Iranian Veterans Research Articles

Physical activity and sport participation in veterans with extremity musculoskeletal disorders

Increasing the physical activity and sport participation rates of people with disabilities has been one of the most important targets of sport policy both at national and international levels. The purpose of the current investigation was to assess participation in sports or physical activities among Iranian veterans with extremity musculoskeletal disorders. Data were obtained from health needs assessment studies conducted among Iranian veterans with musculoskeletal disorders in a 12-year period between 2005 and 2017. The collected Information on sport or physical activity participation was analyzed using χ2 test, independent t-test, partial correlation coefficient and binary logistic regression (p < 0.05). Studies on 2644 veterans with extremity musculoskeletal disorders indicated that 37.6% (n = 994) of them participated in at least one type of sport or physical activity. The highest percentage of sport participation was 65% in bilateral upper limb amputees. Results from logistic regression analysis indicated that the chance of sport participation decreased with ageing while it increased with “Disability Percentage” assigned by the medical commission of the Veterans and Martyrs Affairs Foundation which is responsible for determining the disability rate of the veterans in Iran. It was observed that veterans with a higher “Disability Percentage” had a higher duration and frequency of sport or physical activity participation. The most popular sports among the subjects were track and field (20.1%, n = 192) and swimming (15.6%, n = 149). Generally, more than a third of the subjects participated in sports or physical activities in total and sport or physical activity participation was greater in the high-level lower extremity amputation group.

Spirituality, Trait Gratitude, and Post-Traumatic Growth in Iranian Veterans with PTSD: The Mediating Role of Ego Resilience.

In Iran, spirituality is one of the most critical factors affecting veterans' health. The present study aimed to determine the mediating role of ego resilience in the relationship between spirituality and trait gratitude with post-traumatic growth in Iranian veterans with PTSD. In the present descriptive and correlational study, 300 veterans with PTSD were hospitalized and treated at Isar Psychiatric Hospital in Ardabil in 2021 and were selected as the sample. Data were collected using Tedeschi and Calhoun's Traumatic Developmental Questionnaire, Parsian and Dunning, Mc Cullough et al.'s Trait Gratitude Questionnaire, and Block et al.'s Ego Resilience Questionnaire. Based on the obtained results and various fit indices, the direct and indirect relationships between spirituality, trait gratitude, ego resilience, and post-traumatic growth in veterans with post-traumatic stress disorder were confirmed (p < 0.01). Also, spirituality and trait gratitude through ego resilience indirectly affected the post-traumatic growth of veterans with PTSD (P < 0.05). Thus, targeting these three components through psychological therapies may effectively increase post-traumatic growth in veterans experiencing trauma.

Comparing the Memory Performance of Iranian Veterans With and Without Post-Traumatic Stress Disorder

Background and Objectives The physical and mental health of war veterans depends on paying attention to their psychological problems. This study aims to compare the memory performance of disabled Iranian veterans with and without post-traumatic stress disorder (PTSD). Methods This is a retrospective cohort study conducted in 2016-2017. Participants were 30 veterans with PTSD and 30 veterans without this disorder in Iran who had records in the Foundation of Martyr and Veterans Affair. The diagnosis of PTSD or its absence was previously made by a psychiatrist and approved by the medical commission of the Foundation of Martyr and Veteran Affairs. The sampling method was done using a purposive method and was done based on the inclusion criteria. The data collection tool was the Wechsler memory scale (WMS). Data analysis was performed using multivariate analysis of variance. Results There was a significant difference between the two groups in all WMS subscales (general information, orientation, mental control, logical memory, digit span, visual memory, associate learning). Conclusion Memory performance of disabled Iranian veterans with and without PTSD is different in all dimensions.

Prevalence of rheumatic disorders in Iranian chemical injured patients: a WHO–ILAR COPCORD Study

