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Contents EXECUTIVE SUMMARY Recommendations, 10 The contents of the entire report, from which this Executive Summary is extracted, are reproduced below. INTRODUCTION ........................................................................................ An Emerging Problem, 15 Panels and Committees, 17 Conclusions, 20 Charge to the Committee, 21 Research and Data Issues, 22 The POW as the Less-than-Ideal Setting for Research, 23 Where Do We Go Tom Here?, 25 2. CHARGE TO THE COMMITTEE: ITS FINDINGS AND RECOMMENDATIONS ............................................................................ Overview, 26 The Committee's Charge, 26 Charge 1, 26 Charge 2, 27 Charge 3, 27 Findings and Recommendations, 28 IX .1 14 26
x 3. ENVIRONMENT AND EXPOSURES..... Overview, 36 Natural Environment, 39 Man-Made Environment, 42 Pesticides, 42 Fuels and Decontamination Solution, 43 Oil Well Fires and Spills, 44 Occupational Exposures, 47 Diet, 48 Vaccines and Prophylactic Treatment, 49 Pyridostigmine Bromide, 52 Interactions of Exposures, 53 Depleted Uranium, 55 Psychosocial Exposures, 57 Stressors Associated with Deployment, 59 Anticipation of Combat, 59 Combat Exposure, 60 Aftermath and Long-Term Adjustment, 61 Gender Differences in Exposure to Stress, 63 DVA Environmental Hazards Research Centers, 64 4. HEALTH OUTCOMES Overview, 67 Mortality Studies, 72 Hospitalization Studies, 74 Diagnosed Diseases in PG Veterans, 78 DVA Persian Gulf Health Registry, 79 DoD Comprehensive Clinical Evaluation Program, 81 CONTENTS .36 ...... 67 Predictors of Enrollment in the DVA Persian Gulf Health Registry, 83 Studies of Self-Reported Symptoms, 83 Outbreak Studies, 83 Surveys, 89 Adverse Reproductive Outcome Studies, 93 Pathways for Environmental Influences on Reproduction, 93 Definition of Outcomes, 94 Frequency of Events in the General Population, 96 Confounding, 96 Reproductive Outcome Studies in PG Populations, 97 Mental Health Studies, 101 Issues in Studies of Mental Health, 101 Mental Health Problems and Military Experience, 102 Mental Health: Comparison of Deployed and Nondeployed Troops, 102
CONTENTS Factors Associated with Mental Health Problems: Combat and Other Stressors, 105 Factors Increasing Vulnerability to PTSD and Other Psychiatric Disorders, 105 Factors Enhancing Resilience or Buffering Effects of Stress on Mental Health, 106 Long-Term Mental Health Outcomes, 107 Physical Symptoms and Exposure to Stressors, 107 Discussion of Mental Health Issues, 109 Women's Health Studies' 111 Health Effects of Combat Service for Women, 111 Gender Differences in Health, 113 Health Issues Related to Men and Women Serving Together in Combat Situations, 116 xi 5. SOME HYPOTHESES REGARDING ILLNESSES IN PERSIAN GULF WAR VETERANS 117 Overview, 117 Chronic Fatigue Syndrome, 118 Multiple Chemical Sensitivity, 119 Oxidative Phosphorylation Disorder, 120 Dental Amalgams, 120 Bacterial Illness, 121 Mycoplasma and Chronic Fatigue, 121 Skeletal Muscle Bioenergetics, 122 Sarcoidosis and Lingual Abnormalities, 122 Brainstem Dysregulation Syndrome, 123 Microsporidia Infection, 124 Organophosphate-Induced Delayed Neurotoxicity, 124 Chemically Induced Porphyria, 125 Fibromyalgia, 125 Somatization Disorder, 125 Summary, 126 6. INFORMATION SYSTEMS Overview, 128 Criteria for a Research-Oriented Health Information System, 130 POW Health Information Systems, 131 Health Information Systems for the Future, 133 Conclusions, 137 REFERENCES.. .128 141
~ . X11 CONTENTS APPENDIXES A. Relevant Sections of Public Law 1 02-5 85 1 59 B. Statement of Task 164 C. Committee Meetings and Individuals Providing Information 165 D. Invited Presentations 168 E. Other Groups Reviewing Persian Gulf War Veteran Health Issues 171 F. List of Research and Related Activities on Health Problems of Persian Gulf War Veterans G. Selected DoD, Army, Navy, Air Force, and DVA Databases .175 ..184 --ACRONYMS 1 89
