TABLE OF CONTENTS
INTRODUCTION
This Appendix lists individual ongoing research activities undertaken by the Department of Veterans Affairs (VA), the Department of Defense (DoD), and the Department of Health and Human Services (HHS). Each entry provides information on current results for that activity. Information on results includes: manuscripts/reports in preparation or submitted for publication; manuscripts/reports accepted for publication in scientifically peer reviewed journals but still in press; manuscripts published in scientifically peer reviewed journals; and U.S. Government reports that have been cleared by the appropriate agency. In cases where there are published manuscripts, the appropriate citations are given. Results from studies submitted for peer-review but currently unpublished are not provided in order to avoid compromising the scientific peer review process. When U.S. Government reports are listed, the exact citation is provided.
DEPARTMENT OF VETERANS AFFAIRS
The Department of Veterans Affairs (VA) research efforts examining the health
of Persian Gulf veterans include epidemiological studies, and intramural and
cooperative research. Specific research projects are listed
below:
A. Epidemiology
VA-1 Follow-up Mortality Study of Persian Gulf Veterans
Action: VA Environmental Epidemiology Service (EES).
Purpose: Because of recurring and persistent questions about the mortality experience of Persian Gulf veterans, a mortality follow-up study is planned. The mortality experience of all 697,000 Persian Gulf veterans on the Defense Manpower Data Center (DMDC) file will be compared to a matched sample of Persian Gulf-era veterans who did not serve in the Persian Gulf. Cause-specific mortality for both veterans groups also will be compared to the number of deaths expected in the U.S. civilian population.
Status: Ongoing. Vital status determinations and death record gathering efforts have been initiated. Data collection should be completed by the end of September 1995.
Results: A final report should be available for submission to a leading scientific journal for publication by November 1995.
Coordination: VA and DoD.
VA-2 National Health Survey of Persian Gulf Veterans and Their Family Members
Action: VA Environmental Epidemiology Service (EES).
Purpose: A random survey of 15,000 Reserve/National Guard veterans and active duty personnel who served in the Persian Gulf is being planned by the VA in collaboration with DoD and HHS. This mail/telephone survey will be designed to determine the prevalence of symptomatology experienced by veterans after their service in the Persian Gulf, and the current health status of veterans and their family members. This Persian Gulf war cohort will be compared to a matched group of 15,000 veterans and military members who served in the same era but who were not deployed to the Persian Gulf (Phase I). Selected self-reported data collected by the postal questionnaire will be validated through records review for 1,00 veterans from each group (Phase II). Lastly, a representative sample of eligible respondents will be invited to undergo a physical examination to clinically evaluate reported symptomatology (Phase III).
Status: Ongoing. The first phase of the study is planned to be completed by the end of June 1996. The second phase is expected to be completed by June 1997, and the third phase is expected to be completed by the June 1998.
Results: Preliminary results are expected at the completion of each phase, with final results expected at the completion of Phase III.
Coordination: VA, DoD, and HHS.
VA-3 Use of Roster of Veterans Who Served in Persian Gulf Area
Action: VA, Environmental Epidemiology Service (EES), Environmental Support Group (ESG), and Defense Manpower Data Center (DMDC).
Purpose: To properly address the issue of possible exposure to environmental hazards, all individuals who served in the Persian Gulf region need to be identified. To this end, the Defense Manpower Data Center (DMDC) has prepared a computer file of over 697,000 troops assigned to the Persian Gulf area during Operation Desert Shield/Desert Storm. This database has been made available to VA's Environmental Epidemiology Service, giving VA access to demographic data on all troops stationed in the Persian Gulf.
Status: Ongoing. The ESG is in the process of computerizing troop unit locations in the Persian Gulf theater. The data file has been used by EES in its reviews of the Persian Gulf Veterans Health Registry and the VA Patient Treatment File, and for the planning of a mortality follow-up study of Persian Gulf veterans.
Results: Troop unit locations should be available by the end of 1995.
Coordination: VA and DoD.
B. Environmental Hazards Research Centers
In support of research on the health consequences of exposure to environmental hazards during the Persian Gulf War, VA has established three hospital-based research centers to study military and civilian exposure to environmental and occupational hazards, including psychological stress. The three centers, which were chosen in August 1994 and funded beginning October, 1994, are located at: VA Medical Center East Orange, NJ, VA Medical Center Portland, OR, and VA Medical Center Boston, MA.
