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Wang Y, Ni J, Mao W, Zhang H, Yin L, Zhang T, Wang K, Chen S, Chen M. Military exposure and kidney stones among US adults: findings from 2007-2018 NHANES. BMJ Mil Health 2024; 170:89-91. [PMID: 35584852 DOI: 10.1136/bmjmilitary-2022-002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/15/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Yidi Wang
- Department of Urology, Shanghai Putuo District People's Hospital, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - J Ni
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - W Mao
- Department of Urology, Shanghai Putuo District People's Hospital, Shanghai, China
- Department of Urology, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China
| | - H Zhang
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - L Yin
- Department of Urology, Ruijin Hospital, Shanghai, China
| | - T Zhang
- Department of Urology, Shanghai Putuo District People's Hospital, Shanghai, China
| | - K Wang
- Department of Urology, Shanghai Putuo District People's Hospital, Shanghai, China
- Department of Urology, Shanghai Tenth People's Hospital, Shanghai, China
| | - S Chen
- Department of Urology, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China
| | - M Chen
- Department of Urology, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China
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Burzynski HE, Ayala KE, Frick MA, Dufala HA, Woodruff JL, Macht VA, Eberl BR, Hollis F, McQuail JA, Grillo CA, Fadel JR, Reagan LP. Delayed cognitive impairments in a rat model of Gulf War Illness are stimulus-dependent. Brain Behav Immun 2023; 113:248-258. [PMID: 37437820 PMCID: PMC10530066 DOI: 10.1016/j.bbi.2023.07.003] [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: 02/14/2023] [Revised: 06/07/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Abstract
Gulf War Illness (GWI) collectively describes the multitude of central and peripheral disturbances affecting soldiers who served in the 1990-1991 Gulf War. While the mechanisms responsible for GWI remain elusive, the prophylactic use of the reversible acetylcholinesterase inhibitor, pyridostigmine bromide (PB), and war-related stress have been identified as chief factors in GWI pathology. Post-deployment stress is a common challenge faced by veterans, and aberrant cholinergic and/or immune responses to these psychological stressors may play an important role in GWI pathology, especially the cognitive impairments experienced by many GWI patients. Therefore, the current study investigated if an immobilization stress challenge would produce abnormal responses in PB-treated rats three months later. Results indicate that hippocampal cholinergic responses to an immobilization stress challenge are impaired three months after PB administration. We also assessed if an immune or stress challenge reveals deficits in PB-treated animals during hippocampal-dependent learning and memory tasks at this delayed timepoint. Novel object recognition (NOR) testing paired with either acute saline or lipopolysaccharide (LPS, 30 µg/kg, i.p.), as well as Morris water maze (MWM) testing was conducted approximately three months after PB administration and/or repeated restraint stress. Rats with a history of PB treatment exhibited 24-hour hippocampal-dependent memory deficits when challenged with LPS, but not saline, in the NOR task. Similarly, in the same cohort, PB-treated rats showed 24-hour memory deficits in the MWM task. Ultimately, these studies highlight the long-term effects of PB treatment on hippocampal function and provide insight into the progressive cognitive deficits observed in veterans with GWI.
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Affiliation(s)
- H E Burzynski
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States.
| | - K E Ayala
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
| | - M A Frick
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
| | - H A Dufala
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
| | - J L Woodruff
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
| | - V A Macht
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
| | - B R Eberl
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
| | - F Hollis
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States; Columbia VA Health Care System, Columbia, SC 29208, United States
| | - J A McQuail
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States; Columbia VA Health Care System, Columbia, SC 29208, United States
| | - C A Grillo
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States; Columbia VA Health Care System, Columbia, SC 29208, United States
| | - J R Fadel
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States; Columbia VA Health Care System, Columbia, SC 29208, United States
| | - L P Reagan
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States; Columbia VA Health Care System, Columbia, SC 29208, United States
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Chao LL. Examining the current health of Gulf War veterans with the veterans affairs frailty index. Front Neurosci 2023; 17:1245811. [PMID: 37746142 PMCID: PMC10512703 DOI: 10.3389/fnins.2023.1245811] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Gulf War Illness (GWI) is a chronic, multisymptom (e.g., fatigue, muscle/joint pain, memory and concentration difficulties) condition estimated to affect 25-32% of Gulf War (GW) veterans. Longitudinal studies suggest that few veterans with GWI have recovered over time and that deployed GW veterans may be at increased risks for age-related conditions. Methods We performed a retrospective cohort study to examine the current health status of 703 GW veterans who participated in research studies at the San Francisco VA Health Care System (SFVAHCS) between 2002 and 2018. We used the Veterans Affairs Frailty Index (VA-FI) as a proxy measure of current health and compared the VA-FIs of GW veterans to a group of randomly selected age- and sex-matched, non-GW veterans. We also examined GW veterans' VA-FIs as a function of different GWI case definitions and in relationship to deployment-related experiences and exposures. Results Compared to matched, non-GW veterans, GW veterans had lower VA-FIs (0.10 ± 0.10 vs. 0.12 ± 0.11, p < 0.01). However, the subset of GW veterans who met criteria for severe Chronic Multisymptom Illness (CMI) at the time of the SFVAHCS studies had the highest VA-FI (0.13 ± 0.10, p < 0.001). GW veterans who had Kansas GWI exclusionary conditions had higher VA-FI (0.12 ± 0.12, p < 0.05) than veterans who were Kansas GWI cases (0.08 ± 0.08) and controls (i.e., veterans with little or no symptoms, 0.04 ± 0.06) at the time of the SFVAHCS research studies. The VA-FI was positively correlated with several GW deployment-related exposures, including the frequency of wearing flea collars. Discussion Although GW veterans, as a group, were less frail than non-GW veterans, the subset of GW veterans who met criteria for severe CDC CMI and/or who had Kansas GWI exclusionary conditions at the time of the SFVAHCS research studies were frailest at index date. This suggests that many ongoing studies of GWI that use the Kansas GWI criteria may not be capturing the group of GW veterans who are most at risk for adverse chronic health outcomes.
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Affiliation(s)
- Linda L. Chao
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
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4
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Goto R, Pinchuk I, Kolodezhny O, Pimenova N, Skokauskas N. Study Protocol: Adolescents of Ukraine During the Russian Invasion (AUDRI) Cohort. BMC Public Health 2023; 23:1342. [PMID: 37438711 DOI: 10.1186/s12889-023-16070-3] [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: 01/06/2023] [Accepted: 06/07/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Since February 14, 2022, Ukraine has once again been under attack by the Russian forces, putting the nation in one of the biggest emergencies in Europe since World War II. This puts Ukrainians at high risk of psychiatric disorders, amidst unseen attacks on infrastructure that have put massive strain on Ukraine's mental health services. Despite this, the prevalence of psychiatric disorders among adolescents and their changes over time have not yet been documented in Ukraine during the invasion. More generally, there is a need to more comprehensively uncover the long-term consequences of war on youth, especially their risks and protective factors. METHODS The Adolescents of Ukraine During the Russian Invasion (AUDRI) Cohort is the largest cohort of war-affected Ukrainian adolescents. We will recruit adolescents aged 15 to 18 years attending any school in Ukraine. Data collection will start early 2023, and will be held via online questionnaires every six months during the war as well as after the war has terminated. We will use several well-validated tools to screen for PTSD, depression, anxiety, substance use disorder, and eating disorders. In addition, we will ask participants about possible risks and protective factors of their mental health including resilience and social capital. Using the cohort, we will evaluate the trends in psychiatric disorder prevalence among adolescents in Ukraine over time and evaluate risks and protective factors of adolescents' mental health. DISCUSSION The AUDRI Cohort will provide a unique opportunity to learn more about trauma and resilience among youth in conflict settings, in addition to aiding international efforts to save the mental health of youth in Ukraine. At-risk adolescents identified from our study can directly become beneficiaries of targeted intervention themselves. Building evidence on the mental health of adolescents is especially valuable, as protecting the mental health of war-affected adolescents could help rebuild society and have positive consequences for generations to come.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Irina Pinchuk
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Oleksiy Kolodezhny
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Nataliia Pimenova
- Institute of Psychiatry, Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
- Chair, Child and Adolescent Psychiatry Section, World Psychiatric Association, Geneva, Switzerland.
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Bryant RA, McFarlane AC, Silove D, O'Donnell ML, Forbes D, Creamer M. The Lingering Impact of Resolved PTSD on Subsequent Functioning. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:290-295. [PMID: 37404963 PMCID: PMC10316210 DOI: 10.1176/appi.focus.23021016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
This study investigated whether impairment persists after posttraumatic stress disorder (PTSD) has resolved. Traumatically injured patients (N = 1,035) were assessed during hospital admission and at 3 (85%) and 12 months (73%). Quality of life prior to traumatic injury was measured with the World Health Organization Quality of Life-BREF during hospitalization and at each subsequent assessment. PTSD was assessed using the Clinician-Administered PTSD Scale at 3 and 12 months. After controlling for preinjury functioning, current pain, and comorbid depression, patients whose PTSD symptoms had resolved by 12 months were more likely to have poorer quality of life in psychological (OR = 3.51), physical (OR = 10.17), social (OR = 4.54), and environmental (OR = 8.83) domains than those who never developed PTSD. These data provide initial evidence that PTSD can result in lingering effects on functional capacity even after remission of symptoms. Reprinted from Clin Psychol Sci 2016; 4:493-498, with permission from Sage. Copyright © 2016.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Alexander C McFarlane
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Derrick Silove
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Meaghan L O'Donnell
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - David Forbes
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
| | - Mark Creamer
- School of Psychology, University of New South Wales (Bryant); Brain Dynamics Centre, Westmead Millennium Institute (Bryant); Centre for Military and Veteran Health, University of Adelaide (McFarlane); School of Psychiatry, University of New South Wales (Silove); and Phoenix Australia, Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne (O'Donnell, Forbes, Creamer)
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Yan S, Wang J, Xu J, Jiang W, Xiong M, Cao Z, Wang Y, Wang Z, Zhang T, Wang Z, Sun C, Hou S, Wei W. Exposure to N,N-diethyl- m-toluamide and cardiovascular diseases in adults. Front Public Health 2022; 10:922005. [PMID: 36267998 PMCID: PMC9576625 DOI: 10.3389/fpubh.2022.922005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/09/2022] [Indexed: 01/22/2023] Open
Abstract
Although growing evidence suggests that N,N-diethyl-m-toluamide (DEET) has adverse effects on public health, the relationship of DEET with cardiovascular disease (CVD) is still largely unknown. The purpose of this study was, therefore, to evaluate the association between DEET exposure and total and specific CVD among the US adults. In this cross-sectional study, a total of 5,972 participants were selected from the National Health and Nutrition Examination Survey (NHANES) 2007-2014. CVD was defined as a combination of congestive heart failure (CHF), coronary heart disease (CHD), angina, heart attack, or stroke. Logistic regression models were used to evaluate the association between DEET metabolites and the risks of total and specific CVD. Compared to the lowest quartile, 3-(diethylcarbamoyl) benzoic acid (DCBA) in the highest quartile was associated with the increased risks of CVD (odds ratio [OR]: 1.32, 95% CI: 1.03-1.68, P for trend = 0.025) and CHD (OR: 1.57, 95% CI: 1.10-2.25, P for trend = 0.017), after adjustment for potential covariates. Nevertheless, exposure to DCBA was not significantly associated with heart attack, CHF, angina, and stroke. Further studies are required to confirm these findings and identify the underlying mechanisms.
