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Appendix A: Overview of Illnesses in Gulf War Veterens
Pages 531-561

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From page 531...
... reported that about 23% of patients with aplastic anemia had reported exposure to benzene. The study examined potential risk factors but did not have a comparison population.
From page 532...
... Using interviews with the case and control subjects, the researchers examined several risk factors for aplastic anemia. For the cases ant!
From page 533...
... This appendix uses the term Gulf War veterans in the broadest sense. Unless otherwise specified, the term denotes all military personnel who served in the Gulf War theater between August 2, 1990, and June 13, 1991, regardless of whether they later continued on active duty, returned to the reserves or National Guard, or left military service.
From page 534...
... Some studies of Gulf War veterans covered here are also discussed more thoroughly in the body of this volume because they are relevant to understanding the health effects of insecticides and solvents. There, they are incorporated into the body of evidence evaluated by the committee to reach its conclusions about the health effects of insecticides and solvents.
From page 535...
... No medical diagnosis M~sculoskeletal and connective tissue Mental disorders Respiratory system Skin and subcutaneous tissue Digestive system Nervous system Infectious diseases Circulatory system In jury and poisoning Genitourinary system Neoplasm SOURCE: Murphy et al., 1999. 20.5 18.4 18.0 16.8 14.0 7.9 5.9 4.6 3.6 3.5 12.3 26.8 25.4 14.7 14.0 13.4 11.1 8.0 7.1 6.4 5.3 3.0 0.4 A registry program established by the United Kingdom Ministry of Defence for UK Gulf War veterans found similar types and frequencies of symptoms and diagnoses (Coker et al., ~ 9991.
From page 536...
... EPIDEMIOLOGIC STUDIES OF VETERANS' SYMPTOMS AND GENERAL HEALTH STATUS A number of epidemiologic studies have been conducted on the health status of Gulf War veterans. The driving issues behind many of the studies have been to determine the nature of symptoms and symptom clusters, whether symptom clusters constitute a new and unique syndrome, and what types of exposures might have produced the symptoms.
From page 537...
... of the health of Gulf War veterans. When factor analysis is used in studies of veterans, the observed variables are measurements of veterans' symptoms, and the fundamental factors are symptom groupings that might represent a potential new syndrome.
From page 538...
... Ismail et al., l 999 2614~ 3113/3439 Survey Cherry et al., 2001a; 9585/4790b Cherry et al., 2001b Population-based survey, factor analysis Population-based survey, factor analysis Population-based survey, factor analysis Population-based survey, factor analysis All US branches and duty status 76 All US branches 70 and duty status All Canadian Gulf 64.5 War veterans UK Gulf War veterans (U. London)
From page 539...
... The Iowa Study The "Iowa study," a major population-based study of US Gulf War veterans, was a cross-sectional survey of a representative sample of 4886 military personnel who listed Iowa as their home of record at the time of enlistment (Iowa Persian Gulf Study Group, ~ 997~. The study examined the health of military personnel in all branches of service who were still serving or had left service.
From page 540...
... The study concluded that no exposure to any single agent was related to the conditions that the authors found to be more prevalent in Gulf War veterans (Iowa Persian Gulf Study Group, ~ 9971. 9Sources of questions included the National Health Interview Survey, the Behavioral Risk Factor Surveillance Survey, the National Medical Expenditures Survey, the Primary Care Evaluation of Mental Disorders, the Brief Symptom Inventory, the CAGE questionnaire, the PTSD (Posttraumatic Stress Disorder)
From page 541...
... The study was designed to be representative of the nearly 700,000 US veterans sent to the Persian Gulf and 800,680 non-Gulf veterans of the same era. Questionnaires were mailed to a stratified random sample of ~ 5,000 Gulf War and ~ 5,000 non-Gulf War veterans identified by DOD and representing various military branches and units.
From page 542...
... Runny nose Headache Unrefreshing sleep Anxiety Joint pain Back pain Fatigue Ringing in ears Heartburn Difficulty sleeping Prevalence in Non-Gulf War Veterans (%) 43 37 24 28 27 30 15 23 25 21 56 54 47 45 45 44 38 37 37 37 5 Most Common Self-Reported Chronic Medical Conditions" Sinusitis Gastritis Dermatitis Arthritis Frequent diarrhea Prevalence in Gulf War Veterans (%)
From page 543...
... of 23,7] ~ Gulf War veterans listing Oregon or Washington as their home state of record at the time of deployment.
From page 544...
