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Bourassa KJ, Wagner HR, Halverson TF, Ashley-Koch AE, Beckham J, Garrett ME, Kimbrel NA, Naylor JC. Deployment-related toxic exposures are associated with worsening mental and physical health after military service: Results from a self-report screening of veterans deployed after 9/11. J Psychiatr Res 2024; 174:283-288. [PMID: 38678685 PMCID: PMC11102311 DOI: 10.1016/j.jpsychires.2024.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Exposure to toxins-such as heavy metals and air pollution-can result in poor health and wellbeing. Recent scientific and media attention has highlighted negative health outcomes associated with toxic exposures for U.S. military personnel deployed overseas. Despite established health risks, less empirical work has examined whether deployment-related toxic exposures are associated with declines in mental and physical health after leaving military service, particularly among the most recent cohort of veterans deployed after September 11, 2001. Using data from 659 U.S. veterans in the VISN 6 MIRECC Post-Deployment Mental Health Study, we tested whether self-reported toxic exposures were associated with poorer mental and physical health. At baseline, veterans who reported more toxic exposures also reported more mental health, β = 0.14, 95% CI [0.04, 0.23], p = 0.004, and physical health symptoms, β = 0.21, 95% CI [0.11, 0.30], p < 0.001. Over the next ten years, veterans reporting more toxic exposures also had greater increases in mental health symptoms, β = 0.23, 95% CI [0.15, 0.31], p < 0.001, physical health symptoms, β = 0.22, 95% CI [0.14, 0.30], p < 0.001, and chronic disease diagnoses, β = 0.15, 95% CI [0.07, 0.23], p < 0.001. These associations accounted for demographic and military covariates, including combat exposure. Our findings suggest that toxic exposures are associated with worsening mental and physical health after military service, and this recent cohort of veterans will have increased need for mental health and medical care as they age into midlife and older age.
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Affiliation(s)
- Kyle J Bourassa
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Geriatric Research, Education, and Clinical Center, Durham Veteran Affairs (VA) Health Care System, USA; Center for the Study of Aging and Human Development, Duke University Medical Center, USA.
| | - H Ryan Wagner
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
| | - Tate F Halverson
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA
| | | | - Jean Beckham
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
| | - Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, USA
| | - Nathan A Kimbrel
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, USA
| | - Jennifer C Naylor
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, USA
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Bihn JR, Cioffi G, Waite KA, Kruchko C, Neff C, Price M, Ostrom QT, Swinnerton KN, Elbers DC, Mooney MA, Rachlin J, Stein TD, Brophy MT, Do NV, Ferguson RE, Priemer DS, Perl DP, Hickman RA, Nabors B, Rusiecki J, Barnholtz-Sloan JS, Fillmore NR. Brain tumors in United States military veterans. Neuro Oncol 2024; 26:387-396. [PMID: 37738677 PMCID: PMC10836768 DOI: 10.1093/neuonc/noad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Comprehensive analysis of brain tumor incidence and survival in the Veteran population has been lacking. METHODS Veteran data were obtained from the Veterans Health Administration (VHA) Medical Centers via VHA Corporate Data Warehouse. Brain tumor statistics on the overall US population were generated from the Central Brain Tumor Registry of the US data. Cases were individuals (≥18 years) with a primary brain tumor, diagnosed between 2004 and 2018. The average annual age-adjusted incidence rates (AAIR) and 95% confidence intervals were estimated per 100 000 population and Kaplan-Meier survival curves evaluated overall survival outcomes among Veterans. RESULTS The Veteran population was primarily white (78%), male (93%), and between 60 and 64 years old (18%). Individuals with a primary brain tumor in the general US population were mainly female (59%) and between 18 and 49 years old (28%). The overall AAIR of primary brain tumors from 2004 to 2018 within the Veterans Affairs cancer registry was 11.6. Nonmalignant tumors were more common than malignant tumors (AAIR:7.19 vs 4.42). The most diagnosed tumors in Veterans were nonmalignant pituitary tumors (AAIR:2.96), nonmalignant meningioma (AAIR:2.62), and glioblastoma (AAIR:1.96). In the Veteran population, survival outcomes became worse with age and were lowest among individuals diagnosed with glioblastoma. CONCLUSIONS Differences between Veteran and US populations can be broadly attributed to demographic composition differences of these groups. Prior to this, there have been no reports on national-level incidence rates and survival outcomes for Veterans. These data provide vital information that can drive efforts to understand disease burden and improve outcomes for individuals with primary brain tumors.
