X-ray powder diffraction at the XRD1 beamline at LNLS.

Various upgrades have been completed at the XRD1 beamline at the Brazilian synchrotron light source (LNLS). The upgrades are comprehensive, with changes to both hardware and software, now allowing users of the beamline to conduct X-ray powder diffraction experiments with faster data acquisition times and improved quality. The main beamline parameters and the results obtained for different standards are presented, showing the beamline ability of performing high-quality experiments in transmission geometry. XRD1 operates in the 5.5-14 keV range and has a photon flux of 7.8 × 109 photons s-1 (with 100 mA) at 12 keV, which is one of the typical working energies. At 8 keV (the other typical working energy) the photon flux at the sample position is 3.4 × 1010 photons s-1 and the energy resolution ΔE/E = 3 × 10-4.

Serum dioxin and cognitive functioning among veterans of Operation Ranch Hand.

We used the Halstead-Reitan neuropsychological test battery, the Wechsler adult intelligence scale-revised, the Wechsler memory scale, and the wide range achievement test to assess cognitive functioning among Air Force veterans exposed to Agent Orange and its contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin), during the Vietnam war The index subjects were veterans of Operation Ranch Hand (N = 937), the unit responsible for aerial herbicide spraying in Vietnam from 1962 to 1971. A comparison group of other Air Force veterans (N= 1,052), who served in Southeast Asia during the same period but were not involved with spraying herbicides served as referents. Cognitive functioning was assessed in 1982, and dioxin levels were measured in 1987 and 1992. We assigned each Ranch Hand veteran to the background, low, or high dioxin exposure category on the basis of a measurement of dioxin body burden. Although we found no global effect of dioxin exposure on cognitive functioning, we did find that several measures of memory functioning were decreased among veterans with the highest dioxin exposure. These results became more distinct when we restricted the analysis to enlisted personnel, the subgroup with the highest dioxin levels. An analysis based on dioxin quintiles in the combined cohort produced consistent results, with veterans in the fifth quintile exhibiting reduced verbal memory function. Although statistically significant, these differences were relatively small and of uncertain clinical significance.

Self-reported postwar injuries among Gulf War veterans.

OBJECTIVE: From September 1995 to May 1996, the authors conducted a telephone survey of Iowa military personnel who had served in the regular military or activated National Guard or Reserve during the Gulf War period. To assess the association between military service in a combat zone and subsequent traumatic injury requiring medical consultation, the authors analyzed veterans' interview responses. METHODS: Using data from the larger survey, the authors compared rates of self-reported postwar injuries requiring medical consultation in a sample of Iowa Gulf War veterans to the rates in a sample of Iowa military personnel who served at the same time, but not in the Persian Gulf. RESULTS: Of 3695 veterans, 605 (16%) reported a traumatic injury in the previous three months requiring medical consultation. Self-reported injuries were associated with service in the Persian Gulf (odds ratio 1.26; 95% confidence interval 1.02, 1.55). CONCLUSION: This finding is consistent with the results of earlier studies of traumatic injury mortality rates among war veterans.

Is there a Persian Gulf War syndrome? Evidence from a large population-based survey of veterans and nondeployed controls.

PURPOSE: Concerns have been raised about whether veterans of the Gulf War have a medical illness of uncertain etiology. We surveyed veterans to look for evidence of an illness that was unique to those deployed to the Persian Gulf and was not seen in comparable military controls. SUBJECTS AND METHODS: A population-based sample of veterans (n = 1,896 from 889 units) deployed to the Persian Gulf and other Gulf War-era controls (n = 1799 from 893 units) who did not serve in the Gulf were surveyed in 1995-1996. Seventy-six percent of eligible subjects, including 91% of located subjects, answered questions about commonly reported and potentially important symptoms. We used factor analysis, a statistical technique that can identify patterns of related responses, on a random subset of the deployed veterans to identify latent patterns of symptoms. The results from this derivation sample were compared with those obtained from a separate validation sample of deployed veterans, as well as the nondeployed controls, to determine whether the results were replicable and unique. RESULTS: One half (50%) of the deployed veterans and 14% of the nondeployed controls reported health problems that they attributed to military service during 1990-1991. Compared with the nondeployed controls, the deployed veterans had significantly greater prevalences of 123 of 137 (90%) symptoms; none was significantly lower. Factor analysis identified three replicable symptom factors (or patterns) in the deployed veterans (convergent correlations > or =0.85). However, these patterns were also highly replicable in the nondeployed controls (convergent correlations of 0.95 to 0.98). The three factors also accounted for similar proportions of the common variance among the deployed veterans (35%) and nondeployed controls (30%). CONCLUSIONS: The increased prevalence of nearly every symptom assessed from all bodily organ systems among the Gulf War veterans is difficult to explain pathophysiologically as a single condition. Identification of the same patterns of symptoms among the deployed veterans and nondeployed controls suggests that the health complaints of Gulf War veterans are similar to those of the general military population and are not consistent with the existence of a unique Gulf War syndrome.

