4

Human Health Outcomes

Explosive blasts can cause multiple forms of damage that are more complex than those caused by other wounding agents (Champion et al., 2009). Blasts are the leading cause of death and injury on the military battlefield (Eastridge et al., 2012). Recent reports indicate that almost 80% of all combat-related injuries in US military personnel deployed to Iraq and Afghanistan have been from blasts; this is the highest proportion seen in any large-scale conflict (Murray et al., 2005; Owens et al., 2008). During the last decade, the incidence of primary blast injury and injury severity increased, and return-to-duty rates decreased. Despite increased injury severity, mortality due to explosion injuries remained low and unchanged (Kelly et al., 2008; Ritenour et al., 2010). The acute physical and psychologic human health outcomes in those who survive blast explosions can be devastating. The long-term consequences are less clear.

This chapter summarizes the committee’s evaluation of the literature on the association between exposure to blast and short- and long-term effects on the human body. The guidelines agreed on by the committee and used to determine which studies to include in the evidence review below are described in Chapter 2. The chapter is organized by health outcomes: psychologic and psychiatric, nervous system, auditory and vestibular, ocular, cardiovascular, respiratory, digestive system, genitourinary (GU), dermal, and musculoskeletal outcomes; infections; and burns. The organization generally follows that of the International Classification of Diseases, Ninth Revision. The final section, on blast protection, evaluates whether improvements in blast protection are associated with diminished blast injury.

Although the information here is presented by individual organ systems



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 85
4 Human Health Outcomes E xplosive blasts can cause multiple forms of damage that are more complex than those caused by other wounding agents (Champion et al., 2009). Blasts are the leading cause of death and injury on the military battlefield (Eastridge et al., 2012). Recent reports indicate that almost 80% of all combat-related injuries in US military personnel deployed to Iraq and Afghanistan have been from blasts; this is the highest proportion seen in any large-scale conflict (Murray et al., 2005; Owens et al., 2008). During the last decade, the incidence of primary blast injury and injury severity increased, and return-to-duty rates decreased. Despite increased injury severity, mortality due to explosion injuries remained low and unchanged (Kelly et al., 2008; Ritenour et al., 2010). The acute physi- cal and psychologic human health outcomes in those who survive blast explosions can be devastating. The long-term consequences are less clear. This chapter summarizes the committee’s evaluation of the literature on the association between exposure to blast and short- and long-term effects on the human body. The guidelines agreed on by the committee and used to determine which studies to include in the evidence review below are described in Chapter 2. The chapter is organized by health outcomes: psy- chologic and psychiatric, nervous system, auditory and vestibular, ocular, cardiovascular, respiratory, digestive system, genitourinary (GU), dermal, and musculoskeletal outcomes; infections; and burns. The organization generally follows that of the International Classification of Diseases, Ninth Revision. The final section, on blast protection, evaluates whether improve- ments in blast protection are associated with diminished blast injury. Although the information here is presented by individual organ systems 85

OCR for page 85
86 GULF WAR AND HEALTH Acute blast: Vulnerable Long-term organs/systems Secondary Effects Cardiovascular CNS Musculoskeletal DigesƟve Ocular Auditory/ VesƟbular Dermal Dermal Musculoskeletal Blast CNS Respiratory Cardiovascular Auditory Genitourinary DigesƟve VesƟbular Respiratory Ocular Genitourinary Modified from www.readengage.com FIGURE 4-1  Blast injury may result in primary damage to a number of organ sys- tems. Less studied are the effects that primary damage to a specified organ may have on the long-term consequences of the functioning of other organs. For example, exposure to a blast may result in air emboli that develop from damaged lungs at Figure 4-1 alveolar–pulmonary venous fistulae and cause myocardial ischemia or infarction and thus compromise long-term cardiac function. Damage to the brain may result in R02369 Gulf War motor weakness; voiding dysfunction, such as an overactive (spastic) or, over time, hypoactive bladder; change in auditory processing abilities; visual symptoms; and hypogonadism caused by hypopituitarism. Damage to the cardiovascular system can affect neurologic function through ischemia, which, if sufficiently severe, can lead to permanent brain damage. SOURCE: Created by Linda Noble-Haeusslein for the Committee on Gulf War and Health: Long-Term Effects of Blast Exposures; figure of the human body adapted from www.readengage.com. and specific outcomes, exposure to blast often leads to polytrauma (that is, multiple traumatic injuries) and results in a multisystem response. The sec- tion of Chapter 3 titled “Modifying Potential of Systemic Changes Caused by Blast” describes how the complexity of the blast environment can lead to changes in systemic, local, and cerebral responses. Four important systemic alterations—air emboli, activation of the autonomic nervous system, vascu- lar mechanisms, and systemic inflammation—are explained in detail there.

OCR for page 85
HUMAN HEALTH OUTCOMES 87 Figure 4-1 illustrates how damage to an organ from exposure to blast may have long-term consequences for the functioning of other organs. Nearly all of the epidemiologic studies evaluated by the committee relied on self-reported exposure to blast, not objective measures. The mechanism of blast—primary, secondary, tertiary, quaternary, or quinary— generally was not reported in the studies. As detailed in the committee’s recommendations in Chapter 5, obtaining accurate, objective measurement of exposure to blast is essential for understanding the mechanisms of injury caused by blast. PSYCHOLOGIC AND PSYCHIATRIC OUTCOMES The potential relationship between blast and its psychologic and psy- chiatric outcomes is different from the relationships with other organ systems reviewed. Currently, it is not known whether the primary blast wave itself results in any direct physiologic or neuroanatomic changes to the nervous system that cause acute or long-term mental disorders. That knowledge is in contrast with other etiologies of traumatic brain injury (TBI) in which there is physical evidence of neurotrauma (Bazarian et al., 2013; Jorge et al., 2012). However, blast explosions often result in tremen- dous human carnage in the form of severe, mutilating injuries and death. During the immediate aftermath of blasts (sometimes referred to as the aftermath of battle [Stein et al., 2012]), people often remember the carnage, which can haunt them for days, months, or years. Blast explosions, such as those caused by improvised explosive devices, have been the greatest cause of death and injury in US military personnel deployed to Iraq and Afghanistan (Champion et al., 2009; Ritenour et al., 2010), and exposure to the aftermath of blasts during deployment is probably an important cause of acute and long-term psychologic and psychiatric disorders in mili- tary service members and veterans. Whether the relationship between blasts and health outcomes is primary (in which an injury is caused directly by the blast wave itself) or secondary (in which an injury is a reaction to the emotional impact of the blast) is debatable. According to the Diagnostic and Statistical Manual of Mental Disorders (APA, 2013), witnessing the devastation of a blast explosion would be considered exposure to primary trauma. For the purpose of the present review, blast was evaluated as a pri- mary cause of behavioral health outcomes, even though in some instances it is the psychologic impact and interpretation of the aftermath of a blast that potentially result in a psychologic injury rather than the direct physical impact of the blast wave itself.

OCR for page 85
88 GULF WAR AND HEALTH Acute Effects Exposure to blast has a number of acute psychologic and psychiatric outcomes. Distress reactions that occur within the first 3 days after a blast exposure are considered normal and are referred to as acute stress reac- tions (WHO, 2010). Acute stress reactions are transient disorders in which symptoms develop within minutes of exposure to a traumatic event. The symptoms usually subside within hours or days with resumption of routine activities, when possible, and general support from friends, family, or co- workers. In most cases, professional intervention is not required. When the signs and symptoms of acute stress reactions cluster and arrange in specific combinations and last for at least 3 days, they can lead to a diagnosis of acute stress disorder (APA, 2013). Acute stress disorder includes symptoms of intrusion, negative mood, dissociation, avoidance, and hyperarousal. The symptoms last from 3 days to a month after the trauma exposure. If they persist for more than 1 month, the diagnosis of posttraumatic stress disorder (PTSD) should be considered (APA, 2013). Adjustment disorders are other possible acute outcomes of blast expo- sure in people who do not meet diagnostic criteria for acute stress disorder (APA, 2013). Adjustment disorders include the development of emotional and behavioral symptoms in response to an identifiable stressor, such as a blast, that occurs within 3 months after the event. Major depressive disor- der may also be diagnosed using a separate cluster of the same symptoms at 2 weeks’ duration (APA, 2013). Regardless of whether a person meets the diagnostic criteria for these acute outcomes, it is often only when the symptoms persist over an extended period that most psychologic and psychiatric disorders are identified. Long-Term Effects PTSD is the primary long-term sequela of combat-related trauma expo- sure, such as that experienced as a result of blasts (Peterson et al., 2011; Tanielian and Jaycox, 2008). Few studies have directly evaluated the long- term psychologic and psychiatric outcomes (for example, major depressive disorder, substance-abuse disorders, postconcussive syndrome [related to TBI], sleep disorders, marital and family discord, and suicide) of blast exposure beyond PTSD. Therefore, the present review focuses on PTSD. The long-term effects of TBI from blast are reviewed in the later section “Nervous System Outcomes.” The lifetime prevalence of PTSD has been reported to be 8.0% in the adult US population (4.0% in males and 11.7% in females) (Kessler et al., 2012). Sex differences in population surveys are related primarily to differ- ences in frequency and type of trauma exposure. Females are more likely

