The Health of Former Prisoners of War Results from the Medical Examination Survey of Former POWs of World War II and the Korean Conflict (1992) / Chapter Skim
Currently Skimming:
8 Literature Review and Further Discussion of Findings
8 Literature Review and Further Discussion of Findings
Pages 93-125
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 93... ...
Richardson's study of 100 Hong Kong prisoners of the Japanese (1965) found that during 1946-1964, there were 12 deaths from pulmonary tuberculosis whereas only 5 would have been predicted, had the group been dying at rates comparable to those of the Canadian population.
|
From page 94... ...
(19884. In the examination study, lifetime prevalence rates of infectious disease were extremely high, from 95% to 100%, for both POWs and controls, but current rates were roughly 20-30% in both POWs and controls, with the exception of WE, who had a low rate of 7.4% (see Table 5.C.3~.
|
From page 95... ...
The examination data also support the contention that military captivity is not associated with increased rates of subsequent malignancy. Lifetime prevalence rates of malignancy are around 15-20% for POWs (except for 9% for PWK)
|
From page 96... ...
Diabetes prevalence rates were nonetheless slightly higher among POWs who lost more than 35% of body weight during captivity; they showed no uniform gradient with prison camp symptoms. The simple association with weight loss, however, could have been unduly influenced by differences among POW groups; group-specific correlation analyses showed no evidence of noteworthy correlations.
|
From page 97... ...
It was therefore somewhat surprising to find appreciably lower lifetime prevalences of blood diseases among PWP and PWK- 14% and 12%, respectively compared with WP and WK29.6% and 22.3%, respectively (see Table 4.2~. Current prevalence rates of blood diseases showed similar and, again, noteworthy differences of 12.4% and 11.5% versus 25.9% and 21.4%, respectively, for PWP and PWK versus WP and WK.
|
From page 98... ...
Thus, although the finding that anemia is less prevalent among former POWs than among comparable controls appears to be genuine, it is unexplained by simply measured factors such as percent weight loss and the presence of medical symptoms during captivity.
|
From page 99... ...
In general, rates of depressive symptoms were three to five times higher for POWs than for the general population, and they were positively associated with both weight loss and prison camp symptoms and negatively associated with years of education, age at capture, and being married. (In other words, the more educated, older twhen captured]
|
From page 100... ...
These findings remain anomalous. Studies of other than American former prisoners have found similar evidence of psychiatric illness.
|
From page 101... ...
They found elevated rates of clinically diagnosed anxiety and depressive disorders among the POWsalthough the finding of a difference in the rates of anxiety in the two groups was not statistically significant but no difference in alcoholism rates. Their questionnaire study similarly showed excess rates of depressive symptoms among POWs (Tennant et al., 1986b)
|
From page 102... ...
The results of the medical examination survey complement those of previous follow-ups and present new material on PTSD, a particular focus of the exam follow-up because it was an expected comorbid or underlying diagnosis associated with the kinds of depressive symptoms seen earlier in the 1984-1985 follow-up. Overall, the most striking psychiatric sequelae seen in the exam are depressive symptoms, PTSD, and generalized anxiety disorder, paralleling the findings of most other studies of former POWs.
|
From page 103... ...
Before leaving the subject of lifetime prevalence of PTSD, depression, and generalized anxiety disorder, it is worthwhile to place the exam results against a more general backdrop to see the extraordinary group that these former POWs constitute. Various disclaimers have been made based on the low response rates and the very real potential for serious nonresponse bias about the ability to draw conclusions from the exam data collected.
|
From page 104... ...
Finally, the ECA lifetime prevalence figures for generalized anxiety disorders range from 2.5% to 4.5% for those 65 years of age and older and from 6% to 7% in the age group 45-64. Physician-based prevalence estimates for generalized anxiety disorder were 44% for PWP and 59% for PWK: again, these are quite sizable discrepancies that stand even if worst-case estimates are calculated.
|
From page 105... ...
In the logistic regression analysis, however, which controlled simultaneously for weight loss, prison camp symptoms, and group differences, depressive disorder showed a noteworthy association only with other symptoms (i.e., not with edema or visual symptoms) ; PTSD was associated with visual symptoms and with the PWP and PWK groups, generalized anxiety with other symptoms and PWK, and schizophrenia with PWK status.
|
From page 106... ...
Unfortunately, the markers of captivity stress, weight loss and prison camp symptoms, are not only measures of malnutrition but also of general maltreatment. As a result, their noteworthy associations with psychiatric illness do not tell us a great deal about the specific factors underlying subsequent morbidity.
|
From page 107... ...
examined a group of 20 Canadian former prisoners of the Japanese and 20 of their brothers then living in the Montreal area. They found a significantly higher prevalence of neurological complaints among POWs compared with controls (15 versus 4~; their neurological findings included increased rates of superficial hypesthesia, particularly in the lower extremities (12 versus 3)
|
From page 108... ...