VA-4 Boston Environmental Hazards Research Center
Action: VAMC Boston, MA
Purpose: The Boston Environmental Hazards Research Center, in conjunction with Boston University, is conducting six Persian Gulf-related research projects aimed at determining health effects of environmental exposure to potential hazardous agents, with a particular emphasis on behavioral toxicology, immunotoxicology, cancer epidemiology, and behavioral psychopathology. This interdisciplinary work will extend current Persian Gulf-related research at the Boston VA Medical Center that includes assessment of health, psychological well-being, and neuropsychological function. Data shared among projects will allow investigators to examine such hypotheses as whether performance on psychological tests can be related to immune function, and the relation between pulmonary test results and health symptom complaints. One project will examine the possible relationship between the experience of multiple symptom-based health complaints and such clinical phenomena as chemical sensitivities, chronic fatigue syndrome, organic brain syndromes resulting from toxicant exposures, post-traumatic stress disorder (PTSD), and somatization disorders. Other studies will investigate the central and peripheral nervous system in a group of veterans with possible environmentally related disorders, while another will assess pulmonary and immune system function in the same study cohort. Additional approaches at the Boston Environmental Hazards Research Center will seek validation of neurobehavioral tests, a rodent study of immunologic changes thought to be related to petroleum products, a registry of cancer incidence among Persian Gulf veterans, and a study of cellular receptors as a susceptibility biomarker for polycyclic aromatic hydrocarbon (a component of incomplete petroleum combustion) exposure.
Status: Ongoing. All projects at the Boston Environmental Hazards Research Center are due to be completed by September 1999.
Results: Results from individual projects are expected as individual projects are completed.
Coordination: VA, DoD, and HHS.
VA-5 New Jersey Environmental Hazards Research Center
Action: VAMC East Orange, NJ
Purpose: The New Jersey Environmental Hazards Research Center at the East Orange VA Medical Center, in conjunction with the UMDNJ - New Jersey Medical School, is undertaking four projects to gather information about illnesses among Persian Gulf veterans for development of the most characteristic symptom profiles. An epidemiological study will compare two groups of Persian Gulf veterans to collect and organize symptoms to define illness and identify risk factors through the case-control method. Study subjects will be divided into three groups based on symptom presentation-- chronic fatigue, chemical sensitivity, and asymptomatic -- to participate in a series of studies in such areas as viral, immunological, neuropsychological and autonomic neural function. One project will examine chemical sensitivity through physiologic and cognitive reactivity to chemical challenges. Those fulfilling chronic fatigue criteria will be tested to determine physiologic and cognitive reactivity to exercise. An animal study will evaluate psychosomatic interactions with chemical exposure and pyridostigmine bromide.
Status: Ongoing. All projects at the East Orange Environmental Hazards Research Center are due to be completed by September 1999.
Results: Results from individual projects are expected as individual projects are completed.
Coordination: VA, DoD, and HHS.
VA-6 Portland Environmental Hazards Research Center
Action: VAMC Portland, OR
Purpose: The Portland, OR, VA Medical Center, in conjunction with Oregon Health Sciences University's Center for Research on Occupational and Environmental Toxicology, is sponsoring an environmental hazards research center to examine, in four projects, health effects associated with exposure to selected environmental chemical hazards and biological hazards related to military service. The center will identify exposures through intensive interviews and study risk factors for unexplained illnesses through a case-control epidemiological study. The center also will screen veterans for medical, chemical, and biological markers of exposure and disease, and act as a repository for data collection and analysis. Scientists from the VA medical center and university research center will work together to explore, at the whole organ and at the molecular level, key scientific issues involving epidemiology, neurobehavior, neuroendocrinology, neurotoxicology, dermatology and parasitology. Researchers hope to define more accurately relationships between illnesses in Persian Gulf veterans and post-traumatic stress disorder, or specific environmental, infectious and warfare chemical exposures. Researchers plan to estimate future risks of developing symptoms in the population of exposed veterans and to begin devising appropriate treatments and intervention.
