B Guldager

Bispebjerg Hospital, Copenhagen University, København, Capital Region, Denmark

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Publications (15)11.85 Total impact

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    ABSTRACT: Where much is known about the consequences of spinal and low back pain (LBP) during military deployments, there is lesser knowledge of risk factors for LBP among the deployed forces. The objective of this study was to identify deployment-related exposures associated with LBP. The study was a questionnaire-based cohort study among 1,931 Danish soldiers deployed to Iraq. Of the 680 respondents, 175 (26%) reported LBP. The population of respondents was adjusted for potential nonresponse bias. The associations between LBP and explanatory variables were analyzed using ordinal logistic regression models. Older age (p = 0.016), support from leaders (odds ratio [OR] = 1.69, p = 0.019), psychological stress (OR = 1.71, p = 0.009), awkward working positions (OR = 1.98, p = 0.001), and working in depots or storehouses (OR = 2.60, p = 0.041) were found to be associated with LBP after adjustment of all other variables. Combat and exposure to work, sport, or traffic accidents were not associated with LBP in this study, which was attributed to the characteristics of the actual mission. Preventive measures should include predeployment preparation of leaders to cope with LBP and other musculoskeletal trouble among their subordinates and involve medical personnel, especially deployed physiotherapists, by giving advice to soldiers of different military occupational specialties on how to optimize ergonomics at work.
    Military medicine. 04/2014; 179(4):451-8.
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    ABSTRACT: Using data from an occupational medical health surveillance program, we studied the associations between mental stressors and social support and the two outcome measures postdeployment psychological distress and multiple physical symptoms among Danish soldiers deployed to Iraq. The study was cross-sectional and questionnaire-based with soldiers returning from the mission as the target group. Witnessing atrocities, fear of being physically harmed, feeling of insecurity, feeling of meaninglessness, and having been in touch with prisoners were associated with both outcome measures. In conclusion, our findings support the assumption that other factors than combat exposure-psychosocial and cultural-are of importance in increasing psychological distress among soldiers deployed to Iraq. Additionally, we have shown that the reporting of multiple physical symptoms among the deployed soldiers is closely related to increased psychological discomfort and certain mental stressors.
    Military medicine 10/2011; 176(10):1138-43. · 0.77 Impact Factor
  • Lars Ravnborg Nissen, Bernadette Guldager, Finn Gyntelberg
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    ABSTRACT: To compare the prevalence of musculoskeletal disorders of personnel in the main battle tank (MBT) units in the Danish army with those of personnel in other types of army units, and to investigate associations between job function in the tank, military rank, and musculoskeletal problems. An epidemiologic cross-sectional questionnaire-based examination of an exposed group (MBT personnel) and a reference group (army personnel from other units than MBT units) was conducted. Outcome measures were 1-year prevalence of pain in the anatomical locations of neck, shoulder, low back, knee, and ankle. There were only 4 women in the MBT group; as a consequence, female personnel were excluded from the study. The participation rate was 58.0% (n = 184) in the MBT group and 56.3% (n = 333) in the reference group. The pattern of musculoskeletal disorders among personnel in the main battle tank units of the Danish army was not significantly different from that in other types of units (infantry, signal, combat service support, engineers, and artillery). Working as a gunner less than 2 years increased the risk of reporting neck pain (p = 0.011) and working as a loader increased the risk of reporting shoulder pain (p = 0.017).
    Military medicine 09/2009; 174(9):952-7. · 0.77 Impact Factor
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    ABSTRACT: Compared with controls, up to six years after their return, Danish Gulf War veterans have a significantly higher prevalence of self-reported neuropsychological symptoms, potentially as a result of neurotoxic exposure during deployment. We tested the hypotheses that: 1) GW veterans would perform less well than controls using a computerized neuromotor test battery; and that 2) GW veterans have a psychological profile different from that of controls. A cross-sectional study of 686 subjects who had been deployed in the Persian Gulf within the period August 2, 1990 until December 31, 1997; the control group comprised 231 subjects matched according to age, gender and profession. All participants underwent clinical and paraclinical examinations, along with a neuromotor test battery (CATSYS Test System) and a psychological health status questionnaire, the SCL-90-R rating scale. No differences were found between GW veterans and controls with respect to lifestyle and cohabitational characteristics. Differences between the two groups with respect to neuromotor function were very small. Within the GW veteran group, stratified according to clustering of neuropsychological symptoms, and stratified according to SCL-90-R score, no trends were found suggesting reduced motor function with increasing symptoms. Of nine dimensions constructed on the basis of the SCL-90-R items, six were significantly associated with being a Gulf War veteran. Statistically, the strongest associations were found for ratings of the obsessive-compulsive dimension and of the depression dimension. No associations were found with respect to phobic anxiety, paranoid ideation, and psychoticism. The increased psychological distress found among Danish GW veterans seemed rather due to a mentally distressing environment than to neurotoxic exposure.
