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.

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.

Self-reported health status of Vietnam veterans in relation to perceived exposure to herbicides and combat.

The authors examined how the self-reported health of 7,924 US Army Vietnam veterans in 1985-1986 related to the men's perceived exposure to herbicides and combat in Vietnam. The results showed strong, positive associations between the extent of reported herbicide exposure (classified as a four-level ordinal index) and all 21 health outcomes studied, with clear "dose-response" relations in most instances. In contrast, only chloracne and psychological symptoms, including a symptom pattern consistent with posttraumatic stress disorder, were found to be strongly related to the amount of reported combat exposure (classified as a four-level ordinal index). The multiple herbicide/outcome associations seem implausible because of their nonspecificity and because of collateral biologic evidence suggesting the absence of widespread exposure to dioxin-containing herbicides among US Army combat units. These associations may have resulted from long-term stress reactions that produced somatization, hypochondriasis, and increased utilization of medical care among some Vietnam veterans. The available data suggest, however, that the association between reported combat exposure and psychological symptoms consistent with posttraumatic stress disorder may be causal.

Unexpected geographic variation in rates of hospitalization for patients who have fracture of the hip. Medicare enrollees in the United States.

With the use of data from hospitals for fiscal year 1985, we calculated the rates of hospitalization for fracture of the hip, by state of residence, for all enrollees in Medicare who were sixty-five years old or older; we adjusted for age and race. The rate of fracture of the hip was highest in the South and lowest in the Northeast, especially in women. The cause of this difference is not known.

Renal agenesis and dysgenesis: are they increasing?

Data from the Birth Defects Monitoring Program (BDMP) of the Centers for Disease Control (CDC) suggest that the birth prevalence of renal agenesis and dysgenesis combined is increasing. Medical records were reviewed for 1,404 of 1,669 (84%) infants in the BDMP with renal agenesis or dysgenesis noted on the newborn discharge summary to assess whether the observed trend reflects a true increase in one or both conditions or if it reflects changes in diagnostic, coding, or surveillance practices over time. For 1970-1982, the average rate per 100,000 live births and stillbirths was 3.5 for autopsy-confirmed bilateral renal agenesis and 1.7 for autopsy-confirmed bilateral renal dysgenesis. The birth prevalence of autopsy-confirmed bilateral renal agenesis fluctuated within this time period, peaking in 1975, while the rate of autopsy-confirmed bilateral renal dysgenesis increased steadily by 0.2 cases/100,000 births per year (P less than 0.001) with small peaks in 1976 and 1979. Unilateral renal agenesis or dysgenesis accounted for 17% of the confirmed cases, but most were detected by autopsy among infants who died shortly after birth rather than by diagnostic procedures such as ultrasound. Diagnostic information in the medical record suggested that the increase in the birth prevalence of renal agenesis and dysgenesis combined in the BDMF is due primary to the increasing prevalence of renal dysgenesis. Since medical records did not include sufficient information on risk factors, detailed analytic studies are needed to identify maternal risk factors that might account for the apparent increase in renal dysgenesis over time.

Cigarette smoking and the risk of breast cancer.

The authors examined the relation between cigarette smoking and breast cancer in the Centers for Disease Control Cancer and Steroid Hormone Study, a multicenter, population-based case-control study. The study compared 4,720 women aged 20-54 years with newly diagnosed breast cancer identified through population-based tumor registries with 4,682 women randomly selected from the same geographic areas. Women who reported ever smoking cigarettes had a risk of breast cancer of 1.2 (95 percent confidence interval 1.1-1.3) compared with never smokers. There was no consistent dose-response pattern with any measure of smoking (pack-years of smoking, average number of cigarettes per day, or total years smoked) and little difference in risk between current and former smokers. There was some variation in risk by age, with slightly higher risk estimates for younger women than for older women. Although current smokers had an earlier natural menopause than did never smokers, the authors found no evidence of a protective effect of cigarette smoking on breast cancer risk. These findings suggest that the risk of breast cancer in women who smoke is the same as, or perhaps slightly higher than, women who have never smoked.

The association of peripheral arterial disease with hostility in a young, healthy veteran population.

The association of peripheral arterial disease (PAD) with hostility, a component of Type A behavior, has not been investigated. Previous studies have found an association between coronary arterial disease and hostility. We used Doppler tests to define PAD as consisting of a resting index less than 0.9, absence of posterior tibial waveform, or presence of a femoral bruit. Among 4,462 male veterans, the prevalence and odds ratio of PAD increased statistically significantly with an increase in the Cook-Medley hostility scale. The prevalence of PAD was 0.7%, 1.1%, 1.4%, and 1.6% in the first, second, third, and fourth quartiles of the hostility scale, respectively. Using the first quartile as a reference group, we found that odds ratios of PAD were 1.6, 1.9, and 2.2 for the second, third, and fourth quartiles, respectively. Odds ratios, adjusted for age, race, cigarette smoking, hypertension, familial ischemic heart disease, diabetes, and elevated LDL/HDL were 1.4, 1.6, and 1.8, respectively. The magnitude of the odds ratios and their statistically significant trend suggest an association between PAD and hostility.

Brain cancer and other causes of death in anatomists.

Anatomists are exposed to a wide range of solvents, stains, and preservatives used to prepare biologic specimens. One fixative, formaldehyde, has recently been shown to cause nasal cancer in laboratory rodents. A retrospective cohort study was conducted to assess whether anatomists have an increased risk of mortality from cancer, particularly from cancers of the respiratory tract. The cohort included 2,317 men who joined the American Association of Anatomists between 1888 and 1969 and who were living in the United States when they joined this association. Standardized mortality ratios were 0.3 for lung cancer [95% confidence interval (CI) = 0.1-0.5], 1.5 for leukemia (95% CI = 0.7-2.7), and 2.7 for brain cancer (95% CI = 1.3-5.0) when mortality rates for U.S. white males, available for 1925-79, were used as the referent. When rates for male members of the American Psychiatric Association, available for 1900-69, were used as the referent, standardized mortality ratios were 0.5 for lung cancer (95% CI = 0.2-1.1) and 6.0 for brain cancer (95% CI = 2.3-15.6). Each of the 10 anatomists who died of brain cancer between 1925 and 1979 had a neuroglial cell tumor (either astrocytoma or glioblastoma). The increased risk for leukemia was limited to the myeloid cell type. An etiologic agent associated with these increased risks was not identified.