Status: Ongoing. All projects at the Portland Environmental Hazards Research Center are due to be completed by September 1999.
Results: Results from individual projects are expected as individual projects are completed.
Coordination: VA, DoD, and HHS.
C. Psychological and Neurological Research
VA-7 Desert Storm Reunion Survey
Action: VAMC Boston, MA
Purpose: In Phase I, this study identified a broad range of combat and non-combat experiences associated with deployment during Operation Desert Storm. The study offers precise delineation and quantification of those experiences (including nontraditional deployment events) as well as a determination of their impact on subsequent patterns of adjustment. Both men and women are included in the sample.
Status: Ongoing. Original funding for this project expires September 1995. Funding for the continued follow-up of this cohort has been granted by the Boston Environmental Hazards Center.
Results: Manuscripts published.
Wolfe J, Brown PJ, Kelley JM. 1993. Reassessing War Stress: Exposure and the Persian Gulf War. Journal of Social Issues, 49 (4):15-31.
Wolfe J, Keane TM, Young B. From soldier to civilian: Acute adjustment patterns of returned Persian Gulf veterans. In Ursano RJ, Norwood AE (Eds.), Those left behind: Psychological responses to war in families, children, and soldiers. Washington, DC: American Psychiatric Press.
Wolfe J, Kelley J, Bucsela M, Mark W. 1992. Fort Devens Reunion Survey: report of Phase I. In Rosenheck R (Ed.), Returning Persian Gulf Troops: First Year Findings.
(pp. 19-44). VA Northeast Program Evaluation Center. West Haven, CT.
Coordination: VA, DoD and HHS.
VA-8 Initial Contact Interviews with Marine Reservists in Operations Desert Storm
Action: VAMC Mountain Home, TN
Purpose: To provide a non-pathological model of early intervention, education, and support to Marine reservists by providing: (1) general information about normal reactions to combat/desert duty, (2) opportunities for group or individual discussion of experiences, (3) administration of standardized psychological questionnaires and instruments, and (4) information or referral regarding access to VA and other community services available for health/psychological/other related concerns.
Status: Ongoing. This project is expected to be completed August 1996.
Results: Manuscripts published.
Sloan P, Arsenault L, Hilsenroth M. Harvill L, Handler L. 1995. Rohrshach measures of post-traumatic stress in Persian Gulf War Veterans. Journal of Personality Assessment, 64:397-414.
Sloan P, Arsenault L, McCormick W, Dunn S, Scalf L. 1993. Early intervention with Appalachian Marine Reservists in Operation Desert Storm. National Center for Posttraumatic Stress Disorder Clinical Newsletter, p. 6.
Sloan P, Arsenault L, McCormick W, Dunn S, Scalf L. 1992. Initial contact interviews with Marine Reservists in Operation Desert Storm. In Rosenheck R, (Ed.), Returning Persian Gulf Troops: First Year Findings. (pp. 145-151). VA Northeast Program Evaluation Center. West Haven, CT.
Coordination: VA, DoD and HHS.
VA-9 Evaluation of Cognitive Functioning in Persian Gulf Veterans Reporting War-Related Health Problems
Action: VAMC New Orleans, LA
Purpose: To evaluate potential cognitive correlates of health complaints among veterans of the Persian Gulf War. Participants undergo a clinical diagnostic evaluation of psychological well-being, including standardized interview and self-report inventories. Neuropsychological functioning is assessed with a specialized battery, including tests evaluating relatively stable, premorbid cognitive/intellectual abilities and tests shown to have specificity and sensitivity for detecting changes in localized and diffuse cognitive brain functions.
Status: Ongoing. This project is expected to be completed in Fall 1995.
Results: Expected at the completion of the project.
Coordination: VAMC Boston, DoD and HHS.
VA-10 Memory and Attention in Post Traumatic Stress Disorder
Action: VAMC New Orleans, LA
Purpose: To provide in-depth evaluation of attention and memory dysfunction among two samples of veterans, veterans of the Vietnam War and veterans of the Persian Gulf War, suffering from Post Traumatic Stress Disorder. The protocol incorporates assessment of psychopathology and neuropsychological functioning among veterans with PTSD diagnoses, depression diagnoses, and those found to be free of psychopathology.
