examination of medical records for pregnancies, live births, and outcomes. Male participants (n = 42,818) reported 27,929 pregnancies in their partners and female participants (n = 1269) reported 861 pregnancies. Reports of miscarriages and congenital malformation were clinically validated.

Derivative Studies

Three derivative studies were described in Volume 4; no new derivative studies were identified by the Update committee. Based on results of Maconochie et al. (2003), Doyle et al. (2004) examined the associations between risk of miscarriage, stillbirth, or congenital malformations for deployed and nondeployed women. Maconochie et al. (2004) assessed the risk of infertility male Gulf War veterans (females not included in study); self-reports were validated with clinical diagnosis. Findings from the 2004 study by Maconochie and colleagues are discussed in Chapter 4.

In a subanalysis of the population described by Maconochie et al. (2004) above, Simmons et al. (2004) indicated that 61% of Gulf War veterans reported at least one new medical symptom or disease since 1990 compared with 37% of nondeployed veterans. Further details regarding outcomes are described in Chapter 4.

Australian Veteran Studies

In Volume 4, the reference study for evaluations of the Australian Gulf War veterans was cited as Kelsall et al. (2004a) but the Update committee identified the original report of the study methods and initial findings (Sim et al., 2003). Sim et al. (2003) is considered to be the reference study in this report. Six derivative studies were described in Volume 4 (Forbes et al., 2004; Ikin et al., 2004; Kelsall et al., 2004a,b, 2005; McKenzie et al., 2004) and the Update committee identified two new derivative studies (Kelsall et al., 2006, 2007) based on the Sim et al. cohort. All of these studies are discussed in Chapter 4.

Reference Study

Investigators from Monash University in Australia conducted a study examining the health of all 1871 Australian veterans deployed to the Gulf War region from August 2, 1990, to September 4, 1991; members of the navy were overrepresented (86.5%) in this cohort (Sim et al. 2003). The control group consisted of 2924 nondeployed Australian Defence Force personnel matched by service type, sex, age, and military status. Participation rates were 81% (n = 1456) for the deployed and 57% (n = 1588) for the control group.

A postal questionnaire was distributed, which included the SF-12, GHQ-12, and questions regarding physical and psychological health, military service history, and exposures during deployment. In addition, participants were asked to attend one of 10 Health Services Australia medical clinics to undergo a comprehensive health assessment, a full physical examination, blood work, and fitness tests. Interview-administered questionnaires such as the Composite International Diagnostic Interview (CIDI) were given to all participants (Sim et al., 2003). Gulf War veterans reported more general health symptoms and ones more severe in nature than the nondeployed controls. Chapter 4 discusses the findings of this reference study in greater detail.

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