Background: Rheumatic disorders are one of the most prevalent human diseases which commonly become chronic and cause different types of disabilities. Chemical veterans may suffer from chronic difficulties caused by rheumatic disorders that can lead to decrease of their quality of life. The main purpose of this study was to evaluate the prevalence of rheumatic disorders among Iranian chemical warfare patient’s long-years after sulfur mustard (SM) exposure. Methods: This cross-sectional study was conducted from 2013 to 2014 on 245 Iranian chemical veterans. In order to evaluate rheumatic disorders, a special questionnaire for COPCORD studies were filled by veterans and then general and special rheumatology examinations were applied under the supervision of internists and rheumatologists. Data from all questionnaires were analyzed by SPSS software and the results were reported as percentage or mean ±SD. Results: Osteoarthritis (69.9%) was the most common complications diagnosed in these patients. After that back pain (30.5%) and pre-arthritis (27.2) were the other popular complications among veterans. The percentage of frozen shoulder and moderate carpal tunnel syndrome was 13.2% and 11.5%, respectively. Tennis elbow and fibromyalgia (3.7%), rheumatoid arthritis (0.8%) and gouty arthritis with 0.4% were the lowest complications among these patients. Conclusion: Rheumatic associated complications in Iranian chemical injured veterans are higher than the mean of whole community. This data provided the possibility of calculating the disease’s burden and making efficient decisions in the sanitary and treatment systems.

The prevalence of depression among iran‐iraq war veterans, combatants and former prisoners of war: A systematic review and meta‐analysis

By exposing individuals to trauma, wars can cause a host of psychiatric disorders. This study aimed to collect and compare the studies conducted to estimate the prevalence of depression among veterans, former prisoners of war (POWs) and military personnel in the Iran-Iraq war (1980-1988). In this systematic review, a search was conducted using relevant keywords in major national and international databases, personal archives and national academic libraries. We screened 135 records using their abstracts and selected a total of 56 studies for full-text review. Eventually, 19 studies were included in our systematic review and meta-analysis. The estimated pooled prevalence of depression among Iranian veterans and POWs was 22.4% (95% confidence interval=15.0-32.0). Although the results indicated disparities in the prevalence of depression among veterans and POWs, the aggregate estimated prevalence was much higher than what has been reported for military personnel. Effective policies and strategies are required for prevention and treatment of depression and related psychiatric complications among veterans and former POWs.

Assessing the Clinical Features and Blood Biochemistries of Acute Organophosphorus Chemical Warfare Agents in Iranian Veterans

Background: Nerve Agents (NAs) are a chemical weapons, and their use is prohibited. They were used for numerous-times in the warfare of Iraq against Iran. The present study aimed to assess the clinical features and laboratory findings of the acute poisoning manifestations of organophosphorus chemical warfare agents (NAs) in Iranian veterans early after exposure. Methods: A total of 25 male NAs-exposed cases were enrolled in the present study. We used the medical records of early combat in 1990 for data collection. The data of the exposed-victims were unavailable for a long time. Clinical features were evaluated and fasting blood glucose, sodium, potassium, insulin level, and protein electrophoresis were measured on the first day of exposure. Results: Potassium, sodium, fasting blood glucose, and protein electrophoresis were abnormally noticeable on the first day post-exposure. The clinical features of the studied cases were manifested in the muscarinic and nicotinic systems, and Central Nervous Systems (CNS). Miosis, cramp, restlessness, and respiratory symptoms were dominant features in the study subjects. Conclusion: The investigated exposed-victims of NAs indicated hypokalemia, hyperkalemia, hypoglycemia, normal insulin levels, and abnormal protein electrophoresis. The clinical features of the cholinergic crisis were markedly significant in three levels of the muscarinic, nicotinic, and CNS manifestations. Our findings suggested that the exposed cases were against a significant dose of NAs.

Prevalence of osteoarthritis disorders in Iranian chemical injured patients: A cross-sectional study using the COPCORD approaches

Introduction: Osteoarthritis is considered as the most common joint disease. Sulfur mustard (SM) is a toxic compound, which was applied as a chemical warfare agent by Iraq against Iran veterans during 1980-1988. Chemical veterans suffer from chronic implications caused by sulfur mustard that not only adversely affect their quality of life, but also restrict their working abilities and their participation in social activities. This study aims to consider the prevalence of osteoarthritis disorders among Iranian SM-exposed veterans. Methods: In this cross-sectional study, 248 Iranian SM exposed patients were evaluated from 2013 to 2014. Veterans filled a special questionnaire for COPCORD studies and then general and specific rheumatology examinations were applied under the supervision of internists and rheumatologists. The obtained data from 245 filled questionnaires were analyzed by SPSS software and the results were reported as a percentage or mean ±SD. Results: Bone and joint pain (72%), knee joint pain (52.5%), Joint stiffness (49.2%), and shoulder joint pain (45.8%) were the most common type of complications in these patients. Osteoarthritis in at least one joint was the most common type of osteoarthritis in veterans. 69.5% of veterans had osteoarthritis in at least one joint. Knee osteoarthritis was the secondmost common type of osteoarthritis, which has been found in 58.4% of all veterans. The prevalence of neck osteoarthritis in all veterans was 23.9%. Conclusion: The total prevalence of musculoskeletal disorders among Iranian veterans was significantly higher than the average of society.

