Publications (10)32.45 Total impact
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Article: Effectiveness, suitability, and performance testing of the SKC Deployable Particulate Sampler (DPS) as compared to the currently deployed Airmetrics MiniVol portable air sampler.
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ABSTRACT: Epidemiological studies have linked particulate matter (PM) exposure to morbidity and mortality from cardiovascular and respiratory disease. In order to monitor and assess the potential PM health risk to deployed military personnel, the U.S. Army must field a portable sampler that can accurately sample particles with an aerodynamic diameter less than or equal to a nominal 2.5 mm (PM2.5). In the study described in this article, the SKC Deployable Particulate Sampler (DPS) was compared to the currently deployed Airmetrics MiniVol portable air sampler in the hot, dry environment of Yuma Proving Grounds, Arizona, and the cold, wet environment of Fort Drum, New York. For all measurements taken and averaged, the DPS and the MiniVol did not differ significantly for mean concentration collected; however, the DPS collected 4.0 times more mass than the MiniVol (p < .05). The DPS was shown to be an improvement over the MiniVol when evaluated for measures of effectiveness, suitability, and performance.Journal of environmental health 10/2010; 73(3):16-22. · 0.80 Impact Factor -
Article: Fatal motor vehicle crashes among veterans of the 1991 Gulf War and exposure to munitions demolitions at Khamisiyah: a nested case-control study.
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ABSTRACT: A proposed explanation for the observed higher risk of fatal motor vehicle crashes (MVC) among 1991 Gulf War-deployed veterans is neurocognitive deficits resulting from nerve agent exposure at Khamisiyah, Iraq. Our objective was to assess any association between postwar fatal MVC and possible nerve agent exposure based on 2000 modeled plume data. Cases were defined as MVC deaths with a record in the Department of Transportation Fatality Analysis Reporting System through 1995. Cases (n = 282) and controls (n = 3,131) were derived from a larger nested case-control study of Gulf War-era veterans and limited to Army, male, deployed personnel. Exposure and cumulative dose by case-control status were analyzed using multivariate techniques. Exposure status was not associated with fatal MVC (OR 0.96, 95% CI 0.72-1.26), nor were tertiles of cumulative dose. Findings do not support an association between possible exposures at Khamisiyah and postwar fatal MVC among Gulf War veterans.American Journal of Industrial Medicine 05/2006; 49(4):261-70. · 1.63 Impact Factor -
Article: In-theater hospitalizations of US and allied personnel during the 1991 Gulf War.
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ABSTRACT: The postwar morbidity of Gulf War veterans has been closely examined. However, data have not been available to evaluate morbidity suffered during the 1991 Gulf War. In this report, the authors examine archived records of hospitalizations in US military facilities in the Kuwaiti theater of operations or those medically evacuated to facilities in Europe. Using multivariable logistic regression modeling, the authors determined that service personnel at greatest odds for "in-theater" hospitalization were enlisted, female, White, Reservist, Army, and health care workers. No increase in odds was observed for oil well fire smoke exposure or possible exposure to the nerve agent hazard areas. Although these data may be incomplete, they represent the best-known data reflecting in-theater hospitalizations during the Gulf War of 1991 and show remarkable similarities in risk factors to those for postwar hospitalization.American Journal of Epidemiology 07/2004; 159(11):1064-76. · 5.22 Impact Factor -
Article: The postwar hospitalization experience of Gulf War veterans participating in U.S. health registries.
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ABSTRACT: In response to concerns that Gulf War veterans were experiencing increased morbidity resulting from wartime exposures in the Gulf War, the Department of Veterans Affairs and the Department of Defense (DoD) initiated clinical registries to provide systematic health evaluations for self-referred Gulf War veterans. The authors used Cox's proportional hazard modeling with data from all DoD hospitals to estimate the probability of hospitalization resulting from any cause, resulting from diagnosis in a major diagnostic category, and resulting from a specific diagnosis of interest. After adjusting for other risk factors, registry participants were 1.43 times more likely to have a postwar hospitalization than registry nonparticipants (95% confidence interval, 1.40-1.46). These findings support the hypothesis that registry participants were more likely to experience postwar morbidity than veterans who chose not to enroll in the health registries.Journal of Occupational and Environmental Medicine 05/2004; 46(4):386-97. · 2.06 Impact Factor -
Article: Anthrax vaccination and self-reported symptoms, functional status, and medical conditions in the National Health Survey of Gulf War Era Veterans and Their Families.
