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Shirke AV, Radke EG, Lin C, Blain R, Vetter N, Lemeris C, Hartman P, Hubbard H, Angrish M, Arzuaga X, Congleton J, Davis A, Dishaw LV, Jones R, Judson R, Kaiser JP, Kraft A, Lizarraga L, Noyes PD, Patlewicz G, Taylor M, Williams AJ, Thayer KA, Carlson LM. Expanded Systematic Evidence Map for Hundreds of Per- and Polyfluoroalkyl Substances (PFAS) and Comprehensive PFAS Human Health Dashboard. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:26001. [PMID: 38319881 PMCID: PMC10846678 DOI: 10.1289/ehp13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) encompass a class of chemically and structurally diverse compounds that are extensively used in industry and detected in the environment. The US Environmental Protection Agency (US EPA) 2021 PFAS Strategic Roadmap describes national research plans to address the challenge of PFAS. OBJECTIVES Systematic Evidence Map (SEM) methods were used to survey and summarize available epidemiological and mammalian bioassay evidence that could inform human health hazard identification for a set of 345 PFAS that were identified by the US EPA's Center for Computational Toxicology and Exposure (CCTE) for in vitro toxicity and toxicokinetic assay testing and through interagency discussions on PFAS of interest. This work builds from the 2022 evidence map that collated evidence on a separate set of ∼ 150 PFAS. Like our previous work, this SEM does not include PFAS that are the subject of ongoing or completed assessments at the US EPA. METHODS SEM methods were used to search, screen, and inventory mammalian bioassay and epidemiological literature from peer-reviewed and gray literature sources using manual review and machine-learning software. For each included study, study design details and health end points examined were summarized in interactive web-based literature inventories. Some included studies also underwent study evaluation and detailed extraction of health end point data. All underlying data is publicly available online as interactive visuals with downloadable metadata. RESULTS More than 13,000 studies were identified from scientific databases. Screening processes identified 121 mammalian bioassay and 111 epidemiological studies that met screening criteria. Epidemiological evidence (available for 12 PFAS) mostly assessed the reproductive, endocrine, developmental, metabolic, cardiovascular, and immune systems. Mammalian bioassay evidence (available for 30 PFAS) commonly assessed effects in the reproductive, whole-body, nervous, and hepatic systems. Overall, 41 PFAS had evidence across mammalian bioassay and epidemiology data streams (roughly 11% of searched chemicals). DISCUSSION No epidemiological and/or mammalian bioassay evidence were identified for most of the PFAS included in our search. Results from this SEM, our 2022 SEM on ∼ 150 PFAS, and other PFAS assessment products from the US EPA are compiled into a comprehensive PFAS dashboard that provides researchers and regulators an overview of the current PFAS human health landscape including data gaps and can serve as a scoping tool to facilitate prioritization of PFAS-related research and/or risk assessment activities. https://doi.org/10.1289/EHP13423.
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Affiliation(s)
- Avanti V. Shirke
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), US Environmental Protection Agency (US EPA), Washington, DC, USA
| | - Elizabeth G. Radke
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), US Environmental Protection Agency (US EPA), Washington, DC, USA
| | | | | | | | | | | | | | | | - Xabier Arzuaga
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), US Environmental Protection Agency (US EPA), Washington, DC, USA
| | - Johanna Congleton
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), US Environmental Protection Agency (US EPA), Washington, DC, USA
| | - Allen Davis
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), US Environmental Protection Agency (US EPA), Washington, DC, USA
| | | | - Ryan Jones
- Center for Public Health and Environmental Assessment, Health & Environmental Effects Assessment Division (HEEAD), US EPA, Durham, North Carolina, USA
| | - Richard Judson
- Center for Computational Toxicology and Exposure (CCTE), US EPA, Durham, North Carolina, USA
| | | | - Andrew Kraft
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), US Environmental Protection Agency (US EPA), Washington, DC, USA
| | | | - Pamela D. Noyes
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), US Environmental Protection Agency (US EPA), Washington, DC, USA
| | - Grace Patlewicz
- Center for Computational Toxicology and Exposure (CCTE), US EPA, Durham, North Carolina, USA
| | | | - Antony J. Williams
- Center for Computational Toxicology and Exposure (CCTE), US EPA, Durham, North Carolina, USA
| | | | - Laura M. Carlson
