Review of the Department of Defense Enhanced Particulate Matter Surveillance Program Report (2010) / Chapter Skim
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4 Health Research and Surveillance Needs
4 Health Research and Surveillance Needs
Pages 48-70
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From page 48... ...
Extrapolation from general population-based epidemiologic studies may not provide appropriate estimates of the effects on health, because the chemical composition of PM, the magnitudes of exposure, and the characteristics of deployed military personnel are different from those in the general population. The deployed personnel may be considered relatively healthy compared to the general population with regard to past medical history and physical fitness; however, deployed personnel are exposed to dangerous, stressful conditions and adverse environmental exposures that may affect their overall health adversely.
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From page 49... ...
Results of research can lead to the initiation of surveillance and vice versa, but the two activities are not synonymous. THE NEED FOR HEALTH SURVEILLANCE OF MILITARY PERSONNEL DEPLOYED IN THE MIDDLE EAST After the first Persian Gulf War in 1991, many veterans who had been deployed to that military theater complained of persistent respiratory symptoms.
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From page 50... ...
. In Taiwan, analyses indicate that Asian dust storms may result in increases in daily hospital admissions for chronic obstructive pulmonary disease (Chiu et al.
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From page 51... ...
In addressing the relationship between exposure of military personnel deployed in the Middle East theater to airborne PM and the risk of adverse health effects, exposure assessment is a critical component. There are many levels on which exposure can be assessed, including a broad geographic level and a personal level.
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From page 52... ...
The committee concluded that the exposure data contained in the Department of Defense (DOD) Enhanced Particulate Matter Surveillance Program (EPMSP)
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From page 53... ...
also showed predeployment-to-postdeployment FVC and FEV1 changes 2 Health databases were searched for specific diagnosis codes pertaining to the circulatory system (cardiovascular system, ischemic heart disease, acute myocardial infarction, other forms of heart disease, and cardiac dysrhythmias) , respiratory system (acute respiratory infections, other diseases of the upper respiratory tract, chronic obstructive pulmonary disease and allied conditions, asthma, and other diseases of the respiratory system)
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From page 54... ...
Those initial Army surveillance efforts are commendable, but implementation of a medical-surveillance program that includes the continued systematic collection of health data over a long term is required to provide information that can lead to effective interventions to reduce exposures to hazardous agents. TOXICOLOGIC STUDIES OF PARTICULATE MATTER COLLECTED BY THE ENHANCED PARTICULATE MATTER SURVEILLANCE PROGRAM Toxicologic studies of samples collected through the EPMSP can test hypotheses about the potential of components of PM to cause adverse health effects.
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From page 55... ...
An interesting finding was that cigarette smoke appeared to suppress the responses associated with Iraqi PM and purified silica. Chemical analysis of PM soil specimens from different Middle East military sites demonstrated similarities in composition for a wide variety of elements.
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From page 56... ...
It should be noted that the Navy considered burn pits as an important item for future study. THE VALUE OF THE DEPARTMENT OF DEFENSE ENHANCED PARTICULATE MATTER SURVEILLANCE PROGRAM The EPMSP was impressive in many ways, especially given that it was one of the first efforts to characterize environmental exposures of deployed military personnel that could potentially affect human health.
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From page 57... ...
It is suggested that future investigations consider characteristics of the military target population -- activity patterns, baseline health status, occupations, and other characteristics -- that differ from those of the general population. For example, in most occupational settings, exposures to hazards occur only during work hours, but military personnel deployed at some bases in the Middle East may be exposed to ambient PM 24 hours a day, 7 days a week.
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From page 58... ...
The elements of a medical-surveillance program generally include the following: An initial medical examination and collection of medical and oc cupational history. Periodic medical examinations at regularly scheduled intervals, including specific medical screening tests when warranted.
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From page 59... ...
Challenges arise in extrapolating results of studies of associations of PM with adverse human health outcomes to other regions, populations, or periods. As noted, military personnel deployed in the Middle East dif fer greatly from the U.S.
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From page 60... ...
In particular, the exposure assessment required for the study of potential persistent effects, such as the development of asthma or chronic obstructive pulmonary disease, may be different from that for the study of acute effects, such as respiratory symptoms that vary day to day or heart-rate variability. There is a notable dearth of exposure data from previous wars, particularly the Vietnam War and the first Gulf War.
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From page 61... ...
Utilizing the Millennium Cohort Study One possibility for conducting an epidemiologic study of the effects of PM on deployed military personnel in the Middle East is for the USACHPPM to work collaboratively with the Millennium Cohort Study (Gray et al.
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From page 62... ...
In addition, the cohort has many nondeployed participants who could serve as nonexposed controls. GUIDING PRINCIPLES FOR ASSESSING THE HEALTH OF SOLDIERS IN THE MIDDLE EAST CONFLICTS Predicting likely acute and chronic health effects is complex and difficult.
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From page 63... ...
An independent oversight committee composed of internal and external members who have expertise in air pollution, analytic chemistry, exposure assessment, epidemiology, toxicology, biostatistics, and occupational and environmental medicine should be established to provide guidance and to review specific objectives, study designs, protocols, and results of the various exposure and health-surveillance or research programs that are developed. Such a committee could provide an essential peer-review function, as well as an oversight function, lending scientific credibility to the investigations.
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From page 64... ...
Efforts to conduct surveillance and research programs to assess effects of exposure to PM in military personnel deployed to the Middle East theater should follow the guiding principles outlined in this chapter. Recommendations The DO D should take an inventory of potentially toxic compounds to which deployed personnel may be exposed.
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From page 65... ...
Presentation at the First Meeting on Review of the DOD's Enhanced Particulate Matter Surveillance Program Report, July 9, 2009, Washington, DC. Alfaro-Moreno, E., T.S.
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From page 66... ...
2008. Department of Defense Enhanced Particulate Matter Surveillance Program (EPMSP)
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From page 67... ...
2004. Respiratory health status of Australian veterans of the 1991 Gulf War and the effects of exposure to oil fire smoke and dust storms.
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From page 68... ...
2008. Coarse particulate matter air pollution and hospital admissions for cardio vascular and respiratory disease among Medicare patients.
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From page 69... ...
Central Command theater of operations. Presentation at the First Meeting on Review of the DOD's Enhanced Particulate Matter Surveillance Program Report, July 9, 2009, Washing ton, DC.
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From page 70... ...
2009. Effects of Asian dust storm events on hospital admissions for congestive heart failure in Taipei, Taiwan.
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