    Danish medical bulletin 03/2004; 51(1):108-13. · 0.92 Impact Factor
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    ABSTRACT: Research has shown that Danish Gulf War (GW) veterans reported a significantly higher prevalence of neuropsychological symptoms than did military controls 6 years after GW deployment. To explore the possible central nervous system determinants of these complaints, neuropsychological tests were administered to stratified, random samples of the Danish cohort of 916 GW-deployed veterans and 236 non–GW-deployed participants. Multivariate analyses of covariance were used to analyze neuropsychological test outcomes among the 215 male participants (143 GW-deployed and 72 non–GW-deployed soldiers). No significant differences in neuropsychological test performances were found between the GW-deployed and non–GW-deployed groups. Troops deployed to the GW reported significantly more mood complaints (i.e., fatigue and confusion) than their nondeployed counterparts. Because they were assigned to the Gulf region during the postcombat phase, Danish GW soldiers differed from the majority of American GW-deployed troops in military assignments and possible toxicant exposures.
    Journal of Psychopathology and Behavioral Assessment 05/2003; 25(2):85-93. · 1.55 Impact Factor
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    ABSTRACT: Veterans who have participitated in the Gulf War suffer from a number of symptoms, collectively referred to as the Gulf War Syndrome. It has been hypothesized that a change in the systemic cytokine balance or other changes in immunological parameters could be responsible for some of the symptoms. We analyzed the peripheral blood natural killer (NK) cell activity of 686 Gulf War personnel who had been present in the Persian Gulf area during and immediately after the Gulf War as well as 231 gender and age-matched controls. The test material included individual samples of frozen peripheral blood mononuclear cells kept at −139°C for a period of 50 to 380 days prior to NK cell analysis of freshly thrawed cells. Significant differences in NK-cell activity were not observed by direct comparison of the levels of natural cytotoxic activity in the two groups. However, NK-cell cytotoxicity as such decreased due to cryopreservation. Surprisingly, the NK cells obtained from control donors were significantly (p<0.0001) more sensitive to freezing conditions than cells from the Gulf War personnel, leaving the marginal comparison between the two groups untrustworthy, in particular because of the marked difference between the −139°C storage times used for the two groups. Freshly thawed samples of peripheral blood T lymphocytes (CD2+ cells) from 109 randomly selected Gulf War personnel and 68 gender- and age-matched controls were stimulated for 3 days with phytohemagglutinin followed by 4 h activation by phorbol ester and ionomycin, and were stained for intracellular content of interleukin-2, -5, -10 and interferon-γ. As with natural cytotoxicity, the length of cell storage at −139 °C influenced the production of cytokines. No significant differences in the cytokine production between the two groups were observed when the influence of the storage period was taken into consideration. Together, these data suggest that no overall long-term effects on NK-cell function and T-cell cytokine production are present in the Danish Gulf War personnel. Moreover, cryopreservation is a major potential source of bias when studying the physiology of thawed NK and T cells.
    Apmis 07/2001; 109(7‐8):517 - 524. · 2.07 Impact Factor
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    ABSTRACT: The male reproductive system could have been affected by various hazardous agents and exposures during and in the aftermath of the Persian Gulf War scenario. We tested the hypothesis that, compared to controls, male Danish Gulf War Veterans would have adverse sex hormone levels, decreased fertility, and a larger proportion of adverse pregnancy outcomes including spontaneous abortions, congenital diseases and malformations. A cross-sectional study was performed during the period January 1997 to January 1998 which included 661 male subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997. A control group of 215 Danish military men, not deployed in the Gulf region, was selected with random matching by age and type of work. All participants underwent clinical and paraclinical examinations, and had an interview based on a previously completed comprehensive questionnaire. A venous blood sample was drawn to determine serum concentrations of the follicle-stimulating hormone (FSH), the luteinizing hormone (LH), testosterone, serum hormone binding globulin (SHBG), and inhibin B. The free androgen index was calculated from testosterone and SHBG levels. No differences were found between Gulf War Veterans and controls with respect to any of the reproductive hormones measured, nor with respect to fertility or the prevalence of spontaneous abortions, congenital diseases or malformations among the offspring. Also cohabitational characteristics were similar. Based on the results of this study we conclude that the biological reproductive health of male Danish Gulf War Veterans seemed to be unaffected by their engagement in the post war peace-keeping mission.
