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Index
A
Acetylcholine (ACh), 9
botulinum toxoid vaccines, 288(n.10), 289
pyridostigmine bromide (PB), 11, 12, 13, 207–216 (passim), 224, 227–228
sarin, 18, 19, 21, 169–170, 175, 176, 188, 192, 198
Acetylcholinesterase (AChE)
cyclosarin, 186
organophosphate binding (OP-AChE), 9, 174–175, 177, 178, 180, 186, 208, 210, 366
pyridostigmine bromide binding (PB-AChE), 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 227–228, 232, 235, 241, 244–245
sarin, 9–10, 21, 169–170, 174–175, 176, 177, 178, 180, 186, 187, 190, 194–195
see also Pyridostigmine bromide
Acute cholinergic symptoms/syndrome, 9–13, 19, 366
sarin, 9–10, 170–172, 173, 188, 190, 192, 193, 196, 198
Acute effects, general, 4, 72, 189
anthrax vaccines, 15, 16, 19, 277–287 (passim), 304, 313
botulinum toxoid vaccines, 17, 19, 290, 291, 293–294, 313
multiple vaccinations, 17, 297, 306
organophosphate toxicity, 13, 213
pyridostigmine bromide (PB), 214, 224, 234, 250–251
sarin, 9, 18, 19, 21, 180, 188, 193–194, 199, 328
squalene, 309, 310, 311
vaccines, 270, 271;
see specific vaccines supra
uranium, 99
see also specific acute symptoms
Adjuvants, vaccines, 270, 271, 274, 276, 279, 280, 290
squalene, 268, 280, 307–312, 340
Adrenal gland, see Hypothalamic-pituitary-adrenal processes
Adenovirus vaccines, 295
Age factors, 41, 43, 74
anticholinesterases, 190
multiple vaccinations, 305
organophosphate pesticides, 371–375
phosphate fertilizer production workers, 130
pyridostigmine bromide, 227, 228, 236, 238, 242, 244, 246–247
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uranium workers, 116–117, 119, 121, 128, 134–135, 138, 149
vaccines, 302, 311–312
Agency for Toxic Substances and Disease Registry (ATSDR), 94, 99, 106
Agent Orange, 29, 334
AIDS, 310, 342, 345
Air Force Technical Applications Center (AFTAC), 173
Alcohol abuse, 45, 49
Alkaline phosphatase (ALP), 150
Aluminum hydroxide adjuvant, 274, 276
Alzheimer’s disease, 213, 227
American College of Rheumatology, 355
American Psychiatric Association, 345, 346, 360
Ammunition
depleted uranium, 5, 6, 92–93, 98, 326
sarin, 172
see also Armor
Animal studies, 2, 71–72, 80, 99, 351
anthrax vaccines, 21, 277–280, 330
botulinum toxoid vaccines, 21, 288, 289–291, 330
cyclosarin, 186–187
depleted uranium, 99, 100–101, 151, 327
fatigue, 72, 351
multiple vaccinations, 297–299
pain, 72
pyridostigmine bromide (PB), 209, 210–211, 213, 214, 215, 218–219, 220
sarin, 10, 175–176, 177, 178–187, 288
squalene, 308–309
uranium, 21, 96, 97–98, 99–106, 107, 151, 159, 327
vaccines, 271, 272, 277–280, 288, 289–291, 297–299, 308–309, 330
see also Primate equilibrium platform
Anthrax Vaccine Expert Committee, 284
Anthrax Vaccine Immunization Program, 15, 274, 330
Anthrax vaccines, vii, 1, 2, 4, 14, 15–16, 19, 21, 28, 268, 272, 274–287, 306, 312–313, 330, 335
acute effects, 15, 16, 19, 277–287 (passim), 304, 313
animal studies, 21, 277–280, 330
antibodies, 279, 285, 306
antigens, general, 15, 54, 274–277 (passim), 279–280
cardiovascular system, 278, 280
cellular processes, general, 272, 276, 301, 302
chronic effects, 19, 287, 312–313
clinical studies, 15–16, 19, 282–283, 284–287, 334
dermal effects, 15, 16, 272(n.3), 279, 281–287 (passim)
dose factors, 274–275, 278, 285
edema, 15, 275, 276, 277, 278, 283, 284
exposure routes, 272(n.3), 275
dermal, 272(n.3), 282, 283
ingestion, 272(n.3)
inhalation, 272(n.3), 276–277, 282, 283
injection delivery, 15, 279–286 (passim), 297
FDA, 14, 267, 274, 283–284, 287, 313
fever, 16, 277–278, 282, 284, 285, 287
gastrointestinal effects, 272(n.3), 285
gender factors, 286
genetic effects, 280
headaches, 281, 284, 285
historical perspectives, 272, 274, 281, 283–284, 287
hospitalization following administration, 284, 286
immune system pathologies, 279, 284, 285, 290–292, 306
inflammation, 278, 281, 284, 286, 287, 297
live attenuated spore vaccines, 274, 276, 277–279, 281, 297
lymphatic system, 278
mental disorders, 284
mortality, 277, 278
multiple vaccinations, 301, 304
nausea and vomiting, 284, 285
neuromuscular effects, 281, 284, 285, 286
neuropathy, general, 285
number of vaccinations given, 15, 267, 274, 284
pain, 281–282, 284, 285, 286
protective antigen vaccines, 274, 276–277, 279–280, 281, 282
rashes, 284, 285
reproductive system effects, 226
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research recommendations, 313
respiratory effects, 272(n.3), 276–277, 282, 283
short-term malaise, 15, 281, 283, 284, 285
squalene, 309–310
surveillance, 269
veterans, studies of Gulf War veterans, 285, 286, 293
visual and ocular effects, 286
Antibodies
adverse reactions to vaccines, 17, 272, 298
anthrax vaccines, 279, 285, 306
botulinum toxoid vaccines, 288(n.11), 290, 293, 306
lymphocytes, 158, 272, 278, 301, 302
squalene, 309, 311
uranium, 152, 156–157, 312
see also Autoimmune diseases;
Vaccines
Anticholinesterase, 9, 170, 174, 189, 190, 199, 328, 372
age factors, 190
genetic factors, 31
see also Cyclosarin;
Sarin
Antidotes
cyclosarin, 186
sarin, 170, 179
see also Pyridostigmine bromide
Antigens, 271–272, 273
anthrax vaccines, 15, 54, 274–277 (passim), 279–280
botulinum toxoid vaccines, 290
human leukocyte antigen (HLA), 273
toxicity of, 271–272, 273
see also Vaccines
Anxiety, 49, 57, 171, 196, 226, 350, 354
Armed Forces Epidemiologic Board, 295
Armor, depleted uranium, 5, 91–92
Army Center for Health Promotion and Preventive Medicine, 93–94
Army Medical Corps, 9
Army Medical Research Institute of Infectious Diseases, 284, 285–286, 292
Arthritis, 299–300, 302, 309
Asbestos, 34, 78, 79
Asthma, 45, 49, 215, 231, 236, 237
Atropine, 11, 208, 228, 237
ATSDR, see Agency for Toxic Substances and Disease Registry
Attention deficits, 27, 51
sarin, 171
Autoimmune diseases, 273
arthritis, 299–300, 302, 309
diabetes mellitus, 298–299
fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim)
systemic lupus erythematosus, 157, 284, 311
see also Myasthenia gravis
AVIP, see Anthrax Vaccine Immunization Program
B
Baltimore cohort, Gulf War veterans, 21, 93, 326
Beneficiary Identification and Records Locator Subsystem, 54–55
BEIR, see Committee on the Biological Effects of Ionizing Radiation
Biological warfare agents, general, 1, 34, 35, 48, 325
see also Anthrax vaccines;
Botulinum toxoid vaccines;
Nerve agents;
Vaccines
Birth defects, 56–57, 61(n.25), 62, 104–105
Bladder, see Genitourinary system and urinalysis
Blood, see Cardiovascular system;
Hematologic effects
Blood-brain barrier
pyridostigmine bromide (PB), 11, 207, 219–220
sarin, 177
Bone cancer, 19, 109, 143, 146, 159
Bones, see Musculoskeletal effects
Bosnian conflict, 39, 50–51, 250, 303, 304, 358
Botulinum toxoid vaccines, vii, 1, 2, 4, 14, 16–17, 19, 21, 28, 34, 287–294, 297–298, 301, 306
acetylcholine (ACh), 288(n.10), 289
acute effects, 16, 17, 19, 290, 291, 293–294, 313
animal studies, 21, 288, 289–291, 330
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antibodies, 288(n.11), 290, 293, 306
chronic effects, 19, 294, 313–314