Status: Ongoing. This project is expected to be completed March 1998.
Results: Expected at the completion of the project.
Coordination: VA, DoD, and HHS.
VA-11 Neuropsychological Functioning in Veterans
Action: VAMC New Orleans, LA
Purpose: To investigate neuropsychological functioning, especially attention, learning, and memory processes, among Operation Desert Storm veterans, suffering PTSD and compare results with a sample of Operation Desert Storm veterans not suffering from PTSD. Participants undergo a clinical diagnostic evaluation, including self-report and interview questions that target PTSD symptomatology, substance abuse, and other psychopathology.
Status: Complete.
Results: Vasterling J, Root L, Brailey K, Uddo M, Sutker P. 1994. Attention and memory performances in post-traumatic stress disorder. Paper presented a the 22nd Annual Meeting of the International Neuropsychological Society, Cincinnati, OH.
Coordination: VA, DoD, and HHS.
VA-12 Psychological Assessment of Operation Desert Storm Returnees
Action: VAMC New Orleans, LA
Purpose: To conduct comprehensive psychological assessments and debriefing among troops mobilized in support of Operation Desert Storm, identify psychological, somatic, and cognitive symptoms and mental disorders -- both early and persistent -- associated with Persian Gulf war-zone exposure; and explore personal and environmental factors that may differentiate Persian Gulf-deployed troops exhibiting war-related psychopathology from troops found to be free of psychological disturbances.
Status: Ongoing. This project is expected to be completed in September 1997.
Results: Manuscripts published.
Sutker P, Uddo M, Brailey K, Allain A, Errera P. 1994. Psychological symptoms and psychiatric diagnoses in Operation Desert Storm troops serving graves registration duty. Journal of Traumatic Stress, 7:159-171.
Sutker P, Uddo M, Brailey K, Vasterling J, Errera P. 1994. Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties. Journal of Abnormal Psychology, 103(2):383-390.
Sutker P, Uddo M, Brailey K, Allain A. 1993. Warzone trauma and stress-related symptoms in Operation Desert Storm/Shield (ODS) returnees. Journal of Social Issues, 49(4):33-49.
Sutker P, Uddo M, Brailey K, Allain A. 1992. Operation Desert Shield/Storm Returnee Evaluation Debriefing, and Treatment Program Report. In Rosenheck (Ed.), Returning Persian Gulf Troops: First Year Findings. (pp. 45-68). VA Northeast Program Evaluation Center. West Haven, CT.
Coordination: VA, DoD, and HHS.
VA-13 Neurobehavioral Aspects of Persian Gulf Experience: A Pilot Study
Action: VAMC Pittsburgh (HD), PA
Purpose: The object of the study is to obtain neurobehavioral data from 50 veterans who participated in the Persian Gulf War. This project will study a group of veterans with known exposure or definitive evidence of toxicity to evaluate whether the exposed veterans demonstrate the same cognitive and physiological deficits found in victims of chronic organic solvent exposure. If results in this phase are positive, a second phase will be explored involving development of a screening assessment for individuals with reports of exposure.
Status: Ongoing. This project is expected to be completed by Fall of 1995.
Results: Expected at the completion of the project.
Coordination: VA, DoD and HHS.
D. Depleted Uranium Research
VA-14 Monitoring Gulf War Veterans With Embedded Depleted Uranium (DU) Fragments
Action: VAMC Baltimore, MD, U.S. Army Center for Health Promotion, Aberdeen, MD, and the University of Maryland, with the assistance of the EPA Environmental Monitoring Laboratory in Nevada.
Purpose: To conduct clinical follow-up of Operation Desert Storm veterans with known or suspected embedded depleted uranium fragments and assess health risks from DU.
Status: Ongoing. The list of those to be followed is complete. This is an ongoing, multi-year effort. Exposed soldiers will be followed with X-rays and total body counting. Urine and blood samples will be collected for relevant kidney function tests and 24 hour urine collections will be analyzed for uranium.
Results: Expected at the completion of the project.
Coordination: DoD, VA and HHS.
E. Leishmaniasis Research
VA-15 Vaccine Mediated Immunity Against Leishmania
Action: VAMC Cleveland, OH
Purpose: To understand cytokine-based mechanisms responsible for curative and counter-productive responses during leishmania infection.
