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3 Recommendations
Pages 37-42

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From page 37...
... RECOMMENDATION 1: USE DATA FROM OTHER EPIDEMIOLOGIC STUDIES Despite the importance of clarifying the relationship between military service and the subsequent risk of ALS, and the challenges faced in drawing a conclusion about it, it is unlikely that prospective cohort studies will be designed de novo to examine this question. For this reason, the committee recommends that existing cohort studies designed for other outcomes be explored for their suitability to assess the relationship between ALS and military service.
From page 38...
... The advantage of traditional cohort studies or nested case-control studies is that they provide a well-defined base population (although not necessarily representative of the general population) , and information for a number of potential confounding variables has been collected prior to disease occurrence, thus avoiding recall bias.
From page 39...
... In addition, in case-control studies, it is easier to attain a more rigorous case definition applying modified El Escorial diagnostic criteria and to ensure the exclusion of motor neuron disease other than ALS (such as primary lateral sclerosis)
From page 40...
... The committee recommends that VA identify putative risk factors relevant to military service, particularly risk factors common to military service since the 1940s, and conduct in-depth systematic literature reviews on them. BOX 3.1 Putative ALS Risk Factors Relevant to Military Service • Intensive physical activity • Life-style factors o Cigarette-smoking o Alcohol consumption • Trauma • Transmissible agents • Occupational toxicants o Lead o Pesticides • Environmental toxicants RECOMMENDATION 3: CONDUCT ADDITIONAL EPIDEMIOLOGIC STUDIES OF THE ASSOCIATION BETWEEN MILITARY SERVICE AND AMYOTROPHIC LATERAL SCLEROSIS In reaching the conclusion of limited and suggestive evidence of an association between military service and later development of ALS, the committee was hampered by the paucity of well-conducted epidemiologic studies that are sufficiently free of bias.
From page 41...
... 2004. The National Registry of Veterans with Amyotrophic Lateral Sclerosis: Department of Veterans Affairs Cooperative Studies Program (CSP)

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