clinical studies, 19, 291–294, 333
cramps, 288
dermal tissue, 290, 292, 294
dose factors, 288, 289, 293
edema, 292
fatigue, 288(n.10)
FDA, 16, 288, 293
fever, 288(n.10), 294
genetic factors, 290–291
headaches, 294
hematologic effects, 293
historical perspectives, 16, 288, 291, 293
immune system, impacts on, 290–292
inflammation, 290, 293–294
ingestion, 287–288
injection, 16, 288, 293
neuropathy, general, 288(n.10), 289, 290–291
neuromuscular effects, 288, 289
number of vaccinations given, 268
pain, 288, 292, 293, 294
short-term malaise, 288, 294
surveillance, 269
veterans, studies of Gulf War veterans, 285, 293
Brain
Alzheimer’s disease, 213, 227
blood-brain barrier, 11, 177, 207, 219–220
cyclosarin, 186–187
depleted uranium, 103
electroencephalography, 10, 103, 181, 187, 191, 199, 372
pyridostigmine bromide (PB), 11, 207, 217, 219–220, 247
sarin, 10, 175–176, 177, 180, 181, 182, 186–187, 191, 195, 196, 199
see also Neuropsychological effects
Britain, see United Kingdom
Bronchi
pyridostigmine bromide (PB), 11, 12, 208, 214, 215, 225, 230, 237
sarin, 171
Butyrylcholinesterase (BuChE), 21, 53, 177, 178, 186, 214, 218, 220–221, 245, 250, 329
C
Canada
Gulf War veterans, 39, 45, 46, 48–49, 285, 333, 358
uranium mine workers, 109
Cancer, 55, 79
bone, 19, 109, 143, 146, 159
liver, 79
lung, 6–7, 19, 79, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159
lymphatic, 19, 100, 123, 142–143, 144–145, 159
mortality, 117, 128, 114, 117–118, 126–127, 128, 131
multiple vaccinations, 299
registry data, 42
testicular, 60
uranium, 6–7, 19, 100, 114, 117–118, 121, 126–145 (passim), 159
Carbamates, 34, 169, 207, 210, 213, 219
Cardiovascular system
anthrax vaccines, 278, 280
chest pain, 42, 171
cyclosarin, 187
peripheral vascular resistance, 228–229
pyridostigmine bromide (PB), 215–216, 228–229, 230, 235–236, 245, 249
registry data, 42
sarin, 171, 181, 187, 194–195
uranium, 8, 19, 96, 100, 105, 108–109, 126, 158, 160
vaccines, 272
Case-control studies, 43–44, 52–53, 71, 75, 77, 82, 250
organophosphate pesticides, 370
uranium exposure, 108, 121, 127, 138
CDR, see Comprehensive Epidemiology Data Resource (CEDR)
Cellular processes, general
anthrax vaccines, 272, 276, 301, 302
lymphocytes, 158, 272, 301, 302
lymphomas, 142
pyridostigmine bromide (PB), 219–220
see also Cancer;
DNA;
Genetic factors;
DNA;
Immune system;
Receptor-mediated actions;
Red blood cells;
RNA
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Center for Health Promotion and Preventive Medicine (CHPPM), 93–94
Centers for Disease Control and Prevention (CDC)
AIDS, case definition, 345–346
anthrax vaccines, 283, 284
botulinum toxoid vaccines, 288, 293–294
chronic fatigue syndrome, case definition, 354
multiple vaccines, 295, 296, 304, 305–306
vaccine surveillance, 269, 270, 283, 284
Central Intelligence Agency, 172, 173, 196
Central nervous system (CNS)
depleted uranium, 99, 103
myasthenia gravis, 224
pyridostigmine bromide (PB), 12, 213, 217, 219–220, 223, 224, 226, 235, 240, 241, 247, 251
sarin, 170, 171, 176–177, 182, 191, 195, 196, 327
squalene, 308
uranium, 99, 102, 103
see also Brain
Chemical Abstracts Service, 339–340
Chemical agent-resistant coating, 34
Chemical warfare agents, general, 1, 34, 35, 48, 178, 189–190, 325
see also Antidotes;
Cyclosarin;
Nerve agents;
Sarin
Chlorinated hydrocarbons, 34
Cholinergic effects, see Acetylcholine;
Acetylcholinesterase;
Acute cholinergic symptoms/syndrome;
Anticholinesterase;
Butyrylcholinesterase;
Growth-releasing hormone;
Pyridostigmine bromide
Cholinesterase (ChE), see Pyridostigmine bromide;
Sarin
Chronic effects, general, 4, 13, 49, 50, 51, 53, 54, 58(n.21), 59, 61
anthrax vaccines, 19, 287, 312–313
botulinum toxoid vaccines, 19, 294, 313–314
depleted uranium, 102–103
multiple vaccinations, 17, 298–299, 304
pyridostigmine bromide (PB), 13, 14, 214–215, 252–253
sarin, 183, 188, 191–192, 193, 198
squalene, 311
uranium, 100, 102–103
vaccines, 17, 271, 287, 294, 198–199, 303, 304, 311, 312–314, 330
see also Multisymptom illness;
specific anatomical and chronic diseases and symptoms
Chronic fatigue syndrome (CFS), ix, 27, 45, 48–50 (passim), 62, 342, 343, 350, 354, 356–357, 358, 360, 361
see also Fatigue;
Fibromyalgia;
Multisymptom illness
Clinical studies, 54, 76–77, 82
anthrax vaccines, 15–16, 19, 282–283, 284–287, 334
case definitions, 43–44, 54, 343–361
botulinum toxiod vaccinations, 19, 291–294, 333
fibromyalgia, 355
multiple vaccinations, 17, 305–306
pyridostigmine bromide (PB), 12, 19, 209, 222–231, 249, 329
vaccines, 15–17, 19, 270, 271, 282–283, 284–287, 291–294, 305, 306, 310–311, 333
Cognitive dysfunction, 351, 354, 356, 359
attention deficits, 27, 51, 171
depleted uranium, 153
epidemiological studies, 45–49 (passim), 52, 53, 54, 62, 246, 247–248
memory loss, 1, 27, 39, 40–41, 42, 52, 171, 311, 351
multisymptom illness, 17, 51, 54, 154, 303–306, 342–345
pyridostigmine bromide (PB), 53, 224, 227, 233–235, 236, 242–243, 246, 247–248
sarin, 171, 181, 197
Cohort studies, 13, 44–54, 61, 73–75, 82
depleted uranium, 21, 93, 326–327
organophosphate pesticides, 369
phosphate fertilizer processing workers, 112, 114–115, 130, 131, 132, 148, 152, 159
sarin, 190
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uranium miners and processing workers, 112–114, 115–121, 122, 123–149, 151–152, 154–157, 158, 159
vaccinations, 17, 274, 281, 291, 299, 300–303, 306, 314
see also Occupational exposure, nonmilitary;
Veterans, studies of Gulf War Veterans
Colorado Plateau states, uranium millers, 108, 111, 112, 130, 131, 132, 144
Committee on the Biological Effects of Ionizing Radiation, 107, 143
Compensation of veterans, 20, 28
Comprehensive Clinical Evaluation Program, 40
Comprehensive Epidemiology Data Resource (CEDR), 117
Computerized posturography, sarin, 10, 196, 199
Concentration deficits, see Attention deficits
Controlled studies, viii–ix, 7, 32, 39, 48–62, 74, 76–77, 82, 358
anthrax vaccines, 278
birth defects, 56
botulinum toxoid vaccines, 288(n.10), 291–293
case-control studies, 43–44, 52–53, 71, 75, 77, 82, 108, 121, 127, 138, 250, 370
fibromyalgia, 356
organophosphate pesticides, 370–375
pyridostigmine bromide (PB), 13, 227, 231–245 (passim)
sarin, 10, 181, 193, 327
uranium exposure, 7, 108, 121, 127, 138
vaccines, 270, 278, 288(n.10), 291–293, 301, 301–303
see also Clinical studies
Convulsions, sarin, 10, 170, 175, 176, 179, 188, 192, 193
Cost and cost-benefit factors, 2
compensation of veterans, 20, 28
vaccines, 268
Cramps, 51
botulinum toxoid vaccines, 288
pyridostigmine bromide (PB), 11, 12, 214, 223, 226, 251
sarin, 171
uranium exposure, 151
Cross-sectional studies, 45–48, 61, 73, 75–76, 81, 368, 369
multiple vaccinations, 305
pyridostigmine bromide (PB), 247, 248, 250
Cyclosarin, 2, 9, 28, 172, 173–174, 186–187, 198, 340
see also Pyridostigmine bromide;
Sarin
Cytokines, 272, 275
Czechoslovakia, uranium miners, 109
D
Databases, 54–55, 69, 339–341
Death, see Mortality
DEET, see N,N-diethyl-m-toluamide
