Gulf War and Health Volume 10: Update of Health Effects of Serving in the Gulf War, 2016 (2016) / Chapter Skim
Currently Skimming:
3 Human Cohort Studies and Their Derivatives
3 Human Cohort Studies and Their Derivatives
Pages 37-66
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 37... ...
Some cohorts, once established, led to numerous studies, or multiple publications that examined more detailed questions about Gulf War veterans' health; the committee refers to those studies as derivatives. A derivative study1 is included and summarized under the original cohort (reference study)
|
From page 38... ...
veterans was mandated by Public Law 103-446 in 1994 to estimate the prevalence of symptoms and other health outcomes (including reproductive outcomes in spouses and birth defects in children) in Gulf War deployed vs nondeployed veterans.
|
From page 39... ...
The study population consisted of a stratified random sample of the 11,441 deployed and 9,476 nondeployed veterans who had responded to the mailed questionnaire or telephone interview described above. This study included a comprehensive medical examination and laboratory testing.
|
From page 40... ...
and chronic fatigue syndrome (CFS) in Gulf War veterans.
|
From page 41... ...
conducted a 10-year follow-up general health assessment of Gulf War veterans in wave 2 of the NHS. For this wave, VA and Social Security records through December 2002 were used to identify and mail health questionnaires to the 29,607 living veterans who had been sampled in wave 1 (15,000 Gulf War deployed and 15,000 nondeployed)
|
From page 42... ...
sampled 200 Gulf War veterans with "chronic fatigue-like multi symptoms" and 398 controls veterans. From those contacted, 16 Gulf War veterans and 12 control veterans completed a telephone interview, met eligibility criteria, and completed a clinical exam with autonomic testing (conventional large fiber nerve conduction, quantitative sensory testing, baseline autonomic testing, quantitative sudomotor axon reflex test, and diagnostic tilt-table test)
|
From page 43... ...
It is cited in the discussion of health conditions in Chapter 4 where appropriate. The Iowa Study In Volume 4, the Iowa Persian Gulf Study was presented as a reference study with eight derivative studies, and the Volume 8 committee identified three studies derived from the original Iowa cohort.
|
From page 44... ...
(2000) used factor analysis to attempt to determine if the symptoms reported by Gulf War veterans after their deployment were different than those reported by nondeployed veterans and if the symptoms seen in the deployed veterans could possibly constitute a unique Gulf War syndrome.
|
From page 45... ...
. Oregon and Washington Veteran Studies One reference study discussed in Volume 4 examined Gulf War veterans who listed Oregon or Washington as their residence at the time of their deployment (McCauley et al., 1999a)
|
From page 46... ...
(2012) conducted a case-control study in 2000 that compared Gulf War veteran's exposures in a population-based sample of 304 deployed veterans residing in the greater Kansas City metropolitan area, 144 with Gulf War illness and 160 healthy controls out of 906 households contacted (86% response rate, 68% participation rate)
|
From page 47... ...
. The Volume 8 committee identified five additional derivative studies of the Haley et al.
|
From page 48... ...
(1997b) recruited members of the Twenty-Fourth Naval Reserve Construction Force Battalion into an epidemiologic study in an effort to identify syndromes that might help define the variety of symptoms experienced by Gulf War veterans.
|
From page 49... ...
Twenty-one Gulf War veterans with symptom complexes used by Haley to define three Gulf War illness syndromes and 17 age-, sex- and education-matched controls, underwent a 99mTc-HMPAO-SPECT brain scan with and without an infusion of PB. The Volume 8 committee also summarized other studies by Haley and colleagues on neurologic outcomes as follows: Haley and colleagues performed detailed neurologic assessments in several case-control studies of the original cohort of Seabee reservists.
|
From page 50... ...
(2010) compared 25 Gulf War veterans from Haley's original cohort of Seabees who reported major cognitive complaints (i.e., the veterans met the criteria for Gulf War illness syndromes 1 or 2)
|
From page 51... ...
(2013) performed a nested case-control study of 66 veterans who had Gulf War illness syndromes 1, 2, or 3 and 31 control veterans randomly selected from the Military Health Study.
|
From page 52... ...
excluded Gulf War veterans who were no longer on active duty at the time of study. In 1994, 1,497 study subjects were enrolled: 527 Gulf War veterans and 970 nondeployed veterans.
|
From page 53... ...
