INDEX

A

Abortions, spontaneous, 193, 194, 195, 201-202, 231

Acetylcholine, 263-264

Acetylcholinesterase (AChE), 265-266, 275, 276

inhibitors, 266, 277-278

Alcohol abuse, 8, 49, 75, 80, 90, 99, 100, 101, 102, 104, 106, 108, 109, 110, 112, 113, 121, 126, 132, 134, 177, 208, 232

Allergies

chronic respiratory, 148

skin, 165

Alzheimer’s disease, 8, 121, 129-130

Amyotrophic lateral sclerosis (ALS)

combat exposure and, 121

conclusions, 4, 8, 129, 257

diagnosis, 126, 127

female veterans, 231

hospitalization study, 128

incidence, 127, 128, 134

latency, 8, 9, 258

mortality studies, 75, 125, 128

neurotoxin exposure and, 128-129

pathogenesis, 126, 128

primary studies, 127, 129, 133-134

research recommendations, 9, 10, 260-261

risk factors, 126, 127, 275

secondary studies, 128, 129

updated and supplemental literature, 128-129

Volume 4 summary, 4, 15, 19, 127-128

Anemia, 83

Animal studies, 3, 15, 25, 129, 275-276

Anthrax vaccine, 14, 57

Anxiety disorders, 17, 19, 42, 50, 63, 99, 100, 101, 102, 103-104, 105, 106, 107, 110, 111, 113, 114, 154, 160, 207, 214.

See also Generalized anxiety disorder;

Obsessive-compulsive disorder;

Panic disorder;

Posttraumatic stress disorder;

Social phobia

Arthralgia, 169, 171, 207

Arthritis, 169, 171

Asthma and bronchitis, 4, 5, 20, 33-34, 42, 50, 145, 146, 148, 150, 152, 153, 208