- Center for Public Health and Environmental Assessment, Health & Environmental Effects Assessment Division (HEEAD), US EPA, Durham, North Carolina, USA
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Sillman D, Rigolon A, Browning MHEM, Yoon HV, McAnirlin O. Do sex and gender modify the association between green space and physical health? A systematic review. ENVIRONMENTAL RESEARCH 2022; 209:112869. [PMID: 35123971 DOI: 10.1016/j.envres.2022.112869] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
A growing literature shows that green space can have protective effects on human health. As a marginalized group, women often have worse life outcomes than men, including disparities in some health outcomes. Given their marginalization, women might have "more to gain" than men from living near green spaces. Yet, limited research has deliberately studied whether green space-health associations are stronger for women or men. We conducted a systematic review to synthesize empirical evidence on whether sex or gender modifies the protective associations between green space and seven physical health outcomes (cardiovascular disease, cancer, diabetes, general physical health, non-malignant respiratory disease, mortality, and obesity-related health outcomes). After searching five databases, we identified 62 articles (including 81 relevant analyses) examining whether such effect modification existed. We classified analyses based on whether green space-health were stronger for women, no sex/gender differences were detected, or such associations were stronger for men. Most analyses found that green space-physical health associations were stronger for women than for men when considering study results across all selected health outcomes. Also, women showed stronger protective associations with green space than men for obesity-related outcomes and mortality. Additionally, the protective green space-health associations were slightly stronger among women for green land cover (greenness, NDVI) than for public green space (parks), and women were also favored over men when green space was measured very close to one's home (0-500 m). Further, the green space-health associations were stronger for women than for men in Europe and North America, but not in other continents. As many government agencies and nongovernmental organizations worldwide work to advance gender equity, our review shows that green space could help reduce some gender-based health disparities. More robust empirical studies (e.g., experimental) are needed to contribute to this body of evidence.
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Affiliation(s)
- Delaney Sillman
- Department of City & Metropolitan Planning, The University of Utah, Salt Lake City, UT, 84112, USA.
| | - Alessandro Rigolon
- Department of City & Metropolitan Planning, The University of Utah, Salt Lake City, UT, 84112, USA.
| | - Matthew H E M Browning
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, 29634, USA.
| | - Hyunseo Violet Yoon
- Department of Recreation, Sport, and Tourism, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA.
| | - Olivia McAnirlin
- Department of Parks, Recreation and Tourism Management, Clemson University, Clemson, SC, 29634, USA.
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Carlson LM, Angrish M, Shirke AV, Radke EG, Schulz B, Kraft A, Judson R, Patlewicz G, Blain R, Lin C, Vetter N, Lemeris C, Hartman P, Hubbard H, Arzuaga X, Davis A, Dishaw LV, Druwe IL, Hollinger H, Jones R, Kaiser JP, Lizarraga L, Noyes PD, Taylor M, Shapiro AJ, Williams AJ, Thayer KA. Systematic Evidence Map for Over One Hundred and Fifty Per- and Polyfluoroalkyl Substances (PFAS). ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:56001. [PMID: 35580034 PMCID: PMC9113544 DOI: 10.1289/ehp10343] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are a large class of synthetic (man-made) chemicals widely used in consumer products and industrial processes. Thousands of distinct PFAS exist in commerce. The 2019 U.S. Environmental Protection Agency (U.S. EPA) Per- and Polyfluoroalkyl Substances (PFAS) Action Plan outlines a multiprogram national research plan to address the challenge of PFAS. One component of this strategy involves the use of systematic evidence map (SEM) approaches to characterize the evidence base for hundreds of PFAS. OBJECTIVE SEM methods were used to summarize available epidemiological and animal bioassay evidence for a set of ∼ 150 PFAS that were prioritized in 2019 by the U.S. EPA's Center for Computational Toxicology and Exposure (CCTE) for in vitro toxicity and toxicokinetic assay testing. METHODS Systematic review methods were used to identify and screen literature using manual review and machine-learning software. The Populations, Exposures, Comparators, and Outcomes (PECO) criteria were kept broad to identify mammalian animal bioassay and epidemiological studies that could inform human hazard identification. A