Deployment stressors and a chronic multisymptom illness among Gulf War veterans.

Unusual health problems have been reported by Gulf War (GW) veterans, but no single etiology has been linked to these illnesses. This study was conducted to determine the association between self-reported GW deployment stressors and an illness defined by a combination of fatigue, mood-cognition, and musculoskeletal symptoms. A total of 1002 GW veterans from this cross-sectional survey of four Air Force units completed a self-administered questionnaire that asked about symptoms, demographic and military characteristics, and stressors during deployment. Severe and mild-moderate illness was positively associated with self-reports of pyridostigmine bromide use, insect repellent use and belief in a threat from biological or chemical weapons. Injuries requiring medical attention were only associated with severe illness. These results suggest a link between self-reported chemical, emotional, and physical exposures, and GW veterans' illness. Further research is needed to determine physiological and psychological mechanisms through which such stressors could have contributed to this symptom complex.

Multiple chemical sensitivity syndrome: symptom prevalence and risk factors in a military population.

OBJECTIVE: To assess the prevalence of and risk factors for self-reported symptoms suggestive of multiple chemical sensitivities/idiopathic environmental intolerance (MCS/IEI) in Persian Gulf War (PGW) veterans from Iowa and a comparison group of PGW-era military personnel. METHODS: A population-based sample of Iowa military personnel was surveyed using a cross-sectional telephone interview. Study participants were randomly drawn from 1 of 4 domains: PGW active duty, PGW National Guard/Reserve, non-PGW active duty, and non-PGW National Guard/Reserve. A complex sample survey design was used selecting participants from the following substrata: age, sex, race, rank, and military branch. The criteria for MCS/IEI were developed using expert consensus and the medical literature. RESULTS: A total of 3695 study participants (76% of those eligible) completed the telephone survey. The prevalence of symptoms suggestive of MCS/IEI in all participants was 3.4%. Veterans of the PGW reported a significantly higher prevalence of symptoms suggestive of MCS/IEI than did non-PGW military personnel (5.4% vs 2.6%); greater sensitivity to organic chemicals, vehicle exhaust, cosmetics, and smog; and more lifestyle changes. The following risk factors for MCS/IEI were identified with univariate analysis: deployment to the Persian Gulf, age (>25 years), female sex, receiving a physician diagnosis of MCS, previous professional psychiatric treatment, previous psychotropic medication use, current psychiatric illness, and a low level of preparedness. Multiple logistic regression analysis identified several independent risk factors for MCS/IEI, including deployment to the Persian Gulf, age, sex, rank, branch of service, previous professional psychiatric treatment, and current mental illness. CONCLUSIONS: Self-reported symptoms suggestive of MCS/IEI are relatively frequent in a military population and are more common among PGW veterans than comparable controls. Reported chemical sensitivities and accompanying behavioral changes were also frequent. After adjusting for age, sex, and training preparedness, previous professional psychiatric treatment and previous psychotropic medication use (before deployment) showed a robust association with symptoms suggestive of MCS.

Quality of life and health-services utilization in a population-based sample of military personnel reporting multiple chemical sensitivities.

We sought to assess quality of life and health-services utilization variables in persons with symptoms suggestive of multiple chemical sensitivity/idiopathic environmental intolerance (MCS/IEI) among military personnel. We conducted a cross-sectional telephone survey of a population-based sample of Persian Gulf War (PGW) veterans from Iowa and a comparison group of PGW-era military personnel. A complex sample survey design was used, selecting subjects from four domains: PGW active duly, PGW National Guard/Reserve, non-PGW active duty, and non-PGW National Guard/Reserve. Each domain was substratified by age, gender, race, rank, and military branch. The criteria for MCS/IEI were developed by expert consensus and from the medical literature. In the total sample, 169 subjects (4.6%) of the 3695 who participated (76% of those eligible) met our criteria for MCS/IEI. Persons who met the criteria for MCS/IEI more often reported the following than did other subjects: more than 12 days in bed due to disability, Veteran's Affairs disability status, Veteran's Affairs disability compensation, medical disability, and unemployment. MCS/IEI cases also had higher outpatient rates of physician visits, emergency department visits, and inpatient hospital stays. Subjects who met the criteria for MCS/IEI more often reported impaired functioning on each Medical Outcomes Study 36-Item Short Form subscale, compared with those who did not meet the criteria. We concluded that although the diagnosis of MCS/IEI remains controversial, the persons who met our criteria for the disorder are functionally impaired.

