New Onset of Chronic Diseases and Changes in Lifestyle Risk Factors Among Gulf War Veterans: A Longitudinal Comparison of High and Low Symptom Reporters.

OBJECTIVE: The aim of this study was to compare new chronic diseases onset and longitudinal changes in lifestyle risk factors between Gulf War veterans with different symptom reporting. METHODS: Data were collected from Gulf War veterans over two periods, and participants were grouped according to baseline symptom reporting. Logistic, nominal, and ordinal regressions were used for between-group comparisons. RESULTS: The veterans comprised low, moderate, and high symptom reporters. New onset of sleep apnea [odds ratio (OR) = 9.49; 95% confidence interval (CI) = 3.48 to 25.86], musculoskeletal (OR = 8.70; 95% CI = 4.17 to 18.17), psychological (OR = 5.36; 95% CI = 2.46 to 11.70), and cardiovascular (OR = 3.86; 95% CI = 1.33 to 11.23) conditions was elevated in high versus low symptom reporters. Although odds of obesity and alcohol use increased over time and smoking halved, the changes were similar across groups. CONCLUSIONS: These findings show increasing obesity and alcohol use, and indicate that high symptomatology among veterans may predict future disease onset.

Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Developing a brief depression screen and identifying associations with comorbid physical and psychological illness in Australian Gulf War veterans.

OBJECTIVE: Major depression occurs frequently in veterans, and is associated with comorbid psychological and physical disorders and poorer quality of life. Depression can be difficult to detect in primary care, while lengthy assessment instruments can deter use. Our study aimed to develop a brief depression screen that could be used by veterans and caregivers, and then to compare the association between the brief screen and comorbidities and quality of life with that of a longer instrument. METHODS: Our dataset comprised 1204 male Royal Australian Navy veterans of the 1990/91 Gulf War. Depressive symptoms were assessed using the General Health Questionnaire (GHQ-12), health-related quality of life by the Short-Form Health Survey (SF-12), major depression and comorbid psychiatric diagnoses such as posttraumatic disorder (PTSD) using Diagnostic and Statistical Manual (DSM-IV) criteria. Comorbid physical illnesses including musculoskeletal disorders, chronic fatigue and diabetes were examined. RESULTS: A brief depression screen of three key self-reported symptoms was identified. Veterans with major depression present according to the screen were over four times more likely to have multisymptom illness or PTSD, and almost twice as likely to have musculoskeletal disorders. Having depression according to the brief screen and having at least one other physical or psychological condition was associated with poorer quality of life. Similar results were obtained for a longer screen based on all GHQ-12 items. CONCLUSION: A 3 item depression screen performed as well as a 12 item one in identifying major depression, comorbid physical and psychological illness and poorer quality of life in veterans.

The effect of socioeconomic status on survival from colorectal cancer in the Melbourne Collaborative Cohort Study.

Previous research relating lower socioeconomic status (SES) with poorer survival from colorectal cancer has varied in adjustment for confounding factors and in the use of individual-level or aggregate-level indicators of SES. We investigated the effect of SES and country of birth on survival from colorectal cancers diagnosed in participants of the Melbourne Collaborative Cohort Study. A total of 526 colorectal cancer cases diagnosed since baseline were followed from diagnosis to 1 June 2006 or death. Information on tumour site and stage, and treatments given were obtained from systematic medical record review. SES at diagnosis was assigned using both an area-based measure of social disadvantage and individual level of educational attainment. Cox regression models were used to estimate hazard ratios associated with socioeconomic disadvantage, educational attainment, and country of birth. During an average follow-up of 5.6 years from diagnosis, 230 deaths occurred, 197 from colorectal cancer. After adjusting for age, sex, tumour stage, waist circumference and adjuvant chemotherapy and radiotherapy, the hazard ratios of dying from all causes and from colorectal cancer associated with living in the least disadvantaged areas compared with most disadvantaged areas were 0.73 (95% CI 0.53-1.00, p for trend=0.06) and 0.80 (95% CI 0.57-1.12, p for trend=0.22) respectively. Further adjustment for hospital case-load, tumour characteristics, and lifestyle factors did not change the estimates materially. Level of educational attainment and country of birth were not independent predictors of the risk of dying from colorectal cancer. Despite a universal health care system in Australia, socioeconomic inequalities in survival from colorectal cancer exist, and an enduring challenge is to ensure that improvements in colorectal cancer survival are shared equally across the population.

Reproductive health of male Australian veterans of the 1991 Gulf War.

BACKGROUND: Since the 1991 Gulf War concerns have been raised about the effects of deployment to the Gulf War on veterans' health. Studies of the reproductive health of Gulf War veterans have reported varied findings. METHODS: We undertook a cross-sectional study of male Australian Gulf War veterans (n = 1,424) and a randomly sampled military comparison group (n = 1,548). The study was conducted from August 2000 to April 2002. A postal questionnaire included questions about difficulties achieving pregnancy, pregnancy outcomes including live births, stillbirths, miscarriages and terminations; and for all live births gestation, birth weight, sex, and any cancers, birth defects, chromosomal abnormalities or serious health problems. RESULTS: Male Gulf War veterans reported slightly increased risk of fertility difficulties following the Gulf War (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.0-1.8), but were more successful at subsequently fathering a child (OR 1.8; 95% CI 1.3-2.6). The study groups reported similar rates of pregnancies and live births. There was no increased risk in veterans of miscarriage, stillbirth, or terminations. Children of male Gulf War veterans born after the period of the Gulf War were not at greater risk of being born prematurely, having a low birth weight, or having a birth defect or chromosomal abnormality (OR 1.0; 95% CI 0.6-1.6). The numbers of cancers and deaths in children were too small to draw any firm conclusions. CONCLUSION: The results of this study do not show an increased risk of adverse reproductive outcome in Australian male Gulf War veterans.

Hazardous or harmful alcohol use in Royal Australian Navy veterans of the 1991 Gulf War: identification of high risk subgroups.

Elevated alcohol use disorders have been observed in 1991 Gulf War veterans from a variety of countries. This study used a self-report instrument, the Alcohol Use Disorders Identification Test (AUDIT), to ascertain whether any subgroups of 1232 male Royal Australian Navy (RAN) Gulf War veterans were at higher risk of hazardous or harmful alcohol use. Recursive partitioning/classification and regression tree (CART) analysis, followed by logistic regression, found five subgroups among the veterans, with differing risks of AUDIT caseness. The highest risk subgroup comprised current smokers. The other two high risk groups both consisted of former or never smokers of lower rank who were (1) not married, or (2) married, with a current diagnosis of major depression. The above subgroups were over three times as likely to exhibit AUDIT caseness than those who were former or never smokers of higher rank. The findings have important implications for effective development of public health initiatives designed to encourage safe alcohol use among veterans.