Demographic factors, 41, 43, 348
see also Age factors;
Gender factors;
Racial and ethnic factors;
Socioeconomic status
Department of Defense (DoD)
anthrax vaccines, 284, 285
depleted uranium studies, 91–92, 326
hospitalization studies, 55–56, 189–190
previous research on Gulf War health effects, 30
pyridostigmine bromide (PB), 208, 209
registry programs, 40–43, 77, 357
sarin, 9, 172, 173, 189, 196
squalene, 307
vaccines, 284, 285, 295, 329–330
Department of Energy (DOE), 116, 117
Department of Health and Human Services
Agency for Toxic Substances and Disease Registry, 94, 99, 106
Anthrax Vaccine Expert Committee, 284
National Institutes of Health, 30, 114–115, 274, 310
see also Centers for Disease Control and Prevention;
Food and Drug Administration
Department of Veterans Affairs, 54
committee study, background, vii, 2, 28, 70
compensation of veterans, 20, 28
depleted uranium, 93
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previous research on Gulf War health effects, 30
registry programs, 40–43, 58, 77, 357, 358
Depleted uranium (DU), vii, viii, 1, 2, 5–8, 28, 34, 83, 90–93, 98–99
ammunition containing, 5, 6, 92–93, 98, 326
animal studies, 99, 100–101, 151, 327
armor, 5, 91–94
chronic effects, general, 102–103
cohort studies, 21, 93, 326–327
developmental and reproductive effects, 8, 19, 104–105, 157
exposure, 6, 31, 92, 93–94, 326
gastrointestinal effects, 8, 19, 104
genetic factors, 8, 19, 158
hematologic effects, 8, 19, 99
historical perspectives, 91–92
ingestion, 6, 93, 96, 98–99
inhalation, 6, 93
injection, 99
musculoskeletal effects, 8, 99
neuropathy, 99, 103, 151, 153
renal effects, 7–8, 99, 150
research recommendations, 21, 326–327
respiratory effects, 98
tantalum (Ta), 98–99, 100, 101, 103
wounds, 93, 102–103
see also Uranium
Depression, 350, 354, 355
epidemiologic studies, 45, 46, 48, 49, 52, 62
organophosphate pesticides, 370
pyridostigmine bromide (PB), 233, 245
see also Chronic fatigue syndrome;
Posttraumatic stress disorder
Dermal exposure
anthrax, 272(n.3), 282, 283
sarin, 8, 169, 176
uranium, 96, 151, 156
see also Injection delivery
Dermal tissue, other, 47, 51
anthrax, 272(n.3), 282, 283
anthrax vaccines, 15, 16, 272(n.3), 279, 281–287 (passim)
botulinum toxoid vaccines, 290, 292, 294
pyridostigmine bromide (PB), 215
registry data, 42
sand, blown, 33
uranium, 19, 105, 158
see also Injection delivery;
Perspiration;
Rashes
Developmental effects
birth defects, 56–57, 61(n.25), 62, 104–105
depleted uranium, 8, 19, 104–105, 157
sarin, 186, 187
uranium, 8, 19, 104–105, 157, 158
Diabetes mellitus, 298–299
Diagnosis, vii, 43–44, 56
case definitions, 43–44, 54, 343–361
chronic fatigue syndrome, 354, 356–357, 358–359
Diagnostic and Statistical Manual of Mental Disorders, 58, 346, 360
electrocardiography (EKG), 158, 235, 244
electroencephalography (EEG), 10, 103, 181, 187, 191, 199, 372
electromyography (EMG), 190, 232, 233, 249
International Classification of Diseases, 56, 346, 360
multisymptom illness, 17, 51, 54, 154, 303–306, 342–365
posttraumatic stress disorder, 57, 58, 342
posturography, 10, 196, 199
pyridostigmine bromide (PB) effects, 12, 223
registry data, 40–43
symptom clustering, 43, 44, 48, 49, 50–51, 349
see also specific symptoms (e.g., Pain)
Diagnostic and Statistical Manual of Mental Disorders, 58, 346, 360
Diarrhea, 60
registry data, 42
pyridostigmine bromide (PB), 11, 208, 214, 226, 230, 251
uranium, 156
Diet, 33, 307–308
Digestive system, see Gastrointestinal effects
Diphtheria-tetanus-pertussis vaccines, 268, 295, 296, 299, 300, 301
DNA
anthrax vaccines, 280
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pyridostigmine bromide (PB), 220
sarin, 183
uranium effects, 157
Dose and dose-response, viii, 78–79, 83, 357
anthrax vaccines, 274–275, 278, 285
botulism toxin, 288, 289, 293
committee study methodology, 4, 18, 78
cyclosarin, 186
depleted uranium, 103
multiple exposures and varying doses, 29, 79
pyridostigmine bromide (PB), 11, 12, 14, 208–209, 210–211, 214, 215, 218, 219, 223–238 (passim), 247–248, 251, 252, 329
sarin, 9, 10, 18, 19, 173, 176, 178–183, 186, 188, 192, 199, 288, 327
squalene, 308, 312
uranium, 7, 90, 91, 103, 108, 115–116, 117–118, 120, 121, 123, 125, 128, 130, 135–140, 141, 142, 159
vaccines, general, 272
see also Exposure;
Multiple vaccinations
DSM-III, see Diagnostic and Statistical Manual of Mental Disorders
DTP, see Diphtheria-tetanus-pertussis vaccines
Drug delivery, see Injection delivery
Dysarthria, pyridostigmine bromide (PB), 12, 223, 251
E
Edema
anthrax vaccines, 15, 275, 276, 277, 278, 283, 284
botulinum toxoid vaccines, 292
sarin, 171
see also Inflammation
Electrocardiography (EKG), 158, 235, 244
Electroencephalography (EEG)
depleted uranium, 103
organophosphate pesticides, 372
sarin, 10, 181, 187, 191, 199
Electromyography (EMG), 190, 232, 233, 249
Emotional effects, see Anxiety;
Depression;
Malaise, short-term, Mental disorders;
Mood disorders;
Neuropsychological effects;
Psychological factors
Employment, see terms beginning “Occupational”
Encephalitis vaccines, 295
Enzyme-linked immunosorbent assay (ELISA), 311
Eosinophils, 158, 342
Epidemiology, general, 32, 40, 43–62, 71, 72–76, 82, 83, 84–85, 357–358
birth defects, 56–57, 61(n.25), 62, 104–105
case definitions, 43–44, 54, 343–361
committee study methodology/agenda, 4–5, 18–19, 333
cognitive dysfunction, 45–49 (passim), 52, 53, 54, 62, 246, 247–248
depression, 45, 46, 48, 49, 52, 62
evidence, assessment criteria, 4–5, 18–19, 78–81, 82;
see also “case definitions” supra
fatigue, 45–49 (passim), 54, 62, 357–358
fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim)
infectious diseases, general, 59, 72
injuries, 48, 49, 55
general health status, 43–54
hospitalizations, 55–57, 60, 61, 188, 189–190, 193–195, 284, 286, 311, 368
limitations of, 60–62, 73, 74–76, 82, 83, 84–85, 123–128, 130, 140–142, 143, 252
multiple vaccinations, 305
musculoskeletal effects, 40–41, 42, 45, 46, 48, 49
organophosphate pesticides, 53, 366–377
population-based studies, vii, 3–4, 6, 10, 13, 18, 21, 32, 35, 44–51, 191–193;
see also Registry programs
posttraumatic stress disorder (PTSD), 45, 46, 48, 49, 57–59, 62, 246
pyridostigmine bromide (PB), 13–14, 21, 48, 71, 209, 245–250, 252, 329
sarin, 4, 71, 188, 189–192, 193–195
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specific health endpoints, 54–60
stress-related disorders, 46, 49, 51, 57–59, 57–59, 123
symptom clustering, 43, 44, 48, 49, 50–51, 349
multisymptom illness, 17, 51, 54, 154, 303–306, 342–365
uranium-induced lung cancer, 6–7, 19, 100, 114, 117–118, 126–127, 128–130, 132–142
uranium, 106–121;
see also "uranium” under Occupational exposure, non-military
see also Case-control studies;
Cohort studies;
Cross-sectional studies;
Mortality;
Occupational exposure, noncombat military personnel;
Occupational exposure, non-military;
Recordkeeping;
Registry programs;
Statistical techniques
Erythrocytes, see Red blood cells
Estrogen
contraceptive pills, 273
vaccines, response to, 273
