completed the postal questionnaire; response rates were 80.5% among eligible deployed veterans and 56.8% of eligible nondeployed, as stated above. Questions of interest included those related to pregnancy outcomes (live birth, miscarriage, stillbirth), and for live births, participants were asked about date, weight, gestation, and birth defects (Kelsall et al., 2007). Detailed results regarding all outcomes for this study are found in Chapter 4.

Danish Peacekeeper Studies

One reference study was conducted on the Danish peacekeepers sent to the Persian Gulf at the end of the war (Ishoy et al., 1999b). Volume 4 cited four derivative studies based on the initial cohort. The Update committee did not identify any additional derivative studies on the Danish Gulf War veterans.

Reference Study

Military personnel from Denmark were involved in peacekeeping or humanitarian missions occurring predominantly after the Gulf War ceasefire, but were located in the same areas as other coalition forces who served in Gulf War combat (Ishoy et al., 1999b). A total of 821 Danes, deployed between August 1990 to December 1997, were eligible for inclusion in this population-based cohort; 686 (83.6%) agreed to participate in the study. The deployed veterans were matched by age, sex, and profession to 400 members of the Danish armed forces who were not deployed to the Gulf War; the participation rate was 57.8% (n = 231). Participants completed a detailed questionnaire, including 22 neuropsychologic symptoms, and then received detailed clinical health and laboratory examinations (e.g., height, weight, blood pressure, battery of urinary and blood work, battery of neuropsychologic tests) and physician interviews about their medical history and symptoms. Gulf War participants were also asked about their exposures while in the gulf. The examinations were conducted between 1997 and 1998. Further discussion of the findings is provided in Chapter 4.

Derivative Studies

Proctor et al. (2003) assessed neuropsychologic symptoms in the Danish Gulf War veterans. Gastrointestinal symptoms and diseases and symptoms related to the skin or allergies were evaluated by Ishoy et al. (1999a). Gastrointestinal symptoms were associated with two exposures: burning of waste or manure and exposure to insecticide against cockroaches (Ishoy et al., 1999a).

The investigators also examined male participants for sexual dysfunction and reproductive health. Self-reports of sexual problems were validated with medical examinations and laboratory testing, such as reproductive hormone parameters (Ishoy et al., 2001a,b). Further details can be found in Chapter 4.

One analysis investigated whether 22 neuropsychologic symptoms were associated with 18 self-reported environmental exposures5 (physical, chemical, biologic exposures, and psychological stressors) (Suadicani et al., 1999). Most exposures were significantly associated with three to five relevant neuropsychologic symptoms in bivariate analyses. One psychologic exposure (“having watched colleagues or friends threatened or shot at”) and environmental

5

Exposures did not include pyridostigmine bromide or vaccinations against chemical or biologic warfare agents, because Danish veterans had a peacekeeping role and thus were not at risk for chemical or biologic warfare.



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