Associations between Use of Antimalarial Medications and Health among U.S. Veterans of the Wars in Iraq and Afghanistan.

Mefloquine (Lariam®; Roche Holding AG, Basel, Switzerland) has been linked to acute neuropsychiatric side effects. This is a concern for U.S. veterans who may have used mefloquine during recent Southwest Asia deployments. Using data from the National Health Study for a New Generation of U.S. Veterans, a population-based study of U.S. veterans who served between 2001 and 2008, we investigated associations between self-reported use of antimalarial medications and overall physical and mental health (MH) using the twelve-item short form, and with other MH outcomes using the post-traumatic stress disorder Checklist-17 and the Patient Health Questionnaire (anxiety, major depression, and self-harm). Multivariable logistic regression was performed to examine associations between health measures and seven antimalarial drug categories: any antimalarial, mefloquine, chloroquine, doxycycline, primaquine, mefloquine plus any other antimalarial, and any other antimalarial or antimalarial combination while adjusting for the effects of deployment and combat exposure. Data from 19,487 veterans showed that although antimalarial use was generally associated with higher odds of negative health outcomes, once deployment and combat exposure were added to the multivariable models, the associations with each of the MH outcomes became attenuated. A positive trend was observed between combat exposure intensity and prevalence of the five MH outcomes. No significant associations were found between mefloquine and MH measures. These data suggest that the poor physical and MH outcomes reported in this study population are largely because of combat deployment exposure

Mortality Patterns of Army Chemical Corps Veterans Who were Occupationally Exposed to Herbicides in Vietnam

PURPOSE: This research examined the risk of disease-related mortality of the Army Chemical Corps (ACC) veterans who handled/sprayed herbicides in Vietnam in comparison with their non-Vietnam veteran peers or U.S. men. METHODS: Vital status was determined through December 31, 2005. All-cause mortality and cause-specific mortality were compared for individuals who served in Vietnam (n Z 2872) versus those who did not (n Z 2737). Similar analyses were completed on a subset of the original Vietnam cohort that consisted of individuals who either reported spraying herbicide (n Z 662) or not (n Z 811). The observed deaths for each of the two base cohorts were also compared with expected deaths for U.S. men. RESULTS: Statistically significant excess mortality was found for ACC Vietnam veterans for chronic obstructive pulmonary disease (adjusted relative risk [ARR], 4.82; 95% confidence interval [95% CI], 1.10–21.18). When examining patterns for veterans in the Vietnam veteran subset, we found nonsignificant elevated ARRs among herbicide sprayers for all-cause, respiratory system disease, and respiratory system cancer mortality. Compared with U.S. men, the Vietnam veteran cohort had significant excess mortality for all-causes (standardized mortality ratio [SMR], 1.13; 95% CI, 1.04–1.23), respiratory system cancer (SMR, 1.35; 95% CI, 1.03–1.73), nonmalignant respiratory system disease (SMR, 1.58; 95% CI, 1.08–2.23), and miscellaneous malignant cancers (SMR, 1.77; 95% CI, 1.03–2.84). CONCLUSIONS: The risk of mortality from respiratory disease (malignant or nonmalignant) was significantly greater for ACC Vietnam veterans in comparison with their non-Vietnam veteran peers and U.S. men. Herbicide exposure could be contributing to the patterns observed. Because of the unique nature of their military duties and study limitations, findingsm ay not be generalizeable to Vietnamveterans as awhole. Ann Epidemiol 2010;20:339–346. Published by Elsevier Inc

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

Prevalence and Correlates of Food and/or Housing Instability among Men and Women Post-9/11 US Veterans.

Food and/or housing instability (FHI) has been minimally examined in post-9/11 US veterans. A randomly selected nationally representative sample of men and women veterans (n = 38,633) from the post-9/11 US veteran population were mailed invitation letters to complete a survey on health and well-being. Principal component analysis and multivariable logistic regression were used to identify FHIs key constructs and correlates for 15,166 men and women respondents (9524 men, 5642 women). One-third of veterans reported FHI; it was significantly more likely among women than men (crude odds ratio = 1.31, 95% CI:1.21-1.41) and most prevalent post-service (64.2%). Mental Health/Stress/Trauma, Physical Health, and Substance Use were FHIs major constructs. In both sexes, significant adjusted associations (p < 0.01) were found between FHI and homelessness, depression, adverse childhood experiences, low social support, being enlisted, being non-deployed, living with seriously ill/disabled person(s), and living in dangerous neighborhoods. In men only, posttraumatic stress disorder (adjusted odds ratio (AOR) = 1.37, 95% CI:1.14-1.64), cholesterol level (elevated versus normal, AOR = 0.79, 95% CI:0.67-0.92), hypertension (AOR = 1.25, 95% CI:1.07-1.47), and illegal/street drug use (AOR = 1.28, 95% CI:1.10-1.49) were significant (p < 0.01). In women only, morbid obesity (AOR = 1.90, 95%CI:1.05-3.42) and diabetes (AOR = 1.53, 95% CI:1.06-2.20) were significant (p < 0.05). Interventions are needed that jointly target adverse food and housing, especially for post-9/11 veteran women and enlisted personnel

Residents\u27 perceptions of MRI training in the United States.

PURPOSE: The primary objective of this exploratory study was to gain a better understanding of perceptions of magnetic resonance imaging (MRI) training by US radiology residents. METHODS: Two surveys were administered between September 2002 and June 2003 to nonprobability-based samples totaling approximately 2000 residents, under the auspices of the ACR\u27s Resident Physician Section. The MRI Training Survey was administered in 2002, and it was supplemented by the Cardiac MRI Training Survey in 2003. The response rate for the MRI Training Survey was 15%, whereas the response rate for the Cardiac MRI Training Survey was 43%. RESULTS: The sample of residents surveyed comprised approximately 74% men; approximately 80% were in their third postgraduate year or higher. Eighty-five percent of residents reported the receipt of formal training in MRI physics. At least 60% did not have dedicated MRI rotations in either musculoskeletal or body MRI, and 89% lacked dedicated rotations in cardiac MRI. Seventy percent reported that they viewed overall MRI training as less than adequate; 94% stated that dedicated MRI training was warranted. CONCLUSIONS: This preliminary research suggests that current MRI training may be less than residents feel is needed in many training programs. New comprehensive, electronically disseminated core curricula, as well as a potential future mandate for minimum training requirements by the Accreditation Council for Graduate Medical Education\u27s Radiology Residency Review Committee, may be necessary to strengthen MRI training at a time when the demand for radiology services is growing