    Danish medical bulletin 03/2001; 48(1):29-32. · 0.92 Impact Factor
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    ABSTRACT: Danish Gulf War veterans (GWVs) have a high prevalence of mental and cognitive symptoms and self-reported dyspnoea. 686 GWVs were included in the study and compared with 231 controls. Extensive information about the participants was obtained from a questionnaire, and they all underwent clinical and paraclinical examinations. The prevalence of dyspnoea in GWVs was 29.2%, in controls 19.5%, p = 0.005. Adjusted for age, smoking and physical activity the GWVs OR for dyspnoea at light physical demand was OR = 1.55(1.1-2.3), p = 0.02. Further adjustment for cognitive and mental symptoms reduced the OR to a non significant level, OR = 1.09(0.7-1.6), p = 0.68. The high prevalence of dyspnoea among GWVs could largely be attributed to their high prevalence of mental and cognitive symptoms. In general, the results emphasize the psychological component in dyspnoea.
    Ugeskrift for laeger 01/2001; 162(49):6687-91.
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    ABSTRACT: Compared with controls, up to six years after their return, Danish Gulf War Veterans have a significantly higher prevalence of self-reported neuropsychological symptoms. Independent associations are found for concentration or memory problems, repeated fits of headache, balance disturbances or fits of dizziness, abnormal fatigue not caused by physical activity, and problems sleeping all night. We investigated whether psychosocial, physical, chemical or biological exposures were associated with these symptoms. This study is a prevalence study using retrospective data on exposure. Some 686 subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997 were included; the control group comprised 257 subjects matched according to age, gender and profession. All participants underwent clinical and paraclinical examinations, and were interviewed by a physician based on a completed questionnaire. A clustering of three to five of the above symptoms were found in 21.4% of Gulf War Veterans vs. 6.2% in controls, p < 0.001. Psychosocial and physico-chemical factors were strongly associated with neuropsychological symptoms, and a significant interaction of the two was found, p < 0.001. Although the results of this study are based on self-report the factors identified seem plausible. It may be impossible even in peace-keeping missions to avoid hostile events. However, the results also suggest that psychosocial work conditions known to be important in civilian life, and also environmental factors, should be improved to minimize the risk of long-term neuropsychological symptoms.
    Danish medical bulletin 11/1999; 46(5):423-7. · 0.92 Impact Factor
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    ABSTRACT: Multiple symptoms have been reported in American Gulf War Veterans including headache, fatigue, impaired short-term memory, sleep disturbances, agitation, respiratory symptoms, muscle and joint pain, diseases of the skin, and intermittent fever. The Danish Gulf War Study was performed to clarify if a corresponding pattern existed among Danes having served in the Persian Gulf during and mainly after the conflict. A cross-sectional study was performed during the period January 1997 to January 1998 which included 821 subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997. Of 686 (83.6%) subjects who participated in the study, 95% had been engaged in peace keeping operations after the war. A group consisting of randomly selected age- and gender matched controls, comprised 231 of 400 potential participants (57.7%). All participants underwent clinical and paraclinical examinations, and had an interview based on a previously completed questionnaire. Unspecific symptoms such as repeated fits of headache, fatigue, memory and concentration difficulties, sleep disturbances, agitation, dyspnea, diseases of the skin, and intermittent fever, were significantly more frequent among Danish Gulf War Veterans, p < 0.05, than among controls; no association was found with respect to muscle and joint pain. The higher symptom prevalence among Gulf War Veterans was observed for conditions which had made their first appearance during or after the Gulf War. The prevalence of symptoms which made their first appearance before August 2 1990 was similar for both groups. Except for musculo-skeletal symptoms, this study demonstrated a pattern of symptoms among Danish Gulf War Veterans consistent with the findings among American Gulf War Veterans. Considering that American Gulf War Veterans were predominantly deployed during the armament phase and the brief war phase, and that Danish Gulf War Veterans were predominantly deployed after the war in peace keeping missions, the results indicate the existence of some common risk factors independent of war action.
    Danish medical bulletin 11/1999; 46(5):416-9. · 0.92 Impact Factor
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    ABSTRACT: Compared with controls, up to six years after their return, Danish Gulf War Veterans have a significantly higher prevalence of self-reported gastrointestinal symptoms characterized by constant or occasional recurrent diarrhoea and frequent rumbling of the stomach within the preceding 12 months. The aim of this study was to clarify whether these symptoms could be attributed to physical, chemical or biological exposures. Some 686 subjects who had been deployed in the Persian Gulf within the period August 2 1990 until December 31 1997 were included in a prevalence study using retrospective data on exposure; the control group comprised 257 subjects matched according to age, gender and profession. All participants underwent clinical and paraclinical examinations, and were interviewed by a physician based on a previously completed questionnaire. Among Gulf War Veterans the prevalence of gastrointestinal symptoms was 9.1% vs 1.7% among controls, p < 0.001. Of 24 physical, chemical or biological exposures, 15 were significantly, p < 0.05, associated with the outcome in bivariate analyses. After multivariate adjustment, two exposure variables were significantly associated with the outcome: Burning of waste or manure and exposure to insecticides against cockroaches; tooth brushing using water contaminated with chemicals or pesticides, and bathing in or drinking contaminated water, were nearly significant, p < 0.10. A group of 74 subjects had 3-4 of these exposures, and a prevalence of 18.9%; 164 subjects had 2 exposures and a prevalence of 12.8%, 270 subjects with one symptom had a prevalence of 7.4%, and 153 subjects without any of these exposures had a prevalence of 2.0%, a prevalence comparable to that of controls. The associations were not explained by differences in psychiatric symptoms, age or gender. Our results suggest that, 1) a large proportion of long-term gastrointestinal problems among Gulf War Veterans can be attributed to specific exposures, 2) it should be possible to avoid a large proportion of long-term gastrointestinal symptoms in future similar missions by committed interventive measures.
