Spirometric Pulmonary Restriction in Herbicide-Exposed U.S. Vietnam War Veterans.

Spirometric restriction in herbicide-exposed U.S. Army Chemical Corps Vietnam War veterans was examined because no published research on this topic in Vietnam War veterans exists. Spirometry was conducted on 468 veterans who served in chemical operations in a 2013 study assessing the association between chronic obstructive pulmonary disease (COPD) and herbicide exposure. Exposure was verified based on blood serum values of 2,3,7,8-tetrachlorodibenzo-p-dioxin. Further, the association between herbicide exposure and spirometry restriction (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ≥ lower limit of normal (LLN) and FVC < LLN) was tested after adjustment for military characteristics, selected anthropometrics, and other predictors using multivariable regression. Spirometric restriction in herbicide sprayers (15.7%, 95% CI: 10.6, 20.9) was almost twice that of nonsprayers (9.91%, 95% CI: 5.9, 13.9) (p = 0.081). While spirometric restriction was not significantly associated with herbicide exposure (adjusted odds ratio (aOR) = 1.64, 95% CI: 0.82, 3.29) despite the greater prevalence of restriction in sprayers versus nonsprayers, spirometric restriction was significantly associated with race/ethnicity (aOR = 3.04, 95% CI: 1.36, 6.79) and waist circumference (aOR = 2.46, 95% CI: 1.25, 4.85). Because restrictive pulmonary disease may result from chemically-induced inflammation or sensitivity, research on chemical exposures and restriction in veterans should continue. Future study should include full pulmonary function testing, targeted research designs, and a wider set of explanatory variables in analysis, such as other determinants of health.

Self-reported physician-diagnosed chronic obstructive pulmonary disease and spirometry patterns in Vietnam Era US Army Chemical Corps veterans: A retrospective cohort study.

BACKGROUND: Research on chronic obstructive pulmonary disease (COPD) and herbicide exposure in Vietnam War veterans is limited. METHODS: Survey data were collected from 3193 US Army Chemical Corps veterans on herbicide exposure and self-reported physician-diagnosed COPD. Three spirometric patterns were used to define airflow obstruction (AFO): (i) FEV1 /FVC < 70% ("fixed ratio"); (ii) FEV1 /FVC < lower limit of normal ("LLN"); and (iii) (FEV1 /FVC < LLN and FVC ≥ LLN and FEV1

Health-Related Quality of Life Among U.S. Veterans of Operation Enduring Freedom and Operation Iraqi Freedom-Results From a Population-Based Study.

INTRODUCTION: Recent studies have demonstrated health problems among veterans of the wars in Afghanistan and Iraq (Operation Enduring Freedom and Operation Iraqi Freedom). Veterans from these conflicts have a higher prevalence of mental disorders and physical diseases, though most studies were conducted using administrative data. MATERIALS AND METHODS: This study analyzes data from the National Health Study for a New Generation of U.S. Veterans, a population-based survey that collected data on Operation Enduring Freedom/Operation Iraqi Freedom veterans between 2009 and 2011. Weighted prevalence estimates of deployed and nondeployed veterans were calculated for SF-12 general health perception and clinic and hospital visits. Weighted mean physical (PCS) and mental component summary (MCS) scores were calculated by demographic and military characteristics. Weighted, adjusted odds ratios (aORs), 95% confidence intervals (95% CI), and prevalence estimates were calculated for physician-diagnosed medical conditions comparing deployed to nondeployed veterans. RESULTS: Of 60,000 veterans sampled, 20,563 responded to the survey (response rate = 34%). Deployed veterans had increased odds for significant hearing loss (aOR = 1.48; 95% CI = 1.35, 1.63), and lower odds for arthritis (aOR = 0.90; 95% CI = 0.83, 0.98), diabetes (aOR = 0.70; 95% CI = 0.58, 0.84), and migraines (aOR = 0.88; 95% CI = 0.80, 0.97) compared to nondeployed veterans. The prevalence of clinic visits was nearly equal between deployed and nondeployed veterans, though nondeployed veterans reported a higher percentage of hospitalizations that were overnight or longer. The SF-12 MCS was higher among the nondeployed group compared to the deployed group (p < 0.0001), though the deployed group reported a higher PCS compared to the nondeployed (p < 0.0001). The SF-12 MCS and PCS were lower than the U.S. population mean of 50. CONCLUSIONS: Deployed veterans are at increased risk for some health conditions; however, nondeployed veterans also report a variety of health conditions. Addressing the unique health concerns of both deployed and nondeployed veterans is important and continued observation of all veterans is recommended.

Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans.

OBJECTIVE: We examined hypertension risk in Army Chemical Corps (ACC) veterans who sprayed defoliant in Vietnam. METHODS: We analyzed data from the 2013 health survey of 3086 ACC veterans and investigated the association between self-reported physician-diagnosed-hypertension (SRH) and herbicide-spray-history adjusting for Vietnam-service-status, rank, age, tobacco/alcohol use, race, and body mass index (BMI). Spray-history was verified against serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) (n = 636). SRH was confirmed by blood pressure (BP) measurement by trained medical technicians and medical record reviews. RESULTS: Herbicide-spray-history (ORadjusted[95%confidence interval {CI}] = 1.74[1.44,2.11]) and Vietnam-service-status (ORadjusted = 1.26[1.05,1.53]) were significantly associated with SRH. The association was highest when comparing Vietnam-service-sprayers to non-Vietnam-service-nonsprayers (ORadjusted = 2.21[1.76,2.77]). Serum TCDD was highest for Vietnam-service-sprayers. Mean systolic BPs were significantly higher among veterans with SRH than those without (P ≤ 0.001). Medical records and SRH overall agreement was 89%. CONCLUSION: Occupational herbicide exposure history and Vietnam-service-status were significantly associated with hypertension risk.