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Affiliation(s)
- John R Bihn
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Gino Cioffi
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Danne C Elbers
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob Rachlin
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Thor D Stein
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Mary T Brophy
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Nhan V Do
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ryan E Ferguson
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - David S Priemer
- Department of Pathology, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for The Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Daniel P Perl
- Department of Pathology, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | - Richard A Hickman
- Henry M. Jackson Foundation for The Advancement of Military Medicine, Bethesda, Maryland, USA
- Human Oncology and Pathogenesis Program, Sloan Kettering Institute, New York, New York, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Burt Nabors
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Nathanael R Fillmore
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Smith CJ, Perfetti TA, Chokshi C, Venugopal C, Ashford JW, Singh SK. Alkylating agents are possible inducers of glioblastoma and other brain tumors. Hum Exp Toxicol 2024; 43:9603271241256598. [PMID: 38758727 DOI: 10.1177/09603271241256598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Epidemiological evidence of an association between exposure to chemical carcinogens and an increased risk for development of glioblastoma (GBM) is limited to weak statistical associations in cohorts of firefighters, farmers, residents exposed to air pollution, and soldiers exposed to toxic chemicals (e.g., military burn pits, oil-well fire smoke). A history of ionizing radiation therapy to the head or neck is associated with an increased risk of GBM. Ionizing radiation induces point mutations, frameshift mutations, double-strand breaks, and chromosomal insertions or deletions. Mutational profiles associated with chemical exposures overlap with the broad mutational patterns seen with ionizing radiation. Data on 16 agents (15 chemicals and radio frequency radiation) that induced tumors in the rodent brain were extracted from 602 Technical Reports on 2-years cancer bioassays found in the National Toxicology Program database. Ten of the 15 chemical agents that induce brain tumors are alkylating agents. Three of the 15 chemical agents have idiosyncratic structures and might be alkylating agents. Only two of the 15 chemical agents are definitively not alkylating agents. The rat model is thought to be of possible relevance to humans suggesting that exposure to alkylating chemicals should be considered in epidemiology studies on GBM and other brain tumors.
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Affiliation(s)
- Carr J Smith
- Society for Brain Mapping and Therapeutics, Pacific Palisades, CA, USA
| | | | - Chirayu Chokshi
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Chitra Venugopal
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Center for Discovery in Cancer Research (CDCR), McMaster University, Hamilton, ON, Canada
| | - J Wesson Ashford
- Stanford University and VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sheila K Singh
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Center for Discovery in Cancer Research (CDCR), McMaster University, Hamilton, ON, Canada
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Smith CJ, Perfetti TA, Chokshi C, Venugopal C, Ashford JW, Singh SK. Risk factors for glioblastoma are shared by other brain tumor types. Hum Exp Toxicol 2024; 43:9603271241241796. [PMID: 38520250 DOI: 10.1177/09603271241241796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
The reported risk factors for glioblastoma (GBM), i.e., ionizing radiation, Li-Fraumeni syndrome, Neurofibromatosis I, and Turcot syndrome, also increase the risk of other brain tumor types. Risk factors for human GBM are associated with different oncogenic mutation profiles. Pedigreed domestic dogs with a shorter nose and flatter face (brachycephalic dogs) display relatively high rates of glioma formation. The genetic profiles of canine gliomas are also idiosyncratic. The association of putatively different mutational patterns in humans and canines with GBM suggests that different oncogenic pathways can result in GBM formation. Strong epidemiological evidence for an association between exposure to chemical carcinogens and an increased risk for development of GBM is currently lacking. Ionizing radiation induces point mutations, frameshift mutations, double-strand breaks, and chromosomal insertions or deletions. Mutational profiles associated with chemical exposures overlap with the broad mutational patterns seen with ionizing radiation. Weak statistical associations between chemical exposures and GBM reported in epidemiology studies are biologically plausible. Molecular approaches comparing reproducible patterns seen in spontaneous GBM with analogous patterns found in GBMs resected from patients with known significant exposures to potentially carcinogenic chemicals can address difficulties presented by traditional exposure assessment.
