Chronic Multisymptom Illness in Gulf War Veterans Case Definitions Reexamined (2014) / Chapter Skim
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5 Chronic Multisymptom Illness Case Definitions and Recommendations
5 Chronic Multisymptom Illness Case Definitions and Recommendations
Pages 87-102
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From page 87... ...
The committee recognizes the difficulty of establishing a consensus case definition of CMI, given the lack of uniform symptoms, the variety of symptoms, and the long onset and duration. However, CMI is an important cause of disability in Gulf War veterans and the lack of a consensus case definition poses problems for those who are suffering with it.
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From page 88... ...
(1997) defined multisymptom illness in Gulf War veterans on the basis of factor analysis (see Chapter 4)
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From page 89... ...
The three primary syndrome factors were impaired cognition, confusion–ataxia, and central pain (termed arthromyoneuropathy in the original study) ; and the four additional variables or secondary symptom factors were chronic watery diarrhea, chronic fatigue involving excessive muscle weakness, chronic fever and night sweats, and middle and terminal insomnia.
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From page 90... ...
Several followup studies of Gulf War veterans have used the CDC definition in other study populations, some with modifications. For example, Rayhan et al.
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From page 91... ...
The authors compared their questionnaire results with the CDC definition of CMI and found that 25.3% of Gulf War veterans, 12.2% of era veterans, and 11.8% of Bosnia-deployed veterans met the criteria. In all three groups of veterans, meeting the CDC case definition was significantly associated with a variety of wartime and environmental exposures (Unwin et al., 1999)
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From page 92... ...
The proportion of exclusionary conditions was similar in deployed and nondeployed veterans. Notably, Gulf War veterans were more likely than nondeployed veterans to report moderate or multiple symptoms in three or more symptom groups.
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From page 93... ...
The factor analysis–derived case definition was congruent with the clinically derived definition, but the selection of cases differed, identifying 10 of 113 controls as cases and 52 of 241 cases as controls. Department of Veterans Affairs VA sponsored several studies of the health of Gulf War veterans (Kang et al., 2000, 2002)
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From page 94... ...
This clinically derived definition of unexplained multisymptom illness had the highest adjusted OR among more than 20 conditions but was not unique to Gulf War veterans (Kang et al., 2009)
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From page 95... ...
musculoskeletal symptoms, including back pain, persistent muscle aches or pains, painful joints, swollen joints, joint stiffness, and pain after exertion VA Might include things like fatigue, ≥6 Must not be (Kang et muscle or joint pain, headache, months adequately al., 2009) memory problems, digestive explained by problems, respiratory problems, skin conventional problems, or any other unexplained medical or symptoms that may sometimes be psychiatric diagnosed as chronic fatigue diagnoses syndrome, fibromyalgia, irritable bowel syndrome, or multiple chemical sensitivity NOTE: CDC = Centers for Disease Control and Prevention; VA = Department of Veterans Affairs.
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From page 96... ...
Furthermore, the different symptoms in the symptom-based studies -- as summarized in Chapter 3, Table 4.2, and Appendix B -- were regularly reported with higher frequency in Gulf War veterans than in nondeployed era veterans or veterans deployed elsewhere; they include gastrointestinal, respiratory, and dermatologic symptoms in addition to the fatigue, pain, and neurocognitive symptoms already identified. The committee recognized that two existing definitions -- the CDC definition and the Kansas definition (see Table 5.1)
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From page 97... ...
(2011) NOTE: CDC = Centers for Disease Control and Prevention; CMI = chronic multisymptom illness; FA = factor analysis; GWV = Gulf War veteran; NDV = nondeployed veteran; VA = Department of Veterans Affairs.
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From page 98... ...
The CDC definition captures those three symptoms; the Kansas definition also captures them, but it also includes the symptoms reported most frequently by Gulf War veterans (see Appendix B)
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From page 99... ...
. The Gulf War veterans report more symptoms and with greater frequency and severity than nondeployed veterans or veterans who were deployed elsewhere, but the types and patterns of symptoms are the same in all groups, and this suggests that no unique syndrome is associated with Gulf War deployment.
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From page 100... ...
2001. Prevalence of Gulf War veterans who believe they have Gulf War syndrome: Questionnaire study.
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From page 101... ...
U.S. Gulf War veterans: Service periods in theater, differential exposures, and persistent unexplained illness.
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