Atherosclerosis, 135

Atopic dermatitis, 19, 165, 167, 168

Australian Veteran Studies, 43, 54-56

chronic fatigue syndrome, 213, 219

derivative studies, 43, 54-56

diseases of the digestive system, 158

mental and behavioral disorders, 101-102, 104-106, 112

multisymptom illnesses, 207

reference study, 43, 54

B

Basal ganglia injury, 130-131

Bipolar disorder, 99

Birth defects, 231

conclusions, 8, 192-193, 257

deployment status of parents and, 189, 190-191, 192, 231, 234

derivative studies, 42, 43, 45, 54

environmental exposures and, 190

miscarriages and stillbirths, 193, 201

primary studies, 189-190, 191, 200-201

reference study, 51, 53-54

registries, 189-190, 192

secondary studies, 190-191, 192

updated and supplemental literature, 191-192

Volume 4 summary, 4, 19, 189-191

Bladder infections, 181, 182

Blood and blood-forming organs, diseases of, 7

conclusions, 8, 85, 257

hospitalizations, 83-88

latency, 85

mortality studies, 85

nerve-agent exposure and, 84, 87

oil-well fire smoke exposure and, 84, 87

primary studies, 83-84, 86-88

secondary studies, 84

updated and supplemental literature, 83-84

Body mass index (BMI), 92

Borderline personality disorder, 42, 50-51, 107-108

Botulinum toxoid vaccine, 14, 57

Bradford Hill aspects, 27, 28, 35

Brain cancer, 2, 9, 10, 20, 73-74, 75, 76, 78, 79, 125, 231, 261

Bronchitis. See Asthma and bronchitis

Butyrylcholinesterase (BuChE), 61, 277

C

C-reactive protein, 213

CAGE questionnaire, 49



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INDEX A diseases of the digestive system, 158 mental and behavioral disorders, 101-102, 104-106, Abortions, spontaneous, 193, 194, 195, 201-202, 231 112 Acetylcholine, 263-264 multisymptom illnesses, 207 Acetylcholinesterase (AChE), 265-266, 275, 276 reference study, 43, 54 inhibitors, 266, 277-278 Alcohol abuse, 8, 49, 75, 80, 90, 99, 100, 101, 102, 104, B 106, 108, 109, 110, 112, 113, 121, 126, 132, 134, 177, 208, 232 Basal ganglia injury, 130-131 Allergies Bipolar disorder, 99 chronic respiratory, 148 Birth defects, 231 skin, 165 conclusions, 8, 192-193, 257 Alzheimer’s disease, 8, 121, 129-130 deployment status of parents and, 189, 190-191, 192, Amyotrophic lateral sclerosis (ALS) 231, 234 combat exposure and, 121 derivative studies, 42, 43, 45, 54 conclusions, 4, 8, 129, 257 environmental exposures and, 190 diagnosis, 126, 127 miscarriages and stillbirths, 193, 201 female veterans, 231 primary studies, 189-190, 191, 200-201 hospitalization study, 128 reference study, 51, 53-54 incidence, 127, 128, 134 registries, 189-190, 192 latency, 8, 9, 258 secondary studies, 190-191, 192 mortality studies, 75, 125, 128 updated and supplemental literature, 191-192 neurotoxin exposure and, 128-129 Volume 4 summary, 4, 19, 189-191 pathogenesis, 126, 128 Bladder infections, 181, 182 primary studies, 127, 129, 133-134 Blood and blood-forming organs, diseases of, 7 research recommendations, 9, 10, 260-261 conclusions, 8, 85, 257 risk factors, 126, 127, 275 hospitalizations, 83-88 secondary studies, 128, 129 latency, 85 updated and supplemental literature, 128-129 mortality studies, 85 Volume 4 summary, 4, 15, 19, 127-128 nerve-agent exposure and, 84, 87 Anemia, 83 oil-well fire smoke exposure and, 84, 87 Animal studies, 3, 15, 25, 129, 275-276 primary studies, 83-84, 86-88 Anthrax vaccine, 14, 57 secondary studies, 84 Anxiety disorders, 17, 19, 42, 50, 63, 99, 100, 101, 102, updated and supplemental literature, 83-84 103-104, 105, 106, 107, 110, 111, 113, 114, 154, 160, Body mass index (BMI), 92 207, 214. See also Generalized anxiety disorder; Borderline personality disorder, 42, 50-51, 107-108 Obsessive-compulsive disorder; Panic disorder; Botulinum toxoid vaccine, 14, 57 Posttraumatic stress disorder; Social phobia Bradford Hill aspects, 27, 28, 35 Arthralgia, 169, 171, 207 Brain cancer, 2, 9, 10, 20, 73-74, 75, 76, 78, 79, 125, Arthritis, 169, 171 231, 261 Asthma and bronchitis, 4, 5, 20, 33-34, 42, 50, 145, 146, Bronchitis. See Asthma and bronchitis 148, 150, 152, 153, 208 Butyrylcholinesterase (BuChE), 61, 277 Atherosclerosis, 135 Atopic dermatitis, 19, 165, 167, 168 C Australian Veteran Studies, 43, 54-56 chronic fatigue syndrome, 213, 219 C-reactive protein, 213 derivative studies, 43, 54-56 CAGE questionnaire, 49 289

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290 GULF WAR AND HEALTH Canadian Gulf War Veterans Study, 44, 58 illnesses associated with, 60, 267-268 derivative studies, 44, 58 long-term effects of low doses, 270 diseases of the digestive system, 158, 166 multisymptom illnesses, 57, 61, 62, 278-279 mental and behavioral disorders, 105 studies in Gulf War populations, 60, 271-274 chronic fatigue syndrome, 213 Chronic dysphoria, 105 reference study, 44, 58 Chronic fatigue syndrome (CFS), 7. See also Cancer Multisymptom illnesses all cancers, 8, 74-75, 80-82, 257 chemical sensitivity and, 45 brain cancer, 2, 9, 10, 20, 73-74, 75, 76, 78, 79, 125, comorbidities, 157, 163 231, 261 conclusions, 8, 214, 256 conclusions, 8, 78, 257 definition, 210-211, 212 deployment status and, 74-80 diagnosis, 41, 211 derivative studies, 42, 44, 52 in disabled veterans, 52, 214, 220 digestive tract, 76 etiology, 121, 211 hospitalization studies, 73, 74, 75-76, 80, 81 identification of predictors, 42 incidence, 42, 52, 57, 78 mental and behavioral disorders and, 102 latency, 8, 28, 41, 73, 74, 78 multisymptom illnesses, 60, 207, 211 leukemias and lymphomas, 73 oil-fire smoke exposure and, 214 mortality studies, 73, 74-75, 76, 78, 79, 80, 81, 82, pesticide exposure and, 52, 55, 213, 214 125, 226-227 prevalence, 46, 47, 53, 55, 60, 61, 213, 214 nerve agent exposure and, 73-74, 75, 77, 78, 79 primary studies, 211-212, 219-220 oil-well fire smoke and, 74, 75, 78 pyridostigmine bromide and, 55, 213, 214 pesticide exposure and, 78 secondary studies, 212-213 prevalence, 76, 77 threat of chemical weapons and, 55, 212, 213 primary studies, 75-76, 79-82, 125 updated and supplemental literature, 213-214, 220 recommendation, 78 Volume 4 summary, 19, 211-213 registry data, 9 war stress and, 102, 213 research recommendations, 9, 10 Chronic multisymptom illness (CMI). See Multisymptom secondary studies, 76-78 illnesses skin, 73, 76, 77, 78, 166 Chronic obstructive pulmonary disease, 145, 148, 150 testicular, 2, 4, 15, 19, 73, 74, 76, 78, 79-80, 81, 208 Chronic widespread pain (CWP). See also Fibromyalgia updated and supplemental literature, 75-78 alcohol use and, 177 vaccines/vaccination and, 77 cognitive performance, 50, 118 Volume 4 summary, 4, 19, 20, 73-75 combat exposure and, 50, 177, 178 Carbamates, 266, 267, 268 comorbid with mental disorders, 102 Cardiac dysrhythmia, 135, 140, 141 conclusions, 8, 257 Cardiovascular disease. See Circulatory system diseases delayed-onset, 177 Cause-specific mortality. See External causes of identification of predictors of, 42, 50 mortality pesticide exposure and, 178 Centers for Disease Control and Prevention (CDC), 47, pyridostigmine bromide exposure and, 178 49, 52, 59, 116, 200, 205, 208, 210, 211, 212, 213, musculoskeletal, 1, 3, 10, 18, 19, 47, 57, 118, 120 219, 220, 256, 270 prevalence, 53, 177 Central nervous system (CNS), 160, 267, 270, 275, 276, primary studies, 176-177, 178, 179 278, 279 secondary studies, 177-178 Chalder Fatigue Scale, 213 self-reports of, 18, 42, 43, 57 Chemical agent exposure, and neurological diseases, 47, stress perceptions and, 177, 178 59-60, 121, 133 Volume 4 summary, 3 Chemical and biologic warfare Circulatory system diseases. See also specific diseases exposure to agents of, 49, 58 and conditions threat of, 14-15, 55, 212, 213 birth defects, 189, 200 conclusions, 8, 140, 257 Chlorinated hydrocarbons, 14 female veterans, 138 Cholinesterase inhibitors. See also Pesticide/insecticide hospitalization studies, 135, 136, 137, 140, 141, 142, exposures; Pyridostigmine bromide 218 animal studies, 275-276 latency, 28 exposures during Gulf War, 266-270 genetic susceptibility, 61, 276-278

