMID: 29742706 PMCID: PMC5959385 DOI: 10.1097/md.0000000000010662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
During the Vietnam War, the US military sprayed almost 20 million gallons of Agent Orange (AO), an herbicide contaminated with dioxin, over Vietnam. Approximately, 2.7 million US military personnel may have been exposed to AO during their deployment. Ordinarily, veterans who can demonstrate a nexus between a diagnosed condition and military service are eligible for Department of Veterans Affairs (VA) service-connected disability compensation. Vietnam Veterans have had difficulty, however, establishing a nexus between AO exposure and certain medical conditions that developed many years after the war. In response, VA has designated certain conditions as "presumed service connected" for Vietnam Veterans who were present and possibly exposed. Veterans with any of these designated conditions do not have to document AO exposure, making it easier for them to access the VA disability system. The extent to which VA healthcare utilization patterns reflect easier access afforded those with diagnosed presumptive conditions remains unknown. In this cross-sectional study, we hypothesized that Vietnam Veterans with diagnosed presumptive conditions would be heavier users of the VA healthcare system than those without these conditions. In our analysis of 85,699 Vietnam Veterans, we used binary and cumulative logit multivariable regression to assess associations between diagnosed presumptive conditions and VA healthcare utilization in 2013. We found that diagnosed presumptive conditions were associated with higher odds of 5+ VHA primary care visits (OR = 2.01, 95% CI: 1.93-2.07), 5+ specialty care visits (OR = 2.11, 95% CI: 2.04-2.18), emergency department use (OR = 1.22, 95% CI: 1.11-1.34), and hospitalization (OR = 1.23, 95% CI: 1.17-1.29). Consistent with legislative intent, presumptive policies appear to facilitate greater VA system utilization for Vietnam Veterans who may have been exposed to AO.
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Affiliation(s)
- Dennis A. Fried
- War Related Illness and Injury Study Center, VA-New Jersey Healthcare System 385 Tremont Avenue, East Orange, NJ
- Department of Epidemiology, Rutgers School of Public Health
| | - Mangala Rajan
- War Related Illness and Injury Study Center, VA-New Jersey Healthcare System 385 Tremont Avenue, East Orange, NJ
| | - Chin-lin Tseng
- War Related Illness and Injury Study Center, VA-New Jersey Healthcare System 385 Tremont Avenue, East Orange, NJ
- New Jersey Medical School, Rutgers, The State University of New Jersey 185 South Orange Avenue, MSB, Newark, NJ
| | - Drew Helmer
- War Related Illness and Injury Study Center, VA-New Jersey Healthcare System 385 Tremont Avenue, East Orange, NJ
- New Jersey Medical School, Rutgers, The State University of New Jersey 185 South Orange Avenue, MSB, Newark, NJ
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18
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Hobson H, Hogeveen J, Brewer R, Catmur C, Gordon B, Krueger F, Chau A, Bird G, Grafman J. Language and alexithymia: Evidence for the role of the inferior frontal gyrus in acquired alexithymia. Neuropsychologia 2018; 111:229-240. [PMID: 29360519 PMCID: PMC8478116 DOI: 10.1016/j.neuropsychologia.2017.12.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 11/08/2017] [Accepted: 12/22/2017] [Indexed: 11/25/2022]
Abstract
The clinical relevance of alexithymia, a condition associated with difficulties identifying and describing one's own emotion, is becoming ever more apparent. Increased rates of alexithymia are observed in multiple psychiatric conditions, and also in neurological conditions resulting from both organic and traumatic brain injury. The presence of alexithymia in these conditions predicts poorer regulation of one's emotions, decreased treatment response, and increased burden on carers. While clinically important, the aetiology of alexithymia is still a matter of debate, with several authors arguing for multiple 'routes' to impaired understanding of one's own emotions, which may or may not result in distinct subtypes of alexithymia. While previous studies support the role of impaired interoception (perceiving bodily states) in the development of alexithymia, the current study assessed whether acquired language impairment following traumatic brain injury, and damage to language regions, may also be associated with an increased risk of alexithymia. Within a sample of 129 participants with penetrating brain injury and 33 healthy controls, neuropsychological testing revealed that deficits in a non-emotional language task, object naming, were associated with alexithymia, specifically with difficulty identifying one's own emotions. Both region-of-interest and whole-brain lesion analyses revealed that damage to language regions in the inferior frontal gyrus was associated with the presence of both this language impairment and alexithymia. These results are consistent with a framework for acquired alexithymia that incorporates both interoceptive and language processes, and support the idea that brain injury may result in alexithymia via impairment in any one of a number of more basic processes.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, Social Work and Counselling, University of Greenwich, Avery Hill Road, Eltham, London SE9 2UG, UK
| | - Jeremy Hogeveen
- University of California Davis, M.I.N.D. Institute, 2825 50th St, Sacramento, CA 95817, USA
| | - Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham TW20 0EX, UK
| | - Caroline Catmur
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Barry Gordon
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cognitive Science Department, Johns Hopkins University, Baltimore, MD, USA
| | - Frank Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, VA, USA
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Aileen Chau
- Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Geoffrey Bird
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AF, UK
