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At least 19 recordsLinked to original sources
PubMed1988

Stress symptomatology among Vietnam veterans. Analysis of the Veterans Administration Survey of Veterans. II.

In 1979, the US Veterans Administration conducted a health survey of 11,230 veterans. The present analysis of these data focuses on the association between Vietnam service and combat experience with eight post-traumatic stress disorder symptoms among the 1,787 Vietnam era veterans who entered military service between 1965 and 1975. The advantages of this study are that it includes a large random sample selected from the total US population, had a high interview response rate (93%), and collected data prior to the recent public controversy surrounding the issue of the health effects of possible exposure of Vietnam veterans to Agent Orange. After adjustment for the potential confounding effects of military service and demographic factors, the level of combat exposure was significantly associated with all eight symptoms of post-traumatic stress disorder in a dose response pattern. For seven of the eight symptoms, a twofold increase in the factor-adjusted prevalence odds ratio was observed when non-Vietnam service veterans were compared with Vietnam veterans who experienced the most intense combat experience. Being younger, less well educated, or nonwhite at the time of military service are factors which independently further increased the probability of stress symptoms.

Adult↗
PubMed1988

Utilization, attitudes, and experiences of Vietnam Era veterans with Veterans Administration health facilities: the American Legion experience.

A random sample of American Legion members in six states who had served in the Armed Forces during the Vietnam Era was conducted through a mailed questionnaire, in order to determine patterns of usage of Veterans Administration health facilities, as well as attitudes toward the VA and experiences at these facilities. Of the 6810 male respondents, 42.0% had served in Southeast Asia. These subjects were categorized according to their level of combat in South Vietnam. Thirty-six percent of those who had served in Southeast Asia had used VA health facilities, compared to only 18% of men who served elsewhere. Among Southeast Asia veterans, combat level was an important predictor of extent of usage of VA facilities for problems of both physical and mental health. Combat level was also associated with lack of basic and major medical insurance. While men with lower incomes tended to make greater use of VA mental health facilities, nearly one-fourth of mental health users had family incomes above $30,000. Despite their greater usage of the VA, men with higher combat levels expressed lower feelings of security about this agency, and rated its staff less helpful and of lower quality than did men who experienced lower levels of combat. On the other hand, higher combat veterans thought themselves better informed about VA services. Men who had gone to the VA for mental health assistance reported a disturbingly low frequency of having been asked basic questions that relate to possible diagnosis of post-traumatic stress disorder (PTSD), questions related to combat, which may be one of its etiologic factors, or other questions relating to their military history. Because combat level in Vietnam veterans is a major determinant of both attitudes toward and utilization of VA health facilities, the VA as well as other health agencies which deal with Vietnam veterans should be especially sensitive to this factor, and should take it into consideration when evaluating veterans' physical and mental health.

Attitude↗
PubMed1989

Cancer risk in male veterans utilizing the Veterans Administration medical system.

Age-specific incidence curves, cumulative rates, and relative risks were estimated for selected malignancies among male veterans utilizing the Veterans Administration (VA) medical system during 1970 to 1982. Relative risks for malignant tumors of the lung, bronchus, larynx, oral cavity, and esophagus in males using VA hospitals were approximately double the rates for men of the Surveillance, Epidemiology, and End Results (SEER) cancer registry, thereby supporting the existence of strong effects of chronic cigarette smoking and alcohol consumption on the development of neoplasms at these specific anatomic sites. Relative to the SEER male population, there were significant reductions in the cumulative rates of neoplasms of the colon (15%) and extrahepatic biliary tract (30%), no differences in the rates of cancer of the stomach, small intestine, or pancreas, and a 50% increase in the cumulative rate of liver cancer among the veterans. Rates of malignancies of the genitourinary tract were similar in the VA and SEER registries with the exception of cancer of the penis, for which the cumulative rate was 50% higher in the veterans. These results are consistent with an excess of specific risk exposures among male veterans using VA hospitals, viz., cigarette smoking, alcohol consumption, poor nutrition, and other factors related to low socioeconomic status. The ultimate utility of the VA tumor registry will depend upon its exploitation by epidemiologists to provide leads for etiologic research.

Adult↗
PubMed1991

Occupational therapy in the Department of Veterans Affairs: focus on health care of the elderly veteran.

The Department of Veteran Affairs (VA) operates the largest integrated health care system in the world (VA, 1989), with designated departments and programs designed to meet the long-term care needs of the aging veteran. Occupational therapy is an important intervention to maximize the quality of life of older persons. Because of the increasing number of aging veterans and the national shortage of occupational therapists, the VA has been devising programs to recruit and retain occupational therapists in VA medical centers. The combination of long-term care programs and the VA's commitment to ongoing research, education, and occupational therapy services points to a promising outlook for care of our aging veterans.

