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El. knyga: Gulf War and Health: Volume 8: Update of Health Effects of Serving in the Gulf War

  • Formatas: 318 pages
  • Išleidimo metai: 25-Jun-2010
  • Leidėjas: National Academies Press
  • Kalba: eng
  • ISBN-13: 9780309157650
Kitos knygos pagal šią temą:
  • Formatas: 318 pages
  • Išleidimo metai: 25-Jun-2010
  • Leidėjas: National Academies Press
  • Kalba: eng
  • ISBN-13: 9780309157650
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For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the IOM is conducting an ongoing review of the evidence to determine veterans' long-term health problems and what might be causing those problems. The fourth volume in the series, released in 2006, summarizes the long-term health problems seen in Gulf War veterans. In 2008, the IOM began an update to look at existing health problems and identify possible new ones, considering evidence collected since the initial summary.





In this report, the IOM determines that Gulf War service causes post-traumatic stress disorder (PTSD) and that service is associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; alcohol and other substance abuse; and anxiety disorders and other psychiatric disorders. To ensure that our veterans receive the best possible care, now and in the future, the government should continue to monitor their health and conduct research to identify the best treatments to assist Gulf War veterans still suffering from persistent, unexplained illnesses.

Table of Contents



Front Matter SUMMARY 1 INTRODUCTION 2 CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE 3 MAJOR COHORT STUDIES 4 HEALTH OUTCOMES 5 CONCLUSIONS AND RECOMMENDATIONS APPENDIX A CHOLINESTERASE INHIBITORS AND MULITSYMPTOM ILLNESSES APPENDIX B COMMITTEE BIOGRAPHICAL SKETCHES INDEX
Preface ix
Acronyms xvii
Summary 1(10)
Charge to the Committee
2(1)
Committee's Approach
2(1)
Volume 4 Conclusions
3(1)
Considerations in Identifying and Evaluating the Literature
4(2)
Primary and Secondary Studies
4(1)
Categories of Association
5(1)
Major Cohort Studies
6(1)
Health Outcomes
6(1)
Quality of the Studies
7(2)
Recommendations
9(2)
1 Introduction
11(12)
Background
11(1)
The Gulf War Setting
12(3)
Deployment
13(1)
Living Conditions
13(1)
Environmental and Chemical Exposures
13(1)
Threat of Chemical and Biologic Warfare
14(1)
Charge to the Committee
15(1)
Committee's Approach to Its Charge
16(1)
Complexities in Resolving Gulf War and Health Issues
17(1)
Multiple Exposures and Chemical Interactions
17(1)
Limitations of Exposure Information
17(1)
Individual Variability
18(1)
Volume 4 Conclusions
18(2)
Organization of the Report
20(1)
References
20(3)
2 Considerations in Identifying and Evaluating the Literature
23(16)
Identification of the Literature
23(2)
Types of Evidence
25(3)
Epidemiologic Studies
25(1)
Associations in Epidemiologic Studies
25(2)
Inferring Causality
27(1)
Types of Epidemiologic Studies
28(3)
Cohort Studies
28(1)
Case-Control Studies
29(1)
Cross-Sectional Studies
30(1)
Standardized Mortality Studies
31(1)
Inclusion Criteria
31(2)
Methodologic Rigor
32(1)
Exposure Assessment
32(1)
Health Outcome Assessment
32(1)
Considerations in Assessing the Strength of Evidence
33(2)
Categories of Association
33(2)
Additional Considerations
35(1)
Bias
35(1)
Confounding
35(1)
Sampling Error
35(1)
Multiple Comparisons
36(1)
Limitations of Gulf War Veteran Studies
36(1)
References
36(3)
3 Major Cohort Studies
39(32)
General Limitations of Gulf War Cohort Studies and Derivative Studies
39(2)
Organization of this
Chapter
41(22)
Department of Veterans Affairs Study
45(4)
The Iowa Persian Gulf Study
49(2)
United Kingdom Veteran Studies
51(3)
Australian Veteran Studies
54(2)