- Department of Experimental Psychology, University of Oxford, 5 Parks Rd, Oxford OX1 3PH, UK
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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19
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End-of-Life Care for WW II, Korea, and Vietnam-Era Veterans. Home Healthc Now 2017; 35:E3-4. [PMID: 28953550 DOI: 10.1097/NHH.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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20
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Knight LK, Naaz F, Stoica T, Depue BE. Lifetime PTSD and geriatric depression symptomatology relate to altered dorsomedial frontal and amygdala morphometry. Psychiatry Res Neuroimaging 2017; 267:59-68. [PMID: 28763718 DOI: 10.1016/j.pscychresns.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) affects a large portion of combat deployed Veterans. Moreover, many individuals also suffer from comorbid late life depression (geriatric depression; GD). While a great deal of research has begun to characterize the morphometric features of PTSD and depression individually, few studies have investigated the interacting effect of these two disorders, specifically in a Veteran population. The current study used cortical and subcortical surface-based morphometry (SBM) in combination with psychological assessments of PTSD and GD symptom severity to examine morphometric alterations in Vietnam War Veterans. Our results indicated that increased GD severity, PTSD symptomatology, and their interaction, was related to decreased grey matter volume (GMV) in the left dorsomedial prefrontal cortex (dmPFC). Furthermore, increased symptomatology in the PTSD subscales of reexperiencing and hyperarousal were additionally found to be related to decreased GMV in this same dmPFC region. Subcortically, the interacting effect between PTSD and GD was also significantly related to regional shape variation in the left amygdala. These results suggest that morphometry of cortical (dmPFC) and non-neocortical regions (amygdala) putatively underlying emotional reactivity and the emotional components of memory is altered in PTSD and GD.
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Affiliation(s)
- Lindsay K Knight
- Interdisciplinary Program in Translational Neuroscience, University of Louisville, USA
| | - Farah Naaz
- Department of Psychological and Brain Sciences, University of Louisville, USA
| | - Teodora Stoica
- Interdisciplinary Program in Translational Neuroscience, University of Louisville, USA
| | - Brendan E Depue
- Department of Psychological and Brain Sciences, University of Louisville, USA; Department of Anatomical Sciences and Neurobiology, University of Louisville, USA.
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21
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22
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Abstract
The Vietnam War has long been regarded as pivotal in the history of the Republic of Korea, although its involvement in this conflict remains controversial. While most scholarship has focused on the political and economic ramifications of the war - and allegations of brutality by Korean troops - few scholars have considered the impact of the conflict upon medicine and public health. This article argues that the war had a transformative impact on medical careers and public health in Korea, and that this can be most clearly seen in efforts to control parasitic diseases. These diseases were a major drain on military manpower and a matter of growing concern domestically. The deployment to Vietnam boosted research into parasitic diseases of all kinds and accelerated the domestic campaign to control malaria and intestinal parasites. It also had a formative impact upon the development of overseas aid.
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Affiliation(s)
- Mark Harrison
- Wellcome Unit for the History of Medicine, University of Oxford, 45-47 Banbury Road, Oxford OX2 6PE, UK
| | - Sung Vin Yim
- Kyung Hee University College of Medicine, Seoul 130-701, Korea
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23
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Xian H, Vasilopoulos T, Liu W, Hauger RL, Jacobson KC, Lyons MJ, Panizzon M, Reynolds CA, Vuoksimaa E, Kremen WS, Franz CE. Steeper change in body mass across four decades predicts poorer cardiometabolic outcomes at midlife. Obesity (Silver Spring) 2017; 25:773-780. [PMID: 28349665 PMCID: PMC5373489 DOI: 10.1002/oby.21791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 12/19/2016] [Accepted: 01/04/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study examined patterns of change in adiposity across four decades starting in young adulthood as well as associations between change and midlife cardiometabolic outcomes. METHODS BMI was assessed at ages 20, 40, 56, and 62 years in 977 male veterans from the Vietnam Era Twin Study of Aging. Age 62 (range 56-66) cardiometabolic outcomes included hypertension, diabetes, dyslipidemia, inflammation, and ischemic heart disease. Analyses included latent growth modeling (LGM), latent class growth modeling (LCGM), and logistic regression models. RESULTS Linear BMI slope was associated with all outcomes. Accelerated (quadratic) BMI slope was significantly associated with greater risk for hypertension, diabetes, dyslipidemia, and inflammation; odds ratios ranged from 1.93 (diabetes) to 3.15 (dyslipidemia). Initial BMI did not predict later outcomes. Linear slope contributed significant unique variance for diabetes and dyslipidemia even controlling for age 62 BMI. LCGM revealed three trajectories. Men with the relatively stable, lower BMI trajectory had significantly better outcomes than those with trajectories with accelerated increases, especially those including obesity. CONCLUSIONS How individuals reach late-midlife BMI is important. Steepness of BMI change across 40 years from young adulthood to late midlife, in addition to late-midlife BMI itself, was robustly associated with greater risk for poor cardiometabolic outcomes.