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Affiliation(s)
- Shiwei Yan
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Jianing Wang
- Department of Cerebrovascular Disease, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Jiaxu Xu
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Wenbo Jiang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Menglin Xiong
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Ziteng Cao
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Yu Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Ziqi Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Tongfang Zhang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Zheng Wang
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China,*Correspondence: Wei Wei
| | - Shaoying Hou
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China,Shaoying Hou
| | - Wei Wei
- Department of Nutrition and Food Hygiene, College of Public Health, Harbin Medical University, Harbin, China,Changhao Sun
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Hamblin MR. Photobiomodulation for Gulf War Illness? Photobiomodul Photomed Laser Surg 2022; 40:437-439. [DOI: 10.1089/photob.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, Johannesburg, South Africa
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8
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Burzynski H, Macht V, Woodruff J, Crawford J, Erichsen J, Piroli G, Grillo C, Fadel J, Reagan L. Pyridostigmine bromide elicits progressive and chronic impairments in the cholinergic anti-inflammatory pathway in the prefrontal cortex and hippocampus of male rats. Neurobiol Stress 2022; 18:100446. [PMID: 35573808 PMCID: PMC9095881 DOI: 10.1016/j.ynstr.2022.100446] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Gulf War Illness (GWI) is a multi-symptom illness that continues to affect over 250,000 American Gulf War veterans. The causes of GWI remain equivocal; however, prophylactic use of the acetylcholinesterase inhibitor pyridostigmine bromide (PB), and the stress of combat have been identified as two potential causative factors. Both PB and stress alter acetylcholine (ACh), which mediates both cognition and anti-inflammatory responses. As inflammation has been proposed to contribute to the cognitive deficits and immune dysregulation in GWI, the goal of this study was to determine the long-term effects of PB and stress on the cholinergic anti-inflammatory pathway in the central nervous system and periphery. We used our previously established rat model of GWI and in vivo microdialysis to assess cholinergic neurochemistry in the prefrontal cortex (PFC) and hippocampus following a mild immune challenge (lipopolysaccharide; LPS). We then examined LPS-induced changes in inflammatory markers in PFC and hippocampal homogenates. We found that PB treatment produces a long-lasting potentiation of the cholinergic response to LPS in both the PFC and hippocampus. Interestingly, this prolonged effect of PB treatment enhancing cholinergic responses to LPS was accompanied by paradoxical increases in the release of pro-inflammatory cytokines in these brain regions. Collectively, these findings provide evidence that neuroinflammation resulting from dysregulation of the cholinergic anti-inflammatory pathway is a mechanistic mediator in the progression of the neurochemical and neurocognitive deficits in GWI and more broadly suggest that dysregulation of this pathway may contribute to neuroinflammatory processes in stress-related neurological disorders. Inflammation is thought to contribute to the progressive nature of GWI pathology. PB potentiates the central cholinergic response to LPS over time in model of GWI. PB progressively exacerbates the neuroinflammatory response to LPS. GWI may result from the dysregulation of the cholinergic anti-inflammatory pathway.
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Krengel MH, Zundel CG, Heeren T, Yee M, Spiro A, Proctor SP, Grasso CM, Sullivan K. Health symptom trajectories and neurotoxicant exposures in Gulf War veterans: the Ft. Devens cohort. Environ Health 2022; 21:7. [PMID: 34998396 PMCID: PMC8742929 DOI: 10.1186/s12940-021-00812-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Thirty years ago, Gulf War (GW) veterans returned home with numerous health symptoms that have been associated with neurotoxicant exposures experienced during deployment. The health effects from these exposures have been termed toxic wounds. Most GW exposure-outcome studies utilize group analyses and thus individual fluctuations in symptoms may have been masked. This study investigates health symptom trajectories in the same veterans over 25 years. METHODS Veterans were categorized into 5 a priori trajectory groups for each health symptom and Chronic Multisymptom Illness (CMI) clinical case status. Multinomial logistic regression models were used to investigate associations between these trajectories and neurotoxicant exposures. RESULTS Results indicate that more than 21 Pyridostigmine Bromide (PB) pill exposure was associated with consistent reporting of fatigue, pain, and cognitive/mood symptoms as well as the development of six additional symptoms over time. Chemical weapons exposure was associated with both consistent reporting and development of neurological symptoms over time. Reported exposure to tent heater exhaust was associated with later development of gastrointestinal and pulmonary symptoms. Veterans reporting exposure to more than 21 PB pills were more than 8 times as likely to consistently meet the criteria for CMI over time. CONCLUSION This study highlights the importance of the continued documentation of the health impacts experienced by GW veterans', their resulting chronic health symptoms, and the importance of exposure-outcome relationships in these veterans now 30 years post-deployment.
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Affiliation(s)
- Maxine H. Krengel
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
| | - Clara G. Zundel
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Behavioral Neuroscience Program, Boston University School of Medicine, Boston, MA USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Megan Yee
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Susan P. Proctor
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA USA
| | - Claudia M. Grasso
- Research Service, VA Boston Healthcare System, 150 South Huntington Ave. 8A-90, Jamaica Plain, Boston, MA 02130 USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA USA
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Kozlova EV, Carabelli B, Bishay AE, Denys ME, Chinthirla DB, Tran JD, Hsiao A, Nieden NZ, Curras-Collazo MC. Persistent exercise fatigue and associative learning deficits in combination with transient glucose dyshomeostasis in a GWI mouse model. Life Sci 2021; 289:120094. [PMID: 34710444 PMCID: PMC9053767 DOI: 10.1016/j.lfs.2021.120094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022]
Abstract
Aims: To characterize exercise fatigue, metabolic phenotype and cognitive and mood deficits correlated with brain neuroinflammatory and gut microbiome changes in a chronic Gulf War Illness (GWI) mouse model. The latter have been described in an accompanying paper [1]. Main methods: Adult male C57Bl/6N mice were exposed for 28 days (5 days/week) to pyridostigmine bromide: 6.5 mg/kg, b.i.d., P.O. (GW1) or 8.7 mg/kg, q.d., P.O. (GW2); topical permethrin (1.3 mg/kg in 100% DMSO) and N,N-diethyl-meta-toluamide (DEET 33% in 70% EtOH) and restraint stress (5 min). Exercise, metabolic and behavioral endpoints were compared to sham stress control (CON/S). Key findings: Relative to CON/S, GW2 presented persistent exercise intolerance (through post-treatment (PT) day 161), deficient associative learning/memory, and transient insulin insensitivity. In contrast to GW2, GW1 showed deficient long-term object recognition memory, milder associative learning/memory deficit, and behavioral despair. Significance: Our findings demonstrate that GW chemicals dose-dependently determine the presentation of exercise fatigue and severity/type of cognitive/mood-deficient phenotypes that show persistence. Our comprehensive mouse model of GWI recapitulates the major multiple symptom domains characterizing GWI, including fatigue and cognitive impairment that can be used to more efficiently develop diagnostic tests and curative treatments for ill Gulf War veterans.
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Affiliation(s)
- Elena V Kozlova
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA; Neuroscience Graduate Program, University of California, Riverside, CA, USA
| | - Bruno Carabelli
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA
| | - Anthony E Bishay
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA
| | - Maximilian E Denys
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA
| | - Devi B Chinthirla
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA
| | - Jasmin D Tran
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA
| | - Ansel Hsiao
- Department of Microbiology and Plant Pathology, University of California, Riverside, Riverside, CA, USA
| | - Nicole Zur Nieden
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA
| | - M C Curras-Collazo
- Department of Molecular, Cell and Systems Biology, University of California, Riverside, CA, USA.
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11
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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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Stegner AJ, Almassi NE, Dougherty RJ, Ellingson LD, Gretzon NP, Lindheimer JB, Ninneman JV, Van Riper SM, O'Connor PJ, Cook DB. Safety and efficacy of short-term structured resistance exercise in Gulf War Veterans with chronic unexplained muscle pain: A randomized controlled trial. Life Sci 2021; 282:119810. [PMID: 34256041 DOI: 10.1016/j.lfs.2021.119810] [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: 02/28/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
AIMS Chronic widespread musculoskeletal pain (CMP) is a primary condition of Veterans suffering from Gulf War illness. This study evaluated the influence of resistance exercise training (RET) on symptoms, mood, perception of improvement, fitness, and total physical activity in Gulf War Veterans (GWV) with CMP. MAIN METHODS Fifty-four GWV with CMP were randomly assigned to 16 weeks of RET (n = 28) or wait-list control (n = 26). Supervised exercise was performed twice weekly starting at a low intensity. Outcomes, assessed at baseline, 6, 11 and 17 weeks and 6- and 12-months post-intervention, were: pain, fatigue, mood, sleep quality, perception of improvement, and physical activity via self-report and accelerometry. Muscular strength was assessed at baseline, 8 and 16 weeks. Accelerometer data yielded estimates of time spent in sedentary, light, and moderate-to-vigorous physical activities. Analyses used separate linear mixed models with group and time point as fixed effects. All models, except for perceived improvement, included baseline values as a covariate. KEY FINDINGS Participants assigned to RET completed 87% of training sessions and exhibited strength increases between 16 and 34% for eight lifts tested (Hedges' g range: 0.47-0.78). The treatment by time interaction for perceived improvement (F1,163 = 16.94, p < 0.001) was characterized by greater perceived improvement since baseline for RET at each time point, until the 12-month follow-up. Effects were not significant for other outcomes (p > 0.05). RET caused no adverse events. SIGNIFICANCE After 16 weeks of RET, GWV with CMP reported improvements in their condition and exhibited increases in muscular strength, without symptom exacerbation or reductions in total physical activity.
