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Dieterich-Hartwell R, Malhotra B, Arslanbek A, DeBeer B, Alverio T, Kaimal G. Living With Toxic Wounds: The Voices and Visual Self-Representations of Gulf War Veterans. QUALITATIVE HEALTH RESEARCH 2024; 34:411-423. [PMID: 38019750 DOI: 10.1177/10497323231213818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Operations Desert Shield and Storm occurred over 30 years ago, yet many of those who were deployed continue to experience chronic and debilitating symptoms, now recognized as Gulf War Illness (GWI). While efforts have been made to explore clinical treatments for GWI, misperceptions and skepticism about its complex nature and a lack of consensus on its etiology impede progress in this area. A critical necessity remains to better understand the experiences, needs, and concerns of veterans with GWI. In this qualitative research study, 40 Gulf War veterans were interviewed about their perceptions regarding symptoms of physical health, cognitive functioning, quality of life, and the quality of care received. In addition, they depicted their experiences through an artistic elicitation collage. Through a grounded theory method, key findings indicated that there are remaining hurdles, such as challenging symptoms, persisting unknowns about the illness, and variations in treatment quality. Veterans have mostly managed and coped with GWI, but they voice the need for acknowledgment and support. The main implication from this study is the significance of both clinical and institutional validation and recognition of the GWI experience as well as the need for specific support systems.
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Affiliation(s)
| | - Bani Malhotra
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | - Aslı Arslanbek
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
| | - Bryann DeBeer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VHA Medical Center, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tabitha Alverio
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VHA Medical Center, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Girija Kaimal
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, USA
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Truax LE, Huang JJ, Jensen K, Locatelli EVT, Cabrera K, Peterson HO, Cohen NK, Mangwani-Mordani S, Jensen A, Goldhardt R, Galor A. Pyridostigmine Bromide Pills and Pesticides Exposure as Risk Factors for Eye Disease in Gulf War Veterans. J Clin Med 2023; 12:jcm12062407. [PMID: 36983407 PMCID: PMC10059791 DOI: 10.3390/jcm12062407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
To examine associations between the pyridostigmine bromide (PB) pill and/or pesticide exposure during the 1990-1991 Gulf War (GW) and eye findings years after deployment. A cross-sectional study of South Florida veterans who were deployed on active duty during the GW Era (GWE). Information on GW exposures and ocular surface symptoms were collected via standardized questionnaires and an ocular surface examination was performed. Participants underwent spectral domain-ocular coherence tomography (SD-OCT) imaging that included retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and macular maps. We examined for differences in eye findings between individuals exposed versus not exposed to PB pills or pesticides during service. A total of 40.7% (n = 44) of individuals reported exposure to PB pills and 41.7% (n = 45) to pesticides; additionally, 24 reported exposure to both in the GW arena. Demographics were comparable across groups. Individuals exposed to PB pills reported higher dry eye (DE) symptoms scores (the 5-Item Dry Eye Questionnaire, DEQ-5: 9.3 ± 5.3 vs. 7.3 ± 4.7, p = 0.04) and more intense ocular pain (average over the last week: 2.4 ± 2.6 vs. 1.5 ± 1.8, p = 0.03; Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-E): 18.2 ± 20.0 vs. 10.8 ± 13.8, p = 0.03) compared to their non-exposed counterparts. DE signs were comparable between the groups. Individuals exposed to PB pills also had thicker OCT measurements, with the largest difference in the outer temporal segment of the macula (268.5 ± 22.2 μm vs. 260.6 ± 14.5 μm, p = 0.03) compared to non-exposed individuals. These differences remained significant when examined in multivariable models that included demographics and deployment history. Individuals exposed to pesticides had higher neuropathic ocular pain scores (NPSI-E: 17.1 ± 21.1 vs. 11.6 ± 12.9, p = 0.049), but this difference did not remain significant in a multivariable model. Individuals exposed to PB pills during the GWE reported more severe ocular surface symptoms and had thicker OCT measures years after deployment compared to their non-exposed counterparts.