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Affiliation(s)
- Hong Xian
- Department of Biostatistics, St. Louis University, St. Louis, Missouri, USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Weijian Liu
- Department of Biostatistics, St. Louis University, St. Louis, Missouri, USA
| | - Richard L Hauger
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Kristen C Jacobson
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Michael J Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Matthew Panizzon
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, California, USA
| | - Chandra A Reynolds
- Department of Psychology, University of California Riverside, Riverside, California, USA
| | - Eero Vuoksimaa
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - William S Kremen
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Carol E Franz
- Department of Psychiatry & Center for Behavior Genetics of Aging, University of California San Diego, La Jolla, California, USA
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Korinek K, Loebach P, Trinh HN. Military service and smoking in a cohort of northern Vietnamese older adults. Int J Public Health 2016; 62:43-51. [PMID: 27321700 DOI: 10.1007/s00038-016-0841-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/06/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Wide-ranging scholarship demonstrates war's impacts on US veterans' health. We ask whether, among Vietnamese men of a certain age, wartime experiences contributed to initiating smoking, and thus shaped one behavioral pathway linking war exposure and older adult health. METHODS We analyze the Vietnam Health and Aging Pilot Study (VHAPS), a survey of adults ages 55 and older (N = 405) conducted in one commune of northern Vietnam. We implement Cox discrete-time proportional hazards models to discern the effects of military service upon the initiation of smoking. RESULTS Military service results in a heightened risk of initiating smoking within this cohort (HR 2.13, [CI 1.36, 3.35]). Smoking initiation is also significantly gendered and age graded. Socioeconomic position and social capital variables in the models are statistically insignificant. CONCLUSIONS This study finds that, among older northern Vietnamese men whose early adulthood coincided with mass mobilization in the Vietnam War, involvement in formal military service significantly increased the risk of initiating smoking. Military-induced smoking emerges where tobacco products were not provided by the military institution, but where social availability of tobacco was widespread.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, 380 S. 1530 E., Room 301, Salt Lake City, UT, 84112, USA.
| | - Peter Loebach
- Department of Sociology and Anthropology, Weber State University, Social Science Building, Room 114, Ogden, UT, USA
| | - Ha Ngoc Trinh
- Department of Sociology, University of Utah, 380 S. 1530 E., Room 301, Salt Lake City, UT, 84112, USA
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25
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Department of Veterans Affairs. Health Care for Certain Children of Vietnam Veterans and Certain Korea Veterans--Covered Birth Defects and Spina Bifida. Final rule. Fed Regist 2016; 81:19887-91. [PMID: 27051894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This rule adopts as final a proposed rule of the Department of Veterans Affairs (VA) to amend its regulations concerning the provision of health care to birth children of Vietnam veterans and veterans of covered service in Korea diagnosed with spina bifida, except for spina bifida occulta, and certain other birth defects. In the proposed rule published on May 15, 2015, VA proposed changes to more clearly define the types of health care VA provides, including day health care and health-related services, which we defined as homemaker or home health aide services that provide assistance with Activities of Daily Living or Instrumental Activities of Daily Living that have therapeutic value. We also proposed changes to the list of health care services that require preauthorization by VA. This final rule addresses comments received from the public and adopts as final the proposed rule, without change.
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26
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Gunderson CH, Daroff RB. Neurology in the Vietnam War. Front Neurol Neurosci 2016; 38:201-213. [PMID: 27035455 DOI: 10.1159/000442657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Between December 1965 and December 1971, the United States maintained armed forces in Vietnam never less than 180,000 men and women in support of the war. At one time, this commitment exceeded half a million soldiers, sailors, and airmen from both the United States and its allies. Such forces required an extensive medical presence, including 19 neurologists. All but two of the neurologists had been drafted for a 2-year tour of duty after deferment for residency training. They were assigned to Vietnam for one of those 2 years in two Army Medical Units and one Air Force facility providing neurological care for American and allied forces, as well as many civilians. Their practice included exposure to unfamiliar disorders including cerebral malaria, Japanese B encephalitis, sleep deprivation seizures, and toxic encephalitis caused by injection or inhalation of C-4 explosive. They and neurologists at facilities in the United States published studies on all of these entities both during and after the war. These publications spawned the Defense and Veterans Head Injury Study, which was conceived during the Korean War and continues today as the Defense and Veterans Head Injury Center. It initially focused on post-traumatic epilepsy and later on all effects of brain injury. The Agent Orange controversy arose after the war; during the war, it was not perceived as a threat by medical personnel. Although soldiers in previous wars had developed serious psychological impairments, post-traumatic stress disorder was formally recognized in the servicemen returning from Vietnam.