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Affiliation(s)
- Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; University of Wisconsin-Madison, Madison, WI, United States of America.
| | - Neda E Almassi
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; University of Wisconsin-Madison, Madison, WI, United States of America
| | - Ryan J Dougherty
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Laura D Ellingson
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; Western Oregon University, Monmouth, OR, United States of America
| | - Nicholas P Gretzon
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; University of Wisconsin-Madison, Madison, WI, United States of America
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; University of Wisconsin-Madison, Madison, WI, United States of America
| | - Jacob V Ninneman
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; University of Wisconsin-Madison, Madison, WI, United States of America
| | - Stephanie M Van Riper
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; University of Wisconsin-Madison, Madison, WI, United States of America
| | | | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of America; University of Wisconsin-Madison, Madison, WI, United States of America
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13
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Bloeser K, McCarron KK, Merker VL, Hyde J, Bolton RE, Anastasides N, Petrakis BA, Helmer DA, Santos S, Litke D, Pigeon WR, McAndrew LM. "Because the country, it seems though, has turned their back on me": Experiences of institutional betrayal among veterans living with Gulf War Illness. Soc Sci Med 2021; 284:114211. [PMID: 34271400 DOI: 10.1016/j.socscimed.2021.114211] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
People living with medically unexplained symptoms (MUS) often have poor quality of life and health outcomes. Many struggle to engage with and trust in healthcare systems. This qualitative study examined how experiences with institutions influence perceptions of medical care for MUS by applying the theoretical framework of institutional betrayal to narratives of U.S. military Veterans living with Gulf War Illness (GWI). Institutional betrayal refers to situations in which the institutions people depend upon for safety and well-being cause them harm. Experiences of institutional betrayal both during active military service and when first seeking treatment appeared to shape perceptions of healthcare in this sample. Veterans expressed the belief that the military failed to protect them from environmental exposures. Veterans' concerns regarding subsequent quality of healthcare were intrinsically linked to a belief that, despite official documentation to the contrary, the predominant paradigm of both the U.S. Department of Defense and the U.S. Department of Veterans Affairs (VA) is that GWI does not exist. Veterans reported that providers are not adequately trained on treatment of GWI and do not believe Veterans' descriptions of their illness. Veterans reported taking up self-advocacy, doing their own research on their condition, and resigning themselves to decrease engagement with VA healthcare or seek non-VA care. The study's findings suggest institutional level factors have a profound impact on perceptions of care and the patient-provider relationship. Future research and policy aimed at improving healthcare for people living with MUS should consider the concept of institutional betrayal.
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Affiliation(s)
- Katharine Bloeser
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Silberman School of Social Work at Hunter College, The City University of New York, NY, USA.
| | - Kelly K McCarron
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Vanessa L Merker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Boston University, Department of Medicine, Section General Internal Medicine, Boston, MA, USA
| | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA; Brandeis University, Heller School for Social Policy and Management, MA, USA
| | - Nicole Anastasides
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, MA, USA
| | - Drew A Helmer
- VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, USA
| | - Susan Santos
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - David Litke
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA
| | - Wilfred R Pigeon
- VA Center of Excellence for Suicide Prevention, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa M McAndrew
- The War Related Illness and Injury Study Center, The VA New Jersey Health Care System, 385 Tremont Ave. Mail Stop 129, 11th Floor, East Orange, NJ, 07018, USA; Department of Educational and Counseling Psychology, University at Albany, State University of New York, NY, USA
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14
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Radhakrishnan K, Hauser ER, Polimanti R, Helmer DA, Provenzale D, McNeil RB, Maffucci A, Quaden R, Zhao H, Whitbourne SB, Harrington KM, Vahey J, Gelernter J, Levey DF, Huang GD, Gaziano JM, Concato J, Aslan M. Genomics of Gulf War Illness in U.S. Veterans Who Served during the 1990-1991 Persian Gulf War: Methods and Rationale for Veterans Affairs Cooperative Study #2006. Brain Sci 2021; 11:brainsci11070845. [PMID: 34202057 PMCID: PMC8301942 DOI: 10.3390/brainsci11070845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Approximately 697,000 members of the U.S. Armed Forces were deployed to the Persian Gulf in support of the 1990–1991 Persian Gulf War (GW). Subsequently, many deployed and some non-deployed veterans developed a chronic multi-symptom illness, now named Gulf War Illness (GWI). This manuscript outlines the methods and rationale for studying the genomics of GWI within the Million Veteran Program (MVP), a VA-based national research program that has linked medical records, surveys, and genomic data, enabling genome-wide association studies (GWASs). Methods: MVP participants who served in the military during the GW era were contacted by mail and invited to participate in the GWI study. A structured health questionnaire, based on a previously tested instrument, was also included in the mailing. Data on deployment locations and exposures, symptoms associated with GWI, clinical diagnoses, personal habits, and health care utilization were collected. Self-reported data will be augmented with chart reviews and structured international classification of disease codes, to classify participants by GWI case status. We will develop a phenotyping algorithm, based on two commonly used case definitions, to determine GWI status, and then conduct a nested case-control GWAS. Genetic variants associated with GWI will be investigated, and gene–gene and gene–environment interactions studied. The genetic overlap of GWI with, and causative mechanisms linking this illness to, other health conditions and the effects of genomic regulatory mechanisms on GWI risk will also be explored. Conclusions: The proposed initial GWAS described in this report will investigate the genomic underpinnings of GWI with a large sample size and state-of-the-art genomic analyses and phenotyping. The data generated will provide a rich and expansive foundation on which to build additional analyses.
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Affiliation(s)
- Krishnan Radhakrishnan
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA;
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Renato Polimanti
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Rebecca B. McNeil
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
| | - Alysia Maffucci
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
| | - Hongyu Zhao
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jacqueline Vahey
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Computational Biology and Bioinformatics Program, Duke University, Durham, NC 27705, USA
| | - Joel Gelernter
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Daniel F. Levey
- Division of Human Genetics, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06511, USA;
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT 06516, USA
| | - Grant D. Huang
- Cooperative Studies Program, VA Office of Research and Development, Washington, DC 20420, USA;
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - John Concato
- School of Medicine, Yale University, New Haven, CT 06511, USA;
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
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15
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Ribeiro ACR, Deshpande LS. A review of pre-clinical models for Gulf War Illness. Pharmacol Ther 2021; 228:107936. [PMID: 34171340 DOI: 10.1016/j.pharmthera.2021.107936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 02/08/2023]
Abstract
Gulf War Illness (GWI) is a chronic multisymptomatic disorder that afflicts over 1/3rd of the 1991 GW veterans. It spans multiple bodily systems and presents itself as a syndrome exhibiting diverse symptoms including fatigue, depression, mood, and memory and concentration deficits, musculoskeletal pain and gastrointestinal distress in GW veterans. The etiology of GWI is complex and many factors, including chemical, physiological, and environmental stressors present in the GW arena, have been implicated for its development. It has been over 30 years since the end of the GW but, GWI has been persistent in suffering veterans who are also dealing with paucity of effective treatments. The multifactorial aspect of GWI along with genetic heterogeneity and lack of available data surrounding war-time exposures have proved to be challenging in developing pre-clinical models of GWI. Despite this, over a dozen GWI animal models exist in the literature. In this article, following a brief discussion of GW history, GWI definitions, and probable causes for its pathogenesis, we will expand upon various experimental models used in GWI laboratory research. These animal models will be discussed in the context of their attempts at mimicking GW-related exposures with regards to the variations in chemical combinations, doses, and frequency of exposures. We will discuss their advantages and limitations in modeling GWI followed by a discussion of behavioral and molecular findings in these models. The mechanistic data obtained from these preclinical studies have offered multiple molecular pathways including chronic inflammation, mitochondrial dysfunction, oxidative stress, lipid disturbances, calcium homeostatic alterations, changes in gut microbiota, and epigenetic modifications, amongst others for explaining GWI development and its persistence. Finally, these findings have also informed us on novel druggable targets in GWI. While, it has been difficult to conceive a single pre-clinical model that could express all the GWI signs and exhibit biological complexity reflective of the clinical presentation in GWI, animal models have been critical for identifying molecular underpinnings of GWI and evaluating treatment strategies for GWI.
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Affiliation(s)
- Ana C R Ribeiro
- Departments of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Laxmikant S Deshpande
- Departments of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; Departments of Pharmacology and Toxicology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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16
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Chatterjee S, Bose D, Seth R. Host gut microbiome and potential therapeutics in Gulf War Illness: A short review. Life Sci 2021; 280:119717. [PMID: 34139232 DOI: 10.1016/j.lfs.2021.119717] [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: 01/08/2021] [Revised: 05/22/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
AIMS Since our troops had returned from the first Persian Gulf War in 1990-91, the veterans have reported chronic multisymptomatic illness widely referred to as Gulf War Illness (GWI). We aim to review the current directions of GWI pathology research in the context of chronic multisymptomatic illness and its possible gut microbiome targeted therapies. The veterans of Gulf War show symptoms of chronic fatigue, cognitive deficits, and a subsection report of gastrointestinal complications. METHOD Efforts of finding a suitable treatment regimen and clinical management remain a challenge. More recently, we have shown that the pathology is connected to alterations in the gut microbiome, and efforts of finding a suitable regimen for gut-directed therapeutics are underway. We discuss the various clinical interventions and summarize the possible effectiveness of gut-directed therapies such as the use of short-chain fatty acids (SCFA), phenolic compounds, and their metabolites, use of probiotics, and fecal microbiota transfer. SIGNIFICANCE The short review will be helpful to GWI researchers to expand their studies to the gut and find an effective treatment strategy for chronic multisymptomatic illness.
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Affiliation(s)
- Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; Columbia VA Medical Center, Columbia, SC 29205, USA.
| | - Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; Columbia VA Medical Center, Columbia, SC 29205, USA
| | - Ratanesh Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, University of South Carolina, Columbia, SC 29208, USA; Columbia VA Medical Center, Columbia, SC 29205, USA
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17
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Obesity Worsens Gulf War Illness Symptom Persistence Pathology by Linking Altered Gut Microbiome Species to Long-Term Gastrointestinal, Hepatic, and Neuronal Inflammation in a Mouse Model. Nutrients 2020; 12:nu12092764. [PMID: 32927823 PMCID: PMC7551189 DOI: 10.3390/nu12092764] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 12/18/2022] Open
Abstract
Persistence of Gulf War illness (GWI) pathology among deployed veterans is a clinical challenge even after almost three decades. Recent studies show a higher prevalence of obesity and metabolic disturbances among Gulf War veterans primarily due to the existence of post-traumatic stress disorder (PTSD), chronic fatigue, sedentary lifestyle, and consumption of a high-carbohydrate/high-fat diet. We test the hypothesis that obesity from a Western-style diet alters host gut microbial species and worsens gastrointestinal and neuroinflammatory symptom persistence. We used a 5 month Western diet feeding in mice that received prior Gulf War (GW) chemical exposure to mimic the home phase obese phenotype of the deployed GW veterans. The host microbial profile in the Western diet-fed GWI mice showed a significant decrease in butyrogenic and immune health-restoring bacteria. The altered microbiome was associated with increased levels of IL6 in the serum, Claudin-2, IL6, and IL1β in the distal intestine with concurrent inflammatory lesions in the liver and hyperinsulinemia. Microbial dysbiosis was also associated with frontal cortex levels of increased IL6 and IL1β, activated microglia, decreased levels of brain derived neurotrophic factor (BDNF), and higher accumulation of phosphorylated Tau, an indicator of neuroinflammation-led increased risk of cognitive deficiencies. Mechanistically, serum from Western diet-fed mice with GWI significantly increased microglial activation in transformed microglial cells, increased tyrosyl radicals, and secreted IL6. Collectively, the results suggest that an existing obese phenotype in GWI worsens persistent gastrointestinal and neuronal inflammation, which may contribute to poor outcomes in restoring cognitive function and resolving fatigue, leading to the deterioration of quality of life.
