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Robert W Haley - One of the best experts on this subject based on the ideXlab platform.
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Gulf War illness associated with abnormal auditory p1 event related potential evidence of impaired cholinergic processing replicated in a national sample
Psychiatry Research-neuroimaging, 2019Co-Authors: Gail D Tillman, Robert W Haley, Richard W Briggs, Jeffrey S Spence, John Hart, Michael A KrautAbstract:Abstract Our team previously reported event-related potential (ERP) and hyperarousal patterns from a study of one construction battalion of the U.S. Naval Reserve who served during the 1991 Persian Gulf War. We sought to replicate these findings in a sample that was more representative of the entire Gulf War-era veteran population, including male and female participants from four branches of the military. We collected ERP data from 40 veterans meeting Haley criteria for Gulf War syndromes 1–3 and from 22 matched Gulf War veteran controls while they performed an auditory oddball task. Reports of hyperarousal from the ill veterans were significantly greater than those from the control veterans, and P1 amplitudes in Syndromes 2 and 3 were significantly higher than P1 amplitudes in Syndrome 1, replicating our previous findings. Many of the contributors to the generation of the P1 potential are also involved in the regulation of arousal and are modulated by cholinergic and dopaminergic systems—two systems whose dysfunction has been implicated in Gulf War illness. These differences among the three syndrome groups where their means were on either side of controls is a replication of our previous ERP study and is consistent with previous imaging studies of this population.
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event related potential patterns associated with hyperarousal in Gulf War illness syndrome groups
Neurotoxicology, 2012Co-Authors: Gail D Tillman, Robert W Haley, Richard W Briggs, Clifford S Calley, Timothy A Green, Virginia I Buhl, Melanie M Biggs, Jeffrey S Spence, John HartAbstract:An exaggerated response to emotional stimuli is one of the several symptoms widely reported by veterans of the 1991 Persian Gulf War. Many have attributed these symptoms to post-War stress; others have attributed the symptoms to deployment-related exposures and associated damage to cholinergic, dopaminergic, and white matter systems. We collected event-related potential (ERP) data from 20 veterans meeting Haley criteria for Gulf War Syndromes 1-3 and from 8 matched Gulf War veteran controls, who were deployed but not symptomatic, while they performed an auditory three-condition oddball task with gunshot and lion roar sounds as the distractor stimuli. Reports of hyperarousal from the ill veterans were significantly greater than those from the control veterans; different ERP profiles emerged to account for their hyperarousability. Syndromes 2 and 3, who have previously shown brainstem abnormalities, show significantly stronger auditory P1 amplitudes, purported to indicate compromised cholinergic inhibitory gating in the reticular activating system. Syndromes 1 and 2, who have previously shown basal ganglia dysfunction, show significantly weaker P3a response to distractor stimuli, purported to indicate dysfunction of the dopaminergic contribution to their ability to inhibit distraction by irrelevant stimuli. All three syndrome groups showed an attenuated P3b to target stimuli, which could be secondary to both cholinergic and dopaminergic contributions or disruption of white matter integrity.