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27
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Klickermann F. Legal liability for Agent Orange-related illnesses: a reassessment of the 2005 VAVA case and prospects for new litigation. Med Confl Surviv 2016; 32:138-152. [PMID: 27748632 DOI: 10.1080/13623699.2016.1242044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Attempts through the US courts to hold the corporations responsible for the production of dioxin-contaminated herbicides used by the US military in the 1960s and early 1970s liable for their ongoing health consequences have failed. This article scrutinizes the most recent judgement - that of the United States District Court for the Eastern District of New York handed down in 2005 following a lawsuit brought by the Vietnam Association of Victims of Agent Orange/dioxin (VAVA). It is argued that despite this judgement there is the potential to bring a further legal case, with some prospect of success, on the basis of: (i) debatable legal judgements in the 2005 decision; (ii) new scientific evidence on the health effects of exposure to Agent Orange; and (iii) cases brought in other jurisdictions. The article concludes by noting the underfunding of ongoing remediation efforts, especially for the provision of assistance to affected individuals, and argues that it is desirable to oblige the producers of the herbicides to contribute financially to these efforts.
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28
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Shaffer SW, Moore JH. US Army Physical Therapist Roles and Contributions in Operations Enduring Freedom and Iraqi Freedom. US Army Med Dep J 2016:52-57. [PMID: 27215867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Musculoskeletal injuries are a leading cause of health care utilization, medical evacuation, and disability. US Army physical therapists (PTs) have served as physician extenders for the management of nonsurgical neuromusculoskeletal injuries since the Vietnam conflict. The roles and evidence supporting US Army physical therapy continue to evolve. This article discusses the different levels of care and roles of US Army PTs, the contributions and evidence regarding US Army physical therapy, and physical therapy lessons learned during Operations Enduring Freedom and Iraqi Freedom. Since 2001, US Army PTs and enlisted physical therapy technicians have provided care from Levels 1 to 5 and assignments have expanded to special operations and brigade combat teams. Evidence suggests US Army PTs serving both in referral and direct access roles provided safe and definitive care that maximized readiness while reducing evacuation. Key physical therapy lessons learned include: (1) a continued focus on a Soldier sports medicine forward care model, (2) a need for injury risk assessment, physical performance screenings, and reconditioning programs that optimize readiness, and (3) continued support for physical therapy structure, training, and research that maximizes Soldier readiness and health.
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Affiliation(s)
- Scott W Shaffer
- Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
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29
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Magruder KM, Goldberg J, Forsberg CW, Friedman MJ, Litz BT, Vaccarino V, Heagerty PJ, Gleason TC, Huang GD, Smith NL. Long-Term Trajectories of PTSD in Vietnam-Era Veterans: The Course and Consequences of PTSD in Twins. J Trauma Stress 2016; 29:5-16. [PMID: 26764215 PMCID: PMC5884065 DOI: 10.1002/jts.22075] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We estimated the temporal course of posttraumatic stress disorder (PTSD) in Vietnam-era veterans using a national sample of male twins with a 20-year follow-up. The complete sample included those twins with a PTSD diagnostic assessment in 1992 and who completed a DSM-IV PTSD diagnostic assessment and a self-report PTSD checklist in 2012 (n = 4,138). Using PTSD diagnostic data, we classified veterans into 5 mutually exclusive groups, including those who never had PTSD, and 4 PTSD trajectory groups: (a) early recovery, (b) late recovery, (c) late onset, and (d) chronic. The majority of veterans remained unaffected by PTSD throughout their lives (79.05% of those with theater service, 90.85% of those with nontheater service); however, an important minority (10.50% of theater veterans, 4.45% of nontheater veterans) in 2012 had current PTSD that was either late onset (6.55% theater, 3.29% nontheater) or chronic (3.95% theater, 1.16% nontheater). The distribution of trajectories was significantly different by theater service (p < .001). PTSD remains a prominent issue for many Vietnam-era veterans, especially for those who served in Vietnam.