Aged↗
PubMed1990

Use of Veterans Administration outpatient facilities by older, rural veterans.

A mail survey was conducted in rural northeastern Missouri to study the factors affecting use of Veterans Administration (VA) outpatient medical services by older veterans. During the year preceding the survey, 39.6% of the 169 responding veterans had used VA outpatient facilities. Travel time, long waiting time at the clinic, and travel expense were the most common perceived barriers to use. However, these factors were generally poor predictors of use. The reported percentage of each perceived geographic or administrative barrier to use was consistently greater for previous users than for nonusers of these facilities. Multiple regression analysis revealed private medical insurance coverage to be the only significant predictor of use. Veterans with private medical insurance were more likely to receive ambulatory medical care from local providers than from the VA. The potential impact of removing perceived barriers to use in this population remains unclear.

Aged↗
PubMed1988

Serum 2,3,7,8-tetrachlorodibenzo-p-dioxin levels in US Army Vietnam-era veterans. The Centers for Disease Control Veterans Health Studies.

This study investigates whether military records can be used to identify US Army Vietnam veterans who were likely to be exposed to the herbicide Agent Orange. Serum levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a toxic contaminant in Agent Orange, were obtained for 646 ground combat troops who served in heavily sprayed areas of Vietnam and for 97 veterans who did not serve in Vietnam. The distributions of current TCDD levels in Vietnam and non-Vietnam veterans were nearly identical (mean in each group, approximately equal to 4 parts per trillion [ppt]). Only two men (both Vietnam veterans) had clearly elevated levels (greater than 20 ppt). Levels of TCDD did not tend to increase with greater likelihood of exposure to Agent Orange, as estimated from either military records or self-reported exposure. This study is consistent with other studies and suggests that most US Army ground troops who served in Vietnam were not heavily exposed to TCDD, except perhaps men whose jobs involved handling herbicides.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1989

The veteran athlete: an echocardiographic comparison of veteran cyclists, former cyclists and non-athletic subjects.

To determine the effects of prolonged endurance training on the heart, a comparison was made of veteran cyclists aged 41-51 years, former cyclists, and non-athletic subjects, including echocardiography, ECG, systolic and diastolic time intervals, and maximal oxygen uptake. The veterans had significantly larger diastolic diameter, systolic diameter, thickness of septum, posterior wall, and left ventricular mass. The enlargement of the left ventricle was found to be proportionate, as the ratio of diastolic diameter to wall thickness showed no change. In contrast to earlier reports, no indication of reduced cardiac function was found in the veterans, as echocardiographically measured function parameters, systolic, and diastolic time intervals were similar in the three groups. In the former athletes, whose previous training experience was similar to that of the veterans, no significant variation in cardiac structure and function was found in relation to the control group. This indicates that the physiological hypertrophy caused by physical training can be reversible.

Adaptation, Physiological↗
PubMed1991

Hematopoietic and lymphoproliferative cancer among male veterans using the Veterans Administration Medical System.

Hematopoietic and lymphoproliferative cancer risk among the 3.7 million United States male veterans who use the Veterans Administration (VA) medical system annually was assessed using age-specific incidence curves and cumulative incidence rates. Relative risk comparing the VA with general population risk estimates from the Surveillance, Epidemiology, and End Results (SEER) data were increased significantly for all malignancies examined. The VA sample showed risk increases of 93% for Hodgkin's disease, 20% for non-Hodgkin's lymphomas, 51% for multiple myelomas, and 40% for all leukemias. Among the leukemia subtypes, the observed risk increases were 54%, 23%, 80%, and 46% for lymphocytic, granulocytic, monocytic, and other forms of leukemia, respectively. The large size of the sample and the consistency of risk estimates with two different methods confer validity and strength to these findings. The possible relevance of the high prevalence of tobacco and alcohol use in this population sample to the current findings is discussed and the need for further analytic investigations to explain the increases in risk is emphasized.

Adult↗
PubMed1979

Passive-active immunity from hepatitis B immune globulin. Reanalysis of a Veterans Administration cooperative study of needle-stick hepatitis. The Veterans Administration Cooperative Study Group.

The mechanism of action of hepatitis B immune globulin (HBIG) and immune serum globulin was sought in a reanalysis of a Veterans Administration cooperative study on needle-stick exposure to hepatitis B surface antigen (HBsAg)-positive blood. Sera from 296 exposed persons were tested for HBsAg, antibody to HBsAg (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc) by radioimmunoassay. Type B hepatitis developed in three HBIG (2%) and in 12 ISG (8%) recipients. In contrast, subclinical infection (development of HBsAg or anti-HBs and anti-HBc without symptoms or jaundice) developed in 16 HBIG (10%) but only six immune serum globulin (4%) recipients. Thus, infection occurred equally in both groups but was more likely to be subclinical in HBIG recipients, indicating that HBIG permitted development of passive-active immunity to type B hepatitis. An additional 53 immune serum globulin recipients (36%) but only one HBIG recipient developed anti-HBs alone, without hepatitis, HBsAg, or anti-HBc. This response was more compatible with immunization by HBsAg than with infection. Ultracentrifugation analysis revealed occult HBsAg in the immune serum globulin but not the HBIG, indicating that some immune serum globulin preparations contain HBsAg and can induce active immunity to type B hepatitis.