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INDEX 291 mortality studies, 8, 135, 136, 137, 138, 140, 142, Dermatitis, 164, 165, 166, 206. See also Skin diseases; 143, 144 specific diseases nerve-agent exposure and, 135, 136, 137-138, 139, Diabetes 140, 141, 143 cardiovascular disease, 135 oil-well fire smoke and, 137, 142 conclusions, 19, 95, 257 prevalence, 135 depleted uranium exposure and, 90 primary studies, 135, 136-138, 140, 141-144 hospitalizations, 91 research recommendations, 10 nerve-agent exposure and, 89-90, 91 risk factors, 135 primary studies, 89, 90, 95, 96 secondary studies, 135-136, 138-140 secondary studies, 89-91 updated and supplemental literature, 136-140 updated and supplemental literature, 90-91 Volume 4 summary, 4, 19, 135-136 Volume 4 summary, 4, 89-90 Clinician Administered PTSD Scale (CAPS), 58, 101, Diagnostic and Statistical Manual of Mental Disorders 102-103, 107, 111, 114 (DSM), 33, 99 Cognitive dysfunction, 1, 10, 19, 50, 51, 101, 102, 118, Digestive system diseases. See also specific diseases 119-120, 121, 129, 175. See also Neurocognitive and cancer, 76 neurobehavioral performance birth defects, 201 Colitis, 157 comorbidities, 154, 157 Comprehensive Clinical Evaluation Program (CCEP), 4, conclusions, 8, 159-161, 256 32, 175-176 diagnosis, 154-155, 160 Contact dermatitis, 164 hospitalization studies, 155-156, 158, 162 Coronary heart disease, 135 mortality, 158, 159 Crohn’s disease, 155 neurobehavioral performance, 118, 120 Cyclosarin. See Nerve-agent exposure pesticide/insecticide exposure and, 56 Cytomegalovirus, 213 prevalence, 57 primary studies, 155-156, 162-163 D pyridostigmine bromide exposure and, 159 research needs, 261 Danish Peacekeeper Studies, 43, 56 secondary studies, 156 derivative studies, 43, 56 smoke from buring waste or manure and, 56 diseases of the digestive system, 156-157 updated and supplemental epidemiologic literature, multisymptom illnesses, 206, 217 156-159 reference study, 43, 56 Volume 4 summary, 3, 19, 155-156 DEET, 264, 267, 268, 275 Distal symmetric polyneuropathy (DSP), 42, 46, 122- Defence Analytical Services Agency (UK), 76, 159, 223 123, 132 Defense Medical Surveillance System, 154 Down syndrome, 192 Dementia, 8, 10, 129, 130 Drug abuse and dependence, 99, 100, 104, 112, 113, 208, Department of National Defence (Canada), 58 232 Department of Veterans Affairs (VA) Dyspepsia, 8, 10, 19, 46, 155, 157, 160, 207 charge to IOM committee, 2, 11-12, 15-16 National Health Survey of Gulf War Veterans and E Their Families, 42, 45-48 Research Advisory Committee on Gulf War Ectopic pregnancies, 194, 195, 201-202 Veterans’ Illnesses, 2, 3, 16, 259 Eczema, 165, 166, 167, 168 Emphysema, 145, 146, 148, 150, 152 Depleted uranium (DU) exposure Endocrine, nutritional, and metabolic diseases. See also assessment, 14, 18, 32 Diabetes; Obesity; Thyroid disease endocrine and metabolic diseases, 90, 92, 97 conclusions, 8, 95, 257 external causes of mortality, 53 depleted uranium exposure and, 90, 92, 97 fertility problems, 196, 197, 203 hospitalization studies, 93-95, 96, 97, 98 genitourinary system diseases, 180-181, 185, 186 mortality studies, 95 neurological symptoms, 47 nerve-agent exposure and, 89-90, 91, 93, 97 Depression, 8, 10, 19, 50, 51, 63, 99, 101, 102, 103, 104, oil-well fire smoke exposure and, 94, 98 105, 107, 108, 111, 113, 114, 115, 116, 118, 119, prevalence, 96 154, 207, 214, 229, 230, 232. See also Major primary studies, 89, 90, 91-92, 96-98 depressive disorder secondary studies, 89-91, 95