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Affiliation(s)
- Carr J Smith
- Society for Brain Mapping and Therapeutics, Mobile, AL, USA
| | | | - Chirayu Chokshi
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Chitra Venugopal
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Center for Discovery in Cancer Research (CDCR), McMaster University, Hamilton, ON, Canada
| | - J Wesson Ashford
- Stanford University and VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sheila K Singh
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Center for Discovery in Cancer Research (CDCR), McMaster University, Hamilton, ON, Canada
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5
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Xiao H, Zhu H, Bögler O, Mónica FZ, Kots AY, Murad F, Bian K. Soluble Guanylate Cyclase β1 Subunit Represses Human Glioblastoma Growth. Cancers (Basel) 2023; 15:1567. [PMID: 36900358 PMCID: PMC10001022 DOI: 10.3390/cancers15051567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Malignant glioma is the most common and deadly brain tumor. A marked reduction in the levels of sGC (soluble guanylyl cyclase) transcript in the human glioma specimens has been revealed in our previous studies. In the present study, restoring the expression of sGCβ1 alone repressed the aggressive course of glioma. The antitumor effect of sGCβ1 was not associated with enzymatic activity of sGC since overexpression of sGCβ1 alone did not influence the level of cyclic GMP. Additionally, sGCβ1-induced inhibition of the growth of glioma cells was not influenced by treatment with sGC stimulators or inhibitors. The present study is the first to reveal that sGCβ1 migrated into the nucleus and interacted with the promoter of the TP53 gene. Transcriptional responses induced by sGCβ1 caused the G0 cell cycle arrest of glioblastoma cells and inhibition of tumor aggressiveness. sGCβ1 overexpression impacted signaling in glioblastoma multiforme, including the promotion of nuclear accumulation of p53, a marked reduction in CDK6, and a significant decrease in integrin α6. These anticancer targets of sGCβ1 may represent clinically important regulatory pathways that contribute to the development of a therapeutic strategy for cancer treatment.
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Affiliation(s)
- Haijie Xiao
- Department of Biochemistry and Molecular Medicine, The George Washington University, 2300 I Street NW, Washington, DC 20037, USA
| | - Haifeng Zhu
- The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM), The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Oliver Bögler
- Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
- The National Cancer Institute, NIH, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Fabiola Zakia Mónica
- Department of Biochemistry and Molecular Medicine, The George Washington University, 2300 I Street NW, Washington, DC 20037, USA
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Sao Paolo 13083, Brazil
| | - Alexander Y. Kots
- Veteran Affairs Palo Alto Health Care System, Department of Veteran Affairs, Palo Alto, CA 94304, USA
| | - Ferid Murad
- Veteran Affairs Palo Alto Health Care System, Department of Veteran Affairs, Palo Alto, CA 94304, USA
| | - Ka Bian
- Veteran Affairs Palo Alto Health Care System, Department of Veteran Affairs, Palo Alto, CA 94304, USA
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6
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Pan LF, Chang R, Hsu CY, Tsui KH. Older veterans associated with reduced risk of cancer: Retrospective nationwide matched cohort study in Taiwan. Front Med (Lausanne) 2023; 9:931565. [PMID: 36687435 PMCID: PMC9846208 DOI: 10.3389/fmed.2022.931565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/02/2022] [Indexed: 01/05/2023] Open
Abstract
Importance It remains unknown whether Taiwanese veterans have a lower risk of subsequent cancer compared with non-veterans. Objective To examine whether veterans are associated with reduced cancer risk. Methods From January 2004 to December 2017, this study included 957 veterans and 957 civilians who were propensity score (PS) matched by years of birth, sex, residence, index year, days in the hospital, frequency of outpatient visits, and relevant comorbidities at baseline. Multivariate Cox proportional hazards regression analysis was applied to compare the risks of cancer, overall and by subgroup, and mortality. All the participants were cancer free at the baseline. Exposures Veterans retrieved from Taiwan National Health Insurance Research Database (NHIRD). Main outcome Cancer extracted from the Registry for Catastrophic Illness Patients Database (RCIPD). Results Overall, 1,914 participants were included, and 957 veterans with a mean (SD) age of 75.9 (6.79) years and 946 men (98.9%). The mean follow-up was about 10.5 (±4.51) years. Cancer was recorded in 6.68% (N = 64) and 12.12% (N = 116) of veterans and non-veterans, respectively. Veterans were associated with decreased risk [adjusted hazard ratio (aHR), 0.57; 95% CI: 0.41-0.78; P < 0.001] of cancer compared with civilians after controlling for age, sex, urbanization, hypertension, diabetes, hyperlipidemia, cardiovascular event, COPD, asthma, chronic liver disease, alcohol-related illness, and Parkinson's disease. Cancer subgroup analyses verified this finding (HRs <1.0). The decreased incidence rate was predominantly for liver cancer (aHR, 0.18; 95% CI: 0.05-0.72; P < 0.05). Conclusion Taiwanese older veterans are associated with reduced overall cancer risk than individuals without veteran status.