OCR for page 85
HUMAN HEALTH OUTCOMES 89 to be victims of sexual assault, and males are more likely to experience combat-related trauma (Kessler et al., 1995, 2005). However, when trauma type and frequency are controlled for, sex differences in PTSD are less likely to be found. For example, in a large sample of UK armed forces personnel, men (5.0%) and women (4.2%) reported similar rates of PTSD symptoms after deployment to Iraq (Rona et al., 2007). Similarly, US military men (2.3%) and women (2.3%) experienced the same rates of PTSD symptoms after serving in the war in Iraq (DOD, 2007). Such findings have led some to conclude that the risk of PTSD in military personnel “has more to do with the intensity and frequency of combat experience than gender” (Hoge et al., 2007, p. 328). To evaluate the long-term psychiatric and psychologic health effects of blast exposure, the committee reviewed 40 relevant published peer-reviewed studies that involved some measure of blast injury. Only two met enough of the inclusion guidelines to be considered primary (see Table 4-1) (Bazarian et al., 2013; Polusny et al., 2011). This section details the primary stud- ies and supportive studies of long-term psychiatric and psychologic health outcomes of blast exposure. Primary Studies Polusny et al. (2011) conducted a longitudinal cohort study of combat- deployed National Guard members to assess the associations between mild TBI and PTSD symptoms reported in theater and longer-term psychosocial outcomes. Participants in the study were surveyed in Iraq a month before redeploying home (time 1, during redeployment transition briefings held at military installations in the Iraq combat theater) and again a year later (time 2, with mailed surveys). The first survey included 2,677 National Guard members, and 953 completed the followup survey at time 2. The surveys incorporated the following screening tools to gather outcome measures: the PTSD Checklist–Military, the Beck Depression Inventory, the Patient Health Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), World Health Organization Quality of Life–Brief, and self-reports of blast- related mild TBI, which was defined as an injury during deployment with loss of consciousness or altered mental status. Of the 953 participants surveyed at time 2,206 (22%) reported hav- ing a blast injury. Results for self-reported mild TBI during deployment showed 9.2% at time 1 and 22.0% at time 2. Service members who had a history of mild TBI were more likely than those who did not to report post- deployment postconcussive symptoms and poorer psychosocial outcomes. However, after adjustment for self-reported PTSD symptoms, mild TBI was not associated with post-deployment symptoms or outcomes. Time 1 PTSD symptoms predicted postdeployment PTSD and mild TBI symptoms and

OCR for page 85
90 GULF WAR AND HEALTH TABLE 4-1  Psychiatric and Postconcussive Symptoms—Primary Studies Health Outcomes or Reference Study Design Population Outcome Measures Bazarian et al., Nested cohort Parent cohort Self-report of blast 2013 consisted of 500 exposure and TBI OEF or OIF veterans; symptoms, PTSD subset examined in Checklist–Military, study included 52 combat experiences OEF or OIF combat survey, anatomical MRI, veterans assessed 4 DTI years after last tour of duty Polusny et al., Longitudinal 953 US National Self-report concussion 2011 cohort Guard brigade or mild TBI defined combat team assessed as an injury during in Iraq 1 month deployment with loss of before return (time consciousness (LOC) or 1) and 1 year later altered mental status; (time 2) PTSD checklist–military; Beck Depression Inventory; Patient Health Questionnaire (somatic symptoms); postconcussive symptoms, AUDIT (alcohol); WHO Quality of Life–Brief NOTES: AUDIT = Alcohol Use Disorders Identification Test; CI = confidence interval; DTI = diffusion tensor imaging; LOC = loss of consciousness; MRI = magnetic resonance imag- ing; OEF = Operation Enduring Freedom; OIF = Operation Iraqi Freedom; OR = odds ratio;

OCR for page 85
HUMAN HEALTH OUTCOMES 91 Comments or Results Adjustments Limitations PTSD severity associated with PTSD severity, mild TBI higher 1st percentile values likelihood, severity of of mean diffusivity on DTI exposure to traumatic events, (regression coefficient r = 4.2, time since last tour of duty, p = 0.039), abnormal MRI prior head injury, (r = 13.3, p = 0.046), and age, sex severity of exposure to combat events (r = 5.4, p = 0.007). PTSD severity not associated with self- report of blast exposure. Blast exposure associated with lower 1st percentile values of fractional anisotropy on DTI (OR = 0.38 per SD; 95% CI, 0.15–0.92), normal MRI (OR = 0.00, 95% likelihood ratio test CI, 0.00– 0.09), and severity of exposure to traumatic events (OR = 3.64 per SD; 95% CI, 1.40–9.43). Mild TBI not significantly associated with PTSD severity. Time 1: 9.2% mild TBI, 7.6% PTSD No examination of PTSD, 9.3% depression; moderate or severe TBI time 2: 22% mild TBI, higher rates of PTSD and depression than time 1 (p < 0.001). Of those reporting a history of mild TBI at time 1, 30.2% had probable PTSD at time 2. Service members with a history of mild TBI were more likely than those without such symptoms to report postdeployment postconcussive symptoms and poorer psychosocial outcomes. After adjustment for PTSD symptoms, mild TBI was not associated with postdeployment postconcussive symptoms, depression, problematic drinking, nonspecific somatic complaints, social adjustment, or quality of life. PTSD = posttraumatic stress disorder; SD = standard deviation; TBI = traumatic brain injury; WHO = World Health Organization.

OCR for page 85
92 GULF WAR AND HEALTH outcomes more strongly than did mild TBI history. The results suggest that mild TBI alone does not result in long-term health outcomes as measured in this study. The study is limited, however, in its usefulness in determining the long-term health effects of blast exposure because there was no direct comparison of those who had a blast-related injury with those who had a non-blast injury or no injury at all. Although many of those who reported symptoms of mild TBI, PTSD, or comorbid mild TBI and PTSD had a blast injury (mild TBI, 70%; PTSD, 35.9%; comorbid mild TBI and PTSD, 80%), it cannot be determined from the data analysis in the study whether a blast injury uniquely contributed to these health outcomes. Moreover, all outcome measures were based on self-reports and could have been affected by the service members’ recall, amount of current distress, secondary gain, and so on. Because the survey participants were self-selected from a single brigade combat team and the survey had a low response rate of those who agreed to be contacted for participation in time 2 followup (50.4%), the findings may not be generalizable to all deployed military personnel. Finally, perhaps the most important limitation is that the time 1 assessment was conducted at the end of a 16-month deployment. The study would have been strengthened substantially if the time 1 assessment had been conducted before deployment so that the specific effects of deployment-related blast could be assessed (for example, concussion and mild TBI, PTSD, post- concussive symptoms, problem drinking, and depression). Bazarian et al. (2013) conducted a nested cohort study to understand the relation of PTSD severity to mild TBI, blast exposure, and brain white matter structure. The participants were 52 Iraq and Afghanistan war vet- erans who served in combat areas during 2001–2008 and were studied about 4 years after their last tour of duty. Data on outcome measures were obtained from interview questions concerning blast exposure and TBI symptoms, the PTSD Checklist–Military, the Combat Experiences Scale, anatomic magnetic resonance imaging (MRI), and diffusion tensor imaging (DTI). The results of multivariate analyses demonstrated that PTSD sever- ity was associated with higher 1st percentile values of mean diffusivity on DTI (regression coefficient r = 4.2, p = 0 .039), abnormal MRI (r = 13.3, p = 0.046), and severity of exposure to combat events (r = 5.4, p = 0.007). However, PTSD severity was not associated with self-reported blast expo- sure. Blast exposure was associated with lower 1st percentile values of fractional anisotropy on DTI (which is an abnormal DTI associated with PTSD severity) (odds ratio [OR] = 0.38 per standard deviation [SD]; 95% confidence interval [CI], 0.15–0.92), normal MRI (only five people had abnormalities on MRI, and 47 had normal results) (OR = 0.00, 95% likeli- hood ratio test CI, 0.00–0.09), and severity of exposure to traumatic events