variety of supplemental content was also tracked, including information on in vitro model systems; exposure measurement-only studies in humans; and absorption, distribution, metabolism, and excretion (ADME). Animal bioassay and epidemiology studies meeting PECO criteria were summarized with respect to study design, and health system(s) were assessed. Because animal bioassay studies with ≥ 21 -d exposure duration (or reproductive/developmental study design) were most useful to CCTE analyses, these studies underwent study evaluation and detailed data extraction. All data extraction is publicly available online as interactive visuals with downloadable metadata. RESULTS More than 40,000 studies were identified from scientific databases. Screening processes identified 44 animal and 148 epidemiology studies from the peer-reviewed literature and 95 animal and 50 epidemiology studies from gray literature that met PECO criteria. Epidemiological evidence (available for 15 PFAS) mostly assessed the reproductive, endocrine, developmental, metabolic, cardiovascular, and immune systems. Animal evidence (available for 40 PFAS) commonly assessed effects in the reproductive, developmental, urinary, immunological, and hepatic systems. Overall, 45 PFAS had evidence across animal and epidemiology data streams. DISCUSSION Many of the ∼ 150 PFAS were data poor. Epidemiological and animal evidence were lacking for most of the PFAS included in our search. By disseminating this information, we hope to facilitate additional assessment work by providing the initial scoping literature survey and identifying key research needs. Future research on data-poor PFAS will help support a more complete understanding of the potential health effects from PFAS exposures. https://doi.org/10.1289/EHP10343.
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Affiliation(s)
- Laura M Carlson
- Center for Public Health and Environmental Assessment, Health & Environmental Effects Assessment Division (HEEAD), U.S. Environmental Protection Agency (U.S. EPA), Durham, North Carolina, USA
| | - Michelle Angrish
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Durham, North Carolina, USA
| | - Avanti V Shirke
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Washington, District of Columbia, USA
| | - Elizabeth G Radke
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Washington, District of Columbia, USA
| | - Brittany Schulz
- Oak Ridge Associated Universities (ORAU), Oak Ridge, Tennessee, USA
| | - Andrew Kraft
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Washington, District of Columbia, USA
| | - Richard Judson
- Center for Computational Toxicology and Exposure (CCTE), U.S. EPA, Durham, North Carolina, USA
| | - Grace Patlewicz
- Center for Computational Toxicology and Exposure (CCTE), U.S. EPA, Durham, North Carolina, USA
| | | | | | | | | | | | | | - Xabier Arzuaga
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Washington, District of Columbia, USA
| | - Allen Davis
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Washington, District of Columbia, USA
| | - Laura V Dishaw
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Durham, North Carolina, USA
| | - Ingrid L Druwe
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Durham, North Carolina, USA
| | - Hillary Hollinger
- Center for Public Health and Environmental Assessment, Health & Environmental Effects Assessment Division (HEEAD), U.S. Environmental Protection Agency (U.S. EPA), Durham, North Carolina, USA
| | - Ryan Jones
- Center for Public Health and Environmental Assessment, Health & Environmental Effects Assessment Division (HEEAD), U.S. Environmental Protection Agency (U.S. EPA), Durham, North Carolina, USA
| | - J Phillip Kaiser
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Cincinnati, Ohio, USA
| | - Lucina Lizarraga
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Cincinnati, Ohio, USA
| | - Pamela D Noyes
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Washington, District of Columbia, USA
| | - Michele Taylor
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Durham, North Carolina, USA
| | - Andrew J Shapiro
- Center for Public Health and Environmental Assessment, Health & Environmental Effects Assessment Division (HEEAD), U.S. Environmental Protection Agency (U.S. EPA), Durham, North Carolina, USA
| | - Antony J Williams
- Center for Computational Toxicology and Exposure (CCTE), U.S. EPA, Durham, North Carolina, USA
| | - Kristina A Thayer
- Center for Public Health and Environmental Assessment, Chemical & Pollutant Assessment Division (CPAD), U.S. EPA, Durham, North Carolina, USA
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Han X, Lu T, Hu Y, Duan J, Guan Y, Huang X, Zhou J, Huang R, Tang M, Sun R, Wang Y, Song L, Xia Y, Wang X, Chen M, Chen T. A metabolomic study on the effect of prenatal exposure to Benzophenone-3 on spontaneous fetal loss in mice. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 233:113347. [PMID: 35219956 DOI: 10.1016/j.ecoenv.2022.113347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
