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

Air Force Women Study, 76-77

Air National Guard, 207-208

Alcohol abuse, 59, 126, 220, 223

All-cause hospitalization studies, 223-226

primary studies, 223-224

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

Arthralgias, 5, 250

Arthritis and arthralgia, 64, 185-187

primary studies, 185

secondary studies, 185-186

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

Beck Depression Inventory (BDI), 125, 132, 136



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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 Air Force Women Study, 76-77 Air National Guard, 207-208 Alcohol abuse, 59, 126, 220, 223 All-cause hospitalization studies, 223-226 primary studies, 223-224 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 Arthralgias, 5, 250 Arthritis and arthralgia, 64, 185-187 primary studies, 185 secondary studies, 185-186 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 Beck Depression Inventory (BDI), 125, 132, 136

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 Behavioral Risk Factor Surveillance Survey, 58n Bias, 47, 52, 56-57, 158, 204 selection, 56, 188 Biologic and chemical warfare agents for, 71 threat of, 14-15 vaccination against, 67 Biologic monitoring, 39-41 depleted uranium, 39-40 oil-well fire smoke, 40-41 Bipolar disorder, 122 Birth defects and adverse pregnancy outcomes (ICD-10 O00-Q99), 3, 6, 192-195, 248, 252 adverse pregnancy outcomes, 194-195 birth defects, 192-195 continued surveillance for, 8, 254 Goldenhar syndrome, 194 male fertility problems and infertility, 196 primary studies, 192-193 secondary studies, 193-194 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 Bronchitis, 64, 170-175 BSI. See Brief Symptom Inventory C CAGE questionnaire, 58n, 123 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 all cancers, 117-118, 120-121 brain cancer, 116, 119 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 primary studies, 166-167 secondary studies, 167-168 summary and conclusion, 168

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 secondary studies, 162-163 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 CIA-DOD report, 27-29 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 Air Force Women Study, 76-77 Australian Veteran Studies, 70, 84-85 Canadian Veteran Study, 65 Connecticut National Guard, 77, 102 Danish Peacekeeper Studies, 68-69, 93 defined, 45-47 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 the Iowa Study, 58-60, 78 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 New Orleans Reservist Studies, 76, 100-101 Oregon and Washington Veteran Studies, 63-64, 86-88

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 charge to, 1, 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 medical evaluation findings (Phase III), 62-63 survey findings (Phases I and II), 60-62

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 symptom clustering, 60-61 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 secondary studies, 167-168 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 fibromyalgia, 188-191 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 secondary studies, 154-155 summary and conclusion, 159 Diseases of the respiratory system (ICD-10 J00-J99), 170-179 Primary studies, 170-171 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 continued surveillance for, 8, 255 Eigenvalues, 50, 204

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 Environmental fate, for specific exposures, 37-38 Epidemiologic studies, description of, 48 case-control studies, 47 chance, 52 cohort studies, 45-47 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 nerve agents, 6-7, 174 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 Exposure assessment, 21-41 in epidemiologic studies, 21 recommendations for, 7-8, 254 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

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 Air National Guard, 207-208 Australian Gulf War studies, 206 cluster analysis, 212-213 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 the Iowa study, 205-206 Portland area veterans, 210-212 primary studies, 203-206 Seabee cohort, 208 Seabee cohort and validation study, 208-210 secondary studies, 207-212 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 primary studies, 188-189 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 Germany cohort, 125, 228, 248 GHQ-12. See Nonpsychotic psychologic illness testing (GHQ-12) Goldenhar syndrome, 194 Gulf War deployment, 12-13 environmental and chemical exposures, 13-14 living conditions in, 13 the setting, 12-15 threat of chemical and biologic warfare, 14-15

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 "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 all-cause, 223-226 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 Inclusion criteria, 15-16, 51 Infertility, and male fertility problems, 196-201 Injury and external causes of morbidity and mortality (ICD-10 S00-Y98), 219-222 primary studies, 219-220 secondary studies, 220 summary and conclusion, 220-221

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 women's health, 59-60 Irritable bowel syndrome, 69, 74 J Job-task-unit-exposure matrix, 21 K Kansas Veteran Study, 64, 89, 167 Khamisiyah demolition chronology of, 29-30 dispersion models, 29, 35-36 maps of, 31-34 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 Lagrangian modeling, 37-38 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

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 selected studies, 200-201 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 primary studies, 123-127 secondary studies, 127 summary and conclusion, 127 Metals, monitoring for, 40-41 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 Cullen criteria for, 227-228 difficulties validating, 57 primary studies, 227-228 secondary studies, 228-229 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

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 primary studies, 142-143 related findings of malingering and association of symptoms with objective test results, 140 secondary studies, 144-152 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 modeling, 37-38 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 symptom clustering, 63-64 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 primary studies, 157-158 secondary studies, 158 Persian Gulf War. See Gulf War PFTs. See Pulmonary-function tests

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 Iowa Study, 58-60, 65, 78-79 Kansas Veteran Study, 64, 89 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 Psychiatric outcomes, 122-130 primary studies, 123-127 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 exposure assessment, 7-8, 254 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 exposure to oil-well fire smoke, 6, 172-174

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 other exposures, 174 primary studies, 170-171 secondary studies, 171-172 Respiratory system diseases, 65, 170-179, 253 S Sarin, exposure to, 26-34, 73 SCID. See Structured Clinical Interview for DSM-IV SCL-90 test, 140, 146-149 Screening, recommendations for predeployment and postdeployment, 7 Seabee cohort studies, 73-74, 97, 167, 171, 185, 208, 229 exposure-symptom relationships, 74 larger, 73-74, 97 symptom clustering, 73-74 and validation, 208-210 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 Skin diseases, 183-184. See also Dermatologic conditions SNAP (Schedule for Nonadaptive and Adaptive Personality), 124 Somatization, 73, 208 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 Department of Veterans Affairs Study, 60-61

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 Tent heaters, 13, 25, 26 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 illness, 17, 202 hospitalizations for, 202-203 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 symptom clustering, 66-67 University of Manchester Veteran Study, 67-68, 203-204, 212 exposure-symptom relationships, 67-68 symptom clustering, 67 Uranium. See Depleted uranium exposures Urinary tract abnormalities, 6, 194, 252 continued surveillance for, 8, 255

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Gulf War and Health: Health Effects of Serving in the Gulf War, Volume 4 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 Vaccinations, 21-22 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 Women's health, in the Iowa Study, 59-60

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