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292 GULF WAR AND HEALTH updated and supplemental literature, 90-92, 93-95 Fertility problems Volume 4 summary, 89-90, 93 conclusions, 8, 197, 257 Enteritis, 157 defined, 195 Epilepsy, 121 depleted uranium exposure and, 196, 197, 203 Epstein-Barr virus, 124, 213 female veterans, 231, 233 Exposure to harmful agents. See also Nerve-agent hospitalizations, 195-197 exposure; Oil-well fire smoke exposure; primary studies, 183, 186, 196, 202-203 Pesticide/insecticide exposures; Pyridostigmine secondary studies, 196-197 bromide updated and supplemental literature, 196-197 assessment methods, 17-18, 32 Volume 4 summary, 196 genetic sensitivity, 10, 18 Fibromyalgia. See also Chronic widespread pain interactions of multiple simultaneous exposures, 17 conclusions, 8, 178, 257 limitations of information, 17-18 diagnosis, 18, 41, 175, 178 External causes of mortality hospitalization studies, 175-176, 178, 179 conclusions, 8, 224, 257 multisymptom illnesses, 207 female veterans, 234 neurologic etiology, 121 intentional self-harm, 222, 223, 226 prevalence, 46, 175, 178 nerve-agent exposure and, 223, 225, 227 primary studies, 175-176, 179 primary studies, 221-223, 225-227 psychiatric comorbidities, 101 research recommendations, 9 secondary studies, 176, 178 secondary studies, 222, 223-224 symptoms, 175 suicides, 221, 223, 225, 226-227 updated and supplemental literature, 176-178 transportation accidents, 3-4, 8, 19, 221, 222, 223, Volume 4 summary, 19, 175-176 224, 225, 226, 227, 234 Fibrositis, 175 updated and supplemental literature, 222-224 Folliculitis, 164 Volume 4 summary, 3-4, 19, 221-222 Fort Devens and New Orleans Cohort Study, 44, 59-60 derivative studies, 44, 60 F mental and behavioral disorders, 102-103, 111 multisymptom illnesses, 210 Fatigue symptoms, 1, 46, 55, 103, 116, 118, 120, 123, reference study, 44, 59 124, 175, 210. See also Chronic fatigue syndrome Functional gastrointestinal disorders (FGID), 8, 10, 154- Female veteran health. See also Pregnancy outcomes; 155, 157, 159, 160, 256, 261 Women circulatory system diseases, 138 G combat exposure and, 228-229 deployment experiences, 228-229 Gastritis, 155, 157, 158, 206 digestive disorders, 157 Gastroenteritis, 154, 159 effects reported, 229-231 Gastroesophageal reflux disease, 155 genitourinary system diseases, 180, 181, 182-183, Gastrointestinal. See Digestive system diseases; 184-185, 186, 196-197, 230, 233 Functional gastrointestinal disorders health care utilization, 229 Generalized anxiety disorder (GAD), 8, 99, 101, 108, hospitalization studies, 233 109, 110 mental and behavioral disorders, 47, 106, 107, 229, Genetic susceptibility, 10, 18, 44, 61, 129, 261 230, 231-232, 234 Genitourinary system diseases mortality studies, 234 birth defects, 189, 190, 192, 200, 201 multisymptom illnesses, 229, 231 conclusions, 8, 184-185, 258 neurologic disorders, 230-231 depleted uranium exposure and, 180-181, 185, 186 obesity, 93 female veterans, 180, 181, 182-183, 184-185, 186, PTSD, 42, 47, 103, 106, 111, 231-232, 234 196-197, 230, 233 respiratory illnesses, 230 hospitalization studies, 8, 183-184, 185, 186, 187, sexual assault and harassment (military), 42, 47, 228, 188, 196 232-233, 234 nerve-agent exposure and, 182, 183, 184, 185, 188 size of Gulf War force, 228, 234 oil-well fire smoke exposure and, 183, 184, 187 outcomes, 180-183 skin diseases, 229, 230 primary studies, 180, 183-185, 186-188 summary and conclusions, 234 secondary studies, 181-183, 185