Benzophenone-3 (BP-3) is widely used in a variety of cosmetics and is prevalent in drinking water or food, and women were under notable high exposure burden of BP-3. Reports show the associations between prenatal exposure to BP-3 and the risk of fetal loss, but its underlying mechanism remains largely unknown. Pregnant ICR mice were gavaged with BP-3 from gestational day (GD) 0 to GD 6 at doses of 0.1, 10 and 1000 mg/kg/day. The samples were collected on GD 12. Ultra-performance liquid chromatography coupled with mass spectrometry-based metabolomics was used to detect metabolome changes in fetal mice, the uterus and the placenta to identify the underlying mechanism. The results showed that the body weight and relative organ weights of the liver, brain and uterus of pregnant mice were not significantly changed between the control group and the treatment group. BP-3 increased fetal loss, and induced placental thrombosis and tissue necrosis with enhancement of platelet aggregation. Metabolomic analysis revealed that fructose and mannose metabolism, the TCA cycle, arginine and proline metabolism in the fetus, arginine and proline metabolism and biotin metabolism in the uterus, and arginine biosynthesis and pyrimidine metabolism in the placenta were the key changed pathways involved in the above changes. Our study indicates that exposure to BP-3 can induce placental thrombosis and fetal loss via the disruption of maternal and fetal metabolism in mice, providing novel insights into the influence of BP-3 toxicity on the female reproductive system.
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Affiliation(s)
- Xiumei Han
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ting Lu
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Wujin District Center for Disease Control and Prevention, Changzhou 213164, China
| | - Yanhui Hu
- Department of Public Health, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, China
| | - Jiawei Duan
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yusheng Guan
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xiaomin Huang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jingjing Zhou
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Rui Huang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Miaomiao Tang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Rongli Sun
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
| | - Ying Wang
- Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - Ling Song
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xinru Wang
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Minjian Chen
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| | - Ting Chen
- State Key Laboratory of Reproductive Medicine, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Nanjing Maternity and Child Health Care Institute, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China.
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Ho V, Pelland-St-Pierre L, Gravel S, Bouchard MF, Verner MA, Labrèche F. Endocrine disruptors: Challenges and future directions in epidemiologic research. ENVIRONMENTAL RESEARCH 2022; 204:111969. [PMID: 34461123 DOI: 10.1016/j.envres.2021.111969] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Public concern about the impact of endocrine disrupting chemicals (EDCs) on both humans and the environment is growing steadily. Epidemiologic research provides key information towards our understanding of the relationship between environmental exposures like EDCs and human health outcomes. Intended for researchers in disciplines complementary to epidemiology, this paper highlights the importance and challenges of epidemiologic research in order to present the key elements pertaining to the design and interpretation of an epidemiologic study on EDCs. The conduct of observational studies on EDCs derives from a thoughtful research question, which will help determine the subsequent methodological choices surrounding the careful selection of the study population (including the comparison group), the adequate ascertainment of exposure(s) and outcome(s) of interest, and the application of methodological and statistical concepts more specific to epidemiology. The interpretation of epidemiologic results may be arduous due to the latency occurring between EDC exposure and certain outcome(s), the complexity in capturing EDC exposure(s), and traditional methodological and statistical issues that also deserve consideration (e.g., confounding, effect modification, non-monotonic responses). Moving forward, we strongly advocate for an integrative approach of expertise in the fields of epidemiology, exposure science, risk assessment and toxicology to adequately study the health risks associated with EDCs while tackling their challenges.