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Affiliation(s)
- Lauren E Truax
- Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jaxon J Huang
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Katherine Jensen
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
| | - Elyana V T Locatelli
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Kimberly Cabrera
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
| | - Haley O Peterson
- Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Noah K Cohen
- Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | | | - Andrew Jensen
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
| | - Raquel Goldhardt
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
| | - Anat Galor
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA
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Breneman CB, Reinhard MJ, Allen N, Belouali A, Chun T, Crock L, Duncan AD, Dutton MA. Gulf War Illness: A Randomized Controlled Trial Combining Mindfulness Meditation and Auricular Acupuncture. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231171854. [PMID: 37151571 PMCID: PMC10161299 DOI: 10.1177/27536130231171854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/03/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023]
Abstract
Background Many Gulf War (GW) Veterans report chronic symptoms including pain, fatigue, and cognitive impairment, commonly defined as Gulf War Illness (GWI). Complementary and integrative health (CIH) therapies may potentially improve multiple symptoms of GWI. Objective To examine the effectiveness of combining 2 commonly available CIH therapies, mindfulness meditation and auricular acupuncture, in improving health-related functioning and multiple symptom domains of GWI (e.g., pain, fatigue). Methods This study was a randomized controlled trial in which Veterans with GWI were randomly assigned to either the intervention group (n = 75), wherein they received 2 distinct CIH therapies - mindfulness meditation and auricular acupuncture, or the active control group, wherein they received a GW Health Education (GWHE) program (n = 74), each lasting 8 weeks. Self-report health measures were assessed at baseline, endpoint, and 3 month follow-up. Results In the intention-to-treat analyses, there were significant between-group differences for mental-health related functioning, fatigue, depression symptoms, and Kansas total severity scores for symptoms in which the CIH group had improved scores for these outcomes at endpoint compared to the GWHE group (all P ≤ .05). The CIH group also had significant reductions in pain interference at endpoint and follow-up compared to baseline (estimated marginal mean difference: -2.52 and -2.22, respectively; all P = .01), whereas no significant changes were observed in the GWHE group. For pain characteristics, the GWHE group had a worsening of pain at endpoint compared to baseline (estimated marginal mean difference: +2.83; P = .01), while no change was observed in the CIH group. Conclusion Findings suggest a possible beneficial effect of combining 2 CIH therapies, mindfulness meditation and auricular acupuncture, in reducing overall symptom severity and individual symptom domains of fatigue, musculoskeletal, and mood/cognition in Veterans with GWI. Trial Registration Clinical Trials identifier NCT02180243.
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Affiliation(s)
- Charity B. Breneman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
- Department of Veterans Affairs, War Related Illness and Injury Study Center(WRIISC), Washington, DC, USA
| | - Matthew J. Reinhard
- Department of Veterans Affairs, War Related Illness and Injury Study Center(WRIISC), Washington, DC, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Nathaniel Allen
- Department of Veterans Affairs, War Related Illness and Injury Study Center(WRIISC), Washington, DC, USA
| | - Anas Belouali
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Timothy Chun
- Department of Veterans Affairs, War Related Illness and Injury Study Center(WRIISC), Washington, DC, USA
| | - Lucas Crock
- Department of Veterans Affairs, War Related Illness and Injury Study Center(WRIISC), Washington, DC, USA
| | | | - Mary Ann Dutton
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
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Cruz-Hernandez A, Roney A, Goswami DG, Tewari-Singh N, Brown JM. A review of chemical warfare agents linked to respiratory and neurological effects experienced in Gulf War Illness. Inhal Toxicol 2022; 34:412-432. [PMID: 36394251 PMCID: PMC9832991 DOI: 10.1080/08958378.2022.2147257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Over 40% of veterans from the Persian Gulf War (GW) (1990-1991) suffer from Gulf War Illness (GWI). Thirty years since the GW, the exposure and mechanism contributing to GWI remain unclear. One possible exposure that has been attributed to GWI are chemical warfare agents (CWAs). While there are treatments for isolated symptoms of GWI, the number of respiratory and cognitive/neurological issues continues to rise with minimum treatment options. This issue does not only affect veterans of the GW, importantly these chronic multisymptom illnesses (CMIs) are also growing amongst veterans who have served in the Afghanistan-Iraq war. What both wars have in common are their regions and inhaled exposures. In this review, we will describe the CWA exposures, such as sarin, cyclosarin, and mustard gas in both wars and discuss the various respiratory and neurocognitive issues experienced by veterans. We will bridge the respiratory and neurological symptoms experienced to the various potential mechanisms described for each CWA provided with the most up-to-date models and hypotheses.