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18
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Yee MK, Zundel CG, Maule AL, Heeren T, Proctor SP, Sullivan KA, Krengel MH. Longitudinal Assessment of Health Symptoms in Relation to Neurotoxicant Exposures in 1991 Gulf War Veterans: The Ft. Devens Cohort. J Occup Environ Med 2020; 62:663-668. [PMID: 32890202 PMCID: PMC7478220 DOI: 10.1097/jom.0000000000001910] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This analysis examined the relationship between Gulf War (GW) exposures and health symptoms reported in three time periods over 20 years in Ft. Devens Cohort veterans. METHODS Repeated logistic regression models examined the association of exposures and health symptoms over time. Models included baseline age, active duty status, post-traumatic stress disorder status, sex, and time since deployment as covariates. RESULTS Exposure to tent heaters was associated with increased odds of crying easily and muscle twitching. Exposure to pyridostigmine bromide (PB) pills was associated with increased odds of depression and fatigue. Exposure to the Khamisiyah sarin plume was associated with increased odds of trouble concentrating and crying easily. CONCLUSION This longitudinal analysis demonstrated an association between neurotoxicant exposures and increased odds of cognitive/mood, fatigue, and neurological symptoms. In addition, most symptoms increased over time since deployment regardless of exposure.
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Affiliation(s)
- Megan K Yee
- Research Service, VA Boston Healthcare System, Boston, Massachusetts (Yee, Zundel, Dr Proctor, Dr Krengel); Behavioral Neuroscience Program, Boston University School of Medicine, Boston, Massachusetts (Zundel); Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts (Drs Maule, Sullivan); Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts (Drs Maule, Proctor); Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts (Dr Heeren); and Department of Neurology, Boston University School of Medicine, Boston, Massachusetts (Dr Krengel)
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19
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Zundel CG, Heeren T, Grasso CM, Spiro A, Proctor SP, Sullivan K, Krengel M. Changes in Health Status in the Ft. Devens Gulf War Veterans Cohort: 1997-2017. Neurosci Insights 2020; 15:2633105520952675. [PMID: 32914090 PMCID: PMC7444112 DOI: 10.1177/2633105520952675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022] Open
Abstract
Gulf War veterans (GWVs) were exposed to numerous neurotoxicants during deployment. Upon returning home, many reported a multitude of symptoms including fatigue, pain, gastrointestinal and respiratory issues, and neurological, cognitive, and mood complaints, collectively termed "Gulf War Illness (GWI)." Now, nearly 30 years post-war, many GWVs continue to suffer from these symptoms, in addition to health concerns associated with normal aging. While most research on GWVs has been cross-sectional, it is important to evaluate the progression and onset of new GWI symptoms longitudinally. The current study investigated the health of GWVs 25+ years after the war by resurveying the Ft. Devens Cohort and comparing their current health to their health reported 15 to 20 years earlier. The sample consists of 317 GWVs (~54 years old at the latest survey, 38 women) who responded to both surveys (1997-1998 and 2013-2017). Multivariable regression analyses were used to assess changes in GWI symptomatology and prevalence of medical conditions. The rates of 12 of 25 health symptoms increased significantly from the prior 1997-1998 survey. Anxiety, numbness in extremities, depressed mood, and joint pain had the greatest increase in endorsement. The rates of 7 of 16 medical conditions increased significantly from the prior 1997-1998 survey. High blood pressure, diabetes, and cancer had the greatest increase in prevalence. In summary, this study demonstrates that both symptoms and physician-diagnosed medical conditions associated with GW deployment/exposure increased in prevalence. For GWVs, focus by providers on the treatment of cognitive and mental health issues as well as cardiovascular and cerebrovascular risk factors is warranted. Targeting symptom alleviation would help improve the quality of life in these veterans until treatments addressing the entire illness become available.
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Affiliation(s)
- Clara G Zundel
- Research Service, VA Boston Healthcare System, Boston, MA, USA
- Behavioral Neuroscience Program, Boston University School of Medicine, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | | | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Susan P Proctor
- Research Service, VA Boston Healthcare System, Boston, MA, USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Maxine Krengel
- Research Service, VA Boston Healthcare System, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
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20
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Gowinnage SS, Arambepola C. Quality of life and its determinants among community re-integrated soldiers with permanent disabilities following traumatic limb injuries. Qual Life Res 2020; 29:2119-2127. [PMID: 32222929 DOI: 10.1007/s11136-020-02473-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess health-related-quality of life (HRQOL) after the end of war and its associated factors among soldiers with permanent limb disabilities in Sri Lanka METHODS: A cross-sectional study was conducted among 500 rehabilitated and socially re-integrated Army soldiers having permanent disability following traumatic limb injuries during the last year of ethnic conflict of Sri Lanka. Females, soldiers with no updated data, and soldiers having permanent deafness/total blindness/total brain or spinal cord injury were excluded. The sample was randomly selected from updated 'Disabled Category Registries'. Personal and injury data were collected through postal questionnaire. HRQOL was assessed using SF-36 tool validated for Sri Lankan soldiers. RESULTS SF-36 scores obtained on HRQOL related to overall physical health (mean = 57.1; SD = 19) and mental health (mean = 58.8; SD = 17.2) were comparable. HRQOL was best in social functioning (mean = 73.4; SD = 24) and worst in vitality (mean = 48.4; SD = 15.5). Factors significantly associated with better HRQOL related to the overall physical and mental health were aged over 35 years, being married, being assigned duties, having only upper/lower limbs affected and absence of co-disability. Having duties assigned demonstrated better QOL in almost all domains. None were associated with income or education. CONCLUSIONS Physical and mental health components contribute equally to the HRQOL of rehabilitated soldiers with permanent limb disabilty. Their poorer HRQOL was determined by certain person- and injury-related factors. These need to be addressed during re-integration and post-rehabilitation services.
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Affiliation(s)
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka.
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Lindheimer JB, Stegner AJ, Wylie GR, Klein-Adams JC, Almassi NE, Ninneman JV, Van Riper SM, Dougherty RJ, Falvo MJ, Cook DB. Post-exertional malaise in veterans with gulf war illness. Int J Psychophysiol 2020; 147:202-212. [PMID: 31786249 PMCID: PMC6957714 DOI: 10.1016/j.ijpsycho.2019.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/07/2019] [Accepted: 11/11/2019] [Indexed: 12/31/2022]
Abstract
Post-exertional malaise (PEM) is a potentially debilitating aspect of Gulf War Illness (GWI) that has received limited research attention. The purpose of the present investigation was to determine symptom severity changes following exercise in Veterans with GWI compared to control Veterans without GWI (CO). Sixty-seven Veterans (n = 39 GWI; n = 28 CO) underwent a 30-minute submaximal exercise challenge at 70% of heart rate reserve. Symptom measurements (e.g. fatigue, pain) occurred pre-, immediately post-, and 24-hour post-exercise. Self-reported physical and mental health, and physiological and perceptual responses to exercise were compared between groups using descriptive statistics, independent samples t-tests and repeated measures Analysis of Variance (RM-ANOVA). Post-exertional malaise was modeled using Group by Time (2 × 3) doubly-multivariate, RM-MANOVAs for (1) mood, (2) pain and (3) GWI-related symptoms, respectively (α = 0.05). Data were analyzed for the full sample of Veterans with GWI (n = 39) compared to CO (n = 28) and a subsample of Veterans (n = 18) who endorsed "feeling unwell after physical exercise or exertion" ("PEM endorsers") during screening. Veterans with GWI reported significantly lower physical and mental health. Groups exercised at similar relative exercise intensities, but GWI perceived exercise as more painful and fatiguing. Group-by-Time interactions were not significant for the entire sample for the three PEM models, however limiting the GWI sample to "PEM endorsers" resulted in significant interactions for Pain- and GWI-related PEM models. These results indicate that not all GVs with GWI experience PEM 24 h after exercise, and that more research is needed to determine the extent that exercise worsens symptoms in GWI.
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Affiliation(s)
- Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Glenn R Wylie
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ 07018, United States of America; Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, United States of America; New Jersey Medical School, Rutgers Biomedical and Health Sciences, 185 S Orange Ave, Newark, NJ 07103, United States of America
| | - Jacquelyn C Klein-Adams
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ 07018, United States of America
| | - Neda E Almassi
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Jacob V Ninneman
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Stephanie M Van Riper
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Ryan J Dougherty
- Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America
| | - Michael J Falvo
- War Related Illness and Injury Study Center, Department of Veterans Affairs New Jersey Health Care System, 385 Tremont Ave, East Orange, NJ 07018, United States of America; New Jersey Medical School, Rutgers Biomedical and Health Sciences, 185 S Orange Ave, Newark, NJ 07103, United States of America
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, United States of America; Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Dr, Madison, WI 53706, United States of America.
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22
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Prevalence of Chronic Multisymptom Illness/Gulf War Illness Over Time Among Millennium Cohort Participants, 2001 to 2016. J Occup Environ Med 2020; 62:4-10. [DOI: 10.1097/jom.0000000000001716] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Macht V, Woodruff J, Burzynski H, Grillo C, Reagan L, Fadel J. Interactions between pyridostigmine bromide and stress on glutamatergic neurochemistry: Insights from a rat model of Gulf War Illness. Neurobiol Stress 2019; 12:100210. [PMID: 32258255 PMCID: PMC7109514 DOI: 10.1016/j.ynstr.2019.100210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/15/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022] Open
Abstract
Pyridostigmine bromide (PB) was administered to soldiers during the first Gulf War as a prophylactic treatment to protect against toxicity in the event of exposure to nerve agents. Although originally thought to pose minimal risk to soldiers, epidemiological studies have since correlated PB administration with the development of a variety of symptoms, including cognitive dysfunction, termed Gulf War Illness (GWI). We previously demonstrated in a rodent model of GWI that central cholinergic responses were altered to various stimuli. In the current study we used in vivo microdialysis to examine how combinations of PB and repeated restraint stress (RRS) altered extracellular glutamate levels in response to an innate immune challenge (lipopolysaccharide; LPS) and an immobilization stress challenge in the prefrontal cortex (PFC) and hippocampus. There were four groups in this study: vehicle non-stressed control (Veh-NSC), vehicle-stressed (Veh-RRS), PB-NSC, and PB-RRS. While LPS decreased glutamate levels in PB-treated rats relative to vehicle-treated rats in the PFC, PB and stress interacted to attenuate LPS-induced decreases in hippocampal glutamate levels. Although immobilization stress increased glutamate in the PFC, glutamate levels in PB-NSC rats failed to recover in the post-stress period relative to vehicle-treated rats. In the hippocampus, PB-stressed rats failed to exhibit habituation of the glutamate response to immobilization stress relative to vehicle-stressed rats. Collectively, these results indicate that PB and stress interacted to produce brain-region specific effects on glutamate neurochemistry, providing insight into the potential mechanisms underlying interactions between the immune system and persistent cognitive dysfunction in veterans with GWI.
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Affiliation(s)
- V.A. Macht
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, 29208, USA
| | - J.L. Woodruff
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, 29208, USA
| | - H.E. Burzynski
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA
| | - C.A. Grillo
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, 29208, USA
| | - L.P. Reagan
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, 29208, USA
| | - J.R. Fadel
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC, 29208, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, 29208, USA
- Corresponding author. Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, 6439 Garners Ferry Road, D11, Columbia, SC, 29208, USA.
