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Biomedical subjects

Howard M Kipen

Publications and source records attributed to Howard M Kipen.

14 recordsLinked to original sources
PubMed2006

Military deployment to the Gulf War as a risk factor for psychiatric illness among US troops.

BACKGROUND: Several studies document an excess of psychiatric symptoms among veterans of the the 1991 Gulf War. However, little is known about the prevalence of psychiatric disorders in those who were deployed to that conflict. AIMS: To compare the 12-month prevalence and associated risk factors for DSM Axis I psychiatric diagnoses between random samples of Gulf War-deployed veterans and veterans of the same era not deployed to the Persian Gulf (era veterans). METHOD: Interview data from 967 Gulf War veterans and 784 era veterans were examined to determine current health status, medical conditions, symptoms and Axis I psychiatric disorders. Logistic regression models evaluated risk factors for psychiatric disorder. RESULTS: Gulf War veterans had a significantly higher prevalence of psychiatric diagnoses, with twice the prevalence of anxiety disorders and depression. Lower rank, female gender and divorced or single marital status were significant independent predictors of psychiatric disorder. CONCLUSIONS: Deployment to the Gulf War is associated with a range of mental health outcomes more than 10 years after deployment.

Adult↗
PubMed2006

Persistence of symptoms in veterans of the First Gulf War: 5-year follow-up.

BACKGROUND: During the 1990-1991 Gulf War, approximately 700,000 U.S. troops were deployed to the Persian Gulf theater of operations. Of that number, approximately 100,000 have presented medical complaints through various registry and examination programs. OBJECTIVES: Widespread symptomatic illness without defining physical features has been reported among veterans of the 1991 Gulf War. We ascertained changes in symptom status between an initial 1995 symptom evaluation and a follow-up in 2000. METHODS: We assessed mailed symptom survey questionnaires for 390 previously surveyed members of the U.S. Department of Veterans Affairs Gulf War Registry for changes over the 5-year interval in terms of number and severity of symptoms. RESULTS: For the cohort as a whole, we found no significant changes in symptom number or severity. Those initially more symptomatic in 1995 showed some improvement over time, but remained much more highly symptomatic than those who had lesser initial symptomatology. CONCLUSIONS: The symptom outbreak following the 1991 Gulf War has not abated over time in registry veterans, suggesting substantial need for better understanding and care for these veterans.

Cohort Studies↗
PubMed2005

Bioaerosols and sick building syndrome: particles, inflammation, and allergy.

PURPOSE OF REVIEW: Sick building syndrome is a poorly understood condition that can be vexing to clinicians and public health investigators alike. Concerns about possible causes have recently shifted to bioaerosols, especially indoor mold contamination. Recently, controversy over the health effects of indoor bioaerosols has intensified in the media and in medical forums. Allergists and other clinicians are increasingly being asked to evaluate cases of sick building syndrome attributed to bioaerosol exposure. Although allergy may play a role, it is unlikely to fully explain the nonspecific symptoms of the condition. This review of recent literature will attempt to put into context the roles of allergy and nonallergic mechanisms in sick building syndrome. RECENT FINDINGS: Epidemiological and toxicological studies have provided further evidence of a possible link between bioaerosol exposure and sick building syndrome, but continue to have methodological limitations. Cross-sectional studies of building occupants have found associations between bioaerosols and symptoms of the condition, but case definitions and exposure assessment remain problematic. Attempts to develop better exposure assessment and biomonitoring methods have made limited progress. Toxicological studies of inhalation of bioaerosols continue to indicate potential toxicity, but at doses that are not comparable to human exposures indoors. SUMMARY: Epidemiological studies suggest an association between bioaerosols and sick building syndrome, and toxicological studies have provided some evidence supporting biological plausibility. However, the extent to which bioaerosol exposure may explain the nonspecific symptoms of the condition is unclear. Nonspecific inflammatory responses to bioaerosols, modified by psychosocial factors such as stress, may be a promising area for continued research.

Aerosols↗
PubMed2005

Nasal effects of a mixture of volatile organic compounds and their ozone oxidation products.