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Affiliation(s)
- V Ho
- Health Innovation and Evaluation Hub, Université de Montréal Hospital Research Centre (CRCHUM), Montréal, Québec, Canada; Department of Social and Preventive Medicine, School of Public Health (ESPUM), Université de Montréal, Montréal, Québec, Canada.
| | - L Pelland-St-Pierre
- Health Innovation and Evaluation Hub, Université de Montréal Hospital Research Centre (CRCHUM), Montréal, Québec, Canada; Department of Social and Preventive Medicine, School of Public Health (ESPUM), Université de Montréal, Montréal, Québec, Canada; Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS Centre-Sud, Montréal, Québec, Canada
| | - S Gravel
- . Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montréal, Québec, Canada
| | - M F Bouchard
- Department of Environmental and Occupational Health, School of Public Health (ESPUM), Université de Montréal, Montréal, Québec, Canada; CHU Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
| | - M-A Verner
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS Centre-Sud, Montréal, Québec, Canada; Department of Environmental and Occupational Health, School of Public Health (ESPUM), Université de Montréal, Montréal, Québec, Canada
| | - F Labrèche
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS Centre-Sud, Montréal, Québec, Canada; . Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montréal, Québec, Canada; Department of Environmental and Occupational Health, School of Public Health (ESPUM), Université de Montréal, Montréal, Québec, Canada
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Lagorio S, Blettner M, Baaken D, Feychting M, Karipidis K, Loney T, Orsini N, Röösli M, Paulo MS, Elwood M. The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A protocol for a systematic review of human observational studies. ENVIRONMENT INTERNATIONAL 2021; 157:106828. [PMID: 34433115 PMCID: PMC8484862 DOI: 10.1016/j.envint.2021.106828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has an ongoing project to assess potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMF) in the general and working population. Here we present the protocol for a systematic review of the scientific literature on cancer hazards from exposure to RF-EMF in humans, commissioned by the WHO as part of that project. OBJECTIVE To assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to RF-EMF and risk of neoplastic diseases. ELIGIBILITY CRITERIA We will include cohort and case-control studies investigating neoplasia risks in relation to three types of exposure to RF-EMF: near-field, head-localized, exposure from wireless phone use (SR-A); far-field, whole body, environmental exposure from fixed-site transmitters (SR-B); near/far-field occupational exposures from use of handheld transceivers or RF-emitting equipment in the workplace (SR-C). While no restriction on tumour type will be applied, we will focus on selected neoplasms of the central nervous system (brain, meninges, pituitary gland, acoustic nerve) and salivary gland tumours (SR-A); brain tumours and leukaemias (SR-B, SR-C). INFORMATION SOURCES Eligible studies will be identified through Medline, Embase, and EMF-Portal. RISK-OF-BIAS ASSESSMENT We will use a tailored version of the OHAT's tool to evaluate the study's internal validity. DATA SYNTHESIS We will consider separately studies on different tumours, neoplasm-specific risks from different exposure sources, and a given exposure-outcome pair in adults and children. When a quantitative synthesis of findings can be envisaged, the main aims of the meta-analysis will be to assess the strength of association and the shape of the exposure-response relationship; to quantify the degree of heterogeneity across studies; and explore the sources of inconsistency (if any). When a meta-analysis is judged inappropriate, we will perform a narrative synthesis, complemented by a structured tabulation of results and appropriate visual displays. EVIDENCE ASSESSMENT Confidence in evidence will be assessed in line with the GRADE approach. FUNDING This project is supported by the World Health Organization. Co-financing was provided by the New Zealand Ministry of Health; the Istituto Superiore di Sanità in its capacity as a WHO Collaborating Centre for Radiation and Health; ARPANSA as a WHO Collaborating Centre for Radiation Protection. REGISTRATION PROSPERO CRD42021236798.
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Affiliation(s)
- Susanna Lagorio
- Department of Oncology and Molecular Medicine, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy.
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany.
| | - Dan Baaken
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany.
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Ken Karipidis
- Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie, VIC, Australia.
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Marilia Silva Paulo
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Integrated Risk Information System (IRIS) response to "Assessing risk of bias in human environmental epidemiology studies using three tools: different conclusions from different tools". Syst Rev 2021; 10:235. [PMID: 34419159 PMCID: PMC8380400 DOI: 10.1186/s13643-021-01783-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
"Assessing risk of bias in human environmental epidemiology studies using three tools: different conclusions from different tools," a recent publication in this journal, applied the study evaluation approach developed by the U.S. Environmental Protection Agency's Integrated Risk Information System (IRIS), as well as other approaches, to a set of studies examining polybrominated diphenyl ethers (PBDEs) and neurodevelopment. They concluded that use of the IRIS approach resulted in exclusion of studies, which would lead to hazard conclusions based on an incomplete body of evidence. As scientists in the IRIS program, we support the comparison of approaches to improve systematic review methods for environmental exposures; however, we believe the IRIS approach was misrepresented. In this letter, we demonstrate that the ratings attributed to the IRIS approach were not consistent with our own application of the tool. We also clarify the use of studies rated as "low confidence" and the use of an overall study confidence rating in our systematic reviews. In conclusion, the IRIS study evaluation approach is a transparent method to inform certainty in our evidence synthesis decisions and ensures consistency in the development of IRIS health assessments.
