ALS and Military Service Epidemiology

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What event took place at Yankee Stadium on July 4, 1939?

A speech by a military leader

The announcement of a new disease

Lou Gehrig's retirement announcement (correct)

A baseball game between the Yankees and the Red Sox

What is the connection between Lou Gehrig and people serving in the military, according to the text?

They served in the same war

They share a common hero status

They both gave memorable speeches

They are both at a greater risk of developing ALS (correct)

What conclusion does the existing evidence support regarding military service and ALS, according to the text?

Military service protects against ALS

Military service reduces the risk of developing ALS

Military service has no impact on the risk of developing ALS

Military service increases the risk of developing ALS (correct)

What is one of the main questions raised in the text about ALS and military service?

Why there is a greater risk of ALS with military service Signup and view all the answers

Based on the text, what percentage of U.S. persons meeting the case definition for ALS reported service in the military?

23.5% Signup and view all the answers

What does the CDC report published in 2018 demonstrate about men in older age groups affected by ALS and military service?

They have a disproportionately large fraction of military service history Signup and view all the answers

What does the high percentage of ALS patients reporting military service imply?

There is a significant link between military service and ALS Signup and view all the answers

What is the primary goal of The ALS Association in raising awareness about ALS and military service?

To highlight the need to address the risk of ALS associated with military service Signup and view all the answers

What is a central resource provided by The ALS Association and its local Chapters?

Information, assistance, and support for ALS patients and their families Signup and view all the answers

What is a common symptom experienced by ALS patients as the disease progresses?

Memory loss and cognitive decline Signup and view all the answers

What is a characteristic of frontotemporal dementia (FTD) in relation to ALS?

It is characterized by progressive degeneration of specific brain lobes Signup and view all the answers

What is the prognosis for a person diagnosed with ALS in 2018, as mentioned in the text?

Death in an average of two to five years Signup and view all the answers

Which drug is used as an adjunct medication in the management of ALS symptoms, according to the text?

Nuedexta Signup and view all the answers

What is the role of nerve cells, or motor neurons, in the human body according to the text?

Control of muscle movement throughout the body Signup and view all the answers

What year was Riluzole approved by the FDA for the treatment of ALS, as mentioned in the text?

1995 Signup and view all the answers

What does The ALS Association advocate for in relation to public policies, as stated in the text?

Support for state and federal resources for ALS research Signup and view all the answers

What is known about the effectiveness of Riluzole in extending life for people with ALS?

It marginally prolongs life by just a few months Signup and view all the answers

What does The ALS Association aim to achieve through broad-based research into ALS and the military?

Understanding potential causes and treatments that benefit veterans and non-veterans alike Signup and view all the answers

What is the main purpose of Nuedexta as mentioned in the text?

To treat emotional dysfunction in ALS patients Signup and view all the answers

Based on the text, what additional improvements have been associated with Nuedexta in ALS patients?

Improved speech and swallowing Signup and view all the answers

What is the mechanism of action of Edaravone in treating ALS?

By acting as an antioxidant Signup and view all the answers

How does Edaravone compare to Riluzole in treating ALS?

Riluzole does little to treat the underlying cause of ALS, similar to Edaravone Signup and view all the answers

What has contributed to the increasing prevalence of ALS over the years?

Increased number of older adults Signup and view all the answers

What percentage of all ALS cases are hereditary?

5%-10% Signup and view all the answers

Which of the following is NOT identified as a potential risk factor for sporadic ALS?

Consumption of dairy products Signup and view all the answers

From the text, what have researchers identified as a potential interaction contributing to the onset and progression of ALS?

A complex interaction between environmental and genetic factors Signup and view all the answers

Which occupation has been identified as having a close association with the development of ALS?

Construction work Signup and view all the answers

Based on the text, what do recent results from a Danish cohort indicate regarding ALS risk in men?

Exposures to toxicants in combination with strenuous physical activity increase the odds of developing ALS in men Signup and view all the answers

What do some populations engaging in intense physical activity, such as collegiate- or professional-level athletes, potentially have an association with?

Increased risk of developing ALS Signup and view all the answers

What is the Million Veteran Program mentioned in the text?

A large-scale health survey of veterans Signup and view all the answers

What did the VA establish following the publication of studies linking Gulf War veterans to ALS?

A registry to identify cases of ALS in military veterans Signup and view all the answers

What study evaluated the joint effects of genetic susceptibility and environmental exposures to the risk of sporadic ALS?

Genes and Environmental Exposures in Veterans with ALS (GENEVA) Signup and view all the answers

When was the National ALS Registry, subsuming the 2003-2007 VA registry, launched?

2010 Signup and view all the answers

What did researchers at Harvard University’s School of Public Health seek to assess in 2005?

The relationship between military service and ALS mortality in different time periods Signup and view all the answers

What was the focus of the ALS C.A.R.E. project from 1996-2005?

Tracking the disease course and outcomes of patients with ALS Signup and view all the answers

What did male veterans with ALS exhibit a greater prevalence of, compared to non-veterans?

Deafness Signup and view all the answers

What prompted the interest in studying veterans and ALS?

Accumulating evidence that ALS was occurring in veterans at an unexpected and accelerated rate Signup and view all the answers

What did Congress mandate in 2008, subsuming the 2003-2007 VA registry?

A National ALS Registry Signup and view all the answers

What did the VA request from the National Academies of Science, Engineering, and Medicine in 2006?

An independent assessment of the relationship between military service and the development of ALS Signup and view all the answers

What were the conclusions of retrospective studies conducted by researchers at Harvard University’s School of Public Health?