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ABSTRACT: To evaluate the health status of Gulf War veterans who reported receipt of anthrax vaccination and a small group of Gulf War veterans for whom documentation of anthrax vaccination exists. Among the 11,441 Gulf War veterans who completed a health survey, 4601 reported receiving the anthrax vaccine during the war; 2979 veterans reported not receiving it; 3861 were uncertain. Also, 352 of these respondents were documented by the Department of Defense as having received anthrax vaccination. We compared the medical history of these groups of veterans using multivariate analyses. Finally, we analyzed perception of exposure and its relation to reporting bias. There were statistically significant differences in prevalence for almost all outcomes studied between those who reported having received anthrax vaccination and those who did not so report. However, when we compared the veterans for whom vaccination records exist to the group who self-reported that they had not received the vaccine, the significant differences in prevalence for almost all of the outcomes disappeared. The extent of a reporting bias should be carefully considered when one evaluates the health consequences of anthrax vaccination based on self-reported data.Annals of Epidemiology 03/2004; 14(2):81-8. · 3.21 Impact Factor -
Article: Gulf War veterans and Iraqi nerve agents at Khamisiyah: postwar hospitalization data revisited.
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ABSTRACT: Chemical warfare agents were demolished by US soldiers at Khamisiyah, Iraq, in March 1991. The authors investigated postwar morbidity for Gulf War veterans, contrasting those who may have been exposed to low gaseous levels of nerve agents and those unlikely to have been exposed. Cox regression modeling was performed for hospitalizations from all causes and hospitalizations from diagnoses within 15 categories during the period March 10, 1991, through December 31, 2000, for the duration of active-duty status. After adjustment for all variables in the model, only two of 37 models suggested that personnel possibly exposed to subclinical doses of nerve agents might be at increased risk for hospitalization from circulatory diseases, specifically cardiac dysrhythmias. Of the 724 hospitalizations for cardiac dysrhythmias, 203 were in the potentially exposed group, slightly higher than expected (risk ratio = 1.23, 95% confidence interval: 1.04, 1.44). The increase was small in comparison with potential observational variability, but the findings are provocative and warrant further evaluation. Veterans possibly exposed to nerve agents released by the Khamisiyah demolition were not found to be at increased risk for hospitalizations from any other chronic diseases nearly 10 years after the Gulf War.American Journal of Epidemiology 10/2003; 158(5):457-67. · 5.22 Impact Factor -
Article: Exposures to the Kuwait oil fires and their association with asthma and bronchitis among gulf war veterans.
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ABSTRACT: Military personnel deployed to the Persian Gulf War have reported a variety of symptoms attributed to their exposures. We examined relationships between symptoms of respiratory illness present 5 years after the war and both self-reported and modeled exposures to oil-fire smoke that occurred during deployment. Exposure and symptom information was obtained by structured telephone interview in a population-based sample of 1,560 veterans who served in the Gulf War. Modeled exposures were exhaustively developed using a geographic information system to integrate spatial and temporal records of smoke concentrations with troop movements ascertained from global positioning systems records. For the oil-fire period, there were 600,000 modeled data points with solar absorbance used to represent smoke concentrations to a 15-km resolution. Outcomes included respiratory symptoms (asthma, bronchitis) and control outcomes (major depression, injury). Approximately 94% of the study cohort were still in the gulf theater during the time of the oil-well fires, and 21% remained there more than 100 days during the fires. There was modest correlation between self-reported and modeled exposures (r = 0.48, p < 0.05). Odds ratios for asthma, bronchitis, and major depression increased with increasing self-reported exposure. In contrast, there was no association between the modeled exposure and any of the outcomes. These findings do not support speculation that exposures to oil-fire smoke caused respiratory symptoms among veterans.Environmental Health Perspectives 12/2002; 110(11):1141-6. · 7.04 Impact Factor -
Article: Ten years and 100,000 participants later: occupational and other factors influencing participation in US Gulf War health registries.
