INDEX
A
Abnormal clinical and laboratory findings. See Symptoms, signs, and abnormal clinical and laboratory findings
Abortion. See Spontaneous abortion
Acetylcholinesterase (AChE), 23
Adverse pregnancy outcomes, See Birth defects and adverse pregnancy outcomes
AEHA. See US Army Environmental Health Agency
AFQT. See Armed Forces Qualifying Test
Air Force Technical Applications Center (AFTAC), 28
Alcohol abuse, 59, 126, 220, 223
All-cause hospitalization studies, 223-226
summary and conclusion, 224
ALS. See Amyotrophic lateral sclerosis
American College of Rheumatology (ACR), case definition of fibromyalgia, 4, 62, 188, 249-250
American Thoracic Society questionnaire, 59n
Amyotrophic lateral sclerosis (ALS), 3, 5-6, 153-156, 248, 251
continued surveillance for, 8, 254
Anthrax vaccination, 14, 22-23
Anxiety, 3, 65, 122, 124, 127, 205-206, 248, 250
Armed Forces Qualifying Test (AFQT), 132, 136
Arthritis and arthralgia, 64, 185-187
primary studies, 185
summary and conclusion, 186-187
"Arthromyoneuropathy," 72
Asthma, 3, 59, 64, 170-173, 175, 224, 248, 253
Attributable risk, 46
Australian Veteran studies, 70, 84-85, 126, 167, 171, 206
exposure-symptom relationships, 70
symptom clustering, 70
B
Behavioral Risk Factor Surveillance Survey, 58n
Biologic and chemical warfare
agents for, 71
vaccination against, 67
Bipolar disorder, 122
Birth defects and adverse pregnancy outcomes (ICD-10 O00-Q99), 3, 6, 192-195, 248, 252
adverse pregnancy outcomes, 194-195
continued surveillance for, 8, 254
Goldenhar syndrome, 194
male fertility problems and infertility, 196
spontaneous abortion, 252
summary and conclusion, 194
Brain cancer, 5, 116, 118, 251
continued surveillance for, 8, 254
Brief Symptom Inventory (BSI), 58n, 76, 125
BSI. See Brief Symptom Inventory
C
Canadian Veteran Study, 65, 125, 163, 171, 189, 194, 228, 250
exposure-symptom relationships, 65
symptom clustering, 65
Cancer (ICD-10 C00-D48), 5, 115-121
continued surveillance for, 8, 254
primary and secondary studies, 116-118
summary and conclusion, 118
testicular cancer, 116-117, 119-120
CAPS. See Clinician-Administered PTSD Scale
Carbon monoxide (CO) exposure, 26
Cardiovascular disease, 6, 166-169, 252
summary and conclusion, 168
Case-control studies, 47, 61, 64, 72, 75, 158
Causality, assignment of, 53
CCEP. See Comprehensive Clinical Evaluation Program
Centers for Disease Control and Prevention (CDC) Chronic Fatigue Syndrome Questionnaire, 59n
CFS. See Chronic fatigue syndrome
Chalder Fatigue Scale, 59n
Charcot's disease. See Amyotrophic lateral sclerosis
CHD. See Congenital heart disease
Chemical and biologic warfare, See Biologic and chemical warfare
Chronic fatigue syndrome (CFS), 3-4, 57, 64-65, 74-75, 124, 161-165, 247, 249
case definition, 162
difficulties validating, 57
primary studies, 162
summary and conclusion, 163-164
Chronic Fatigue Syndrome Questionnaire, See Centers for Disease Control and Prevention (CDC) Chronic Fatigue Syndrome Questionnaire