Chronic multisymptom illness affecting Air Force veterans of the Gulf War.

CONTEXT: Gulf War (GW) veterans report nonspecific symptoms significantly more often than their nondeployed peers. However, no specific disorder has been identified, and the etiologic basis and clinical significance of their symptoms remain unclear. OBJECTIVES: To organize symptoms reported by US Air Force GW veterans into a case definition, to characterize clinical features, and to evaluate risk factors. DESIGN: Cross-sectional population survey of individual characteristics and symptoms and clinical evaluation (including a structured interview, the Medical Outcomes Study Short Form 36, psychiatric screening, physical examination, clinical laboratory tests, and serologic assays for antibodies against viruses, rickettsia, parasites, and bacteria) conducted in 1995. PARTICIPANTS AND SETTING: The cross-sectional questionnaire survey included 3723 currently active volunteers, irrespective of health status or GW participation, from 4 air force populations. The cross-sectional clinical evaluation included 158 GW veterans from one unit, irrespective of health status. MAIN OUTCOME MEASURES: Symptom-based case definition; case prevalence rate for GW veterans and nondeployed personnel; clinical and laboratory findings among veterans who met the case definition. RESULTS: We defined a case as having 1 or more chronic symptoms from at least 2 of 3 categories (fatigue, mood-cognition, and musculoskeletal). The prevalence of mild-to-moderate and severe cases was 39% and 6%, respectively, among 1155 GW veterans compared with 14% and 0.7% among 2520 nondeployed personnel. Illness was not associated with time or place of deployment or with duties during the war. Fifty-nine clinically evaluated GW veterans (37%) were noncases, 86 (54%) mild-to-moderate cases, and 13 (8%) severe cases. Although no physical examination, laboratory, or serologic findings identified cases, veterans who met the case definition had significantly diminished functioning and well-being. CONCLUSIONS: Among currently active members of 4 Air Force populations, a chronic multisymptom condition was significantly associated with deployment to the GW. The condition was not associated with specific GW exposures and also affected nondeployed personnel.

Combat exposure and adult psychosocial adjustment among U.S. Army veterans serving in Vietnam, 1965-1971.

This study investigated the relationship between combat exposure and adult antisocial behavior in a sample of 2,490 male Army veterans of the Vietnam War who completed questionnaires about their psychological functioning. After adjustment for history of childhood behavior problems, posttraumatic stress disorder diagnosis, and demographic and military characteristics, it was found that veterans who experienced high and very high levels of combat were twice as likely to report adult antisocial behavior as veterans with no or low levels of combat and were also more likely to meet criteria for antisocial personality disorder. The results indicate that exposure to traumatic events during late adolescence or early adulthood is associated with multiple adult adjustment problems in vocational, interpersonal, and societal functioning. Treatment focusing on the effects of the trauma is likely to be necessary but not sufficient for improving affected veterans' behavior.

Cognitive functioning and posttraumatic stress disorder.

OBJECTIVE: The authors examined the association of cognitive impairment with posttraumatic stress disorder (PTSD) and other psychiatric diagnoses known to affect cognitive functioning. METHOD: The results of standardized neuropsychological tests were compared in four groups of Vietnam veterans: veterans with both a lifetime history of PTSD and a current diagnosis of depression, anxiety, or substance abuse; veterans with only a PTSD diagnosis; veterans with only a current diagnosis of depression, anxiety, or substance abuse; and veterans with none of these diagnoses. RESULTS: Veterans with both PTSD and concurrent diagnoses. exhibited more impairment in cognitive functioning than did veterans without these diagnoses. CONCLUSIONS: Cognitive deficits seen among persons diagnosed with PTSD may be associated with their concomitant diagnoses.

An investigation of medical examiner cases in which methadone was detected, Harris County, Texas, 1987-1992.

