Publications by authors named "Clare M Mahan"

To guide budgetary and policy-level decisions, the U.S. Department of Veterans Affairs (VA) produces quarterly reports that count the number of Iraq and Afghanistan veterans with International Classification of Diseases, 9(th) Revision, Clinical Modification (ICD-9-CM) codes for posttraumatic stress disorder (PTSD; 309.

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Background: Concern has been raised that US veterans of the 1990-1991 Gulf War (GW1) may be at increased risk to develop neurologic disease.

Methods: An incident cohort of multiple sclerosis (MS) and other demyelinating disease (ODD) was assembled from the US military comprising the Gulf War era (1990-2007). Cases of MS and ODD meeting standard diagnostic criteria were matched to a database of all active duty personnel from the Department of Defense.

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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.

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We characterize here a new nationwide incident cohort of multiple sclerosis from the US military-veteran population. This cohort provides an update to the only other US nationwide incidence study of multiple sclerosis performed during the 1970s. Medical records and data from the Department of Defense and Department of Veterans Affairs for cases of multiple sclerosis who served in the military between 1990, the start of the Gulf War era, and 2007 and who were service-connected for this disorder by the Department of Veterans Affairs from 1990 on, were reviewed.

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The authors assessed changes in the health status of US 1991 Gulf War-era veterans from a 1995 baseline survey to a 2005 follow-up survey, using repeated measurement data from 5,469 deployed Gulf War veterans and 3,353 nondeployed Gulf War-era veterans who participated in both surveys. Prevalence differences in health status between the 2 surveys were estimated for adverse health indices and chronic diseases for each veteran group. Persistence risk ratios and incidence risk ratios were calculated after adjustment for demographic and military service characteristics through Mantel-Haenszel stratified analysis.

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BACKGROUND: Several health conditions and concerns have been reported to be increased among Gulf War veterans including post-traumatic stress disorder (PTSD), chronic fatigue syndrome (CFS), CFS-like illness, and unexplained multi-symptom illness (MSI). As the cohort of Gulf War veterans advance in age, they are likely to be at risk of not only certain deployment-related health conditions but also chronic diseases associated with lifestyle factors. METHODS: To clarify relationships between PTSD, CFS-like illness, MSI, and obesity, we analyzed data from a cross-sectional survey of health information among population-based samples of 15,000 Gulf War veterans and 15,000 veterans who served during the same era.

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Introduction: A sizable literature has analyzed the frequency of alcohol consumption and patterns of drinking among veterans. However, few studies have examined patterns of alcohol use in veterans of the first Gulf War or factors associated with problem drinking in this population. We examined the frequency and patterns of alcohol use in male and female veterans who served in the 1991 Gulf War or during the same era and the relationships between alcohol use and selected health conditions.

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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.

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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 questionnaire.

Results: Gulf veterans reported significantly higher rates of unexplained multi-symptom illness, chronic fatigue syndrome-like illness, 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.

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The current investigation identified the gender-specific prevalence of sexual harassment and assault experienced during U.S. military service and the negative mental and physical health correlates of these experiences in a sample of former reservists.

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A previous symptom-based survey of veterans of the 1990-1991 Persian Gulf War suggested a neurological syndrome (blurred vision, loss of balance/dizziness, tremors/shaking, and speech difficulty). The authors conducted the present study to determine whether specific findings could indicate an organic basis for this possible syndrome. They completed an extensive clinical and laboratory evaluation on Gulf War veterans with all 4 symptoms, using 3 comparison groups.

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The purpose of this study was to examine the association of notification of potential exposure to chemical warfare agents in the 1991 Gulf War with subsequent self-reported morbidity. The study sample included 1,056 deployed Army Gulf War veterans who responded to the 1995 National Health Survey of Gulf War Era Veterans and who were resurveyed in 2000. One-half of the subjects had been notified of potential exposure to chemical warfare agents and one-half had not.

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In March 1991, U.S. troops detonated the Khamisiyah, Iraq, ammunition depot, possibly releasing two chemical warfare agents, sarin and cyclosarin.

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Objectives: We investigated whether US Army Gulf War veterans who were potentially exposed to nerve agents during the March 1991 weapons demolitions at Khamisiyah, Iraq, are at increased risk of cause-specific mortality.

Methods: The cause-specific mortality of 100487 exposed US Army Gulf War veterans was compared with that of 224980 unexposed US Army Gulf War veterans. Exposure was determined with the Department of Defense 2000 plume model.

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The possible relationship between military deployment and the subsequent increase in cancer rates has been prominent since the Vietnam War. The objective of this study was to investigate whether any form of cancer was increased among veterans deployed to the Persian Gulf in the 1991 conflict. This study matched data from central cancer registries in the District of Columbia and New Jersey with the records for 1.

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Purpose: 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.

Methods: 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.

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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.

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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.

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To identify a syndrome unique to Gulf War veterans, the authors applied an exploratory factor analysis to the 47-symptom correlation matrix of 10,423 Gulf War and 8,960 non-Gulf War veteran respondents. A separate factor analysis was performed for Gulf War and non-Gulf War veterans, and the resulting 6 factors were compared between the 2 groups. Five of the factors were very similar in the 2 groups; however, 1 of the factors in the Gulf War group, but not the non-Gulf War group, contained a cluster of symptoms consistent with neurological impairment.

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