The symmetry rule: a seven-year study of symptoms and explanatory labels among Gulf War veterans

Longitudinal Assessment of Health Symptoms in Relation to Neurotoxicant Exposures in 1991 Gulf War Veterans: The Ft. Devens Cohort

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.

Resilience of HPV vaccine uptake in Denmark: Decline and recovery

BACKGROUND

Immunization programs' resilience to shocks is central to their success, but little empirical evidence documents resilience in action. We sought to characterize the decline of HPV vaccination in Denmark after negative media coverage and recovery during a national information campaign.

METHODS

We conducted a population-based retrospective cohort study of all girls born in Denmark from 1997 to 2006 (N = 328,779), aged 12-15. The outcome measure was HPV vaccine uptake (first dose), as reported to the Danish national health registry from 2009 to 2019, when HPV vaccine was freely available to girls in primary care clinics in Denmark. Events that created 4 natural time periods for study were HPV vaccine reaching the uptake of other vaccines in the national program (2009), some negative media coverage of HPV vaccination (2013), extensive negative media coverage (2015), and a national information campaign about the vaccine's safety and effectiveness (2017-2019).

RESULTS

In the period with some negative media coverage, HPV vaccine uptake fell to 83.6% (95% CI:78.0%-89.7%) of baseline uptake. In the period with extensive negative media coverage, uptake fell even further to 49.6% (95% CI:44.5%-55.2%) of baseline uptake. After the information campaign, HPV vaccine uptake recovered to its baseline level (109.2%, 95% CI:90.1%-132.4%) due in part to catch-up doses. Despite the recovery, an estimated 26,000 fewer girls initiated the vaccine than if uptake had not declined.

CONCLUSIONS

The experience in Denmark offers one of the first opportunities to document how a nation grappled with negative media coverage of HPV vaccination and the steadying impact of action by national authorities.

Anthrax Exposure, Belief in Exposure, and Postanthrax Symptoms Among Survivors of a Bioterrorist Attack on Capitol Hill

BACKGROUND

Following chemical, biological, radiological, and nuclear disasters, medically unexplained symptoms have been observed among unexposed persons.

OBJECTIVES

This study examined belief in exposure in relation to postdisaster symptoms in a volunteer sample of 137 congressional workers after the 2001 anthrax attacks on Capitol Hill.

METHODS

Postdisaster symptoms, belief in exposure, and actual exposure status were obtained through structured diagnostic interviews and self-reported presence in offices officially designated as exposed through environmental sampling. Multivariate models were tested for associations of number of postdisaster symptoms with exposure and belief in exposure, controlling for sex and use of antibiotics.

RESULTS

The sample was divided into 3 main subgroups: exposed, 41%; unexposed but believed they were exposed, 17%; and unexposed and did not believe that they were exposed, 42%. Nearly two-thirds (64%) of the volunteers reported experiencing symptoms after the anthrax attacks. Belief in anthrax exposure was significantly associated with the number of ear/nose/throat, musculoskeletal, and all physical symptoms. No significant associations were found between anthrax exposure and the number of postdisaster symptoms.

CONCLUSIONS

Given the high incidence of these symptoms, these data suggest that even in the absence of physical injury or illness, there may be surges in health care utilization. (Disaster Med Public Health Preparedness. 2019;13:555-560).

Symptom attribution and symptom reporting in Australian Gulf War veterans

OBJECTIVE

To better understand the consistent elevated symptom reporting by Gulf War veterans; we compared Australian Gulf War veterans and military-comparison group on symptom attributional styles and the relationship with total number and grouping of somatic and psychological symptoms.

METHOD

Postal questionnaires were completed by Australian Gulf War veterans (n=697) and military-comparison group (n=659) in 2000-2002 and 2011-2012. Data were collected on deployments, military-psychological stressors, symptom reporting, symptom factors and attributional style (normalising, psychologising, somatising, mixed-attribution).

RESULTS

Gulf War veterans did not differ in attributional style from comparison group (p>0.05); normalising was the predominant style. Groups were combined for analyses. Psychologisers reported the highest overall symptoms (mean(M)=10.95, standard deviation(SD)=9.15), the most psychophysiological (M=1.71, SD=2.82), cognitive (M=5.79, SD=5.09) and arthro-neuromuscular symptoms (M=1.53, SD=1.73). Psychologisers and somatisers reported significantly more symptoms across overall symptoms, all three symptom factors and psychological distress than normalisers. Normalisers consistently reported fewest overall symptoms (M=2.85, SD=4.49), psychophysiological (M=0.40, SD=0.98), cognitive (M=1.14, SD=2.22), and arthro-neuromuscular symptoms (M=0.72, SD=1.31). Persistent symptoms, rather than remitted, between baseline and follow-up were associated with increased rates of psychologising and mixed-attribution compared with normalising. For incident symptoms a similar pattern was observed, some symptoms also showed increased rates of somatising.

CONCLUSIONS

In veterans, psychologising was associated with higher symptom reporting, whilst somatisers and mixed-attribution also demonstrated higher reporting than normalisers. Symptom persistence and incidence were associated with symptom attribution. The findings indicate that attributional style is associated with patterns of symptom reporting and highlights both past and present symptoms may influence attributional style.

Accentuate the positive: Counteracting psychogenic responses to media health messages in the age of the Internet

OBJECTIVE

The Internet has expanded the scope for creating health scares and increased the risk of nocebo responding in individuals exposed to misinformation about threats to personal health posed by aspects of modern life, such as exposure to new technologies. It was the aim of this experiment to investigate whether the delivery of positive expectations might reduce or reverse symptoms triggered by negative expectations formed from such misinformation.

METHOD

In the context of a study investigating symptoms during exposure to windfarm sound, 64 volunteers assessed their symptomatic experiences during two discrete sessions, throughout which they listened to wind turbine sound containing audible and sub-audible (infrasound) components. Participants were randomly assigned to watch either positive or negative information about the health effects of infrasound prior to their first infrasound exposure session. They were then shown the alternate information and exposed to infrasound during their second session.

RESULTS

Participants receiving negative expectations were less symptomatic during exposure if they had previously received positive expectations about infrasound. Further, participants given positive expectations after the earlier delivery of negative expectations exhibited a placebo response, reversing the nocebo response exhibited in their first exposure session.

CONCLUSION

Results suggest accessing positively framed health information may reverse or dilute the effect of negative expectations formed from exposure to media warnings about health risks posed by new technologies, such as wind turbines.

Prevalence of environmental and other military exposure concerns in Operation Enduring Freedom and Operation Iraqi Freedom veterans

OBJECTIVE

This study examined the prevalence of self-reported exposures in returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans and the relationship of exposure reports to current physical symptoms.

METHODS

Using self-reports obtained immediately after return from deployment in a cohort of 760 enlisted Army reserve component military personnel, we assessed prevalence rates of environmental and other exposures and the association of these exposures to severity of physical symptoms.

RESULTS

Reporting of environmental exposures was relatively low in veterans of OEF/OIF, but reporting more environmental and other exposures, in particular screening positive for a traumatic brain injury, was related to greater physical symptom severity immediately after deployment.

CONCLUSIONS

Non-treatment-seeking, enlisted Army reserve component personnel reported relatively few exposures immediately after return from deployment; however, more exposures was modestly associated with greater severity of physical symptoms when controlling for predeployment symptoms, gender, and other deployment-related exposures.