Grappling with Gulf War Illness: Perspectives of Gulf War Providers

Background: Although the Gulf War occurred almost 30 years ago, the chronic symptoms of Gulf War illness (GWI), which include respiratory, gastrointestinal, and skin problems, as well as fatigue, pain, and mood alterations, currently affect over 200,000 veterans. Meanwhile, healthcare providers lack clear guidelines about how to best treat this illness. The objective in this study was to learn about the perceptions and experiences of healthcare providers of GWI veterans in terms of medical symptoms, resources for treatment, and quality of care. Methods: We interviewed 10 healthcare providers across the United States and subsequently conducted a qualitative grounded theory study which entailed both systematic data analysis and generating a grounded theory framework. Results: Our findings indicated multiple challenges for providers of veterans with GWI, including gaps in knowledge about GWI, lack of treatment options, absence of consistent communication within the Department of Veterans Affairs (VA) system, and personalized care that was limited to validation. Conclusion: While this study had several limitations, it supported the notion that healthcare providers have inadequate knowledge and awareness about GWI, which leads to continued uncertainty about how to best care for GWI veterans. This could be remedied by the creation of a comprehensive curriculum for a Massive Open Online Course (MOOC) to serve as an educational tool for those attending to this largely overlooked veteran population.

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Rapid Single-Cell Microbiological Analysis: Toward Precision Management of Infections and Dysbiosis

SLAS TECHNOLOGY Translating Life Sciences Innovation ◽

10.1177/2472630319858922 ◽

2019 ◽

Vol 24 (6) ◽

pp. 603-605

Author(s):

Hui Li ◽

Michael Morowitz ◽

Neal Thomas ◽

Pak Kin Wong

Keyword(s):

Bacterial Infections ◽

Treatment Options ◽

Healthcare Providers ◽

The Elderly ◽

The United States ◽

Microbiological Analysis ◽

Global Health Issue ◽

Improper Use ◽

New Antibiotics ◽

Prohibitive Cost

Bacterial infection is a leading cause of morbidity and mortality (from infants to the elderly) and accounts for more than $20 billion in healthcare costs in the United States each year. The pathogens responsible for many of the common infectious diseases, such as urinary tract infection (UTI) and ventilator-associated infections (VAIs), have proven to be highly adept in acquiring mechanisms of antimicrobial resistance. The use of broad-spectrum antibiotics by healthcare providers and the infiltration of antibiotics in the environment have accelerated the selection and growth of resistant pathogens. To further exacerbate the problem, the need for new antibiotics has far outpaced the development of new classes of antibiotics by the pharmaceutical industry (only two new classes of antibiotics have reached the market in the last 20 years), in large part due to prohibitive cost and historically poor return on investment to develop new antibiotics. Consequently, clinicians have limited treatment options, particularly in the neediest patients. To tackle this major global health issue, we are developing novel technological approaches for rapid definitive clinical microbiological analysis. These technologies will improve the clinical management of bacterial infections and reduce the improper use of antibiotics in current practice, hopefully limiting the spread of drug-resistant organisms.

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Qualitative exploration of factors associated with shared decision-making in diabetes management: a health care provider’s perspective

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa073 ◽

2020 ◽

Vol 32 (7) ◽

pp. 464-469

Author(s):

Amena Moazzam Baig ◽

Ayesha Humayaun ◽

Sara Mehmood ◽

Muhammed Waqar Akram ◽

Syed Abbass Raza ◽

...

Keyword(s):

Decision Making ◽

Qualitative Research ◽

Grounded Theory ◽

Shared Decision Making ◽

Cultural Context ◽

Diabetes Management ◽

Treatment Options ◽

Healthcare Providers ◽

Shared Decision ◽

Depth Interviews

Abstract Objective Internationally, patient–doctor interaction has shifted from the paternalist model to the shared decision-making (SDM) model, which is an essential part of effective management of chronic illnesses, especially diabetes. It is a relatively new concept in Pakistan, and data about healthcare providers’ perspectives are lacking. The aim was to explore significant facilitators and barriers to effective SDM as perceived by endocrinologists. Design A qualitative research using in-depth interviews based on grounded theory was done. It was written in line with the Consolidated Criteria for Reporting Qualitative Research checklist. Setting The interviews were conducted at the workplace of the endocrinologist between April and July 2019. Participants Prominent endocrinologists of Pakistan residing in Lahore were approached for in-depth interviews. The transcripts were analyzed simultaneously, and theme saturation was achieved in 11 interviews. Main outcome measures Thematic analysis of data done using grounded theory. Results Four major and two minor themes were identified. The most cited barriers to effective SDM from the doctors’ side were the shortage of time during consultations and the absence of formal training of clinicians in communication skills. However, the patients’ hesitation in questioning the doctor, perceiving him as a paternalist ‘messiah’ in society and lack of education limits their ability to understand and comprehend treatment options. Conclusion There are many barriers perceived by providers as well as clients/patients by effectively using SDM. Local cultural context is influencing a lot.

