Epidemiology in Military and Veteran Populations

Proceedings of the Second Biennial Conference March 7, 1990

William F. Page, Editor

Medical Follow-up Agency

Institute of Medicine

National Academy Press
Washington, D.C. 1991



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Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference March 7, 1990 Epidemiology in Military and Veteran Populations Proceedings of the Second Biennial Conference March 7, 1990 William F. Page, Editor Medical Follow-up Agency Institute of Medicine National Academy Press Washington, D.C. 1991

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Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference March 7, 1990 National Academy Press 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competencies and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education. This project was supported by funds from the Institute of Medicine and the Andrew W. Mellon Foundation. Library of Congress Catalog Card No. 91-62332 International Standard Book Number 0-309-04548-7 Additional copies of this report are available from: National Academy Press 2101 Constitution Avenue, NW Washington, DC 20418 S411 Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference March 7, 1990 PREFACE In June 1988, the first Conference on Epidemiology in Military and Veteran Populations was held in Washington, D.C. at the National Academy of Sciences. That conference brought together a number of speakers on a variety of topics and produced, as a byproduct, several ideas for epidemiologic studies. The success of that first conference led to a second. It was suggested that the proceedings of the second conference, when held, might be published. With the generous sponsorship of the Institute of Medicine and the Andrew W. Mellon Foundation, the second conference was held; with their continued help these proceedings are now being brought to print. In the interest of simplicity, the papers from these proceedings are being reproduced as submitted, without further copy-editing. The obvious reason for publishing such proceedings is to bring the presentations at the conference to the attention of a wider audience, but here there are, in fact, two such audiences. A great deal of epidemiologic work in military and veteran populations is dispersed among a large number of independent organizations. One purpose of the proceedings is to make these organizations more aware of the relevant work of their colleagues in other settings; this is the first audience. The second, even wider, audience is the community of all epidemiologists. Although there are some research issues and specific methodologies of primary interest only to those who study military and veteran populations, to a considerable degree the interests and practices of those who study such populations are the same as those of other epidemiologists. It is important that the wider community of epidemiologists is informed of and, in turn, informs the work of the smaller community doing epidemiologic research in military and veteran populations. The publication of these proceedings may assist in serving that end.

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Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference March 7, 1990 In closing this preface, let me offer my thanks to Dr. William Page, editor of these proceedings and planner of the conference. Let me also thank my colleagues, the members of the Medical Follow-up Agency 's oversight committee, the Committee on Epidemiology and Veterans Follow-up Studies (list follows), for their assistance and support, as well as Dr. Samuel Thier, President of the Institute of Medicine, and Dr. Enriqueta Bond, its Executive Director, for their support and sponsorship. Thanks are, in addition, due to a number of persons on the Agency's staff who helped arrange travel, type letters and memos, and so forth--it is they who made the conference run smoothly. Finally, let me thank the presenters for their talks at the conference and their subsequent papers. Richard D. Remington, Chairman Committee on Epidemiology and Veterans Follow-up Studies

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Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference March 7, 1990 COMMITTEE ON EPIDEMIOLOGY AND VETERANS FOLLOW-UP STUDIES Richard D. Remington, Ph.D. University of Iowa Dan G. Blazer, M.D., Ph.D. Duke University Medical Center Ethel S. Gilbert, Ph.D. Battelle Memorial Institute Michel A. Ibrahim, M.D. University of North Carolina at Chapel Hill Lawrence F. McMahon, Jr., M.D., M.P.H. University of Michigan Medical Center Paul D. Stolley, M.D. University of Pennsylvania H. Eldon Sutton, Ph.D. University of Texas at Austin Myrna M. Weissman, Ph.D. Columbia University

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Epidemiology in Military and Veteran Populations: Proceedings of the Second Biennial Conference March 7, 1990 CONTENTS     Means and Ends   1     Synopses of Papers   5     Yellow Fever Vaccine-Associated Hepatitis Epidemic During World War II: Follow-up More Than 40 Years Later Leonard B. Seeff   9     Substance Use in World War II Veteran Twins: A Genetic Analysis Dorit Carmelli, Gary E. Swan, and Dennis Robinette   19     Hemorrhagic Fever with Renal Syndrome: Past Accomplishments and Future Challenges James W. LeDuc, James E. Childs, Greg E. Glass, and A. J. Watson   35     Psychological Effects of Military Captivity Brian E. Engdahl and William F. Page   49     Dioxins and Dibenzofurans in Adipose Tissue of U.S. Vietnam Veterans and Controls Han K. Kang, Kevin Watanabe, Joseph Breen, Janet Remmers, Margaret G. Conomos, John Stanley, and Michele Flicker   67     Radiation Risk Studies in Military Populations Seymour Jablon   81     Resources for Epidemiologic Research in Vietnam Era Veteran Populations within the Department of Veterans Affairs Han K. Kang   97

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