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INDEX 293 updated and supplemental literature, 180-183 Infectious disease/agents, 1, 12, 17, 46, 49, 58, 71, 121, Volume 4 summary, 19 125, 128, 154, 180, 181, 182 Goiter, 92 Iowa Persian Gulf Study, 42, 49-51 Goldenhar syndrome, 190, 192, 200 derivative studies, 42, 50-51 Gulf War syndrome, 1, 9, 11, 42, 50, 52, 59, 61, 77, 115, mental and behavioral disorders, 101, 110 116, 118, 123. See also Multisymptom illnesses multisymptom illnesses, 206 Guillain Barré syndrome, 121 reference study, 42, 49 Irritable bowel syndrome (IBS), 8, 10, 18, 32-33, 154- 155, 156, 157, 158, 159, 160, 163, 261 H Ischemic heart disease, 137 Hair loss and hair diseases, 165, 168 K Hawaii and Pennsylvania Active Duty and Reserve Study, 44, 62 Kansas Veteran Study, 44, 58-59 derivative studies, 44, 62 diseases of the digestive system, 157 reference study, 44, 62 mental and behavioral disorders, 105 Healthy warrior effect, 29, 31, 35, 40, 51, 74, 99, 100, multisymptom illnesses 77 127, 158, 209 Khamisiyah demolition. See Nerve-agent exposure Heart attacks, 138 Kidney disease, 180, 181, 184, 187 High blood pressure, 135-136, 138, 139, 144 HIV/AIDS, 122, 225 L Hospitalizations. See also Utilization of health services blood and blood-forming organs, diseases of, 83-88 Lead exposure, 14, 49, 126, 129 cancer studies, 73, 74, 75-76, 80, 81 Leukemias and lymphomas, 73 circulatory systems disease studies, 135, 136, 137, Lou Gehrig’s disease. See Amyotrophic lateral sclerosis 140, 141, 142 Low birth weight, 194, 195 discharge diagnoses, 7, 9, 80, 86, 93, 94, 97 endocrine and metabolic diseases, 93-95, 96, 97, 98 M female veterans, 233 fertility problems, 195-197 Major depressive disorder (MDD) and major depression, fibromyalgia, 175-176, 178, 179 99, 101, 102, 103, 104, 105, 106, 107, 108, 110, 111, genitourinary system diseases, 8, 180, 181, 182-183, 112, 113, 114. See also Depression 184-185, 186, 196 Mental and behavioral disorders. See also Posttraumatic limitations of studies, 95 stress disorder; other specific disorders mental and behavioral disorders, 104, 112 anxiety disorders, 17, 19, 42, 50, 63, 99, 100, 101, multisymptom illnesses, 207-208, 218-219 102, 103-104, 105, 106, 107, 110, 111, 113, 114. musculoskeletal diseases, 170, 171, 172, 173-174 See also Generalized anxiety disorder; Obsessive- neurological diseases, 128 compulsive disorder; Panic disorder; Posttraumatic stress disorder; Social phobia prevalence, 4, 61 chronic fatigue syndrome, 102 proportional morbidity ratios, 94 cognitive dysfunction, 101, 102 respiratory system diseases, 145, 146, 147, 151, 152, combat exposure and, 101, 102, 103-104, 105, 108, 153 114 skin diseases, 166-167 comorbidities, 19, 50, 101, 102, 107 Volume 4 summary, 19 conclusions, 8, 108-109, 256 Hypercholesterolemia, 135 disabled veterans, 106, 108-109, 113 Hypertension, 7, 135, 136, 138, 139, 140, 141, 144, 206, female veterans, 47, 106, 107, 229, 230, 231-232, 214 234 Hyperthyroidism, 91, 96 fibromyalgia, 101 Hypochondriasis, 99, 102 hospitalizations, 104, 112 Hypothalamic-pituitary-adrenal axis dysfunction, 154, mood disorders, 1, 19, 52, 99, 100, 106, 108, 115- 160, 205, 211 116, 118, 119, 120. See also Bipolar disorder; Hypothyroidism, 91, 96, 134 Depression; Major depressive disorder multisymptom syndromes, 154, 207 I neurocognitive and neurobehavioral performance, 101, 102, 118, 120 Immunizations. See Vaccines/vaccination