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absolute quantification of human brain metabolites in Gulf War syndrome using proton mr spectroscopy at 3t
2010Co-Authors: S Cheshkov, Richard W Briggs, A Chang, S Ganji, E Babcock, Robert W HaleyAbstract:Results Spectra with a large water line width (> 0.14 ppm or 18 Hz), low water suppression (< 99%), or obvious artifacts were discarded. On the basis of the criteria, 8 (15%) of 55 spectra in left BG and 2 (4%) of 53 spectra in right BG had unacceptable spectral quality. Short-TE MR spectra acquired on localized volume of interest in MRI normal-appearing basal ganglia of Gulf War veterans are shown in Figure 1. After the T1 and T2 corrections were made, the NAA concentration was significantly lower in basal ganglia in veterans with Syndrome 1 (left, P = 0.028; right, P = 0.008), Syndrome 2 (left, P = 0.002; right, P = 0.028), and Syndrome 3 (left, P = 0.313; right, P = 0.027) than in the control subjects, which is consistent with the findings of the previous study [1], which reported only ratios. In addition, the mean NAA concentration was significantly higher in the left basal ganglia than in the right basal ganglia in all GW syndrome groups, with an overall hemispheric effect significance of P < 0.0001 (Figure 2). Discussion This study represents, to our knowledge, the first in vivo measurements of absolute metabolite concentrations from the basal ganglia in veterans with Gulf War syndrome using 1 H MRS. The main observation in this work was the reduction of NAA concentration (-6% for Syndrome 1, -8% for Syndrome 2, and -3% for Syndrome 3) in left BG and in right BG (-6% for Syndrome 1, -6% for Syndrome 2, and -4% for Syndrome 3) of GWS subjects compared to healthy control subjects, significant for Syndromes 1 and 2 in left BG and Syndromes 1, 2, and 3 in right BG. Hence, the present study demonstrated that quantitative in vivo 1 H MRS can be used to detect the biochemical abnormalities in brain of GW illness veterans, which may have relevance for the mechanisms of Gulf War syndrome. Our finding supports that the various neurological symptoms reported by Gulf War veterans could be linked to brain injury incurred during the Gulf War. References
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blunted circadian variation in autonomic regulation of sinus node function in veterans with Gulf War syndrome
The American Journal of Medicine, 2004Co-Authors: Robert W Haley, Frederick Petty, Wanpen Vongpatanasin, Gil I Wolfe, Wilson W Bryan, Roseanne Armitage, Robert Hoffmann, Timothy S Callahan, Elizabeth Charuvastra, William E ShellAbstract:Purpose To test the hypothesis that subtle abnormalities of the autonomic nervous system underlie the chronic symptoms reported by many Gulf War veterans, such as chronic diarrhea, dizziness, fatigue, and sexual dysfunction. Methods Twenty-two ill Gulf War veterans and 19 age-, sex-, and education-matched control veterans underwent measurement of circadian rhythm of heart rate variability by 24-hour electrocardiography, ambulatory blood pressure recording, Valsalva ratio testing, sympathetic skin response evaluation, sweat imprint testing, and polysomnography. Investigators were blinded to case- or control-group status. Results High-frequency spectral power of heart rate variability increased normally 2.2-fold during sleep in controls but only 1.2-fold in ill veterans (P Conclusion Some symptoms of Gulf War syndrome may be due to subtle autonomic nervous system dysfunction.
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severely reduced functional status in veterans fitting a case definition of Gulf War syndrome
American Journal of Public Health, 2002Co-Authors: Robert W Haley, Ann Matt Maddrey, Howard K GershenfeldAbstract:More than 110 000 (16%) of the 696 000 US military personnel who served in the 1991 Persian Gulf War have been granted service-connected disability compensation.1 This is 2 to 3 times the rate that followed World War II (8.6%), the Korean Conflict (5%), or the Vietnam War (9.6%).1 Although many veterans report serious impairments in daily functioning, no research, to our knowledge, has assessed the health impact of Gulf War syndrome as measured by a systematic case definition. In 1997, Haley et al. described a case definition of Gulf War syndrome composed of 3 primary symptom complexes (syndromes) beginning during or shortly after the War.2–4 This case definition, identified by a factor analysis of symptoms in 249 members of a battalion that served in the War, was found to be strongly associated (relative risks of 4 to 8) with self-reported Wartime exposures to low-level chemical nerve agents and other cholinesterase-inhibiting chemicals,4 genetic susceptibility to chemical nerve agents and other organophosphates,5,6 abnormal audiovestibular tests indicating brainstem dysfunction,3,7 evidence of basal ganglia and brain stem neuronal loss