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Haley, R.W and Kurt, T.L. Self-reported Exposure to Neurotoxic Chemical Combinations in the Gulf War. JAMA 1997; 277- 231-237.

The authors administered surveys to the 249 participants in the study above, using standardized booklets to record self-reported GW exposures to 19 suspected risk factors for illness during the war. Syndrome 1 (see above two studies) was more common in veterans who reported having worn pet flea-and-tick collars during the war and in veterans whose main job during the GW involved security. Syndrome 2 was more common in veterans who reported having experienced a likely chemical weapons attack and in veterans who were located in "Sector 7" in northeastern Saudi Arabia on January 20, 1991. Syndrome 3 was more common in veterans who used more insect repellent on their skin and in those with more adverse effects from pyridostigmine. The three syndromes were not associated with any of the other suspected risk factors. The authors conclude that they have demonstrated associations between specific risk factors (especially cholinesterase-inhibiting compounds) and systematically defined syndromes in GW veterans. They liken the syndromes to variants of organophosphate-induced delayed polyneuropathy (OPIDP). The article’s discussion elaborates on the mechanism of OPIDP and the related scientific evidence which is compatible with their hypothesis. They discuss at length the controversy about whether or not chemical agents which do not cause acute symptoms can cause delayed neurological effects. Limitations of the study are some of those described for the above two studies, recall bias in this repeatedly examined group, the speculative nature of reported exposures to chemical weapons, and the paucity of data which would permit extrapolation from animal studies to GW veterans.

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