Status: Ongoing. Original funding for this project is due to expire December 1995.
Results: Manuscripts published.
Heinzel F, Rerko R, Ling P, Hakimi J, Schoenhaut D. 1994. Interleukin 12 is produced in vivo during endotoxemia and stimulates synthesis of interferon-y. Infect. Immun., 62:4244-9.
Heinzel F. 1994. Interleukin 12 and the regulation of CD4+ T cell subset responses during murine leishmaniasis. Parasitol. Today, 10:190-2.
Heinzel F, Schoenhaut D, Rerko R, Roesser L, Gately M. 1993. Recombinant interleukin 12 cures mice infected with Leishmania major. Journal of Experimental Medicine, 177(5):1505-9.
Coordination: VA, DoD and HHS.
VA-16 Protective Immunity in Experimental Visceral Leishmaniasis
Action: VAMC San Antonio, TX
Purpose: To characterize the mechanisms involved in protective immunity and identify vaccine candidate antigens in experimental visceral leishmaniasis.
Status: Ongoing. This project is expected to be completed September 1997.
Results: Expected at the completion of the project.
Coordination: VA, DoD and HHS.
F. Other Research
VA-17 Immunological Evaluation of Persian Gulf War Veterans
Action: VAMC Birmingham, AL
Purpose: To evaluate potential changes in the immunological status of Persian Gulf War veterans using sensitive biological assays of immune cellular functions.
Status: Ongoing. This project is expected to be completed by the Fall of 1995.
Results: Expected at the completion of the project.
Coordination: VA, DoD, and HHS.
VA-18 Chronic Gastrointestinal Illness in Desert Storm Veterans: A Survey and Questionnaire
Action: VAMC Boston, MA
Purpose: To determine if there exists a statistically significant difference in chronic gastrointestinal symptoms in Persian Gulf veterans compared to age-matched controls. If such a difference is found, these data will serve as a starting point in designing future studies to investigate a possible etiology.
Status: Ongoing. This project is expected to be completed October 1996.
Results: Expected at the completion of the project.
Coordination: VA, DoD, HHS
DEPARTMENT OF DEFENSE
DoD efforts in response to the health problems of Persian Gulf veterans are closely coordinated with VA and HHS. In addition to joint efforts mentioned previously, DoD has the lead for the following projects:
A. Epidemiology
DoD-1 Epidemiological Studies of Morbidity among Gulf War Veterans: A Search for Etiologic Agents and Risk Factors
Action: Naval Health Research Center (NHRC), San Diego, CA, and VA.
Purpose: To conduct epidemiologic studies of symptoms, hospitalizations, and birth outcomes among large cohorts of active duty Gulf War veterans. DoD, in close coordination with VA and the Centers for Disease Control and Prevention (CDC), has initiated a research program that entails epidemiological studies of morbidity among Gulf War veterans and control groups. A series of epidemiological studies is being conducted of active duty personnel deployed to the Gulf compared to troops who served elsewhere. These studies will include detailed personal interviews and physiologic testing of approximately 2,250 Seabees (1500 Gulf War vets and 750 military personnel not deployed to the Persian Gulf), and analyses of hospitalization and birth records of over 1.2 million service members. These studies will involve both cohort and nested case-control designs, yielding risk factor analyses of symptoms/signs, hospitalizations, and birth outcomes.
Status: Ongoing. The first group of Seabees was surveyed in September 1994. Initial analysis of hospital and birth outcome data has begun. The first studies are expected to be completed in late 1995. Other projects will be completed at later dates.
Results: Results from individual projects are expected as the projects are completed.
Coordination: DoD, VA, CDC, and the University of California.
B. Environmental Research
DoD-2 DoD Funded Environmental Research
Action: U.S. Army Medical Research Detachment/U.S. Naval Medical Research Institute Detachment, Wright Patterson AFB, OH.
Purpose: The study at Wright Patterson AFB has been initiated and will evaluate the physiologic and behavioral effects in rodents of insecticides, jet fuel, and kerosene heater emissions, and will look for the formation of biological markers to these exposures. The effects of JP4 diesel fuel and other combustion products, as well as possible interactions with pesticides, pyridostigmine and stress, will be evaluated.