OCR for page 85
HUMAN HEALTH OUTCOMES 93 (OR = 3.64 per SD; 95% CI, 1.40–9.43). Mild TBI was not significantly associated with PTSD severity. The findings of the study showed that PTSD severity is related to the severity of combat stress and observed structural brain changes on MRI and DTI but not related to a clinical diagnosis of mild TBI. The observed relation between blast exposure and abnormal DTI suggests that subclinical TBI may play a role in the genesis of PTSD in a combat environment. The study demonstrates that asking questions about TBI symptoms may not be a good way to determine whether a person has suffered brain damage. The study was limited by its small sample and its use of self-reports of exposure. Supportive Studies Four secondary studies provide some additional information on pos- sible long-term psychological and psychiatric outcomes of blast exposure; however, each has limitations related to study design and the quantity and quality of information reported. In a longitudinal cross-sectional and cohort study, Rona et al. (2012) conducted a questionnaire to assess the prevalence of mild TBI in UK military personnel deployed to Iraq and Afghanistan. They looked at risk factors associated with mild TBI and the association between mild TBI and postconcussive symptoms and other psychologic health outcomes. During 2007–2009, 4,620 personnel who had deployed to Iraq and Afghanistan completed the questionnaire in phase 2; 2,333 of them had been studied in 2005 (phase 1 predeployment health outcomes were observed in 2005 when the study was first established). Outcome measures included the reported incidence of mild TBI during deployment on the basis of a modi- fied version of the Brief Traumatic Brain Injury Screen questionnaire and self-reported postconcussive symptoms that occurred in the month before the questionnaire was completed. Comorbid mental health conditions also were assessed with the PTSD checklist, General Health Questionaire–12, and AUDIT. Results showed that the overall prevalence of mild TBI was 4.4% and the prevalence in those who had a combat role, 9.5%. Hav- ing mild TBI was associated with current symptoms: PTSD (adjusted OR [AOR] = 5.2; 95% CI, 2.3–11.4), alcohol misuse (AOR = 2.3; 95% CI, 1.4–3.7), and multiple physical symptoms (AOR = 2.6; 95% CI, 1.3–5.2). Of those who had mild TBI with loss of consciousness, 46.8% reported that the mechanism of injury was blast. Of those who had mild TBI and altered mental status, 37.7% reported that the mechanism of injury was blast. No other comparison or analysis was done in this study to determine specific outcomes in blast- versus non-blast-injured people. The study has limitations for the committee’s determination of long- term psychologic outcomes of blast because of the data that were collected

OCR for page 85
94 GULF WAR AND HEALTH and the comparisons reported. For instance, the study did not report the average time between injury and reported health outcomes, so it is impos- sible to determine whether the observed outcomes were long-term conse- quences of injury or acute reactions. Another important limitation is that two samples were added in the phase 2 assessment because the authors were concerned that the followup sample would be too small. A separate longitudinal cohort analysis of the same samples before and after deploy- ment would have strengthened the study. Hoge et al. (2008) surveyed US Army infantry service members 3–4 months after their return from a year-long deployment to Iraq to compare service members who reported mild TBI with those who reported other injuries. Mild TBI was defined as a self-reported injury with loss of con- sciousness (LOC) or altered mental status (for example, being dazed or confused). Of 4,618 service members in two brigades who were asked to participate, 2,714 (59%) completed the questionnaire; 2,525 were then included in the study (others were screened out because of missing data or reports of head injury with no LOC or altered mental status). Find- ings showed that 79.0% of service members who suffered an injury with LOC were injured by blast exposure, 72.7% of those who had an injury with altered mental status were injured by blast, and only 23.2% of other reported injuries were due to blast. Service members who had mild TBI with LOC were significantly more likely to report poor general health, missed workdays, a high number of medical visits, and a high number of somatic and postconcussive symptoms than service members who had other injuries, such as moderate or severe TBI. However, after adjustment for PTSD and depression, mild TBI was no longer significantly associated with those physical health outcomes or symptoms, except for headache and heart pounding. Mild TBI was significantly associated with psychiatric symptoms such as those occurring with PTSD (more than 40% of service members who had injuries associated with LOC met criteria for PTSD). The study suggests that most of the postconcussive symptoms attributed to having previously experienced a blast-related mild TBI might actually be related to posttraumatic stress symptoms. Thus, the development of PTSD symptoms may be a long-term outcome of blast-induced mild TBI. How- ever, analysis was not done to determine whether the blast mechanism of injury contributed uniquely to psychiatric symptoms as opposed to other mechanisms of injury. Although the study conducted surveys 3–4 months after deployment, it is impossible to know when the injuries took place and whether the reported symptoms were short-term or long-term symptoms. As is also discussed in the section “Auditory and Vestibular Outcomes,” Vanderploeg et al. (2012) conducted a cross-sectional cohort study that was based on data collected in anonymous online surveys to determine whether there was an association between military experience and immediate and

OCR for page 85
HUMAN HEALTH OUTCOMES 95 long-term physical and psychologic health outcomes. The study also aimed to examine the effects of multiple deployment-related TBIs on health out- comes. The study included 3,098 members of the Florida National Guard (1,443 who had deployed and 1,655 who had not deployed). About 10,400 letters were mailed to solicit participation in the survey; 4,005 people completed the survey, and those who had been deployed completed it an average of 31.8 months (SD = 24.4 months, range = 0–95 months) after their deployment. ORs were calculated to assess the association between current health status and deployment-related factors, such as physical inju- ries, exposure to potentially traumatic deployment experiences, combat, blast exposure, and mild TBI. Demographics and predeployment experi- ences were controlled for as potential cofounders. The survey included a large number of questions to measure many predictors of health outcomes, such as blast exposure; of the 3,098 people in the study sample, 743 (24%) reported being exposed to blast. Results showed that deployment-related mild TBI was associated with depression, anxiety, PTSD, and postconcus- sive symptoms collectively and individually. There were also statistically significant increases in the frequency of depression, anxiety, PTSD, and a postconcussive symptom complex when people who had single incidents of TBI were compared with those who had multiple TBIs. A predeployment TBI did not appear to increase the likelihood of another TBI from a blast exposure. The experience of seeing others wounded or killed or experienc- ing the death of a fellow soldier or leader was associated with indigestion and headaches but not with depression, anxiety, or PTSD. The major limitations of this study are its cross-sectional design and its reliance on self-reported measures for all outcomes. In addition, the survey had a low response rate (41.3%), so the results shown here may not be generalizable to all deployed and nondeployed service members. Finally, Bryant et al. (2009) conducted a longitudinal cohort study to examine the incidence of PTSD in a civilian population after nonmilitary traumatic injury in those who had mild TBI and those who had no TBI. Study participants were 1,167 survivors of traumatic injury (459 who had mild TBI and 708 who had no TBI) who were admitted to four level 1 trauma centers in Australia from April 2004 to February 2006. The sub- jects were assessed for PTSD symptoms and posttraumatic amnesia during hospitalization and then assessed for PTSD 3 months later. At the followup assessment, 90 (9.4%) of the 920 who were still participating met criteria for PTSD (mild TBI, 50, 11.8%; no TBI, 40, 7.5%). After controlling for injury severity, it was concluded that mild TBI patients were more likely to develop PTSD than no-TBI patients (AOR = 1.86; 95% CI, 1.78–2.94). Although the study is limited in its usefulness by its report outcomes only out to 3 months and not looking at blast injuries specifically, it adds to the evidence of a relationship between mild TBI and PTSD symptoms.

