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1 Introduction
Pages 13-25

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From page 13...
... In 1998, IOM and the VA entered into a contract for a series of studies that would provide conclusions about the strength of the association between exposure to the agents of concern and health outcomes as observed in the epidemiologic literature. Congress, also responding to the growing concerns of ill veterans, passed legislation in 1998 for a study similar to that previously requested by the VA (the Persian Gulf War Veterans Act of 1998, PL 105 277, and the Veterans Programs Enhancement Act of 1998, PL 105-368)
From page 14...
... and overstimulation of muscles and nerves. After sufficient exposure to sarm or other OP nerve agents, that overstimulation causes what has been termed the acute cholinergic syndrome (see Chapter 2)
From page 15...
... The letter also urged survey recipients to call the Gulf incident Hotline with any additional information about the Khamisiyah incident or to report illnesses they attributed to their service in the Gulf War. The CIA-DOD models integrated four components: · UNSCOM reporting and intelligence summaries of the amount, purity, and type of chemical-wa fare agents stored at Khamisiyah.
From page 16...
... . The second CIA-DOD model differed from the first m that it incorporated updated unit location and personnel data, revised meteorologic models, reduced estimates of nerve-agent release, combined toxicity of sarin md cyclosarin (the first model used only sarin)
From page 17...
... Exposure models indicate that the degree of exposure of US troops m the path of the sarin cyclosarin plume was low. Two other storage sites in central Iraq that contained sarm, cyclosarin, and mustard gas were damaged m air attacks, but modeling mdicates that all US troops were outside the range of contammation from those sites.
From page 18...
... However, no well-controlled human studies have looked expressly at sarm's longtetm health effects at doses that do not produce acute sigms and symptoms. CHARGE TO THE PRESENT COMMITTEE The pre em committee was charged to review the peer-reviewed literature published since earlier IOM reports on health effects associated with exposure to sarm and related compounds, including relevant epidemiologic studies.
From page 19...
... The committee's review included recommendations for additional scientific studies to resolve continued scienrifc uncertainty as war anted. The committee was not charged with determining whether a unique Gulf War syndrome exists, nor was it to make judgments regarding magnitudes of exposure of veterans to the putative agents.
From page 20...
... The committee endeavored to express its judgment as clearly and precisely as the available data allowed, and it used the established categories of association from previous IOM studies because they have gained wide acceptance over more Box 1-1 Categories of Evidence Sufficient Evidence of a Causal Relationship Evidence from available studies is sufficient to conclude that a causal rolationship sadists bstwssn exposure to a specific agent and a specific health outcome in humans. and the evidence is supported by srpsrimental data The evidence fulfills the guidelines for sufficient evidence of an assoaation (below)
From page 21...
... , which in turn are morn specific than thoss Assessing pashcidss morn generally With rsspect to sensitivity, studiss are judged by the instruments used to manners sxposurs Biologic mon itoring data are theoretically the most pref srabis but are al most never obtainabis in the context of a nonpersistent chemical and a disease with long latency, such elm cancer Other kinds of efforts can obtain ssnsiLvs msasurss of exposure, such Elm use of occupational or environmental monitoring data, use of morn extensive industrial hygiene Assessments, use of interview tschniquss that help to minimixs recall biro (for sxampis, photos of products and home and workplace walklhroughs) Similarly there are questions about quality of outcoms Assessment—whether an outcoms ho basn Unfed by a medical diagnosis in a consistent Inshion 3Factors used to make this judgment in udn data on the relationship bstwssn potential confounders and rninted hnrbfh end points in n given study blond ton on subject selection, and cir~nifcation of exposure 21
From page 22...
... Epidemiologic studies can establish statistical associations between exposure to specific agents and health effects, and associations are generally estimated by using relative risks or odds ratios. To conclude that an association exists, it is necessary for exposure to an agent to be followed by the health outcome more frequency than it would be expected to by chance alone.
From page 23...
... . By eximmlulg numerous epidemiologic studies, the committee addressed the question, "Does the available evidence support a causal relationship or m association between exposure to a specific agent and a health outcome?
From page 24...
... 1998. Review of health consequences fmm high-, imenmediate- and l ow level expostne to organophosphotus netye agenw.
From page 25...
... INTRODUCHON 25 Snsser M


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