"Chronic multisymptom illness," 3, 66-67, 75, 205, 207, 247
Chronic pain, 124
CIDI. See Composite International Diagnostic Interview
Circulatory system diseases, 166-169
Clinical findings, abnormal. See Symptoms, signs, and abnormal clinical and laboratory findings
Clinician-Administered PTSD Scale (CAPS), 71, 124-125
Cluster analysis, 2, 50-51, 204, 212-213, 248
CO. See Carbon monoxide exposure
Cognitive dysfunction, 3-4, 59, 65, 141
Cohort studies, definition of, 45-47
Australian Veteran Studies, 70, 84-85
Canadian Veteran Study, 65
Connecticut National Guard, 77, 102
Danish Peacekeeper Studies, 68-69, 93
Department of Veterans Affairs Study, 60-63, 79-80
Ft. Devens and New Orleans cohort studies, 70-71, 89-92
general limitations of Gulf War cohort studies and derivative studies, 56-57
Hawaii and Pennsylvania Active Duty and Reserve Study, 76, 102
Kansas Veteran Study, 64-65, 89
larger Seabee cohort studies, 73-74, 97
London School of Hygiene and Tropical Medicine Veteran Study, 68
military-unit-based studies, 70-75, 98-104
Pennsylvania Air National Guard Study, 74-75, 96
population-based studies, 58-70
as prevalence studies, 25
prospective, definition of, 46
retrospective, definition of, 46
Seabee Reserve Battalion Studies, 71-73, 94-96
United Kingdom Veteran Studies, 65-68, 81-84
University of London Veteran Studies, 65-67
University of Manchester Veteran Study, 67-68
Combat Exposure Scale, 25, 205
Expanded, 124
Committee on Gulf War and Health
approach to its charge, 1-2, 15
Complexities in resolving Gulf War and health issues, 16-17
individual variability, 17
limitations of exposure information, 16-17
multiple exposures and chemical interactions, 16
unexplained symptoms, 17
Composite International Diagnostic Interview (CIDI), 126
Comprehensive Clinical Evaluation Program (CCEP), 25, 189
Confounding variables, 46, 47, 52, 249
"Confusion-ataxia syndrome," 72
Congenital heart disease (CHD), 194
Connecticut National Guard, 77, 102
Connective tissue diseases, l85-187
Cox proportional-hazards modeling, 116, 167
Cross-sectional studies, see epidemiologic studies, cross-sectional studies
Cullen criteria for MCS, 227-228
Cyclosarin, exposure, 26-34, 35-36
D
Danish Peacekeeper Studies, 68-69, 93, 181
exposure-symptom relationships, 69
symptom clustering, 69
Department of Defense (DOD)
Comprehensive Clinical Evaluation Program (CCEP), 25
Gulf War Health Registry, 58, 115
Manpower Data Center, 62-63, 166, 180, 183, 185
Office of the Special Assistant for Gulf War Illnesses, 35, 40
vaccination records, 22
Department of Veterans Affairs Study, 60-63
exposure-symptom relationships, 61-62
Department of Veterans Affairs (VA), 1, 11, 57
Gulf War Health Registry, 58, 115, 212-213
Depleted uranium (DU) exposures, 14, 24, 39-40
Deployment to the Persian Gulf, 11-13
Depression, 3, 5, 59, 64, 70-71, 73, 75-76, 122-127, 248, 250.