Danish Peacekeeper Studies
56(1)
Oregon and Washington Veteran Studies
57(1)
Canadian Gulf War Veterans Study
58(1)
Kansas Veteran Study
58(1)
Fort Devens and New Orleans Cohort Studies
59(1)
Seabee Studies
60(2)
Pennsylvania Air National Guard Study
62(1)
Hawaii and Pennsylvania Active Duty and Reserve Study
62(1)
New Orleans Reservist Studies
63(1)
References
63(8)
4 Health Outcomes
71(184)
Organization of the
Chapter
71(2)
Cancer
73(10)
Summary of Volume 4
73(2)
Updated and Supplemental Literature
75(3)
Summary and Conclusions
78(5)
Diseases of the Blood and Blood-Forming Organs
83(6)
Updated and Supplemental Literature
83(2)
Summary and Conclusions
85(4)
Endocrine, Nutritional, and Metabolic Diseases
89(10)
Diabetes
89(2)
Thyroid Disease
91(1)
Obesity
92(1)
Hospitalization Studies
93(2)
Mortality Studies
95(1)
Summary and Conclusions
95(4)
Mental and Behavioral Disorders
99(16)
Summary of Volume 4
101(4)
Updated and Supplemental Literature
105(3)
Summary and Conclusion
108(7)
Neurocognitive and Neurobehavioral Outcomes
115(6)
Summary of Volume 4
115(1)
Updated and Supplemental Literature
116(2)
Summary and Conclusions
118(3)
Diseases of the Nervous System
121(14)
Peripheral Neuropathy and Myopathy
121(3)
Multiple Sclerosis
124(2)
Amyotrophic Lateral Sclerosis
126(3)
Other Neurodegenerative Diseases
129(1)
Other Neurological Outcomes
130(5)
Diseases of the Circulatory System
135(10)
Summary of Volume 4
135(1)
Updated and Supplemental Literature
136(4)
Summary and Conclusions
140(5)
Diseases of the Respiratory System
145(9)
Summary of Volume 4
145(2)
Updated and Supplemental Literature
147(2)
Summary and Conclusions
149(5)
Diseases of the Digestive System
154(10)
Summary of Volume 4
155(1)
Updated and Supplemental Epidemiologic Literature
156(3)
Summary and Conclusions
159(5)
Skin Diseases
164(5)
Summary of Volume 4
164(1)
Updated and Supplemental Literature
165(2)
Summary and Conclusions
167(2)
Diseases of the Musculoskeletal System
169(6)
Summary of Volume 4
169(1)
Updated and Supplemental Literature
170(1)
Summary and Conclusion
171(4)
Fibromyalgia and Chronic Widespread Pain
175(5)
Summary of Volume 4
175(1)
Updated and Supplemental Literature
176(2)
Summary and Conclusion
178(2)
Diseases of the Genitourinary System
180(9)
Genitourinary Outcomes
180(3)
Hospitalization for Genitourinary System Diseases
183(1)
Summary and Conclusions
184(5)
Adverse Reproductive and Perinatal Outcomes
189(15)
Birth Defects
189(4)
Adverse Pregnancy Outcomes
193(2)
Fertility
195(3)
Sexual Dysfunction
198(6)
Multisymptom Illnesses
204(17)
Factor Analyses and Surveys
204(3)
Hospitalization Studies
207(1)
Other Reports
208(2)
Summary and Conclusions
210(1)
Chronic Fatigue Syndrome
210(11)
External Causes of Mortality
221(7)
Summary of Volume 4
221(1)
Updated and Supplemental Literature
222(2)
Summary and Conclusions
224(4)
Female Veterans' Health
228(7)
Deployment Experiences
228(1)
Health Effects
229(2)
Mental Health Effects
231(1)
Military Sexual Assault and Harassment
232(1)
Hospitalization and Mortality
233(1)
Summary and Conclusions
234(1)
References
235(20)
5 Conclusions and Recommendations
255(10)
Quality of the Studies
258(1)
Possible Causes of Multisymptom Illness in Veterans
259(1)
The Path Forward
260(5)
APPENDIX A CHOLINESTERASE INHIBITORS AND MULTISYMPTOM ILLNESSES
265(20)
Exposures to Cholinesterase Inhibitors and Other Pesticides During the Gulf War
266(4)
Pesticides
266(4)
Long-Term Effects of Low Doses of Cholinesterase Inhibitors
270(1)
Studies in Gulf War Populations
271(4)
Animal Studies
275(1)
Genetic Susceptibility to Cholinesterase Inhibitors
276(2)
The Role of Cholinesterase Inhibitors and Pesticides in Multisymptom Illness
278(1)
References
279(6)
APPENDIX B COMMITTEE BIOGRAPHICAL SKETCHES
285(4)
Index 289