Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress.
BACKGROUND: Most US troops returned home from the Persian Gulf War (PGW) by Spring 1991 and many began reporting increased health symptoms and medical problems soon after. This investigation examines the relationships between several Gulf-service environmental exposures and health symptom reporting, and the role of traumatic psychological stress on the exposure-health symptom relationships. METHODS: Stratified, random samples of two cohorts of PGW veterans, from the New England area (n = 220) and from the New Orleans area (n = 71), were selected from larger cohorts being followed longitudinally since arrival home from the Gulf. A group of PGW-era veterans deployed to Germany (n = 50) served as a comparison group. The study protocol included questionnaires, a neuropsychological test battery, an environmental interview, and psychological diagnostic interviews. This report focuses on self-reported health symptoms and exposures of participants who completed a 52-item health symptom checklist and a checklist of environmental exposures. RESULTS: The prevalence of reported symptoms was greater in both Persian Gulf-deployed cohorts compared to the Germany cohort. Analyses of the body-system symptom scores (BSS), weighted to account for sampling design, and adjusted by age, sex, and education, indicated that Persian Gulf-deployed veterans were more likely to report neurological, pulmonary, gastrointestinal, cardiac, dermatological, musculoskeletal, psychological and neuropsychological system symptoms than Germany veterans. Using a priori hypotheses about the toxicant effects of exposure to specific toxicants, the relationships between self-reported exposures and body-system symptom groupings were examined through multiple regression analyses, controlling for war-zone exposure and post-traumatic stress disorder (PTSD). Self-reported exposures to pesticides, debris from Scuds, chemical and biological warfare (CBW) agents, and smoke from tent heaters each were significantly related to increased reporting of specific predicted BSS groupings. CONCLUSIONS: Veterans deployed to the Persian Gulf have higher self-reported prevalence of health symptoms compared to PGW veterans who were deployed only as far as Germany. Several Gulf-service environmental exposures are associated with increased health symptom reporting involving predicted body-systems, after adjusting for war-zone stressor exposures and PTSD. (+info)
Socioeconomic inequalities in health in the working population: the contribution of working conditions.
BACKGROUND: The aim was to study the impact of different categories of working conditions on the association between occupational class and self-reported health in the working population. METHODS: Data were collected through a postal survey conducted in 1991 among inhabitants of 18 municipalities in the southeastern Netherlands. Data concerned 4521 working men and 2411 working women and included current occupational class (seven classes), working conditions (physical working conditions, job control, job demands, social support at work), perceived general health (very good or good versus less than good) and demographic confounders. Data were analysed with logistic regression techniques. RESULTS: For both men and women we observed a higher odds ratio for a less than good perceived general health in the lower occupational classes (adjusted for confounders). The odds of a less than good perceived general health was larger among people reporting more hazardous physical working conditions, lower job control, lower social support at work and among those in the highest category of job demands. Results were similar for men and women. Men and women in the lower occupational classes reported more hazardous physical working conditions and lower job control as compared to those in higher occupational classes. High job demands were more often reported in the higher occupational classes, while social support at work was not clearly related to occupational class. When physical working conditions and job control were added simultaneously to a model with occupational class and confounders, the odds ratios for occupational classes were reduced substantially. For men, the per cent change in the odds ratios for the occupational classes ranged between 35% and 83%, and for women between 35% and 46%. CONCLUSIONS: A substantial part of the association between occupational class and a less than good perceived general health in the working population could be attributed to a differential distribution of hazardous physical working conditions and a low job control across occupational classes. This suggests that interventions aimed at improving these working conditions might result in a reduction of socioeconomic inequalities in health in the working population. (+info)
The meaning and use of the cumulative rate of potential life lost.
BACKGROUND: The 'years of potential life lost' (YPLL) is a public health measure in widespread use. However, the index does not apply to the comparisons between different populations or across different time periods. It also has the limit of being cross-sectional in nature, quantifying current burden but not future impact on society. METHODS: A new years-lost index is proposed-the 'cumulative rate of potential life lost' (CRPLL). It is a simple combination of the 'cumulative rate' (CR) and the YPLL. Vital statistics in Taiwan are used for demonstration and comparison of the new index with existing health-status measures. RESULTS: The CRPLL serves the purpose of between-group comparison. It can also be considered a projection of future impact, under the assumption that the age-specific mortality rates in the current year prevail. For a rare cause of death, it can be interpreted as the expected years (days) of potential life lost during a subject's lifetime. CONCLUSIONS: The CRPLL has several desirable properties, rendering it a promising alternative for quantifying health status. (+info)
Thiamine deficiency is prevalent in a selected group of urban Indonesian elderly people.
This cross-sectional study involved 204 elderly individuals (93 males and 111 females). Subjects were randomly recruited using a list on which all 60-75 y-old-people living in seven sub-villages in Jakarta were included. The usual food intake was estimated using semiquantitative food frequency questionnaires. Hemoglobin, plasma retinol, vitamin B-12, red blood cell folate and the percentage stimulation of erythrocyte transketolase (ETK), as an indicator of thiamine status, were analyzed. Median energy intake was below the assessed requirement. More than 75% of the subjects had iron and thiamine intakes of approximately 2/3 of the recommended daily intake, and 20.2% of the study population had folate intake of approximately 2/3 of the recommended daily intake. Intakes of vitamins A and B-12 were adequate. Biochemical assessments demonstrated that 36.6% of the subjects had low thiamine levels (ETK stimulation > 25%). The elderly men tended to have lower thiamine levels than the elderly women. The overall prevalence of anemia was 28.9%, and the elderly women were affected more than the elderly men. Low biochemical status of vitamins A, B-12 and RBC folate was found in 5.4%, 8.8 % and 2.9% of the subjects, respectively. Dietary intakes of thiamine and folate were associated with ETK stimulation and plasma vitamin B-12 concentration (r = 0.176, P = 0.012 and r = 0.77, P = 0.001), respectively. Results of this study suggest that anemia, thiamine and possibly vitamin B-12 deficiency are prevalent in the elderly living in Indonesia. Clearly, micronutrient supplementation may be beneficial for the Indonesian elderly population living in underprivileged areas. (+info)
Diabetic peripheral neuropathy and quality of life.