In 1991, media reports of an increase in the number of deaths attributed to methadone toxicity in Harris County, Texas, raised public concern about the safety of methadone. This concern was heightened by publicity surrounding the closure of three Harris County methadone maintenance treatment programs due to their poor compliance with federal methadone regulations. In response to this concern, the Texas Department of Public Health requested that the Centers for Disease Control and Prevention (CDC) assist in an epidemiologic study to determine the extent of methadone-related mortality in Harris County during 1991 and to determine the role of methadone maintenance treatment in these deaths. We reviewed cases investigated by the Harris County Medical Examiner's Office from 1987 through 1992 in which methadone was detected by postmortem drug testing. The autopsy reports for cases occurring in 1991 were also reviewed by three independent forensic pathologists who were asked to determine the role of methadone in the death. In addition, we attempted to document Harris County methadone maintenance treatment program enrollment for each decedent. We identified 91 decedents in whom methadone was detected at the time of death, with the largest number of cases occurring in 1991 (n = 27). Other substances, including alcohol, were detected in 85% of the cases. The Harris County Medical Examiner attributed 11 of the deaths to methadone toxicity. No more than three cases per year from 1987 through 1992 were attributed to methadone toxicity. In contrast, 34 deaths were attributed to polydrug toxicity, the largest number occurring in 1991 (n = 11). There was good agreement between the results of the independent review and the opinions of the Harris County Medical Examiner. Only 20% of the decedents were found to have been enrolled in a Harris County methadone maintenance treatment program at the time of death. Four people died of drug toxicity shortly after enrolling in a methadone maintenance treatment program. We found an increase in the number deaths occurring in Harris County, Texas, in 1991 in which methadone was detected. We also found that methadone blood levels were higher among decedents identified for 1991 and 1992 than among those identified in the previous years studied. However, we did not find evidence that the cause of these deaths could be attributed solely to methadone toxicity. Instead, for all years studied, the use of multiple drugs was the leading cause of death among people in whom methadone was detected. This finding points out the difficulties involved in determining the role of methadone as a cause of death.

Evaluation of smoking on the physical activity and depressive symptoms relationship.

Physical activity is inversely associated with depressive symptoms, and cigarette smoking is positively associated with depressive symptoms. Data from the first National Health and Nutrition Examination Survey (NHANES I) and the NHANES I Epidemiologic Follow-up study were analyzed to determine whether the relationship between physical activity and self-reported distress (depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale) was different for cigarette smokers and nonsmokers. Logistic regression was used to calculate odds ratios (adjusted for age, race, sex, education, alcohol use, and perceived health status) for depressive symptoms (> or = 16) associated with physical activity and smoking status among 2,054 respondents. At baseline, the odds ratio for depressive symptoms was about 2 times higher for moderately active smokers and nonsmokers, and 3 times higher for low active smokers and nonsmokers, compared with highly active nonsmokers. For 1,132 persons with a low number of depressive symptoms (< 16) at baseline, the incidence of depressive symptoms after 7-9 yr of follow-up was about 2 times higher for low/moderately active smokers and nonsmokers than for highly active nonsmokers. The association between physical activity and the prevalence and incidence of depressive symptoms is not significantly modified by smoking status.

Evaluation of the psychosocial impact of the MiniMed variable-rate implantable insulin pump.

We examined the psychosocial impact of treatment with an implantable insulin pump among persons with insulin-dependent diabetes mellitus (IDDM). Of specific interest was whether use of the MiniMed implantable insulin pump (MIP) resulted in changes in functional status, performance of diabetes self-care behavior, psychologic symptoms, and perceived level of stress. From a sample of 36 patients with IDDM, 10 persons were randomly selected to receive the MIP, while the remaining 26 served as control subjects. Additionally, a nonrandom sample of three MIP recipients from an additional site were included in the MIP group. At regular assessment intervals, all participants completed self-report questionnaires regarding psychosocial functioning and monitored blood glucose levels. After 4 months of MIP use, MIP recipients did not significantly differ from control subjects on any measure of psychosocial functioning; however, MIP use did have an impact on diabetes self-care. The MIP users monitored their blood glucose levels more frequently and had lower average blood glucose levels than control subjects. Additional follow-up is needed to determine the long-term psychosocial impact of implantable insulin pump therapy.

Plasma lipid levels and psychologic characteristics in men.

Results of several studies suggest that either a reduction in the serum level of total cholesterol level or a persistently low cholesterol level may be associated with an increase in violent deaths. Although there are several possible explanations for these observations, it has been suggested that the cholesterol level could influence various behaviors. We therefore examined the cross-sectional relation of several psychologic characteristics, assessed by the Diagnostic Interview Schedule and the Minnesota Multiphasic Personality Inventory, to levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides among 3,490 men aged 31-45 years who were examined in 1985-1986. (All men had served in the US Army between 1965 and 1971). Compared with that of other men, the mean total cholesterol level was 5 mg/dl higher among 697 men diagnosed with generalized anxiety disorder (possibly because of increased catecholamine levels) and 7 mg/dl lower among 325 men with antisocial personality disorder (p < 0.01 for each association). These differences could not be attributed to education, relative weight, cigarette smoking, use of various medications, or other potential confounders. In contrast, cholesterol levels were not significantly associated with major depression or hostility; levels of high-density lipoprotein cholesterol and triglycerides were not related to any diagnosis. If the serum level of total cholesterol is found to be predictive of antisocial personality disorder in longitudinal analyses, this association may have implications for cholesterol-lowering recommendations.