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Affiliation(s)
- Li-Fei Pan
- Department of General Affair Office, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,College of Finance and Banking, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan,*Correspondence: Renin Chang,
| | - Chung Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Kuan-Hao Tsui
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan,Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,Kuan-Hao Tsui,
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7
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Cruz-Hernandez A, Roney A, Goswami DG, Tewari-Singh N, Brown JM. A review of chemical warfare agents linked to respiratory and neurological effects experienced in Gulf War Illness. Inhal Toxicol 2022; 34:412-432. [PMID: 36394251 PMCID: PMC9832991 DOI: 10.1080/08958378.2022.2147257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Over 40% of veterans from the Persian Gulf War (GW) (1990-1991) suffer from Gulf War Illness (GWI). Thirty years since the GW, the exposure and mechanism contributing to GWI remain unclear. One possible exposure that has been attributed to GWI are chemical warfare agents (CWAs). While there are treatments for isolated symptoms of GWI, the number of respiratory and cognitive/neurological issues continues to rise with minimum treatment options. This issue does not only affect veterans of the GW, importantly these chronic multisymptom illnesses (CMIs) are also growing amongst veterans who have served in the Afghanistan-Iraq war. What both wars have in common are their regions and inhaled exposures. In this review, we will describe the CWA exposures, such as sarin, cyclosarin, and mustard gas in both wars and discuss the various respiratory and neurocognitive issues experienced by veterans. We will bridge the respiratory and neurological symptoms experienced to the various potential mechanisms described for each CWA provided with the most up-to-date models and hypotheses.
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Affiliation(s)
- Angela Cruz-Hernandez
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Roney
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Dinesh G Goswami
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Neera Tewari-Singh
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jared M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Haley RW, Kramer G, Xiao J, Dever JA, Teiber JF. Evaluation of a Gene-Environment Interaction of PON1 and Low-Level Nerve Agent Exposure with Gulf War Illness: A Prevalence Case-Control Study Drawn from the U.S. Military Health Survey's National Population Sample. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:57001. [PMID: 35543525 PMCID: PMC9093163 DOI: 10.1289/ehp9009] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Consensus on the etiology of 1991 Gulf War illness (GWI) has been limited by lack of objective individual-level environmental exposure information and assumed recall bias. OBJECTIVES We investigated a prestated hypothesis of the association of GWI with a gene-environment (GxE) interaction of the paraoxonase-1 (PON1) Q192R polymorphism and low-level nerve agent exposure. METHODS A prevalence sample of 508 GWI cases and 508 nonpaired controls was drawn from the 8,020 participants in the U.S. Military Health Survey, a representative sample survey of military veterans who served during the Gulf War. The PON1 Q192R genotype was measured by real-time polymerase chain reaction (RT-PCR), and the serum Q and R isoenzyme activity levels were measured with PON1-specific substrates. Low-level nerve agent exposure was estimated by survey questions on having heard nerve agent alarms during deployment. RESULTS The GxE interaction of the Q192R genotype and hearing alarms was strongly associated with GWI on both the multiplicative [prevalence odds ratio (POR) of the interaction=3.41; 95% confidence interval (CI): 1.20, 9.72] and additive (synergy index=4.71; 95% CI: 1.82, 12.19) scales, adjusted for measured confounders. The Q192R genotype and the alarms variable were independent (adjusted POR in the controls=1.18; 95% CI: 0.81, 1.73; p=0.35), and the associations of GWI with the number of R alleles and quartiles of Q isoenzyme were monotonic. The adjusted relative excess risk due to interaction (aRERI) was 7.69 (95% CI: 2.71, 19.13). Substituting Q isoenzyme activity for the genotype in the analyses corroborated