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Affiliation(s)
- Kathryn M. Magruder
- Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Christopher W. Forsberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Matthew J. Friedman
- National Center for Posttraumatic Stress Disorder, Department of Veterans Affairs, White River Junction, Vermont, USA
- Departments of Psychiatry and Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brett T. Litz
- Massachusetts Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Patrick J. Heagerty
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Theresa C. Gleason
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - Grant D. Huang
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - Nicholas L. Smith
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Hogeveen J, Bird G, Chau A, Krueger F, Grafman J. Acquired alexithymia following damage to the anterior insula. Neuropsychologia 2016; 82:142-148. [PMID: 26801227 PMCID: PMC4752907 DOI: 10.1016/j.neuropsychologia.2016.01.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/06/2016] [Accepted: 01/17/2016] [Indexed: 12/31/2022]
Abstract
Alexithymia is a subclinical condition characterized by impaired awareness of one's emotional states, which has profound effects on mental health and social interaction. Despite the clinical significance of this condition, the neurocognitive impairment(s) that lead to alexithymia remain unclear. Recent theoretical models suggest that impaired anterior insula (AI) functioning might be involved in alexithymia, but conclusive evidence for this hypothesis is lacking. We measured alexithymia levels in a large sample of brain-injured patients (N=129) and non-brain-injured control participants (N=33), to determine whether alexithymia can be acquired after pronounced damage to the AI. Alexithymia levels were first analysed as a function of group, with patients separated into four groups based on AI damage: patients with >15% damage to AI, patients with <15% damage to AI, patients with no damage to AI, and healthy controls. An ANOVA revealed that alexithymia levels varied across groups (p=0.009), with >15% AI damage causing higher alexithymia relative to all other groups (all p<0.01). Next, a multiple linear regression model was fit with the degree of damage to AI, the degree of damage to a related region (the anterior cingulate cortex, ACC), and the degree of damage to the whole brain as predictor variables, and alexithymia as the dependent variable. Critically, increased AI damage predicted increased alexithymia after controlling for the other two regressors (ACC damage; total lesion volume). Collectively, our results suggest that pronounced AI damage causes increased levels of alexithymia, providing critical evidence that this region supports emotional awareness.
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Affiliation(s)
- J Hogeveen
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - G Bird
- MRC Social, Genetic, and Developmental Psychology Centre, King's College London, London, United Kingdom; Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - A Chau
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - F Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, VA, USA; Department of Psychology, George Mason University, Fairfax, VA, USA
| | - J Grafman
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Neurology, Feinberg School of Medicine, Northwestern University, USA.
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Washington DL, Bird CE, LaMonte MJ, Goldstein KM, Rillamas-Sun E, Stefanick ML, Woods NF, Bastian LA, Gass M, Weitlauf JC. Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative. Gerontologist 2016; 56 Suppl 1:S126-37. [PMID: 26768386 PMCID: PMC5881617 DOI: 10.1093/geront/gnv669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. DESIGN AND METHODS WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. RESULTS After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23). IMPLICATIONS Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.
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Affiliation(s)
- Donna L Washington
- VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, California. University of California Los Angeles, Geffen School of Medicine.
| | - Chloe E Bird
- RAND Corporation, Pardee Rand Graduate School, Santa Monica, California
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo
| | | | | | - Marcia L Stefanick
- Stanford University School of Medicine, Stanford Center for Health Research on Women & Sex Differences in Medicine, California
| | - Nancy F Woods
- Division of Biobehavioral Nursing & Health Systems, University of Washington School of Nursing, Seattle
| | - Lori A Bastian
- VA Connecticut, and University of Connecticut Health Center, West Haven
| | - Margery Gass
- The North American Menopause Society, Mayfield Heights, Ohio
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
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MacDonald E. Real Heroes. Air Med J 2016; 35:22-23. [PMID: 26856656 DOI: 10.1016/j.amj.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/17/2015] [Indexed: 06/05/2023]
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Stanton S. Norma Small--Faith Community Nursing Pioneer (1936-2015). J Christ Nurs 2016; 33:11. [PMID: 26817363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Hoyt R, Linnville S, Thaler S, Moore J. Digital Family History Data Mining with Neural Networks: A Pilot Study. Perspect Health Inf Manag 2016; 13:1c. [PMID: 26903781 PMCID: PMC4739442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Following the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, electronic health records were widely adopted by eligible physicians and hospitals in the United States. Stage 2 meaningful use menu objectives include a digital family history but no stipulation as to how that information should be used. A variety of data mining techniques now exist for these data, which include artificial neural networks (ANNs) for supervised or unsupervised machine learning. In this pilot study, we applied an ANN-based simulation to a previously reported digital family history to mine the database for trends. A graphical user interface was created to display the input of multiple conditions in the parents and output as the likelihood of diabetes, hypertension, and coronary artery disease in male and female offspring. The results of this pilot study show promise in using ANNs to data mine digital family histories for clinical and research purposes.
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Affiliation(s)
- Robert Hoyt
- Health Informatics Program at the College of Science, Engineering and Health at the University of West Florida in Pensacola, FL
| | - Steven Linnville
- Robert E. Mitchell Center for Prisoner of War Studies in Pensacola, FL
| | | | - Jeffrey Moore
- Robert E. Mitchell Center for Prisoner of War Studies in Pensacola, FL
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Schlenger WE, Corry NH, Williams CS, Kulka RA, Mulvaney-Day N, DeBakey S, Murphy CM, Marmar CR. A Prospective Study of Mortality and Trauma-Related Risk Factors Among a Nationally Representative Sample of Vietnam Veterans. Am J Epidemiol 2015; 182:980-90. [PMID: 26634285 DOI: 10.1093/aje/kwv217] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/12/2015] [Indexed: 11/13/2022] Open
Abstract
Because Vietnam veterans comprise the majority of all living veterans and most are now older adults, the urgency and potential value of studying the long-term health effects of service in the Vietnam War, including effects on mortality, is increasing. The present study is the first prospective mortality assessment of a representative sample of Vietnam veterans. We used one of the longest follow-up periods to date (spanning older adulthood) and conducted one of the most comprehensive assessments of potential risk factors. Vital status and cause of death were ascertained for the 1,632 veterans who fought in the Vietnam theater (hereafter referred to as theater veterans) and for 716 Vietnam War-era veterans (hereafter referred to as era veterans) who participated in the National Vietnam Veterans Readjustment Study (1987-2011). As of April 2011, 16.0% (95% confidence interval: 13.1, 19.0) of all Vietnam veterans who were alive in the 1980s were deceased. Male theater veterans with a high probability of posttraumatic stress disorder (PTSD) were nearly 2 times more likely to have died than were those without PTSD, even after adjustment for sociodemographic and other characteristics. A high level of exposure to war zone stress was independently associated with mortality for both male and female theater veterans after adjustment for sociodemographic characteristics, PTSD, and physical comorbid conditions. Theater veterans with a high level of exposure to war zone stress and a high probability of PTSD had the greatest mortality risk (adjusted hazard ratio = 2.34, 95% confidence interval: 1.24, 4.43).