See also Major depressive disorder major, 65
Dermatologic conditions, 4-5, 60, 62, 183, 250
Diagnostic medical tests, health outcomes with, 5-8, 251-254
Digestive system diseases, 180-182
Diseases of the circulatory system (ICD-10 I00-I99), 166-169
primary studies, 166
summary and conclusion, 168
Diseases of the digestive system (ICD-10 K00-K99), 180-182
primary studies, 180
secondary studies, 181
summary and conclusion, 181
Diseases of the musculoskeletal system and connective tissue (ICD-10 M00-M99), 185-191
arthritis and arthralgia, 185-187
Diseases of the nervous system (ICD-10 G00-G99), 153-160
amoyotrophic lateral sclerosis, 153-156
other neurological outcomes, 158-159
peripheral neuropathy, 157-158
primary studies, 154
summary and conclusion, 159
Diseases of the respiratory system (ICD-10 J00-J99), 170-179
Secondary studies, 183
Summary and conclusion, 183
Diseases of the skin and subcutaneous tissue (ICD-10 L00-L99), 183-184
primary studies, 183
secondary studies, 183
summary and conclusion, 183
Dispersion models, of the Khamisiyah demolition, 27-36
Distal symmetric polyneuropathy, 62-63, 157-158
DU. See Depleted uranium
Dyspepsia, 4, 62, 180-181, 205, 250
E
Ectopic pregnancy, 194-195, 252
Environmental fate, for specific exposures, 37-38
Epidemiologic studies, description of, 48
case-control studies, 47
chance, 52
confounding, 52
cross-sectional studies, 47-48
defining a new syndrome, 48-49
identifying and evaluating, 45-53
inclusion criteria, 51
limitations of Gulf War veteran studies, 53
misclassification, of outcomes, 57
multiple comparisons, 52
nested case-control studies, 47
statistical techniques used to develop a case definition, 49-51
summary, 53
types of epidemiologic studies, 45-48
Expanded Combat Exposure Scale, 25, 124
Exposure (in the Persian Gulf), 21-41
to depleted uranium, 24
to oil-well fire smoke, 6, 22, 40-41, 172-174
pyridostigmine bromide tablets for, 14, 23-24
studies using biologic monitoring for specific exposures, 39-41
studies using environmental fate and transport models for specific exposures, 37-38
studies using simulation to assess the potential magnitude of exposures, 26-36
summary and conclusions, 41
in epidemiologic studies, 21
Exposure assessment with questionnaires, 21-24
exposure to depleted uranium, 24
exposure to oil-well fire smoke, 22
exposure to pyridostigmine bromide, 23-24
exposure to vaccination, 22-23
Exposure information, limitations of, 16-17
Exposure misclassification, 36
Exposure-symptom relationships
in Australian Veteran Studies, 70
in Canadian Veteran Study, 65
in Danish Peacekeeper Studies, 69
in Department of Veterans Affairs Study, 61-62
in Ft. Devens and New Orleans cohort studies, 71
in the Iowa Study, 59
in Seabee cohort studies, 74
in Oregon and Washington Veteran Studies, 64
in the Pennsylvania Air National Guard Study, 75
in Seabee Reserve Battalion Studies, 72-73
in University of London Veteran Studies, 67
in University of Manchester Veteran Study, 68
F
Factor analysis, 2, 49-50, 59, 213-214, 248
Factor-analysis derived syndromes, 203-214
Australian Gulf War studies, 206
Department of Veterans Affairs, 204-205
Department of Veterans Affairs Gulf War Health Registry, 212, 213
Guy's, King's, St. Thomas's Schools of Medicine, 206, 212-213
Portland area veterans, 210-212
Seabee cohort, 208
Seabee cohort and validation study, 208-210
summary and conclusion, 213-214
University of Manchester, 203-204, 212
Fatigue. See Chronic fatigue syndrome
Fibromyalgia, 3-4, 59, 62, 188-191, 247, 249
difficulties validating, 57
secondary studies, 189
summary and conclusion, 190
Fort Devens and New Orleans cohort studies, 70-71, 89-92, 124-125, 163, 183, 228
exposure-symptom relationships, 71
symptom clustering, 71
G
Gastrointestinal symptoms, 4, 60, 64, 250
GHQ-12. See Nonpsychotic psychologic illness testing (GHQ-12)
Goldenhar syndrome, 194
Gulf War
environmental and chemical exposures, 13-14
living conditions in, 13
"Gulf War syndrome" (GWS), 3, 17, 202, 209
GWS. See "Gulf War syndrome"
H
Hawaii and Pennsylvania Active Duty and Reserve Study, 76, 102
Health outcomes, 115-231, 247-255
all-cause hospitalization studies of, 223-226
based primarily on symptoms and self-reports, 3-5, 248-250
