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© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Veterans with difficult-to-diagnose conditions who receive care in the Department of Veterans Affairs (VA) healthcare system can be referred for evaluation at one of three specialty VA War-Related Illness and Injury Study Centers (WRIISC). Veterans of the 1990–1991 Gulf War have long experienced excess rates of chronic symptoms associated with the condition known as Gulf War Illness (GWI), with hundreds evaluated at the WRIISC. Here we provide the first report from a cohort of 608 Gulf War Veterans seen at the WRIISC who completed questionnaires on chronic symptoms (>6 months) consistent with GWI as well as prominent exposures during Gulf War deployment. These included veterans’ reports of hearing chemical alarms/donning Military-Ordered Protective Posture Level 4 (MOPP4) gear, pesticide use, and use of pyridostigmine bromide (PB) pills as prophylaxis against the effects of nerve agents. Overall, veterans in the cohort were highly symptomatic and reported a high degree of exposures. In multivariable models, these exposures were significantly associated with moderate-to-severe chronic symptoms in neurocognitive/mood, fatigue/sleep, and pain domains. Specifically, exposure to pesticides was associated with problems with concentration and memory, problems sleeping, unrefreshing sleep, and joint pain. Use of MOPP4 was associated with light sensitivity and unrefreshing sleep and use of PB was associated with depression. We also evaluated the association of exposures with symptom summary scores based on veterans’ severity of symptoms in four domains and overall. In multivariable modeling, the pain symptom severity score was significantly associated with pesticide use (Odds ratio (OR): 4.13, 95% confidence intervals (CI): 1.78–9.57) and taking PB pills (OR: 2.28, 95% CI: 1.02–5.09), and overall symptom severity was significantly associated with use of PB pills (OR: 2.41, 95% CI: 1.01–5.75). Conclusion: Decades after deployment, Gulf War veterans referred to a VA tertiary evaluation center report a high burden of chronic symptoms, many of which were associated with reported neurotoxicant exposures during the war.

Details

Title
Association of Gulf War Illness-Related Symptoms with Military Exposures among 1990–1991 Gulf War Veterans Evaluated at the War-Related Illness and Injury Study Center (WRIISC)
Author
Ahmed, Sarah T 1 ; Steele, Lea 2 ; Richardson, Peter 3 ; Nadkarni, Shree 4 ; Bandi, Sandhya 5 ; Rowneki, Mazhgan 5 ; Sims, Kellie J 6 ; Vahey, Jacqueline 7 ; Gifford, Elizabeth J 8 ; Boyle, Stephen H 6 ; Nguyen, Theresa H 9 ; Alice Nono Djotsa 3 ; White, Donna L 1 ; Hauser, Elizabeth R 10 ; Chandler, Helena 5 ; Jose-Miguel Yamal 11 ; Helmer, Drew A 1 

 Center for Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; [email protected] (S.T.A.); [email protected] (P.R.); [email protected] (A.N.D.); [email protected] (D.L.W.); Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA 
 Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; [email protected] 
 Center for Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; [email protected] (S.T.A.); [email protected] (P.R.); [email protected] (A.N.D.); [email protected] (D.L.W.) 
 War Related Illness and Injury Study Center, Veteran Affairs (VA) New Jersey Healthcare System, East Orange, NJ 07018, USA; [email protected] (S.N.); [email protected] (S.B.); [email protected] (M.R.); [email protected] (H.C.); Rutgers New Jersey Medical School, Newark, NJ 07103, USA 
 War Related Illness and Injury Study Center, Veteran Affairs (VA) New Jersey Healthcare System, East Orange, NJ 07018, USA; [email protected] (S.N.); [email protected] (S.B.); [email protected] (M.R.); [email protected] (H.C.) 
 Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; [email protected] (K.J.S.); [email protected] (J.V.); [email protected] (E.J.G.); [email protected] (S.H.B.); [email protected] (E.R.H.) 
 Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; [email protected] (K.J.S.); [email protected] (J.V.); [email protected] (E.J.G.); [email protected] (S.H.B.); [email protected] (E.R.H.); Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, NC 27705, USA 
 Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; [email protected] (K.J.S.); [email protected] (J.V.); [email protected] (E.J.G.); [email protected] (S.H.B.); [email protected] (E.R.H.); Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, NC 27708, USA 
 Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA; [email protected] 
10  Cooperative Studies Program Epidemiology Center-Durham, Durham VA Medical Center, Durham VA Health Care System, Durham, NC 27705, USA; [email protected] (K.J.S.); [email protected] (J.V.); [email protected] (E.J.G.); [email protected] (S.H.B.); [email protected] (E.R.H.); Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, NC 27701, USA 
11  Department of Biostatistics and Data Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; [email protected] 
First page
321
Publication year
2022
Publication date
2022
Publisher
MDPI AG
e-ISSN
20763425
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2642344903
Copyright
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.