臨床医学に環境・労働の観点を

・11月12日は、歌手の岩崎宏美の誕生日。私と同い年です。年齢は言うまい。「あなたおーねがーいよー」の『ロマンス』がすき。『ドリーム』や『未来』もお気に入り。残念なのは、コロッケのために封印されてしまった『シンデレラ・ハネムーン』。ちょっとマイナーなところで、『パピヨン』もよろしい。以前ブログにかいた『私の1095日』もね。余談ですが、巨人の原辰徳も同い年です。（原監督は7月22日生）

・アメリカ合衆国と日本の時差はマイナス14時間だから、まだ11月11日ですよね。11月11日はVeterans Day だそうです。Ｗｉｋｉｐｅｄｉａでは、復員軍人の日、または退役軍人の日と訳されているそうです。この日の説明は、http://ja.wikipedia.org/wiki/%E9%80%80%E5%BD%B9%E8%BB%8D%E4%BA%BA%E3%81%AE%E6%97%A5

で、ご覧下さい。また、ＵＳＡの行政機関のWebsiteは下記です。

http://www1.va.gov/opa/vetsday/

・で、THE NATIONAL ACADEMIES PRESSが、退役軍人の健康問題について色々レポートを書いています。一番最近のレポートは、

Gulf War and Health:Volume 6. Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress

というもので、なんとon lineで無料でみれます。ＰＤＦでsummaryもあります。Ｌａｎｃｅｔなんかに、ときどきGulf　War関係の記事が載っていましたが、このレポートは、結構まとめてくれているみたいです。（サマリーのところを、チョコットみただけで、全部読んだわけではございません）下の表が、サマリーです。（うまくcopyできていません。また、青字も実際はリンクしていません）

自衛隊員の健康問題（特にイラク派遣隊員の）が公にされるとういことがあるのでしょうか？自殺がとても多いと聞きますが...

TABLE S-1 Summary of Findings Regarding the Association Between Deployment to a War Zone and
Specific Health and Psychosocial Effects
Sufficient Evidence of a Causal Association
Evidence from available studies is sufficient to conclude that there is a causal relationship between
deployment to a war zone and a specific health effect in humans. The evidence is supported by
experimental data and fulfills the guidelines for sufficient evidence of an association (below). The
evidence must be biologically plausible and satisfy several of the guidelines used to assess causality, such
as strength of association, dose-response relationship, consistency of association, and temporal
relationship.
• No effects.

Sufficient Evidence of an Association
Evidence from available studies is sufficient to conclude that there is a positive association. That is, a
consistent positive association has been observed between deployment to a war zone and a specific health
effect in human studies in which chance and bias, including confounding, could be ruled out with
reasonable confidence. For example, several high-quality studies report consistent positive associations,
and the studies are sufficiently free of bias and include adequate control for confounding.
• Psychiatric disorders, including PTSD, other anxiety disorders, and depressive disorders.
• Alcohol abuse.
• Accidental death in the early years after deployment.
• Suicide in the early years after deployment.
• Marital and family conflict.

Limited but Suggestive Evidence of an Association
Evidence from available studies is suggestive of an association between deployment to a war zone and a
specific health effect, but the body of evidence is limited by the inability to rule out chance and bias,
including confounding, with confidence. For example, at least one high-quality study reports a positive
association that is sufficiently free of bias, including adequate control for confounding, and other
corroborating studies provide support for the association (corroborating studies might not be sufficiently
free of bias, including confounding). Alternatively, several studies of lower quality show consistent
positive associations, and the results are probably not due to bias, including confounding.
• Drug abuse.
• Chronic fatigue syndrome.
• Gastrointestinal symptoms consistent with functional gastrointestinal disorders, such as irritable
bowel syndrome or functional dyspepsia.
• Skin disorders.
• Fibromyalgia and chronic widespread pain.
• Increased symptom reporting, unexplained illness, and chronic pain.
• Incarceration.
Copyright National Academy of Sciences. All rights reserved.

Inadequate/Insufficient Evidence to Determine Whether an Association Exists
Evidence from available studies is of insufficient quantity, quality, or consistency to permit a conclusion
regarding the existence of an association between deployment to a war zone and a specific health effect in
humans.
• Cancer.
• Diabetes mellitus.
• Thyroid disease.
• Neurocognitive and neurobehavioral effects.
• Sleep disorders or objective measures of sleep disturbance.
• Hypertension.
• Coronary heart disease.
• Chronic respiratory effects.
• Structural gastrointestinal diseases.
• Reproductive effects.
• Homelessness.
• Adverse employment outcomes.

Limited/Suggestive Evidence of No Association
Evidence is consistent in not showing a positive association between deployment to a war zone and a
specific health effect after exposure of any magnitude. A conclusion of no association is inevitably
limited to the conditions, magnitudes of exposure, and length of observation in the available studies. The
possibility of a very small increase in risk after deployment cannot be excluded.
• No effects.