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Boscutti A, Delvecchio G, Pigoni A, Cereda G, Ciappolino V, Bellani M, Fusar-Poli P, Brambilla P. Olfactory and gustatory dysfunctions in SARS-CoV-2 infection: A systematic review. Brain Behav Immun Health 2021; 15:100268. [PMID: 34027497 PMCID: PMC8129998 DOI: 10.1016/j.bbih.2021.100268] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Among Coronavirus Disease 2019 (COVID-19) manifestations, Olfactory (OD) and Gustatory (GD) Dysfunctions (OGD) have drawn considerable attention, becoming a sort of hallmark of the disease. Many have speculated on the pathogenesis and clinical characteristics of these disturbances; however, no definite answers have been produced on the topic. With this systematic review, we aimed to collect all the available evidence regarding the prevalence of OGD, the timing of their onset and their resolution, their rate of recovery and their role as diagnostic and prognostic tools for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. METHODS A systematic review comprising all the observational studies that reported the prevalence and/or the longitudinal trajectories of OGD in COVID-19 patients, as self-reported by patients or measured through objective psychophysical tests. RESULTS After the selection process, 155 studies were included, with a total of 70,920 patients and 105,291 not-infected individuals. Prevalence reports were extremely variable across studies, with wide ranges for OD (0%-98%) and GD (0-89%) prevalence. OGD occurred early during the disease course and only rarely preceded other symptoms; out of 30 studies with a follow-up time of at least 20 days, only in 5 studies OGD fully resolved in more than 90% of patients. OGD had low sensitivity and high specificity for SARS-CoV-2 infection; accuracy of OD and GD for infection identification was higher than 80% in 10 out of 33 studies and in 8 out of 22 studies considered, respectively. 28 out of 30 studies that studied the association between OGD and disease severity found how OGD were associated with lower rates of severe pneumonia, hospitalization and mortality. CONCLUSIONS OGD seem to be highly prevalent in SARS-CoV-2 infection. They occur early, concomitantly with other symptoms and often persist after recovery, in some cases for months; whether a full recovery eventually occurs in all cases is not clear yet. OGD are good predictors of SARS-CoV-2 infection and are associated with a milder disease course.
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Affiliation(s)
- A. Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - G. Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - A. Pigoni
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - G. Cereda
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - V. Ciappolino
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122, Milan, Italy
| | - M. Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
- UOC Psychiatry, Azienda Ospedaliera Universitaria Integrata, Verona (AOUI), Italy
| | - P. Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - P. Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122, Milan, Italy
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9
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Yost EE, Galizia A, Kapraun DF, Persad AS, Vulimiri SV, Angrish M, Lee JS, Druwe IL. Health Effects of Naphthalene Exposure: A Systematic Evidence Map and Analysis of Potential Considerations for Dose-Response Evaluation. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:76002. [PMID: 34251878 PMCID: PMC8274693 DOI: 10.1289/ehp7381] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Naphthalene is a polycyclic aromatic hydrocarbon that has been associated with health effects, including cancer. As the state of the science on naphthalene toxicity continues to evolve, updated toxicity reference value(s) may be required to support human health risk assessment. OBJECTIVES We present a systematic evidence map of studies that could be used to derive toxicity reference value(s) for naphthalene. METHODS Human and animal health effect studies and physiologically based pharmacokinetic (PBPK) models were identified from a literature search based on populations, exposures, comparators, and outcomes (PECO) criteria. Human and animal studies meeting PECO criteria were refined to a smaller subset considered most informative for deriving chronic reference value(s), which are preferred for assessing risk to the general public. This subset was evaluated for risk of bias and sensitivity, and the suitability of each study for dose-response analysis was qualitatively assessed. Lowest observed adverse effect levels (LOAELs) were extracted and summarized. Other potentially relevant studies (e.g., mechanistic and toxicokinetic studies) were tracked as supplemental information but not evaluated further. Existing reference values for naphthalene are also summarized. RESULTS We identified 26 epidemiology studies and 16 animal studies that were considered most informative for further analysis. Eleven PBPK models were identified. The available epidemiology studies generally had significant risk of bias and/or sensitivity concerns and were mostly found to have low suitability for dose-response analysis due to the nature of the exposure measurements. The animal studies had fewer risk of bias and sensitivity concerns and were mostly found to be suitable for dose-response analysis. CONCLUSION Although both epidemiological and animal studies of naphthalene provide weight of evidence for hazard identification, the available animal studies appear more suitable for reference value derivation. PBPK models and mechanistic and toxicokinetic data can be applied to extrapolate these animal data to humans, considering mode of action and interspecies metabolic differences. https://doi.org/10.1289/EHP7381.
