No evidence for altered cellular immune functions in personnel deployed in the Persian Gulf during and after the Gulf War--The Danish Gulf War study.

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.

Major reproductive health characteristics in male Gulf War Veterans. The Danish Gulf War Study.

INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

[The most dramatic train accident in Denmark: Gentofte 1897]. / Gentofteulykken 1897 - Danmarks største togkatastrofe.

One of the most dramatic train accidents in Denmark happened at a railway station close to midnight on the 11th of July 1897. Forty passengers were killed and approximately 150 people were more or less seriously wounded. Three different actors involved in the accident (a stoker of the collided engine, a journalist and a physician) have later described the scenario of the disaster according to their professional backgrounds. The principles of disaster management, the emergency response including a rather quick involvement from different types of relevant professions, the triage and the prehospital treatment of victims seemed to have been adequate according to the framework at that time. The descriptions refer shortly to the psychopathological reactions following a life threatening experience which today are well defined and described as symptoms of PTSD (Post Traumatic Stress Disorder).

[Self-reported dyspnea is strongly associated with psychological and cognitive symptoms. The Danish Gulf War Study]. / Selvrapporteret dyspnø er staerkt associeret med psykiske og kognitive symptomer. The Danish Gulf War Study.

INTRODUCTION: Danish Gulf War veterans (GWVs) have a high prevalence of mental and cognitive symptoms and self-reported dyspnoea. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Risk factors for gastrointestinal symptoms. The Danish Gulf War Study.

INTRODUCTION: 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. METHODOLOGY: 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. RESULTS: 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. CONCLUSION: 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.

State of health after deployment in the Persian Gulf. The Danish Gulf War Study.

BACKGROUND: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Determinants of long-term neuropsychological symptoms. The Danish Gulf War Study.

INTRODUCTION: 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. METHODOLOGY: 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. RESULTS: 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. CONCLUSION: 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.

[Health status after serving in the Gulf war area. The Danish Gulf War Study]. / Helbredsstatus efter udstationering i Golfkrigsområdet. The Danish Gulf War Study.

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.

[Stab wounds and lacerations among operating room personnel]. / Stik- og snitlaesioner hos operationspersonale.

In order to illustrate frequency of peroperative accidental needle-stick injuries and lacerations among operation theatre staff, the theatre staffs in the Central Hospital in Hillerød (CH), the County Hospital in Roskilde (ASR) and the St. Elisabeth Municipal Hospital in Copenhagen (SE) were requested to complete a questionnaire after every operation in which they had participated. This investigation took place during a period of three months in CH and two months in ASR and SE. A total of 861 questionnaires were completed with a percentage of replies of 54.4. Of these, 355 (41%) were gynaecological/obstetric interventions, 297 (35%) orthopaedic surgical interventions and 188 (22%) general surgical while 21 (2%) were unspecified. A total 187 (21.7%) cases of holes in the gloves, 47 (5.5%) accidental needlesticks and two (0.23%) accidental lacerations. The frequency of needlestick injuries was greater during gynaecological operations than with the orthopedic surgical and general surgical operations. No differences were observed in the average durations of operation in cases of lesion or total number of lesions. Among the operations, 657 (76.3%) were elective operations, 168 (19.5%) were emergencies and 36 (4.2%) were unspecified. Thirty (4.6%) of the needlestick injuries occurred during the elective interventions and 14 (8.3%) during the emergency operations. As a rule, it was the operating surgeon who injured himself with a needle and the commonest site of the lesion was the pulp of the left index finger. Only one of these lesions had been notified as an occupational injury.