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International collaborations offer new perspectives and important opportunities for health researchers to share information, experiences, and methods that provide the basis for population-based health studies of mutual interest. Collaborations that involve completely different cultural perspectives also present distinct challenges. We share our experiences following a successful international collaboration to study health outcomes among Saudi Arabian National Guard (SANG) soldiers following the 1991 Gulf War. Our study involved a multidisciplinary team, including two physician researchers from the Kingdom of Saudi Arabia and eight researchers from the United States with expertise in epidemiology, preventive medicine, occupational medicine, biostatistics, data programming, and analyses. The findings from our epidemiological study are reported separately. In this commentary, we address some of the major distinctions between the Kingdom of Saudi Arabia and the United States, including geopolitical, social and religious, as well as healthcare system and language differences that had an impact on our research collaboration. Despite the challenges, our international collaboration was a very worthwhile experience. In addition to all that was learned about the process of gathering information on health outcomes in an international setting, we also gained much in the area of improved cross-cultural understanding and cooperation, which can contribute to a global network of scientists committed to building a science-based foundation for health research., Published in American Journal of Infection Control, v33 n3 p192-196, Apr 2005. The original document contains color images.

There has been considerable publicity that the 1991 Gulf War may have caused a wide array of health problems in military personnel. Although postwar health outcomes have been studied in US, British, Canadian, and other deployed troops, this issue has not been previously evaluated in coalition forces native to the Gulf region. A collaborative team of US and Saudi health researchers was assembled, data sources evaluated, and hospitalizations among Saudi Arabian National Guard (SANG) soldiers between 1991 and 1999 analyzed. Multivariate modeling was used to evaluate differences between 8342 soldiers exposed to combat at Al Khafji and a comparison group of 7270 soldiers in the Riyadh area. This is the first reported epidemiological investigation of postwar hospitalization among coalition forces native to the Gulf region that participated in the 1991 Gulf War. A very small increase in hospitalizations was identified in SANG soldiers exposed to combat at Al Khafji. However, because of data limitations, the clinical relevance of this finding should be interpreted with caution. Future collaborative studies to better understand the health effects of deployment should be encouraged., Published in the International Journal of Epidemiology, v34 n4 p801-808, 2005. The original document contains color images.

For more than a decade after the gulf War, there has been concern that wartime exposures have resulted in significant morbidity among Gulf War veterans. After the end of the war, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) initiated health registries to provide systematic clinical evaluations of Gulf War veterans who chose to participate. By September 1999, there were 32,876 participants in the DoD Comprehensive Clinical Evaluation Program and 70,385 participants in the VA Gulf War Registry Health Examination Program. Demographic and military service factors were identified as well as potential war-related exposures associated with subsequent registry participation after 10 years of observation. Veterans potentially exposed to oil well fire smoke, those near Khamisiyah, Reserve and National Guard, Army veterans, and veterans in the theater of operations during intense combat periods were most likely to elect to participated in a registry. These findings support the hypothesis that certain occupational factors and wartime exposures may influence subsequent health care-seeking behavior., Published in the Journal of Occupational and Environmental Medicine, v44 p758-768, 2002.

Context There has been much public and veteran concern over possible toxic exposures and reported symptoms by Gulf War veterans. Objective To determine if there is an increased risk of postwar morbidity severe enough to warrant hospitalization among those exposed to Kuwaiti oil well fire smoke. Design, Setting, and Participants In this historical cohort study, complete exposure and demographic data were available for 518,87 Gulf War veterans consisting of 87.3% regular active duty and 12.7% Reserve personnel. Main Outcome Measures Using data from all Department of Defense hospitals, Cox modeling was completed for hospitalizations du to any cause, hospitalizations with diagnoses in 15 major categories, and hospitalizations for specific diagnoses thought to be likely manifestations of the exposure. Observation time was calculated from February 2, 1991, until hospitalization, separation from active- duty service, or January 31, 1999, whichever occurred first. Results Exposure to oil well fire smoke particulate matter was determined through the overlay of meteorologic and diffusion modeling data onto troop location data. We constructed 7 exposure groups based on duration and amount of exposure. Among the 25 models, the only model at increased adjusted hospitalization risk was that for diagnoses in the injury and poisoning (RR=1.O5; 95% CI, 1.01- 1.11). Conclusions Having some limitations, these data do not support the hypothesis that Gulf War veterans are suffering an increased risk of postwar morbidity from exposure to Kuwaiti oil well fire smoke.