OCR for page 85
174 GULF WAR AND HEALTH Huang, M. X., S. Nichols, A. Robb, A. Angeles, A. Drake, M. Holland, S. Asmussen, J. D’Andrea, W. Chun, M. Levy, L. Cui, T. Song, D. G. Baker, P. Hammer, R. McLay, R. J. Theilmann, R. Coimbra, M. Diwakar, C. Boyd, J. Neff, T. T. Liu, J. Webb-Murphy, R. Farinpour, C. Cheung, D. L. Harrington, D. Heister, and R. R. Lee. 2012. An automatic MEG low-frequency source imaging approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes. Neuroimage 61(4):1067-1082. Hudak, S. J., A. F. Morey, T. A. Rozanski, and C. W. Fox, Jr. 2005. Battlefield urogenital injuries: Changing patterns during the past century. Urology 65(6):1041-1046. Hudolin, T., and I. Hudolin. 2003. Surgical management of urogenital injuries at a war hospi- tal in Bosnia-Hrzegovina, 1992 to 1995. Journal of Urology 169(4):1357-1359. Huller, T., and Y. Bazini. 1970. Blast injuries of the chest and abdomen. Archives of Surgery 100(1):24-30. IOM (Institute of Medicine). 2006. Noise and Military Service: Implications for Hearing Loss and Tinnitus. Washington, DC: The National Academies Press. IOM. 2009. Gulf War and Health, Volume 7: Long-Term Consequences of Traumatic Brain Injury. Washington, DC: The National Academies Press. Iwashyna, T. J., E. W. Ely, D. M. Smith, and K. M. Langa. 2010. Long-term cognitive impair- ment and functional disability among survivors of severe sepsis. Journal of the American Medical Association 304(16):1787-1794. Jagade, M. V., R. A. Patil, I. S. Suhail, P. Kelkar, S. Nemane, J. Mahendru, V. Kalbande, and P. Kewle. 2008. Bomb blast injury: Effect on middle and inner ear. Indian Journal of Otolaryngology and Head and Neck Surgery 60(4):324-330. Johnson, E. N., T. C. Burns, R. A. Hayda, D. R. Hospenthal, and C. K. Murray. 2007a. Infec- tious complications of open type III tibial fractures among combat casualties. Clinical Infectious Diseases 45(4):409-415. Johnson, I. O. N., C. J. Fox, P. White, E. Adams, M. Cox, N. Rich, and D. L. Gillespie. 2007b. Physical exam and occult post-traumatic vascular lesions: Implications for the evaluation and management of arterial injuries in modern warfare in the endovascular era. Journal of Cardiovascular Surgery 48(5):581-586. Jorge, R. E., L. Acion, T. White, D. Tordesillas-Gutierrez, R. Pierson, B. Crespo-Facorro, and V. A. Magnotta. 2012. White matter abnormalities in veterans with mild traumatic brain injury. American Journal of Psychiatry 169(12):1284-1291. Kauvar, D. S., L. C. Cancio, S. E. Wolf, C. E. Wade, and J. B. Holcomb. 2006a. Comparison of combat and non-combat burns from ongoing U.S. military operations. Journal of Surgical Research 132(2):195-200. Kauvar, D. S., S. E. Wolf, C. E. Wade, L. C. Cancio, E. M. Renz, and J. B. Holcomb. 2006b. Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF/ OEF explosion burns). Burns 32(7):853-857. Keen, E. F., 3rd, C. K. Murray, B. J. Robinson, D. R. Hospenthal, E. M. Co, and W. K. Aldous. 2010. Changes in the incidences of multidrug-resistant and extensively drug- resistant organisms isolated in a military medical center. Infection Control and Hospital Epidemiology 31(7):728-732. Kelly, J. F., A. E. Ritenour, D. F. McLaughlin, K. A. Bagg, A. N. Apodaca, C. T. Mallak, L. Pearse, M. M. Lawnick, H. R. Champion, C. E. Wade, and J. B. Holcomb. 2008. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006. Journal of Trauma: Injury, Infection, & Critical Care 64(2 Suppl):S21-S26; discussion S26-S27. Kennedy, J. E., M. A. Cullen, R. R. Amador, J. C. Huey, and F. O. Leal. 2010. Symptoms in military service members after blast mTBI with and without associated injuries. Neuro- rehabilitation 26(3):191-197.

OCR for page 85
HUMAN HEALTH OUTCOMES 175 Kessler, R. C., A. Sonnega, E. Bromet, M. Hughes, and C. B. Nelson. 1995. Posttraumatic- stress-disorder in the National Comorbidity Survey. Archives of General Psychiatry 52(12):1048-1060. Kessler, R. C., P. Berglund, O. Demler, R. Jin, and E. E. Walters. 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62(6):593-602. Kessler, R. C., M. Petukhova, N. A. Sampson, A. M. Zaslavsky, and H.-U. Wittchen. 2012. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research 21(3):169-184. Killion, M. C., T. Monroe, and V. Drambarean. 2011. Better protection from blasts with- out sacrificing situational awareness. International Journal of Audiology 50(Suppl 1): S38-S45. King, M. S., J. E. Johnson, R. F. Miller, R. Eisenberg, J. H. Newman, J. J. Tolle, J. F. E. Harrell, H. Nian, M. Ninan, E. S. Lambright, and J. R. Sheller. 2011. Constrictive bronchiolitis in soldiers returning from Iraq and Afghanistan. New England Journal of Medicine 365(3):222-230. Kishikawa, M., T. Yoshioka, T. Shimazu, H. Sugimoto, T. Yoshioka, and T. Sugimoto. 1991. Pulmonary contusion causes long-term respiratory dysfunction with decreased functional residual capacity. Journal of Trauma 31(9):1203-1210. Koc, E., M. Tunca, A. Akar, A. H. Erbil, B. Demiralp, and E. Arca. 2008. Skin problems in amputees: A descriptive study. International Journal of Dermatology 47(5):463-466. Konitzer, L. N., M. V. Fargo, T. L. Brininger, and M. Lim Reed. 2008. Association between back, neck, and upper extremity musculoskeletal pain and the individual body armor. Journal of Hand Therapy 21(2):143-148; quiz 149. Krzywiecki, A., D. Ziora, G. Niepsuj, D. Jastrzebski, S. Dworniczak, and J. Kozielski. 2007. Late consequences of respiratory system burns. Journal of Physiology & Pharmacology 58(Suppl 5)(Pt 1):319-325. Kushelevsky, B. P. 1949. Pulmonary emphysema combined with bronchial asthma following injury. Klinicheskaia Meditsina 27(3):3-10. Larsen, B., K. Netto, and B. Aisbett. 2011. The effect of body armor on performance, thermal stress, and exertion: A critical review. Military Medicine 176(11):1265-1273. Lawrence, J. W., S. T. Mason, K. Schomer, and M. B. Klein. 2012. Epidemiology and impact of scarring after burn injury: A systematic review of the literature. Journal of Burn Care & Research 33(1):136-146. Leibovici, D., O. N. Gofrit, M. Stein, S. C. Shapira, Y. Noga, R. J. Heruti, and J. Shemer. 1996. Blast injuries: Bus versus open-air bombings: A comparative study of injuries in survivors of open-air versus confined-space explosions. Journal of Trauma: Injury, Infection, & Critical Care 41(6):1030-1035. Leone, M., F. Brégeon, F. Antonini, K. Chaumoître, A. Charvet, L. H. Ban, Y. Jammes, J. Albanèse, and C. Martin. 2008. Long-term outcome in chest trauma. Anesthesiology 109(5):864-871. Levin, H. S., E. Wilde, M. Troyanskaya, N. J. Petersen, R. Scheibel, M. Newsome, M. Radaideh, T. Wu, R. Yallampalli, Z. Chu, and X. Li. 2010. Diffusion tensor imaging of mild to moderate blast-related traumatic brain injury and its sequelae. Journal of Neurotrauma 27(4):683-694. Lew, H. L., T. K. Pogoda, E. Baker, K. L. Stolzmann, M. Meterko, D. X. Cifu, J. Amara, and A. M. Hendricks. 2011. Prevalence of dual sensory impairment and its association with traumatic brain injury and blast exposure in OEF/OIF veterans. Journal of Head Trauma Rehabilitation 26(6):489-496.