the findings. Sensitivity analyses suggested that recall bias had forced the estimate of the GxE interaction toward the null and that unmeasured confounding is unlikely to account for the findings. We found a GxE interaction involving the Q-correlated PON1 diazoxonase activity and a weak possible GxE involving the Khamisiyah plume model, but none involving the PON1 R isoenzyme activity, arylesterase activity, paraoxonase activity, butyrylcholinesterase genotypes or enzyme activity, or pyridostigmine. DISCUSSION Given gene-environment independence and monotonicity, the unconfounded aRERI>0 supports a mechanistic interaction. Together with the direct evidence of exposure to fallout from bombing of chemical weapon storage facilities and the extensive toxicologic evidence of biochemical protection from organophosphates by the Q isoenzyme, the findings provide strong evidence for an etiologic role of low-level nerve agent in GWI. https://doi.org/10.1289/EHP9009.
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Affiliation(s)
- Robert W. Haley
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gerald Kramer
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Junhui Xiao
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jill A. Dever
- RTI International, Washington, District of Columbia, USA
| | - John F. Teiber
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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9
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Brady CB, Robey I, Stein TD, Huber BR, Riley J, Abdul Rauf N, Spencer KR, Walt G, Adams L, Averill JG, Walker S, McKee AC, Thomson SP, Kowall NW. The Department of Veterans Affairs Gulf War Veterans' Illnesses Biorepository: Supporting Research on Gulf War Veterans' Illnesses. Brain Sci 2021; 11:1349. [PMID: 34679413 PMCID: PMC8533803 DOI: 10.3390/brainsci11101349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS To introduce a resource supporting research on Gulf War illness (GWI) and related disorders, the Gulf War Veterans' Illnesses Biorepository (GWVIB). METHODS Gulf War era veterans (GWVs) are recruited nationally and enrolled via telephone and email/postal mail. Enrolled veterans receive annual telephone and mail follow-up to collect health data until their passing. A postmortem neuropathological examination is performed, and fixed and frozen brain and spinal cord samples are banked to support research. Investigators studying GWI and related disorders may request tissue and data from the GWVIB. RESULTS As of September 2021, 127 GWVs from 39 states were enrolled; 60 met the criteria for GWI, and 14 met the criteria for chronic multisymptom illness (CMI). Enrollees have been followed up to six years. Postmortem tissue recoveries were performed on 14 GWVs. The most commonly found neuropathologies included amyotrophic lateral sclerosis, chronic traumatic encephalopathy, and Lewy body disease. Tissue was of good quality with an average RNA integrity number of 5.8 (SD = 1.0) and ≥4.8 in all of the cases. DISCUSSION The availability of health data and high-quality CNS tissue from this well-characterized GWV cohort will support research on GWI and related disorders affecting GWVs. Enrollment is ongoing.
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Affiliation(s)
- Christopher B. Brady
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Ian Robey
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Thor D. Stein
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Veterans Affairs Medical Center, Bedford, MA 01730, USA
| | - Bertrand R. Huber
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Jessica Riley
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Nazifa Abdul Rauf
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Keith R. Spencer
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Gabriel Walt
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - Latease Adams
- Research and Development Service, VA Boston Healthcare System, Boston, MA 02130, USA; (J.R.); (N.A.R.); (K.R.S.); (G.W.); (L.A.)
| | - James G. Averill
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Sean Walker
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
| | - Ann C. McKee
- Pathology Service, VA Boston Healthcare System, Boston, MA 02130, USA; (T.D.S.); (A.C.M.)
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stephen P. Thomson
- Southern Arizona VA Healthcare System, Tucson, AZ 85723, USA; (I.R.); (J.G.A.); (S.W.); (S.P.T.)