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Affiliation(s)
- Angela Cruz-Hernandez
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Roney
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Dinesh G Goswami
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Neera Tewari-Singh
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Jared M Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, The University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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5
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Kelton K, Young JR, Evans MK, Eshera YM, Blakey SM, Mann AJD, Pugh MJ, Calhoun PS, Beckham JC, Kimbrel NA. Complementary/integrative healthcare utilization in US Gulf-War era veterans: Descriptive analyses based on deployment history, combat exposure, and Gulf War Illness. Complement Ther Clin Pract 2022; 49:101644. [PMID: 35947938 PMCID: PMC9669216 DOI: 10.1016/j.ctcp.2022.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/20/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
Complementary and integrative health (CIH) approaches have gained empirical support and are increasingly being utilized among veterans to treat a myriad of conditions. A cluster of medically unexplained chronic symptoms including fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems, often referred to as Gulf War Illness (GWI) prominently affect US Gulf War era (GWE) veterans, yet little is known about CIH use within this population. Using data collected as part of a larger study (n = 1153), we examined the influence of demographic characteristics, military experiences, and symptom severity on CIH utilization, and utilization differences between GWE veterans with and without GWI. Over half of the sample (58.5%) used at least one CIH modality in the past six months. Women veterans, white veterans, and veterans with higher levels of education were more likely to use CIH. GWE veterans with a GWI diagnosis and higher GWI symptom severity were more likely to use at least one CIH treatment in the past six months. Over three quarters (82.7%) of veterans who endorsed using CIH to treat GWI symptoms reported that it was helpful for their symptoms. Almost three quarters (71.5%) of veterans indicated that they would use at least one CIH approach if it was available at VA. Results provide a deeper understanding of the likelihood and characteristics of veterans utilizing CIH to treat health and GWI symptoms and may inform expansion of CIH modalities for GWE veterans, particularly those with GWI.
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Affiliation(s)
- Katherine Kelton
- South Texas Veteran Health Care System, Audie L. Murphy Veteran Hospital San Antonio, TX, USA; National Center for Homelessness Among Veterans, USA.
| | - Jonathan R Young
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Mariah K Evans
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Yasmine M Eshera
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Shannon M Blakey
- Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System and IDEAS Center of Innovation, Salt Lake City UT, USA; University of Utah School of Medicine, Department of Medicine, Salt Lake City UT, USA
| | - Patrick S Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA
| | - Nathan A Kimbrel
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Health Care System, Durham, NC, USA; Mid-Atlantic Mental Illness Research, Education, And Clinical Center (MIRECC), Durham, NC, USA; Durham HSRD Center (ADAPT), USA
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6
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McAndrew LM, Khatib LA, Sullivan NL, Winograd DM, Kolar SK, Santos SL. Healthcare providers' perceived learning needs and barriers to providing care for chronic multisymptom illness and environmental exposure concerns. Life Sci 2021; 284:119757. [PMID: 34425128 DOI: 10.1016/j.lfs.2021.119757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Patient provider encounters for chronic multisympom illness (CMI) and/or environmental exposures are difficult often resulting in Veterans and providers having high levels of dissatisfaction. Patients attribute these difficulties to providers lacking knowledge about these health concerns. It is not known whether providers perceive themselves as lacking expertise in CMI and environmental exposure concerns. METHODS This needs assessment used a descriptive online survey design. A total of 3632 VA healthcare providers across disciplines were surveyed. RESULTS Healthcare providers reported speaking with Veterans about CMI and environmental exposures despite feeling they have minimal to no knowledge of these topics. At the same time, only half of the providers had taken an available training on CMI or environmental exposure within the last year. CONCLUSION Healthcare providers recognize a knowledge gap regarding CMI and environmental exposures, despite this, there is low uptake of provider education on these topics. PRACTICE IMPLICATIONS A better understanding of barriers to uptake of training on CMI and environmental exposures is needed to increase engagement with these important trainings.
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Affiliation(s)
- Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA; Department of Educational and Counseling Psychology, University at Albany, Albany, NY 12222, USA.
| | - Linda A Khatib
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA.
| | - Nicole L Sullivan
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA.
| | - Darren M Winograd
- Department of Educational and Counseling Psychology, University at Albany, Albany, NY 12222, USA.
| | - Stephanie K Kolar
- Employee Education System, Veterans Health Administration Veterans Affairs, Long Beach Medical Facility, 901 East 7thStreet, Long Beach, CA 90822, USA.
| | - Susan L Santos
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, 385 Tremont Avenue, East Orange, NJ 07018, USA.