OCR for page 85
176 GULF WAR AND HEALTH Li, C.J., P.F. Zhu, Z.H. Liu, Z.G. Wang, C. Yang, H.B. Chen, X. Ning, J.H. Zhou, and J. Chen. 2006. Comparative observation of protective effects of earplug and barrel on auditory organs of guinea pigs exposed to experimental blast underpressure. Chinese Journal of Traumatology 9(4):242-245. Lippa, S. M., N. J. Pastorek, J. F. Benge, and G. M. Thornton. 2010. Postconcussive symptoms after blast and nonblast-related mild traumatic brain injuries in Afghanistan and Iraq War veterans. Journal of the International Neuropsychological Society 16(5):856-866. Mac Donald, C. L., A. M. Johnson, D. Cooper, E. C. Nelson, N. J. Werner, J. S. Shimony, A. Z. Snyder, M. E. Raichle, J. R. Witherow, R. Fang, S. F. Flaherty, and D. L. Brody. 2011. Detection of blast-related traumatic brain injury in U.S. military personnel. New England Journal of Medicine 364(22):2091-2100. Magnuson, J., F. Leonessa, and G. S. F. Ling. 2012. Neuropathology of explosive blast trau- matic brain injury. Current Neurology and Neuroscience Reports 12(5):570-579. Magone, M. T., G. C. Cockerham, and S. Y. Shin. 2013. Visual dysfunction in combat related mild traumatic brain injury: A review. US Ophthalmic Review 6(1):48-51. Markell, K. W., E. M. Renz, C. E. White, M. E. Albrecht, L. H. Blackbourne, M. S. Park, D. A. Barillo, K. K. Chung, R. A. Kozar, J. P. Minei, S. M. Cohn, D. N. Herndon, L. C. Cancio, J. B. Holcomb, and S. E. Wolf. 2009. Abdominal complications after severe burns. Journal of the American College of Surgeons 208(5):940-947; discussion 947-949. Matthews, S., A. Simmons, and I. Strigo. 2011. The effects of loss versus alteration of con- sciousness on inhibition-related brain activity among individuals with a history of blast- related concussion. Psychiatry Research 191(1):76-79. Matthews, S. C., A. D. Spadoni, J. B. Lohr, I. A. Strigo, and A. N. Simmons. 2012. Diffusion tensor imaging evidence of white matter disruption associated with loss versus alteration of consciousness in warfighters exposed to combat in Operations Enduring and Iraqi Freedom. Psychiatry Research 204(2-3):149-154. Mayorga, M. A. 1997. The pathology of primary blast overpressure injury. Toxicology 121(1):17-28. McEntire, B. J., and P. Whitely. 2005. Blunt Impact Performance Characteristics of the Ad- vanced Combat Helmet and the Paratrooper and Infantry Personnel Armor System for Ground Troops Helmet. USAARL 2005-12 US Army Aeromedical Research Laboratory. McKee, A. C., T. D. Stein, C. J. Nowinski, R. A. Stern, D. H. Daneshvar, V. E. Alvarez, H. S. Lee, G. Hall, S. M. Wojtowicz, C. M. Baugh, D. O. Riley, C. A. Kubilus, K. A. Cormier, M. A. Jacobs, B. R. Martin, C. R. Abraham, T. Ikezu, R. R. Reichard, B. L. Wolozin, A. E. Budson, L. E. Goldstein, N. W. Kowall, and R. C. Cantu. 2012. The spectrum of disease in chronic traumatic encephalopathy. Brain Jan;136(Pt 1):43-64. McKibben, J. B., L. Ekselius, D. C. Girasek, N. F. Gould, C. Holzer, M. Rosenberg, S. Dissanaike, and A. C. Gielen. 2009. Epidemiology of burn injuries II: Psychiatric and behavioural perspectives. International Review of Psychiatry 21(6):512-521. Mendez, M. F., E. M. Owens, E. E. Jimenez, D. Peppers, and E. A. Licht. 2013. Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces. Brain Injury 27(1):10-18. Mesquita-Guimaraes, J., F. Azevedo, and S. Aguiar. 1987. Silica granulomas secondary to the explosion of a land mine. Cutis 40(1):41-43. Mody, R. M., M. Zapor, J. D. Hartzell, P. M. Robben, P. Waterman, R. Wood-Morris, R. Trotta, R. C. Andersen, and G. Wortmann. 2009. Infectious complications of damage control orthopedics in war trauma. Journal of Trauma: Injury, Infection, & Critical Care 67(4):758-761. Morley, M. G., J. K. Nguyen, J. S. Heier, B. J. Shingleton, J. F. Pasternak, and K. S. Bower. 2010. Blast eye injuries: A review for first responders. Disaster Medicine & Public Health Preparedness 4(2):154-160.

OCR for page 85
HUMAN HEALTH OUTCOMES 177 Mossadegh, S., N. Tai, M. Midwinter, and P. Parker. 2012. Improvised explosive device related pelvi-perineal trauma: Anatomic injuries and surgical management. Journal of Trauma and Acute Care Surgery 73(2 Suppl 1):S24-S31. Murray, C. K. 2008a. Epidemiology of infections associated with combat-related injuries in Iraq and Afghanistan. Journal of Trauma: Injury, Infection, & Critical Care 64(3 Suppl):S232-S238. Murray, C. K. 2008b. Infectious disease complications of combat-related injuries. Critical Care Medicine 36(7 Suppl):S358-S364. Murray, C. K., J. C. Reynolds, J. M. Schroeder, M. B. Harrison, O. M. Evans, and D. R. Hospenthal. 2005. Spectrum of care provided at an echelon II medical unit during Op- eration Iraqi Freedom. Military Medicine 170(6):516-520. Murray, C. K., F. L. Loo, D. R. Hospenthal, L. C. Cancio, J. A. Jones, S. H. Kim, J. B. Holcomb, C. E. Wade, and S. E. Wolf. 2008. Incidence of systemic fungal infection and related mortality following severe burns. Burns 34(8):1108-1112. Murray, C. K., H. C. Yun, M. E. Griffith, B. Thompson, H. K. Crouch, L. S. Monson, W. K. Aldous, K. Mende, and D. R. Hospenthal. 2009. Recovery of multidrug-resistant bacteria from combat personnel evacuated from Iraq and Afghanistan at a single military treat- ment facility. Military Medicine 174(6):598-604. Murray, C. K., K. Wilkins, N. C. Molter, F. Li, L. Yu, M. A. Spott, B. Eastridge, L. H. Blackbourne, and D. R. Hospenthal. 2011. Infections complicating the care of combat casualties during Operations Iraqi Freedom and Enduring Freedom. Journal of Trauma: Injury, Infection, & Critical Care 71(1 Suppl):S62-S73. NATO (North Atlantic Treaty Organization). 2004. Test Methodologies for Personal Protec- tive Equipment Against Anti-Personnel Mine Blast. Research Technology Organization. http://ftp.rta.nato.int/public//PubFullText/RTO/TR/RTO-TR-HFM-089///TR-HFM-089- $$TOC.pdf (accessed November 13, 2013). Needham, D. M., J. Davidson, H. Cohen, R. O. Hopkins, C. Weinert, H. Wunsch, C. Zawistowski, A. Bemis-Dougherty, S. C. Berney, O. J. Bienvenu, S. L. Brady, M. B. Brodsky, L. Denehy, D. Elliott, C. Flatley, A. L. Harabin, C. Jones, D. Louis, W. Meltzer, S. R. Muldoon, J. B. Palmer, C. Perme, M. Robinson, D. M. Schmidt, E. Scruth, G. R. Spill, C. P. Storey, M. Render, J. Votto, and M. A. Harvey. 2012. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders’ confer- ence. Critical Care Medicine 40(2):502-509. Nelson, E. R., V. W. Wong, P. H. Krebsbach, S. C. Wang, and B. Levi. 2012a. Heterotopic os- sification following burn injury: The role of stem cells. Journal of Burn Care & Research 33(4):463-470. Nelson, N. W., J. B. Hoelzle, B. M. Doane, K. A. McGuire, A. G. Ferrier-Auerbach, M. J. Charlesworth, G. J. Lamberty, M. A. Polusny, P. A. Arbisi, and S. R. Sponheim. 2012b. Neuropsychological outcomes of U.S. Veterans with report of remote blast-related con- cussion and current psychopathology. Journal of the International Neuropsychological Society 18(5):845-855. Norin, J. A., D. C. Emanuel, and T. R. Letowski. 2011. Speech intelligibility and passive, level-dependent earplugs. Ear Hear 32(5):642-649. NRC (National Research Council). 2012. Testing of Body Armor Materials: Phase III. Wash- ington, DC: The National Academies Press. Oertel, M., W. J. Boscardin, W. D. Obrist, T. C. Glenn, D. L. McArthur, T. Gravori, J. H. Lee, and N. A. Martin. 2005. Posttraumatic vasospasm: The epidemiology, severity, and time course of an underestimated phenomenon: A prospective study performed in 299 patients. Journal of Neurosurgery 103(5):812-824. Okie, S. 2005. Traumatic brain injury in the war zone. New England Journal of Medicine 352(20):2043-2047.