as measured by magnetic resonance spectroscopy,8,9 and abnormal brain dopamine production.10 Results were recently replicated in an independent sample of Gulf War veterans.11 In 1998, we conducted a nested case–control study at the University of Texas Southwestern Medical Center involving individuals from a naval reserve battalion; 22 subjects with the highest scores on one of the 3 Haley syndrome factor scales were selected as case patients.2,3 This criterion allowed selection of subjects with symptoms most typical of the case definition irrespective of symptom severity (not measured) and total number of symptoms, and thus there was no bias for or against severity of illness. Sixteen healthy veterans matched with case patients in regard to age, sex, and education level were selected from the same battalion to serve as controls.3 We administered the Medical Outcomes Study 36-Item Short Form (MOS SF-36) self-report questionnaire, a validated, widely accepted measure of general health, functional status, and well-being, to assess the functional status and well-being of the case patients and controls.12 Because of the existence of population-based, noninstitutionalized norms, this questionnaire serves as the “gold standard” for comparisons among illnesses. Hundreds of published studies have applied the instrument in such comparisons.12 We found that the level of impairment of ill Gulf War veterans meeting the Haley case definition was generally far worse than that of patients with common illnesses known to have a substantial negative impact, including congestive heart failure, type 2 diabetes, recent acute myocardial infarction, chronic obstructive pulmonary disease, and clinical depression (Figure 1 ▶).12 Moreover, a repeated measures analysis of variance (F1,20 = 18, P < .001) showed that the impact of Haley's “confusion–ataxia” syndrome was substantially worse than that of his “impaired cognition” and “central pain” syndromes, confirming earlier published observations.2–5,7,8,10 In other settings, low MOS SF-36 scores such as those revealed in this study have been shown to be highly predictive of inability to work at a paying job.12 FIGURE 1 —Medical Outcomes Study 36-Item Short Form (MOS SF-36) scores among Gulf War veteran case patients and controls (top) and MOS SF-36 scores for 6 reference medical conditions (bottom). A previous survey suggested that MOS SF-36 scores were only slightly lower in samples of Gulf War veterans than in nondeployed military personnel residing in Iowa, giving rise to the view that Gulf War–related illness has a small impact on functional status and well-being.13 However, the Iowa study reported the scores of ill Gulf War veterans combined with those of the far larger veteran population, thus obscuring the true disability level of the former group. By separating ill Gulf War veterans by means of a case definition, our study demonstrated severely diminished functional status and quality of life among those affected, commensurate with our clinical observations. This finding, coupled with previous research,1–10 suggests that many veterans are seriously impaired by brain illnesses or injuries sustained in the Gulf War.
Han K. Kang - One of the best experts on this subject based on the ideXlab platform.
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Self-reported post-exertional fatigue in Gulf War veterans: roles of autonomic testing
Frontiers Media S.A., 2014Co-Authors: Han K. Kang, Clare M Mahan, Mian Eli, Changqing Exu, Wenguo EyaoAbstract:To determine if objective evidence of autonomic dysfunction exists from a group of Gulf War veterans with self-reported post-exertional fatigue, we evaluated 16 Gulf War ill veterans and 12 Gulf War controls. Participants of the ill group had self- reported, unexplained chronic post-exertional fatigue and the illness symptoms had persisted for years until the current clinical study. The controls had no self-reported post-exertional fatigue either at the time of initial survey nor at the time of the current study. We intended to identify clinical autonomic disorders using autonomic and neurophysiologic testing in the clinical context. We compared the autonomic measures between the 2 groups on cardiovascular function at both baseline and head-up tilt, and sudomotor function. We identified 1 participant with orthostatic hypotension, 1 posture orthostatic tachycardia syndrome, 2 distal small fiber neuropathy, and 1 length dependent distal neuropathy affecting both large and small fiber in the ill group; whereas none of above definable diagnoses was noted in the controls. The ill group had a significantly higher baseline heart rate compared to controls. Compound autonomic scoring scale showed a significant higher score (95% CI of mean: 1.72 to 2.67) among ill group compared to controls (0.58 to 1.59). We conclude that objective autonomic testing is necessary for the evaluation of self-reported, unexplained post-exertional fatigue among some Gulf War veterans with multi-symptom illnesses. Our observation that ill veterans with self-reported post-exertional fatigue had objective autonomic measures that were worse than controls Warrants validation in a larger clinical series