Men who had served in the military and were born between 1915-1939 had higher ALS mortality rates than those who did not serve in the military. Signup and view all the answers

What was examined through long-term follow-up conducted by the ALS C.A.R.E project?

The disease course and outcomes of patients with ALS. Signup and view all the answers

What is a likely reason for the higher incidence of ALS in military personnel?

Exposure to diesel exhaust and certain substances Signup and view all the answers

Which study reported an increased risk of ALS among all branches of the military?

Horner et al. study Signup and view all the answers

What was the funding source for the Horner et al. study?

Department of Veterans Affairs and the Department of Defense Signup and view all the answers

What did the Haley et al. study focus on?

Excess incidence of ALS in young Gulf War veterans Signup and view all the answers

Which substance is NOT mentioned as a risk factor thought to be linked to ALS in military personnel?

Asbestos Signup and view all the answers

What did the Horner et al. study seek to identify?

Cases of ALS in the military after the start of the Gulf War Signup and view all the answers

What was the observed incidence of ALS in young Gulf War veterans according to the Haley et al. study?

> 5 cases/year Signup and view all the answers

What percentage of Desert Storm veterans diagnosed with ALS were younger than 25 according to the Haley et al. study?

> 50% Signup and view all the answers

What was a major finding of the Horner et al. study?

Gulf War veterans were nearly twice as likely to develop ALS Signup and view all the answers

What environmental trigger was suggested by the Haley et al. study?

"War-related trigger" Signup and view all the answers

What was the main finding of the Institute of Medicine (IOM) committee regarding the connection between ALS and military service?

The existing evidence supports an increased risk of ALS in veterans Signup and view all the answers

What did the VA implement in 2008, two years after the IOM report, regarding ALS and military service?

Regulations to establish a presumption of service connection for ALS Signup and view all the answers

What did the studies conducted by epidemiologists at Harvard’s School of Public Health in 2009 and 2015 find regarding the risk of ALS in men with a history of military service?

A 60% increase in the risk of ALS in men with a history of military service Signup and view all the answers

What aspect of military service did the IOM committee call for further investigation into, regarding its contribution to disease etiology?

The effect of deployment during wartime on disease etiology Signup and view all the answers

What did the meta-analysis conducted using eight case-control studies and three cohort studies indicate about the risk of ALS in military personnel compared to non-military personnel?

The risk was significantly increased in military personnel Signup and view all the answers

What is one limitation of the studies conducted by epidemiologists at Harvard’s School of Public Health regarding their assessment of the relationship between military service and mortality from ALS?

The studies did not have data on deployment during wartime Signup and view all the answers

What distinguishes the presumption for ALS from other presumptions issued by the VA?

It applies to veterans diagnosed with ALS at any time following service in the military and is not limited to where or when a veteran served Signup and view all the answers

What did the 2016 meta-analysis conducted using case-control and cohort studies indicate about the relationship between military service and the risk of ALS?

It indicated a significantly increased risk of ALS in military personnel Signup and view all the answers

Based on the text, what does The National Academies advise on public health issues and healthcare policy?

It advises the federal government on public health issues and healthcare policy. Signup and view all the answers

What does The IOM committee call for further investigation into, based on their evaluation of existing scientific literature?

They call for high-quality studies into aspects of military service contributing to disease etiology. Signup and view all the answers

What does The VA regulation put into place in 2008 regarding veterans with ALS?

It provides full service-connected benefits for veterans diagnosed with ALS at any time following service in the military. Signup and view all the answers

What has contributed to making the presumption for ALS broad, unlike other presumptions issued by the VA?

The regulation is limited by specific eras or exposures. Signup and view all the answers

What did the recent large population-based case-control study in Denmark find regarding the association between military employment and ALS?

A 1.3-fold increased rate of ALS Signup and view all the answers

What did the Defense and Veterans Brain Injury Center (DVBIC) find to be the strongest evidence for an association between ALS and TBI?

TBI occurring within a year of the ALS diagnosis Signup and view all the answers

According to the DVBIC research review, what factor was found to be more closely associated with the risk of developing ALS in relation to TBI?

Multiple TBIs and shortened duration between the TBI and ALS diagnosis Signup and view all the answers

What did researchers from the VA Biorepository Brain Bank find regarding the comorbidity of ALS and chronic traumatic encephalopathy (CTE)?

9 out of 155 subjects examined had both ALS and CTE Signup and view all the answers

What were subjects with ALS and CTE comorbidity more likely to have, according to the researchers from the VA Biorepository Brain Bank?

A history of brain injury or repetitive head injury Signup and view all the answers

What did the DVBIC authors report about the links and associations noted in the studies they considered?

"did not provide strong enough evidence to establish causality between TBI and an ALS diagnosis" Signup and view all the answers

"Ultimately, what were the results of The DVBIC research review regarding the joint effects of genetic susceptibility and environmental exposures to the risk of sporadic ALS?"

"Inconclusive" Signup and view all the answers

"What are some common risk factors facing military personnel that need to be considered in future research, as stated in the text?"

"Smoking, use of smokeless tobacco, stress, and sleep issues" Signup and view all the answers

"What percentage of subjects examined by researchers from the VA Biorepository Brain Bank were found to have both ALS and CTE comorbidity?"

"5.8%" Signup and view all the answers

"What is the traumatic brain injury center of excellence for the Defense Health Agency?"

"The Defense and Veterans Brain Injury Center (DVBIC)" Signup and view all the answers

"What did researchers from the VA Biorepository Brain Bank aim to examine regarding subjects with confirmed ALS?"

Possible links between ALS and chronic traumatic encephalopathy (CTE) Signup and view all the answers