The association between alcohol use and health behaviors related to the risk of cardiovascular disease: the South Carolina Cardiovascular Disease Prevention Project.

OBJECTIVE: This study examines the relationship between alcohol use and health behaviors related to the risk of cardiovascular disease (CVD). In particular, we examined the relationship between alcohol use and leisure time physical activity, participation in community physical activity programs and behaviors used for weight loss. Numerous studies have found a "protective" effect of moderate alcohol consumption on the risk of CVD. However, most of these studies have not adequately controlled for potential confounding by health behaviors associated with alcohol use. METHOD: We used descriptive and logistic regression analyses to examine cross-sectional survey data from 2,072 participants in the South Carolina Cardiovascular Disease Prevention Project. RESULTS: After controlling for age, race, education and preexisting CVD, moderate and heavy drinkers who do not smoke were more likely than nondrinkers to report engaging in regular leisure time physical activity. The relationship between other health behaviors and alcohol consumption was less clear. Among men, moderate and heavy drinkers were no more likely than nondrinkers to participate in community physical activity programs; among women, moderate and heavy drinkers were more likely than nondrinkers to report this activity. Moderate drinkers were more likely than nondrinkers to report that they were attempting to lose weight, however this difference was not statistically significant. CONCLUSIONS: These data suggest that at least some of the apparent protective effect of moderate alcohol consumption found in other studies may be due to differences between nondrinkers and drinkers with respect to physical activity and other health practices.

Trends in oral contraceptive use and cigarette smoking. Behavioral Risk Factor Surveillance System, 1982 and 1988.

OBJECTIVE: To investigate trends in oral contraceptive (OC) use and smoking among women of reproductive age and to determine factors related to smoking among OC users. DESIGN, SETTING, AND PARTICIPANTS: Telephone interviews of women aged 18 through 45 years in 16 states and the District of Columbia who participated in the Behavioral Risk Factor Surveillance System in 1982 (N = 3553) and in 1988 (N = 7384). RESULTS: Between 1982 and 1988, the prevalence of smoking decreased from 31% to 24% among OC users and from 32% to 28% among non-OC users. In both 1982 and 1988, more than half of the OC users who smoked were heavy smokers (smoked 15 or more cigarettes per day). Nearly one fourth of 35- to 45-year-old women who used OCs were smokers. After we standardized for age, race, and education, the decline in the prevalence of smoking among OC users did not differ substantially from the decline in smoking among non-OC users. CONCLUSIONS: Despite the possible synergistic effects of smoking and OC use on the risk of cardiovascular disease, we found no accelerated decline in the prevalence of smoking among OC users. As of 1988, nearly one fourth of all OC users were smokers. These data emphasize the need to reduce the prevalence of smoking among women who use OCs before they reach the age at which their risk for cardiovascular disease increases substantially.

Endemic food-borne botulism: clinical experience, 1973-1986 at Alaska Native Medical Center.

Clinical features are described for 35 cases of endemic food-borne botulism managed at a single medical center over 14 years. Important diagnostic findings included dryness of mucous membranes (90%), weakness (84%), and abnormal pupillary reaction (79%). Sensory examination was normal. Dizziness, dyspnea, and weakness of the extremities were significantly more common in patients requiring assisted ventilation. Transitory neurological deterioration occurred in 38% of patients despite the early administration of trivalent (ABE) equine antitoxin. The short course of respiratory failure suggests that toxin effect is unusually ephemeral with a mean intubation interval of only 8.6 days. Rapid recovery of strength without relapsing respiratory failure followed extubation. Tracheostomy was associated with a high complication rate and was abandoned. Extremely thick, tenacious sputum probably contributed to the high nosocomial pneumonia rate. Empirical antibiotic use to eliminate persistent C. botulinum was associated with unacceptably high nosocomial infection rates (p less than .01). Unexpected significant elevations of blood leukocyte and neutrophil band forms were noted.

Assessment of psychosocial functioning of patients with sickle cell disease.

The Chronic Illness Problem Inventory (CIPI) was used to assess level of psychosocial functioning in 89 patients with sickle cell disease. The results indicated that sickle cell patients have significant psychosocial distress in the areas of employment and finances, sleeping and eating, and performance of normal daily activities. Fear and anxiety regarding body deterioration, and lack of assertiveness in social relationships were also found. These findings suggest that depression may be a common problem among sickle cell patients. Treatment alternatives that address these areas are reviewed.