- Department of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Neil W. Kowall
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA; (B.R.H.); (N.W.K.)
- Neurology Service, VA Boston Healthcare System, Boston, MA 02130, USA
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10
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Dursa EK, Cao G, Porter B, Culpepper WJ, Schneiderman AI. The Health of Gulf War and Gulf Era Veterans Over Time: U.S. Department of Veterans Affairs' Gulf War Longitudinal Study. J Occup Environ Med 2021; 63:889-894. [PMID: 34483304 DOI: 10.1097/jom.0000000000002331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe the self-reported physical and mental health over the course over 19 years of follow up of a population-based cohort of Gulf War and Gulf Era veterans. METHODS A multi-modal health survey of 6338 Gulf War and Gulf Era veterans who participated in all three waves of the longitudinal study. RESULTS Gulf War and Gulf War Era veterans experienced an increase in prevalence of chronic disease over time. The adjusted odds ratios suggest that Gulf War veterans not only had significantly higher odds of reporting medical conditions, but also began to report them earlier. CONCLUSIONS The findings from this analysis suggest that Gulf War veterans are not only more likely than their non-deployed counterparts to report chronic disease, they were more likely to report it earlier.
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Affiliation(s)
- Erin K Dursa
- Post Deployment Health Services, Department of Veterans Affairs, Washington, DC (Dr Dursa, Dr Culpepper, and Dr Schneiderman); Hines VA Cooperative Studies Program Coordinating Center, Hines, Illinois (Dr Dursa and Ms Cao); Social Science Research Center, Mississippi State University, Starkville, Mississippi (Dr Porter)
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11
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Woo C, Cioffi GN, Bej TA, Wilson B, Briggs JM, Markt SC, Schumacher FR, Kruchko C, Waite KA, Nabors LB, Nock CJ, Jump RLP, Barnholtz-Sloan JS. Data Matching to Support Analysis of Cancer Epidemiology Among Veterans Compared With Non-Veteran Populations-An Exemplar in Brain Tumors. JCO Clin Cancer Inform 2021; 5:985-994. [PMID: 34554825 PMCID: PMC8807020 DOI: 10.1200/cci.21.00052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE State and national cancer registries do not systematically include Veteran data, which hinders analysis of the diagnosis patterns, treatment trajectories, and clinical outcomes of Veterans compared with non-Veteran populations. This study used data matching approaches to compare cases included in the Oncology Domain of the Veterans Affairs (VA) Corporate Data Warehouse and the Ohio Cancer Incidence Surveillance System, using brain tumors as an exemplar. METHODS We used direct data matching, on the basis of protected health information (PHI) common to both databases, to compare primary brain tumors from Veterans and non-Veterans diagnosed from 2000 to 2016. Working with this matched data set, we used six data elements that did not contain PHI, to assess the feasibility of using deterministic data matching to compare Veterans and non-Veterans. RESULTS Between 2000 and 2016, 223 Veterans from Ohio had a primary brain tumor; of those, 55 (25%) were not included in Ohio Cancer Incidence Surveillance System. Direct data matching showed that Veterans experienced a greater proportion of glioblastomas (41%) compared with non-Veterans (21%). Sex did not account for this difference. Deterministic data matching within the matched data set found that 75% (126 of 168) of Veterans had exact matches for at least five of six non-PHI variables common to both databases. CONCLUSION This study indicated that direct and deterministic data matching approaches to compare brain tumors in Veterans and in non-Veterans is feasible. This approach has the potential to promote comparisons of the distribution of tumors, the impact of chemical and environmental exposures, treatment trajectories, and clinical outcomes among Veteran and non-Veteran populations with brain tumors as well as other cancers and rare diseases.