birth defects and adverse pregnancy outcomes (ICD-10 O00-Q99), 192
cancer (ICD-10 C00-D48), 115-121
cardiovascular disease, 166-169
chronic fatigue syndrome, 161-165
diseases of the circulatory system (ICD-10 I00-I99), 166-169
diseases of the digestive system (ICD-10 K00-K99), 180-182
diseases of the musculoskeletal system and connective tissue (ICD-10 M00-M99), 185-187
diseases of the nervous system (ICD-10 G00-G99), 153-160
diseases of the respiratory system (ICD-10 J00-J99), 170-179
diseases of the skin and subcutaneous tissue (ICD-10 L00-L99), 183-184
injury and external causes of morbidity and mortality (ICD-10 S00-Y98), 219-222
mental and behavioral disorders (ICD-10 F00-F99), 122-130
multiple chemical sensitivity, 227-231
neurobehavioral and neurocognitive outcomes (ICD-10 F00-F99), 131-152
symptoms, signs, and abnormal clinical and laboratory findings (ICD-10 R00-R99), 202-218
Health Symptom Checklist (HSC), 124-125
Healthy-warrior effect, 56, 227, 251
Heaters, tent, 26
Hormones. See Male reproductive hormones
Hospitalizations
for unexplained illness, 202-203
HSC. See Health Symptom Checklist
Hypertension, 166, 167, 168, 252
I
ICD. See International Classification of Diseases and Related Health Problems
Impact of Event Scale, 76
Infertility, and male fertility problems, 196-201
Injury and external causes of morbidity and mortality (ICD-10 S00-Y98), 219-222
secondary studies, 220
International Classification of Diseases and Related Health Problems, 9th Revision, Clinical Modification (ICD-9-CM), 126
International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), 115n
Intestinal conditions. See Gastrointestinal symptoms
The Iowa study, 58-60, 78-79, 163, 189, 205-206, 228, 250
exposure-symptom relationships, 59
symptom clustering, 59
Irritable bowel syndrome, 69, 74
J
Job-task-unit-exposure matrix, 21
K
Kansas Veteran Study, 64, 89, 167
Khamisiyah demolition
potential exposure to sarin and cyclosarin, 6-7, 26-36, 166-168, 174-176
L
Laboratory findings, abnormal. See Symptoms, signs, and abnormal clinical and laboratory findings
Laufer Combat Scale, 125
Leishmaniasis, 74
Limitations of Gulf War veteran studies, 2, 53
of cohort studies and derivative studies, 56-57
London School of Hygiene and Tropical Medicine Veteran Study, 68
Lou Gehrig's disease. See Amyotrophic lateral sclerosis
Louisiana. See Fort Devens and New Orleans cohort studies
M
Major depressive disorder (MDD), 122-123
Male fertility problems and infertility, 196-201
primary studies, 196
summary and conclusion, 196
Male reproductive hormones, levels of, 252
Manpower Data Center, 62-63, 78, 103, 162, 166, 180, 183, 185
Maps of the Khamisiyah demolition, See Khamisiyah demolition
MCS. See Multiple chemical sensitivity
MDD. See Major depressive disorder
Medical tests. See Diagnostic medical tests or objective measures
Mental and behavioral disorders (ICD-10 F00-F99), 122-130
secondary studies, 127
summary and conclusion, 127
Migraine headaches, 64
Military service, adverse health effects of, 15-16
Military-unit-based studies, 70-75, 98-104
Ft. Devens and New Orleans cohort studies, 70-71, 89-92
larger Seabee cohort studies, 73-74, 97
Pennsylvania Air National Guard Study, 74-75
Seabee Reserve Battalion Studies, 71-73
Ministry of Defence for UK Gulf War, Gulf War health registry, 58
Mississippi Scale for Combat-Related PTSD, 125, 127
Mood-cognition-fatigue, 207
Mood-cognition symptoms, 75
Motor neuron disease. See Amyotrophic lateral sclerosis
Motor-vehicle accidents, 219
Multiple chemical sensitivity (MCS), 3-4, 64-65, 227-231, 247-249
difficulties validating, 57
summary and conclusion, 229
Multisymptom-based medical conditions, 3-4, 203-205, 247-249,
See also "Chronic multisymptom illness"
Multivariate analysis, 64, 69, 74, 228, 230
Musculoskeletal symptoms, 71, 75, 207, 213
Musculoskeletal system diseases, l85-191
N
National Adult Reading Test (NART), 132, 136, 142
National Comorbidity Survey Replication, 122
National Health and Nutrition Examination Surveys, 39
National Health Interview Survey, 58n, 60
National Health Service Central Register, 117
National Medical Expenditures Survey, 58n
Nerve agent exposure, 6-7, 174.