Drug Interactions in Iranian Veterans With Chronic Spinal Cord Injury - A Descriptive Study

Background: Veterans with chronic spinal cord injury usually have various comorbidities. They are, therefore, visited by different doctors and use different medications. It is necessary to monitor the health of these veterans. One of the important issues in this regard is the attention to drug interactions. The purpose of this study was to investigate the drugs used and their interactions.Methods: This descriptive study of the cross-sectional studies was carried out retrospectively in 2015 under the Shefa Neuroscience Research Center’s supervision, examining the medical records of veterans with spinal cord injury participating in the health screening program at Khatam Alanbiya hospital in Tehran. Demographic data, comorbidities, used drugs, and the level of involvement collected. According to the FDA, drug interactions among the drugs used for each patient has evaluated and classified into three severe, moderate, and weak groups. SPSS v. 21 analyzed data.Results: The study population consisted of 404 men, ranging in age from 41 to 74, with a mean of 51.6 ± 6.4 years. One hundred forty-two of them (35.1%) had a complete injury, and 262 veterans (64.8%) had an incomplete injury. Only 17 veterans (4.2%) had no drug interactions. The number of drug interactions varied from 1 to 38, with an average of 5.9 ± 12.8 interactions per patient. The total number of interactions was 2856, of which 32.5% were weak, 55.3% moderate, and 12.2% severe, with a 95% confidence interval. Among the severe drug interactions in the study, the highest number belonged to the antidepressant drugs.Conclusion: This study highlights the necessity of developing a strategy for investigating and preventing drug interactions in veterans with chronic spinal cord injury. It has recommended that physicians pay more attention to other medications used by the patient and prescribe as little as possible of the drug and the drug with the least number of interactions.

Resting State Functional Connectivity in PTSD Veterans: An EEG Study

Posttraumatic stress disorder (PTSD) is a chronic debilitating disorder which may occur as a result of life-threatening mental trauma. Combat experience may lead to PTSD in veterans. In this paper we study resting state functional connectivity based on EEG signals of Iranian veterans with PTSD. We investigate whether there is a significant difference among PTSD group and two control groups including trauma exposed non-PTSD veterans and healthy controls who has not experienced any trauma. Preprocessed signals are divided into epochs. ciPLV (corrected imaginary part of phase locking value) is calculated between each pair of channels, in each sub band as well as the whole band. After studying networks, three graph features are extracted from networks: nodal degree, nodal efficiency and betweenness centrality. Repeated measure ANOVA is used at confidence level of 99%. Results demonstrate consequent networks are significantly different among three groups. Moreover, p-values illustrate three groups are significantly different. They also suggest which features and which channels can be proper choices for automatic classification. In addition to achieved results, our work shares two main features. First, we study combat related PTSD which lasts at least 30 years. Second, brain networks in PTSD group are compared to not only healthy controls, but also trauma-exposed non-PTSD participants.

Are Iranian Sulfur Mustard Gas-Exposed Survivors More Vulnerable to SARS-CoV-2? Some Similarity in Their Pathogenesis.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged as a health problem worldwide. It seems that COVID-19 is more lethal for Iranian veterans with a history of exposure to mustard gas. There are some similarities in the pathogenesis of SARS-CoV-2 and mustard gas in immune system disruption and pulmonary infection. SARS-CoV-2 and mustard gas inducing oxidative stress, immune system dysregulation, cytokine storm, and overexpression of angiotensin-converting enzyme II (ACE2) receptor in lungs that act as functional entry receptors for SARS-CoV-2. Moreover, Iranian survivors of mustard gas exposure are more susceptible and vulnerable to COVID-19. It is suggested that the principles of COVID-19 infection prevention and control be adhered to more stringently in Iranian survivors of mustard gas exposure than others who have not been exposed to mustard gas. Therefore, in this review, we discuss the different pathologic aspects of lung injury caused by mustard gas and also the relationship between this damage and the increased susceptibility of Iranian mustard gas exposed survivors to COVID-19.