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Keating JA, Shaughnessy C, Baubie K, Kates AE, Putman-Buehler N, Watson L, Dominguez N, Watson K, Cook DB, Rabago D, Suen G, Gangnon R, Safdar N. Characterising the gut microbiome in veterans with Gulf War Illness: a protocol for a longitudinal, prospective cohort study. BMJ Open 2019; 9:e031114. [PMID: 31431446 PMCID: PMC6707676 DOI: 10.1136/bmjopen-2019-031114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Approximately 25%-35% of the 1991 Gulf War Veteran population report symptoms consistent with Gulf War Illness (GWI), a chronic, multi-symptom illness characterised by fatigue, pain, irritable bowel syndrome and problems with cognitive function. GWI is a disabling problem for Gulf War Veterans, and there remains a critical need to identify innovative, novel therapies.Gut microbiota perturbation plays a key role in the symptomatology of other chronic multi-symptom illnesses, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Given similarities between ME/CFS and GWI and the presence of gastrointestinal disorders in GWI patients, Veterans with GWI may also have gut abnormalities like those seen with ME/CFS. In this longitudinal cohort study, we are comparing the diversity (structure) and the metagenomes (function) of the gut microbiome between Gulf War Veterans with and without GWI. If we find differences in Veterans with GWI, the microbiome could be a target for therapeutic intervention to alleviate GWI symptoms. METHODS AND ANALYSIS Participants answer questions about diet, exercise and lifestyle factors. Participants also complete a questionnaire (based on the Kansas case definition of GWI) regarding their medical history and symptoms; we use this questionnaire to group participants into GWI versus healthy control cohorts. We plan to enrol 52 deployed Gulf War Veterans: 26 with GWI and 26 healthy controls. Participants provide stool and saliva samples weekly for an 8-week period for microbiome analyses. Participants also provide blood samples at the beginning and end of this period, which we will use to compare measures of inflammation markers between the groups. ETHICS AND DISSEMINATION The protocol was approved by the University of Wisconsin-Madison Health Sciences Institutional Review Board and the William S. Middleton Memorial Veterans Hospital Research and Development Committee. Results of this study will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Julie A Keating
- Research, William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Catherine Shaughnessy
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Kelsey Baubie
- Research, William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Ashley E Kates
- Research, William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Nathan Putman-Buehler
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Lauren Watson
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Nadia Dominguez
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Kal Watson
- Research, William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Dane B Cook
- Research, William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
- Department of Kinesiology, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - David Rabago
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Garret Suen
- Department of Bacteriology, College of Agricultural and Life Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Nasia Safdar
- Research, William S Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
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Pruitt LD, Smolenski DJ, Bush NE, Tucker J, Issa F, Hoyt TV, Reger MA. Suicide in the Military: Understanding Rates and Risk Factors Across the United States’ Armed Forces. Mil Med 2019; 184:432-437. [PMID: 30423136 DOI: 10.1093/milmed/usy296] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/04/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
This paper presents data from the United States Department of Defense Suicide Event Report System for years 2012–2015 to detail descriptive, longitudinal rate data and risk factor profiles associated with military suicide. The annual findings were aggregated from all U.S. military suicide deaths and suicide attempts. Data elements included the most common method of suicide (firearms), most common behavioral health diagnoses (substance abuse/dependence), common life stressors (failed intimate–partner relationships), and an individual’s history of operational deployment. Age- and sex-adjusted rates for the Services were compared with rates for the U.S. adult population. Results showed that the current reporting period (2015) is similar to patterns that have been observed over the preceding years and to patterns reported in the overall U.S. adult population. Suicide rates remain elevated but stable for both the Active and Reserve Components of the Military Services compared to historical levels observed prior to 2003. Finally, we discuss common errors and misinterpretations that can occur when analyzing surveillance data.
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Affiliation(s)
- Larry D Pruitt
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Nigel E Bush
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Jennifer Tucker
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Fuad Issa
- Psychological Health Center of Excellence, Defense Health Agency (J-9), 1335 East-West Hwy Suite 900, Silver Spring, MD
| | - Timothy V Hoyt
- Connected Health Branch, Defense Health Agency (J-3), 9933 West Hayes Street, Box 339500 MS 34, Joint Base Lewis-McChord, WA
| | - Mark A Reger
- VA Puget Sound Health Care System, Tacoma, Washington, 9600 Veterans Dr (A-116), Tacoma, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA
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Zundel CG, Krengel MH, Heeren T, Yee MK, Grasso CM, Janulewicz Lloyd PA, Coughlin SS, Sullivan K. Rates of Chronic Medical Conditions in 1991 Gulf War Veterans Compared to the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060949. [PMID: 30884809 PMCID: PMC6466358 DOI: 10.3390/ijerph16060949] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/16/2022]
Abstract
Prevalence of nine chronic medical conditions in the population-based Ft. Devens Cohort (FDC) of GW veterans were compared with the population-based 2013–2014 National Health and Nutrition Examination Survey (NHANES) cohort. Excess prevalence was calculated as the difference in prevalence estimates from the Ft. Devens and NHANES cohorts; and confidence intervals and p-values are based on the standard errors for the two prevalence estimates. FDC males were at increased risk for reporting seven chronic medical conditions compared with NHANES males. FDC females were at decreased risk for high blood pressure and increased risk for diabetes when compared with NHANES females. FDC veterans reporting war-related chemical weapons exposure showed higher risk of high blood pressure; diabetes; arthritis and chronic bronchitis while those reporting taking anti-nerve gas pills had increased risk of heart attack and diabetes. GW veterans are at higher risk of chronic conditions than the general population and these risks are associated with self-reported toxicant exposures.
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Affiliation(s)
- Clara G Zundel
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
- Division of Graduate Medical Sciences, Behavioral Neuroscience, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Maxine H Krengel
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA.
| | - Megan K Yee
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
| | - Claudia M Grasso
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA.
| | | | - Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912, USA.
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA.
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Inhibition of microRNA-124-3p as a novel therapeutic strategy for the treatment of Gulf War Illness: Evaluation in a rat model. Neurotoxicology 2018; 71:16-30. [PMID: 30503814 DOI: 10.1016/j.neuro.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/01/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022]
Abstract
Gulf War Illness (GWI) is a chronic, multisymptom illness that continues to affect up to 30% of veterans deployed to the Persian Gulf during the 1990-1991 Gulf War. After nearly 30 years, useful treatments for GWI are lacking and underlying cellular and molecular mechanisms involved in its pathobiology remain poorly understood, although exposures to pyridostigmine bromide (PB) and pesticides are consistently identified to be among the strongest risk factors. Alleviation of the broad range of symptoms manifested in GWI, which involve the central nervous system, the neuroendocrine system, and the immune system likely requires therapies that are able to activate and inactivate a large set of orchestrated genes. Previous work in our laboratory using an established rat model of GWI identified persistent elevation of microRNA-124-3p (miR-124) levels in the hippocampus whose numerous gene targets are involved in cognition-associated pathways and neuroendocrine function. This study aimed to investigate the broad effects of miR-124 inhibition in the brain 9 months after completion of a 28-day exposure regimen of PB, DEET (N,N-diethyl-3-methylbenzamide), permethrin, and mild stress by profiling the hippocampal expression of genes known to play a critical role in synaptic plasticity, glucocorticoid signaling, and neurogenesis. We determined that intracerebroventricular infusion of a miR-124 antisense oligonucleotide (miR-124 inhibitor; 0.05-0.5 nmol/day/28 days), but not a negative control oligonucleotide, into the lateral ventricle of the brain caused increased protein expression of multiple validated miR-124 targets and increased expression of downstream target genes important for cognition and neuroendocrine signaling in the hippocampus. Off-target cardiotoxic effects were revealed in GWI rats receiving 0.1 nmol/day as indicated by the detection in plasma of 5 highly elevated protein cardiac injury markers and 6 upregulated cardiac-enriched miRNAs in plasma exosomes determined by next-generation sequencing. Results from this study suggest that in vivo inhibition of miR-124 function in the hippocampus is a promising, novel therapeutic approach to improve cognition and neuroendocrine dysfunction in GWI. Additional preclinical studies in animal models to assess feasibility and safety by developing a practical, noninvasive drug delivery system to the brain and exploring potential adverse toxicologic effects of miR-124 inhibition are warranted.