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294 GULF WAR AND HEALTH perceptions of stressors and, 55 hospitalization studies, 207-208, 218-219 primary studies, 100-104, 105-107, 110-114 nerve agent exposure and, 47, 48, 57, 58, 263, 271- quality of life status and, 42, 48 274 research recommendations, 9 neurobehavioral performance, 115-116, 118, 120 secondary studies, 72, 105, 107-108 neurologic etiology, 121, 206 somatoform disorders, 99, 104, 106, 107, 108, 109, pesticide/insecticide exposure and, 62, 205, 259, 265, 113. See also Hypochondriasis; Somatization 266-270, 271-274, 278-279 disorder possible causes, 47, 259-260 updated and supplemental literature, 105-108 prevalence, 11, 42, 48, 58, 62, 77, 209 Volume 4 summary, 19, 101-105 PTSD overlap, 206, 207 Metabolic diseases. See Endocrine, nutritional, and pyridostigmine bromide use and, 205, 259, 265, 271- metabolic diseases; specific diseases 274 Metabolic syndrome, 207 research recommendations, 9, 10, 260, 261-262 Miscarriages and stillbirths, 8, 9, 43, 54, 55, 193, 194, stressors and, 205-206 195, 201, 231, 234 symptom clusters, 204-207, 216-218 Moodiness and mood disorders, 1, 19, 52, 99, 100, 106, vaccination and, 44, 52, 57, 58 108, 115-116, 118, 119, 120, 195. See Bipolar Volume 4 summary, 3, 19 disorder; Depression; Major depressive disorder; Musculoskeletal diseases. See also Fibromyalgia; Mental and behavioral disorders Multisymptom illnesses Mortality. See also External causes of mortality birth defects, 190, 201 blood and blood-forming organs, diseases of, 85 conclusions, 8, 171, 257 cancer studies, 73, 74-75, 76, 78, 79, 80, 81, 82, 125 hospitalization studies, 170, 171, 172, 173-174 circulatory system disease studies, 8, 135, 136, 137, nerve-agent exposure and, 59-60, 170-171, 173-174 138, 140, 142, 143, 144 oil-well fire smoke exposure and, 171, 173 endocrine and metabolic disease, 95 prevalence, 57, 210 neurological diseases, 125, 128, 129-130, 133 primary studies, 169, 170-171, 172-174 respiratory system diseases, 147, 148-149, 151, 153 secondary studies, 169, 171 self-reported exposure and, 43, 52-53, 57 updated and supplemental literature, 170-171 Multiple chemical sensitivity (MCS), 7, 19, 42, 44, 45, vaccination and, 51, 60 50, 52, 60, 157, 163, 206, 255, 271 Volume 4 summary, 19, 169 Multiple sclerosis (MS) Myasthenia gravis, 268 combat exposure and, 121 conclusions, 8, 125-126, 257 N female veterans, 231 latency, 8, 125 National Health Survey of Gulf War Veterans and Their mortality studies, 75, 125, 133 Families, 42, 45-48 pathogenesis, 124 derivative studies, 42, 46-48 primary study, 125, 133 diseases of the digestive system, 155, 157, 162 research recommendations, 9 mental and behavioral disorders, 102, 105, 107, 108, risk factors, 124-125 114 secondary study, 125 multisymptom illnesses, 206, 208-209, 211, 212 updated and supplemental literature, 125 reference study, 45-46 Multisymptom illnesses. See also Chronic fatigue Nerve-agent exposure syndrome animal studies, 25, 276 biologic and chemical weapons threat and, 62, 205 blood and blood-forming organs, diseases of, 84, 87 chemical sensitivity and, 44, 60, 206 cancer, 73-74, 75, 77, 78, 79 cholinesterase inhibitors and, 57, 61, 62, 278-279 cholinesterase inhibitors, 269-270 chronic multisymptom illness, 47, 48, 58 chronic fatigue syndrome and, 60, 207, 211 circulatory system diseases, 135, 136, 137-138, 139, chronic widespread pain, 209-210 140, 141, 143 conclusions, 8, 57, 210, 256 endocrine and metabolic diseases, 89-90, 91, 93, 97 definitions, 7, 205, 209 genitourinary system diseases, 182, 183, 184, 185, factor analyses and surveys, 42, 43, 44, 50, 52, 61-62, 188 204-207, 215-217 modeling, 15, 17-18, 32, 41, 46, 47-48, 73-74, 84, female veterans, 229, 231 116, 122, 147, 170, 184, 269 fibromyalgia, 207 multisymptom illnesses, 47, 48, 57, 58 genetic susceptibility, 261-262, 276-278

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INDEX 295 musculoskeletal diseases, 59-60, 170-171, 173-174 Nutritional diseases. See Endocrine, nutritional, and neurological diseases, 45, 47, 60, 122-123, 128, 129, metabolic diseases; specific diseases 130, 132 neuropsychological functioning, 44, 55, 60 O prophylaxis. See Pyridostigmine bromide reproductive outcomes, 199 Obesity, 92-93, 95, 135 respiratory symptom system diseases, 20, 47, 145, Obsessive-compulsive disorder, 99, 104 147, 148, 153 Oil-well fire smoke exposure signs and symptoms of toxic effects, 267, 269-270 blood and blood-forming organs, diseases of, 84, 87 Volume 4 summary, 20 cancer, 74, 75, 78 Nervous system diseases. See also Alzheimer’s disease; chronic fatigue syndrome, 214 Amyotrophic lateral sclerosis; Multiple sclerosis; circulatory system diseases, 137, 142 Parkinson’s; Peripheral neuropathy and myopathy; endocrine and metabolic diseases, 94, 98 other specific diseases extent of, 13-14, 17, 47, 229 brain injury and, 129 external causes of mortality, 53 chemical agent exposure and, 47, 59-60, 121, 133 genitourinary system diseases, 183, 184, 187 combat stress and, 125 modeling, 18, 32, 45, 46, 49, 50, 84, 94, 137, 142, environmental factors, 124-125, 129 146, 171, 184 factor-derived syndromes, 130-131 musculoskeletal diseases, 171, 173 female veterans, 230-231 reproductive outcomes, 192 genetic susceptibility, 44, 61, 129 respiratory system diseases, 4, 20, 42, 50, 55, 145, hospitalization studies, 128 146, 152-153 latency, 121, 125, 130 Operation Desert Shield, 1, 11, 13, 17 mortality studies, 125, 128, 129-130, 133 Operation Desert Storm, 1, 11, 13, 17 neuromuscular symptoms, 43, 52, 123, 210 Oregon and Washington Veteran Studies, 43-44, 57 neurotoxicant exposure and, 45, 47, 60, 122-123, derivative studies, 43-44, 57 128, 129, 130, 132 multisymptom illnesses, 274 pesticide/insecticide exposure and, 51, 55, 121, 122, Organophosphate-induced delayed polyneuropathy, 265, 123-124, 129, 133 268 pyridostigmine bromide and, 55, 121, 123-124 Organophosphates, 14, 18, 20, 60, 61, 78, 130, 266, 267, research recommendations, 9, 126, 261 268, 270 vaccines/vaccination and, 121, 123-124, 125, 133 Osteoarthritis, 171 Neurocognitive and neurobehavioral performance conclusions, 8, 118, 257 P deployment status and, 115, 117, 118, 119 derivative studies, 42, 43, 44, 48, 52, 56, 58-60 Pain. See also Chronic widespread pain; Fibromyalgia domains examined, 116-117 disorder, 107 factor analysis, 117-118 nervous system diseases and, 122, 124 mental and behavioral disorders and, 101, 102, 118, systemic, 177 120 visceral, 154, 159, 160 nerve-agent exposure and, 44, 56, 59-60, 116-117, Paints, exposure to chemical-agent-resistant compounds, 118 14, 17, 47, 206 primary studies, 115, 116, 119-120 Palpitations, 138, 139, 140 psychological stressors and, 56 Panic disorder, 99, 101, 104, 110 secondary studies, 115, 116, 117 Paraoxonase-1 (PON1), 52, 61, 130, 276-277 tests, 33, 115, 116-117 Parkinson’s disease, 2, 8, 15, 75, 121, 125, 129-130, 231, updated and supplemental literature, 116-118 270, 278 Volume 4 summary, 19, 115-116 Pennsylvania Air National Guard Study, 44, 61-62 Neurotransmitters, 265-266 derivative studies, 44, 62 New Orleans Reservist Studies, 45, 63 reference study, 44, 61 derivative studies, 45, 63 Peptic ulcer, 158, 163 Perinatal outcomes. See Birth defects mental and behavioral disorders, 102-103, 111 Peripheral neuropathy and myopathy multisymptom illnesses, 210 conclusions, 8, 124, 257 reference study, 45, 63 defined, 121 Nuclear Industry Family Study, 194 derivative studies, 52, 53