OCR for page 85
178 GULF WAR AND HEALTH Owens, B. D., J. F. Kragh, Jr., J. C. Wenke, J. Macaitis, C. E. Wade, and J. B. Holcomb. 2008. Combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom. Journal of Trauma: Injury, Infection, & Critical Care 64(2):295-299. Owers, C., J. L. Morgan, and J. P. Garner. 2011. Abdominal trauma in primary blast injury. British Journal of Surgery 98(2):168-179. Ozer, O., I. Sari, V. Davutoglu, and C. Yildirim. 2009. Pericardial tamponade consequent to a dynamite explosion: Blast overpressure injury without penetrating trauma. Texas Heart Institute Journal 36(3):259-260. Paolino, K. M., J. A. Henry, D. R. Hospenthal, G. W. Wortmann, and J. D. Hartzell. 2012. Inva- sive fungal infections following combat-related injury. Military Medicine 177(6):681-685. Paquette, E. L. 2007. Genitourinary trauma at a combat support hospital during Operation Iraqi Freedom: The impact of body armor. Journal of Urology 177(6):2196-2199. Peker, A. F., I. Yildirim, S. Bedir, F. Sumer, and M. Dayanc. 2002. Penile reconstruction with prosthesis and free skin graft in a patient with land mine blast injury. Journal of Urology 167(5):2133-2134. Peleg, K., A. Liran, A. Tessone, A. Givon, A. Orenstein, and J. Haik. 2008. Do burns increase the severity of terror injuries? Journal of Burn Care & Research 29(6):887-892. Penn-Barwell, J. G., C. A. Fries, I. D. Sargeant, P. M. Bennett, and K. Porter. 2012. Aggressive soft tissue infections and amputation in military trauma patients. Journal of the Royal Naval Medical Service 98(2):14-18. Peral Gutierrez De Ceballos, J., F. Turegano Fuentes, D. Perez Diaz, M. Sanz Sanchez, C. Martin Llorente, and J. E. Guerrero Sanz. 2005. Casualties treated at the closest hospi- tal in the Madrid, March 11, terrorist bombings. Critical Care Medicine 33(Suppl 1): S107-S112. Peskind, E. R., E. C. Petrie, D. J. Cross, K. Pagulayan, K. McCraw, D. Hoff, K. Hart, C.-E. Yu, M. A. Raskind, D. G. Cook, and S. Minoshima. 2011. Cerebrocerebellar hypometabo- lism associated with repetitive blast exposure mild traumatic brain injury in 12 Iraq War veterans with persistent post-concussive symptoms. Neuroimage 54(Suppl 1):S76-S82. Peterson, A. L., C. A. Luethcke, E. V. Borah, A. M. Borah, and S. Young-McCaughan. 2011. Assessment and treatment of combat-related PTSD in returning war veterans. Journal of Clinical Psychology in Medical Settings 18(2):164-175. Phillips, Y. Y. 1986. Primary blast injuries. Annals of Emergency Medicine 15(12):1446-1450. Phillips, Y. Y., and D. R. Richmond. 1991. Primary blast injury and basic research: A brief history. In Conventional Warfare: Ballistic, Blast, and Burn Injuries. Washington, DC: Office of the Surgeon General at TMM Publications. Pp. 221-240. Phillips, Y. Y., T. G. Mundie, J. T. Yelverton, and D. R. Richmond. 1988. Cloth ballistic vest alters response to blast. Journal of Trauma: Injury, Infection, & Critical Care 28(1 Suppl):S149-S152. Phillips, Y. Y., T. G. Mundie, R. Hoyt, and K. T. Dodd. 1989. Middle ear injury in animals exposed to complex blast waves inside an armored vehicle. Annals of Otology, Rhinol- ogy, & Laryngology—Supplement 140:17-22. Polusny, M. A., S. M. Kehle, N. W. Nelson, C. R. Erbes, P. A. Arbisi, and P. Thuras. 2011. Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in National Guard soldiers deployed to Iraq. Archives of General Psychiatry 68(1):79-89. Potter, B. K., T. C. Burns, A. P. Lacap, R. R. Granville, and D. A. Gajewski. 2007. Heterotopic ossification following traumatic and combat-related amputations: Prevalence, risk fac- tors, and preliminary results of excision. Journal of Bone & Joint Surgery—American Volume 89(3):476-486.

OCR for page 85
HUMAN HEALTH OUTCOMES 179 Ragel, B. T., C. D. Allred, S. Brevard, R. T. Davis, and E. H. Frank. 2009. Fractures of the thoracolumbar spine sustained by soldiers in vehicles attacked by improvised explosive devices. Spine 34(22):2400-2405. Ramasamy, A., A. M. Hill, S. D. Masouros, F. Gordon, J. C. Clasper, and A. M. J. Bull. 2011. Evaluating the effect of vehicle modification in reducing injuries from landmine blasts: An analysis of 2212 incidents and its application for humanitarian purposes. Accident Analysis & Prevention 43(5):1878-1886. Ramasamy, A., S. Evans, J. M. Kendrew, and J. Cooper. 2012. The open blast pelvis: The significant burden of management. Journal of Bone & Joint Surgery—British Volume 94(6):829-835. Resick, P. A., L. F. Williams, M. K. Suvak, C. M. Monson, and J. L. Gradus. 2012. Long-term outcomes of cognitive-behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology 80(2):201-210. Ressner, R. A., C. K. Murray, M. E. Griffith, M. S. Rasnake, D. R. Hospenthal, and S. E. Wolf. 2008. Outcomes of bacteremia in burn patients involved in combat operations overseas. Journal of the American College of Surgeons 206(3):439-444. Ritenour, A. E., and T. W. Baskin. 2008. Primary blast injury: Update on diagnosis and treat- ment. Critical Care Medicine 36(7 Suppl):S311-S317. Ritenour, A. E., L. H. Blackbourne, J. F. Kelly, D. F. McLaughlin, L. A. Pearse, J. B. Holcomb, and C. E. Wade. 2010. Incidence of primary blast injury in US military overseas contin- gency operations: A retrospective study. Annals of Surgery 251(6):1140-1144. Rivera, J. C., J. C. Wenke, J. A. Buckwalter, J. R. Ficke, and A. E. Johnson. 2012. Posttrau- matic osteoarthritis caused by battlefield injuries: The primary source of disability in war- riors. Journal of the American Academy of Orthopaedic Surgeons 20(Suppl 1):S64-S69. Riviere, S., V. Schwoebel, K. Lapierre-Duval, G. Warret, M. Saturnin, P. Avan, A. Job, and T. Lang. 2008. Hearing status after an industrial explosion: Experience of the AZF explo- sion, 21 September 2001, France. International Archives of Occupational and Environ- mental Health 81(4):409-414. Rona, R. J., N. T. Fear, L. Hull, and S. Wessely. 2007. Women in novel occupational roles: Mental health trends in the UK armed forces. International Journal of Epidemiology 36(2):319-326. Rona, R. J., M. Jones, N. T. Fear, L. Hull, D. Murphy, L. Machell, B. Coker, A. C. Iversen, N. Jones, A. S. David, N. Greenberg, M. Hotopf, and S. Wessely. 2012. Mild traumatic brain injury in UK military personnel returning from Afghanistan and Iraq: Cohort and cross-sectional analyses. Journal of Head Trauma Rehabilitation 27(1):33-44. Ruff, R. L., S. S. Ruff, and X. F. Wang. 2008. Headaches among Operation Iraqi Freedom/ Operation Enduring Freedom veterans with mild traumatic brain injury associated with exposures to explosions. Journal of Rehabilitation Research and Development 45(7):941-952. Ruskin, A., and O. W. Beard. 1948. The Texas City disaster: Cardiovascular studies, with followup results. Texas Reports on Biology and Medicine 6(2):234-259. Ruskin, A., O. W. Beard, and R. L. Schaffer. 1948. Blast hypertension: Elevated arterial pres- sures in the victims of the Texas City disaster. American Journal of Medicine 4(2):228-236. Salinas, N. L., and J. A. Faulkner. 2010. Facial trauma in Operation Iraqi Freedom casualties: An outcomes study of patients treated from April 2006 through October 2006. Journal of Craniofacial Surgery 21(4):967-970. Savolainen, S., and K. M. Lehtomaki. 1997. Impulse noise and acute acoustic trauma in Finnish conscripts. Number of shots fired and safe distances. Scandinavian Audiology 26(2):122-126. Sayer, N. A. 2012. Traumatic brain injury and its neuropsychiatric sequelae in war veterans. Annual Review of Medicine 63:405-419.