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Bøg M, Filges T, Jørgensen AMK. Deployment of personnel to military operations: impact on mental health and social functioning. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-127. [PMID: 37131363 PMCID: PMC8427986 DOI: 10.4073/csr.2018.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This Campbell systematic review examines the effects of deployment on mental health. The review summarizes evidence from 185 studies. All studies used observational data to quantify the effect of deployment. This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment). Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. Plain language summary Deployment to military operations negatively affects the mental health functioning of deployed military personnel: While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel.What is this review about?: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health.The primary condition under consideration is deployment to an international military operation. Deployment to a military operation is not a uniform condition; rather, it covers a range of scenarios. Military deployment is defined as performing military service in an operation at a location outside the home country for a limited time period, pursuant to orders.The review included studies that reported outcomes for individuals who had been deployed. This review looked at the effect of deployment on mental health outcomes. The mental health outcomes are: post-traumatic stress disorder (PTSD), major depressive disorder (MDD), common mental disorders (depression, anxiety and somatisation disorders) and substance-related disorders.By identifying the major effects of deployment on mental health and quantifying these effects, the review can inform policy development on deployment and military activity as well as post-deployment support for veterans. In this way the review enables decision-makers to prioritise key areas.What are the main findings of this review?: What studies are included?: This review includes studies that evaluate the effects of deployment on mental health. A total of 185 studies were identified. However, only 40 of these were assessed to be of sufficient methodological quality to be included in the final analysis. The studies spanned the period from 1993 to 2017 and were mostly carried out in the USA, UK and Australia. The studies all had some important methodological weaknesses. None of the included studies used experimental designs (random assignment).Does deployment have an effect on mental health?: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all mental health domains (PTSD, depression, substance abuse/dependence, and common mental disorders), particularly on PTSD. For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive.What do the findings of this review mean?: The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long-lasting.Overall the risk of bias in the majority of included studies was high. While it is difficult to imagine a randomised study design to understand how deployment affects mental health, other matters such as changes to personnel policy, or unanticipated shocks to the demand for military personnel, could potentially be a rich source of quasi-experimental variation.How up-to-date is this review?: The review authors searched for studies up to 2017. This Campbell systematic review was published in March 2018. Executive summary BACKGROUND: When military personnel are deployed to military operations abroad they face an increased risk of physical harm, and an increased risk of adverse shocks to their mental health. Research suggests that the increased risk to mental health is mainly due to the hazards of war, combat exposure: firing weapons, road side bombs, seeing fellow soldiers, friends, civilians, and enemies being injured, maimed or killed. These experiences may lead to severe mental stress. The adverse impact on mental health is the psychological cost of war, and it is of interest to policymakers to learn the magnitude of these effects. This review sets out to synthesise available evidence about the consequences of deployment for deployed military personnel in the mental health and social functioning domains.OBJECTIVES: The objective of this review isto synthesise the consequences of deployment to military operation on the mental health and social functioning of deployed military personnel.SEARCH METHODS: We searched electronic databases, grey literature, and references from primary studies and related reviews. No language or date restrictions were applied to the searches. We searched the following electronic databases: Academic Search Elite, Cochrane Library, EMBASE, ERIC, MEDLINE, PsycINFO, Science Citation Index, Social Science Citation Index, SocINDEX, as well as the Nordic platforms: bibliotek.dk, BIBSYS, and LIBRIS. The conclusions of this review are based on the most recent searches performed. The last search was performed in April 2017.SELECTION CRITERIA: Primary studies had to meet the following inclusion criteria: Participants: The participants should be military personnel.Intervention: The condition should be deployment to a military operation.Comparison: The relevant comparisons were either comparing a) deployed military personnel to non-deployed military personnel, b) deployed military personnel to military personnel deployed elsewhere, for example personnel deployed to non-combat operations, c) military personnel deployed to the same operation but stratified by combat exposure.Outcomes: The study should report on one or more mental health outcomes, and/or social functioning for the deployed participants. In particular studies should report on one or more of the following mental health outcomes: PTSD, major depression, substance abuse or dependence (including alcohol), and common mental disorders (depression and anxiety disorders). The following social functioning outcomes were relevant: employment, and homelessness.Study Designs: Both experimental and quasi-experimental designs with a comparison group were eligible for inclusion in the review. Studies were excluded if they: Reported on deployments taking place before 1989.Used a within group pre-post study design.Did not report on at least one of the mental health or social functioning outcomes. DATA COLLECTION AND ANALYSIS: The total number of potentially relevant studies constituted31,049records. A total of 185 studies met the inclusion criteria and were critically appraised by the review authors. The final selection of 185 studies was from 13 different countries.Forty eight of the 185 studies did not report effect estimates or provide data that would allow the calculation of an effect size and standard error. Fifty four studies were excluded because of overlapping samples. The majority of those studies were from USA but the main reason for not using studies from USA in the synthesis was lack of information to calculate an effect size. Nearly half the studies from the UK could not be used in the synthesis due to overlap of data samples. Forty three studies were judged to have a very high risk of bias (5 on the scale) and, in accordance with the protocol, we excluded these from the data synthesis on the basis that they would be more likely to mislead than inform., Thus a total of 40 studies, from five different countries, were included in the data synthesis.Random effects models were used to pool data across the studies. We used the odds ratio. Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were calculated. The meta-analyses were carried out by time since exposure (short, medium, long, and other time since exposure) and by type of comparison (deployed versus non-deployed, all deployed but stratified by either combat operations versus non-combat operations, or stratified by combat exposure). We performed single factor subgroup analysis. The assessment of any difference between subgroups was based on 95% confidence intervals. Funnel plots were used to assess the possibility of publication bias. Sensitivity analysis was used to evaluate whether the pooled effect sizes were robust across components of methodological quality.MAIN RESULTS: The findings were mixed, depending on the outcome, the time since exposure and the approach (deployed versus non-deployed termed absolute or stratified by extent of combat termed relative) used to investigate the effect. It was not possible to analyse the outcomes homelessness and employment. All studies that could be used in the data synthesis reported on the impact of deployment on mental health; PTSD, depression, substance use or common mental disorder.For assessments taken less than 24 months since exposure the evidence was inconclusive either because too few studies reported results in the short and medium term and/or the degree of heterogeneity between studies was large.For assessments taken at other time points (a variable number of months since exposure) the evidence was inconclusive for the relative comparisons due to either too few studies or a substantial degree of heterogeneity between studies. For the absolute comparison the analysis of common mental disorder was inconclusive, whereas the average effects of PTSD and depression were positive and statistically significant (PTSD odds ratio (OR) was 1.91 (95% confidence interval (CI): 1.28 to 2.85) and OR=1.98 (95% CI: 1.05 to 3.70) for depression). The analysis concerning substance use indicated that deployed participants did not have higher odds of screening positive for substance use compared to non-deployed participants (OR=1.15 (95% CI: 0.98 to 1.36)).For assessments taken more than 24 months post exposure, meta-analyses indicated that the odds of screening positive for PTSD, depression, substance use and common mental disorder were higher for participants in the deployed group compared to participants in the group that were not deployed (PTSD OR=3.31 (95% CI: 2.69 to 4.07), OR=2.19 (95% CI: 1.58 to 3.03) for depression, OR=1.27 (95% CI: 1.15 to 1.39) for substance use, and OR=1.64 (95% CI: 1.38 to 1.96) for common mental disorder). Likewise, participants reporting high combat exposure had higher odds of screening positive for PTSD and depression than participants reporting lower exposure for long term assessments (PTSD OR=3.05 (95% CI: 1.94 to 4.80) and OR=1.81 (95% CI: 1.28 to 2.56) for depression). The analyses of substance use and common mental disorder were inconclusive due to too few studies.On the basis of the prevalence of mental health problems in pre-deployed or non-deployed population based comparison sampleswe would therefore expect the long term prevalence of PTSD in post-deployed samples to be in the range 6.1 - 14.9%, the long term prevalence of depression to be in the range from 7.6% to 18%, the long term prevalence of substance use to be in the range from 2.4% to 17.5% and the prevalence of common mental disorder to be in the range from 10% to 23%.Sensitivity analyses resulted in no appreciable change in effect size, suggesting that the results are robust.It was only possible to assess the impact of two types of personnel characteristics (branch of service and duty/enlistment status) on the mental health outcomes. We found no evidence to suggest that the effect of deployment on any outcomes differ between these two types of personnel characteristics.AUTHORS' CONCLUSIONS: Deployment to military operations negatively affects the mental health functioning of deployed military personnel. We focused on the effect of deployment on PTSD (post-traumatic stress disorder), depression, substance abuse/dependence, and common mental disorders (depression and anxiety disorders). For assessments taken less than 24 months (or a variable number of months since exposure) the evidence was less consistent and in many instances inconclusive. For assessments taken more than 24 months since exposure, we consistently found adverse effects of deployment on all domains, particularly on PTSD. There is increased political awareness of the need to address post deployment mental health problems. The odds of screening positive for PTSD and depression were consistently high in the longer term. This suggests that efforts should be increased to detect and treat mental disorders, as effects may be long lasting. Mental illness is of particular concern in the military for operational reasons, but they may be hard to detect in the military setting because a military career is intimately linked with mental and physical strength.It was not possible to examine a number of factors which we had reason to expect would impact on the magnitude of the effect. This would have been particularly relevant from a policy perspective because these are direct parameters that one could use to optimally "organize" deployment in order to minimize impacts on mental health functioning.While additional research is needed, the current evidence strongly supports the notion that deployment negatively affects mental health functioning of deployed military personnel. The next step is to begin to examine preventive measures and policies for organizing deployment, in order to minimize the effects on mental health.
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Leading causes of cardiovascular hospitalization in 8.45 million US veterans. PLoS One 2018; 13:e0193996. [PMID: 29566396 PMCID: PMC5864414 DOI: 10.1371/journal.pone.0193996] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/22/2018] [Indexed: 11/19/2022] Open
Abstract
Background We sought to determine the leading causes of cardiovascular (CV) hospitalization, and to describe and compare national rates of CV hospitalization by age, gender, race, ethnicity, region, and year, among U.S. veterans. Methods We evaluated the electronic health records of all veterans aged ≥18 years who had accessed any healthcare services at either a VA healthcare facility or a non-VA healthcare facility that was reimbursed by the VA, between January 1 2010 and December 31 2014. Among these 8,452,912 patients, we identified the 5 leading causes of CV hospitalization and compared rates of hospitalization by age, gender, race, ethnicity, region, year and type of VA healthcare user. Results The top 5 causes of CV hospitalization were: coronary atherosclerosis, heart failure, acute myocardial infarction, stroke and atrial fibrillation. Overall, 297,373 (3.5%) veterans were hospitalized for one or more of these cardiovascular conditions. The percentage of veterans hospitalized for one or more of these CV conditions decreased over time, from 1.23% in 2010 to 1.18% in 2013, followed by a slight increase to 1.20% in 2014. There was significant variation in rates of CV hospitalization by gender, race, ethnicity, geographic region, and urban vs. rural zip code. In particular, older, male, Black, non-Hispanic, urban and Continental region veterans experienced the highest rates of CV hospitalizations. Conclusions Among 8.5 million patients enrolled in the VA healthcare system from 2010 to 2014, there was substantial variation in rates of CV hospitalization by age, gender, race, geographical distribution, year, and use of non-VA (vs. VA only) healthcare care facilities.
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Maule AL, Janulewicz PA, Sullivan KA, Krengel MH, Yee MK, McClean M, White RF. Meta-analysis of self-reported health symptoms in 1990-1991 Gulf War and Gulf War-era veterans. BMJ Open 2018; 8:e016086. [PMID: 29440208 PMCID: PMC5829661 DOI: 10.1136/bmjopen-2017-016086] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Across diverse groups of Gulf War (GW) veterans, reports of musculoskeletal pain, cognitive dysfunction, unexplained fatigue, chronic diarrhoea, rashes and respiratory problems are common. GW illness is a condition resulting from GW service in veterans who report a combination of these symptoms. This study integrated the GW literature using meta-analytical methods to characterise the most frequently reported symptoms occurring among veterans who deployed to the 1990-1991 GW and to better understand the magnitude of ill health among GW-deployed veterans compared with non-deployed GW-era veterans. DESIGN Meta-analysis. METHODS Literature databases were searched for peer-reviewed studies published from January 1990 to May 2017 reporting health symptom frequencies in GW-deployed veterans and GW-era control veterans. Self-reported health symptom data were extracted from 21 published studies. A binomial-normal meta-analytical model was used to determine pooled prevalence of individual symptoms in GW-deployed veterans and GW-era control veterans and to calculate combined ORs of health symptoms comparing GW-deployed veterans and GW-era control veterans. RESULTS GW-deployed veterans had higher odds of reporting all 56 analysed symptoms compared with GW-era controls. Odds of reporting irritability (OR 3.21, 95% CI 2.28 to 4.52), feeling detached (OR 3.59, 95% CI 1.83 to 7.03), muscle weakness (OR 3.19, 95% CI 2.73 to 3.74), diarrhoea (OR 3.24, 95% CI 2.51 to 4.17) and rash (OR 3.18, 95% CI 2.47 to 4.09) were more than three times higher among GW-deployed veterans compared with GW-era controls. CONCLUSIONS The higher odds of reporting mood-cognition, fatigue, musculoskeletal, gastrointestinal and dermatological symptoms among GW-deployed veterans compared with GW-era controls indicates these symptoms are important when assessing GW veteran health status.
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Affiliation(s)
- Alexis L Maule
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Patricia A Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kimberly A Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Maxine H Krengel
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Research Service, VA Boston Health Care System, Boston, Massachusetts, USA
| | - Megan K Yee
- Research Service, VA Boston Health Care System, Boston, Massachusetts, USA
| | - Michael McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
Several studies have implicated immune system disruption in the pathophysiology of GWI. In addition, alterations in brain structure and functioning have been associated with specific exposures in theater, including pyridostigmine bromide and nerve gas agents. Recent studies conducted up to 25 years after the 1991 conflict have examined factors associated with the continuation or worsening of GWI. Drawing upon published studies of neural and immune system abnormalities in veterans with GWI, this paper proposes a model of GWI that takes into account neurologic and immunologic pathways, neuroimmune mechanisms of disease pathophysiology, individual predisposition due to sex and genetic background, and comorbid factors including neurological conditions such as neuritis/neuralgia and epilepsy that may occur along a continuum with GWI. The proposed neuroimmune model of GWI is likely to be useful for designing new research studies, clarifying factors involved in the continuation or worsening of GWI, and identifying biomarker screening algorithms for the illness. The proposed model goes beyond previously proposed frameworks for GWI by taking into account potential differences in risk based upon female vs. male sex, time elapsed since exposure to neurotoxicants, duration and severity of illness, comorbid conditions, and genotype.