    Danish medical bulletin 11/1999; 46(5):420-3. · 0.92 Impact Factor
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    ABSTRACT: Increased symptom reporting has been found in American Gulf War Veterans. The symptoms comprise headache, fatigue, impaired short-term memory, sleep disturbances, agitation, respiratory symptoms, muscle and joint pain, diseases of the skin, and intermittent fever. This cross-sectional study was performed to clarify whether a corresponding pattern existed among Danes having served in the Persian Gulf during and mainly after the Gulf War. The investigation took place during the period January 1997 to January 1998 and included 821 subjects who had been deployed in the Persian Gulf within the period August 2, 1990 until December 31, 1997. Of 686 (83.6%) subjects who participated in the study, 95% had been engaged in peace keeping operations after the war. A group consisting of randomly selected age- and gender matched controls, comprised 231 of 400 potential participants (57.7%). All participants underwent clinical and paraclinical examinations, and had an interview based on a previously completed questionnaire. Unspecific symptoms such as repeated fits of headache, fatigue, memory and concentration difficulties, sleep disturbances, agitation, dyspneoa, diseases of the skin, and intermittent fever, were significantly more frequent among Danish Gulf War Veterans (p < 0.05) than among controls; no association was found with respect to muscle and joint pain. The higher symptom prevalence among Gulf War Veterans was observed for conditions which had made their first appearance during or after the Gulf War. The prevalence of diseases and symptoms which had made their first appearance before August 2, 1990 was similar for both groups. This study demonstrated a pattern of diseases and symptoms among Danish Gulf War Veterans consistent with the findings among American Gulf War Veterans. Considering that American Gulf War Veterans were predominantly deployed during the armament phase and the brief war phase, and that Danish Gulf War Veterans were predominantly deployed after the war restoring peace, the results indicate the existence of some common risk factors independent of war action.
    Ugeskrift for laeger 09/1999; 161(39):5423-8.
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    ABSTRACT: Veterans who have participated in the Gulf War suffer from a number of symptoms, collectively referred to as the Gulf War Syndrome. It has been hypothesized that a change in the systemic cytokine balance or other changes in immunological parameters could be responsible for some of the symptoms. We analyzed the peripheral blood natural killer (NK) cell activity of 686 Gulf War personnel who had been present in the Persian Gulf area during and immediately after the Gulf War as well as 231 gender and age-matched controls. The test material included individual samples of frozen peripheral blood mononuclear cells kept at -139 degrees C for a period of 50 to 380 days prior to NK cell analysis of freshly thawed cells. Significant differences in NK-cell activity were not observed by direct comparison of the levels of natural cytotoxic activity in the two groups. However, NK-cell cytotoxicity as such decreased due to cryopreservation. Surprisingly, the NK cells obtained from control donors were significantly (p<0.0001) more sensitive to freezing conditions than cells from the Gulf War personnel, leaving the marginal comparison between the two groups untrustworthy, in particular because of the marked difference between the -139 degrees C storage times used for the two groups. Freshly thawed samples of peripheral blood T lymphocytes (CD2+ cells) from 109 randomly selected Gulf War personnel and 68 gender- and age-matched controls were stimulated for 3 days with phytohemagglutinin followed by 4 h activation by phorbol ester and ionomycin, and were stained for intracellular content of interleukin-2, -5, -10 and interferon-gamma. As with natural cytotoxicity, the length of cell storage at -139 degrees C influenced the production of cytokines. No significant differences in the cytokine production between the two groups were observed when the influence of the storage period was taken into consideration. Together, these data suggest that no overall long-term effects on NK-cell function and T-cell cytokine production are present in the Danish Gulf War personnel. Moreover, cryopreservation is a major potential source of bias when studying the physiology of thawed NK and T cells.
    Apmis 109(7-8):517-24. · 2.07 Impact Factor
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