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Abstract
OBJECTIVES To inform the provision of support to veterans by analysing hospital discharge data, thereby identifying which conditions show an excess risk, require specific management strategies and deserve further investigation. SETTING Tertiary level care, including all public and private New Zealand hospitals. PARTICIPANTS All New Zealand Vietnam veterans with service between 1964 and 1972. PRIMARY OUTCOME MEASURES Standardised hospitalisation ratios (SHRs) were calculated based on the number of first observed hospital admissions for a condition, those expected being based on New Zealand national hospitalisation rates. RESULTS The SHR for all causes of hospitalisation was 1.18, 95% CI 1.15 to 1.21, with modest increases for the major common causes, cardio and cerebrovascular disease. Admission rates for chronic renal failure and chronic obstructive pulmonary disease were highest in the 2006-2009 time period. The highest statistically significant hospitalisation risk was for alcohol-related mental disorder, SHR 1.91, 99% CI 1.39 to 2.43. CONCLUSIONS Chronic renal failure has limited attribution to veteran service but along with chronic obstructive pulmonary disease has the potential to have high costs both to the individual and the health system. We suggest that routine surveillance of veterans by way of a 'flag' in national and primary care databases would facilitate the recognition of service-related conditions and the appropriate provision of healthcare.
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Affiliation(s)
- Brian Cox
- Hugh Adam Cancer Epidemiology Unit, University of Otago, Dunedin, New Zealand
| | - David McBride
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - John Broughton
- Ngai Tahu Māori Health Research Unit, University of Otago, Dunedin, New Zealand
| | - Darryl Tong
- Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand
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Abstract
Commentary On: Atkinson Brigadier (Ret'd) RN, Fraser RD. 100 years-Anzac, Vietnam to now. Spine J 2015:15:2454-6 (in this issue). Robertson PA. Gallipoli 100 years on: a New Zealand perspective. Spine J 2015:15:2457-8 (in this issue).
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Affiliation(s)
- Eugene J Carragee
- Department of Orthopaedic Surgery, Stanford University, Department of Orthopedic Surgery, Stanford University School of Medicine, 450 Broadway, Redwood City, CA 94063, USA.
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Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Mil Med 2015; 180:1019-21. [PMID: 26444461 DOI: 10.7205/MILMED-D-15-00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Blue Water Navy Vietnam Veterans and Agent Orange Exposure. Mil Med 2015; 180:839-41. [PMID: 26226521 DOI: 10.7205/MILMED-D-15-00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
Veterans of the Vietnam era are now the largest group of United States Veterans, and are at or approaching Social Security and Medicare eligibility. As a result, it is likely that home care clinicians will be caring for many patients who are Vietnam Veterans. The purpose of this article is to increase awareness of the unique healthcare needs of Vietnam Veterans. Having an understanding of military and Veteran culture can help inform home healthcare clinicians in ways to manage the unique healthcare needs of Veterans and engage previously learned behaviors and attitudes from military service. In addition, knowing the types of exposures and health risks specific to this era could be beneficial in identifying potential problems that may have not yet been addressed.
