ObjectivesAcross diverse groups of Gulf War (GW) veterans, reports of musculoskeletal pain, cognitive dysfunction, unexplained fatigue, chronic diarrhoea, rashes and respiratory problems are common. GW illness is a condition resulting from GW service in veterans who report a combination of these symptoms. This study integrated the GW literature using meta-analytical methods to characterise the most frequently reported symptoms occurring among veterans who deployed to the 1990–1991 GW and to better understand the magnitude of ill health among GW-deployed veterans compared with non-deployed GW-era veterans.DesignMeta-analysis.MethodsLiterature databases were searched for peer-reviewed studies published from January 1990 to May 2017 reporting health symptom frequencies in GW-deployed veterans and GW-era control veterans. Self-reported health symptom data were extracted from 21 published studies. A binomial-normal meta-analytical model was used to determine pooled prevalence of individual symptoms in GW-deployed veterans and GW-era control veterans and to calculate combined ORs of health symptoms comparing GW-deployed veterans and GW-era control veterans.ResultsGW-deployed veterans had higher odds of reporting all 56 analysed symptoms compared with GW-era controls. Odds of reporting irritability (OR 3.21, 95% CI 2.28 to 4.52), feeling detached (OR 3.59, 95% CI 1.83 to 7.03), muscle weakness (OR 3.19, 95% CI 2.73 to 3.74), diarrhoea (OR 3.24, 95% CI 2.51 to 4.17) and rash (OR 3.18, 95% CI 2.47 to 4.09) were more than three times higher among GW-deployed veterans compared with GW-era controls.ConclusionsThe higher odds of reporting mood-cognition, fatigue, musculoskeletal, gastrointestinal and dermatological symptoms among GW-deployed veterans compared with GW-era controls indicates these symptoms are important when assessing GW veteran health status.

Objectives Most frequently, multimorbidity measures available in the literature are heavily dependent on one outcome. We propose a method to construct a global multimorbidity score that incorporates chronic and non-chronic health conditions as well as health-related behaviours and symptoms, regardless of any specific outcome. Method Cross-sectional study of 373 905 Spanish workers who underwent a standardised medical evaluation in 2006. By applying an algorithm based on the results of a multi-correspondence analysis we computed a multimorbitidy score separated by sex. The score distribution was described by age groups and occupational social class for both sexes. Results Two dimensions were generated by the multi-correspondence analysis that explained around 80% of the total variability in both sexes. The main dimension was related to cardiovascular chronic conditions and personal habits, whereas the second dimension included symptoms, in addition to sleep disturbances in women. As compared to women, men showed a higher prevalence of multimorbidity (78% vs 17%), higher scores [mean 14 (SD 11.9) versus mean 9 (SD 9.5)], and a rising trend with age. No differences were found by occupational social class. Conclusions Multimorbidity can reflect clustering of healthrelated conditions, providing information on its burden and distribution in a specific population By calculating a multimorbidity score that considers both health-related conditions and symptoms, we provide a more holistic approach to multimorbidity, applicable to any database. Objectives Direct reading instruments are valuable tools for assessing exposure in the workplace. Adaption of such instruments to serve as valid and efficient tools to provide personal exposure data for environmental surveillance and occupational epidemiology studies fulfils a critical research need. 0018 VALIDATION OF A WEARABLE REAL-TIME MONITOR OF EXPOSURE TO NAPHTHALENEMethod A project is underway to validate new sensor technology that utilises native fluorescence of molecules excited by ultraviolet light with the goal of delivering laboratory-quality data for qualitative and quantitative analyses. The initial chemical of focus with this technology is naphthalene. The project is proceeding in two stages: independent laboratory validation and an exposure assessment field study, which is being conducted in two Phases: Phase I examines the degree to which the instrument serves as a sensor of naphthalene by assessing the concordance between measured personal air levels and those measured with conventional technologies e.g. active samplers; Phase II evaluates the validity of the instrument to serve as a dosimeter, correlating instrument-measured naphthalene levels in air with biological markers of exposure from skin, urine and exhaled breath. Results Independent laboratory evaluations indicate the instrument is accurate within accepted laboratory guidelines, when compared to standard gas chromatography methods. Results from the Phase I field study with US military personnel working w...

Objective In Nicaragua, an epidemic of chronic kidney disease (CKD) with unknown aetiology has been described primarily among young, male sugarcane workers. Our goals were to characterise the type of kidney damage and evaluate the potential role of occupational factors. Methods Our study population included 284 sugarcane workers, 51 miners, 60 construction workers, and 53 port workers in Western Nicaragua. For sugarcane workers in seven jobs (e.g. cane cutters, pesticide applicators, etc.), blood and urine samples were collected at the beginning and end of the 6-month sugarcane harvest. One round of samples were also collected from workers who were employed in the other three industries (but had never worked in the sugarcane industry). Biomarkers of kidney injury included serum creatinine, urinary albumin, and urinary neutrophil gelatinase-associated lipocalin (NGAL). Linear regression models were used to determine whether biomarkers of kidney injury increased during the harvest and/or varied by job. Results Biomarkers of kidney injury were significantly different by sugarcane job and estimated glomerular filtration rate (eGFR) declined significantly during the harvest among those engaged in the most strenuous work tasks, while urine albumin remained low in all groups. Compared to factory workers, eGFR was lowest among cane cutters (p = 0.006) and urinary NGAL was highest among cane cutters (p = 0.04). Workers in other industries also had higher than expected prevalence of eGFR <60 mL/min/1.73 m2. Conclusions Our results provide evidence that the type of kidney damage occurring in sugarcane workers, as well as among workers in other industries, is primarily tubulointerstitial (and not glomerular) in nature. Biomarkers of kidney injury varied by job and were highest among workers engaged in more strenuous physical labour. If acute kidney damage is on the causal pathway to CKD, heat or other work-related exposures may be contributing to this epidemic.

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