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Romero Starke K, Bolm-Audorff U, Reissig D, Seidler A. Dose-response-relationship between occupational exposure to diesel engine emissions and lung cancer risk: A systematic review and meta-analysis. Int J Hyg Environ Health 2024; 256:114299. [PMID: 38194821 DOI: 10.1016/j.ijheh.2023.114299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In 2012, the International Agency for Research on Cancer (IARC) concluded that diesel engine emissions (DEE) emissions cause cancer in humans. However, there is still controversy surrounding this conclusion, due to several studies since the IARC decision citing a lack of evidence of a dose-response relationship. OBJECTIVES Through a systematic review, we aimed to evaluate all evidence on the association between occupational DEE and lung cancer to investigate whether there is an increased risk of lung cancer for workers exposed to DEE and if so, to describe the dose-response relationship. METHODS We registered the review protocol with PROSPERO and searched for observational studies in relevant literature databases. Two independent reviewers screened the studies' titles/abstracts and full texts, and extracted and assessed their quality. Studies with no direct DEE measurement but with information on length of exposure for high-risk occupations were assigned exposure values based on the DEE Job-Exposure-Matrix (DEE-JEM). After assessing quality and informativeness, we selected appropriate studies for the dose-response meta-analysis. RESULTS Sixty-five reports (from thirty-seven studies) were included in the review; one had a low risk of bias (RoB) (RR per 10 μg/m3-years: 1.014 [95%CI 1.007-1.021]). There was an increased, statistically significant risk of lung cancer with increasing DEE exposure for all studies (RR per 10 μg/m3-years = 1.013 [95%CI 1.004-1.021]) as well as for studies with a low RoB in the exposure category (RR per 10 μg/m3-years = 1.008 [95% CI1.001-1.015]). We obtained a doubling dose of 555 μg/m3-years for all studies and 880 μg/m3-years for studies with high quality in the exposure assessment. DISCUSSION We found a linear positive dose-response relationship for studies with high quality in the exposure domain, even though all studies had an overall high risk of bias. Current threshold levels for DEE exposure at the workplace should be reconsidered.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Ulrich Bolm-Audorff
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Sanmarchi F, Bucci A, Nuzzolese AG, Carullo G, Toscano F, Nante N, Golinelli D. A step-by-step researcher's guide to the use of an AI-based transformer in epidemiology: an exploratory analysis of ChatGPT using the STROBE checklist for observational studies. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-36. [PMID: 37361298 PMCID: PMC10215032 DOI: 10.1007/s10389-023-01936-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023]
Abstract
Objective This study aims at investigating how AI-based transformers can support researchers in designing and conducting an epidemiological study. To accomplish this, we used ChatGPT to reformulate the STROBE recommendations into a list of questions to be answered by the transformer itself. We then qualitatively evaluated the coherence and relevance of the transformer's outputs. Study design Descriptive study. Methods We first chose a study to be used as a basis for the simulation. We then used ChatGPT to transform each STROBE checklist's item into specific prompts. Each answer to the respective prompt was evaluated by independent researchers in terms of coherence and relevance. Results The mean scores assigned to each prompt were heterogeneous. On average, for the coherence domain, the overall mean score was 3.6 out of 5.0, and for relevance it was 3.3 out of 5.0. The lowest scores were assigned to items belonging to the Methods section of the checklist. Conclusions ChatGPT can be considered as a valuable support for researchers in conducting an epidemiological study, following internationally recognized guidelines and standards. It is crucial for the users to have knowledge on the subject and a critical mindset when evaluating the outputs. The potential benefits of AI in scientific research and publishing are undeniable, but it is crucial to address the risks, and the ethical and legal consequences associated with its use.
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Affiliation(s)
- Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
| | - Andrea Bucci
- Department of Economics and Law, University of Macerata, Macerata, Italy
| | | | - Gherardo Carullo
- Department of Italian and Supranational Public Law, University of Milan, Milan, Italy
| | | | - Nicola Nante
- Present Address: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy
- Present Address: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Zhang Y, Liu N, Li Y, Long Y, Baumgartner J, Adamkiewicz G, Bhalla K, Rodriguez J, Gemmell E. Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review. Environ Health 2023; 22:2. [PMID: 36604680 PMCID: PMC9814186 DOI: 10.1186/s12940-022-00955-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/29/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor-human health outcome pairs. METHOD On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard. RESULTS Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads. CONCLUSIONS This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.
