Adequacy of the Comprehensive Clinical Evaluation Program A Focused Assessment (1997) / Chapter Skim
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Appendix C
Appendix C
Pages 79-90
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From page 79... ...
Recommendations follow each of the findings. The committee was charged as follows: These findings and recommendations were taken from the Institute of Medicine report, Health Consequences of Service During the Persian Gulf War: Recommendations for Research and Information Systems, Washington, D.C.: National Academy Press, 1996.
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From page 80... ...
in this report regarding the collection and maintenance of information that is potentially useful for assessing the health consequences of military service in the POW. These recommendations support completion of certain data sets, prompt reporting of research findings and submission for publication in peerreviewed journals, strengthened medical and epidemiologic research capabilities of the armed forces, and strengthening the decision-making processes for study selection.
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From page 81... ...
FINDINGS AND RECOMMENDATIONS Finding Recent military deployments, especially in Vietnam and in the Persian Gulf, have demonstrated that concerns about the health consequences of participation in military action may arise long after deployment has ended and that the evaluation of those concerns and the provision of health care to affected personnel may present formidable challenges both to epidemiologists and to medical caregivers. Although some of these challenges can be attributed to the intrinsic difficulty of evaluating poorly understood clusters of events that were not among the expected consequences of combat or of environmental conditions, they also may be attributed in part to limitations of the systems used to collect and manage data regarding the health and service-related exposures of military personnel.
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From page 82... ...
, allow linkage to exposure and other data sets, and have the capability to incorporate relevant medical data from beyond DoD and DVA institutions (e.g., U.S. Public Health Service facilities, civilian medical providers, and other health care institutions)
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From page 83... ...
The DoD should ensure that military medical preparedness for deployments includes detailed attempts to monitor natural and man-made environmental exposures and to prepare for rapid response, early investigation, and accurate data collection, when possible, on physical and natural environmental exposures that are known or possible in the specific theater of operations. Finding National Guard and reserve component personnel may differ substantially from active duty personnel in average age, level of training, occupational specialties, family status, and readiness for deployment.
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From page 84... ...
The DVA should exert greater effort to improve understanding of the reasons for excess mortality from unintentional injury. Detailed evaluation is needed beyond death certificate data concerning the circumstances surrounding fatal injury through more focused case-control studies to identify both individual risk factors and remediable causes.
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From page 85... ...
The DoD should complete development of information systems to expeditiously and directly pinpoint unit locations at a high level of disaggregation in space and time (that is, fine detail) and to document local environmental conditions, including appropriate data quality checks, with direct data entry into the system.
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From page 86... ...
· The Naval Health Research Center at San Diego has undertaken a series of studies under the general title of "Epidemiologic Studies of Morbidity Among Gulf War Veterans: A Search for Etiologic Agents and Risk Factors." These studies hold promise for answering some important questions about the health of PGW veterans after demobilization and about the possibility that veterans and their spouses may experience an excess risk of adverse pregnancy outcomes as a result of service in the PGW. The studies are being carried out with care, excellent planning, and proper pilot efforts to determine feasibility.
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From page 87... ...
may provide useful information as to what objectively measurable factors contribute to selfselection into the registry. In addition to the proposed analysis of associations among demographics, past health experiences, and health behaviors as possible predictors of enrollment, information on the eligibility of individuals for health care, as well as the type of health care, could generate additional hypotheses to be investigated.
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From page 88... ...
The epidemiologic capabilities of the armed forces should be strengthened rather than reduced. The command structure should be kept informed about the reasons for and the results of this recommendation and its relevance to military preparedness and effectiveness, and should be encouraged to support appropriate epidemiologic work in the theater of operations and in the postdeployment period.
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From page 89... ...
The Congress, DVA, and DoD should adopt a policy that unless there are well-specified, openly stated reasons to the contrary, requests for proposals for research related to unexplained illnesses or other needed health-related research will be publicly announced and open to the scientific community at large, that proposals will be reviewed by panels of appropriately qualified experts, and that funding will follow the recommendations of those experts.
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