The analyses of Chapter 6 thus focused specifically on peripheral neuropathy and showed higher rates of current peripheral nerve disease among PWP and PWK. Peripheral neuropathy had a noteworthy association, among all POWs, with both weight loss and prison camp symptoms; in PWP it was appreciably correlated with prison camp symptoms and in PWE, with both weight loss and prison camp symptoms.
|
From page 109... ...
In the current exam survey, lifetime prevalence rates of sense organ disease were quite high among both POWs and controls, generally from 8090%, with no noteworthy differences seen between the two groups. The prevalence rates for current (unresolved)
|
From page 110... ...
Gill's (1983) report of mortality and autopsy findings among former British Far East POWs showed a proportion of deaths from ischemic heart disease that was roughly equal to the rate seen in the general population of England and Wales and lower than the rate seen in Scotland.
|
From page 111... ...
Richardson notes that the abnormally high atherosclerotic heart disease rate and approximately normal overall death rate are difficult to explain, yet judges that for whatever cause, "it seems necessary to conclude that service in the Far East has probably played some part in the unfavourable mortality experience from atherosclerotic heart disease." In contrast, a 1973 study by Salmond and colleagues (1977) that compared samples of New Zealand ax-prisoners, ax-servicemen who went overseas, and ex-homeservicemen who did not serve overseas found current disablement pension rates for circulatory system disorders of 4.3%, 0%, and 7.1%, respectively.
|
From page 112... ...
at the Denver VA Medical Center report the occurrence of hypertension in 34% of POOP, 33% of PWE, and 27% of PWK; these figures are a little lower than those of Eberly and Engdahl but still roughly comparable to the MFUA rates. Oboler reports no findings consistent with chronic beriberi heart disease and states that "no definite connection could be drawn between these veterans' POW confinement and their current cardiovascular disease." The examination data showed no appreciably higher lifetime prevalence rates among POWs for either heart disease, cerebrovascular disease, or hypertension and other circulatory diseases (Table 4.2)
|
From page 113... ...
Although the appreciable association between increased prevalence of ischemic heart disease later in life among POWs and self-reported symptoms of edema in prison camp is new, the acute cardiac effects of nutritional deprivation are well known. Unlike the situation for psychiatric conditions, the reporting of edema in prison camp is not only a general measure of stress but also indicates a specific nutritional deficiency, beriberi.
|
From page 114... ...
The logistic regression analysis, however, showed that for both conditions the only noteworthy association was with weight loss, with each additional 10% of precaptivity weight loss increasing the prevalence of disease by 30-40%. The lack of association with symptoms indicating a specific deficiency, such as in the case of ischemic heart disease and cerebrovascular disease, combined with little clinical information on nutritional risk factors, makes further explication of this finding impossible.
|
From page 115... ...
Analyses of the relationship of asthma and prison camp treatment, however, revealed a noteworthy association of asthma with prison camp symptoms, and in PWP the current prevalence of asthma was appreciably correlated with both weight loss and prison camp symptoms. In the logistic regression analysis, an increased prevalence of asthma was associated with increased visual symptoms, and each additional reported symptom increased the prevalence by roughly 29%.
|
From page 116... ...
The examination data showed an appreciably higher lifetime prevalence of digestive disorders among PWK (Table 4.2) than among controls and
|
From page 117... ...
The logistic regression analysis, however, showed a noteworthy association of ulcer with both visual symptoms and with PWK status, and gastroenteritis had a noteworthy association with the reporting of other symptoms. Each additional reported visual symptom was estimated to increase the current prevalence of ulcer by 15%; all other things being equal, PWK had about 1.8 times as high a prevalence as the WW II POWs.
|
From page 118... ...
than for ax-servicemen (3.4%~. The examination data showed no appreciably higher lifetime or current prevalence rates of skin conditions among POWs compared with controls (Tables 4.2 and 5.C.3~.
|
From page 119... ...
In the examination data, the lifetime prevalence of musculoskeletal disorders among POWs was quite high 87% to 94%; it was appreciably higher among PWK than WK (Table 4.2~. Current prevalence rates (Table 5.C.3)
|
From page 120... ...
CONGENITAL CONDITIONS, SYMPTOMS AND ILL-DEFINED CONDITIONS, INJURY AND POISONING, AND FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES (V-CODES) The medical conditions under these headings have been grouped together because they are all somewhat atypical.
|
From page 121... ...
Lifetime prevalence rates of V-codes were around 50% in all groups; there were no noteworthy differences. PWP had an appreciably lower prevalence of current V-code conditions than did WP, and there were no other noteworthy differences.
|
From page 122... ...
Nevertheless, localized edema is a noteworthy risk factor for only two current medical conditions in these POW examinations- peripheral nerve disease and ischemic heart disease both of which are acutely related to thiamin deficiency, either the "dry" form of beriberi (peripheral nerve disease) or the "wet" form (cardiac problems)
|
From page 123... ...
1992. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh artery study.
|
From page 124... ...
1991. Patterns of disease among World War II prisoners of the Japanese: hunger, weight loss, and deficiency diseases in two camps.
|
From page 125... ...
1989. PTSD 40 years later: incidence and person-situation correlates in former POWs.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.