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Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action E Activities (as of September 1994) Related to Potential Health Consequences of Service in the Persian Gulf Activity Organization Nature of Activity Boards and Committees Persian Gulf Expert Scientific Panel Office of the Chief Medical Director for Environmental Medicine and Public Health, VA Provide advice to the VA on diagnosis, treatment and research on PG-related health conditions. Task Force on Persian Gulf War Health Effects Defense Science Board, DoD Report to the Under Secretary of Defense (Acquisition) on review of all available reports of detection of chemical agents and toxins during ODS/S and postwar period; and review scientific and medical evidence relating exposure to nerve agents, environmental pollutants, endemic biology and other health hazards (DSB, 1994). Persian Gulf Veterans Coordinating Board Secretaries of DoD, HHS, and VA Ensure interagency coordination of all efforts, separate and joint, in the areas of research, clinical care, and disability determination and compensation for post-DOS/S unexplained illnesses (PGVCB, 1994). Persian Gulf Interagency Research Coordinating Council DoD, EPA, HHS, and VA Coordinate all research activities undertaken or funded by the Executive Branch of the federal government on the health consequences of military service in PG theater; VA appointed as lead agency (PL 102-585. sec. 707).
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Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action Activity Organization Nature of Activity NIH Technology Assessment Workshop: The Persian Gulf Experience and Health Persian Gulf Interagency Research Coordinating Council Develop a case definition of ''mystery illness'' and provide a list of recommendations. April 27–29, 1994 (NIH Technology Assessment Workshop Panel, 1994). Population-Based Activities Registry of unit locations Environmental Support Group, Dept. of the Army Database that identifies the daily location of PG units. Health-Outcomes-Based Activities—Completed or Well Underway Constructing a Case Definition Working Group on Unexplained Illnesses Walter Reed Army Medical Center Review and analyze medical records of ODS/S veterans with unexplained symptoms to establish a working case definition for post-PG unexplained illnesses. Outbreak Investigations Investigation of a possible outbreak among ODS veterans, Fort Benjamin Harrison, Ind. Division of Preventive Medicine, WRAIR Examined and surveyed 79 soldiers with unexplained signs and symptoms. Post-Persian-Gulf illness reported in Naval Reserve Mobile Construction Battalion 24 Navy Preventive Medicine Unit 2, Dept. of the Navy Follow-up of members of construction battalion units reporting unexplained signs and symptoms. VA Health Registry and Clinical Evaluations Persian Gulf Health Registry Environmental Agents Service, VA Collects data from PG veterans self-referred for examination at VAMC. Review of Health Registry Data Environmental Epidemiology Service, VA Descriptive analysis of registry data. Persian Gulf Referral Centers Washington, D.C.; Houston, Texas; and West Los Angeles, Calif. Local VAMC physicians refer PG veterans for more extensive physical examinations, when needed. Comprehensive Clinical Evaluation Program Office of Health Affairs, DoD Clinical three-phase evaluation of active duty PG veterans and family members with unexplained signs and symptoms. Mental Health Desert Storm Reunion Survey Boston, Mass., VAMC Determine impact of combat and noncombat experiences on subsequent pattern of adjustment (NEPEC, 1992; Wolfe et al., 1993). Neuropsychological and psychological profiles of PG soldiers returning home Boston, Mass., VAMC Neuropsychiatric evaluation to diagnose PTSD and anxiety disorders.
