OBJECTIVE A wave of bombings struck France in 1995 and 1996, killing 12 people and injuring more than 200. The authors conducted follow-up evaluations with the victims in 1998 to determine the prevalence of and factors associated with posttraumatic stress disorder (PTSD). METHOD Victims directly exposed to the bombings (N=228) were recruited into a retrospective, cross-sectional study. Computer-assisted telephone interviews were conducted to evaluate PTSD, per DSM-IV criteria, and to assess health status before the attack, initial injury severity and perceived threat at the time of attack, and psychological symptoms, cosmetic impairment, hearing problems, and health service use at the time of the follow-up evaluation. Factors associated with PTSD were investigated with univariate logistic regression followed by multiple logistic regression analyses. RESULTS A total of 196 respondents (86%) participated in the study. Of these, 19% had severe initial physical injuries (hospitalization exceeding 1 week). Problems reported at the follow-up evaluation included attack-related hearing problems (51%), cosmetic impairment (33%), and PTSD (31%) (95% confidence interval=24.5%-37.5%). Results of logistic regression analyses indicated that the risk of PTSD was significantly higher among women (odds ratio=2.54), participants age 35-54 (odds ratio=2.83), and those who had severe initial injuries (odds ratio=2.79) or cosmetic impairment (odds ratio=2.74) or who perceived substantial threat during the attack (odds ratio=3.99). CONCLUSIONS The high prevalence of PTSD 2.6 years on average after a terrorist attack emphasizes the need for improved health services to address the intermediate and long-term consequences of terrorism.

There have been claims of an increased risk for gestational trophoblastic disease (i.e., hydatidiform mole and choriocarcinoma) in Vietnam since the period of Agent Orange sprayings. In 1990, we conducted a case-control study in Ho Chi Minh City to investigate risk factors for gestational trophoblastic disease in Vietnam. Eighty-seven married women, all of whom had a recent pathologic diagnosis of gestational trophoblastic disease, identified in the Obstetrical and Gynecological Hospital, were included in the study. Eighty-seven married women who were admitted mainly in the surgery departments of the same hospital were the controls, and they were matched to cases for age and area of residence. Odds ratios (ORs), adjusted for matching variables and other potential confounders, were estimated with unconditional logistic regression. A statistically significant trend in risk was observed with previous live births (p = .01). Cases were found to eat less meat per wk (OR = 0.4, 95% confidence interval [95% CI] = 0.2-0.9 for greater than or equal to five meat dishes) and to own fewer consumer goods than controls. An increase in risk was associated with the breeding of pigs (OR = 5.7, 95% CI = 1.2-27.6 for raising three or more pigs). A cumulative Agent Orange exposure index was constructed, using the patient's complete residence history. No significant difference was found between cases and controls for this index (OR = 0.7, 95% Ci = 0.2-1.8 for high-exposure category), nor was such a difference noted for the agricultural use of pesticides.

CORDIER, S.; HA, M. C.; BARD, D.; QUTNH, HOANG TRONG; ABENHAIM, L.; NGOC PHUONG, NGUYEN THI; DAJ, LE CAO Author Information

To permit new epidemiologic studies of the effects of dioxin on humans in Vietnam, we evaluated a model for quantifying exposure to Agent Orange (exposure index) based on the residential histories of 27 Vietnamese subjects and on information about spraying from the U.S. Army records (Herbs Tape) and compared this index to the dioxin levels measured in the subjects′ adipose tissue. The mean dioxin level was 7.8 ppt, and dioxin and furan isomer profiles were similar to those already reported in industrialized countries. In addition, there was a highly significant correlation between the levels of almost all the isomers, whatever their degree of chlorination. For the group of 27 subjects, we found a Pearson correlation coefficient of 0.36 (P = 0.07) between the dioxin levels and the exposure index after log-transformation of both variables. When the analysis was restricted to the 22 subjects with a positive exposure index, the Pearson correlation coefficient rose to 0.50 (P = 0.02). We conclude that despite the limitations and power conditions of the study, this result is encouraging because it will be useful for future epidemiologic studies in Vietnam.

A case-control study investigating risk factors for hepatocellular carcinoma (HCC) was conducted in Hanoi, in the north of Vietnam, between 1989 and 1992. Male cases of HCC (152) diagnosed in 2 hospitals were included. Hospital controls (241) admitted mainly to abdominal surgery departments were frequency-matched to cases for sex, age, hospital and place of residence (Hanoi, province). Odds ratios adjusted for matching variables and other potential confounders were estimated using unconditional logistic regression, or exact non-parametric statistical inference when numbers were small. Positivity for hepatitis B surface antigen (HBsAg) was the main risk factor for HCC in this sample. Five subjects (3 cases, 2 controls) had been infected by hepatitis C virus (HCV), and none of them were carriers of HBsAg, giving an OR of 38 associated with HCV infection among HBsAG-negative subjects. Alcohol drinking was associated with HCC and interacted with HBsAg positivity. Agricultural use of organophosphorous pesticides (30 liters/year or more) and military service in the south of Vietnam for 10 years or more were also associated with an increased risk of HCC. This study confirms the major role played by HBV infection and its association with HCC in south-east Asia. It also suggests how other factors such as alcohol consumption or exposure to chemicals may interact with HBV infection.

Various high-to-low dose extrapolation models (Probit, Logit, Extreme-Value, One-Hit, Multistage) are applied to all 6 available data sets (Kociba et al. study, 1978: male and female Sprague-Dawley rats; National Toxicology Program study, 1982: male and female Osborne-Mendel rats, male and female B6C3F1 mice), in order to assess 2,3,7,8 TCDD-related carcinogenic risk at low doses. Our results show that risk assessment at low doses, based on experimental data, is limited by a huge amount of uncertainty (106 at least), according to both models and species under consideration.