Strategies to Protect the Health of Deployed U.S. Forces -- Copyright -- REVIEWERS -- Preface -- Acronyms -- Contents -- Executive Summary -- MEDICALLY UNEXPLAINED SYMPTOMS -- Recommendations -- MEDICAL SURVEILLANCE -- Recommendation -- Recommendations (Additional Recommendations are in Chapter 4) -- Recommendations -- POSTDEPLOYMENT REINTEGRATION -- Recommendations -- MEDICAL RECORD KEEPING -- Recommendations (Additional Recommendations are in Chapter 5) -- Recommendations -- Recommendation -- RISK COMMUNICATION -- Recommendation -- RESERVES -- Recommendation -- CONCLUSIONS -- 1 Introduction -- EMPHASIS AND IMPLICIT ASSUMPTIONS -- RELATED EFFORTS -- STUDY PROCESS AND INFORMATION SOURCES -- THE FUTURE MILITARY -- 2 Risks to Deployed Forces -- INFECTIOUS DISEASES -- NON-BATTLE INJURIES -- Heat and Cold Injuries -- PSYCHOLOGICAL STRESS -- TOXIC INDUSTRIAL CHEMICALS -- CHEMICAL WEAPONS -- BIOLOGICAL WEAPONS -- PROTECTIVE MEDICATIONS -- INTERACTIONS -- 3 Medically Unexplained Symptoms -- EPIDEMIOLOGY -- PREDISPOSING FACTORS -- Physiological Differences and Susceptibilities -- Early Life Adversity -- Chronic Medical Illness -- PRECIPITATING FACTORS -- PERPETUATING FACTORS -- PROGNOSTIC INDICATORS -- 4 Medical Surveillance -- DOD POLICIES ON MEDICAL SURVEILLANCE -- Force Health Protection -- DoD Joint Directive -- DoD Joint Instruction -- DoD Joint Memorandum on Deployment Health Surveillance and Readiness -- Joint Publication 4-02 Doctrine for Joint Health Service Support -- National Science and Technology Council, Presidential Review Directive 5 -- CURRENT SERVICE PRACTICES AND PLANS -- Garrison -- Recruit Assessment Program -- Periodic Health Assessments -- Periodic Blood Draw -- Surveillance for Drug-and Vaccine-Associated Adverse Events -- Laboratory-Based Surveillance -- Defense Medical Surveillance System.

Global Surveillance for Infectious Disease Threats to Military Operations - Role of Overseas Medical Laboratories -- Deployment -- Pre-and Postdeployment Questionnaires -- Capture of Ambulatory Care and Inpatient Data During Deployments -- Theater Medical Information Program -- Identifying Deployed Populations -- Deployment Exposure Data -- Postdeployment Medical Surveillance -- Immediate Postdeployment Surveillance -- Routine Postdeployment Surveillance -- Deployment-Related Registries -- Long-Term Surveillance -- Reproductive Outcomes -- Confidentiality of Health Information -- FINDINGS AND RECOMMENDATIONS -- 5 Medical Record Keeping -- INFORMATION NEEDS OF THE MILITARY HEALTH SYSTEM -- Individual Care -- Preventive Care -- Medical Surveillance -- Databases for Epidemiologic Studies -- Longitudinal Record Keeping -- MAJOR INFORMATION SYSTEMS ACTIVITIES -- Composite Health Care System -- Government Computer-Based Patient Record Project -- Health Assessment Instruments -- Preventive Health Care Application -- Pre-and Postdeployment Questionnaires -- Recruit Assessment Program -- Deployment Medical Surveillance System -- Personal Information Carrier -- INFORMATION SYSTEMS ACQUISITION AND DEVELOPMENT PROCESS -- CONFIDENTIALITY OF HEALTH INFORMATION -- SUMMARY -- FINDINGS AND RECOMMENDATIONS -- 6 Prevention Measures for Deployed Forces -- RISK COMMUNICATION -- PREVENTIVE MEASURES BEFORE DEPLOYMENT -- Preventive Measures on Entrance into the Service -- Risk Communication -- Accession Standards -- Retention Standards -- Recruit Assessment Plan -- Preventive Measures During Training and Routine Garrison Life -- Doctrine -- Training -- Vaccines -- Policy -- Vaccine Acquisition and Supply -- Identification of Biological Warfare Threats -- Vaccine Coverage -- Immunization Record Keeping -- Anthrax Vaccine -- Preventive Measures Immediately Before Deployment.