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Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action Activity Organization Nature of Activity Development of neuropsychological function norms and assessment of neurotoxin exposure in PGW veterans and controls Birmingham, Ala., VAMC Provide basic neuropsychological and environmental exposure database information as core project support for future studies of symptomatic veterans and controls from the PGW. Early intervention with Appalachian Marine reservists in ODS Mt. Home, Tenn., VAMC Debriefing PG veterans on the stresses of deployment and combat-related PTSD (NEPEC, 1992; Sloan et al., unpublished a, b). Investigation of relation between experience in ODS and postwar adjustment Clarksburg, W.V., VAMC and Dept. of Psychology, West Virginia University Investigate the effects that involvement in ODS may have had on veterans, their spouses, or significant others, and their children (Scotti et al., 1993). Psychological assessment of ODS returnees New Orleans, La., VAMC Ongoing debriefing and assessment protocol conducted among troops mobilized in support of the PGW (NEPEC, 1992; Sutker et al., 1993, 1994a, 199b). Psychological adjustment in ODS/S veterans Gainesville, Fla., VAMC Conduct psychological tests to determine if differences existed between PG veterans and controls in terms of overall mental health (NEPEC, 1992). ODS follow-up survey Salt Lake City, Utah, VAMC To elicit VAMC employees' perceptions of ODS activation, deployment, and reintegration experiences. ODS Outreach Program Cincinnati, Ohio, VAMC Explore relation between early life stressors, combat stressors, coping skills and current level of symptomatology. Other completed VAMC studies Evaluation of possible psychological consequences of PG service (NEPEC, 1992). West Haven VAMC ODS report West Haven, Conn. (NEPEC, 1992) The PG Outreach Program at the Little Rock VAMC Little Rock, Ark. (NEPEC, 1992) An Evaluation of Troops Returning from the PG: A Preliminary Report Providence, R.I. (NEPEC, 1992) Coming Home for Good: The ODS Veterans and Family Psychosocial Debriefing Project Portland, Oreg. (NEPEC, 1992)
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Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action Activity Organization Nature of Activity The Need for Continuing Mental Health Intervention in Soldiers Returning form the PGW: Assessment of Deployed and Non-Deployed Reserve Units from Western Pennsylvania, Eastern Ohio, and West Virginia Highland Drive, Pa. (NEPEC, 1992) PG Veterans Seen Through VA's Readjustment Counseling Service and Impact of the PGW on VA's Provision of Readjustment Counseling Washington, D.C. (NEPEC, 1992) Stress-related surveys of active duty, national guard, and reserve personnel Dept. of Military Psychology, WRAIR Assess stresses and psychological and psychosocial impacts of commitment to combat and probable stress consequences, such as posttraumatic and postdeployment stress symptoms and stresses due to return and adjustment. Leishmaniasis Leishmaniasis research Infectious Disease Section, WRAIR Clinical assessment of viscerotropic leishmaniasis as a potential cause of some of the unexplained PGW illnesses. Health-Outcomes-Based Activities—New or Just Beginning Reproductive Health Children of PG veterans Jackson, Miss., VAMC, CDC, Miss. State Health Department Clearinghouse for data on reported birth defects in children of members of Waynesboro, Miss., National Guard. GAO Birth Defects Report GAO Review of reproductive outcomes among children of PG veterans. Mortality study Environmental Agents Service, VA Study of mortality of all PG veterans compared to PG-era veterans. Health survey Environmental Agents Service, VA Study of prevalence of health outcomes in 15,000 PG veterans and 15,000 PG-era veterans. Iowa survey National Center for Environmental Health, CDC Assess prevalence of self-reported adverse health outcomes among Iowa residents who were deployed to the PG during ODS compared to Iowa veterans deployed elsewhere during the same era.