Reference Study One of the first epidemiologic studies of U.S. Gulf War veterans was a congressionally mandated study evaluating the psychologic and physical health of active-duty and reserve Army, Navy, Air Force, and Marine Corps personnel from bases in Hawaii and Pennsylvania (Stretch et al., 1995)
|
From page 54... ...
looked at the incidence of MS and other demyelinating diseases in Gulf War veterans only and investigated disease risk based on selfreported exposures. This study examined 1,841 MS cases (387 deployed; 1,454 nondeployed)
|
From page 55... ...
Derivative Studies Volume 4 noted one study published using the same groups of veterans. The same authors undertook a secondary analysis to address concerns about differential case ascertainment among deployed vs nondeployed veterans.
|
From page 56... ...
No new studies pertaining to the UK veterans were identified by the Volume 10 committee. Although not traditional cohort studies per se, UK Defence Analytical Services Agency has periodically assessed the rates and causes of mortality for the entire population of UK Gulf War veterans.
|
From page 57... ...
(2002) conducted a case-control study examining neuromuscular symptoms in 49 Gulf War veterans with more than four neuromuscular symptoms and lower functioning according to the SF-36 compared with 26 healthy Gulf War deployed veterans, 13 symptomatic Bosnia deployed veterans, and 22 symptomatic nondeployed controls.
|
From page 58... ...
The exposed cohort consisted of all UK Gulf War veterans, and the unexposed cohort consisted of a random sample of nondeployed UK military personnel from the same period. Although the participation rates were low (47.3% and 37.5% of male and female Gulf War veterans, respectively, and 57.3% and 45.6% of male and female nondeployed veterans)
|
From page 59... ...
. Reference Study Investigators from Monash University in Australia conducted the Australian Gulf War Veterans' Health Study by examining all 1,871 Australian veterans deployed to the Gulf War region from August 2, 1990, to September 4, 1991; naval personnel made up 86.5% of this cohort (Sim et al., 2003)
|
From page 60... ...
This study confirms the greater extent and severity of symptoms in Gulf War veterans, even in a predominantly naval population with few direct military attacks, no deaths, and few casualties. The Volume 8 committee identified two additional derivative studies of the Australian Gulf War veterans.
|
From page 61... ...
Neither the Volume 8 nor the Volume 10 committees identified any additional derivative studies on Danish Gulf War veterans. Reference Study Military personnel from Denmark were involved in peacekeeping or humanitarian missions occurring predominantly after the Gulf War ceasefire, but were located in the same areas as other coalition forces who served in Gulf War combat (Ishoy et al., 1999b)
|
From page 62... ...
was considered to be a secondary study in Volume 4, and the Volume 8 committee agreed with that classification because the study relied on self-reports gathered through a mailed questionnaire. The Volume 8 committee identified one new study based on the Canadian Gulf War veterans (Statistics Canada, 2005)
|
From page 63... ...
Zwerling et al., 2000 Prevalence of self-reported postwar injuries Barrett et al., 2002 Association between PTSD and self-reported physical health issues Lange et al., 2002 Exposure to Kuwait oil fires and risk of asthma and bronchitis Black et al., 2004a Prevalence of psychiatric disorders Black et al., 2004b Prevalence and risk factors for anxiety disorders Volume 8 Ang et al., 2006 Identification of predictors of chronic widespread pain Black et al., 2006 Prevalence of borderline personality disorder Forman-Hoffman et al., Prevalence of self-reports of symptoms of chronic widespread pain 2007 New None Oregon and Washington Veterans, McCauley et al., 1999a Volume 4 Bourdette et al., 2001 Prevalence of unexplained illness Spencer et al., 2001 Self-reported exposure and unexplained illness continued
|
From page 64... ...
Military Health Survey, Iannacchione et al., 2011 Volume 4 None Volume 8 None New Haley and Tuite, 2013 Indicators of exposure to chemical warfare and Gulf War illness Haley et al., 2013 Measures of cholinergic autonomic dysfunction in Gulf War illness Hubbard et al., 2014 Executive functioning assessed by fMRI Seabees, Gray et al., 1999a Volume 4 Knoke et al., 2000 Self-report of symptoms Gray et al., 2002 Self-report of symptoms and general health status
|
From page 65... ...