Ethnicity, see Racial and ethnic factors
Event-related potential (ERP)
sarin, 10, 195, 196, 199, 327
see also Visual evoked potential
Experimental allergic encephalomyelitis, 309
Exposure, 18–19, 43, 49, 51, 71, 72, 73–77, 81–85, 99, 360
case definition, 348
community study, methodology/agenda, viii, 2–3, 4–5, 18, 29, 35, 335
depleted uranium, 6, 31, 92, 93–94, 326
duration, 29, 31, 71, 72, 76
uranium, 71, 116–117, 121, 126, 130
multiple exposures and chemical interactions, 29, 31, 79, 298–299;
see also Interactions, chemical
multiple chemical sensitivity (MCS), 46, 49, 350, 352, 356–357, 358, 359
organophosphate pesticides, long-term, 366–377
phosphate fertilizer production workers, 112, 114–115, 130, 132, 148, 152, 159
registry programs, 40
routes, 71, 80, 94–96;
see also Dermal exposure;
Ingestion;
Inhalation;
Injection delivery
anthrax, 15, 272(n.3), 275, 276–277, 279–286 (passim), 282, 283, 297
botulinum toxoid vaccines, 268
sarin, 9, 18, 19, 31, 170–173, 178, 182–183, 188
terrorism, viii, 3, 10, 70, 177–178, 188
smoke, 1, 27–28, 33–34, 48
depleted uranium, 6, 93
oil-well fires, 1, 27, 31, 33
uranium,
depleted uranium, 6, 31, 92, 93–94, 326
occupational exposure, 6–7, 19, 31, 108, 111, 113, 114, 115–117, 120, 121, 123–129, 130, 134, 135, 138, 140–141, 142, 149, 159
see also Dose and dose-response;
Dermal exposure;
Epidemiology;
Ingestion;
Inhalation
Eyes, see Visual and ocular effects;
Visual evoked potential
F
Fatigue, 1, 27, 32, 39, 343, 350–360 (passim)
animal studies, 72, 351
botulinum toxoid vaccines, 288(n.10)
epidemiological studies, 45–49 (passim), 54, 62, 357–358
fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim)
multiple vaccinations, 304, 306, 314
pesticides, organophosphate, 367–375
pyridostigmine bromide (PB), 211, 226, 230, 233, 236, 245, 329
registry data, 40–41, 42
myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251
sarin, 171, 189, 193, 194, 195, 198, 199, 327, 328
squalene, 311
see also Chronic fatigue syndrome
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Federal government, 28–29, 39
see also Legislation;
Regulatory factors;
specific departments and agencies
Fernald Feed Materials Production Center, 117–118, 121, 122, 135, 137
Fertilizers, see Phosphate fertilizers
Fever
anthrax vaccines, 16, 277–278, 282, 284, 285, 287
botulinum toxoid vaccines, 288(n.10), 294
yellow fever vaccines, 295, 296, 301
Fibromyalgia, 45, 46, 48, 49, 62, 343, 352, 355–360 (passim)
Fires, see Smoke
Follicle-stimulating hormone (FSH), 157
Food, see Diet
Food and Drug Administration (FDA)
anthrax vaccines, 14, 267, 274, 283–284, 287, 313
Investigational New Drug (IND) status,
anthrax vaccines, 274, 283–284
botulinum toxoid vaccines, 16, 288, 293
pyridostigmine bromide (PB), 208
pyridostigmine bromide (PB), 11, 207, 208
squalene, 307, 309
vaccine surveillance, 269
Formaldehyde, 274, 288, 289–290, 292
Fort Bragg Booster Study, 285, 293
Fort Detrick Studies, 17, 274, 281, 291, 299, 300–303, 306, 314
Freedom of Information Act (FOIA), 283
G
Gamma-aminobutyric acid (GABA), 175
Gamma-glutamyltransferase (GGT), 150
Gas chromatograph-mass spectroscopy (GC-MS), 191, 194
Gastrointestinal effects, 47, 51, 60
anthrax, 272(n.3)
anthrax vaccines, 285
depleted uranium, 8, 19, 104
infections, 59–60
pyridostigmine bromide (PB), 11, 12, 208. 209, 214, 223, 225–226, 230, 236, 242, 251
registry data, 42
sarin, 171, 180
uranium, 8, 19, 104, 156, 158, 160
see also Diarrhea;
Ingestion;
Nausea and vomiting;
Salivation
Gender factors, 41, 43, 74
anthrax vaccines, 286
organophosphate pesticides, 371–375
phosphate fertilizer production workers, 115
pyridostigmine bromide, 226, 231, 239, 244
sarin, 196, 197
testicular cancer, 60
uranium processing workers/miners, 117, 118, 119, 121, 149, 157
women, symptoms specific to, 51–52
see also Sexual functioning
General Accounting Office (GAO)
anthrax vaccines, 283
squalene, 307
Genetic factors, 71–72
anthrax vaccines, 280
botulinum toxoid vaccines, 290–291
depleted uranium, 8, 19, 158
individual variability, 31, 197–198, 220–222, 244–245, 272, 334
multiple vaccines, 298
organophosphates, 31, 53
pyridostigmine bromide, 21, 220–222, 244–245, 328, 329
research recommendations, 21, 328, 329
sarin, 21, 53, 183, 187, 197–198, 328
uranium, 8, 19, 100–101, 157, 158
vaccines, 272, 273, 280, 290–291
see also DNA;
RNA
Genitourinary system and urinalysis, 47, 54
depleted uranium, 158
pyridostigmine bromide (PB), 12, 208, 225–226
registry data, 42
sarin, 171, 177–178
uranium, 97, 100–101, 119, 123, 124, 150
see also Renal effects;
Sexual functioning
Germany, sarin development, 8
GGT, see Gamma-glutamyltransferase
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GH-releasing hormone (GHRH), 222–223, 224
Growth hormone, pyridostigmine bromide (PB), 12, 209, 220, 222–224, 251, 334
Guillain-Barré syndrome, 284
Gulf War, background and setting, 1, 9, 27, 32, 172–174, 209
see also Veterans, studies of Gulf War veterans
H
Haemophilus influenzae type B (HIB), 296
Headaches, 1, 39, 350, 351, 354
anthrax vaccines, 281, 284, 285
botulinum toxoid vaccines, 294
pyridostigmine bromide (PB), 236
registry data, 40–41, 42
sarin, 10, 171, 193, 194, 198
Heat, 33, 235, 243
see also Thermoregulation
Hematologic effects, 54
botulinum toxoid vaccines, 293
depleted uranium, 8, 19, 99
lymphocytes, 158, 272, 301, 302
multiple vaccines, 301–302
pyridostigmine bromide (PB), 11, 208, 244
rheumatoid factor, 299–300, 302
sarin, 177, 178, 188, 192, 194–195
squalene, 311
uranium, 8, 19, 96, 97, 99, 105–106, 109, 157–158
see also Cardiovascular system;
Red blood cells
Hepatic effects, 79
pyridostigmine bromide (PB), 210
sarin, 177
squalene, 308
uranium, 19, 97, 100, 104, 108–109, 158
Hepatitis vaccines, 295, 296
Herpes simplex virus, 310
HIAA, see 5-hydroxyindoleacetic acid
HIB, see Haemophilus influenzae type B
Histocompatibility, 273
Historical perspectives, 28–29, 30, 339, 343
AIDS, 345–346
anthrax vaccines, 272, 274, 281, 283–284, 287
Bosnian conflict, 39, 50–51, 250, 303, 304, 358
botulinum toxoid vaccines, 16, 288, 291, 293
chemical warfare agents, testing of military volunteers, 189
depleted uranium, 91–92
fatigue syndrome, 354
Kurdish/Iraqi conflict, 34
Operation Desert Storm, significant dates, 1, 9, 27, 32, 172–174, 209
organophosphates, general, 182
pyridostigmine bromide (PB), 207, 225
sarin, 8, 191
Japan, terrorist attack, 3, 10, 177–178, 188, 191–196, 199
squalene, 307
vaccines, general, 267, 268, 294, 295, 300–303;
see also specific vaccines supra
HIV, see AIDS
Hoffman-La Roche, 207
Hormones, 230, 244, 244
contraceptives, 230
follicle-stimulating hormone, 157
GH-releasing hormone (GHRH), 222–223, 224
growth hormone, 12, 209, 220, 222–224, 251, 334
hypothalamic-pituitary-adrenal processes, 354, 360
pyridostigmine bromide (PB), 209, 220, 223, 250–251
luteinizing hormone (LH), 157
pineal gland, 220
vaccines, response to, 273
Hospitalization, 39, 55–57, 60, 61
anthrax vaccines, 284, 286
influenza vaccines, 311