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Affiliation(s)
- Christine Woo
- Healthcare Leadership Talent Institute, Veterans Health Administration, Cleveland, OH.,College of Public Health, Kent State University, Kent, OH
| | - Gino N Cioffi
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Trans-Divisional Research Program, Bethesda, MD.,Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL
| | - Taissa A Bej
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH
| | - Brigid Wilson
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Janet M Briggs
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH
| | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL
| | - Kristin A Waite
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Trans-Divisional Research Program, Bethesda, MD.,Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL
| | - L Burt Nabors
- Division of Neuro-oncology, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Charles J Nock
- Hematology and Oncology Section, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH.,Department of Medicine, Division of Hematology and Oncology, University Hospitals Health System, Cleveland, OH
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Jill S Barnholtz-Sloan
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Trans-Divisional Research Program, Bethesda, MD.,Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL.,National Cancer Institute, Center for Biomedical Informatics & Information Technology, Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, Bethesda, MD
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12
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Bytnar JA, Lin J, Eaglehouse YL, Enewold L, Shriver CD, Zhu K. Brain cancer incidence: a comparison of active-duty military and general populations. Eur J Cancer Prev 2021; 30:328-333. [PMID: 32898014 DOI: 10.1097/cej.0000000000000625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the USA, brain cancer disproportionately affects young adults. The US military has a younger age structure than the general population and may have differential exposures related to brain cancer. This study aimed to compare the incidence rates of brain cancer in the active-duty military and general populations to provide clues for future etiologic research. The rates between military service branches were also compared. METHODS The data for this study were from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results 9 (SEER-9) registries. Age- and sex-adjusted incidence rates of malignant neuroepithelial brain cancer among adults 20-54 years of age from 1990-2013 were calculated and compared between the two populations, given as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). RESULTS The age and sex-adjusted incidence rate for malignant neuroepithelial brain cancer was significantly lower in the active-duty population than in the US general population (IRR = 0.62, 95% CI, 0.56-0.68). The reduced incidence rate in the active-duty population was observed in men, all races, individuals 20-44 of age, and for all histological subtypes and time periods assessed. There were no significant differences in rates between the military service branches. CONCLUSION The incidence rates of neuroepithelial brain cancer were lower in the active-duty military population than the US general population. This study highlights the need for more research to enhance our understanding of variations in brain cancer incidence between these two populations.
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Affiliation(s)
- Julie A Bytnar
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
| | - Jie Lin
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Yvonne L Eaglehouse
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, Medical Center Drive
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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Murillo J, Artz J, Brahmaroutu A, Gunnell S, Benge J, Lyon K, Fonkem E. An Exploratory Study of the Frequency of Central Nervous System Tumors by Type in the Central Texas Military and Civilian Populations. Cureus 2021; 13:e13885. [PMID: 33868849 PMCID: PMC8043054 DOI: 10.7759/cureus.13885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The types of central nervous system (CNS) tumors in a patient population with a history of military service were compared to the types of CNS tumors in a similar patient population without a military service history to determine if a relationship exists between military service and CNS tumor type. METHODS This study analyzed data for adult patients diagnosed with an intra- or extra-axial CNS tumor from January 2016 to July 2019. One cohort was constructed of patients who had a history of military service (MIL), and the other cohort was made of patients who did not have a history of military service (NMIL). Appropriate parametric and non-parametric analyses were used to compare frequencies of tumor types between cohorts adjusting for potential confounders. RESULTS We identified 2001 patients (MIL, n = 190; NMIL, n = 1811). In the MIL cohort, most patients were males, younger, and more racially diverse. In the primary analysis, the MIL cohort showed higher diagnoses of metastatic tumors compared with the NMIL cohort (X2(1)= 3.71, p=.05). The MIL cohort also showed lower diagnoses of meningioma compared to the NMIL cohort. There was no statically significant difference between cohorts or tumors after adjusting for primary source by gender. CONCLUSIONS MIL experience was associated with lower diagnoses of meningioma but higher diagnoses of metastatic cancer, providing support that there may be potential differences in tumor types between patients with a history of military service and those without military history regarding primary CNS tumor frequency.