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Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action Activity Organization Nature of Activity Epidemiologic studies of morbidity among PG veterans Clinical Epidemiology Branch, Naval Health Research Center 1) Cohort study of members of PG and control construction battalions; 2) cohort study of PG veterans and control hospitalization diagnoses; and 3) outcomes of hospitalization for pregnancy among cohorts in study 2. Exposure-Based Activities Environmental Air monitoring of oil well fires U.S. Interagency Air Assessment Team (EPA, HHS, NOAA) and representatives from Coast Guard, DoD, DOE Assessed pollutants from oil well fires. Report to Congress: United States Gulf Environmental Technical Assessment (January 27–July 31, 1991) International cooperative effort coordinated by U.N.; EPA coordinated U.S. activities (PL 102-27, sec. 309) Coordinated effort of international activities in response to health, atmospheric, and environmental impacts of oil discharge and fires. Report to Congress on health effects of exposure to burning oil fields DoD—Depts. of Army, Navy, and Air Force Results of Army, Navy, and Air Force studies of potential health consequences of exposure to fumes from burning oil. Environmental toxicology studies Dept. of Environmental and Toxicologic Pathology, Armed Forces Institute of Pathology Human autopsy studies; veterinary pathology reports with toxicological results of potentially hazardous PG environmental exposures. Kuwait Oil Fire Health Risk Assessment USAEHA Quantitative assessment of carcinogenic and noncarcinogenic health risks of exposure to oil well fires (USAEHA, 1992; 1994a). Biologic Surveillance Initiative USAEHA, Armed Forces Institute of Pathology Biologic Surveillance Initiative: Surveillance of German-based 11th Armored Calvary (before, during, and after deployment to the PG) (USAEHA 1994b). Laboratory studies of pesticides Army Research and Development Command, Dept. of the Army Proposed activities: USAEHA will study the effects of combined exposure to PB, DEET, and permethrin in rats; South Florida Research Corporation will study the effects of PB in humans (men and women); Duke University will study the delayed reactions in chickens of exposure to DEET, permethrin, and sarin.
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Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action Activity Organization Nature of Activity Vaccines and Prophylactic Treatment Retrospective survey of PG Troops who received Clostridium botulinum toxoid U.S. Army Medical Material Development Activity, Dept. of the Army Retrospective postcard survey of side-effects in the Marine contingent that received vaccine, Camp Pendleton, Calif., August 1991. Retrospective studies involving military use of pyridostigmine as pretreatment for nerve agent poisoning U.S. Army Medical Research Institute of Chemical Defense, Dept. of the Army Collect safety data for pending New Drug Application to the FDA. Depleted Uranium Monitoring PG veterans with imbedded depleted uranium fragments Baltimore, Md., VAMC, Dept. of the Army, and University of Maryland 5-year follow-up of soldiers with depleted uranium fragments. Environmental Centers Health effects of environmental exposures during the Persian Gulf War Boston. Mass., VAMC Six projects are planned to determine the health effects of environmental exposure to potential hazards, with a particular emphasis on behavioral toxicology, immunotoxicology, cancer epidemiology, and behavioral psychopathology, Environmental illnesses in PG veterans The New Jersey Environmental Hazards Research Center, and East Orange, N.J., VAMC Four projects are planned to gather information about illnesses in PG veterans to develop the most characteristic symptom profiles. Exposure to environmental, chemical, and biological hazards related to military service Portland, Ore., VAMC and the Oregon Health Sciences University's Center for Research on Occupational and Environmental Toxicology Four projects are planned to identify exposures and to define more accurately relations between illnesses in PG veterans and PTSD, or specific environmental, infectious, or chemical warfare exposures. NOTE: CDC = Centers for Disease Control and Prevention; DoD = Dept. of Defense; DOE = Dept. of Energy; EPA = Environmental Protection Agency; GAO = General Accounting Office; FDA = Food and Drug Administration; HHS = Dept. of Health and Human Services; NIH = National Institutes of Health; NOAA = National Oceanographic and Atmospheric Administration; ODS = Operation Desert Storm; ODS/S = Operation Desert Shield/Desert Storm; PB = pyridostigmine bromide; PG = Persian Gulf; PGVCB = Persian Gulf Veterans Coordinating Board; PGW Persian Gulf War; PL = public law; PTSD posttraumatic stress disorder; USAEHA = U.S. Army Environmental Hygiene Agency; VA = Dept. of Veterans Affairs; VAMC = VA Medical Center; and WRAIR = Walter Reed Army Institute of Research.
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