organophosphate insecticides, 368
sarin, 188, 189–190, 193–195
HPA, see Hypothalamic-pituitary-adrenal
Human leukocyte antigen (HLA), 273
Humoral immune response, 276–277
HSV, see Herpes simplex virus
5-hydroxyindoleacetic acid, 176
5-hydroxytryptamine, see Serotonin
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multisymptom illness, 17, 51, 54, 154, 303–306, 342–365
myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251
pain, muscle and joint, 27, 39, 40, 42, 45, 46, 48, 49, 72, 193. 194, 198, 281, 284, 285, 286, 288, 293–294, 350, 351, 354, 355
pyridostigmine bromide (PB), 11, 12, 211–213, 220–221, 223, 226, 230, 232–233, 246, 248, 251
registry data, 40–41, 42
sarin, 9, 10, 171, 173, 179–180, 187, 190, 193, 194, 197, 327
uranium, 72, 105, 123, 158, 160
see also Chronic fatigue syndrome;
Fatigue;
Psychomotor effects
Neuropathy, general, 46, 47, 52
Alzheimer’s disease, 213, 227
anthrax vaccine, 285
botulinum toxoid vaccines, 288(n.10), 289, 290–291
cyclosarin, 186–187
depleted uranium, 99, 103, 151, 153
genetic factors, 53
pyridostigmine bromide, 21, 220–222, 244–245, 328, 329
sarin, 21, 53, 183, 187, 197–198, 328
insecticides, 53
myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251
organophosphate-induced delayed neuropathy (OPIDN), 181–182, 183, 192, 197, 213, 217, 218, 248, 249, 252, 328
organophosphates, general, 367–368, 371–375
pyridostigmine bromide (PB), 11, 12, 13, 53, 219–220, 247–249, 252, 328
registry data, 42
sarin, 9–10, 175–176, 180–185, 186–187, 190, 192, 193, 194, 197, 327–328
convulsions, 10, 170, 175, 176, 179, 188, 192, 193
squalene, 308, 309
uranium, 19, 99, 102–103, 123, 151–153
vestibular nerve, 52, 197, 327
see also Acetylcholine;
Acetylcholinesterase;
Acute
cholinergic symptoms/syndrome;
Anticholinesterase;
Brain;
Butyrylcholinesterase;
Central nervous system;
Chronic
fatigue syndrome;
Convulsions;
Cyclosarin;
Nerve agents;
Neuromuscular effects;
Pain;
Peripheral nervous system;
Psychomotor effects
Neuropathy target esterase (NTE), 181, 182, 183, 187
Neuropsychological effects, 47, 51, 351
anxiety, 49, 57, 171, 196, 226, 350, 354
attention deficits, 27, 51, 171
malaise,
anthrax vaccines, 15, 281, 283, 284, 285
botulinum toxoid vaccines, 288, 294
organophosphates, general, 367–375
pyridostigmine bromide (PB), 13, 213–214, 227, 233–235, 236, 242–244, 252
sarin, 171, 175, 180, 188, 195, 195, 197, 328
uranium exposure, 151
see also Cognitive dysfunction;
Mental disorders;
Psychological effects
Nicotinic effects
pyridostigmine bromide (PB), 11, 208, 211, 223, 226, 230, 237, 240, 251
sarin, 170, 171, 175
N,N-diethyl-m-toluamide (DEET), 217, 218, 248, 334
Nuclear Regulatory Commission, 90, 92
Nutrition, see Diet
O
Oak Ridge, Tennessee, uranium processing workers, 7, 118–121, 122, 131–148 (passim), 152, 159
Occupational exposure, noncombat military personnel, 1, 27, 34
anthrax vaccines, 284–285
botulinum toxoid vaccines, 291–292
Occupational exposure, non-military, 74–75, 80
anthrax vaccines, 272, 282
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botulinum toxoid vaccines, 16, 288
multiple vaccinations, 17
organophosphates, 188, 191, 199
phosphate fertilizer production workers, 112, 114–115, 130, 132, 152
sarin, 188, 191
uranium miners/processors, viii, 3, 6–7, 19, 21, 71, 89, 98, 106, 107–121, 122, 123–152, 154–159, 340–341
age factors, 116–117, 119, 121, 128, 134–135, 138, 149
bone cancer, 19, 109, 143, 146, 159
cardiovascular effects, 108–109, 126, 158, 160
cancer, general, 6–7, 19, 114, 117–118, 126–127, 128, 131, 135
dermal effects, 158, 160
gastrointestinal effects, 156, 158, 160
gender factors, 117, 118, 119, 121, 149, 157
genitourinary effects, 119, 123, 124, 150
genotoxicity, 158, 160
hematological effects, 109, 157–158, 160
hepatic effects, 19, 108–109, 158
immunologic effects, 154, 156–157, 158, 160
lung cancer, 6–7, 19, 79, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159
lymphatic cancer, 19, 100, 123, 142–143, 144–145, 159
mortality, see “uranium workers” under Mortality
musculoskeletal effects, 123, 158, 160
neuropathy, 151–152, 160
ocular effects, 158, 160
race/ethnicity, 112, 113, 116, 119, 121
renal disease, 19, 115, 123, 147–151, 159
reproductive/developmental effects, 157, 158, 160
respiratory effects, 19, 108–109, 153–156, 159, 160;
see also “lung cancer” supra
socioeconomic status, 7, 117, 121, 138, 141
vaccines, 15, 16, 272, 282, 288, 294–295
Ocular effects, see Visual and ocular effects;
Visual evoked potential
Office of Technology Assessment, 30
Office of the Special Assistant for Gulf War Illnesses, 268
Oil well fires, 1, 27, 31, 33
OP-AChE bond, 9, 174–175, 177, 178, 180, 186, 210, 366
Oral delivery, see Ingestion
Ordnance, see Ammunition
Organophosphate-induced delayed neuropathy (OPIDN), 181–182, 183, 192, 196, 197, 212–213, 217, 218–219, 248, 249, 252, 328
Organophosphates, general, 1, 13, 28, 34, 53, 175, 182–183, 188, 213, 328, 330, 340, 369
acute effects of toxicity, 13, 213
age factors, 371–375
animal studies, 10
depression, 370
epidemiologic studies, 53, 366–377
fatigue, 367–375
genetic factors, 31, 53
neuropathy, 367–368, 371–375
organophosphate-induced delayed neuropathy (OPIDN), 181–182, 183, 192, 197, 213, 217, 218, 248, 249, 252, 328
occupational exposure, non-military, 188, 191, 199
organophosphate binding (OP-AChE), 9, 174–175, 177, 178, 180, 186, 208, 210, 366
psychological effects, 367–375
sexual function, 370
smoking and, 371
see also Cyclosarin;
Pyridostigmine bromide;
Sarin
P
Pain, 48, 49
animal studies, 72
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anthrax vaccines, 281–282, 284, 285, 286
botulinum toxoid vaccines, 288, 292, 293, 294
chest, 42, 171
muscle and joint, 27, 39, 40, 42, 45, 46, 48, 49, 72, 193. 194, 198, 281, 284, 285, 286, 288, 293–294, 350, 351, 354, 355
pyridostigmine bromide (PB), 11, 12, 236
registry data, 40, 41, 42
sarin, 10, 171, 171, 193, 194, 198
uranium, 151, 156
see also Cramps;
Headaches;
Nausea and vomiting
Paints, 1, 27, 34
Paraoxonase/arylesterase 1 (PON1), 221–222, 250, 328, 329
PB, see Pyridostigmine bromide
PB-AChE bond, 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 235, 241, 244–245
Peer review
anthrax vaccines, 15, 280, 286, 287, 312, 313
botulinum toxoid vaccines, 291
committee study methodology, 3, 18, 35, 61(n.26), 70
sarin, 173
uranium, 94
PEP, see Primate equilibrium platform
Peripheral nervous system, 50
pyridostigmine bromide (PB), 213, 247
sarin, 170
squalene, 308
uranium, 151
Peripheral vascular resistance, 228–229
Persian Gulf Registry and Uniform Protocol, 40
Persian Gulf War Veterans Act, 2, 28
Perspiration
pyridostigmine bromide (PB), 11, 12, 225
sarin, 171
see also Thermoregulation
Pesticides, see Insecticides and insect repellants
Petroleum and petrochemical products, 1, 14, 27–28, 30, 34, 48
oil well fires, 1, 27
Pharmacodynamics, pyridostigmine bromide (PB), 217–219, 230, 244
Pharmacokinetics
pyridostigmine bromide (PB), 244
uranium, 94–99