Status: Ongoing.
Results: Expected at the completion of the project.
Coordination: DoD, VA, HHS
DoD-3 Study of Effects of Smoke Inhalation
Action: U.S. Army Medical Research and Materiel Command.
Purpose: Conduct studies in animal models to define the pathology resulting from smoke inhalation.
Status: Ongoing. A rodent model is being developed to define and characterize the pathology resulting from smoke inhalation under controlled conditions. A related sheep model is also being explored. This work predates Operations Desert Shield/Storm and is a necessary adjunct to research on clinical burn care. The current inhalation injury models are expected to be able to supply data addressing the acute toxicity of various components of smoke, as well as the effectiveness of standard and novel medical countermeasures in the amelioration of smoke inhalation injury.
Results: Expected at the completion of the project.
Coordination: DoD, VA.
C. Psychological and Neurological Research
DoD-4 Follow-up, Psychological Studies of Veterans from Hawaii and Pennsylvania Deployed in Operations Desert Shield/Storm
Action: Department of Military Psychiatry, WRAIR, and VA (VAMC Honolulu and VAMC Pittsburgh).
Purpose: To identify psychological consequences and risk factors of deployment to the Persian Gulf during Operations Desert Shield/Storm. In response to Congressional action, H-10437, which directs the Honolulu VAM&ROC to collaborate with DoD in an attempt to track all ODS veterans residing in Hawaii. Congressional mandate required the following: (1) Identification of ODS veterans living in Hawaii; (2) administration of a number of instruments (Brief symptom Inventory, Impact of Events Scale, Combat Exposure Scale) to each veteran; (3) provide orientation sessions to ODS veterans and their families; (4) provide in-depth debriefings to ODS veterans and their families, if requested; and, (5) complete congressional reporting requirements.
Status: Ongoing. Questionnaires were administered in the Persian Gulf to five military divisions and after the war to active duty and reserve Army, Navy, and Air Force personnel in Hawaii and Pennsylvania. Further follow-up studies are planned of military personnel initially evaluated while deployed to the Persian Gulf. Also, a case-control study is planned with VA (Pittsburgh VAMC) to compare patients enrolled in the VA registry and DoD CCEP with military personnel who were not deployed to the Persian Gulf.
Results: Report prepared.
U.S. Army Medical Research, Development, Acquisition and Logistics Command. The General Well-Being of Gulf War Era Service Personnel from the State of Pennsylvania and Hawaii: A Survey (1994).
Coordination: DoD, VA and HHS.
DoD-5 Operational Stress and Human Performance
Action: U.S. Army Medical Research and Materiel Command.
Purpose: Extend and elaborate on work conducted under "Continued Psychological Studies of Veterans from Hawaii and Pennsylvania Deployed in Operations Desert Shield/Storm," that is described above. Identify psychological consequences and risk factors of deployment during Operations Desert Shield/Storm in a wider range of military populations.
Status: Ongoing.
Results: Expected at the completion of the project.
Coordination: DoD, VA.
DoD-6 Combat Stress Diagnosis
Action: U.S. Army Medical Research and Materiel Command.
Purpose: Develop a diagnostic algorithm for field combat stress diagnosis. Identify mechanisms of and pharmaceutical countermeasures for combat stress effects. Emphasis is on rapidly acting countermeasures that could be administered far forward, and which would allow the stress casualty to remain on duty.
Status: Ongoing. Determined key stressors operating among mortuary affairs personnel in the Persian Gulf War and at the Dover Air Force Base Mortuary. Currently evaluating pharmaceutical countermeasures to combat stress in validated animal models of stress. Pharmaceutical countermeasures must be free of unwanted side effects, such as sedation or impairment of memory or performance.
Results: Expected at the completion of the project.
Coordination: DoD, VA.
D. Depleted Uranium Research
DoD-7 Research Studies of the Health Effects of Embedded Fragments of Depleted Uranium (DU)
Action: U.S. Army Medical Research and Materiel Command (USAMRMC).
