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9 "Veterans"
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Original Articles
Comorbid Conditions in Persons Exposed to Ionizing Radiation and Veterans of the Soviet–Afghan War: A Cohort Study in Kazakhstan
Saule Sarkulova, Roza Tatayeva, Dinara Urazalina, Ekaterina Ossadchaya, Venera Rakhmetova
J Prev Med Public Health. 2024;57(1):55-64.   Published online November 1, 2023
DOI: https://doi.org/10.3961/jpmph.23.333
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  • 152 Download
AbstractAbstract AbstractSummary PDF
Objectives
This study investigated the prevalence and characteristics of comorbid conditions in patients exposed to ionizing radiation and those who were involved in the Soviet–Afghan war.
Methods
This study analyzed the frequency and spectrum of morbidity and comorbidity in patients over a long-term period (30-35 years) following exposure to ionizing radiation at the Semipalatinsk nuclear test site or the Chornobyl nuclear power plant, and among participants of the Soviet–Afghan war. A cohort study, both prospective and retrospective, was conducted on 675 patients who underwent comprehensive examinations.
Results
Numerical data were analyzed using the Statistica 6 program. The results are presented as the mean±standard deviation, median, and interquartile range (25-75th percentiles). The statistical significance of between-group differences was assessed using the Student t-test and Pearson chi-square test. A p-value of less than 0.05 was considered statistically significant. We found a high prevalence of cardiovascular diseases, including hypertension (55.0%) and cardiac ischemia (32.9%); these rates exceeded the average for this age group in the general population.
Conclusions
The cumulative impact of causal occupational, environmental, and ultra-high stress factors in the combat zone in participants of the Soviet–Afghan war, along with common conventional factors, contributed to the formation of a specific comorbidity structure. This necessitates a rational approach to identifying early predictors of cardiovascular events and central nervous system disorders, as well as pathognomonic clinical symptoms in this patient cohort. It also underscores the importance of selecting suitable methods and strategies for implementing treatment and prevention measures.
Summary
Key Message
This study investigated the long-term health effects on 675 individuals exposed to ionizing radiation at Semipalatinsk and Chornobyl, and those involved in the Soviet–Afghan war. Results showed a higher prevalence of cardiovascular diseases, notably hypertension (55%) and cardiac ischemia (32.9%), compared to the general population. The findings highlight the need for early detection of cardiovascular and central nervous system disorders in these groups, emphasizing tailored treatment and prevention strategies.
Cancer Incidence in Korean Vietnam Veterans During 1992-2003: The Korean Veterans Health Study
Sang-Wook Yi
J Prev Med Public Health. 2013;46(6):309-318.   Published online November 28, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.6.309
  • 21,026 View
  • 146 Download
  • 22 Crossref
AbstractAbstract PDF
Objectives

The aim of this study was to investigate the association between Vietnam experience including exposure to military herbicides and cancer incidence in Korean Vietnam War veterans.

Methods

The cancer cases of 185 265 Vietnam veterans from January 1, 1992 to December 31, 2003 were confirmed from the Korea National Cancer Incidence Database. The age-adjusted incidence and standardized incidence ratios (SIRs) were calculated using the male population during 1992 to 2003 as a standard population.

Results

The age-adjusted overall cancer incidence per 100 000 person-years was 455.3 in Vietnam veterans. The overall cancer incidence was slightly yet significantly lower in veterans (SIR, 0.97; 95% confidence interval, 0.95 to 0.99) than in the general population. The overall cancer incidence in enlisted soldiers was not lower (SIR, 1.00), whereas that in officers was significantly lower (SIR, 0.87) than in the general population. The incidences of prostate cancer and T-cell lymphoma in all veterans, and lung cancer and bladder cancer in enlisted soldiers, and colon cancer and kidney cancer in non-commissioned officers, and colon cancer, kidney cancer, and prostate cancer in officers, were higher than in the general population. The SIR for overall cancer among Vietnam veterans rose from 0.92 for 1992-1997 to 0.99 for 1998-2003.

Conclusions

The overall cancer incidence in Vietnam veterans was not higher than in the general male population. Vietnam veterans and military rank subcohorts experienced a higher incidence of several cancers, including prostate cancer, T-cell lymphoma, lung cancer, bladder cancer, kidney cancer, and colon cancer than the general population. The SIR for overall cancer increased over time in Vietnam veterans.