OBJECTIVE: Our objective was to determine if low levels of a mixture of volatile organic compounds (VOCs) and their ozone (O3) oxidation products, similar to what might be found in "sick buildings," cause nasal irritation and inflammation under controlled exposure conditions. METHODS: Healthy, nonsmoking women (n=130) completed 2-hour controlled exposures to VOCs, VOCs and O3, and a masked air "MA" control in random order at least 1 week apart. VOCs and O3 concentrations were approximately 25 mg/m and approximately 40 ppb, respectively. Nasal symptoms were rated before, during, and after exposure. Nasal lavage fluid was analyzed for polymorphonuclear cells, total protein, interleukin-6, and interleukin-8. RESULTS: We found no significant differences in symptoms or markers of nasal inflammation between exposure conditions. CONCLUSIONS: Results suggest that VOCs and their oxidation products may not cause acute nasal effects at low concentrations.

Adult↗
PubMed2004

Why do people report better health by phone than by mail?

CONTEXT: Past research shows that fewer health symptoms are reported by phone than by mail. OBJECTIVES: We sought to examine whether interview mode-dependent differences in health symptom reporting are the result of socially desirable responding or to expending less cognitive effort when formulating responses, a behavior known as satisficing. DESIGN: Participants were randomly assigned to telephone interview only or to mail interview followed 2 weeks later by telephone interview. SETTING & PARTICIPANTS: Participants were American veterans from the Gulf War Registry (n=719). MAIN OUTCOME MEASURES: Our main outcome measure was the number of mild, moderate, or severe symptoms reported (of 48 possible). RESULTS: Veterans reported an average of 5 more symptoms via mail than via telephone, F (1, 709) = 32.50, P < 0.001. The difference was mainly the result of symptoms reported by mail as mild but not reported at all by phone. Veterans with higher social desirability scores reported fewer symptoms by phone and mail, F (1, 709) = 10.11, P = 0.001, but social desirability scores did not interact with interview mode. Furthermore, embarrassing symptoms such as genital complaints were no less likely to be reported by phone. CONCLUSIONS: Reporting of better health in phone surveys is the result of fewer mild symptoms reports but not of socially desirable responding. The findings are consistent with phone interviews encouraging satisficing by limiting the recall of less severe health states. Researchers should handle mild symptom reports with some skepticism.

Adult↗
PubMed2003

A pilot study of telephone-based smoking cessation intervention in asbestos workers.

Smoking markedly increases the risk of asbestos-related lung cancer. We conducted a randomized pilot trial of a telephone-based smoking cessation intervention in asbestos workers. Fifty-nine smokers were assigned to either a control or telephone-based smoking cessation treatment group and were followed-up at 6 months. Intent-to-treat analysis revealed a 16.7% quit rate at 6 months for the intervention group compared to 6.9% for the control group (P = 0.25). Treatment-received quit-rates were 33% for the intervention group and 6.9% for the control group (P = 0.05). The intervention group was twice as likely to use smoking cessation medicines and progressed further along the stage of change continuum compared with the control group. Incorporating telephone-based smoking cessation treatment into medical screening activities for asbestos workers is feasible and the intervention is effective in increasing quit rates at 6 months.

Adult↗
PubMed2003

Unexplained symptoms after terrorism and war: an expert consensus statement.

Twelve years of concern regarding a possible "Gulf War syndrome" has now given way to societal concerns of a "World Trade Center syndrome" and efforts to prevent unexplained symptoms following the most recent war in Iraq. These events serve to remind us that unexplained symptoms frequently occur after war and are likely after terrorist attacks. An important social priority is to recognize, define, prevent, and care for individuals with unexplained symptoms after war and related events (eg, terrorism, natural or industrial disasters). An international, multidisciplinary, and multiinstitutional consensus project was completed to summarize current knowledge on unexplained symptoms after terrorism and war.

Causality↗
PubMed2003

Reported exposures, stressors, and life events among Gulf War Registry veterans.

We investigated the association of 15 exposures, 10 stressors, and 18 life events with illness symptoms reported by 978 veterans who believe they suffer from Gulf War-related illnesses. A mail survey was completed by veterans (60% response rate) from the Gulf War Health Registry. Variables most associated with high symptom group membership were reported chemical/biologic warfare (CBW), concerns with infection and faulty equipment, feelings of mistrust in the military, and disability leading to work stoppage within 2 years after the war. These data suggest that belief in CBW exposure, and the experience of war stress and serious negative life events after the war, are important concomitants of Gulf War illness. Models seeking to explain Gulf War symptoms need to incorporate a range of exposure and psychosocial factors to fully account for important influences.