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investigating the risk of cancer in 1990 1991 us Gulf War veterans with the use of state cancer registry data
Annals of Epidemiology, 2010Co-Authors: Heather A Young, Han K. Kang, Clare M Mahan, Samuel J Simmens, Paul H Levine, Jessica MaillardAbstract:Purpose The purpose of this study was to determine whether proportional cancer incidence is greater among Gulf War veterans compared with non-Gulf War veterans. Methods Files obtained from the Defense Manpower Data Center included data for 621,902 veterans who were deployed to the Persian Gulf during the 1990 to 1991 Gulf War (August 2, 1990, to March 1, 1991) and 746,248 non-Gulf War veteran controls. Identification of veterans who received a cancer diagnosis between 1991 and 2006 was accomplished through record linkage of the Defense Manpower Data Center dataset with files from 28 state cancer registries and the Department of Veterans Affairs Central Cancer Registry. By the use of logistic regression, proportional incidence ratios adjusted for demographic and military characteristics were calculated by comparing the proportion of a specific cancer among all cancers in the Gulf War veterans to the proportion of that specific cancer among all cancers in the non-Gulf War veterans. Results Only lung cancer showed a statistically significant relative excess among Gulf War veterans compared with non-Gulf War veterans (adjusted proportional incidence ratios, 1.15; 95% confidence interval, 1.03−1.29). When adjusted for race, age, and sex, the overall proportion of cancers among Gulf War and non-Gulf War veterans was similar (odds ratio, 0.99; 95% CI, 0.96−1.02). Conclusions With the exception of lung cancer, there is little evidence of excess risk of cancer associated with Gulf War deployment. A follow-up study is Warranted to confirm this finding and to evaluate the role of greater smoking rates among deployed personnel.
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the role of sexual assault on the risk of ptsd among Gulf War veterans
Annals of Epidemiology, 2005Co-Authors: Han K. Kang, Clare M Mahan, Nancy A Dalager, Erick K IshiiAbstract:PURPOSE: The 1991 Gulf War was the first major military deployment where female troops were integrated into almost every military unit, except for combat ground units. We evaluated the impact of reported sexual trauma during this deployment on the risk of post-traumatic stress disorder (PTSD) after the War. METHODS: A nested case-control analysis was conducted using the data collected in a population-based health survey of 30,000 Gulf War era veterans. A total of 1381 Gulf War veterans with current PTSD were compared with 10,060 Gulf veteran controls without PTSD for self-reported in-theater experiences of sexual harassment/assault and combat exposure. RESULTS: The adjusted odds ratio (aOR) for PTSD associated with a report of sexual assault was 5.41 (95% confidence interval [CI], 3.19-9.17) in female veterans and 6.21 (95% CI, 2.26-17.04) in male veterans. The aOR for PTSD associated with "high" combat exposure was also statistically significant (aOR, 4.03 [95% CI, 1.97-8.23] for females; aOR, 4.45 [95% CI, 3.54-5.60] for males). CONCLUSION: Notwithstanding a possibility of recall bias of combat and sexual trauma, for both men and women, sexual trauma as well as combat exposure appear to be strong risk factors for PTSD.
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factor analysis of fatiguing syndrome in Gulf War era veterans implications for etiology and pathogenesis
Journal of Occupational and Environmental Medicine, 2003Co-Authors: Heather A Young, Han K. Kang, Clare M Mahan, Samuel J Simmens, Paul H LevineAbstract:This study used factor analysis to identify possible subgroups of symptoms of fatiguing syndrome (FS). Subjects were classified with FS according to the 1994 modified Centers for Disease Control and Prevention criteria with the exception that the chronicity of excessive fatigue could not be documented. The cases consisted of 640 Gulf War veterans who met the criteria, whereas the control groups were composed of 5417 Gulf War and 6493 non-Gulf War veterans who did not meet the criteria and had none of the medical conditions that were exclusionary in the FS group. Factor analyses were performed separately in each group. Factor analysis revealed 6 subgroups: fatigue, pain, infectious, gastrointestinal, respiratory, and neurologic/mood/fatigue. Although the factors were similar for both groups, they were more differentiated in the FS group than in the control group as evidenced by interfactor correlations.