Summary

Citations

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    Ibrahem Hanafi, Dana Abo Samra, Rama Alsaqqa, Ahmad Naeem, Baraa Shebli, Ghassan Ajlyakin
    JAMA Network Open.2024; 7(3): e242091.     CrossRef
  • Military environmental exposures and risk of breast cancer in active-duty personnel and veterans: a scoping review
    Dylan J. Jester, Mehret T. Assefa, Daya K. Grewal, Abou M. Ibrahim-Biangoro, Jennifer S. Jennings, Maheen M. Adamson
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • Exposures and Bladder Cancer Risk Among Military Veterans: A Systematic Review and Meta-analysis
    Shane Kronstedt, Jackson Cathey, Cedrick B. Chiu, Gal Saffati, David E. Hinojosa-Gonzalez, Nikola Rakic, Sagar R. Patel, Gabrielle Lyon, Neel Srikishen, Jennifer M. Taylor, Jeremy Slawin, Jeffrey A. Jones
    Urology.2024;[Epub]     CrossRef
  • Older veterans associated with reduced risk of cancer: Retrospective nationwide matched cohort study in Taiwan
    Li-Fei Pan, Renin Chang, Chung Y. Hsu, Kuan-Hao Tsui
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Cancer risk in Vietnam war veterans from the Korean Vietnam war veterans’ health study cohort
    Wanhyung Lee, Soyoung Park, Seong-Kyu Kang, Seunghon Ham, Jin-Ha Yoon, Won-Jun Choi
    Frontiers in Oncology.2023;[Epub]     CrossRef
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    Ecotoxicology and Environmental Safety.2021; 219: 112327.     CrossRef
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    Un Je Park, So Hee Park
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    Gansukh Enkhtaivan, Pandurangan Muthuraman, Doo Hwan Kim
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    Chrystal Chang, Michael Benson, Mina M. Fam
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    S.-W. Yi, S.-Y. Ryu
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    Annals of Epidemiology.2015; 25(4): 275.     CrossRef
  • Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative
    Julie C. Weitlauf, Andrea Z. LaCroix, Chloe E. Bird, Nancy F. Woods, Donna L. Washington, Jodie G. Katon, Michael J. LaMonte, Mary K. Goldstein, Shari S. Bassuk, Gloria E. Sarto, Marcia L. Stefanick
    Women's Health Issues.2015; 25(6): 649.     CrossRef
  • A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer
    Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Philip Cole, Jack S. Mandel
    European Journal of Epidemiology.2014; 29(10): 667.     CrossRef
  • Urinary Bladder Cancer in Dogs, a Naturally Occurring Model for Cancer Biology and Drug Development
    D. W. Knapp, J. A. Ramos-Vara, G. E. Moore, D. Dhawan, P. L. Bonney, K. E. Young
    ILAR Journal.2014; 55(1): 100.     CrossRef
  • Challenges in investigating the association between Agent Orange and cancer: Site‐specific cancer risk and accuracy of exposure assessment
    Thomas H. Sinks
    Cancer.2014; 120(23): 3595.     CrossRef
  • Agent Orange exposure and cancer incidence in Korean Vietnam veterans: A prospective cohort study
    Sang‐Wook Yi, Heechoul Ohrr
    Cancer.2014; 120(23): 3699.     CrossRef
Serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin Levels and Their Association With Age, Body Mass Index, Smoking, Military Record-based Variables, and Estimated Exposure to Agent Orange in Korean Vietnam Veterans
Sang-Wook Yi, Heechoul Ohrr, Jong-Uk Won, Jae-Seok Song, Jae-Seok Hong
J Prev Med Public Health. 2013;46(5):226-236.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.226
  • 11,561 View
  • 87 Download
  • 12 Crossref
AbstractAbstract PDF
Objectives

The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans.

Methods

Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model.

Results

The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status.

Conclusions

The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.

Summary

Citations

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    S.-W. Yi, S.-Y. Ryu
    International Journal of Epidemiology.2015; 44(1): 359.     CrossRef
  • A critical review of the epidemiology of Agent Orange or 2,3,7,8-tetrachlorodibenzo-p-dioxin and lymphoid malignancies
    Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Jack S. Mandel
    Annals of Epidemiology.2015; 25(4): 275.     CrossRef
  • A critical review of the epidemiology of Agent Orange/TCDD and prostate cancer
    Ellen T. Chang, Paolo Boffetta, Hans-Olov Adami, Philip Cole, Jack S. Mandel
    European Journal of Epidemiology.2014; 29(10): 667.     CrossRef
  • Challenges in investigating the association between Agent Orange and cancer: Site‐specific cancer risk and accuracy of exposure assessment
    Thomas H. Sinks
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    Cancer.2014; 120(23): 3699.     CrossRef
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    Sang-Wook Yi, So-Yeon Ryu, Heechoul Ohrr, Jae-Seok Hong
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Agent Orange Exposure and Prevalence of Self-reported Diseases in Korean Vietnam Veterans
Sang-Wook Yi, Heechoul Ohrr, Jae-Seok Hong, Jee-Jeon Yi
J Prev Med Public Health. 2013;46(5):213-225.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.213
  • 12,584 View
  • 153 Download
  • 34 Crossref
AbstractAbstract PDF
Objectives

