Impact of the first Gulf war on multiple sclerosis risk in Kuwait: a quasi-experimental study.

OBJECTIVE: It has been reasoned that stressful life events tend to alter immune function thereby increasing the susceptibility to autoimmune diseases including multiple sclerosis (MS). Using the database of Kuwait National MS Registry, this quasi-experimental study assessed the impact of the first Gulf War (Iraqi invasion of Kuwait in 1990) on MS risk in Kuwait. METHODS: MS incidence data from 1980 to 2019 were obtained from the Kuwait National MS Registry. Annual age-standardized incidence rates (ASIRs) (per 105 person-years) were computed using the World Standard Population as a reference. Interrupted time series analysis with the option of autoregressive order (1) was used to evaluate the impact of the first Gulf War on MS risk by treating 1990 as an intervention year. RESULTS: Estimated baseline annual ASIR (per 105 person-years) was 0.38 (95% CI: -1.02, 1.78; p = 0.587). MS ASIRs (per 105 person-years) tended to increase significantly every year prior to 1990 by 0.45 (ASIR per 105 person-years = 0.45; 95% CI: 0.15, 0.76; p = 0.005). During the first year of the first Gulf War, there seemed to be a non-significant increase (step change) in ASIRs (per 105 person-years) of MS (ASIR per 105 person-years = 0.85; 95% CI: - 5.16, 6.86; p = 0.775) followed by a non-significant increase in the annual trend in MS ASIRs per 105 person-years (relative to the preintervention trend i.e., the difference between the pre-first Gulf War versus the post-first Gulf War trends) by 0.65 (ASIR per 105 person-years = 0.65; 95% CI: - 0.22, 1.52; p = 0.138). However, a postestimation measure of the post-first Gulf War trend was statistically significant (ASIR per 105 person-years = 1.10; 95% CI: 0.40, 1.80; p = 0.003), which implies that the post-first Gulf War trend in the annual ASIRs (per 105 person-years) inclined to be the same as was the pre-first Gulf War (i.e., counterfactual of the pre-first Gulf War trend in annual ASIRs (per 105 person-years) as if no first Gulf War took place).The Durbin-Watson test statistic (d = 1.89) showed almost non-significant autocorrelations across the time series observations on ASIRs (per 105 person-years). CONCLUSIONS: This study suggests that the first Gulf War was not significantly associated with the increasing trend in MS risk at population level in Kuwait neither with any short-term change nor with secular trend. Future studies may consider confirming the role of conflict-related stress or other stressful life events in potential exacerbation of MS risk along with unraveling biologically plausible mechanistic pathways.

Strategies for cost-effective remediation of widespread oil-contaminated soils in Kuwait, an environmental legacy of the first Gulf War.

The Kuwaiti oil fire during the first Gulf War resulted in the formation of approximately 300 "oil lakes" of varying sizes that covered over 110 km2 of the desert land. This threatens the fragile desert ecosystems and human health. Following the award of over US$2 billion to the State of Kuwait by the United Nations, large-scale remediation of the oil-contaminated soils has now been on the agenda. However, how to implement the remediation program in a cost-effective way represents a major challenge. In this study, cost-effective remediation strategies were developed based on field and laboratory investigations in a typical oil lake area. Overall, most of the lighter petroleum hydrocarbons (PHCs) were lost due to evaporation. Long-chain aliphatic PHCs dominated the PHCs in the investigated oil lake area. This has implications for developing remediation strategies. Toxicity assessment results showed that the majority of soils pose a low environmental risk with a hazard index <1. Therefore, intensive treatment of these PHCs may not be necessary for these soils. Although active treatment methods are needed to remove the contaminants as soon as practical for the relatively small areas of high contamination, more cost-effective passive methods should be considered to minimize the remedial costs for the larger area of the non-hotspot areas. Given the extremely low risk in terms of groundwater contamination by the contaminated soils, it may not be necessary to remove the soils from the contaminated sites. A low-cost capping method should be sufficient to minimize human exposure to the PHC-contaminated soils.