Phosphate fertilizers, worker exposure, 112, 114–115, 130, 131, 132, 148, 152, 159
Pituitary gland, see Hypothalamic-pituitary-adrenal processes
Plague vaccines, 295
Polio virus, 226
vaccines, 268, 296
POM, see Pro-opiomelanocortin
PON1, see Paraoxonase/arylesterase 1
Population-based studies, vii, 3–4, 6, 10, 13, 18, 21, 32, 35, 44–62, 70
see also Occupational exposures, military personnel;
Occupational exposures, nonmilitary;
Registry programs
Portsmouth Uranium Enrichment Facility, 115–116, 131, 132, 134, 145, 148, 152, 159
Posttraumatic stress disorder (PTSD), 342
diagnosis, 57, 58, 342
epidemiologic studies, 45, 46, 48, 49, 57–59, 62, 246
multiple vaccinations, 304, 305
pyridostigmine bromide (PB), 246
sarin, 10, 195–196, 198
Posturography, see Computerized posturography
Presidential Advisory Committee, 172
Primate equilibrium platform, sarin, 180
Prolactin (PL), 156, 157
Pro-opiomelanocortin (POM), 213
Protective antigen vaccines, 274, 276–277, 279–280, 281, 282
Psychological factors, 46
anxiety, 49, 57, 171, 196, 226, 350, 354
malaise,
anthrax vaccines, 15, 281, 283, 284, 285
botulinum toxoid vaccines, 288, 294
individual variability, 31
multiple vaccinations, 304
sarin, other, 171, 175, 180, 188, 197, 328
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see also Mental disorders;
Neuropsychological effects;
Posttraumatic stress disorder;
Stress, general
Psychomotor effects
depleted uranium, 103
dysarthria, 12, 223, 251
pyridostigmine (PB), 11, 12, 227, 223, 233, 240, 241, 242, 251
sarin, 10, 171, 175, 180, 196, 199
see also Convulsions;
Musculoskeletal effects
Public Law 103–446, 61
Pyrethroids, 34
Pyridostigmine bromide (PB), vii, viii, 1, 2, 3, 4, 8–9, 11–14, 19, 28, 34, 207–264, 330, 340
acetylcholine (ACh), 11, 12, 13, 207–216 (passim), 224, 227–228
Acetylcholinesterase (AChE), PB binding, 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 227–228, 232, 235, 241, 244–245
acute effects, 214, 224, 234, 250–251
age factors, 227, 228, 236, 238, 242, 244, 246–247
animal studies, 209, 210–211, 213, 214, 215, 218–219, 220
brain, 11, 207, 217, 219–220, 247
central nervous system, general, 12, 213, 217, 219–220, 223, 224, 226, 235, 240, 241, 247, 251
chronic effects, general, 13, 14, 214–215, 252–253
clinical studies, 12, 19, 209, 222–231, 249, 329
cognitive effects, general, 53, 224, 227, 233–235, 236, 242–243, 246, 247–248
cramps, 11, 12, 214, 223, 226, 251
dermal tissue, 215
depression, 233, 245
diagnosis of effects, 12, 223
dose factors, 11, 12, 14, 208–209, 210–211, 214, 215, 218, 219, 223–238 (passim), 247–248, 251, 252, 329
dysarthria, 12, 223, 251
epidemiological studies, 13–14, 21, 48, 71, 209, 245–250, 252, 329
fatigue, 211, 226, 230, 233, 236, 245, 329
FDA status, 11, 207, 208
gastrointestinal effects, 11, 12, 208. 209, 214, 223, 225–226, 230, 236, 242, 251
nausea and vomiting, 11, 12, 208, 214, 226, 245, 251
salivation, 11, 12, 208, 214, 225, 226, 242, 251
gender factors, 226, 231, 239, 244
genetic factors, 21, 220–222, 244–245, 328, 329
genitourinary system and urinalysis, 12, 208, 225–226
growth hormone, 12, 209, 220, 222–224, 251, 334
headaches, 236
hematologic effects, 11, 208, 210, 211–212, 244–245, 244
hepatic effects, 210
historical perspectives, 207, 225
hypothalamic-pituitary-adrenal processes, 209, 220, 223, 250–251
ingestion, 11, 12, 207–209, 210–211, 214, 223, 225, 234, 236, 237, 238, 240, 251
injection, 11, 207, 231, 236–237
interactions, chemical, 187, 209, 217–220, 229–230, 235, 248, 328, 328, 330, 334
lungs, 231, 237
mood disorders, 246
myasthenia gravis, 3, 11, 12, 70, 71, 207, 208, 209, 224–225, 227–228, 230, 231, 250–251
nausea and vomiting, 11, 12, 208, 214, 226, 245, 251
neuromuscular effects, 11, 12, 211–213, 220–221, 223, 226, 230, 232–233, 246, 248, 251
neuropathy, general, 11, 12, 13, 53, 219–220, 247–249, 252, 328
nicotinic effects, 11, 208, 211, 223, 226, 230, 237, 240, 251
pain, 11, 12, 236
peripheral nervous system, 213, 247
perspiration, 11, 12, 225
pharmacodynamics, 217–219, 230, 244
posttraumatic stress disorder, 246
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psychological effects, 13, 213–214, 227, 233–235, 236, 242–244, 252
psychomotor effects, 11, 12, 227, 223, 233, 240, 241, 242, 251
rashes, 215, 225
red blood cells, 210, 211–212, 244–245
renal effects, 11, 208, 210
reproductive effects, 215, 226
research methodology, issues, 6–7, 11, 13, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159, 231, 237
research recommendations, 21, 328–329
respiratory effects, 11, 12, 208, 214, 215, 221, 225, 230–231, 235, 236–237
salivation, 11, 12, 208, 214, 225, 226, 242, 251
sleep disturbance, 226
stress, general, 226, 243–244, 328
thermoregulation, 216–217, 237–240
perspiration, 11, 12, 225
veterans, studies of Gulf War veterans, 209, 225–226, 245, 246–250, 252
visual and ocular effects, 11, 12, 208, 225, 233, 240–242, 248, 249
R
Rabies vaccines, 295
Racial and ethnic factors, 41, 43, 60, 74
phosphate fertilizer production workers, 115
uranium workers, 112, 113, 116, 119, 121
Radiation effects, 48, 49
see also Depleted uranium;
Uranium
Rank of personnel, 41, 305
Rashes, 1, 27, 51, 52, 351
anthrax vaccines, 284, 285
pyridostigmine bromide (PB), 215, 225
registry data, 39, 40, 42
Receptor-mediated actions
anthrax vaccines, 275
botulinum toxoid vaccines, 289
organophosphate binding (OP-AChE), 9, 174–175, 177, 178, 180, 186, 210, 366
pyridostigmine bromide binding (PB-AChE), 9, 11, 13, 53, 208, 210–213 (passim), 215, 217, 220, 223, 235, 241, 244–245
sarin, 9, 169–170, 175, 176
uranium, 96
see also Nicotinic effects;
terms listed under Cholinergic effects
Recordkeeping, viii–ix, 55(n.17), 61–62
anthrax vaccines, 284
botulinum toxoid vaccines, 268
phosphate fertilizer production workers, exposure, 130
uranium workers, exposure, 124
vaccines, 21, 268, 269, 270, 284, 330
Red blood cells (RBCs)
pyridostigmine bromide (PB), 210, 211–212, 244–245
sarin, 177, 178, 190, 191
uranium, 96
Registry programs, 39, 40–43, 58, 77, 357, 358, 368
uranium, 94, 99, 106, 114, 149
Regulatory factors
uranium, 90, 92
vaccines, 294
see also Food and Drug Administration;
Legislation
Renal effects
depleted uranium, 7–8, 99, 150
pyridostigmine bromide (PB), 11, 208, 210
sarin, 177
uranium, 7–8, 19, 72, 97, 99, 100, 101–102, 115, 123, 147–151, 159
see also Genitourinary system and urinalysis
Reproductive system, 52, 56–57, 61(n.25)
anthrax vaccines, 226
birth defects, 56–57, 61(n.25), 62, 104–105
depleted uranium, 8, 19, 104–105, 157
pyridostigmine bromide (PB), 215, 226
sarin, 186, 187, 197
sexual functioning, 48, 49, 197, 370
uranium, 104–105, 157, 158, 160
Research methodology, viii–ix, 69–85, 334, 335, 342–365
clinical case definitions, 43–44, 54, 343–361
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committee study, viii, 2–5, 18, 28, 32, 34–35, 40, 69–71, 78, 325, 339–341
disease classification, 342–365
dose factors, 4, 18, 78
evidence, assessment criteria, 4–5, 18–19, 78–81, 82–84
exposure, 69–70, 123–125
posttraumatic stress disorder, 58