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A Detoxification Intervention for Gulf War Illness: A Pilot Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16214143 ◽

2019 ◽

Vol 16 (21) ◽

pp. 4143

Author(s):

Kathleen Kerr ◽

Gayle Morse ◽

Donald Graves ◽

Fei Zuo ◽

Alain Lipowicz ◽

...

Keyword(s):

Quality Of Life ◽

Short Form ◽

Controlled Trial ◽

The United States ◽

Gulf War ◽

Gulf War Illness ◽

Waitlist Control ◽

Persistent Symptoms ◽

Sf 36

Approximately 30% of the 700,000 US veterans of the 1990–1991 Persian Gulf War developed multiple persistent symptoms called Gulf War illness. While the etiology is uncertain, several toxic exposures including pesticides and chemical warfare agents have shown associations. There is no effective medical treatment. An intervention to enhance detoxification developed by Hubbard has improved quality of life and/or reduced body burdens in other cohorts. We evaluated its feasibility and efficacy in ill Gulf War (GW) veterans in a randomized, waitlist-controlled, pilot study at a community-based rehabilitation facility in the United States. Eligible participants (n = 32) were randomly assigned to the intervention (n = 22) or a four-week waitlist control (n = 10). The daily 4–6 week intervention consisted of exercise, sauna-induced sweating, crystalline nicotinic acid and other supplements. Primary outcomes included recruitment, retention and safety; and efficacy was measured via Veteran’s Short Form-36 (SF-36) quality of life, McGill pain, multidimensional fatigue inventory questionnaires and neuropsychological batteries. Scoring of outcomes was blinded. All 32 completed the trial and 21 completed 3-month follow-up. Mean SF-36 physical component summary score after the intervention was 6.9 (95% CI; −0.3, 14.2) points higher compared to waitlist control and 11 of 16 quality of life, pain and fatigue measures improved, with no serious adverse events. Most improvements were retained after 3 months. The Hubbard regimen was feasible, safe and might offer relief for symptoms of GW illness.

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Gene–Toxicant Interactions in Gulf War Illness: Differential Effects of the PON1 Genotype

Brain Sciences ◽

10.3390/brainsci11121558 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1558

Author(s):

Jacqueline Vahey ◽

Elizabeth J. Gifford ◽

Kellie J. Sims ◽

Blair Chesnut ◽

Stephen H. Boyle ◽

...

Keyword(s):

Candidate Gene ◽

Respiratory Symptoms ◽

Primary Outcome ◽

Treatment Options ◽

High Linkage Disequilibrium ◽

Gulf War ◽

Biological Pathways ◽

Gulf War Illness ◽

Model Studies ◽

Systemic Symptoms

About 25–35% of United States veterans who fought in the 1990–1991 Gulf War report several moderate or severe chronic systemic symptoms, defined as Gulf War illness (GWI). Thirty years later, there is little consensus on the causes or biological underpinnings of GWI. The Gulf War Era Cohort and Biorepository (GWECB) was designed to investigate genetic and environmental associations with GWI and consists of 1343 veterans. We investigate candidate gene–toxicant interactions that may be associated with GWI based on prior associations found in human and animal model studies, focusing on SNPs in or near ACHE, BCHE, and PON1 genes to replicate results from prior studies. SOD1 was also considered as a candidate gene. CDC Severe GWI, the primary outcome, was observed in 26% of the 810 deployed veterans included in this study. The interaction between the candidate SNP rs662 and pyridostigmine bromide (PB) pills was found to be associated with CDC Severe GWI. Interactions between PB pill exposure and rs3917545, rs3917550, and rs2299255, all in high linkage disequilibrium in PON1, were also associated with respiratory symptoms. These SNPs could point toward biological pathways through which GWI may develop, which could lead to biomarkers to detect GWI or to better treatment options for veterans with GWI.

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