Gulf War and Health Volume 10: Update of Health Effects of Serving in the Gulf War, 2016 (2016) / Chapter Skim
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2 Considerations in Identifying and Evaluating the Literature
2 Considerations in Identifying and Evaluating the Literature
Pages 25-36
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From page 25... ...
The categories of association that were used to draw conclusions about the possible health effects that might result from being deployed are then presented. Finally, the committee describes some of the issues it encountered when considering the literature on Gulf War exposures and health outcomes such as multiple exposures and individual variability.
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From page 26... ...
Because this is the last volume in the Gulf War and Health series, the committee considered it prudent to look at the new literature on Gulf War illness, particularly animal models that attempt to simulate the multiple exposures experienced by Gulf War veterans during deployment. Therefore, an additional literature search was conducted to identify toxicologic and other animal studies that specifically sought to reproduce Gulf War exposures or describe a model of Gulf War illness.
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From page 27... ...
reviewed all titles and abstracts and identified papers for full text retrieval. Initially, the Volume 8 health conditions were used as the basis for the health conditions
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From page 28... ...
Some of the larger cohort studies used a variety of methods and instruments to assess the health status of Gulf War veterans and it is for this reason that the committee discussed at some length the diagnostic approaches and use of self-reports for each paper. Because of the variability in the description and diagnosis of the health conditions considered in this report, the committee made no a priori assumptions about the usefulness of any paper for a health outcome; each paper was discussed individually for each health outcome (several papers assessed numerous health outcomes)
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From page 29... ...
The committee also did not consider health outcomes seen in veterans of conflicts other than the Gulf War unless those veterans formed an appropriate control group (for example, veterans who had served in Bosnia)
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From page 30... ...
Health conditions should have been diagnosed or confirmed by a clinical evaluation, imaging, hospital record, or other medical record. For psychiatric conditions, standardized interviews were preferred, such as the Structured Clinical Interview for the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders-IV-TR)
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From page 31... ...
In an effort to be inclusive, these ancillary studies are discussed in a section called "Other Related Studies" for each health outcome to which they pertain; however, no conclusions were based solely on these ancillary studies. INDIVIDUAL VARIABILITY Differences among people in their genetic, biologic, psychologic, and social vulnerabilities add to the complexities in determining health outcomes related to specific agents.
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From page 32... ...
Various exposure assessment tools have been used in research to fill gaps in exposure information, but there are problems in reconstruction of past exposure events. Many studies have assessed military personnel exposures to various preventive agents including PB and pesticides agents during the Gulf War.
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From page 33... ...
Sufficient Evidence of a Causal Relationship Evidence is sufficient to conclude that a causal relationship exists between being deployed to the Gulf War and a health outcome. The evidence fulfills the criteria for sufficient evidence of a causal association in which chance, bias, and confounding can be ruled out with reasonable confidence.
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From page 34... ...
However, the challenge of understanding the effects of aging can be addressed with well-designed epidemiologic studies that select appropriate reference populations and apply rigorous analytical methods. The epidemiologic and clinical studies conducted to date have provided valuable information regarding the health of Gulf War veterans; however, many of the studies have significant limitations of design or implementation that hinder accurate assessment of the veterans' health status.
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From page 35... ...
The committee's process for reaching conclusions about the strength of the association between deployment to the Gulf War and its potential for adverse health outcomes was collective, interactive, iterative, and based on the process used by the Volume 8 committee. The committee thoroughly evaluated the scientific literature attending to the design, methodological, and special considerations described above, particularly the limitations of exposure information and outcomes assessment.
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