Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress

Proctor, Susan P.; Heeren, Timothy; White, Roberta F.; Wolfe, Jessica; Borgos, Marlana Sullivan; Davis, Jennifer; Pepper, Lewis; Clapp, Richard; Sutker, Patricia B.; Vasterling, Jennifer J.; Ozonoff, David

doi:10.1093/ije/27.6.1000

Cited by 222 publications

(158 citation statements)

References 6 publications

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“…In fact, a range of other exposures show associations in many studies as well, although these are commonly weaker and/or less consistent. Moreover, compared with AChEi exposures and the broader exposure classes (e.g., pesticides) queried to get at them, the relation of other exposures to multisymptom illness is less consistently retained (perhaps excepting anthrax and multiple vaccines) or is consistently lost (e.g., psychological stressors) in models that adjust for other exposures (17,24,25,30,33,35).…”

Section: Resultsmentioning

confidence: 99%

Acetylcholinesterase inhibitors and Gulf War illnesses

Golomb

2008

Proc. Natl. Acad. Sci. U.S.A.

197

161

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Increasing evidence suggests excess illness in Persian Gulf War veterans (GWV) can be explained in part by exposure of GWV to organophosphate and carbamate acetylcholinesterase inhibitors (AChEis), including pyridostigmine bromide (PB), pesticides, and nerve agents. Evidence germane to the relation of AChEis to illness in GWV was assessed. Many epidemiological studies reported a link between AChEi exposure and chronic symptoms in GWV. The link is buttressed by a dose–response relation of PB pill number to chronic symptoms in GWV and by a relation between avidity of AChEi clearance and illness, based on genotypes, concentrations, and activity levels of enzymes that detoxify AChEis. Triangulating evidence derives from studies linking occupational exposure to AChEis to chronic health symptoms that mirror those of ill GWV. Illness is again linked to lower activity of AChEi detoxifying enzymes and genotypes conferring less-avid AChEi detoxification. AChEi exposure satisfies Hill's presumptive criteria for causality, suggesting this exposure may be causally linked to excess health problems in GWV.

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Section: Resultsmentioning

confidence: 99%

Acetylcholinesterase inhibitors and Gulf War illnesses

Golomb

2008

Proc. Natl. Acad. Sci. U.S.A.

197

161

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“…Gulf War veterans have reported multiple chronic symptoms, and multiple studies have found a higher prevalence of symptoms among Gulf War veterans compared with military controls [4][5][6][7][8][9]. Data from several large, populationbased studies with appropriate controls demonstrate that the pattern of symptoms is comparable in Gulf War deployed and Gulf War era personnel [6,[10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Methodologic issues in a population-based health survey of Gulf War veterans

Doebbeling

Jones

Hall

et al. 2002

Journal of Clinical Epidemiology

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This report describes the principal methods used in the development, conduct, and analysis of the research study "Health Assessment of Persian Gulf War Veterans from Iowa" (Iowa Gulf War Study). The methods presented include an outline of the organizational structure, study timeline, hypotheses, outcome definitions, and study design. Adhering to a strict timeline, the study protocol and instruments were developed, and a stratified sample of 3,695 military personnel (76% participation) was located and surveyed by structured telephone interview. The study tracked personnel from all service branches residing nationally and internationally, including those discharged from service. This study required development and implementation of methods appropriate to analysis of data collected in a complex sampling framework and methodological procedures to ensure scientific rigor in a highly public and politicized environment. Statistical analyses were conducted on a priori health outcomes and required development of methods to compute Cochran-Mantel-Haenszel adjusted rate differences. This environment facilitated rapid implementation, critique by scientific and public advisors, a high participation rate, and rapid publication. AbstractThis report describes the principal methods used in the development, conduct, and analysis of the research study "Health Assessment of Persian Gulf War Veterans from Iowa" (Iowa Gulf War Study). The methods presented include an outline of the organizational structure, study timeline, hypotheses, outcome definitions, and study design. Adhering to a strict timeline, the study protocol and instruments were developed, and a stratified sample of 3,695 military personnel (76% participation) was located and surveyed by structured telephone interview. The study tracked personnel from all service branches residing nationally and internationally, including those discharged from service. This study required development and implementation of methods appropriate to analysis of data collected in a complex sampling framework and methodological procedures to ensure scientific rigor in a highly public and politicized environment. Statistical analyses were conducted on a priori health outcomes and required development of methods to compute Cochran-Mantel-Haenszel adjusted rate differences. This environment facilitated rapid implementation, critique by scientific and public advisors, a high participation rate, and rapid publication.

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“…Gulf War veterans have reported a higher prevalence of symptoms than contemporaneous soldiers not deployed to the war for many illnesses, including bronchitis and asthma (2)(3)(4)(5)(6)(7)(8)(9)(10). Principal respiratory exposures that occurred during the war include combustion products, chemical agent-resistant coating paint, sand, and smoke emanating from oilwell fires within Kuwait.…”

mentioning

confidence: 99%

Exposures to the Kuwait oil fires and their association with asthma and bronchitis among gulf war veterans.

Lange

Schwartz

Doebbeling

et al. 2002

Environ Health Perspect

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Military personnel deployed to the Persian Gulf War have reported a variety of symptoms attributed to their exposures. We examined relationships between symptoms of respiratory illness present 5 years after the war and both self-reported and modeled exposures to oil-fire smoke that occurred during deployment. Exposure and symptom information was obtained by structured telephone interview in a population-based sample of 1,560 veterans who served in the Gulf War. Modeled exposures were exhaustively developed using a geographic information system to integrate spatial and temporal records of smoke concentrations with troop movements ascertained from global positioning systems records. For the oil-fire period, there were 600,000 modeled data points with solar absorbance used to represent smoke concentrations to a 15-km resolution. Outcomes included respiratory symptoms (asthma, bronchitis) and control outcomes (major depression, injury). Approximately 94% of the study cohort were still in the gulf theater during the time of the oil-well fires, and 21% remained there more than 100 days during the fires. There was modest correlation between self-reported and modeled exposures (r = 0.48, p < 0.05). Odds ratios for asthma, bronchitis, and major depression increased with increasing self-reported exposure. In contrast, there was no association between the modeled exposure and any of the outcomes. These findings do not support speculation that exposures to oil-fire smoke caused respiratory symptoms among veterans.

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Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress

Cited by 222 publications

References 6 publications

Acetylcholinesterase inhibitors and Gulf War illnesses

Acetylcholinesterase inhibitors and Gulf War illnesses

Methodologic issues in a population-based health survey of Gulf War veterans

Exposures to the Kuwait oil fires and their association with asthma and bronchitis among gulf war veterans.

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