The quality of life (QOL) of 79 people with type 1 and type 2 diabetes and 37 non-diabetic controls was assessed using the Nottingham Health Profile (NHP). The NHP consists of six domains assessing energy, sleep, pain, physical mobility, emotional reactions and social isolation. Symptomatic diabetic neuropathy was present in 41 of the patients. The neuropathy patients had significantly higher scores (impaired QOL) in 5/6 NHP domains than either the other diabetic patients (p < 0.01) or the non-diabetic (p < 0.001) controls. These were: emotional reaction, energy, pain, physical mobility and sleep. The diabetic patients without neuropathy also had significantly impaired QOL for 4/6 NHP domains compared with the non-diabetic control group (p < 0.05) (energy, pain, physical mobility and sleep). This quantification of the detrimental effect on QOL of diabetes, and in particular of chronic symptomatic peripheral diabetic neuropathy, emphasizes the need for further research into effective management of these patients. (+info)
Why do short term workers have high mortality?
Increased mortality is often reported among workers in short term employment. This may indicate either a health-related selection process or the presence of different lifestyle or social conditions among short term workers. The authors studied these two aspects of short term employment among 16,404 Danish workers in the reinforced plastics industry who were hired between 1978 and 1985 and were followed to the end of 1988. Preemployment hospitalization histories for 1977-1984 were ascertained and were related to length of employment between 1978 and 1988. Workers who had been hospitalized prior to employment showed a 20% higher risk of early termination of employment than those never hospitalized (rate ratio (RR) = 1.20, 95% confidence interval (CI) 1.16-1.29), and the risk increased with number of hospitalizations. For workers with two or more preemployment hospitalizations related to alcohol abuse or violence, the rate ratios for short term employment were 2.30 (95% CI 1.74-3.06) and 1.86 (95% CI 1.35-2.56), respectively. An unhealthy lifestyle may also be a determinant of short term employment. While it is possible in principle to adjust for lifestyle factors if proper data are collected, the health-related selection of workers requires careful consideration when choosing a reference group for comparative studies of cumulative occupational exposure. (+info)
Economic consequences of the progression of rheumatoid arthritis in Sweden.
OBJECTIVE: To develop a simulation model for analysis of the cost-effectiveness of treatments that affect the progression of rheumatoid arthritis (RA). METHODS: The Markov model was developed on the basis of a Swedish cohort of 116 patients with early RA who were followed up for 5 years. The majority of patients had American College of Rheumatology (ACR) functional class II disease, and Markov states indicating disease severity were defined based on Health Assessment Questionnaire (HAQ) scores. Costs were calculated from data on resource utilization and patients' work capacity. Utilities (preference weights for health states) were assessed using the EQ-5D (EuroQol) questionnaire. Hypothetical treatment interventions were simulated to illustrate the model. RESULTS: The cohort distribution among the 6 Markov states clearly showed the progression of the disease over 5 years of followup. Costs increased with increasing severity of the Markov states, and total costs over 5 years were higher for patients who were in more severe Markov states at diagnosis. Utilities correlated well with the Markov states, and the EQ-5D was able to discriminate between patients with different HAQ scores within ACR functional class II. CONCLUSION: The Markov model was able to assess disease progression and costs in RA. The model can therefore be a useful tool in calculating the cost-effectiveness of different interventions aimed at changing the progression of the disease. (+info)
Risk factors for injuries and other health problems sustained in a marathon.
OBJECTIVES: To identify risk factors for injuries and other health problems occurring during or immediately after participation in a marathon. METHODS: A prospective cohort study was undertaken of participants in the 1993 Auckland Citibank marathon. Demographic data, information on running experience, training and injuries, and information on other lifestyle factors were obtained from participants before the race using an interviewer-administered questionnaire. Information on injuries and other health problems sustained during or immediately after the marathon were obtained by a self administered questionnaire. Logistic regression analyses were undertaken to identify significant risk factors for health problems. RESULTS: This study, one of only a few controlled epidemiological studies that have been undertaken of running injuries, has identified a number of risk factors for injuries and other health problems sustained in a marathon. Men were at increased risk of hamstring and calf problems, whereas women were at increased risk of hip problems. Participation in a marathon for the first time, participation in other sports, illness in the two weeks before the marathon, current use of medication, and drinking alcohol once a month or more, were associated with increased self reported risks of problems. While increased training seemed to increase the risk of front thigh and hamstring problems, it may decrease the risk of knee problems. There are significant but complex relations between age and risk of injury or health problem. CONCLUSIONS: This study has identified certain high risk subjects and risk factors for injuries and other health problems sustained in a marathon. In particular, subjects who have recently been unwell or are taking medication should weigh up carefully the pros and cons of participating. (+info)