The Relationship Between Spirituality Dimensions and Death Anxiety among Iranian Veterans: Partial Least Squares Structural Equation Modeling Approach.

The purpose of the present study was to examine the relationship among spiritual intelligence, spiritual well-being and death anxiety among Iranian veterans. In this predictive correlational study, 211 veterans completed King and DeCicco's Spiritual Intelligence Scale, Paloutzian and Ellison's Spiritual Well-being Scale and Templer's Death Anxiety Scale-Extended. After confirming the reliability of the constructs using intra-class correlation coefficient, partial least squares structural equation modeling method was utilized to assess the impact of spiritual well-being and spiritual intelligence on death anxiety. This study found a significant positive relationship between spiritual intelligence and death anxiety after controlling for the effects of age, education level and disability. However, there was a significant negative relationship between spiritual well-being and death anxiety among Iranian veterans. Negative relationships were found between spiritual well-being and death anxiety among Iranian veterans. However, spiritual intelligence had a positive impact on death anxiety.

Chronic musculoskeletal pain, phantom sensation, phantom and stump pain in veterans with unilateral below-knee amputation.

Many individuals with lower limb loss report concerns about other musculoskeletal symptoms resulting from amputation. The objective of this study was to assess chronic musculoskeletal pain in Iranian veterans with unilateral below-knee amputation. The participants agreed to take part in a health needs assessment and were interviewed face-to-face by trained interviewers. The assessment consisted of demographic information, wearing a prosthesis, pain locations in extremities, stump complications, severity of pains related to amputation and low back pain. Of 247 unilateral below knee amputees, 97.9% wore a prosthetic limb and times walking or standing with the prosthesis were 12.47 ± 3.84 and 4.22 ± 3.53 h a day, respectively. Low soft tissue coverage of the stump (15.4%) and symptomatic osteoarthritis in the contralateral lower extremity (40.1%) were the most common complications. The prevalence of stump pain, phantom sensations, phantom pain, low back pain, and knee pain was 84.2%, 77.3%, 73.7%, 78.1%, and 54.7% respectively. The odds ratio of stump pain in amputees with phantom pain was 2.22 times higher than those who did not experience phantom pain [OR = 2.22 (CI: 1.19-4.17); p = 0.012] and the odds ratio of low back pain was higher in amputees with stump pain [OR = 3.06 (CI: 1.50-6.21); p = 0.002]. This research enhances our understanding of comorbid musculoskeletal problems in below-knee amputees which can help health providers to identify rehabilitation needs and emphasizes the importance of regular assessments. These findings underline the importance of paying closer attention to different dimensions and aspects of musculoskeletal complications in veterans with unilateral below-knee amputation.

Whose Disability (Studies)?

This article is part of a larger inquiry into the production of disabled bodies due to violence. I examine processes of disablement in the global south, namely Iran and Iraqi Kurdistan, by wars launched and nurtured by both the local nation-states in the Middle East as well as the global north - the United States, Russia, and Western Europe. Utilizing a dialectical and historical materialist approach, I studied the Iran-Iraq war, the longest war of the 20th century. I explore how the disablement of global southern bodies in imperialist and nationalist wars is persistently naturalized – that is, attributed to the natural state of affairs in those regions, with the inevitable consequence that they cannot be connected to the violence of ongoing global and regional imperialism. This paper briefly touches upon the theoretical framework and methodology utilized to conduct this research, as well as the “problem” of disability in Iran. Subsequently, it goes on to extensively discuss the living conditions of the surviving Iranian veterans and surviving civilians of the Iran-Iraq war told through their own resilient voices. The veterans’ narratives expose their post-war experiences, including poverty, unemployment, inadequate medical-care, lack of medication due to the U.S.-imposed economic sanctions, and the presence of a dysfunctional disability-measurement system employed by the Iranian state. As a survivor of this war myself, I invite the reader to bear witness to how the violence of imperialism and nationalism not only renders people disabled, but also fetishizes their disablement by masking/mystifying the socio-political and economic relations that mediate the violent processes that render people disabled. By focusing on the veterans’ actual living conditions, this paper seeks to defetishize disablement, shifting the narrative of disabled veterans and civilians from tales of terrorism, heroism, living martyrdom, and patriotism, towards recognition of disability of/in human beings in need of care and support.

Current status of the acquired immune system of Iranian patients with long-term complications of sulfur mustard poisoning.