Purpose: As a result of friendly-fire accidents, approximately two dozen U.S. Persian Gulf war veterans may have embedded DU fragments. There is currently no information about the long-term health consequences of this exposure, including the effects of radiation and heavy metal toxicity. This information is needed as a basis for the most appropriate medical management of DU fragments injuries and to decide if these injuries should be treated differently than the management of other embedded metal fragments.
Status: Ongoing. Two studies were funded by the USAMRMC following advertisement by a Broad Agency Announcement. A study by the Armed Forces Radiobiological Research Institute (AFRRI) will determine: (1) the extent of localized tissue inflammatory responses and damage; (2) toxicological effects of DU on the nervous system, including effects on motor activity, memory, and nerve conduction; (3) long-term toxicological effects on kidney function; and, (4) the distribution of uranium in various tissues over time. A second study by the Inhalation Toxicology Research Institute (ITRI, Albuquerque, NM) will determine: 1) if there is reason to believe that DU will increase the carcinogenic potential of metal fragments, and 2) the timecourse and significance of urinary concentrations of uranium in individuals with embedded fragments. Both the AFRRI and ITRI studies will be conducted using rodent models. The AFRRI study is expected to be completed by the end of 1997. The ITRI study is expected to by completed by the end of 1998.
Results: Results from individual projects are expected as the projects are completed.
Coordination: DoD, DOE, VA.
E. Leishmaniasis Research
DoD-8 Leishmaniasis Diagnostics Research
Action: U.S. Army Medical Research and Development Command.
Purpose: To develop a reliable serologic assay and skin test for leishmania infection. Rapid diagnostic tests for identifying leishmania infection are being pursued. Initial characterization studies are being conducted to gather data for submission of an Investigational New Drug (IND) application by the third quarter of FY 1995 for a skin test to detect leishmania infection. This skin test is considered the best candidate for screening populations to detect past leishmania infection. A rapid, simple, non-invasive diagnosis of leishmania infection would aid in the evaluation of both symptomatic and asymptomatic veterans. Studies are planned for evaluating the skin test in Persian Gulf veterans already diagnosed with leishmaniasis. Also, a polymerase chain reaction (PCR)-based blood test for leishmania infection is being pursued and will aid in identification of active infection among veterans with positive skin tests.
Status: Ongoing.
Results: Expected at the completion of the project.
Coordination: DoD, VA and HHS.
DoD-9 Identification of the Genetic Factors Which Control Tropism in Leishmania
Action: U.S. Army Medical Research Unit, WRAIR
Purpose: Service members from ODS may have latent L. Tropica infections and be at risk of the disease should they become immunosupressed (through HIV infection, transplantation, etc.). Even if all service members with viscerotropic L. Tropica are diagnosed and treated, the parasite will remain as a life-long symbiont of the macrophages, still placing the individual at risk of reactivation of disease at a later date if immunosupression occurs. The goal of this joint DoD/VA research is to identify the gene(s) that control tropism in Leishmania. The identification of a "tropism" gene will enable the development of specific gene probes (primers) to be used in a patient screening program to identify those at risk of (re)activation of latent infections.
Status: Ongoing. This project is expected to be completed in Spring 1996.
Results: Expected at the completion of the project.
Coordination: DoD, VA
F. Pyridostigmine Research
DoD-10 DoD Sponsored Research of Pyridostigmine and Synergism Between Various Chemical Agents Present during the Gulf War
Action: DoD, U.S. Army Medical Research and Materiel Command and U.S. Army Environmental Hygiene Agency.
Purpose: To evaluate any possible acute effects from exposure to pyridostigmine in combination with other chemicals present during the Persian Gulf War, including insecticides, DEET, permethrin.
Status: Complete.
Results: Report prepared.
DoD (Department of Defense). 1995a. Acute Oral Toxicity Study of Pyridostigmine Bromide, Permethrin, and DEET in the Laboratory Rat (Toxicological Study 75-48- 2665). U.S. Army Center for Health Promotion and Preventive Medicine.
Coordination: DoD and VA.
DoD-11 DoD Sponsored Research of Male/Female Differential Tolerances to Pyridostigmine Bromide
Action: U.S. Army Medical Research and Material Command.
Purpose: To evaluate the tolerances of pyridostigmine, 30mg, every 8 hours for 21 days; to evaluate multiple dose kinetics; and, to evaluate the effect of weight in males and females.