HUMAN COHORT STUDIES AND THEIR DERIVATIVES 65 TABLE 3-1 Continued Cohort/ Reference Study Derivative Studies Purpose/Outcome Volume 8 None New None Pennsylvania Air National Guard Veterans, Fukuda et al., 1998 Volume 4 Nisenbaum et al., 2000 Self-reported exposures and chronic multisymptom illness Nisenbaum et al., 2004 Factor analysis of self-reported symptoms Volume 8 None New None Hawaii and Pennsylvania Active-Duty and Reserve, Stretch et al., 1995 Volume 4 Stretch et al., 1996a Prevalence of psychiatric disorders Stretch et al., 1996b Prevalence of PTSD Volume 8 None New None New Orleans Reservists, Sutker et al., 1995 Volume 4 Sutker et al., 1995 Prevalence of psychologic disorders Brailey et al., 1998 Prevalence of psychiatric disorders Volume 8 None New None Multiple Sclerosis Cohort, Wallin et al., 2012 New Wallin et al., 2014 Risk of MS Amyotrophic Lateral Sclerosis Cohort, Horner et al., 2003 Volume 4 Coffman et al., 2005 Risk of ALS Volume 8 Horner et al., 2008 Risk of ALS New Kasarkis et al., 2009 Clinical features of ALS UK Veterans: University of London, Unwin et al., 1999 Volume 4 Macfarlane et al., 2000 Self-reported exposure and mortality Reid et al., 2001 Self-reported exposure and multiple chemical sensitivity and chronic fatigue syndrome Sharif et al., 2002 Neuromuscular symptoms evaluated through objective tests Hotopf et al., 2003a,b Neurologic assessments Macfarlane et al., 2003 Incidence of cancer Nisenbaum et al., 2004 Factor analysis of self-reported symptoms Rose et al., 2004 Neuromuscular symptoms evaluated through objective tests Macfarlane et al., 2005 Self-reported exposure and mortality Volume 8 Stimpson et al., 2006 Self-report of chronic widespread pain Ismail et al., 2008 Prevalence of chronic fatigue and related disorders through assessment New None continued
|
From page 66... ...
66 GULF WAR AND HEALTH TABLE 3-1 Continued Cohort/ Reference Study Derivative Studies Purpose/Outcome UK Veterans: University of Manchester, Cherry et al., 2001a,b Volume 4 None Volume 8 None New None UK Veterans: London School of Hygiene and Tropical Medicine, Maconochie et al., 2003 Volume 4 Doyle et al., 2004 Prevalence of miscarriage, stillbirth, and congenital malformations Maconochie et al., 2004 Self-report of fertility problems Simmons et al., 2004 Self-report of medical symptoms or disease Volume 8 None New None Australian Veterans, Sim et al., 2003 Volume 4 Forbes et al., 2004 Factor analysis of self-reported symptoms Ikin et al., 2004 Prevalence of psychiatric disorders Kelsall et al., 2004a Association between self-reported exposures with numerous symptoms and medical conditions Kelsall et al., 2004b Self-reported exposure and respiratory health status Mckenzie et al., 2004 Psychological health and functioning Kelsall et al., 2005 Self-report of exposures and neurological symptoms Ikin et al., 2005 Self-report of exposure to stressful events Volume 8 Kelsall et al., 2006 Self-reported exposure and prevalence of chronic fatigue syndrome Kelsall et al., 2007 Self-reported birth defects and other pregnancy outcomes New Kelsall et al., 2009 Comorbidities of multisymptom illness Kelsall et al., 2014 Psychological comorbidities of musculoskeletal disorders Gwini et al., 2015 Prevalence, persistence, and incidence of symptoms Sim et al., 2015 Australian Gulf War Veterans Follow Up Health Study -- all health outcomes Danish Peacekeepers, Ishoy et al., 1999b Volume 4 Ishoy et al., 1999a Prevalence of gastrointestinal symptoms and diseases, skin disease, and respiratory symptoms and function Suadicani et al., 1999 Associations between exposures and self-reported neuropsychological symptoms Ishoy et al., 2001a,b Self-report of sexual dysfunction and birth defects Proctor et al., 2003 Prevalence of neuropsychiatric symptoms and neurobehavioral performance Volume 8 None New None Canadian Veterans, Goss Gilroy Inc., 1998 Volume 4 None Volume 8 Statistics Canada, 2005 Mortality rate and cancer incidence New None NOTE: ALS = amyotrophic lateral sclerosis; CFS = chronic fatigue syndrome; fMRI = functional magnetic resonance imaging; GWI = Gulf War illness; MRI = magnetic resonance imaging; MS = multiple sclerosis; PTSD = posttraumatic stress disorder.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.