... In Canadian Gulf War veterans, the greatest number of symptom groupings was associated with self-reported exposures to psychologic stressors and physical trauma. Several symptom groupings also were associated with exposure to chemical-warfare agents, nonroutine immunizations, sources of infectious diseases, and ionizing or nonionizing radiation.
From page 545...
... set out to determine whether the symptoms that occurred with heightened prevalence in UK Gulf War veterans constituted a new syndrome. By applying factor analysis, they were able to identify three fundamental factors, which they classified as related to mood, respiratory system, and peripheral nervous system.
From page 546...
... None of the factors was exclusive to Gulf War veterans, so the investigators concluded that their findings did not support a new syndrome (Cherry et al., 2001a)
From page 547...
... Findings of health examinations were not used in the study's analysis of symptom-exposure relationships. Of 22 neuropsychologic symptoms, ~ 7 were significantly more prevalent among Gulf War veterans than among controls.
From page 548...
... . Other Studies of Veterans' Symptoms and General Health Status One of the first epidemiologic studies of US Gulf War veterans was of more than A ^~ , · ~ vvo act~ve-ctuty and reserve personnel from Pennsylvania and Hawaii (Stretch et al., ~ 9951.
From page 549...
... The authors concluded that some Gulf War veterans had delayed, chronic nervous system syndromes as a result of exposure to combinations of neurotoxic chemicals (Haley and Kurt, 19971. Another study by Haley and collaborators (1999)
From page 550...
... used factor analysis and other methods to assess the health status of Gulf War veterans. By studying an Air Force National Guard unit from Pennsylvania and three comparison Air Force populations, the investigators aimed to organize symptoms into a case definition and to carry out clinical evaluations on a subset of veterans.
From page 551...
... The first study compared almost 550,000 Gulf War veterans with almost 620,000 nondeployec! veterans and found no significant and consistent differences in hospitalizations after the war (Gray et al., ~ 9961.
From page 552...
... found too few cases of Goldenhar syndrome from which to draw definitive conclusions. The recently published population-based VA study of US Gulf War veterans found that male veterans reported a significantly higher rate of miscarriage than did controls, and both male and female veterans reported significantly higher birth defects among liveborn infants.
From page 553...
... Studies of Stress-Related Disorders Two population-based epidemiologic studies of Gulf War veterans described earlier detected a significant increase in the self-reported prevalence of symptoms of PTSD and depression (Goss Gilroy Inc., 1998; Iowa Persian Gulf Study Group, 1997~.22 In the Iowa study, ~ 7% of Gulf War veterans reported symptoms of depression and ~ .9% reported symptoms of PTSD.23 Those figures were significantly higher than those for nondeployed controls, whose prevalences were ~ I% and 0.~%, respectively (Table A.41. The third population-based study found that UK Gulf War veterans were about 2.5 times more likely than controls to have symptoms of PTSD, there were no significant differences in the levels of depression between deployed veterans and controls (Unwin et al., ~ 9991.
From page 554...
... Yet nearly two-thirds of veterans who reported health symptoms in the moderate to high range had no current psychiatric diagnosis, such as PTSD or major depressive disorder.25 The authors concluded that although psychiatric diagnosis is associated with some Gulf War health complaints, such diagnoses do not account entirely for the full range and extent of Gulf War veterans' symptom reporting. Studies of Infectious Disease, Gastrointestinal Symptoms, and Testicular Cancer During the Gulf War, the occurrence of infectious diseases was lower than expected (Hyannis et al., ~ 9951.
From page 555...
... . LIMITATIONS OF PAST AND CURRENT STUDIES The epidemiologic studies of Gulf War veterans summarized above have contributes!
From page 556...
... Gulf War veterans report more symptoms than do their nondeployed counterparts, according to methodologically robust studies from several countries (Goss Gilroy Tnc., 199S, Kang et al., 2000; Towa Persian Gulf Study Group, 1997; Unwin et al., ~ 9991. Symptoms related to cognition, the musculoskeletal system, and fatigue are more prevalent among Gulf War veterans than controls.
From page 557...
... 1997. Relationship between posttraumatic stress disorder and self-reported physical symptoms in Persian Gulf War veterans.
From page 558...
... 1997. The risk of birth defects among children of Persian Gulf War veterans.
From page 559...
... 1997. A comprehensive clinical evaluation of 20,000 Persian Gulf War veterans.
From page 560...
... 1998. Health status of Persian Gulf War veterans: Self-reported symptoms, environmental exposures and the effect of stress.
From page 561...
... 1998. Signs, symptoms, and ill-defined conditions in Persian Gulf War veterans: Findings from the Comprehensive Clinical Evaluation Program.


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