The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans.

Methods

A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model.

Results

The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis.

Conclusions

Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

Summary

Citations

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    Sang‐Wook Yi, Heechoul Ohrr
    Cancer.2014; 120(23): 3699.     CrossRef
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    Sang-Wook Yi, So-Yeon Ryu, Heechoul Ohrr, Jae-Seok Hong
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Pilot Study on Recruiting Medical Checkup Participants by Mail Survey among Korean Vietnam Veterans.
Sang Wook Yi, Jae Seok Hong, Heechoul Ohrr
Korean J Prev Med. 2003;36(2):171-178.
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  • 21 Download
AbstractAbstract PDF
OBJECTIVE
The aim of this study was to identify the validity of recruiting medical checkup participants of Vietnam veterans using a mail survey, and to identify the 'Vietnam service related characteristics' and `general characteristics' of Vietnam veterans groups. METHOD: In this study, a total 900 veterans were randomly selected from the list of Vietnam veterans from 1964 to 1973. The veterans were classified into 5 groups, taking into consideration their registered status in the Ministry of Patriots and Veterans Affairs; the VRD (veterans who have agent orange-related diseases), VSD (veterans who have agent orange-suspected disease), VM (veterans who performed meritorious deeds during the war), VR (veterans who were registered with the Ministry of Patriots and Veterans Affair) and OV (other veterans) groups. By means of postal surveys, the veterans' intention to participate in the medical checkup for our research, and their socioeconomic and general characteristics were investigated. 52 surveys were returned due to the subjects not residing at the listed address, and were excluded from the analysis. RESULT: 699 of the 848 veterans (82.4%) responded to the survey, of which 619 (88.6%) intended to participate in the medical checkup for our research. The 5 veterans groups all had similar ages, Vietnam service period, Agent Orange exposure, troop characteristic and wartime class, with the exception of VM, who were older, and with a greater number of officers than the other 4 groups. There was a big difference in the health statius among the Vietnam veterans group. The VM and OV were much healthier than VRD, VSD and VR groups. The socioeconomic stati of the VRD, VSD and VR groups were lower than those of the VM and OV groups. CONCLUSION: Although there were some limitations, the recruitment, by mail, of medical checkup participants from Vietnam veterans is a valid and feasible method. The VM and OV groups were much healthier, and with higher socioeconomic stati, than the VRD, VSD, and VR groups.
Summary
Validation Studies
A Proposal of Study Designs and Methods for Evaluating the Adverse Health Effects of Agent Orange among Korean Vietnam Veterans.
Sang Wook Yi, Jong Uk Won, Jae Seok Hong, Heechoul Ohrr
Korean J Prev Med. 2001;34(3):228-236.
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OBJECTIVES
To propose a feasible, valid and appropriate study designs and epidemiologic methods for evaluating the adverse health effects of Agent Orange-chemical defoliants used in Vietnam- in Korea. METHODS: A literature study was performed on Agent Orange, herbicides, pesticides and dioxins. The study subjects, study design, exposure assessment and health outcomes assessment were examined in each study. The potential data sources for the study subjects, study design, exposure assessment and health outcomes assessment in Korea were investigated. RESULTS AND CONCLUSION: In earlier Korean studies, research subjects for studying the effects of Agent Orange were identified from the patients or persons who claimed to have Agent Orange-related diseases due to the difficulties in identifying the entire population of Vietnam veterans in Korea. In this study, an attempt was made to identify the total number of Vietnam veterans in Korea. As a result, the addresses of 20,000 Vietnam veterans were obtained. It is proposed that a retrospective cohort design on a sample of the total number of Vietnam veterans is a feasible and appropriate study design. Self report questionnaires and military records were proposed to assess the exposure level. It is believed that measuring the plasma or tissue TCDD should be used only for a validation study assessing the level of exposure. For the health outcomes assessment, it is possible to obtain the mortality, cancer frequency, physical examination, screening and medical insurance record data.
Summary
Original Articles
A Study on the Correlation between Categorization of the Individual Exposure Levels to Agent Orange and Serum Dioxin Levels Among the Korean Vietnam Veterans.