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Affiliation(s)
- Brenda Elliott
- Brenda Elliott, PhD, RN, is an Adjunct Faculty, College of Nursing, Drexel University, Philadelphia, Pennsylvania
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Sharkey JM, Abraham JH. Evaluation of Postdeployment Cancers Among Active Duty Military Personnel. US Army Med Dep J 2015:68-75. [PMID: 26276948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Anthony M. Vietnam Veterans--Thank Them for Their Service. Home Healthc Now 2015; 33:353-354. [PMID: 26121503 DOI: 10.1097/nhh.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Department of Veterans Affairs. Presumption of Herbicide Exposure and Presumption of Disability During Service for Reservists Presumed Exposed to Herbicide. Interim final rule. Fed Regist 2015; 80:35246-9. [PMID: 26103644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Department of Veterans Affairs (VA) is amending its regulation governing individuals presumed to have been exposed to certain herbicides. Specifically, VA is expanding the regulation to include an additional group consisting of individuals who performed service in the Air Force or Air Force Reserve under circumstances in which they had regular and repeated contact with C-123 aircraft known to have been used to spray an herbicide agent ("Agent Orange'') during the Vietnam era. In addition, the regulation will establish a presumption that members of this group who later develop an Agent Orange presumptive condition were disabled during the relevant period of service, thus establishing that this service constituted "active, naval, military or air service.'' The effect of this action is to presume herbicide exposure for these individuals and to allow individuals who were exposed to herbicides during reserve service to establish veteran status for VA purposes and eligibility for some VA benefits. The need for this action results from a recent decision by the Secretary of Veterans Affairs to acknowledge that individuals who had regular and repeated exposure to C-123 aircraft that the United States Air Force used to spray the herbicides in Vietnam during Operation Ranch Hand were exposed to Agent Orange.
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Ross JH, Hewitt A, Armitage J, Solomon K, Watkins DK, Ginevan ME. Exposure to TCDD from base perimeter application of Agent Orange in Vietnam. Sci Total Environ 2015; 511:82-90. [PMID: 25531592 DOI: 10.1016/j.scitotenv.2014.11.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/09/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
Using recognized methods routinely employed by pesticide regulatory agencies, the exposures of military personnel that were mixer/loader/applicators (M/L/A) of Agent Orange (AO) for perimeter foliage at bases during the Vietnam War were estimated. From the fraction of TCDD in AO, absorbed dosage of the manufacturing contaminant was estimated. Dermal exposure estimated from spray drift to residents of the bases was calculated using internationally recognized software that accounted for proximity, foliar density of application site, droplet size and wind speed among other factors, and produced estimates of deposition. Those that directly handled AO generally had much higher exposures than those further from the areas of use. The differences in exposure potential varied by M/L/A activity, but were typically orders of magnitude greater than bystanders. However, even the most-exposed M/L/A involved in perimeter application had lifetime exposures comparable to persons living in the U.S. at the time, i.e., ~1.3 to 5 pg TCDD/kg bodyweight.
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Affiliation(s)
- John H Ross
- LLC, 5150 Fair Oaks Blvd. #101-370, Carmichael, CA 95608, United States.
| | - Andrew Hewitt
- Centre for Pesticide Application and Safety, The University of Queensland, Gatton, QLD 4343, Australia; Lincoln University, Christchurch 7640, New Zealand; The University of Nebraska, North Platte, NE, United States
| | - James Armitage
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario M1C 1A4, Canada
| | - Keith Solomon
- Centre for Toxicology, School of Environmental Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Deborah K Watkins
- M.E. Ginevan & Associates, 307 Hamilton Ave., Silver Spring, MD 20901, United States
| | - Michael E Ginevan
- M.E. Ginevan & Associates, 307 Hamilton Ave., Silver Spring, MD 20901, United States
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Ferrie JE. 'Knowing is not enough; we must apply. Willing is not enough; we must do.'. Int J Epidemiol 2015; 43:1671-7. [PMID: 25688412 DOI: 10.1093/ije/dyu230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ross JH, Hewitt A, Armitage J, Solomon K, Watkins DK, Ginevan ME. Handler, bystander and reentry exposure to TCDD from application of Agent Orange by C-123 aircraft during the Vietnam War. Sci Total Environ 2015; 505:514-525. [PMID: 25461054 DOI: 10.1016/j.scitotenv.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
Using validated models and methods routinely employed by pesticide regulatory agencies, the absorbed dosages of Agent Orange (AO) herbicide contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) were estimated for mixer/loaders, applicators, and individuals in the vicinity of applications of AO by C-123 aircraft during the Vietnam War. Resulting dosages of TCDD were then transformed to estimates of adipose residues, and compared to population biomonitoring of known mixer/loaders and applicators as well as ground troops in Vietnam and civilians in the U.S. Results demonstrate that mixer/loaders and applicators had the greatest exposures and their measured residues of TCDD in adipose were consistent with the estimated exposures. Further, the potentially exposed ground troops, including those who could have been directly sprayed during aerial defoliation, had measured adipose residues that were consistent with those in civilian U.S. populations with no defined source of exposure exposures and both of those cohorts had orders of magnitude less exposure than the mixer/loaders or applicators. Despite the availability of validated exposure modeling methods for decades, the quantitative TCDD dose estimates presented here are the first of their kind for the Vietnam conflict.