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Affiliation(s)
- Erin E. Yost
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Audrey Galizia
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Dustin F. Kapraun
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Amanda S. Persad
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Suryanarayana V. Vulimiri
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Michelle Angrish
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Janice S. Lee
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
| | - Ingrid L. Druwe
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Washington, District of Columbia, USA
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10
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Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052563. [PMID: 33806546 PMCID: PMC7967323 DOI: 10.3390/ijerph18052563] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.
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11
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Arroyave WD, Mehta SS, Guha N, Schwingl P, Taylor KW, Glenn B, Radke EG, Vilahur N, Carreón T, Nachman RM, Lunn RM. Challenges and recommendations on the conduct of systematic reviews of observational epidemiologic studies in environmental and occupational health. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:21-30. [PMID: 32415298 PMCID: PMC7666644 DOI: 10.1038/s41370-020-0228-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 05/05/2023]
Abstract
Systematic reviews are powerful tools for drawing causal inference for evidence-based decision-making. Published systematic reviews and meta-analyses of environmental and occupational epidemiology studies have increased dramatically in recent years; however, the quality and utility of published reviews are variable. Most methodologies were adapted from clinical epidemiology and have not been adequately modified to evaluate and integrate evidence from observational epidemiology studies assessing environmental and occupational hazards, especially in evaluating the quality of exposure assessments. Although many reviews conduct a systematic and transparent assessment for the potential for bias, they are often deficient in subsequently integrating across a body of evidence. A cohesive review considers the impact of the direction and magnitude of potential biases on the results, systematically evaluates important scientific issues such as study sensitivity and effect modifiers, identifies how different studies complement each other, and assesses other potential sources of heterogeneity. Given these challenges of conducting informative systematic reviews of observational studies, we provide a series of specific recommendations based on practical examples for cohesive evidence integration to reach an overall conclusion on a body of evidence to better support policy making in public health.
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Affiliation(s)
| | - Suril S Mehta
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Neela Guha
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Pam Schwingl
- Integrated Laboratory Systems, Morrisville, NC, USA
| | - Kyla W Taylor
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Barbara Glenn
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Elizabeth G Radke
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Nadia Vilahur
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Tania Carreón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Rebecca M Nachman
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Ruth M Lunn
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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12
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Green Gentrification and Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030907. [PMID: 33494268 PMCID: PMC7908481 DOI: 10.3390/ijerph18030907] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/25/2022]
Abstract
Urban greening initiatives are often linked to enhanced human health and wellbeing, but they can also be a driver of gentrification. To date, few studies have focused on how green gentrification shapes health. In this scoping review, we analyzed existing peer-reviewed research on how greening initiatives in gentrifying neighborhoods impact health, well-being, and health pathways (e.g., physical activity, affordable housing). Using a multi-step approach to scoping the literature (including searches in PubMed, JSTOR, and Google Scholar), we identified 15 empirical studies that met our inclusion criteria. We found studies focusing on green space use, physical activity, sense of community, safety, and self-reported health. Overall, longtime, marginalized residents are negatively impacted by green gentrification as they experience a lower sense of community, feel that they do not belong in green space, and, in many studies, use green space less often than newcomers. Overall, the research in this area is limited, and more studies on mental health and cardiovascular health markers could advance this literature. Based on the limited available evidence, we suggest that public health, urban planning, and parks professionals could collaborate to enhance the use of green space for marginalized residents and their feelings of inclusion in gentrifying areas.