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Affiliation(s)
- Steven S Coughlin
- Department of Clinical and Digital Health Sciences, Augusta University, Augusta, GA.,Research Service, Charlie Norwood VA Medical Center, Augusta, GA
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Abdullah L, Evans JE, Emmerich T, Crynen G, Shackleton B, Keegan AP, Luis C, Tai L, LaDu MJ, Mullan M, Crawford F, Bachmeier C. APOE ε4 specific imbalance of arachidonic acid and docosahexaenoic acid in serum phospholipids identifies individuals with preclinical Mild Cognitive Impairment/Alzheimer's Disease. Aging (Albany NY) 2017; 9:964-985. [PMID: 28333036 PMCID: PMC5391242 DOI: 10.18632/aging.101203] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/11/2017] [Indexed: 01/09/2023]
Abstract
This study was designed to explore the influence of apolipoprotein E (APOE) on blood phospholipids (PL) in predicting preclinical Alzheimer's disease (AD). Lipidomic analyses were also performed on blood from an AD mouse model expressing human APOE isoforms (EFAD) and five AD mutations and from 195 cognitively normal participants, 23 of who converted to mild cognitive impairment (MCI)/AD within 3 years. APOE ε4-carriers converting to MCI/AD had high arachidonic acid (AA)/docosahexaenoic acid (DHA) ratios in PL compared to cognitively normal ε4 and non-ε4 carriers. Arachidonic acid and DHA containing PL species, ε4-status and Aβ42/Aβ40 ratios provided 91% accuracy in detecting MCI/AD. Fish oil/omega-3 fatty acid consumption was associated with lower AA/DHA ratios even among ε4 carriers. High plasma AA/DHA ratios were observed in E4FAD compared to EFAD mice with other isoforms. In particular, alterations in plasma AA and DHA containing PL species were also observed in the brains of E4FAD mice compared to E3FAD mice. Despite the small sample size and a short follow-up, these results suggest that blood PL could potentially serve as biomarkers of preclinical MCI/AD.
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Affiliation(s)
| | | | | | | | | | | | | | - Leon Tai
- University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Mary J LaDu
- University of Illinois at Chicago, Chicago, IL 60607, USA
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Cerebral white matter structure is disrupted in Gulf War Veterans with chronic musculoskeletal pain. Pain 2017; 158:2364-2375. [DOI: 10.1097/j.pain.0000000000001038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Screening for novel central nervous system biomarkers in veterans with Gulf War Illness. Neurotoxicol Teratol 2017; 61:36-46. [DOI: 10.1016/j.ntt.2017.03.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
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Barth SK, Kang HK, Bullman T. All-Cause Mortality Among US Veterans of the Persian Gulf War: 13-Year Follow-up. Public Health Rep 2016; 131:822-830. [PMID: 28123229 DOI: 10.1177/0033354916676278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We determined cause-specific mortality prevalence and risks of Gulf War deployed and nondeployed veterans to determine if deployed veterans were at greater risk than nondeployed veterans for death overall or because of certain diseases or conditions up to 13 years after conflict subsided. METHODS Follow-up began when the veteran left the Gulf War theater or May 1, 1991, and ended on the date of death or December 31, 2004. We studied 621 901 veterans who served in the 1990-1991 Persian Gulf War and 746 247 veterans who served but were not deployed during the Gulf War. We used Cox proportional hazard models to calculate rate ratios adjusted for age at entry to follow-up, length of follow-up, race, sex, branch of service, and military unit. We compared the mortality of (1) Gulf War veterans with non-Gulf War veterans and (2) Gulf War army veterans potentially exposed to nerve agents at Khamisiyah in March 1991 with those not exposed. We compared standardized mortality ratios of deployed and nondeployed Gulf War veterans with the US population. RESULTS Male Gulf War veterans had a lower risk of mortality than male non-Gulf War veterans (adjusted rate ratio [aRR] = 0.97; 95% confidence interval [CI], 0.95-0.99), and female Gulf War veterans had a higher risk of mortality than female non-Gulf War veterans (aRR = 1.15; 95% CI, 1.03-1.28). Khamisiyah-exposed Gulf War army veterans had >3 times the risk of mortality from cirrhosis of the liver than nonexposed army Gulf War veterans (aRR = 3.73; 95% CI, 1.64-8.48). Compared with the US population, female Gulf War veterans had a 60% higher risk of suicide and male Gulf War veterans had a lower risk of suicide (standardized mortality ratio = 0.84; 95% CI, 0.80-0.88). CONCLUSION The vital status and mortality risk of Gulf War and non-Gulf War veterans should continue to be investigated.
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Affiliation(s)
- Shannon K Barth
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Han K Kang
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Tim Bullman
- Epidemiology Program, Post-Deployment Health Services, Office of Patient Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
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Self-Reported Traumatic Brain Injury, Health and Rate of Chronic Multisymptom Illness in Veterans From the 1990-1991 Gulf War. J Head Trauma Rehabil 2016; 31:320-8. [DOI: 10.1097/htr.0000000000000173] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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New Onset of Chronic Diseases and Changes in Lifestyle Risk Factors Among Gulf War Veterans. J Occup Environ Med 2016; 58:770-7. [DOI: 10.1097/jom.0000000000000799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pierce LM, Kurata WE, Matsumoto KW, Clark ME, Farmer DM. Long-term epigenetic alterations in a rat model of Gulf War Illness. Neurotoxicology 2016; 55:20-32. [DOI: 10.1016/j.neuro.2016.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 02/07/2023]
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Abstract
OBJECTIVE Migrant tobacco farmworkers experience regular occupational exposure to pesticides and nicotine. The present study was designed to determine whether there are differences in brain anatomy between Latino farmworkers and non-farmworkers. METHODS Magnetic resonance brain images were compared between farmworkers and non-farmworkers. In addition, blood cholinesterase activity and urinary cotinine levels were also used to identify associations with pesticide and nicotine exposure. RESULTS Farmworkers had greater gray matter signal in putamen and cerebellum, and lower gray matter signal in frontal and temporal lobes. Urinary cotinine was associated with the observed differences in brain anatomy, but blood cholinesterase activity was not. CONCLUSIONS Nicotine exposure was associated with neuroanatomical differences between Latino farmworkers and non-farmworkers. Future studies are needed to differentiate iron deposition from brain atrophy and to further assess the potential role of nicotine and pesticide exposure.
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Mindfulness-based Stress Reduction in Addition to Usual Care Is Associated with Improvements in Pain, Fatigue, and Cognitive Failures Among Veterans with Gulf War Illness. Am J Med 2016; 129:204-14. [PMID: 26519614 DOI: 10.1016/j.amjmed.2015.09.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Many Gulf War I veterans report ongoing negative health consequences. The constellation of pain, fatigue, and concentration/memory disturbances is referred to as "Gulf War illness." Prior research suggests that mindfulness-based stress reduction may be beneficial for these symptoms, but mindfulness-based stress reduction has not been studied for veterans with Gulf War illness. The objective of this trial was to conduct a pilot study of mindfulness-based stress reduction for veterans with Gulf War illness. METHODS Veterans (N = 55) with Gulf War illness were randomly assigned to treatment as usual plus mindfulness-based stress reduction or treatment as usual only. Mindfulness-based stress reduction was delivered in 8 weekly 2.5-hour sessions plus a single 7-hour weekend session. Pain, fatigue, and cognitive failures were the primary outcomes, assessed at baseline, after mindfulness-based stress reduction, and 6 months follow-up. Secondary outcomes included symptoms of posttraumatic stress disorder and depression. RESULTS In intention-to-treat analyses, at 6-month follow-up, veterans randomized to mindfulness-based stress reduction plus treatment as usual reported greater reductions in pain (f = 0.33; P = .049), fatigue (f = 0.32; P = .027), and cognitive failures (f = 0.40; P < .001). Depressive symptoms showed a greater decline after mindfulness-based stress reduction (f = 0.22; P = .050) and at 6 months (f = 0.27; P = .031) relative to treatment as usual only. Veterans with posttraumatic stress disorder at baseline randomized to mindfulness-based stress reduction plus treatment as usual experienced significantly greater reductions in symptoms of posttraumatic stress disorder after mindfulness-based stress reduction (f = 0.44; P = .005) but not at 6 months follow-up (f = 0.31; P = .082). CONCLUSIONS Mindfulness-based stress reduction in addition to treatment as usual is associated with significant improvements in self-reported symptoms of Gulf War illness, including pain, fatigue, cognitive failures, and depression.
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Golier JA, Caramanica K, Michaelides AC, Makotkine I, Schmeidler J, Harvey PD, Yehuda R. A randomized, double-blind, placebo-controlled, crossover trial of mifepristone in Gulf War veterans with chronic multisymptom illness. Psychoneuroendocrinology 2016; 64:22-30. [PMID: 26600007 DOI: 10.1016/j.psyneuen.2015.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 01/21/2023]
Abstract
No pharmacological treatments have been demonstrated to effectively treat chronic multisymptom illness (CMI) in Gulf War veterans (GWV). This study assessed the effect of the glucocorticoid receptor antagonist mifepristone in GWV with CMI. A randomized, double-blind, cross-over trial of mifepristone, with two six-week treatment phases separated by a one-month washout period, was conducted at a Veterans Affairs (VA) hospital between 2008 and 2011. Participants were randomized to receive either 200mg of mifepristone per day or matched placebo first. The primary clinical outcome measure was change in self-reported physical health. Neurocognitive functioning and self-reported measures of depression, PTSD, and fatigue were secondary outcomes. Sixty-five participants enrolled, of whom 36 were randomized and 32 (mean age, 49.1 (7.2) years) completed the study. Physical and mental health status and neurocognitive functioning were poor at baseline. Mifepristone treatment was not associated with improvement in self-reported physical health (p=0.838) or in other self-reported measures of mental health. Mifepristone treatment was significantly associated with improvements in verbal learning (p=0.008, d=0.508), in the absence of improvement in other cognitive measures (working memory (p=0.914), visual learning (p=0.643) and a global composite measure (p=0.937). Baseline morning cortisol levels and lysozyme IC50-DEX, a measure of peripheral glucocorticoid sensitivity, displayed a significant relationship with endpoint verbal learning scores (p=0.012 and p=0.007, respectively). The magnitude of cortisol change during treatment mediated the improvement in verbal learning. This study was negative for the primary and secondary clinical outcomes. However, the data suggest a moderate dose of mifepristone may have circumscribed cognitive-enhancing effects in CMI. Further study is warranted to determine whether and through which mechanisms mifepristone treatment can yield clinically meaningful improvement in cognitive function in CMI or other neuropsychiatric conditions associated with HPA axis dysregulation.