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Affiliation(s)
- Jennifer Murillo
- Neurology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Jonathan Artz
- Psychiatry, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Ankita Brahmaroutu
- Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Spencer Gunnell
- Neurology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Jared Benge
- Neuropsychology, University of Texas at Austin Dell Medical School, Austin, USA
| | - Kristopher Lyon
- Neurosurgery, Baylor Scott & White Medical Center - Temple, Temple, USA
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14
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Bullman T, Schneiderman A, Dursa E. Cause-specific mortality risks among U.S. veterans: 25 years after their service in the 1990-1991 gulf war. Ann Epidemiol 2021; 57:1-6. [PMID: 33581241 DOI: 10.1016/j.annepidem.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is concern about adverse health effects related to military service in the 1990-1991 Gulf War. This study assessed cause-specific mortality risks among Veterans who served in the war. METHODS The mortality of 621,244 veterans deployed to the Gulf War was compared to that of 745,704 Veterans who served during the war but were not deployed to the Gulf Theater. Cause-specific mortality of both deployed and nondeployed was also compared to that of the US general population. RESULTS There was no increased risk of disease-specific mortality among deployed Veterans compared to nondeployed. Deployed Veterans did have an increased risk of motor vehicle deaths compared to nondeployed Veterans, (hazard ratio, 1.12, 95% confidence interval, 1.04-1.21). Cause-specific mortality of both deployed and non-deployed Veterans was less than that of the US population. When stratified by gender, only female Veterans, both deployed and nondeployed, had increased risks of suicide compared to the female US population (standardized mortality ratio, 1.40; 95% confidence interval, 1.13-1.71 and standardized mortality ratio, 1.22; 95% confidence interval, 1.05-1.40, respectively). CONCLUSION There was no increased risk of disease mortality among Veterans of the 1990-1991 Gulf War. Both deployed and nondeployed female Veterans had increased risks of suicide compared to US female population.
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Affiliation(s)
- Tim Bullman
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC.
| | - Aaron Schneiderman
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC
| | - Erin Dursa
- Post Deployment Health Services, US Department of Veterans Affairs, Washington DC
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15
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Alozi M, Rawas-Qalaji M. Treating organophosphates poisoning: management challenges and potential solutions. Crit Rev Toxicol 2020; 50:764-779. [DOI: 10.1080/10408444.2020.1837069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Maria Alozi
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Mutasem Rawas-Qalaji
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
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16
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Dursa EK, Tadesse BE, Carter CE, Culpepper WJ, Schneiderman AI, Rumm PD. Respiratory illness among Gulf War and Gulf War era veterans who use the Department of Veterans Affairs for healthcare. Am J Ind Med 2020; 63:980-987. [PMID: 32851693 DOI: 10.1002/ajim.23172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Veterans of the 1990-1991 Gulf War were exposed to a variety of toxic substances during their service that included several airborne hazards, but only a few small studies have assessed respiratory outcomes in Gulf War veterans. This paper presents population prevalence estimates and prevalence ratios of respiratory disease among Gulf War and Gulf War Era veterans who use VA healthcare. METHODS A total of 360,909 Gulf War deployed veterans and 323,638 Gulf War Era non-deployed veterans were included in the analysis. Ten-year period prevalence rates (PRs) for fifteen respiratory diseases were calculated for Gulf War and Gulf War Era veterans and period prevalence ratios comparing Gulf War veterans to Gulf War Era veterans were calculated. RESULTS The five respiratory conditions with the highest prevalence per 100,000 veterans across both Gulf War deployed and Gulf War Era non-deployed veterans (respectively) were: allergic rhinitis (8,400 and 8,041), chronic obstructive pulmonary disease (4,763 and 4,795), asthma (4,685 and 4,477), chronic airway obstruction (3,983 and 4,059), and chronic sinusitis (2,863 and 2,672). The adjusted PRs showed a small, but significantly increased, elevation in Gulf War-deployed compared to Gulf War Era non-deployed veterans for chronic bronchitis (PR 1.19; 95% CI 1.10, 1.28), emphysema (PR 1.11; 95% CI 1.01, 1.21), chronic airway obstruction (PR 1.09; 95% CI 1.07, 1.12), and chronic obstructive pulmonary disease (PR 1.09; 1.07, 1.11). DISCUSSION Gulf War veterans should continue to be monitored in the future to better evaluate the potential long-term consequences on respiratory health.
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Affiliation(s)
- Erin K. Dursa
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
| | | | | | - William J. Culpepper
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
| | - Aaron I. Schneiderman
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
| | - Peter D. Rumm
- Post‐Deployment Health Services Department of Veterans Affairs Washington District of Columbia
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