Adult↗
PubMed2003

Symptom patterns among Gulf War registry veterans.

OBJECTIVES: We identify symptom patterns among veterans who believe they suffer from Gulf War-related illnesses and characterize groups of individuals with similar patterns. METHODS: A mail survey was completed by 1161 veterans drawn from the Gulf War Health Registry. RESULTS: An exploratory factor analysis revealed 4 symptom factors. A K-means cluster analysis revealed 2 groups: (1) veterans reporting good health and few moderate/severe symptoms, and (2) veterans reporting fair/poor health and endorsing an average of 37 symptoms, 75% as moderate/severe. Those in Cluster 2 were more likely to report having 1 or more of 24 medical conditions. CONCLUSIONS: These findings are consistent with previous investigations of symptom patterns in Gulf War veterans. This multisymptom illness may be more fully characterized by the extent, breadth, and severity of symptoms reported.

Chronic Disease↗
PubMed2002

The role of environmental factors in medically unexplained symptoms and related syndromes: conference summary and recommendations.

This monograph of peer-reviewed articles is based on presentations at the conference "Environmental Factors in Medically Unexplained Physical Symptoms and Related Syndromes" held 10-12 January 2001 in Piscataway, New Jersey, USA. The purpose of the conference was to determine research priorities for elucidating the role of environmental factors in medically unexplained symptoms and symptom syndromes. These include conditions such as chronic fatigue syndrome, multiple chemical sensitivities, sick building syndrome, Gulf War illness, and the like. Approximately 1 1/2 days were devoted to plenary talks and 1 day was devoted to break-out sessions to discuss epidemiologic, psychosocial, and experimental research. Recommendations were made for a series of epidemiologic, psychosocial, and experimental research approaches, with acknowledgment that nosology issues are clearly fundamental to advancing understanding of these conditions.

Environmental Exposure↗
PubMed2002

Environmental factors in medically unexplained symptoms and related syndromes: the evidence and the challenge.

Symptoms, and especially those without clear underlying medical explanations, account for a large percentage of clinical encounters. Many unexplained symptoms have been organized by patients and practitioners into syndromes such as chronic fatigue syndrome, multiple chemical sensitivity, sick building syndrome, Gulf War syndrome, and the like. All these syndromes are defined solely on the basis of symptoms rather than by medical signs. Some of the above-described conditions overlap strongly with explained conditions such as asthma. The relationship of such symptoms and syndromes to environmental exposure is often sharply debated, as is the distinction between the various syndromes. This leads to problems of what type of research should be conducted and who should conduct it. It is time to develop a comprehensive research agenda to sort out nomenclature, epidemiology, and environmental causation for these conditions, moving toward comprehensive and effective public health and clinical approaches.

Environmental Health↗
PubMed2002

The vomeronasal organ and chemical sensitivity: a hypothesis.

Environmental exposures to very low levels of airborne chemicals are associated with adverse symptoms, often affecting multiple organ systems, in the phenomenon of chemical sensitivity (CS). Recent surveys suggest a significant prevalence of chemically sensitive subjects in the United States, but the mechanism linking exposure to symptoms remains unclear, despite the advancement of a variety of theoretical models. In many of these models, exposure of the nasal respiratory system to an airborne agent is the first step in the pathway leading to symptoms. In this article, we advance the hypothesis that interactions between environmental chemicals and the vomeronasal organ (VNO) may play a role in the etiology of CS. The VNO, a bilateral, tubular organ located in the nose, serves in animals as part of a sensitive chemosensory system; however, evidence suggesting that the VNO retains a functional role in the adult human is controversial. Reported characteristics of the human VNO relevant to CS, including location, prevalence, selective sensitivity to airborne chemical exposure, and capacity to produce systemic effects, are discussed within the context of this ongoing debate. Beyond relevance to CS, the demonstration of an active, adult VNO could have significant impact on environmental toxicology.

Air Pollutants↗