discussion of wound-associated infections (for example, infections caused by Acinetobacter baumannii) that appear to be more prevalent in OIF and OEF personnel than in civilian populations (Davis et al. 2005). Chapter 6 discusses Al Eskan disease, IAEP, wound-associated infections, mycoplasmas, and biologic-warfare agents.

REVIEW AND EVALUATION OF THE LITERATURE

Selection of the Literature

The committee adopted a policy of basing its conclusions primarily on peer-reviewed, published literature. Non-peer-reviewed publications provided additional information for the committee and raised issues that were researched further in the peer-reviewed literature.

Although the process of peer review by fellow professionals ensures high standards of quality, it does not guarantee the validity of a study or the generalizability of its results. Accordingly, committee members read each study critically and considered its relevance and quality.

Amassing the Literature

The committee oversaw a multistep process for amassing a robust collection of scientific literature about the long-term adverse health outcomes of the diseases listed in Box 2.3. The process began with a search of PubMed, a database created and managed by the National Library of Medicine that includes more than 15 million citations of biomedical publications from the 1950s to the present. The PubMed search focused on journal articles published through December 2005 that contain information about late complications, long-term sequelae, and latent infections related to the relevant infectious diseases and etiologic agents identified by the committee. Additional studies were identified from the reference lists of topical technical reports, textbooks, and other documents. Further PubMed searches identified pertinent articles on Al Eskan disease, IAEP, wound-associated infections, mycoplasmas, and biologic-warfare agents. Those initial searches generated about 20,000 articles.

Reviewing the Literature

On closer examination of that large body of literature, a subset of about 1,200 articles appeared to provide the types and quality of scientific evidence that the committee needed to accomplish its task. After securing the full text of those articles, the committee reviewed and assessed them for evidence of associations between primary infections by the etiologic agents of interest and specific long-term adverse health outcomes in humans.

The committee included several types of studies, including epidemiologic studies, case reports, and case series. Ideally, epidemiologic studies should have methodologic details, a control or reference group, reasonable adjustment for confounders, and statistical power to detect effects. Review articles, technical reports, and textbooks were used for background information.

The committee relied heavily on studies that focused on human adult populations. Because the IOM task concerns adults who may have become infected during military service, studies of children were generally excluded unless the studies dealt with reproductive outcomes. One exception is that studies of children were included if they provided information about adult



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