See also Khamisiyah demolition
Nervous system diseases, 153-160
Neurobehavioral and neurocognitive outcomes (ICD-10 F00-F99), 131-152
neurobehavioral deficits, 248
neurobehavioral tests and confounding factors, 131-132
related findings of malingering and association of symptoms with objective test results, 140
summary and conclusion, 140-141
Neurological outcomes, See Nervous system diseases
Neuropathy. See Peripheral neuropathy
Neuropsychologic symptoms, 3, 69, 71,140, 213
New Orleans cohort. See Fort Devens and New Orleans cohort studies
New Orleans Reservist Studies, 76, 100-101
Nuclear Industry Family Study, 195
O
Obsessive-compulsive disorders, 73, 126, 208, 216
ODTP. See Oregon Dual Task Procedure
Oil-well fire smoke exposures, 6, 11, 13, 22, 37-38, 40-41, 172-174, 178-179
Operation Desert Shield, 12-13, 16
Operation Desert Storm, 13, 16, 24
Oregon and Washington Veteran Studies, 63-64, 86-88, 189
exposure-symptom relationships, 64
Oregon Dual Task Procedure (ODTP), 136, 140
Overview of health outcomes, summary, 247-254
outcomes based primarily on symptoms and self-reports, 247-250
outcomes with objective measures or diagnostic medical tests, 251-254
P
PAH. See Polycyclic aromatic hydrocarbons
PCL-M. See Posttraumatic Stress Disorder Checklist-Military
Pennsylvania Air National Guard Study, 74-75, 168
exposure-symptom relationships, 75
medical evaluation, 75
symptom clustering, 75
Peripheral neuropathy, 157-160, 251-252
secondary studies, 158
Persian Gulf War. See Gulf War
PFTs. See Pulmonary-function tests
Physical and mental health screening questionnaire (SF-12), 70, 126
PIR. See Proportional incidence rate
PMRs. See Proportional morbidity ratios
Polycyclic aromatic hydrocarbons (PAH), 37, 40-41
Population-based studies, 58-70
Australian Veteran Studies, 70, 84-85
Canadian Veteran Study, 65
Danish Peacekeeper Studies, 68-69, 93
Department of Veterans Affairs Study, 60-63
London School of Hygiene and Tropical Medicine Veteran Study, 68
Oregon and Washington Veteran Studies, 63-64, 86-88
United Kingdom Veteran Studies, 65-68, 81-84
University of London Veteran Studies, 65-67
University of Manchester Veteran Study, 67-68
Portland area veterans, 210-212
Postdeployment and predeployment screening recommendations for, 7, 254
Posttraumatic stress disorder (PTSD), 3, 5, 59, 64-65, 70-71, 74, 76-77, 122-130, 248, 250
Posttraumatic Stress Disorder Checklist-Military (PCL-M), 123, 125-126, 128-129
Predeployment and postdeployment screening, See Postdeployment and predeployment screening
Pregnancy. See Ectopic pregnancy
Primary Care Evaluation of Mental Disorders (PRIME-MD), 123-125, 128-130
Proportional incidence rate (PIR), 117, 119
Proportional morbidity ratios (PMRs), 180, 182, 203, 220, 222-224
Prospective cohort studies, 46
secondary studies, 127
summary and conclusion, 127
PTSD. See Posttraumatic stress disorder
PTSD Checklist-Military, see Posttraumatic Stress Disorder Checklist-Military
Pulmonary-function tests (PFTs), 63, 170, 177
Pyridostigmine bromide (PB) use, 14, 23-24
R
Recommendations, 7-8, 10, 254-255
predeployment and postdeployment screening, 7, 254
surveillance for adverse outcomes, 8, 254-255
Respiratory outcomes, 6-7, 170-179, 252-253
exposure to nerve agents, 174
other exposures, 174
Respiratory system diseases, 65, 170-179, 253
S
SCID. See Structured Clinical Interview for DSM-IV