Sulfur mustard (SM) is a powerful blistering chemical warfare agent that has genotoxic effects. Cells with excessive proliferation such as lymphocytes may inherit this cellular toxicity which can lead to their malfunctions in the long-term. This study was designed to evaluate the status of acquired immunity among SM poisoned veterans around three decades after exposure. Thirty five male Iranian veterans having at least 25% disability due to SM poisoning with long-term complications in the respiratory system, skin or eyes were investigated. Non-functional/functional tests including hematological parameters, immunostaining analysis, lymphocyte proliferation assay, cytokine profile, and levels of total serum IgM, IgG and IgA were performed. The results showed that most of the parameters of adaptive immune system of the veterans were currently within the normal ranges. However, changes in the proliferation index (PI) of lymphocytes showed problems with the lymphocytes which cannot be proliferated appropriately. PI values for PBMCs (peripheral blood mononuclear cells) in presence of PHA (Phytohemagglutinin-A) and LPS (lipopolysaccharide) mitogens were 1.16 ± 0.14 and 1.13 ± 0.07, respectively which are less than expected. Based on the results gathered in this study, most of the parameters of acquired immunity were normal. However, the observed failure of lymphocyte functions may disrupt physiological activity of whole immune system leading to long-term complications; including recurrent respiratory tract infections. Indeed, further cellular and molecular studies with regard to lymphocytes function are required to better understand the status of adaptive immunity in these patients. Graphical abstract ᅟ.

Identifying and validating requirements of telemental health services for Iranian veterans.

Background:The ability of timely access to mental health care is very important for combat veterans that are facing many barriers such as living in rural and remote areas and the lack of integration. Telemental health services improve the veterans’ health situation by providing mental health care from a distance. We aimed to identify the telemental health service requirements for Iranian veterans and validate them from the perspective of the statistical population.Methods:This descriptive cross-sectional study was conducted in 2018. In the first phase, a review was conducted in relevant databases, such as PubMed, Scopus, Ovid, Ebsco, and Web of Science. In the second phase, veterans, mental health providers, and telemedicine experts were consulted to validating of the identified telemental health service requirements by a researcher-made questionnaire. Analysis of collecting data was done using SPSS software.Results:By full-text reviewing of 15 related articles, the identified elements were justified in 2 main categories and 24 subcategories including telemental health services (17 items) and telemental health requirements (7 items). According to the findings, the highest score was related to “save health-care costs” (4.47) and “reduce transportation-related problems” (4.47). Moreover, the “feasible alternative to face-to-face care” (2.22) obtained the lowest score from the perspective of the statistical population.Conclusion:Due to the importance of accessibility and patient-based mental health services, more studies are needed to investigate the point of views of patients and specialists to better understand the concerns and barriers to the implementation and use of telemental health services.

Late Cardiac Complications of Sulfur Mustard Poisoning in 38 Iranian Veterans.

It was aimed to investigate possible late cardiac effects of Sulfur mustard (SM) exposure in Iranian veterans. Thirty-eight veterans with late complications of SM exposure were investigated. Clinical history, physical examinations, 12 leads electrocardiography and transthoracic echocardiography were performed. Computed tomography coronary angiography (CTCA) was performed as clinically indicated for angiographic assessment and patients were stratified according to the CTCA findings. Incomplete right bundle branch block and right axis deviation were detected in 3 (7.9%) and 4 (10.5%) cases, respectively. Mean value of left ventricular ejection fraction was 55.7 ± 2.9%. Different degrees of right ventricular dilation was observed in seven (18.4%) patients. All the patients showed mild to moderate degrees of tricuspid regurgitation. Increased pulmonary artery pressure (PAP) was detected in 16 (42.1%) patients. Out of 18 patients who underwent CTCA, non-obstructive and obstructive coronary artery disease (CAD) were observed in three (16.66%) and eight (44.44%) patients, respectively. CAD was stratified to single vessel (5.5%), two vessels (27.8%) and three vessels disease (11.1%). Mean coronary artery calcium score was 50.91 ± 115.58. SM has cardiovascular toxicity, as a delayed complication of this chemical warfare poisoning.