pyridostigmine bromide (PB), 6–7, 11, 13, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159, 231, 237
sarin, 173
uranium effects, 123–128, 153, 159
vaccine studies, 269–271
see also Animal studies;
Clinical studies;
Cohort studies;
Epidemiology;
Peer review;
Recordkeeping;
Statistical techniques
Research recommendations, 20, 325–330
anthrax vaccines, 21, 330
botulinum toxoid vaccines, 21, 330
depleted uranium, 21, 326–327
genetic factors, 21, 328, 329
interactions, chemical, 21, 325, 328
pyridostigmine bromide, 21, 328–329
sarin, 21, 327–328
vaccines, 21, 329–330
Respiratory effects, 46, 49, 52, 351, 356
anthrax, 272(n.3), 276–277
anthrax vaccine, 282, 283
asthma, 45, 49, 215, 231, 236, 237
botulinum toxoid vaccines, 289
bronchi, 11, 12, 171, 208, 214, 215, 225, 230, 237
depleted uranium, 98
infections, 59
macrophages, respiratory, 154, 272, 275
pyridostigmine bromide (PB), 11, 12, 208, 214, 215, 221, 225, 230–231, 235, 236–237
sarin, 171, 173, 174, 179–180, 188, 190, 193, 194
shortness of breath, 42
uranium, 19, 94–96, 97–98, 99, 100, 108–109, 153–156, 159
lung cancer, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159
lungs, other, 96, 97–98, 99, 100, 108–109, 114, 117, 121, 123, 154–156
see also Inhalation;
Lung cancer;
Lungs
Rheumatoid factor, 299–300, 302
Rubella, see Measles-mumps-rubella
S
Salivation
pyridostigmine bromide (PB), 11, 12, 208, 214, 225, 226, 242, 251
sarin, 171
Sand, 1, 27, 33, 34
Sarin, vii, 2, 4, 8–10, 28, 169–204, 340
acetylcholine (ACh), 18, 19, 21, 169–170, 175, 176, 188, 192, 198
acetylcholinesterase (AChE), 9–10, 21, 169–170, 174–175, 176, 177, 178, 180, 186, 187, 190, 194–195
acute effects, 9, 18, 19, 21, 180, 188, 193–194, 199, 328
animal studies, 10, 175–176, 177, 178–187, 288
antidotes, 170, 179
brain, 10, 175–176, 177, 180, 181, 182, 186–187, 191, 195, 196, 199
central nervous system, general, 170, 171, 176–177, 182, 191, 195, 196, 327
chronic effects, general, 183, 188, 191–192, 193, 198
cognitive effects, general, 171, 181, 197
convulsions, 10, 170, 175, 176, 179, 188, 192, 193
cramps, 171
dermal exposure, 8, 169, 176
developmental effects, 186, 187
dose factors, 9, 10, 18, 19, 173, 176, 178–183, 186, 188, 192, 199, 288, 327
edema, 171
exposure, general, 9, 18, 19, 31, 170–173, 178, 182–183, 188
terrorist attacks, viii, 3, 10, 70, 177–178, 188
fatigue, 171, 189, 193, 194, 195, 198, 199, 327, 328
gastrointestinal effects, 171, 180
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gender factors, 196, 197
genetic factors, 21, 53, 183, 187, 197–198, 328
genitourinary system and urinalysis, 171, 177–178
headaches, 10, 171, 193, 194, 198
hematologic effects, 177, 178, 188, 190, 191, 192, 194–195
hepatic effects, 177
historical perspectives, 8, 191
Japan, terrorist attack, 3, 10, 177–178, 188, 191–196, 199
hospitalizations, 188, 189–190, 193–195
ingestion, 176
inhalation, 169, 174, 176, 189
Japan, terrorist attack, 3, 10, 177–178, 188, 191–196, 199
injection, 176, 186, 189
insecticides and, 8, 10, 188, 328
interactions, chemical, 181, 187, 328
insecticides and, 8, 10, 188, 328
lungs, 171, 174
memory loss, 171
mood disorders, 195, 197, 199
mortality, 179, 188, 190
nausea and vomiting, 171
neuromuscular effects, 9, 10, 171, 173, 179–180, 187, 190, 193, 194, 197, 327
neuropathy, 9–10, 175–176, 180–185, 186–187, 190, 192, 193, 194, 197, 327–328
convulsions, 10, 170, 175, 176, 179, 188, 192, 193
nicotinic effects, 170, 171, 175
pain, 10, 171, 171, 193, 194, 198;
see also “headaches” supra
peripheral nervous system, 170
perspiration, 171
posttraumatic stress disorder, 10, 195–196, 198
posturography, 10, 196, 199
psychological effects, 171, 175, 180, 188, 195, 195, 197, 328
psychomotor effects, 10, 171, 175, 180, 196, 199
receptor-mediated actions, general, 9, 169–170, 175, 176
red blood cells, 177, 178, 190, 191
renal effects, 177
reproductive system effects, 186, 187, 197
research recommendations, 21, 327–328
respiratory effects, 171, 173, 174, 179–180, 188, 190, 193, 194
salivation, 171
sexual functioning, 197
sleep disturbance, 10, 171, 191, 194, 195, 199
stress, general, 176
terrorists attacks, viii, 3, 10, 70, 177–178, 188
toxicokinetics, 176–178
veterans, studies of Gulf War veterans, 172–174, 187–190, 196–197
visual and ocular effects, 10, 195, 196, 199, 171, 173, 174, 175, 188, 192, 193, 194, 195, 196, 199, 327
see also Cyclosarin;
Pyridostigmine bromide
Serotonin, 176
Sex-based differences, see Gender factors
Sexual functioning, 48, 49
organophosphate pesticides, 370
sarin, 197
Skeletal effects, see Musculoskeletal effects
Skin, see Dermal exposure;
Dermal tissue, other;
Injection delivery;
Perspiration;
Rashes
SLE, see Systemic lupus erythematosus
Sleep disturbance, 52, 351, 355
pyridostigmine bromide, 226
registry data, 42
sarin, 10, 171, 191, 194, 195, 199
Smoke, 1, 27–28, 33–34, 48
depleted uranium, 6, 93
oil well fires, 1, 27, 31, 33
Smoking, tobacco, 75, 81
organophosphate pesticides, 371
sarin exposure and difficulty in, 194
uranium miners/processors, 6, 7, 107, 108, 114, 120, 121, 127, 130, 135, 137, 138, 139, 141–142, 154, 156, 159
Social factors
disease classification, 343, 348, 349
individual variability, 31
living conditions, 33, 35
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Social Security Administration, 114–115, 116, 119
Socioeconomic status
organophosphate pesticides, 371
uranium workers, 7, 117, 121, 138, 141
Solvents, 1, 27, 34, 48
Soviet Union, 281
Special Immunization Safety Study, 284–285
Speech, see Dysarthria
Squalene, 268, 280, 307–312, 340
Statistical techniques, 4, 7, 8, 55(n.12), 79, 82
aggregation of data, 44
clinical classifications, 347
factor analysis, 44, 52, 53–54, 246, 347
uranium effects, 125–127, 159
vaccine studies, 270–271
see also Epidemiology;
Multivariate analysis
Stool, see Feces
Stress, general, 1, 21, 28, 35, 46, 49, 51, 57–59, 334
living conditions, 33, 35
multiple vaccinations, 305
pyridostigmine bromide, 226, 243–244, 328
sarin and, 176
see also Posttraumatic stress disorder
Subcutaneous drug delivery, see Injection delivery
Sweating, see Perspiration
Swelling, see Edema;
Inflammation
Symptom clustering, 43, 44, 48, 49, 50–51, 349
multisymptom illness, 17, 51, 54, 154, 303–306, 342–365
Systemic lupus erythematosus, 157, 284, 311
T
Tanks, military assault vehicles
depleted uranium, 5, 92–94
Tantalum (Ta), 98–99, 100, 101, 103
Tennessee Eastman Corporation, Oak Ridge plant uranium processing workers, 7, 118–121, 122, 123, 131–148 (passim), 152, 159
Terrorist attacks, sarin, viii, 3, 10, 70, 177–178, 188
Testicular cancer, 60
Thermoregulation, 33, 216–217, 235, 237–240
see also Perspiration
Tobacco use, see Smoking
Tokyo, Japan, see Sarin
Toxicokinetics
anthrax vaccines, 275
antigens, general, 271–272, 273
botulinum toxoid vaccines, 289–291
genetic factors, 31, 63
multiple vaccines, 296–299
organophosphates, 31
pyridostigmine bromide (PB), 210
sarin, 176–178
uranium, 94–99, 327
see also Pharmacokinetics