Screening, recommendations for predeployment and postdeployment, 7
Seabee cohort studies, 73-74, 97, 167, 171, 185, 208, 229
exposure-symptom relationships, 74
Seabee Reserve Battalion Studies, 71-73
exposure-symptom relationships, 72-73
symptom clustering, 72
SF-12. See Physical and mental health screening questionnaire
SF-36. See 36-Item Short-Form Health Survey
Sickness Impact Profile, 59n
Signs. See Symptoms, signs, and abnormal clinical and laboratory findings
Simulation assessment of potential exposure magnitude, 26-36
epidemiologic studies using fate and transport models to assess exposure to sarin and cyclosarin, 35-36
Khamisiyah demolition and potential exposure to sarin and cyclosarin, 26-34
tent heaters, 26
Sinusitis, 60
See also Dermatologic conditions
SNAP (Schedule for Nonadaptive and Adaptive Personality), 124
Spontaneous abortion, 194-195, 252
continued surveillance for, 8, 255
Stomach conditions. See Gastrointestinal symptoms
Structured Clinical Interview for DSM-IV (SCID), 124, 228
Subcutaneous tissue diseases, 183-184
Substance abuse, 3, 70-71, 248, 250
Surveillance for adverse outcomes recommendations for, 8, 254-255
Survey findings (Phases I and II), in Department of Veterans Affairs Study, 60-62
Symptom clustering, 202
in Australian Veteran Studies, 70
in Canadian Veteran Study, 65
in Danish Peacekeeper Studies, 69
in Ft. Devens and New Orleans cohort studies, 71
in the Iowa Study, 59
in larger Seabee cohort studies, 73-74
in Oregon and Washington Veteran Studies, 63-64
in the Pennsylvania Air National Guard Study, 75
in Seabee Reserve Battalion Studies, 72
in University of London Veteran Studies, 66-67
in University of Manchester Veteran Study, 67
Symptoms, signs, and abnormal clinical and laboratory findings (ICD-10 R00-R99), 202-218
factor-analysis derived syndromes, 203-214
hospitalizations for unexplained illness, 202-203
unexplained illness, 202
Syndromes, defining a new, 48-49, 66-67
factor-analysis derived, 203
T
Test of Memory Malingering (TOMM), 140
Testicular cancer, 5, 116-117, 119-120
continued surveillance for, 8, 254
36-Item Short-Form Health Survey (SF-36), 59, 124
Threats, of chemical and biologic warfare, 14-15
Thyroid conditions, 64
TOMM. See Test of Memory Malingering
Transport models, for specific exposures, 37-38
Transportation accidents, 219-221
U
Unexplained symptoms, 17
United Kingdom Veteran Studies, 65-68, 81-84.
See also University of London Veteran Studies;
University of Manchester Veteran Study
London School of Hygiene and Tropical Medicine Veteran Study, 68
University of London Veteran Studies, 65-67
exposure-symptom relationships, 67
University of Manchester Veteran Study, 67-68, 203-204, 212
exposure-symptom relationships, 67-68
symptom clustering, 67
Uranium. See Depleted uranium exposures
Urinary-uranium testing, 39-40
US Armed Services Center for Unit Records Research, 38
US Army Center for Health Promotion, 38
US Army Environmental Health Agency (AEHA), 37, 40
V
against biologic and chemical warfare agents, 67
Veterans Programs Enhancement Act, 1, 11
Volatile organic compounds (VOCs), monitoring for, 40-41
W
WAIS. See Wechsler Adult Intelligence Scale
Warfare, threat of chemical and biologic, 14-15, 23, 65, 71
Washington State, 154.
See also Oregon and Washington Veteran Studies
Wechsler Adult Intelligence Scale (WAIS), 132
Whiteley Index, 124