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Affiliation(s)
- John H Ross
- risksciences.net, LLC, 5150 Fair Oaks Blvd. #101-370, Carmichael, CA 95608, United States.
| | - Andrew Hewitt
- Centre for Pesticide Application and Safety, The University of Queensland, Gatton QLD 4343, Australia; Lincoln University, Christchurch 7640, New Zealand; The University of Nebraska, North Platte, NE, United States
| | - James Armitage
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, 1265 Military Trail, Toronto, ON M1C 1A4, Canada
| | - Keith Solomon
- Centre for Toxicology, School of Environmental Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Deborah K Watkins
- M.E. Ginevan & Associates, 307 Hamilton Ave., Silver Spring, MD 20901, USA
| | - Michael E Ginevan
- M.E. Ginevan & Associates, 307 Hamilton Ave., Silver Spring, MD 20901, USA
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Phillips AC, Carroll D, Drayson MT, Batty GD. Raised levels of immunoglobulin G, A and M are associated with an increased risk of total and cause-specific mortality: the Vietnam Experience Study. J Epidemiol Community Health 2015; 69:129-35. [PMID: 25267764 DOI: 10.1136/jech-2014-204345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Immunoglobulins (Ig) are essential for combating infectious disease. However, high levels are associated with a range of diseases and/or poor health behaviours, such as autoimmune diseases, chronic infection, HIV and excessive alcohol consumption. In the present analyses, we extend this body of work by examining whether higher levels of serum Ig G, A and M are associated with increased mortality risk. METHODS Participants were 4255 Vietnam-era, former US army personnel (the Vietnam Experience Study). From military service files, telephone interviews in 1983 and a medical examination in 1986, sociodemographic, and health data were collected. Contemporary morning fasted blood samples were taken from which IgG, IgA and IgM concentrations were determined. Mortality surveillance over 15 years gave rise to deaths ascribed to all-causes, cardiovascular disease mortality, all cancers combined mortality, external cause and 'other' causes (predominantly comprising deaths due to infectious disease). Cox proportional hazard models were utilised to compute HRs per SD increase in Ig which were first adjusted for age and then additionally adjusting for a range of candidate confounders. RESULTS In multiply adjusted analyses, in general, the higher the immunoglobulin concentration, the greater the risk of death. Thus, IgA (HR=2.0 95% CI 1.47 to 2.73), IgM (HR=1.5 95% CI 1.11 to 1.91) and IgG (HR=5.8 95% CI 3.38 to 9.95) were positively related to all-cause mortality. Corresponding results for 'other' causes of mortality were 4.7 (2.64 to 8.19), 3.5 (2.29 to 5.45) and 33.4 (15.13 to 73.64). CONCLUSIONS In the present study, high levels of Ig are associated with an elevated risk of death from total and 'other' causes, mainly infectious disease. High levels of Ig, particularly IgG, may signal subclinical disease.
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Affiliation(s)
- Anna C Phillips
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Douglas Carroll
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Mark T Drayson
- Department of Clinical Immunology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, UK and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, London, UK
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Abstract
Traumatic brain injury (TBI) in all of its forms--blast, concussive, and penetrating--has been an unfortunate sequela of warfare since ancient times. The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to blast-related TBI whose long-term effects on behavior and cognition are not yet known. Advances in medical care have greatly increased survival from these types of injuries. Therefore, an understanding of the potential health effects of TBI is essential. This review focuses on specific aspects of military-related TBI. There exists a large body of literature reporting the environmental conditions, forces, and staging of injury. Many of these studies are focused on the neuropathology of TBI, due to blast overpressure waves, and the emergence of large numbers of mild blast-related TBI cases.
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Lally JF. The hill battles of Khe Sanh: a marine corps doctor remembers. Del Med J 2014; 86:377-379. [PMID: 25942792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Grufferman S, Lupo PJ, Vogel RI, Danysh HE, Erhardt EB, Ognjanovic S. Parental military service, agent orange exposure, and the risk of rhabdomyosarcoma in offspring. J Pediatr 2014; 165:1216-21. [PMID: 25241182 PMCID: PMC4254119 DOI: 10.1016/j.jpeds.2014.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/15/2014] [Accepted: 08/07/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the role of parental military service-related exposures and rhabdomyosarcoma (RMS) risk in offspring using data from a large case-control study of childhood RMS. STUDY DESIGN Cases (n = 319) were enrolled from the third trial run by the Intergroup Rhabdomyosarcoma Study Group. Population-based controls (n = 319) were pair-matched to cases on race, sex, and age. Conditional logistic regression was used to evaluate parental military service-related exposures and their associations with childhood RMS by generating aORs and 95% CIs. Statistical significance was defined as P < .05. RESULTS There were no significant associations between parental military service and childhood RMS. The strongest association was with maternal military service; however, this association was attenuated and did not remain significant after adjusting for covariates (aOR = 2.75, 95% CI 0.71, 10.62). An elevated effect estimate was found when assessing paternal exposure to Agent Orange (AO) and childhood RMS but was not statistically significant (aOR = 1.72, 95% CI 0.55, 5.41). CONCLUSIONS We found little evidence that parental military service of AO exposure influences the risk of RMS in offspring. These findings are notable in light of the continuing controversies surrounding the intergenerational effects of AO exposure.
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Affiliation(s)
- Seymour Grufferman
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX.
| | | | - Heather E Danysh
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - Erik B Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM
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