Joung Soon Kim, Han K Kang, Hyun Sul Lim, Hae Kwan Cheong, Min Kyung Lim
Korean J Prev Med. 2001;34(1):80-88.
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OBJECTIVES
In an epidemiologic study on the health impact of Agent Orange exposure, the valid estimation of exposure level is the most important step. Based on recent studies, we examined the correlation between exposure levels categorized by personal exposure estimates and serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD, Dioxin), exploring the possibility of utilizing the exposure level as a surrogate for the estimate of exposure to agent orange. METHODS: During the study period (Jan 1996-Feb 1996), blood specimens of 745 subjects taken randomly among 1,329 persons and kept frozen, were analyzed for 2,3,7,8-TCDD and six other dioxin congeners. The serum dioxin and congeners were measured in 1998 by CDC ,adjusted for serum lipids. We categorized the total exposure scores into five groups based on Agent Orange exposure data collected by interview and military records. Pearson and Spearman's correlation coefficients & multiple regression analysis were used to identify the relationship of the exposure level categorized with serum concentration of 2,3,7,8-TCDD, and six other dioxin congeners. RESULTS: Dioxin and the other congeners, except 1,2,4,6,7,8-HpCDD, showed significant correlations to exposure categories (p<0.005); 2,3,7,8-TCDD and OCDD showed positive correlations, whereas the other congeners did negative. The values of 2,3,7,8-TCDD differed according to exposure category and proportionally increased from the low exposure group to the high, a dose-response relationship, even after other possible confounding variables were adjusted for. In multiple regression analysis, age(beta=0.033), dioxin(beta=0.433), 1,2,3,7,8-PeCDD(beta=0.998), 1,2,3,4,7,8-HxCDD(beta=0.773), 1,2,3,6,7,8-HxCDD(beta=0.255), 1,2,3,7,8,9-HxCDD(beta=3.468), 1,2,3,4,6,7,8-HpCDD(beta=0.109) were found to be significantly related to the total exposure score(p<0.005). CONCLUSION: This study demonstrated that the use of such categorizations as a surrogate measure of agent orange exposure in identifying exposure degrees in a health impact study is valid.
Summary
A Study on the Health Status of Korean Vietnam Veterans' Children: A Result of Questionnaire Survey on Vietnam Veterans of Pusan Area Who Diagnosed as Cases by Korean Veteran's Hospital Diagnostic Criteria.
Jin Ho Chun, Hak Joon Kim, Hae Sook Sohn, Sang Hwa Urm, Soo Kyung Park, Byung Chul Yu, Jong Tae Lee
Korean J Prev Med. 2000;33(1):17-24.
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OBJECTIVES
To propose the referential data to evaluate the health impacts of Vietnam veterans' children whose father were exposed to herbicides in Vietnam War. METHODS: Vietnam veterans who visited to Pusan Veteran Hospital for medical care were recruited from April to October, 1998. They were 71 and asked about their own combat history, symptoms and illness, and health status of their 182 children. The informations were collected by direct and phone interview. Exposure estimation was also performed as exposure score depending on year and unit of participation, and personal episodes related to exposure to herbicide in the war. It classified into three groups; lower(<18.0), moderate(18-53), high(> or =53) exposure group. RESULTS: The mean age and the period into the combat of the veterans were 52.8 years and 15.0 months. The mean exposure score was 18.1+/-9.9, and mainly distributed in lower (46.5%) and moderate(52.1%) exposure group. Most(90.1%) of them were diagnosed as sequelae(21 cases) and suspected sequelae(43 cases) of the herbicides by Korean veteran's hospital diagnostic criteria. The major sequelae was peripheral neuropathy 13 cases, chloracne 5 cases, and the major suspected sequelae was hypertension 20 cases, diabetes mellitus 18 cases, liver disease 12 cases, central neuropathy 11 cases, etc. About birth, 42.2% and 16.9% experienced spontaneous abortion and stillbirth, respectively. The mean exposure score was higher in stillbirth experience group(p<0.05). About half of the children(90 cases, 49.5%) hold the abnormal health status: those were skin pigmentation 38 cases, rash 23 cases, congenital anomaly 15 cases, general weakness 12 cases, purpura 8 cases, visual disturbance 8 cases, etc. These health problems had no association with father's exposure level(p>0.05). CONCLUSIONS: These results were depend on their own answers, and expectation for compensation did not excluded, therefore, this study may have limitations: inaccuracy of informations due to recall bias and response bias. Nevertheless, through this study, we could image the fundamental aspect for health impacts of Vietnam veterans' children for preparing the national control program and policy. A large scale epidemiologic study with valid exposure assessment on the health impacts of Vietnam veterans' children is recommneded.