Hepatitis B↗
PubMed1992

Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group.

BACKGROUND: Conventional medical treatment for gastroesophageal reflux disease involves life-style modifications and combination drug therapy, but few studies have included these features in their protocols. Antireflux surgery has seldom been studied prospectively, and there have been no trials comparing modern medical and surgical treatments for reflux disease. METHODS: We conducted a long-term, randomized trial of medical therapy (lifestyle modifications and up to four medications) and surgical therapy (Nissen fundoplication) in 247 patients (243 men and 4 women) with peptic esophageal ulcer, stricture, erosive esophagitis, or Barrett's esophagus. They received by random assignment either continuous medical therapy, medical therapy for symptoms only, or surgical therapy. Symptoms were assessed quarterly with a disease-activity index; esophagoscopy was performed at base line and each year for two years. The outcomes evaluated at one and two years included the activity index, and the endoscopic grade of esophagitis. RESULTS: Follow-up data were available for 176 patients at one year and for 106 patients at two years. The mean (+/- SE) activity-index score (possible range, 74 to 172) decreased in one year from 108 +/- 3 to 87 +/- 2 in the group receiving continuous medical therapy, from 107 +/- 3 to 88 +/- 2 in the group receiving medical therapy for symptoms only, and from 109 +/- 3 to 78 +/- 2 in the surgical-therapy group (P less than 0.0001 for the change from base line, for all comparisons). The mean (+/- SE) grade of esophagitis (possible range, 1 to 4) decreased in the respective groups from 2.9 +/- 0.1 to 2.0 +/- 0.1, from 2.9 +/- 0.1 to 2.3 +/- 0.1, and from 2.9 +/- 0.1 to 1.4 +/- 0.1 (P less than 0.005 vs. base line, for all comparisons). The mean activity-index score and the grade of esophagitis were significantly better in the surgical-therapy group than in either medical-therapy group during the two years of follow-up (P less than 0.003). CONCLUSIONS: In men with complicated gastroesophageal reflux disease, surgery is significantly more effective than medical therapy in improving the symptoms and endoscopic signs of esophagitis for up to two years, although medical treatment is also effective.

Antacids↗
PubMed1990

A randomized trial of Veterans Administration home care for severely disabled veterans.

This randomized study screened hospital admissions to all wards except Psychiatry and Spinal Cord Injured during a 3-year period to identify 233 severely disabled patients (2 impairments on the Katz Index of ADL) and caregivers who were willing to participate in a pretest-multiple posttest trial of the Hines VA Hospital-based Home Care (HBHC) Program. Patient functional status, morale, and satisfaction with care were measured at baseline, 1 month and 6 months post discharge. Caregiver satisfaction and morale were assessed at the same time periods. All health care services used by both groups were tracked over the 6-month period and converted to cost. Findings include improved 1-month satisfaction with care (P = 0.04) and improved 6-month cognitive functioning (P = 0.04) among HBHC patients and improved 1-month (P = 0.04) and 6-month satisfaction with care (P less than 0.01) among their caregivers. A nonsignificant 10% decrease in net cost of care, was found in the treatment group, largely due to lower use of private sector hospital care.

Aftercare↗
PubMedDate not supplied

[Contributions and difficulties of the social approach in psychiatry: apropos of the American Forces and veterans in Vietnam. 3. Pathogenic and therapeutic problems in veterans].

Especially among a wide psychiatric population, the risk of a mingling between etiology, pathogenesis and description, peculiarly between correlations and explanations, is an important stumbling-block. However, like as acute war diseases, the part of a previous psychical vulnerability appears to be less important than the classical one which is played by "stressors", chiefly in case of their summation. Here, interfere not only combat "traumas", but also the circumstances of the readjustment after returning. In spite of interesting contributions to the mechanisms of traumatic neurosis followed up after Vietnam conflict, the reflection about intrusive-repetitive syndrome does not seem to have given rise to new developments. Concerning the therapeutics, the opinions about the results achieved--particularly with psychotherapies, in fact delicate and protracted--are more pessimistic than that of the authors.

Adaptation, Psychological↗
PubMed1991

Treatment of hypertension in the elderly. III. Response of isolated systolic hypertension to various doses of hydrochlorothiazide: results of a Department of Veterans Affairs cooperative study. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents.