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Protocol for a type 1 hybrid effectiveness/implementation clinical trial of collaborative specialty care for Veterans with Gulf War Illness. Life Sci 2021; 292:120004. [PMID: 34599935 DOI: 10.1016/j.lfs.2021.120004] [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: 02/26/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022]
Abstract
AIMS We describe a clinical trial to determine the effectiveness and understand implementation outcomes for tele-collaborative specialty care for Veterans with GWI. MAIN METHODS This study will be a hybrid type 1 randomized effectiveness/implementation trial comparing tele-collaborative specialty care to electronic consultation for Gulf War Veterans with GWI (N = 220). In tele-collaborative specialty care, the specialty provider team will deliver health coaching and problem-solving treatment to Veterans and recommend a plan for analgesic optimization. In electronic consultation, the specialty provider team will make a one-time recommendation to the primary care team for locally delivered health coaching, problem-solving treatment and analgesic optimization. The primary aim will be to determine the effectiveness of tele-collaborative specialty care to reduce disability related to GWI. Our secondary aim will be to understand implementation outcomes. SIGNIFICANCE There is a need to improve care for Veterans with GWI. A potentially useful model to address these barriers and improve care is tele-collaborative specialty care where the specialists work with primary care provider to synergistically treat the patients. DISCUSSION This is the first clinical trial to prospectively compare different models of care for Veterans with GWI. This responds to multiple calls for research to improve treatment for Veterans with GWI, including from the National Academy of Medicine.
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8
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Steele L, Klimas N, Krengel M, Quinn E, Toomey R, Little D, Abreu M, Aenlle K, Killiany R, Koo BB, Janulewicz P, Heeren T, Clark AN, Ajama J, Cirillo J, Buentello G, Lerma V, Coller JK, Sullivan K. Brain-Immune Interactions as the Basis of Gulf War Illness: Clinical Assessment and Deployment Profile of 1990-1991 Gulf War Veterans in the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study. Brain Sci 2021; 11:brainsci11091132. [PMID: 34573153 PMCID: PMC8467437 DOI: 10.3390/brainsci11091132] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022] Open
Abstract
The Boston University-based Gulf War Illness Consortium (GWIC) is a multidisciplinary initiative developed to provide detailed understanding of brain and immune alterations that underlie Gulf War illness (GWI), the persistent multisymptom disorder associated with military service in the 1990–1991 Gulf War. The core GWIC case-control clinical study conducted in-depth brain and immune evaluation of 269 Gulf War veterans (223 GWI cases, 46 controls) at three U.S. sites that included clinical assessments, brain imaging, neuropsychological testing, and analyses of a broad range of immune and immunogenetic parameters. GWI cases were similar to controls on most demographic, military, and deployment characteristics although on average were two years younger, with a higher proportion of enlisted personnel vs. officers. Results of physical evaluation and routine clinical lab tests were largely normal, with few differences between GWI cases and healthy controls. However, veterans with GWI scored significantly worse than controls on standardized assessments of general health, pain, fatigue, and sleep quality and had higher rates of diagnosed conditions that included hypertension, respiratory and sinus conditions, gastrointestinal conditions, and current or lifetime depression and post-traumatic stress disorder. Among multiple deployment experiences/exposures reported by veterans, multivariable logistic regression identified just two significant GWI risk factors: extended use of skin pesticides in theater (adjusted OR = 3.25, p = 0.005) and experiencing mild traumatic brain injury during deployment (OR = 7.39, p = 0.009). Gulf War experiences associated with intense stress or trauma (e.g., participation in ground combat) were not associated with GWI. Data and samples from the GWIC project are now stored in a repository for use by GWI researchers. Future reports will present detailed findings on brain structure and function, immune function, and association of neuroimmune measures with characteristics of GWI and Gulf War service.
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Affiliation(s)
- Lea Steele
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
- Correspondence: (L.S.); (K.S.)
| | - Nancy Klimas
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
- Department of Veterans Affairs, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Maxine Krengel
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Emily Quinn
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (T.H.)
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University College of Arts and Sciences, Boston, MA 02215, USA;
| | - Deborah Little
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Maria Abreu
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
| | - Kristina Aenlle
- Institute for Neuroimmune Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA; (N.K.); (M.A.); (K.A.)