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Affiliation(s)
- Julia A Golier
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, United States; Psychiatry Department, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, United States.
| | - Kimberly Caramanica
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, United States
| | - Andreas C Michaelides
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, United States
| | - Iouri Makotkine
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, United States; Psychiatry Department, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, United States
| | - James Schmeidler
- Psychiatry Department, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, United States
| | - Philip D Harvey
- Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136, United States
| | - Rachel Yehuda
- James J. Peters VA Medical Center, OOMH-526, 130 West Kingsbridge Road, Bronx, NY 10468, United States; Psychiatry Department, Icahn School of Medicine at Mount Sinai, 1428 Madison Ave, New York, NY 10029, United States
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Gwini SM, Kelsall HL, Sim MR, Ikin JF, McFarlane AC, Forbes AB. Stability of symptom patterns in Australian Gulf War veterans: 10-year longitudinal study: Table 1. Occup Environ Med 2016; 73:195-8. [DOI: 10.1136/oemed-2015-103169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022]
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Gwini SM, Forbes AB, Kelsall HL, Ikin JF, Sim MR. Increased symptom reporting persists in 1990-1991 Gulf War veterans 20 years post deployment. Am J Ind Med 2015; 58:1246-54. [PMID: 26497120 DOI: 10.1002/ajim.22490] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Following the 1990-1991 Gulf War, Gulf War veterans (veterans) reported health symptoms more commonly than non-deployed groups. This article examines symptom persistence, incidence and prevalence 20 years on. METHODS In 2000-2003 and 2011-2012, a 63-item symptom checklist was administered to 697 veterans and 659 comparison group. Symptomatology was compared using log-binomial regression. RESULTS Both veterans and comparison group reported significantly increased prevalence (3-52%) over time in more than half the symptoms, with a similar overall rate of increase. Half the symptoms had higher incidence (risk-ratios ranged 1.43-1.50) and a quarter were more persistent (risk-ratios ranged 1.12-1.20) in veterans than the comparison group. CONCLUSIONS Symptomatology increased in both groups over time, but persisted to a similar extent and had higher incidence among veterans than the comparison group. The gap in symptom prevalence between the two groups remained unchanged. These findings suggest enduring health consequences of Gulf War service.
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Affiliation(s)
- Stella M. Gwini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Helen L. Kelsall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Jillian F. Ikin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Malcolm R. Sim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
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Long-term disability associated with war-related experience among Vietnam veterans: retrospective cohort study. Med Care 2015; 53:401-8. [PMID: 25768060 PMCID: PMC4396733 DOI: 10.1097/mlr.0000000000000336] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Recent combat operations have involved large numbers of personnel. Long-term health effects of military deployment remain largely unknown. Objectives: To examine patterns and trends in long-term disability among combat veterans and to relate disability to aspects of wartime experience. Participants: A total of 60,228 Australian military personnel deployed between 1962 and 1975 during the Vietnam War, and 82,877 military personnel who were not deployed overseas. Outcome Measures: Accepted physician-assessed disability claims were evaluated over follow-up periods up to 50 years after deployment, and compared with age-matched controls. Multivariable analysis was used to examine differences by service branch, rank, age, and deployment duration. Results: The steepest rise in disability incidence was observed among Vietnam veterans starting in the 1990s, around 20–30 years after deployment for most veterans. After 1994, when Statements of Principles were introduced to guide evaluation of disability claims, the hazard ratio for disability incidence was 1.53 (95% confidence interval, 1.32–1.77) compared with the prior period. By January 2011, after an average follow-up of 42.5 years, 69.7% (95% confidence interval, 69.4%–70.1%) of veterans had at least 1 war-related disability. Many veterans had multiple disabilities, with leading causes being eye and ear disorders (48.0%), mental health conditions (47.9%), and musculoskeletal disorders (18.4%). For specific categories of disability, relative risks for accepted claims among veterans compared with controls were highest for mental health disorders, at 22.9 (21.9–24.0) and lowest for injuries, at 1.5 (1.4–1.6) with a relative risk for any disability of 3.7 (3.7–3.8). Veterans with service of >1 year were 2.5 (2.2–2.7) times more likely to have a mental health disability than those who served <100 days, and 2.3 (2.1–2.5) times more likely to have other disabilities. Conclusions: Long-term effects of deployment into military conflicts are substantial, and likelihood of war-related disability is associated with service history. If similar patterns follow from more recent conflicts, significant additional resources will be needed to prevent and treat long-term health conditions among veterans.
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Mohanty AF, Muthukutty A, Carter ME, Palmer MN, Judd J, Helmer D, McAndrew LM, Garvin JH, Samore MH, Gundlapalli AV. Chronic multisymptom illness among female Veterans deployed to Iraq and Afghanistan. Med Care 2015; 53:S143-8. [PMID: 25767968 DOI: 10.1097/mlr.0000000000000314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic multisymptom illness (CMI) may be more prevalent among female Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) deployed Veterans due to deployment-related experiences. OBJECTIVES To investigate CMI-related diagnoses among female OEF/OIF/OND Veterans. RESEARCH DESIGN We estimated the prevalence of the International Classification of Disease-9th edition-Clinical Modification coded CMI-related diagnoses of chronic fatigue syndrome, fibromyalgia (FM), and irritable bowel syndrome (IBS) among female OEF/OIF/OND Veterans with Veterans Health Administration (VHA) visits, FY2002-2012 (n=78,435). We described the characteristics of female Veterans with and without CMI-related diagnoses and VHA settings of first CMI-related diagnoses. RESULTS The prevalence of CMI-related diagnoses among female OEF/OIF/OND Veterans was 6397 (8.2%), over twice as high as the prevalence 95,424 (3.9%) among the totality of female Veterans currently accessing VHA (P<0.01). There were statistically significant differences in age, education, marital status, military component, service branch, and proportions of those with depression and/or post-traumatic stress disorder diagnoses across females with and without CMI-related diagnoses. Diagnoses were mainly from primary care, women's health, and physical medicine and rehabilitation clinics. CONCLUSIONS CMI-related diagnoses were more prevalent among female OEF/OIF/OND Veterans compared with all female Veterans who currently access VHA. Future studies of the role of mental health diagnoses as confounders or mediators of the association of OEF/OIF/OND deployment and CMI are warranted. These and other factors associated with CMI may provide a basis for enhanced screening to facilitate recognition of these conditions. Further work should evaluate models of care and healthcare utilization related to CMI in female Veterans.
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Affiliation(s)
- April F Mohanty
- *Informatics, Decision Enhancement, and Surveillance (IDEAS) Center, VA Salt Lake City Health Care System, Department of Internal Medicine, University of Utah School of Medicine †Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT ‡Department of Veteran Affairs, War Related Illness and Injury Study Center, New Jersey Health Care System, East Orange, NJ §Department of Education and Counseling Psychology, University of Albany, Albany, NY
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Reinhard MJ, Nassif TH, Bloeser K, Dursa EK, Barth SK, Benetato B, Schneiderman A. CAM utilization among OEF/OIF veterans: findings from the National Health Study for a New Generation of US Veterans. Med Care 2015; 52:S45-9. [PMID: 25397822 DOI: 10.1097/mlr.0000000000000229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is increasingly seen as an adjunct to traditional plans of care. This study utilized a representative sample of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and OEF/OIF-era veterans to explore the prevalence and characteristics of CAM users. RESEARCH DESIGN The National Health Study for a New Generation of US Veterans (NewGen) is a longitudinal health study of a population-based cohort of OEF/OIF (deployed) and OEF/OIF-era (nondeployed) veterans. Data from the 2009-2011 NewGen survey (n=20,563) were analyzed to determine prevalence of CAM use by demographic and military characteristics, the types of CAM modalities used, and where the modalities were sought. Results were weighted to the entire population of OEF/OIF and OEF/OIF-era veterans. RESULTS There was no statistically significant association between CAM use and deployment. Those who used Department of Veterans Affairs (VA) health care after separation were more likely to be CAM users compared with those who did not use VA care; however, the majority of veterans using CAM are using it outside the VA health care system. Massage was the most prevalent CAM modality followed by chiropractic treatment; males were less likely to use CAM than women. CONCLUSIONS CAM modalities are being utilized by OEF/OIF veterans for health problems mainly outside the VA. Policymakers should determine appropriate use of these modalities.
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Affiliation(s)
- Matthew J Reinhard
- *War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center †Georgetown University Medical School, Department of Psychiatry ‡American University School of Education, Teaching and Health §US Department of Veterans Affairs, Office of Public Health, Post Deployment Health, Epidemiology Program, Washington, DC ∥Veterans Affairs Greenville NC CBOC ¶East Carolina University, College of Nursing, Greenville, NC
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Physical Health, Mental Health, and Utilization of Complementary and Alternative Medicine Services Among Gulf War Veterans. Med Care 2014; 52:S39-44. [DOI: 10.1097/mlr.0000000000000223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roncati L, Gatti AM, Pusiol T, Barbolini G, Maiorana A. Acquired immunodeficiency similar to Gulf War illness in a dead former serviceman. J ROY ARMY MED CORPS 2014; 161:153-5. [DOI: 10.1136/jramc-2014-000345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/20/2014] [Indexed: 11/04/2022]
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Galanter M, Dermatis H, Sampson C. Narcotics Anonymous: A Comparison of Military Veterans and Non-Veterans. J Addict Dis 2014; 33:187-95. [DOI: 10.1080/10550887.2014.950031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hull A, Reinhard M, McCarron K, Allen N, Jecmen MC, Akhter J, Duncan A, Soltes K. Acupuncture and meditation for military veterans: first steps of quality management and future program development. Glob Adv Health Med 2014; 3:27-31. [PMID: 25105073 PMCID: PMC4104562 DOI: 10.7453/gahmj.2013.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Veterans of all war eras have a high rate of chronic disease, mental health disorders, and chronic multi-symptom illnesses (CMI).(1-3) Many veterans report symptoms that affect multiple biological systems as opposed to isolated disease states. Standard medical treatments often target isolated disease states such as headaches, insomnia, or back pain and at times may miss the more complex, multisystem dysfunction that has been documented in the veteran population. Research has shown that veterans have complex symptomatology involving physical, cognitive, psychological, and behavioral disturbances, such as difficult to diagnose pain patterns, irritable bowel syndrome, chronic fatigue, anxiety, depression, sleep disturbance, or neurocognitive dysfunction.(2-4) Meditation and acupuncture are each broad-spectrum treatments designed to target multiple biological systems simultaneously, and thus, may be well suited for these complex chronic illnesses. The emerging literature indicates that complementary and integrative medicine (CIM) approaches augment standard medical treatments to enhance positive outcomes for those with chronic disease, mental health disorders, and CMI.(5-12.)
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Affiliation(s)
- Amanda Hull
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
| | - Matthew Reinhard
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
| | - Kelly McCarron
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
| | - Nathaniel Allen
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
| | - M Cory Jecmen
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
| | - Jeanette Akhter
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
| | - Alaine Duncan
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
| | - Karen Soltes
- War Related Illness and Injury Study Center, Veteran Affairs Medical Center, Washington, DC, United States
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