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ABSTRACT: For more than a decade after the Gulf War, there has been concern that wartime exposures have resulted in significant morbidity among Gulf War veterans. After the end of the war, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) initiated health registries to provide systematic clinical evaluations of Gulf War veterans who chose to participate. By September 1999, there were 32,876 participants in the DoD Comprehensive Clinical Evaluation Program and 70,385 participants in the VA Gulf War Registry Health Examination Program. We identified demographic and military service factors, as well as potential war-related exposures associated with subsequent registry participation after 10 years of observation. Veterans potentially exposed to oil well fire smoke, those near Khamisiyah, Reserve and National Guard, Army veterans, and veterans in the theater of operations during intense combat periods were most likely to elect to participate in a registry. These findings support the hypothesis that certain occupational factors and wartime exposures may influence subsequent health care-seeking behavior.Journal of Occupational and Environmental Medicine 09/2002; 44(8):758-68. · 2.06 Impact Factor -
Article: Are Gulf War veterans experiencing illness due to exposure to smoke from Kuwaiti oil well fires? Examination of Department of Defense hospitalization data.
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ABSTRACT: There has been much concern among the public and veterans that specific environmental exposures incurred during the Gulf War were the cause of subsequent illness among Gulf War veterans. In this historical cohort study, the authors compared the postwar morbidity of US military personnel exposed to smoke from the 1991 Kuwaiti oil well fires with that of unexposed personnel. Complete exposure and demographic data were available for 405,142 active-duty Gulf War veterans who did not remain in the region after the war. The authors used data from all Department of Defense hospitals for the period August 1, 1991-July 31, 1999 to estimate rates of hospitalization due to any cause, hospitalization due to a diagnosis in one of 15 major categories, and hospitalization due to one of nine diagnoses likely to be manifestations of smoke exposure. Exposures to particulate matter from oil-well-fire smoke were based on the integration of meteorologic data, diffusion modeling, and troop location data. The authors constructed seven exposure groups combining duration and amount of exposure. In Cox modeling, three of the 25 models showed an increased adjusted risk of hospitalization. However, there was no evidence of a dose-response relation. Despite some limitations, these data do not support the hypothesis that Gulf War veterans have an increased risk of postwar morbidity from exposure to Kuwaiti oil-well-fire smoke.American Journal of Epidemiology 06/2002; 155(10):908-17. · 5.22 Impact Factor -
Article: The Postwar Hospitalization Experience of Gulf War Veterans Possibly Exposed to Chemical Munitions Destruction at Khamisiyah, lraq
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ABSTRACT: Using Department of Defense hospital data, the authors examined the postwar hospitalization experience from March 1991 through September 1995 of US Guff War veterans who were near Khamisiyah, Iraq, during nerve agent munition destruction in March 1991. Multiple sources of meteorologic, munition, and toxicology data were used to circumscribe geographic areas of low level, vaporized nerve agent for 4 days after the destruction. Plume estimates were overlaid on military unit positions, and exposure was estimated for the 349, 291 US Army Gulf War veterans. Exposure was classified as not exposed (n = 224, 804), uncertain low dose exposure (n = 75, 717), and specific estimated subclinical exposure (n = 48, 770) categorized into three groups for dose-response evaluation. Using Cox proportional hazard modeling, the authors compared the postwar experiences of these exposure groups for hospitalization due to any cause, for diagnoses in 15 unique categories, and for specific diagnoses an expert panel proposed as most likely to reflect latent disease from such subclinical exposure. There was little evidence that veterans possibly exposed to the nerve agent plumes experienced unusual postwar morbidity. While there were several differences in hospitalization risk, none of the models suggested a dose-response relation or neurologic sequelae. These data, having a number of limitations, do not support the hypothesis that Gulf War veterans are suffering postwar morbidity from subclinical nerve agent exposure. Am J Epidemiol 1999; 150: 532–40.
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2004
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U.S. Department of Veterans Affairs
Washington, D. C., DC, USA
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