Status: Ongoing. Protocol to be conducted at South Florida Research Corporation.
Results: Expected at the completion of the project.
Coordination: DoD, VA.
G. Other Research
DoD-12 Forward Deployment Diagnosis of Infectious Diseases
Action: U.S. Army Medical Research and Materiel Command
Purpose: To develop simple diagnostic assays suitable for forward deployed preventive medicine teams and Area Medical Laboratories.
Status: Ongoing. Rapid and simple diagnostic tests are being developed to permit the identification of the causes of infection outbreaks before they reach the epidemic state. Serological assays are being developed for typhus fever, dysenteries caused by shigellosis and other bacteria, and leptospirosis. Tests utilizing polymerase chain reaction (PCR) technology are being explored for diagnosing dengue fever. Fluorescent assays for malaria and other parasitic diseases are under investigation.
Results: Expected at the completion of the project.
Coordination: DoD.
DoD-13 Evaluation of Military Working Dogs Who Participated in Operations Desert Shield/Storm
Action: DoD Working Dog Center, Lackland Air Force Base, San Antonio, TX
Purpose: To help identify any infectious diseases or environmental exposures that may be related to human illnesses reported by Persian Gulf veterans.
Status: Ongoing.
Results: Expected at the completion of the project.
Coordination: DoD, VA, and HHS.
HEALTH AND HUMAN SERVICES
The Department of Health and Human Services has been playing a vital role in activities related to the health of troops deployed during the Persian Gulf conflict. Its involvement began within days of the end of the conflict when the CDC participated in early studies on the potential health effects of smoke from oil wells. The Department of Health and Human Services continues to play an important role in several key research areas that it coordinates closely with VA and DoD.
A. Epidemiology
HHS-1 Centers for Disease Control and Prevention (CDC) Survey of Veterans from Iowa
Action: CDC (National Center for Environment Health), Iowa Department of Public Health (IDPH), the University of Iowa.
Purpose: The CDC will direct a telephone survey of approximately 1,500 Iowa veterans who served in the Persian Gulf and 1,500 Iowa veterans who served elsewhere during the same time period to determine the prevalence of symptoms/disease and possible risk factors. This survey also will include questions on the health status of spouses and children.
Status: Ongoing. Currently in planning stages. Extensive discussions have taken place between CDC, VA, and DoD to ensure coordination between this study and the VA's random survey of 15,000 Persian Gulf veterans and the cohort studies being conducted by DoD/NHRC. Funds were awarded to IDPH on 1 December 1994 to conduct the study.
Results: A final report is expected by mid-1996.
Coordination: HHS, VA, DoD
HHS-2 Centers for Disease Control and Prevention (CDC) Investigation of Veterans in Pennsylvania
Action: CDC, Pennsylvania Department of Health
Purpose: The CDC will conduct an investigation of the illnesses experienced by Pennsylvania veterans who served in the Persian Gulf. Clinical evaluations, survey questionnaire and a case-control study are planned.
Status: Ongoing.
Results: Report published.
Unexplained Illness Among Persian Gulf War Veterans in an Air National Guard Unit: Preliminary Report -- August 1990 - March 1995. Morbidity and Mortality Weekly Report, 44(23):443-447. Morbidity and Mortality Weekly Report, June 16, 1995.
Coordination: CDC, VA, DoD
B. Other Studies
HHS-3 Biomarkers of Susceptibility and Polycyclic Aromatic Hydrocarbon (PAH) Exposure in Urine and Blood Cell DNA from U.S. Army Soldiers Exposed to Kuwaiti Oil Well Fires
Action: NIH/NCI
Purpose: Studies using immunoassays (the benzo[a]pyrene-DNA ELISA and DELFIA), are being performed on blood samples from individuals exposed to coke ovens, aluminum plant fumes and oil well fires to determine levels of polycyclic aromatic hydrocarbons (PAHs) bound to nucleated blood cell DNA. Such assays are indicators of PAH exposure. This study is designed to determine if there is any increase in PAHs in blood cell DNA of military personnel who were in the Persian Gulf during the Kuwaiti oil well fires.
Status: Ongoing.
Results: Some available but not yet published.
Coordination: HHS, VA, and DoD.