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post traumatic stress disorder and chronic fatigue syndrome like illness among Gulf War veterans a population based survey of 30 000 veterans
American Journal of Epidemiology, 2003Co-Authors: Han K. Kang, Benjamin H Natelson, Clare M Mahan, Frances M MurphyAbstract:: The authors estimated the prevalence of post-traumatic stress disorder (PTSD) and illness resembling chronic fatigue syndrome (CFS) in the entire population of Gulf War and non-Gulf-War veterans. They also evaluated the relation between the extent of deployment-related stress and the risk of either PTSD or CFS. In 1995-1997, the authors conducted a health survey in which these two symptom-based medical diagnoses in a population-based sample of 15,000 Gulf War veterans representing four military branches and three unit components (active, reserve, and National Guard) were compared with those of 15,000 non-Gulf veteran controls. Gulf War veterans, compared with non-Gulf veteran controls, reported significantly higher rates of PTSD (adjusted odds ratio = 3.1, 95% confidence interval: 2.7, 3.4) and CFS (adjusted odds ratio = 4.8, 95% confidence interval: 3.9, 5.9). The prevalence of PTSD increased monotonically across six levels of deployment-related stress intensity (test for trend: p < 0.01), while the prevalence of CFS rose only at the low end of the stress spectrum. While deployment-related stress could account for the higher risks of both PTSD and CFS, additional factor(s) unique to the Gulf environment may have contributed to the risk of CFS among Gulf War veterans.
Lea Steele - One of the best experts on this subject based on the ideXlab platform.
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Associations of Immune Genetic Variability with Gulf War Illness in 1990–1991 Gulf War Veterans from the Gulf War Illness Consortium (GWIC) Multisite Case-Control Study
'MDPI AG', 2021Co-Authors: Janet K. Coller, Lea Steele, Nancy Klimas, Emily Quinn, Maria Abreu, Kristina Aenlle, Jonathan Tuke, Taylor J. Wain, Kimberly SullivanAbstract:Gulf War illness (GWI) encompasses a constellation of persistent debilitating symptoms associated with significant changes in central nervous system (CNS) and immune functioning. Currently, there is no validated biomarker for GWI risk susceptibility. Given the impact of immune responses linked to GWI symptomology, genetic variability that causes persistent inflammatory/immune alterations may be key. This Boston University-based Gulf War Illness Consortium (GWIC) study investigated the impact of single nucleotide polymorphisms (SNPs) in variants of immune and pain genetic markers IL1B, IL2, IL6, IL6R, IL10, TNF, TGF, TLR2, TLR4, MD2, MYD88, BDNF, CRP, ICE, COMT and OPRM1 on GWI occurrence in a Caucasian subset of Gulf War (GW) veterans with (cases, n = 170) and without (controls, n = 34) GWI. Logistic regression modeling created a prediction model of GWI risk that associated genetic variability in TGF (rs1800469, p = 0.009), IL6R (rs8192284, p = 0.004) and TLR4 (rs4986791, p = 0.013) with GWI occurrence. This prediction model was specific and sensitive, with a receiver operator characteristic area under the curve of 71.4%. This is the first report of immune genetic variability being predictive of GWI and Warrants validation in larger independent cohorts. Future reports will present interactions of these genetic risk factors with other characteristics of GW service
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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
'MDPI AG', 2021Co-Authors: Lea Steele, Nancy Klimas, Maxine Krengel, Emily Quinn, Rosemary Toomey, Deborah Little, Maria Abreu, Kristina Aenlle, Ronald Killiany, Bang-bon KooAbstract: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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butyrylcholinesterase genotype and enzyme activity in relation to Gulf War illness preliminary evidence of gene exposure interaction from a case control study of 1991 Gulf War veterans
Environmental Health, 2015Co-Authors: Lea Steele, Oksana Lockridge, Mary M Gerkovich, Mary R Cook, Antonio SastreAbstract:Background Epidemiologic studies have implicated Wartime exposures to acetylcholinesterase (AChE)-inhibiting chemicals as etiologic factors in Gulf War illness (GWI), the multisymptom condition linked to military service in the 1991 Gulf War. It is unclear, however, why some veterans developed GWI while others with similar exposures did not. Genetic variants of the enzyme butyrylcholinesterase (BChE) differ in their capacity for metabolizing AChE-inhibiting chemicals, and may confer differences in biological responses to these compounds. The current study assessed BChE enzyme activity and BChE genotype in 1991 Gulf War veterans to evaluate possible association of this enzyme with GWI.
