Gulf War and Health Volume 3: Fuels, Combustion Products, and Propellants (2005) / Chapter Skim
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Pages 317-346
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317 8 OTHER HEALTH OUTCOMES This chapter will review the epidemiologic literature on possible associations between exposure to fuels and combustion products and a variety of health outcomes: posttraumatic stress disorder, neurologic outcomes, multiple chemical sensitivity, dermatologic outcomes, and sarcoidosis. The outcomes discussed in this chapter do not necessarily have a large literature base, but they are reviewed here because there might be veterans who have an interest in them.
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318 GULF WAR AND HEALTH • Exposure-free period for reversible neurologic effects. To be relevant to Gulf War veterans, the study had to examine long-term rather than short-term effects.
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OTHER HEALTH OUTCOMES 319 Peripheral Neuropathy The committee defined peripheral neuropathy as requiring a diagnosis with a thorough neurologic examination confirmed by quantitative laboratory testing, preferably using nerveconduction studies and electromyography. Because peripheral neuropathy is often irreversible, the committee did not require a study to meet its criterion for an exposure-free period.
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320 GULF WAR AND HEALTH Neurobehavioral Effects A team of Australian researchers (Maruff et al.
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OTHER HEALTH OUTCOMES 321 correlation between blood lead and neurobehavioral outcomes and a lack of correlation between blood toluene or benzene and outcomes. Chronic lead exposure, accumulated over a lifetime, has been found within the last several years to be associated with cognitive deficits in adults (Muldoon et al.
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322 GULF WAR AND HEALTH Posttraumatic Stress Disorder PTSD is a commonly studied neurologic effect in firefighters, one of the occupations of interest to this committee. It is a highly disabling anxiety disorder that affects 3-4% of the US population (US DHHS 1999)
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OTHER HEALTH OUTCOMES 323 exposure or injury (Baker et al.
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324 GULF WAR AND HEALTH together with Gulf War studies, all of which had self-reported exposure, provide only weak evidence of a relationship. The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between exposure to combustion products and neurobehavioral effects.
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OTHER HEALTH OUTCOMES 325 low on the basis of area of residence where H2S was mapped with passive sampling. Exposureresponse trends were found for diseases of the nervous system and sense organs (p for trend <0.0001)
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326 GULF WAR AND HEALTH exposures. MCS is not formally recognized as a diagnosis in the 10th revision of ICD.
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OTHER HEALTH OUTCOMES 327 US Population-Based Sample Condition Prevalence Kreutzer et al. 1999, n = 4,046 Self-reported doctor-diagnosed illness (environmental illness or MCS)
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328 GULF WAR AND HEALTH varied in methods, samples of veterans, definitions of exposure (for example, causal exposure vs trigger) and case definitions of MCS.
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OTHER HEALTH OUTCOMES 329 from oil fires, burning rubbish/feces, diesel on skin, and Scud missile explosion. The exposures were the same as in Unwin et al.
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330 GULF WAR AND HEALTH down when investigators found benzene at 60 ppm. No air measurements of gasoline were taken, because pumps malfunctioned, but the authors reported that those workers symptoms of headache, throat irritation, eye irritation, and cough were consistent with gasoline at 150 and 500 ppm.
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OTHER HEALTH OUTCOMES 331 TABLE 8.2 Common Triggers and Original Causes Reported by People with Chemical Sensitivity (n = 235) Population-Based Sample What triggers a reaction?
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332 GULF WAR AND HEALTH long-term dermatologic effects; each one examined some form of dermatitis, and they are discussed below. Dermatitis is inflammation of the skin as evidenced by signs of scaling, crusting, redness, and swelling.
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334 R ef er en ce T yp e of S tu dy a nd Po pu la tio n E xp os ur e D et er m in at io n H ea lth O ut co m e an d H ow M ea su re d R es ul ts A dj us te d O R (9 5% C I o r p)
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OTHER HEALTH OUTCOMES 335 Jia et al.
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336 GULF WAR AND HEALTH study found higher rates of skin sensitization to D pteronyssinus or mixed threshings among those with the combination exposure (OR 1.78, 95% CI 1.06-2.97)
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OTHER HEALTH OUTCOMES 337 SARCOIDOSIS Sarcoidosis is an inflammatory disorder that features accumulation of T lymphocytes and mononuclear phagocytes. The lungs are most frequently affected and undergo inflammatory changes, fibrosis, and other abnormalities; but skin, eyes, and lymph nodes may also be affected.
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339 R ef er en ce , C ou nt ry C as es C on tr ol s E xp os ur e D et er m in at io n E xp os ur e A dj us te d O R (9 5% C I o r p)
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340 GULF WAR AND HEALTH The study had numerous limitations, such as inadequate description of how the cases without biopsy confirmation were diagnosed and the lack of control for employment history (besides farming) , recall bias, and lack of measurement of pollutant concentrations.
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OTHER HEALTH OUTCOMES 341 laboratory results. Investigators compared medical history, exposures, chest radiographs, and seromarkers of T-lymphocyte activation; serum neopterin and interleukin-2 receptors, which are surrogate markers of lymphocytic alveolitis, were used because subjects were not willing to undergo bronchoalveolar lavage.
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342 GULF WAR AND HEALTH Bates MN, Garrett N, Graham B, Read D
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OTHER HEALTH OUTCOMES 343 Davidoff AL, Keyl PM, Meggs W
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344 GULF WAR AND HEALTH Kern DG, Neill MA, Wrenn DS, Varone JC.
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OTHER HEALTH OUTCOMES 345 Prezant DJ, Dhala A, Goldstein A, Janus D, Ortiz F, Aldrich TK, Kelly KJ.
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346 GULF WAR AND HEALTH US DHHS (US Department of Health and Human Services)
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