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National Institutes of Health Technology Assessment Workshop Panel. The Persian Gulf Experience and Health. JAMA 1994; 272: 391-395.

Summary of conclusions of workshop following 1.5 days of presentations, testimony by veterans, and questions and discussion. Panel responded to following key questions:

1. What is the evidence for an increased incidence of unexpected illnesses attributable to service in the Persian Gulf War? Panel defined unexpected illnesses as previously unrecognized and unanticipated symptom complexes or illnesses that do not fit traditional diagnostic categories. Available data are too limited to draw any conclusions about the incidence of unexpected illnesses. Lacking are data that individuals reporting symptoms are representative of all persons at risk for developing these symptoms. Nevertheless, available data suggest that deployed personnel report more symptoms than those who did not deploy and veterans of previous wars.

2. If unexpected illnesses have occurred, what are the components of the most practical working case definition(s) based on existing data? It is impossible at this time to establish a single case definition. To achieve such a case definition, evaluations of PG veterans and comparison groups should be carried out.

3. If unexpected illnesses have occurred, what are the plausible etiologies and biological explanations for these unexpected illnesses? No single or multiple etiology or biological explanation for the reported symptoms was identified from the data available to the panel. Possible causative or contributing factors discussed were: leishmaniasis, petroleum vapors, solvents, and combustion products, sand/dust, depleted uranium, pyridostigmine, pesticides, chemical agent-resistant coatings, biological and chemical war agents, vaccines, and various stressors.

4. What future research is necessary? A more accurate estimate of symptom prevalence should be established through questionnaires of all GW veterans or of a representative sample. Departments of Veterans Affairs (DVA) and Defense (DoD) should develop and apply a coordinated, uniform case assessment protocol for diagnosis and treatment. Symptom rates should be compared among personnel deployed to the Gulf, deployed elsewhere, and not deployed, using both cohort studies and case-control studies. Pulmonary function should be evaluated among those exposed to oil fire plumes. Studies should simulate and model indoor exposures associated with heaters, petroleum, insecticides, and spray painting. Studies should investigate the relationship of stressors of deployment and combat to the symptoms afflicting some GW veterans. The DVA should develop more effective approaches to diagnosis and therapy of veterans affected by stress-related or stress-exacerbated illness. DoD should develop plans for prompt collection of high-quality data for future deployments, including baseline health status, environmental exposures during deployments, and health status both before and after deployments. Research should be conducted to facilitate more sensitive means of diagnosis of viscerotropic leishmaniasis and apply such screening to veterans with unexplained illness.

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