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Prevalence and Patterns of Gulf War Illness Steele Prevalence and Patterns of Gulf War Illness in Kansas Veterans: Association of Symptoms with Characteristics of Person, Place, and Time of Military
2014Co-Authors: Lea SteeleAbstract:Gulf War veterans have reported health problems that they attribute to their military service, but little is understood about the nature or extent of these conditions. To determine whether Kansas Gulf War veterans are affected by excess health problems, a population-based survey of 1,548 veterans who served in the Persian Gulf War (PGW) and 482 veterans who served elsewhere (non-PGW) was conducted in 1998. Gulf War illness, defined as having chronic symptoms in three of six domains, occurred in 34 % of PGW veterans, 12 % of non-PGW veterans who reported receiving vaccines during the War, and 4 % of non-PGW veterans who did not receive vaccines. The prevalence of Gulf War illness was lowest among PGW veterans who served on board ship (21%) and highest among those who were in Iraq and/or Kuwait (42%). Among PGW veterans who served away from battlefield areas, Gulf War illness was least prevalent among those who departed the region prior to the War (9%) and most prevalent among those who departed in June or July of 1991 (41%). Observed patterns suggest that excess morbidity among Gulf War veterans is associated with characteristics of their Wartime service, and that vaccines used during the War may be a contributing factor. Am J Epidemiol 2000;152:992–1002. fatigue syndrome, chronic; Persian Gulf syndrome; risk factors; symptoms and general pathology; veterans Received for publication December 17, 1999, and accepted for publication August 3, 2000. Abbreviations: CI, confidence interval; non-PGW, veterans who did not serve in the Persian Gulf War; OR, odds ratio; PGW, veter-ans who served in the Persian Gulf War
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prevalence and patterns of Gulf War illness in kansas veterans association of symptoms with characteristics of person place and time of military service
American Journal of Epidemiology, 2000Co-Authors: Lea SteeleAbstract:: Gulf War veterans have reported health problems that they attribute to their military service, but little is understood about the nature or extent of these conditions. To determine whether Kansas Gulf War veterans are affected by excess health problems, a population-based survey of 1,548 veterans who served in the Persian Gulf War (PGW) and 482 veterans who served elsewhere (non-PGW) was conducted in 1998. Gulf War illness, defined as having chronic symptoms in three of six domains, occurred in 34% of PGW veterans, 12% of non-PGW veterans who reported receiving vaccines during the War, and 4% of non-PGW veterans who did not receive vaccines. The prevalence of Gulf War illness was lowest among PGW veterans who served on board ship (21%) and highest among those who were in Iraq and/or Kuwait (42%). Among PGW veterans who served away from battlefield areas, Gulf War illness was least prevalent among those who departed the region prior to the War (9%) and most prevalent among those who departed in June or July of 1991 (41%). Observed patterns suggest that excess morbidity among Gulf War veterans is associated with characteristics of their Wartime service, and that vaccines used during the War may be a contributing factor.
Clare M Mahan - One of the best experts on this subject based on the ideXlab platform.