Toxicological Profile for Uranium, 94
Trauma, injury, see Injuries
Tri-o-cresyl phosphate (TOCP), 182
Tripler Army Medical Center Survey, 286
Tumor necrosis factor (TNF), 275
Typhoid vaccines, 295, 301
U
Union Carbide, Oak Ridge plant uranium processing workers, 7, 118–121, 122, 131–148 (passim), 152, 159
United Kingdom, personnel, 39, 45, 46, 50–51, 356, 357, 358
anthrax vaccines, 274, 281
birth defects, 56–57
multiple vaccines, 303–305, 314
pyridostigmine bromide (PB), 250, 252
registry program, 41
sarin, 190
United Nations Special Commission on Iraq, 9, 172, 268
United Nuclear Corporation, 111, 114
Uranium, 90–167
acute effects, 99
animal studies, 21, 96, 97–98, 99–106, 107, 151, 159, 327
antibodies, 152, 156–157, 312
cancer, 113, 117–118, 121, 123, 128–142, 159
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cardiovascular effects, 8, 19, 96, 100, 105, 108–109, 126, 158, 160
case-control studies, 108, 121, 127, 138
central nervous system, general, 99, 102, 103
chronic effects, general, 100, 102–103
cohort studies, 112–114, 115–121, 122, 123–149, 151–152, 154–157, 158, 159
cramps, 151
Department of Energy (DOE), 116, 117
dermal effects, 19, 105, 158
dermal exposure, 96, 151, 156
developmental effects, 8, 19, 104–105, 157, 158
dose factors, 7, 90, 91, 103, 108, 115–116, 117–118, 120, 121, 123, 125, 128, 130, 135–140, 141, 142, 159
exposure, general,
depleted uranium, 6, 31, 92, 93–94, 326
occupational exposure, see also “uranium miners/processors” under Occupational exposure, nonmilitary
gastrointestinal effects, 8, 19, 104, 156, 158, 160
genetic factors, 8, 19, 100–101, 157, 158
genitourinary system and urinalysis, 97, 100–101, 119, 123, 124, 150
hematologic effects, 8, 19, 96, 97, 99, 105–106, 109, 157–158
hepatic effects, 19, 97, 100, 104, 108–109, 158
immune system, 8, 154, 156–157, 158
ingestion, 6, 93, 96, 98–99, 100, 105, 123, 147, 149–150, 151
inhalation, 93, 94–96, 97, 97–98, 99, 100, 105, 106, 115, 118–120, 121, 123, 142–143, 154, 156, 158
injection, 99, 144
interactions, chemical, 154, 159
lung cancer, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159
mood disorders, 109, 151
neuromuscular effects, 72, 105, 123, 158, 160
neuropathy, general, 19, 99, 102–103, 123, 151–153
occupational exposures, miners and processors, see also “uranium miners/processors” under Occupational exposure, non-military
pain, 151, 156
peripheral nervous system, 151
pharmacokinetics, 94–99
phosphate fertilizer production workers, 112, 114–115, 130, 132, 148, 152, 159
psychological effects, 151
registry programs, 94, 99, 106, 114, 149
regulatory issues, 90, 92;
see also Nuclear Regulatory Commission
renal effects, 7–8, 19, 72, 97, 99, 100, 101–102, 115, 123, 147–151, 159
reproductive system effects, 104–105, 157, 158, 160
research methodology issues, 123–128, 153, 159
respiratory system, 19, 94–96, 97–98, 99, 100, 108–109, 153–156, 159
lung cancer, 6–7, 19, 100, 108–109, 110, 113, 117–118, 121, 123, 128–142, 159
lungs, other, 96, 97–98, 99, 100, 108–109, 114, 117, 121, 123, 154–156
smoking tobacco, 6, 7, 75, 81, 107, 108, 114, 120, 121, 127, 130, 135, 137, 138, 141–142, 154, 156, 159
visual and ocular effects, 8, 105, 158
see also Depleted uranium
Urinary system, see Genitourinary system and urinalysis
U.S., Uranium Registry, 149
V
VA, see Department of Veterans Affairs
Vaccine Adverse Events Reporting System (VAERS), 269, 270, 284, 296
Vaccines, viii, 4, 14–18, 19, 49, 51, 267–324
acute effects, general, 270, 271
antibodies, adverse reactions, 17, 272, 298
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adjuvants, vaccines, 270, 271, 274, 276, 279, 280, 290
squalene, 268, 280, 307–312, 340
age factors, 302, 311–312
animal studies, 271, 272, 277–280, 297–299, 330
cardiovascular effects, general, 272
chronic effects, general, 17, 271, 287, 294, 198–199, 303, 304, 311, 312–314, 330
clinical studies, 15–17, 19, 270, 271, 282–283, 284–287, 291–294, 305, 306, 310–311, 333
cohort studies, 17, 274, 281, 291, 299, 300–303, 306, 314
dose factors, 272
genetic factors, 272, 273, 280, 290–291
hepatitis virus, 295, 296
herpes simplex virus, 310
historical perspectives, general, 267, 268, 294, 295, 300–303
HIV, 310
hormonal effects, 273
immune system response, 17, 271–272, 273, 278, 284, 288, 290, 296, 297, 298–299
influenza, 295, 310–311
insecticides and, 305
interactions, chemical, 272, 296, 330
insecticides and, 305
see also Multiple vaccinations
meningitis, 284, 295, 296
mortality, 302–303, 311
number of military doses delivered, 14, 267, 268, 269
occupational exposures, non-military, 15, 16, 272, 282, 288, 294–295
polio, 268, 296
recordkeeping, 21, 268, 269, 270, 284, 330
research methodology issues, 269–271
research recommendations, 21, 329–330
regulatory factors, 294;
see also Food and Drug Administration
squalene, 268, 280, 307–312, 340
surveillance and reporting, 269, 270
typhoid, 295, 301
veterans studies, Gulf War, 285, 286, 293, 299–300, 303–305, 311–312, 329, 330
visual and ocular effects, 286, 288(n.10), 294
yellow fever, 295, 296, 301
see also Anthrax vaccines;
Botulinum toxoid vaccines;
Centers for Disease Control and Prevention;
Multiple vaccinations
VAERS, see Vaccine Adverse Events Reporting System
Varicella vaccines, 295
VEP, see Visual evoked potential
Vestibular nerve, 52, 197, 327
Veterans Administration, see Department of Veterans Affairs
Veterans, studies of Gulf War veterans, 43–62, 325
anthrax vaccines, 285, 286, 293
botulinum toxoid vaccines, 285, 293
clinical definitions, 43–44, 54, 347–348, 349–361
Canadian, 39, 45, 46, 48–49, 285, 333, 358
Iowa Persian Gulf study, 45, 46, 48, 49, 52, 57, 60, 62, 358, 333, 358
multiple vaccinations, 299–300
multisymptom illness, 17, 51, 54, 154, 303–304
pyridostigmine bromide (PB), 209, 225–226, 245, 246–250, 252
sarin, 172–174, 187–190, 196–197
squalene, 311–312
United Kingdom, 39, 41, 45, 46, 50–51, 56–57, 190, 250, 252, 274, 281, 303–305, 314, 356, 357, 358
uranium, see Depleted uranium
vaccines, 285, 286, 293, 299–300, 303–305, 311–312, 329, 330
Veterans Programs Enhancement Act, 2, 28
Vietnam War
herbicides, 3, 29, 334
Vinyl chloride, 79
Visual and ocular effects
anthrax vaccines, 286
botulinum toxoid vaccines, 288(n.10), 294
miosis, 11, 12, 171, 174, 188, 208, 240, 241, 248, 249
pyridostigmine bromide (PB), 11, 12, 208, 225, 233, 240–242, 248, 249
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sand, 33
sarin, 10, 195, 196, 199, 327, 171, 173, 174, 175, 188, 192, 193, 194, 195, 196, 199, 327
uranium, 8, 105, 158
visual evoked potential (VEP),
pyridostigmine bromide (PB), 240, 248, 249
sarin, 10, 195, 196, 199, 327
Vomiting, see Nausea and vomiting
W
Weather, 33, 235, 243
Weight loss, 52, 245
White blood cells, see Lymphocytes
Women, see Gender factors
World Health Organization, 346, 360
Wounds, depleted uranium, 93, 102–103
Y
Yellow fever vaccines, 295, 296, 301
Representative terms from entire chapter:
anthrax vaccines
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