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13
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Verbeek J, Oftedal G, Feychting M, van Rongen E, Rosaria Scarfì M, Mann S, Wong R, van Deventer E. Prioritizing health outcomes when assessing the effects of exposure to radiofrequency electromagnetic fields: A survey among experts. ENVIRONMENT INTERNATIONAL 2021; 146:106300. [PMID: 33395944 DOI: 10.1016/j.envint.2020.106300] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 05/23/2023]
Abstract
Exposure to radiofrequency (RF) electromagnetic fields (EMF) (frequencies of 100 kHz to 300 GHz) has been steadily increasing. In addition to heat-related effects of RF EMF, other yet-unspecified biological effects, might exist which could possibly lead to health effects. Given the large number of health endpoints that have been studied, we wanted to prioritize those that would merit systematic reviews. We developed a survey listing of all health endpoints reported in the literature and we asked 300 RF EMF experts and researchers to prioritize these health effects for systematic review as critical, important or unimportant. We also asked the experts to provide the rationale for their prioritization. Of the 300 RF EMF experts queried, 164 (54%) responded. They rated cancer, heat-related effects, adverse birth outcomes, electromagnetic hypersensitivity, cognitive impairment, adverse pregnancy outcomes and oxidative stress as outcomes most critical regarding RF EMF exposure. For these outcomes, systematic reviews are needed. For heat-related outcomes, the experts based their ranking of the critical outcomes on what is known from human or animal studies, and for cancer and other outcomes, they based their rating also on public concern. To assess health risks of an exposure in a robust manner, it is important to prioritize the health outcomes that should be systematically reviewed. Here we have shown that it feasible to do so in an inclusive and transparent way.
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Affiliation(s)
- Jos Verbeek
- Amsterdam University Medical Center, Cochrane Work Review Group, Amsterdam, the Netherlands.
| | - Gunnhild Oftedal
- Department of Electronic Systems, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eric van Rongen
- Health Council of the Netherlands, Den Haag, the Netherlands
| | - Maria Rosaria Scarfì
- National Research Council, Institute for Electromagnetic Sensing of the Environment, Naples, Italy
| | - Simon Mann
- Public Health England, Chilton, Didcot, United Kingdom
| | | | - Emilie van Deventer
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
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14
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Radke EG, Yost EE, Roth N, Sathyanarayana S, Whaley P. Application of US EPA IRIS systematic review methods to the health effects of phthalates: Lessons learned and path forward. ENVIRONMENT INTERNATIONAL 2020; 145:105820. [PMID: 33081976 DOI: 10.1016/j.envint.2020.105820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Elizabeth G Radke
- US EPA Center for Public Health and Environmental Assessment, Washington, DC, United States.
| | - Erin E Yost
- US EPA Center for Public Health and Environmental Assessment, Research Triangle Park, NC, United States
| | - Nicolas Roth
- Swiss Centre for Applied Human Toxicology, University of Basel, Basel, Switzerland
| | - Sheela Sathyanarayana
- University of Washington and Seattle Children's Research Institute, Seattle, WA, United States
| | - Paul Whaley
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK
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15
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LaKind JS, Naiman J, Burns CJ. Translation of Exposure and Epidemiology for Risk Assessment: A Shifting Paradigm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124220. [PMID: 32545710 PMCID: PMC7345532 DOI: 10.3390/ijerph17124220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
Risk assessment is a well-established process used for various types of public health decision-making, such as setting chemical site clean-up levels, developing limits on exposures to chemicals in soil, water, air and food, and determining occupational exposure limits[...].
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Affiliation(s)
- Judy S. LaKind
- LaKind Associates, University of Maryland School of Medicine, 106 Oakdale Avenue, Catonsville, MD 21228, USA
| | - Joshua Naiman
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, USA;
| | - Carol J. Burns
- Burns Epidemiology Consulting, 255 W. Sunset Ct., Sanford, MI 48657, USA;
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