PREVENTIVE MEASURES DURING DEPLOYMENT -- Risk Communication -- Combat Stress Reactions and Control -- Use of Investigational New Drugs by the Armed Forces -- PREVENTIVE MEASURES AFTER DEPLOYMENT -- Risk Communication -- Reintegration -- Medical Management and Symptomatic Treatment of Medically Unexplained Symptoms -- FINDINGS AND RECOMMENDATIONS -- 7 Postdeployment Reintegration -- INTRODUCTION -- Family-and Work-Related Problems of Deployment -- Effects of Downsizing and Increased Operational Tempo -- MILITARY REUNION AND REINTEGRATION LITERATURE REVIEW -- Information Gathering -- Family Factors -- Reunion Period -- Return Phase -- Readjustment Phase -- Reintegration Phase -- Return of the Wounded or Ill -- Role of Family in Readjustment -- Family Roles in Readjustment in Non-Military Settings -- Prevention of War-Related Stress for Family Members -- PROGRAMS TO ASSIST FAMILIES AND SERVICE MEMBERS WITH REINTEGRATION -- Navy Support Services -- Army Support Services -- Air Force Support Services -- Programs to Help Support National Guard and Reserves -- VA Support Programs -- FINDINGS AND RECOMMENDATIONS -- 8 Protecting the Health of the Reserve Component -- DEMOGRAPHICS AND HEALTH ISSUES -- Categories of Reserve Forces -- Demographics -- Deployments of Reserve Forces -- Health Problems in Reserves -- UNIQUE CIRCUMSTANCES -- IMPLEMENTATION OF REPORT RECOMMENDATIONS -- Medical Surveillance -- Medical Record Keeping -- Preventive Measures -- Reintegration -- FINDINGS AND RECOMMENDATIONS -- References -- APPENDIX A Population and Need-Based Prevention of Unexplained Physical Symptoms in the Community -- SYNOPSIS -- UNDERSTANDING MEDICALLY UNEXPLAINED PHYSICAL SYMPTOMS -- EPIDEMIOLOGY OF SYMPTOMS AND SYMPTOM-BASED DISORDERS -- Prevalence in the Community and Primary Care -- Natural History of MUPS.

Prognostic Factors: Prediction of Outcomes and Assessment of Future Needs -- PREVENTION OF SYMPTOMS AND SYMPTOM-BASED DISORDERS -- Advantages of Population-Based Intervention -- Advantages of Need-Based Intervention -- Population-Based Care: Matching Resources to Needs -- Implementing and Improving Population-Based Care -- Information Systems -- Practice Design -- Patient Education and Clinical Risk Communication -- Stepped-Care Approach to Population MUPS Management -- Step One: Preevent Primary Prevention -- Step Two: Postevent Primary Prevention -- Step Three: Routine Primary Care -- Routine Primary Care Physician Management -- Teaching MUPS Management to Primary Care Physicians -- Step Four: Collaborative Interventions in Primary Care -- Step Five: Specialized Intensive Multimodal Care -- Components of Specialized Services -- Obstacles to Specialized Services -- CONCLUSIONS -- REFERENCES -- APPENDIX B Statement of Task -- APPENDIX C Roster and Biographies of Study Team -- PRINCIPAL INVESTIGATORS -- ADVISORS -- BIOGRAPHIES -- Principal Investigators -- Advisors -- APPENDIX D Principal Investigators' and Advisors' Meeting Dates and Locations -- APPENDIX E Workshop Agendas -- Appendix F Commissioned Papers -- APPENDIX G Acknowledgments -- APPENDIX H Department of Defense Directive 6490.2: Joint Medical Surveillance -- APPENDIX I Department of Defense Instruction 6490.3 Implementation and Application of Joint Medical Surveillance for… -- APPENDIX J Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998.