Cigarette Smoking and Sociodemographic, Military, and Health Characteristics of Operation Enduring Freedom and Operation Iraqi Freedom Veterans: 2009-2011 National Health Study for a New Generation of US Veterans.

OBJECTIVE: We examined the sociodemographic, military, and health characteristics of current cigarette smokers, former smokers, and nonsmokers among Operation Enduring Freedom (OEF) / Operation Iraqi Freedom (OIF) veterans and estimated smoking prevalence to better understand cigarette use in this population. METHODS: We analyzed data from the US Department of Veterans Affairs (VA) 2009-2011 National Health Study for a New Generation of US Veterans. On the basis of a stratified random sample of 60 000 OEF/OIF veterans, we sought responses to a 72-item questionnaire via mail, telephone, or Internet. Cigarette smoking status was based on self-reported cigarette use in the past year. We used multinomial logistic regression to evaluate associations between smoking status and sociodemographic, military, and health characteristics. RESULTS: Among 19 911 veterans who provided information on cigarette smoking, 5581 were current smokers (weighted percentage: 32.5%, 95% confidence interval [CI]: 31.7-33.2). Current smokers were more likely than nonsmokers or former smokers to be younger, to have less education or income, to be separated/divorced or never married/single, and to have served on active duty or in the army. Comparing current smokers and nonsmokers, some significant associations from adjusted analyses included the following: having a Mental Component Summary score (a measure of overall mental health) above the mean of the US population relative to below the mean (adjusted odds ratio [aOR] = 0.81, 95% CI: 0.73-0.90); having physician-diagnosed depression (aOR = 1.52, 95% CI: 1.33-1.74), respiratory conditions (aOR = 1.16, 95% CI: 1.04-1.30), or repeated seizures/blackouts/convulsions (aOR = 1.80, 95% CI: 1.22-2.67); heavy alcohol use vs never use (aOR = 5.49, 95% CI: 4.57-6.59); a poor vs excellent perception of overall health (aOR = 3.79, 95% CI: 2.60-5.52); and being deployed vs nondeployed (aOR = 0.87, 95% CI: 0.78-0.96). Using health care services from the VA protected against current smoking. CONCLUSION: Mental and physical health, substance use, and military service characteristics shape cigarette-smoking patterns in OEF/OIF veterans.

The National Health Study for a New Generation of United States Veterans: methods for a large-scale study on the health of recent veterans.

This article describes the methodology used in the "National Health Study for a New Generation of U.S. Veterans," a large-scale longitudinal study of the health of 30,000 Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq) veterans, and 30,000 veterans who were not deployed to these conflicts. Veterans could participate by mail, online, or through a computer-assisted telephone interview. A medical records review was also conducted to validate responses to the survey. The response rate was 34.3%, with 20,563 surveys accepted. This study underscores the complexity of sampling and studying this population of recent veterans.

Impact of vessel size on outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents: a subgroup analysis of the SIRTAX trial.

OBJECTIVES: We assessed the impact of vessel size on angiographic and long-term clinical outcome after percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) within a randomized trial (SIRTAX [Sirolimus-Eluting Stent Compared With Paclitaxel-Eluting Stent for Coronary Revascularization]). BACKGROUND: Percutaneous coronary intervention in small-vessel disease is associated with an increased risk of major adverse cardiac events (MACE). METHODS: A total of 1,012 patients were randomly assigned to treatment with SES (n = 503) or PES (n = 509). A stratified analysis of angiographic and clinical outcome was performed up to 2 years after PCI according to size of the treated vessel (reference vessel diameter < or =2.75 vs. >2.75 mm). RESULTS: Of 1,012 patients, 370 patients (37%) with 495 lesions underwent stent implantation in small vessels only, 504 patients (50%) with 613 lesions in large vessels only, and 138 patients (14%) with 301 lesions in both small and large vessels (mixed). In patients with small-vessel stents, SES reduced MACE by 55% (10.4% vs. 21.4%; p = 0.004), mainly driven by a 69% reduction of target lesion revascularization (TLR) (6.0% vs. 17.7%; p = 0.001) compared with PES at 2 years. In patients with large- and mixed-vessel stents, rates of MACE (large: 10.4% vs. 13.1%; p = 0.33; mixed: 16.7% vs. 18.0%; p = 0.83) and TLR (large: 6.9% vs. 8.6%; p = 0.47; mixed: 16.7% vs. 15.4%; p = 0.86) were similar for SES and PES. There were no significant differences with respect to death and myocardial infarction between the 3 groups. CONCLUSIONS: Compared with PES, SES more effectively reduced MACE and TLR in small-vessel disease. Differences between SES and PES appear less pronounced in patients with large- and mixed-vessel disease. (The SIRTAX trial; http://clinicaltrials.gov/ct/show/NCT00297661?order=1; NCT00297661).