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FAST TRACK ARTICLE Health of US Veterans of 1991 Gulf War: A Follow-Up Survey in 10 Years
2015Co-Authors: Han Kang K. Drph, Clare M Mahan, Seth A. Eisen, Charles C. EngelAbstract:Objective: To assess periodically the health status of a cohort of 1991 Gulf War veterans by comparing various health outcomes with those of their military peers who were not deployed to the Gulf. Methods: We conducted a follow-up health survey to collect health information among population-based samples of 30,000 veterans (15,000 Gulf War veterans and 15,000 Gulf Era veterans) using a structured question-naire. Results: Gulf veterans reported significantly higher rates of unexplained multi-symptom illness, chronic fatigue syndrome-like ill-ness, posttraumatic stress disorder, functional impairment, health care utilization, a majority of selected physical conditions and all mental disorders queried during the survey than did Gulf Era veteran controls. Conclusions: Fourteen years after deployment, 1991 Gulf War veterans continue to report a higher prevalence of many adverse health outcomes
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Self-reported post-exertional fatigue in Gulf War veterans: roles of autonomic testing
Frontiers Media S.A., 2014Co-Authors: Han K. Kang, Clare M Mahan, Mian Eli, Changqing Exu, Wenguo EyaoAbstract:To determine if objective evidence of autonomic dysfunction exists from a group of Gulf War veterans with self-reported post-exertional fatigue, we evaluated 16 Gulf War ill veterans and 12 Gulf War controls. Participants of the ill group had self- reported, unexplained chronic post-exertional fatigue and the illness symptoms had persisted for years until the current clinical study. The controls had no self-reported post-exertional fatigue either at the time of initial survey nor at the time of the current study. We intended to identify clinical autonomic disorders using autonomic and neurophysiologic testing in the clinical context. We compared the autonomic measures between the 2 groups on cardiovascular function at both baseline and head-up tilt, and sudomotor function. We identified 1 participant with orthostatic hypotension, 1 posture orthostatic tachycardia syndrome, 2 distal small fiber neuropathy, and 1 length dependent distal neuropathy affecting both large and small fiber in the ill group; whereas none of above definable diagnoses was noted in the controls. The ill group had a significantly higher baseline heart rate compared to controls. Compound autonomic scoring scale showed a significant higher score (95% CI of mean: 1.72 to 2.67) among ill group compared to controls (0.58 to 1.59). We conclude that objective autonomic testing is necessary for the evaluation of self-reported, unexplained post-exertional fatigue among some Gulf War veterans with multi-symptom illnesses. Our observation that ill veterans with self-reported post-exertional fatigue had objective autonomic measures that were worse than controls Warrants validation in a larger clinical series
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investigating the risk of cancer in 1990 1991 us Gulf War veterans with the use of state cancer registry data
Annals of Epidemiology, 2010Co-Authors: Heather A Young, Han K. Kang, Clare M Mahan, Samuel J Simmens, Paul H Levine, Jessica MaillardAbstract:Purpose The purpose of this study was to determine whether proportional cancer incidence is greater among Gulf War veterans compared with non-Gulf War veterans. Methods Files obtained from the Defense Manpower Data Center included data for 621,902 veterans who were deployed to the Persian Gulf during the 1990 to 1991 Gulf War (August 2, 1990, to March 1, 1991) and 746,248 non-Gulf War veteran controls. Identification of veterans who received a cancer diagnosis between 1991 and 2006 was accomplished through record linkage of the Defense Manpower Data Center dataset with files from 28 state cancer registries and the Department of Veterans Affairs Central Cancer Registry. By the use of logistic regression, proportional incidence ratios adjusted for demographic and military characteristics were calculated by comparing the proportion of a specific cancer among all cancers in the Gulf War veterans to the proportion of that specific cancer among all cancers in the non-Gulf War veterans. Results Only lung cancer showed a statistically significant relative excess among Gulf War veterans compared with non-Gulf War veterans (adjusted proportional incidence ratios, 1.15; 95% confidence interval, 1.03−1.29). When adjusted for race, age, and sex, the overall proportion of cancers among Gulf War and non-Gulf War veterans was similar (odds ratio, 0.99; 95% CI, 0.96−1.02). Conclusions With the exception of lung cancer, there is little evidence of excess risk of cancer associated with Gulf War deployment. A follow-up study is Warranted to confirm this finding and to evaluate the role of greater smoking rates among deployed personnel.
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the role of sexual assault on the risk of ptsd among Gulf War veterans
Annals of Epidemiology, 2005Co-Authors: Han K. Kang, Clare M Mahan, Nancy A Dalager, Erick K IshiiAbstract:PURPOSE: The 1991 Gulf War was the first major military deployment where female troops were integrated into almost every military unit, except for combat ground units. We evaluated the impact of reported sexual trauma during this deployment on the risk of post-traumatic stress disorder (PTSD) after the War. METHODS: A nested case-control analysis was conducted using the data collected in a population-based health survey of 30,000 Gulf War era veterans. A total of 1381 Gulf War veterans with current PTSD were compared with 10,060 Gulf veteran controls without PTSD for self-reported in-theater experiences of sexual harassment/assault and combat exposure. RESULTS: The adjusted odds ratio (aOR) for PTSD associated with a report of sexual assault was 5.41 (95% confidence interval [CI], 3.19-9.17) in female veterans and 6.21 (95% CI, 2.26-17.04) in male veterans. The aOR for PTSD associated with "high" combat exposure was also statistically significant (aOR, 4.03 [95% CI, 1.97-8.23] for females; aOR, 4.45 [95% CI, 3.54-5.60] for males). CONCLUSION: Notwithstanding a possibility of recall bias of combat and sexual trauma, for both men and women, sexual trauma as well as combat exposure appear to be strong risk factors for PTSD.