In a double-blind randomized study, we evaluated the effects of 25 mg vs 50 mg of hydrochlorothiazide in 51 elderly patients (aged 68.9 +/- 7.0 years) with isolated systolic hypertension (blood pressure, 160 to 239 mm Hg systolic and less than 90 mm Hg diastolic). Dose levels could be increased to twice daily to control blood pressure. The reductions in blood pressure (25.4/6.8 mm Hg and 28.9/7.4 mm Hg) and proportion of patients in whom blood pressure was controlled (78% and 89%) were similar in the lower- and higher-dose groups during the titration phase. However, serum potassium level was reduced more in the higher-dosage (0.57 mmol/L) than the lower-dosage (0.17 mmol/L) group. There were no significant changes in blood pressure during a 24-week maintenance phase. No patient required withdrawal from the study because of adverse effects, and cognitive-behavioral function was well preserved. We conclude that hydrochlorothiazide is effective and well tolerated in older patients with isolated systolic hypertension, many of whom may be effectively treated with 25 mg of hydrochlorothiazide once daily.

Aged↗
PubMed1991

Coronary bypass surgery improves survival in high-risk unstable angina. Results of a Veterans Administration Cooperative study with an 8-year follow-up. Veterans Administration Unstable Angina Cooperative Study Group.

To identify high-risk subgroups, 468 patients with unstable angina were prospectively stratified according to the clinical presentation of unstable angina (type I or type II) and left ventricular function (normal or abnormal) and were randomized to conventional medical therapy or surgical treatment with coronary bypass surgery. Type I patients (n = 374) were those who had progressive effort angina or recent angina at rest. Type II patients (n = 94) were those who had severe rest angina associated with ST-T changes on the electrocardiogram. Follow-up for 8 years showed that the cumulative mortality rates for type II patients with abnormal left ventricular function were significantly lower in the surgical patients compared with the medical cohorts (13% versus 46%, p less than 0.04). In the other subgroups, cumulative medical and surgical mortality rates were not different. Thus, type II patients with abnormal left ventricular function appear to be the subgroup of patients who are at the highest risk with medical therapy. Coronary bypass surgery significantly reduces the mortality in this high-risk subgroup of patients with unstable angina.

Angina, Unstable↗
PubMed1991

Mortality among Vietnam veterans: with methodological considerations.

The Department of Veterans Affairs previously conducted a proportionate mortality study of Army and Marine Vietnam-era veterans who died during 1965 through 1982. In the present study, 11,325 veterans who died during 1982 through 1984 and 50,743 veterans from the previous analysis made up the final sample of 62,068 veterans. When compared with all non-Vietnam veterans, Army Vietnam veterans had statistically significant excesses of deaths from external causes (proportionate mortality ratio [PMR] = 1.03), laryngeal cancer (PMR = 1.53), and lung cancer (PMR = 1.08). Marine Vietnam veterans had a significantly elevated PMR for external causes (PMR = 1.06) with a significant excess of homicide deaths (PMR = 1.16) when compared to all non-Vietnam veterans. The elevated PMRs for lung cancer and non-Hodgkin's lymphoma among Marine Vietnam veterans reported in the earlier VA study persisted when compared with Marine non-Vietnam veterans. However, it was found that these elevations probably were due to a deficit among the Marine non-Vietnam veterans rather than an excess among Marine Vietnam veterans.

Accidents, Traffic↗
PubMed1991

Mortality among women Vietnam veterans, 1973-1987.

A retrospective cohort mortality study was conducted to examine health effects of US military service in Vietnam on women veterans who served there between July 4, 1965 and March 28, 1973. About 4,600 women Vietnam veterans and 5,300 women veterans who had never served in Vietnam were identified from military records and followed for vital status on December 31, 1987. Mortality rates for all causes of death combined and for all cancers among Vietnam veterans were similar to those among non-Vietnam veterans (relative risk (RR) = 0.93). There was a slight excess of mortality from external causes among women Vietnam veterans compared with non-Vietnam veterans (RR = 1.33), primarily due to an excess of motor vehicle accidents (RR = 3.19). Suicide rates were nearly the same in both cohorts (RR = 0.96). Vietnam veterans had twofold increases in mortality from cancers of the pancreas and uterine corpus compared with non-Vietnam veterans. Women Vietnam veterans and non-Vietnam veterans had lower-than-expected mortality from all causes of death combined (standardized mortality ratio (SMR) = 0.82 and 0.88, respectively), based on rates for US women, due to significant deficits of deaths from circulatory diseases. Compared with rates for US women, mortality from cancers of the pancreas (five deaths, SMR = 3.27) and uterine corpus (four deaths, SMR = 4.05) was significantly elevated among Vietnam veteran nurses.

Adult↗