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Australian Gulf War Veterans’ Health Study

1,57

211

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4574

Health Services Australia

2003

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Table of contents

Volume 1

Authors . 1

Table of contents . 2

Executive summary . 12

Introduction .12

Study aims .12

Methods .13

Recruitment, demographics and non-Gulf War exposures .13

Gulf War and other exposures 14

Summary of health findings .14

Strengths and limitations of the study .17

Recommendations .18

Acknowledgments 20

List of abbreviations 22

1. Introduction . 28

2. Australian involvement in the Gulf War . 29

2.1 The Gulf Region .29

2.2 Australian Deployment in the Gulf War 29

2.2.1 Damask I . 30

2.2.2 Damask II 30

2.2.3 Damask III. 31

2.2.4 Clearance Diving Team 3 31

2.2.5 Task Group Medical Support Elements on USNS Comfort 32

2.2.6 Operation Habitat 33

2.2.7 The United Nations Special Commission (UNSCOM). 33

2.2.8 Summary of ADF Deployments 33

2.2.8.1 Nominal Roll 34

3. Review of literature on exposures during the Gulf War . 39

3.1 Introduction .39

3.2 Smoke from oil well fires (SMOIL)40

3.2.1 Background . 40

3.2.2 Plume dispersal 41

3.2.3 SMOIL exposure measurements . 44

3.2.4 SMOIL exposure recall by veterans 46

3.3 Particulate matter .46

3.4 Psychological stressors .47

3.5 Immunisations and other prophylactic medications 48

3.6 Pyridostigmine bromide 50

3.7 Pesticide use 51

3.7.1 Insect repellent use 52

3.8 Biological and chemical weapons.53

3.9 Interactions between pesticides, PB and chemical warfare agents .56

3.10 Depleted uranium .56

3.11 Infectious disease agents .58

3.12 Other exposures .59

3.13 Multi-exposures and recall bias .60

3.14 Summary .60

4. Review of health studies 63

4.1 Scope of review of health studies literature 63

4.2 History of Gulf War veterans’ health research.63

4.3 Symptoms 71

4.4 Factor analysis .73

4.5 Medical conditions .76

4.6 Demographics and lifestyle factors 77

4.7 Psychological health .78

4.8 Respiratory health 80

4.9 Infectious diseases .84

4.10 Immunisations 86

4.11 Chronic fatigue and immunological markers .87

4.12 Neurological symptoms .89

4.13 Musculoskeletal .92

4.14 Skin 93

4.15 Gastrointestinal conditions 94

4.16 DU related health problems .95

4.17 Reproductive outcomes .95

4.18 Cancer .96

4.19 Hospitalisations, medical care utilisation due to illness, functional impairment and limitation of

work .97

4.20 Mortality .99

4.21 Self-referral evaluation programs. 100

4.22 Summary . 103

5. Cross-sectional study methods 107

5.1 Aims and objectives 107

5.2 Study design 107

5.3 Study population 108

5.3.1 Definition of the Gulf War veteran group . 108

5.3.2 Definition of the comparison group 108

5.4 Sample size 109

5.4.1 Gulf War veteran group. 109

5.4.2 Comparison group . 109

5.5 Contact strategy and recruitment procedures . 110

5.5.1 DVA-based Contact and Recruitment team 110

5.5.2 Contact procedures 110

5.5.3 Methods to maximise participation . 111

5.5.4 Participation options 112

5.5.5 Telephone-questionnaire option 112

5.5.6 Administration of appointments for medical assessments 112

5.6 Data collection instrumentation and measures . 113

5.6.1 Postal self-administered questionnaire 114

5.6.1.1 Demographic information 115

5.6.1.2 Exposure assessment 115

5.6.1.2.1 History of military service postings 116

5.6.1.2.2 Gulf War deployment history and specific exposures 117

5.6.1.2.3 Active (war or peacekeeping) deployment history and deployment exposures 118

5.6.1.2.4 Military Service Experience questionnaire. 119

5.6.1.2.5 Civilian occupational history 120

5.6.1.3 Health outcomes assessment 120

5.6.1.3.1 Short-Form-12 Health Survey (SF-12) . 120

5.6.1.3.2 Twelve item General Health Questionnaire (GHQ-12) 121

5.6.1.3.3 Symptom questionnaire 122

5.6.1.3.4 Neuropathic symptom questionnaire 122

5.6.1.3.5 Doctor diagnosed or treated medical conditions. 122

5.6.1.3.6 General medical history 123

Hospitalisation 123

Functional impairment due to illness or injury . 123

Current use of medication. 123

Family history . 123

5.6.1.3.7 Cigarette smoking and tobacco use. 123

5.6.1.3.8 Alcohol consumption 123

5.6.1.3.9 Posttraumatic Stress Disorder Checklist – S (PCL-S) 124

5.6.1.3.10 Reproductive health outcomes 124

5.6.1.4 Nomination of a medical practitioner to receive a copy of their medical report 125

5.6.2 Medical assessment . 125

5.6.2.1 Nurse-administered data collection 125

5.6.2.1.1 Informed Consent . 126

5.6.2.1.2 Standardised measurement of height, weight, hip and waist circumference 126

Body mass index. 127

Waist circumference and waist-to-hip ratio 127

5.6.2.1.3 Blood pressure 127

5.6.2.1.4 Visual acuity . 128

5.6.2.1.5 Symptoms of tiredness or fatigue . 128

5.6.2.1.6 Spirometry 129

5.6.2.1.7 Skin prick testing for common allergens 130

5.6.2.1.8 Respiratory Health Questionnaire. 130

5.6.2.1.9 Laboratory investigations and pathology service . 131

Laboratory investigations . 131

Storage of samples for later analysis (overview) 131

Storage of samples for possible analysis within 12 months . 132

Indefinite storage of a serum sample 133

Pathology service 133

5.6.2.1.10 Urinalysis 133

5.6.2.2 Psychologist’s assessment 133

5.6.2.2.1 Psychological assessment procedure 134

5.6.2.2.2 Modifications to the posttraumatic stress disorder module 135

5.6.2.3 Medical examination 135

5.6.2.3.1 Physical examination 136

5.6.2.3.2 Assessment of symptoms of extreme tiredness or fatigue 137

Lymphocyte subsets 139

5.6.2.3.3 Review of the doctor diagnosed or treated medical conditions section of the postal

questionnaire 139

5.6.2.3.4 General health questions and additional findings . 140

5.6.2.3.5 Fitness test. 140

5.6.2.3.6 Feedback to Participants . 141

5.6.3 Telephone questionnaire participants 141

5.6.4 Consistency and validation measures and other sources of data. 141