OCR for page 85
180 GULF WAR AND HEALTH Sayer, N. A., C. E. Chiros, B. Sigford, S. Scott, B. Clothier, T. Pickett, and H. L. Lew. 2008. Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror. Archives of Physical Medicine & Rehabilita- tion 89(1):163-170. Scekic, M., D. Ignjatovic, M. Duknic, and P. Janjic. 1991. Secondary perforation of the co- lon in a patient with blast injury of the abdomen: Case report. Vojnosanitetski Pregled 48(6):562-563. Scheibel, R. S., M. R. Newsome, M. Troyanskaya, X. Lin, J. L. Steinberg, M. Radaideh, and H. S. Levin. 2012. Altered brain activation in military personnel with one or more traumatic brain injuries following blast. Journal of the International Neuropsychological Society 18(1):89-100. Scherer, M., H. Burrows, R. Pinto, and E. Somrack. 2007. Characterizing self-reported diz- ziness and otovestibular impairment among blast-injured traumatic amputees: A pilot study. Military Medicine 172(7):731-737. Schneider, J. C., and H. D. Qu. 2011. Neurologic and musculoskeletal complications of burn injuries. Physical Medicine in Rehabilitation Clinics of North America 22(2):261-275. Schnurr, P. P., C. A. Lunney, A. Sengupta, and L. C. Waelde. 2003. A descriptive analysis of PTSD chronicity in Vietnam Veterans. Journal of Traumatic Stress 16(6):545-553. Schoenfeld, A. J., R. L. Newcomb, M. P. Pallis, J. A. Serrano, J. O. Bader, and B. R. Waterman. 2013. Characterization of spinal injuries sustained by American service members killed in Iraq and Afghanistan: A study of 2,089 instances of spine trauma. Journal of Trauma & Acute Care Surgery 74(4):1112-1118. Schofield, C. M., C. K. Murray, E. E. Horvath, L. C. Cancio, S. H. Kim, S. E. Wolf, and D. R. Hospenthal. 2007. Correlation of culture with histopathology in fungal burn wound colonization and infection. Burns 33(3):341-346. Schweickert, W. D., and J. Hall. 2007. ICU-acquired weakness. Chest 131(5):1541-1549. Scott, B. A., J. R. Fletcher, M. W. Pulliam, and R. D. Harris. 1986. The Beirut terrorist bomb- ing. Neurosurgery 18(1):107-110. Serkin, F. B., D. W. Soderdahl, J. Hernandez, M. Patterson, L. Blackbourne, and C. E. Wade. 2010. Combat urologic trauma in US military overseas contingency operations. Journal of Trauma: Injury, Infection, & Critical Care 69(Suppl 1):S175-S178. Shah, F. A., F. Pike, K. Alvarez, D. Angus, A. B. Newman, O. Lopez, J. Tate, V. Kapur, A. Wilsdon, J. A. Krishnan, N. Hansel, D. Au, M. Avdalovic, V. S. Fan, R. G. Barr, and S. Yende. 2013. Bidirectional relationship between cognitive function and pneumonia. American Journal of Respiratory & Critical Care Medicine 188(5):586-592. Shariat, S., S. Mallonee, E. Kruger, K. Farmer, and C. North. 1999. A prospective study of long-term health outcomes among Oklahoma City bombing survivors. Journal— Oklahoma State Medical Association 92(4):178-186. Sherwood, J. E., S. Fraser, D. M. Citron, H. Wexler, G. Blakely, K. Jobling, and S. Patrick. 2011. Multi-drug resistant Bacteroides fragilis recovered from blood and severe leg wounds caused by an improvised explosive device (IED) in Afghanistan. Anaerobe 17(4):152-155. Shively, S. B., and D. P. Perl. 2012. Traumatic brain injury, shell shock, and posttraumatic stress disorder in the military—past, present, and future. Journal of Head Trauma Re- habilitation 27(3):234-239. Silla, R. C., J. Fong, J. Wright, and F. Wood. 2006. Infection in acute burn wounds following the Bali bombings: A comparative prospective audit. Burns 32(2):139-144. Simmons, J. W., C. E. White, J. D. Ritchie, M. O. Hardin, M. A. Dubick, and L. H. Blackbourne. 2011. Mechanism of injury affects acute coagulopathy of trauma in combat casualties. Journal of Trauma: Injury, Infection, & Critical Care 71(1 Suppl):S74-S77.

OCR for page 85
HUMAN HEALTH OUTCOMES 181 Smith, B., C. A. Wong, T. C. Smith, E. J. Boyko, and G. D. Gackstetter. 2009. Newly reported respiratory symptoms and conditions among military personnel deployed to Iraq and Afghanistan: A prospective population-based study. American Journal of Epidemiology 170(11):1433. Sponheim, S. R., K. A. McGuire, S. S. Kang, N. D. Davenport, S. Aviyente, E. M. Bernat, and K. O. Lim. 2011. Evidence of disrupted functional connectivity in the brain after combat-related blast injury. Neuroimage 54(Suppl 1):S21-S29. St. Onge, P., D. S. McIlwain, M. E. Hill, T. J. Walilko, and L. B. Bardolf. 2011. Marine Corps breacher training study: Auditory and vestibular findings. US Army Medical Department Journal 96-106. Stein, N. R., M. A. Mills, K. Arditte, C. Mendoza, A. M. Borah, P. A. Resick, B. T. Litz, and S. S. Consortium. 2012. A scheme for categorizing traumatic military events. Behavior Modification 36(6):787-807. Stevens, D. L., L. L. Laposky, P. McDonald, and I. Harris. 1988. Spontaneous gas gangrene at a site of remote injury: Localization due to circulating antitoxin. Western Journal of Medicine 148(2):204-205. Stewart, W. F., A. Schechter, and B. K. Rasmussen. 1994. Migraine prevalence: A review of population-based studies. Neurology 44(6):17-23. Svennevig, J. L., J. Vaage, A. Westheim, G. Hafsahl, and H. E. Refsum. 1989. Late sequelae of lung contusion. Injury 20(5):253-256. Tanielian, T., and L. H. Jaycox. 2008. Invisible Wounds of War: Psychological and Cogni- tive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation. Tarmey, N. T., C. L. Park, O. J. Bartels, T. C. Konig, P. F. Mahoney, and A. J. Mellor. 2011. Outcomes following military traumatic cardiorespiratory arrest: A prospective observa- tional study. Resuscitation 82(9):1194-1197. Teasdale, G., and B. Jennett. 1974. Assessment of coma and impaired consciousness. A practi- cal scale. Lancet 2(7872):81-84. Teasdale, G., and B. Jennett. 1976. Assessment and prognosis of coma after head injury. Acta Neurochirurgica 34(1-4):45-55. Theeler, B. J., and J. C. Erickson. 2009. Mild head trauma and chronic headaches in returning US soldiers. Headache 49(4):529-534. Theeler, B. J., F. G. Flynn, and J. C. Erickson. 2010. Headaches after concussion in US soldiers returning from Iraq or Afghanistan. Headache 50(8):1262-1272. Theeler, B. J., F. G. Flynn, and J. C. Erickson. 2012. Chronic daily headache in US Soldiers after concussion. Headache 52(5):732-738. Thomas, R., J. G. McManus, A. Johnson, P. Mayer, C. Wade, and J. B. Holcomb. 2009. Ocu- lar injury reduction from ocular protection use in current combat operations. Journal of Trauma: Injury, Infection, & Critical Care 66(4 Suppl):S99-S103. Thompson, I. M., S. F. Flaherty, and A. F. Morey. 1998. Battlefield urologic injuries: The Gulf War experience. Journal of the American College of Surgeons 187(2):139-141. Tintle, S. M., M. F. Baechler, G. P. Nanos, J. A. Forsberg, and B. K. Potter. 2012. Reopera- tions following combat-related upper-extremity amputations. Journal of Bone & Joint Surgery­—American Volume 94(16):e1191-e1196. Tribble, D. R., N. G. Conger, S. Fraser, T. D. Gleeson, K. Wilkins, T. Antonille, A. Weintrob, A. Ganesan, L. J. Gaskins, P. Li, G. Grandits, M. L. Landrum, D. R. Hospenthal, E. V. Millar, L. H. Blackbourne, J. R. Dunne, D. Craft, K. Mende, G. W. Wortmann, R. Herlihy, J. McDonald, and C. K. Murray. 2011. Infection-associated clinical outcomes in hospitalized medical evacuees after traumatic injury: Trauma infectious disease outcome study. Journal of Trauma: Injury, Infection, & Critical Care 71(1 Suppl):S33-S42.