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296 GULF WAR AND HEALTH diagnosis, 122 secondary studies, 193-194 nerve-agent exposure and, 122-123, 132 updated and supplemental literature, 194-195 pesticides and, 122, 133 Volume 4 summary, 193-194 primary studies, 122-123, 132-133 Preterm births, 194, 195, 231 pyridostigmine bromide and, 122 Prostatitis, 180, 181 secondary studies, 123 Psoriasis, 164, 165, 166, 167 types, 121-122 Psychiatric conditions. See Mental and behavioral updated and supplemental literature, 123-124 disorders; Posttraumatic stress disorder; other Volume 4 summary, 4, 19, 122-123 specific disorders Permethrin, 266, 268, 275 Pyrethroids, 14, 266-267, 268 Persian Gulf War Veterans Act, 1, 11 Pyridostigmine bromide (PB), 132 Personality disorders, 42, 50-51, 102, 107-108 adverse health outcomes, 57 Pesticide/insecticide exposures. See also specific classes animal studies, 275-276 of pesticides assessment of exposure, 18, 32, 45, 46, 49 animal studies, 25, 277 chronic fatigue syndrome, 55, 213, 214 assessment, 17, 18, 45 chronic multisymptom illness, 62 cancer, 78 chronic widespread pain, 178 chronic fatigue syndrome, 52, 55, 213, 214 exposure opportunities, 14-15 chronic widespread pain, 178 multisymptom illnesses, 205, 259 documentation of, 267-268 neurological symptoms, 55, 121, 123-124 external causes of mortality, 53 psychological health, 55 illnesses associated with, 267-268 toxicity symptoms from overexposure, 1, 267, 268- multiple chemical sensitivity, 52 269 multisymptom illnesses, 62, 205, 259, 266-270, 278- 279 Q neurological diseases, 51, 55, 121, 122, 123-124, 129, 133 Quality-of-life studies, 78 psychological health, 55 assessment, 44 reproductive outcomes, 192 multiple chemical sensitivity and, 42, 50 respiratory system diseases, 51, 145 psychiatric disorders, 42, 48 skin diseases, 56, 164 types, 266 R Petroleum-based combustion products, exposure to, 14, 17, 46, 49, 57, 229 Rashes, 46, 57, 164, 165, 166, 229, 230 Polyneuropathy, 122. See also Distal symmetric Reproductive outcomes. See also Fertility problems; polyneuropathy Perinatal outcomes; Pregnancy outcomes; Sexual Posttraumatic stress disorder (PTSD) dysfunction borderline personality disorder and, 107-108 cohort study, 6 comorbidities, 102, 107-108, 111, 118, 154, 157, 163 female, 231 conclusions, 8, 256 male, 55-56 diagnosis, 99-100, 101, 102-103 Respiratory system diseases female veterans, 42, 47, 103, 106, 111, 231-232, 234 conclusions, 4, 8, 149, 257 multisymptom illnesses, 206, 207 deployment status and, 145-146, 147, 148-149, 150, personality and coping factors and, 63 151 predictors of, 103, 104, 107, 111 derivative studies, 42, 43, 47, 52, 53-54, 55 prevalence, 47, 50, 61, 62-63, 101, 102, 103, 104, female veterans, 230 106, 111, 112 hospitalization studies, 145, 146, 147, 151, 152, 153 POWs, 107, 114 mortality studies, 147, 148-149, 151, 153 sexual assault and harassment and, 42, 47 nerve agent exposure and, 20, 47, 145, 147, 148, 153 Volume 4 conclusions, 3, 19 oil-well fire smoke exposure and, 4, 20, 42, 50, 55, Pregnancy outcomes, adverse. See also Birth defects 145, 146, 152-153 conclusions, 8, 195, 257 pesticide exposure and, 51, 145 mood problems, 195 primary studies, 145-146, 147, 150-153 research recommendations, 10 prevalence, 47, 55-56, 61 secondary studies, 146-149 primary studies, 193, 201-202 updated and supplemental literature, 147-149 reference study, 51, 53-54, 61