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factor analysis of fatiguing syndrome in Gulf War era veterans implications for etiology and pathogenesis
Journal of Occupational and Environmental Medicine, 2003Co-Authors: Heather A Young, Han K. Kang, Clare M Mahan, Samuel J Simmens, Paul H LevineAbstract:This study used factor analysis to identify possible subgroups of symptoms of fatiguing syndrome (FS). Subjects were classified with FS according to the 1994 modified Centers for Disease Control and Prevention criteria with the exception that the chronicity of excessive fatigue could not be documented. The cases consisted of 640 Gulf War veterans who met the criteria, whereas the control groups were composed of 5417 Gulf War and 6493 non-Gulf War veterans who did not meet the criteria and had none of the medical conditions that were exclusionary in the FS group. Factor analyses were performed separately in each group. Factor analysis revealed 6 subgroups: fatigue, pain, infectious, gastrointestinal, respiratory, and neurologic/mood/fatigue. Although the factors were similar for both groups, they were more differentiated in the FS group than in the control group as evidenced by interfactor correlations.
Adam F Carpenter - One of the best experts on this subject based on the ideXlab platform.
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human leukocyte antigen hla and Gulf War illness gwi hla drb1 13 02 spares subcortical atrophy in Gulf War veterans
EBioMedicine, 2017Co-Authors: Lisa M James, Peka Christova, Brian E Engdahl, Scott M Lewis, Adam F CarpenterAbstract:Abstract Background Gulf War Illness (GWI) is a multisystem disorder that has affected a substantial number of veterans who served in the 1990–91 Gulf War. The brain is prominently affected, as manifested by the presence of neurological, cognitive and mood symptoms. We reported previously on the protective role of six Human Leukocyte Antigen (HLA) alleles in GWI (Georgopoulos et al., 2016) and their association with regional brain function (James et al., 2016). More recently, we reported on the presence of subcortical brain atrophy in GWI (Christova et al., 2017) and discussed its possible relation to immune mechanisms. Here we focused on one of the six HLA GWI-protective HLA alleles, DRB1*13:02, which has been found to have a protective role in a broad range of autoimmune diseases (Furukawa et al., 2017), and tested its effects on brain volumes. Methods Seventy-six Gulf War veterans (55 with GWI and 21 healthy controls) underwent a structural Magnetic Resonance Imaging (sMRI) scan to measure the volumes of 9 subcortical brain regions to assess differences between participants with (N = 11) and without (N = 65) HLA class II allele DRB1*13:02. Findings We found that DRB1*13:02 spared subcortical brain atrophy in Gulf War veterans; overall subcortical volume was 6.6% higher in carriers of DRB1*13:02 (P = 0.007). The strongest effect was observed in the volume of cerebellar gray matter which was 9.6% higher (P = 0.007) in carriers of DRB1*13:02 than in non-carriers. By contrast, DRB1*13:01 had no effect. Interpretation These findings document the protective effect of DRB1*13:02 on brain atrophy in Gulf War veterans and are in keeping with recent results documenting sharing of brain mechanisms between GWI and other immune-related diseases (Georgopoulos et al., 2017). We hypothesize that the protective role of DRB1*13:02 is due to its successful elimination of external antigens to which Gulf War veterans were exposed, antigens that otherwise would persist causing low-grade inflammation and possibly leading to autoimmunity. Funding source U.S. Department of Defense ( W81XWH-15-1-0520 ), Department of Veterans Affairs, American Legion Brain Sciences Chair , and University of Minnesota .