OCR for page 85
182 GULF WAR AND HEALTH Trudeau, D. L., J. Anderson, L. M. Hansen, D. N. Shagalov, J. Schmoller, S. Nugent, and S. Barton. 1998. Findings of mild traumatic brain injury in combat veterans with PTSD and a history of blast concussion. Journal of Neuropsychiatry & Clinical Neurosciences 10(3):308-313. Tucker, K., and A. Lettin. 1975. The Tower of London bomb explosion. British Medical Journal 3(5978):287-290. US Army. 2010. Operator Manual for Improved Outer Tactical Vest (IOTV) and Improved Outer Tactical Vest Gen II (IOTV GEN II) Part of the Interceptor Body Armor System. TM 10-8470-208-10 US Army. VA (Department of Veterans Affairs). 2011. Annual Benefits Report Fiscal Year 2011. http:// www.publichealth.va.gov/docs/epidemiology/healthcare-utilization-report-fy2013-qtr1. pdf (accessed November 13, 2013). VA. 2013. Analysis of VA Health Care Utilization Among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans. Washington, DC: Department of Veterans Affairs. http://www.publichealth.va.gov/docs/ epidemiology/healthcare-utilization-report-fy2013-qtr1.pdf (accessed November 20, 2013). VA and DOD. 2009. Clinical Practice Guideline: Management of Concussion/Mild Traumatic Brain Injury. http://www.healthquality.va.gov/mtbi/concussion_mtbi_full_1_0.pdf (ac- cessed November 20, 2013). Vadivelu, S., R. S. Bell, B. Crandall, T. DeGraba, and R. A. Armonda. 2010. Delayed detection of carotid-cavernous fistulas associated with wartime blast-induced craniofacial trauma. Neurosurgical Focus 28(5):E6. Valiyaveettil, M., Y. Alamneh, S. A. Miller, R. Hammamieh, Y. Wang, P. Arun, Y. Wei, S. Oguntayo, and M. P. Nambiar. 2012. Preliminary studies on differential expression of auditory functional genes in the brain after repeated blast exposures. Journal of Reha- bilitation Research & Development 49(7):1153-1162. Van Campen, L. E., J. M. Dennis, R. C. Hanlin, S. B. King, and A. M. Velderman. 1999a. One- year audiologic monitoring of individuals exposed to the 1995 Oklahoma City bombing. Journal of the American Academy of Audiology 10(5):231-247. Van Campen, L. E., J. M. Dennis, S. B. King, R. C. Hanlin, and A. M. Velderman. 1999b. One-year vestibular and balance outcomes of Oklahoma City bombing survivors. Journal of the American Academy of Audiology 10(9):467-483. Vanderploeg, R. D., H. G. Belanger, R. D. Horner, A. M. Spehar, G. Powell-Cope, S. L. Luther, and S. G. Scott. 2012. Health outcomes associated with military deployment: Mild trau- matic brain injury, blast, trauma, and combat associations in the Florida National Guard. Archives of Physical Medicine and Rehabilitation 93(11):1887-1895. Verfaellie, M., G. Lafleche, A. Spiro, 3rd, C. Tun, and K. Bousquet. 2013. Chronic postconcus- sion symptoms and functional outcomes in OEF/OIF veterans with self-report of blast exposure. Journal of the International Neuropsychological Society 19(1):1-10. Vuckovic, I., A. Tucak, J. Gotovac, B. Karlovic, I. Matos, K. Grdovic, and M. Zelic. 1995. Croatian experience in the treatment of 629 urogenital war injuries. Journal of Trauma: Injury, Infection, & Critical Care 39(4):733-736. Walker, W. C., S. D. McDonald, J. M. Ketchum, M. Nichols, and D. X. Cifu. 2013. Iden- tification of transient altered consciousness induced by military-related blast exposure and its relation to postconcussion symptoms. Journal of Head Trauma Rehabilitation 28(1):68-76. Walsh, R. M., J. P. Pracy, A. M. Huggon, and M. J. Gleeson. 1995. Bomb blast injuries to the ear: The London Bridge incident series. Journal of Accident & Emergency Medicine 12(3):194-198.

OCR for page 85
HUMAN HEALTH OUTCOMES 183 Wani, I., F. Q. Parray, T. Sheikh, R. A. Wani, A. Amin, I. Gul, and M. Nazir. 2009. Spectrum of abdominal organ injury in a primary blast type. World Journal of Emergency Surgery 4:46. Warkentien, T., C. Rodriguez, B. Lloyd, J. Wells, A. Weintrob, J. R. Dunne, A. Ganesan, P. Li, W. Bradley, L. J. Gaskins, F. Seillier-Moiseiwitsch, C. K. Murray, E. V. Millar, B. Keenan, K. Paolino, M. Fleming, D. R. Hospenthal, G. W. Wortmann, M. L. Landrum, M. G. Kortepeter, and D. R. Tribble. 2012. Invasive mold infections following combat-related injuries. Clinical Infectious Diseases 55(11):1441-1449. WHO (World Health Organization). 2010. International Statistical Classification of Dis- eases and Related Health Problems. 10th ed. http://apps.who.int/classifications/icd10/ browse/2010/en#/F43.0 (accessed November 20, 2013). Wiechman, S. A. 2011. Psychosocial recovery, pain, and itch after burn injuries. Physical Medicine and Rehabilitation Clinics of North America 22(2):327-345. Wijekoon, C. J., K. H. Weerasekera, and A. K. Weerasinghe. 1995. Sarcoid-like granulomas of the skin seven years after bomb blast injury. Ceylon Medical Journal 40(3):126-127. Wilk, J. E., R. K. Herrell, G. H. Wynn, L. A. Riviere, and C. W. Hoge. 2012. Mild traumatic brain injury (concussion), posttraumatic stress disorder, and depression in U.S. soldiers involved in combat deployments: Association with postdeployment symptoms. Psycho- somatic Medicine 74(3):249-257. Wilkinson, C. W., K. F. Pagulayan, E. C. Petrie, C. L. Mayer, E. A. Colasurdo, J. B. Shofer, K. L. Hart, D. Hoff, M. A. Tarabochia, and E. R. Peskind. 2012. High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild trau- matic brain injury. Frontiers in Neurology 3:11. Wisse, R. P., W. R. Bijlsma, and J. S. Stilma. 2010. Ocular firework trauma: A systematic review on incidence, severity, outcome and prevention. British Journal of Ophthalmol- ogy 94(12):1586-1591. Wolf, D. G., I. Polacheck, C. Block, C. L. Sprung, M. Muggia-Sullam, Y. G. Wolf, A. Oppenheim-Eden, A. Rivkind, and M. Shapiro. 2000. High rate of candidemia in patients sustaining injuries in a bomb blast at a marketplace: A possible environmental source. Clinical Infectious Diseases 31(3):712-716. Wolf, S. E., D. S. Kauvar, C. E. Wade, L. C. Cancio, E. P. Renz, E. E. Horvath, C. E. White, M. S. Park, S. Wanek, M. A. Albrecht, L. H. Blackbourne, D. J. Barillo, and J. B. Holcomb. 2006. Comparison between civilian burns and combat burns from Operation Iraqi Free- dom and Operation Enduring Freedom. Annals of Surgery 243(6):786-792. Wood, G. W., M. B. Panzer, J. K. Shridharani, K. A. Matthews, B. P. Capehart, B. S. Myers, and C. R. Bass. 2012. Attenuation of blast pressure behind ballistic protective vests. Injury Prevention 19(1):19-25. Xydakis, M. S., G. S. Ling, L. P. Mulligan, C. H. Olsen, and W. C. Dorlac. 2012. Epidemio- logic aspects of traumatic brain injury in acute combat casualties at a major military medical center: A cohort study. Annals of Neurology 72(5):673-681. Yzermans, C. J., G. A. Donker, J. J. Kerssens, A. J. E. Dirkzwager, R. J. H. Soeteman, and P. M. H. ten Veen. 2005. Health problems of victims before and after disaster: A longitudinal study in general practice. International Journal of Epidemiology 34(4):820-826. Zachar, M. R., C. Labella, C. P. Kittle, P. B. Baer, R. G. Hale, and R. K. Chan. 2013. Charac- terization of mandibular fractures incurred from battle injuries in Iraq and Afghanistan from 2001-2010. Journal of Oral & Maxillofacial Surgery 71(4):734-742. Zachariah, J. R., A. L. Rao, R. Prabha, A. K. Gupta, M. K. Paul, and S. Lamba. 2012. Post burn pruritus: A review of current treatment options. Burns 38(5):621-629. Zanni, G. R. 2012. Thermal burns and scalds: Clinical complications in the elderly. The Con- sultant Pharmacist 27(1):16-22.

OCR for page 85