Gulf War and Health Volume 3: Fuels, Combustion Products, and Propellants (2005) / Chapter Skim
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Pages 18-27
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18 2 CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE This chapter presents the committees approach to identifying the literature for review and its considerations in evaluating the strength of evidence presented in that literature. It provides information about the types of literature the committee identified how the committee assessed the strength of the evidence, and the categories of association that the committee used to summarize its findings.
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CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE 19 IDENTIFICATION OF THE LITERATURE The committees first step was to identify the literature it would review. It began its work by overseeing extensive searches of the peer-reviewed medical and scientific literature (Appendix B)
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20 GULF WAR AND HEALTH EPIDEMIOLOGIC STUDIES Epidemiology deals with the study of the determinants, frequency, and distribution of disease in human populations. A focus on populations distinguishes epidemiology from medical disciplines that focus on the individual.
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CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE 21 agent and disease is the exception in large populations (IOM 1994b)
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22 GULF WAR AND HEALTH before evaluation of study subjects. The committee required an exposure-free interval specifically for effects that might be reversible (such as headache, light-headedness, poor coordination, rash, or cough)
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CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE 23 based on knowledge of a specific industry; if specific exposures were associated with an occupational title or industry, such as when a JEM was used to categorize exposure; or if an assessment was made by an industrial hygienist. Studies that had self-reported exposures were considered, at best, support studies.
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24 GULF WAR AND HEALTH than when the association is nonspecific to the exposure or the health outcome. The committee recognized, however, that perfect specificity could not be expected, given the multifactorial etiology of many of the diseases under examination.
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CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE 25 variable. Other common sources of information bias are the inability of study subjects to recall accurately the circumstances of their exposure (recall bias)
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26 GULF WAR AND HEALTH Sufficient Evidence of an Association Evidence is sufficient to conclude that there is an association. That is, a consistent association has been observed between exposure to a specific agent and a specific health outcome in human studies in which chance and bias, including confounding, could be ruled out with reasonable confidence.
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CONSIDERATIONS IN IDENTIFYING AND EVALUATING THE LITERATURE 27 with the extent to which the authors reduced common sources of errorchance variation and bias, including confoundingin drawing inferences. Accordingly, the criteria for each category express a degree of confidence based on the extent to which sources of error were reduced.
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