Summary
A Preliminary Epidemiologic Study on Korean Veterans Exposed to Herbicides in Vietnam War.
Joung Soon Kim, Hyun Sul Lee, Hong Bok Lee, Won Young Lee, Young Joo Park, Sung Soo Kim
Korean J Prev Med. 1994;27(4):711-734.
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AbstractAbstract PDF
Among chemical agents in herbicides, dioxin(2,3,7,8-tetrachloro dibenzo-rho-dioxin: a chemical contaminant in herbicides sprayed during the vietnam war has been known to be the major agent causing toxic effects. Approximately 320,000 korean soldiers participated the vietnam war from 1964 to 1974. Although the potential hazards of the herbicides among Korean veterans exposed were implicated, the problem had not been a public issue until 1991 when Korean veterans were informed U. S. companies, the herbicides manufacturer payed fund, from which a trust fund for New Zealand and Australian Class members were established in 1985. After a series of appeals and demonstration by the korean veterans demanding medical care and compensation for their serious health damages, a bill of medical care and compensation for herbicides victims was promulgated in March 1993 and become effective from May 1993. This study was carried out with two major objectives: the first to understand the health problems caused from the herbicides by reviewing literatures published, and the second to examine the nature and extent of health impacts among Korean veterans exposed and to develop valid study methods for the major study by interviewing and reviewing records on a part of veterans (638 persons) registered and completed medical examination in Seoul Veterans Administration Hospital from June to october 1993. The results obtained are as follows: 1. The literature review of 107 papers revealed that: l) Dioxin is teratogenic, carcinogenic and affects almost all organs including nertous, endocrine, and reproductive systems in animal experiments. 2) The diseases showing evidence of causal association were Hodgkin's disease, non-Hodgkin's disease, lung cancer, lymphoma, soft tissue sarcoma, chloroacne and polyneuropathy when judged on the basis of consistency in study results and biological plausibility. 2. Interview and medical record review study on 638 veterans, though limited validity owing to lack of control group, crude estimates of dioxin exposure levels (no biomarkers measurable), and uncertainty of diagnosis, showed that: 1) Most of the study subject's were in their 40's of age and had been dispatched to vietnam during the period from 1965-1970 around one year. 2) Most frequently complained symptoms in medical examination were motor weakness(32%), sensory abnormalities in extremities(23%), skin diseases(22%), and pain in extremities(20%) whereas in interview they were more frequent in order of skin problem(44%), motor weakness (38%), sensory abnormalities and pain in extremities(l7% and 19% each). Kappa indices on the same category of complaints between two sources of information were variable and relatively low. 3) On medical examination, only a part of the 638 subjects had initial impression (442 pts) and final diagnosis (218 pts) suggesting decision making on diagnosis appeared to be difficult even with all available modern medical technologies; in initial impression disorders from peripheral and central neuropathy were predominant whereas in final diagnosis various types of skin disorder were most frequent. 4) when dose-response relationship between several conditions (from questionnaire) and arbitrary exposure scores were examined by CMH linear trend test, spontaneous abortion, sexual problems and health problem of offsprings showed statistically significant linear trends. However, pregnancy, accident and suicidal attempts did not show any relationship in this study capacity. 5) Among complaints, psychosis and neurosis(anxiety, phobia) in interview study, and memory disorder and psychosis in medical record study revealed linear trend. 6) Skin disorder was the only condition showing linear trend in initial impression and none in final diagnosis on medical examination. Even though objective to select out dioxin-related disease or group of diseases from this study was not achieved the research experiences provided firm basis for developing various methodological approaches. 3. From this preliminary study we concluded that a larger scale major epidemiologic study on health impacts of herbicides among Korean veterans exposed is not only indispensible but also well designed study with more valid exposure information and diagnosis may be able to establish causal relationship between certain groups of diseases and exposure to the herbicides among Korean veterans.
Summary

JPMPH : Journal of Preventive Medicine and Public Health
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