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INDEX 297 Volume 4 summary, 3, 19, 20, 145-147 Structured Clinical Interview for DSM (SCID), 33, 50, Rheumatic diseases, 171 58, 59, 101, 102, 110, 111 Substance abuse, 8, 19, 100, 108, 109. See also Alcohol S abuse Substance use disorders, 99, 100, 102, 106 Sarin. See Nerve-agent exposure Sympathetic-adrenal-medullary axis dysfunction, 205 Scud missile smoke and debris, exposure to, 53, 60, 214 Seabee Studies, 44, 60-61 T derivative studies, 44, 60-61 diseases of the digestive system, 157, 163 Tachycardia, 139, 206 reference study, 44, 60, 61 Test of Memory Malingering (TOMM), 119 Seborrheic dermatitis, 164, 168 Testicular cancer, 2, 4, 15, 19, 73, 74, 76, 78, 79-80, 81, Serum hormone-binding globulin, 196 208 Sexual assault and harassment (military), 42, 47, 228, Testosterone, 196 232-233, 234 Thyroid disease Sexual dysfunction conclusions, 95, 257 combat exposure and, 198 depleted uranium and, 92 conclusions, 8, 185, 199, 257 primary studies, 91-92, 96 nerve-agent exposure and, 199 secondary studies, 92 primary studies, 203 updated and supplemental literature, 91-92 secondary studies, 181, 182 Thyroxine-stimulating hormone, 93 updated and supplemental literature, 198-199 Traumatic brain injury (TBI), 1, 12, 26, 31, 121 Volume 4 summary, 198 Skin diseases. See also specific disorders U cancer, 73, 76, 77, 78, 166 conclusions, 8, 167, 257 Ulcerative colitis, 155 disabled veterans, 164, 165, 168 United Kingdom Veterans Studies female veterans, 229, 230 chronic fatigue syndrome, 213-214 hospitalizations, 166-167 derivative studies, 42-43, 52-53, 54 neurobehavioral performance, 118, 120 diseases of the digestive system, 158-159 pesticide/insecticide exposure and, 56, 164 London School of Hygiene and Tropical Medicine, prevalence, 46, 57 43, 53-54, 90 primary studies, 164, 165, 167, 168 mental and behavioral disorders, 105, 113 secondary studies, 164, 165-167 multisymptom illnesses, 206, 209-210, 215, 217 smoke from burning waste or manure and, 56 reference studies, 51, 53-54 solvent exposure and, 164 University of London, 42-43, 51-53, 93, 119, 123, updated and supplemental literature, 165-167 132 vaccines and, 51 University of Manchester, 43, 53 Volume 4 summary, 3, 19, 164-165 Urinary tract infections, 180, 181 Sleep disturbance/disorder, 1, 10, 62, 99, 103, 106, 118, Urolithiasis, 180, 181 120, 175, 210, 230 US Agricultural Health Study, 270, 278 Small-fiber polyneuropathy, 124 US National Comorbidity Survey Replication, 100 Social phobia, 99 Utilization of health services, 42, 45, 50, 229. See also Solvents, exposures to, 1, 11, 12, 14-15, 17, 25, 49, 133, Hospitalizations 164, 206 Somatization disorder, 99, 106-107, 109, 154, 160 V Somatoform disorders, 99, 104, 106, 107, 108, 109, 113, 207 Vaccines/vaccination cancer, 77 Smoke from burning waste or manure, 56. See also Oil- chronic multisymptom illness, 44 well fire smoke exposure limitations of studies, 32 Spondyloarthropathy, 171 multisymptom illnesses, 44, 52, 57, 58 Standardized mortality ratio (SMR), 31, 128 musculoskeletal diseases, 51, 60 Standardized mortality studies, 31 neurological diseases, 55, 121, 123-124, 125, 133 Stress. SeePosttraumatic stress disorder skin diseases, 51 Stroke, 135, 138 Verruca vulgaris, 19, 164, 165, 167, 168

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298 GULF WAR AND HEALTH Veterans Programs Enhancement Act, 1, 11 Visceral hypersensitivity, 154, 159, 160 Volume 4, Gulf War and Health assessment of studies cited in, 3, 12, 16, 255 charge to committee, 12, 15 conclusions, 18-20, 255-256 recommendations, 20 summary of findings and recommendations, 19-20, 255-256 W Warts, 19, 164, 165, 167, 168 Wechsler Adult Intelligence Scale (WAIS), 115, 116- 117, 119 Wechsler Memory Scale (WMS), 119 Wisconsin Card Sorting Test (WCST), 119 Women. See also Female veteran health; Pregnancy outcomes troops deployed to Persian Gulf, 13, 228 World Health Organization (WHO), 105 Wound healing, retarded, 165