- Department of Veterans Affairs, Miami VA Healthcare System, Miami, FL 33125, USA
| | - Ronald Killiany
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Bang-Bon Koo
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; (E.Q.); (T.H.)
| | - Allison N. Clark
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Joy Ajama
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Joanna Cirillo
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
| | - Gerardo Buentello
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
| | - Vanesa Lerma
- Veterans Health Research Program, Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; (G.B.); (V.L.)
| | - Janet K. Coller
- Discipline of Pharmacology, School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (R.K.); (B.-B.K.); (P.J.); (J.A.); (J.C.)
- Correspondence: (L.S.); (K.S.)
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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: 10] [Impact Index Per Article: 3.3] [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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10
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Malhotra B, Dieterich-Hartwell R, DeBeer B, Burns C, Kaimal G. Collage-based graphic elicitation method for capturing the lived experiences of veterans with Gulf War illness. Life Sci 2021; 284:119656. [PMID: 34043995 DOI: 10.1016/j.lfs.2021.119656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/03/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS Graphic elicitation is an emergent data gathering approach in qualitative research. An overview of the development and application of a collage based graphic elicitation method in gaining greater understanding about the experience of Gulf War Illness (GWI) is presented in this paper. The unique contributions of this method are also discussed. MAIN METHODS Fourteen veterans with GWI were interviewed and then invited to represent their experiences in a visual format through a collage graphic elicitation task. Interviews and collage artworks were coded and compared to both verbal and art responses during the graphic elicitation process. KEY FINDINGS Comparison of the content in the interview responses and collage artwork indicates that the graphic elicitation process resulted in three distinct responses: (1) Synthesis and confirmation of content articulated in the interviews, (2) focus on salient aspects of living with GWI, and (3) revealing previously unarticulated experiences. SIGNIFICANCE This work demonstrates the unique contributions of collage graphic elicitation, including allowing for spontaneity, metaphorical thinking, enriching verbal explication, and uncovering lived experiences and new affective responses. The sample size was too small to make any generalizations, and more research is needed to further validate these initial findings.
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Affiliation(s)
- Bani Malhotra
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States of America.
| | | | - Bryann DeBeer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VHA Medical Center, Aurora, CO and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Christina Burns
- Independent Researcher, 4408D Lakeshore Drive, Waco, TX 76710
| | - Girija Kaimal
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA, United States of America
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Winograd DM, Sullivan NL, Thien SR, Pigeon WR, Litke DR, Helmer DA, Rath JF, Lu SE, McAndrew LM. Veterans with Gulf War Illness perceptions of management strategies. Life Sci 2021; 279:119219. [PMID: 33592197 DOI: 10.1016/j.lfs.2021.119219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
AIMS Gulf War Illness (GWI) is a prevalent and disabling condition characterized by persistent physical symptoms. Clinical practice guidelines recommend self-management to reduce the disability from GWI. This study evaluated which GWI self-management strategies patients currently utilize and view as most effective and ineffective. MATERIALS AND METHODS Data were collected from 267 Veterans during the baseline assessment of a randomized clinical trial for GWI. Respondents answered 3 open-ended questions regarding which self-management strategies they use, view as effective, and view as ineffective. Response themes were coded, and code frequencies were analyzed. KEY FINDINGS Response frequencies varied across questions (in-use: n = 578; effective: n = 470; ineffective: n = 297). Healthcare use was the most commonly used management strategy (38.6% of 578), followed by lifestyle changes (28.5% of 578), positive coping (13% of 578), and avoidance (13.7% of 578). When asked about effective strategies, healthcare use (25.9% of 470), lifestyle change (35.7% of 470), and positive coping (17.4% of 470) were identified. Avoidance was frequently identified as ineffective (20.2% of 297 codes), as was invalidating experiences (14.1% of 297) and negative coping (10.4% of 297). SIGNIFICANCE Patients with GWI use a variety of self-management strategies, many of which are consistent with clinical practice guidelines for treating GWI, including lifestyle change and non-pharmacological strategies. This suggests opportunities for providers to encourage effective self-management approaches that patients want to use.
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Affiliation(s)
- Darren M Winograd
- University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, USA
| | - Nicole L Sullivan
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA
| | - Scott R Thien
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Veterans Affairs Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - David R Litke
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA; Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Joseph F Rath
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Shou-En Lu
- Rutgers Unviersity, Piscataway, NJ 08854, USA
| | - Lisa M McAndrew
- University at Albany, State University of New York, 1400 Washington Ave., Albany, NY 12222, USA; War Related Illness and Injury Study Center, Veterans Affairs New Jersey Healthcare System, East Orange, NJ 07018, USA.
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