Effectiveness of a Combined Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction Intervention on Depression Symptoms and Quality of Life in a Group of Iranian Veterans with Posttraumatic Stress Disorder

Effectiveness of a Combined Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction Intervention on Depression Symptoms and Quality of Life in a Group of Iranian Veterans with Posttraumatic Stress Disorder

Mustard Gas Effects on Iranian Veterans After 20 Years as Shown on Chest High-resolution Computed Tomography: A Follow-up Study

Introduction: Mustard gas is a known chemical weapon that was used in the 1980-1988 Iran- Iraq War. It causes many health problems, including serious respiratory damage. In this study, we used high-resolution computed tomography to assess the pulmonary complications after 20 years of veterans of the Iran-Iraq War who were exposed to mustard gas. Materials and Methods: This was a follow-up study conducted on 200 Iranian veterans with a history of exposure to mustard gas at least 20 years previously. High-resolution computed tomography was performed on all veterans and was interpreted by two independent expert radiologists who were blinded to the study. The frequency of high-resolution computed tomography ndings was reported. Data were analyzed with statistical package for the social sciences version 20 software. Results:One hundred twenty veterans (60%) showed HRCT abnormalities. The most frequent high-resolution computed tomography ndings were diffuse hyper-aeration, 63 (52.5%); interstitial opacity, 50 (41.7%); parenchymal opacity, 26 (21.7%); bronchiectasis, 15 (12.5%); sub-pleural air trapping, 13 (10.8%); and local brosis, 10 (8.3%). Generally, lower lobes were more frequently affected. Conclusion: This study showed a high frequency of abnormal high-resolution computed tomography ndings in veterans who were exposed to mustard gas, and most abnormalities were irreversible. These ndings included diffuse hyper-aeration, interstitial opacity, parenchymal opacity, bronchiectasis, sub-pleural air trapping, and local brosis.

Innate Immune System Status of Sulphur Mustard-Poisoned Iranian Veterans Three Decades after Exposure.

Sulphur mustard (SM) is an incapacitating chemical warfare agent which causes acute and chronic toxicities in different body organs of affected individuals. The aim of this study was to investigate the innate immune status of the Iranian veterans who were exposed to SM around 30 years earlier and had more than 25% disabilities. In this regard, most functional and non-functional parameters of innate immunity were evaluated in 35 veterans. Phagocytic activity, nitroblue tetrazolium (NBT) reduction assay and haemolytic complement activity (HCA) in addition to routine haematological parameters, serum protein electrophoresis, complements C3 and C4 levels were studied. Measures of haematological parameters, serum proteins, C3 and C4 were almost within the normal range. Functional experiments such as phagocytic activity, NBT reduction assay and HCA were normal as well. However, serum protein analysis revealed a fair decrease in percentages of α1 -globulin. Mean values of the parameters of innate immune system of the veterans three decades after SM poisoning were almost within the upper and lower normal limits. Reduced α1 -globulin - maybe subsequent to a chain of SM-induced genetic disorders - may have been the result of α1 -antitrypsin deficiency which may result in prevalent respiratory complications among these veterans. As a supplementary study, measurement of serum α1 -antitrypsin in SM-poisoned veterans could be beneficial. Further studies are required to prove this hypothesis. Further investigations on the evaluation of the acquired immunity parameters as the second line of defence may reveal a better understanding of SM veterans' immune system status.

Telomere shortening associated with increased levels of oxidative stress in sulfur mustard-exposed Iranian veterans

Sulfur Mustard (SM) is the most widely used chemical weapon. It was used in World War 1 and in the more recent Iran-Iraq conflict. Genetic toxicity and DNA alkylation effects of SM in molecular and animal experiments are well documented. In this study, lymphocytic telomere lengths and serum levels of isoprostane F2α were measured using q-PCR and enzyme immunoassay-based methods in 40 Iranian veterans who had been exposed to SM between 1983-88 and 40 non-exposed healthy volunteers. The relative telomere length in SM-exposed individuals was found to be significantly shorter than the non-exposed individuals. In addition, the level of 8-isoprostane F2α was significantly higher in the SM-exposed group compared to controls. Oxidative stress can be caused by defective antioxidant responses following gene mutations or altered activities of antioxidant enzymes. Chronic respiratory diseases and infections may also increaseoxidative stress. The novel finding of this study was a the identification of ‘premature ageing phenotype’. More specifically, telomere shortening which occurs naturally with aging is accelerated in SM-exposed individuals. Oxidative stress, mutations in DNA repair genes and epimutaions may be among the major mechanisms of telomere attrition. These findings may help for a novel therapeutic strategy by telomere elongation or for validation of an exposure biomarker for SM toxicity.