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Affiliation(s)
- Yuyang Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Ningrui Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Yan Li
- School of Architecture, Tsinghua University, Beijing, China
| | - Ying Long
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, No. 1 Qinghuayuan, Haidian District, Beijing, 100084, China.
| | - Jill Baumgartner
- Institute for Health and Social Policy & Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan, School of Public Health, Boston, MA, USA
| | - Kavi Bhalla
- Public Health Sciences, University of Chicago, Chicago, IL, USA
| | | | - Emily Gemmell
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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4
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Shinohara J, Hanai S, Jung J, Song KH, Iwata M, Terasawa T. Association of Repeated Blood Cultures With Mortality in Adult Patients With Gram-Negative Bacilli Bacteremia: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 9:ofac568. [PMCID: PMC9745776 DOI: 10.1093/ofid/ofac568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022] Open
Abstract
Background Performing repeat blood cultures after an initial positive culture (ie, follow-up blood cultures [FUBCs]) in patients with gram-negative bacilli (GNB) bacteremia is controversial. We aimed to comprehensively review the association of FUBCs with improvement in patient-relevant clinical outcomes in GNB bacteremia. Methods We performed a systematic review and random-effects meta-analysis to calculate summary effect estimates. We used hazard ratios as the effect measure. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were length of treatment and length of hospital stay. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials (Central) without language restrictions from inception to April 29, 2022. Original clinical studies evaluating the association between FUBCs and mortality in adult patients with GNB bacteremia were included. FUBC details were reviewed. Two independent reviewers used the Risk of Bias in Non-randomised Studies of Interventions tool. Results We identified 9 eligible retrospective studies. In total, 7778 hospitalized patients with GNB bacteremia were included. The studies were clinically heterogeneous and had a critical risk of bias. The utilization of FUBCs varied across studies (18%–89%). Random-effects meta-analysis of covariate-adjusted estimates found that FUBC use was associated with reduced mortality. Although not a result of the meta-analysis, lengths of treatment and hospital stay were longer for patients with FUBCs than for those without. Adverse events were not reported. Conclusions FUBC acquisition was associated with lower mortality and longer hospital stay and treatment duration in GNB bacteremia. The risk of bias was critical, and no firm data were available to support mechanisms.
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Affiliation(s)
- Jun Shinohara
- Correspondence: Jun Shinohara, MD, Section of General Internal Medicine, Department of Emergency and General Internal Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukakecho, Toyoake 470-1192, Japan ()
| | - Shogo Hanai
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Jongtak Jung
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Mitsunaga Iwata
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Lunn RM, Mehta SS, Jahnke GD, Wang A, Wolfe MS, Berridge BR. Cancer Hazard Evaluations for Contemporary Needs: Highlights From New National Toxicology Program Evaluations and Methodological Advancements. J Natl Cancer Inst 2022; 114:1441-1448. [PMID: 36029241 PMCID: PMC9949597 DOI: 10.1093/jnci/djac164] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 08/23/2022] [Indexed: 01/04/2023] Open
Abstract
The National Toxicology Program strives to raise awareness of cancer hazards in our environment. Identifying cancer hazards is key to primary prevention, informing public health decision making, and decreasing the global cancer burden. In December 2021, the US congressionally mandated 15th Report on Carcinogens was released, adding 8 new substances to the cumulative report. Chronic infection with Helicobacter pylori is listed as "known to be a human carcinogen." Antimony trioxide and 6 haloacetic acids found as water disinfection by-products-dichloroacetic acid, dibromoacetic acid, bromochloroacetic acid, tribromoacetic acid, bromodichloroacetic acid, chlorodibromoacetic acid-are listed as "reasonably anticipated to be a human carcinogen." A new dashboard provides interactive visualization and interrogation of the 256 listed substances, their uses, and associated cancers. Also, the National Toxicology Program recently published a Cancer Hazard Assessment Report on exposure scenarios associated with circadian disruption, concluding that persistent night shift work can cause breast cancer and certain lighting conditions may cause cancer. As highlighted in these reports and evaluations, we are evolving our approaches to meet contemporary challenges. These approaches include focusing on real-world exposures and advancing our methods to address challenges in cancer hazard assessments (eg, developing more structured approaches to evaluate mechanistic data and incorporating read-across approaches to assess chemicals lacking adequate human or animal cancer data). To promote public health, we provide information on environmental health disparities and disease prevention. Building on these efforts, we aim to continue our contributions to the war on cancer, declared 50 years ago.
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Affiliation(s)
- Ruth M Lunn
- Correspondence to: Ruth M. Lunn, DrPH, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, P.O. Box 12233, MD K2-14, Research Triangle Park, NC 27709, USA (e-mail: )
| | | | - Gloria D Jahnke
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Amy Wang
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Mary S Wolfe
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Brian R Berridge
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Naghibzadeh-Tahami A, Khosravi Y, Es'haghi M, Haghdoost AA. Scoping Review of 5 Common Occupational Cancers and Their Related Exposures. Med J Islam Repub Iran 2022; 36:84. [PMID: 36128290 PMCID: PMC9448458 DOI: 10.47176/mjiri.36.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Occupational cancers can be avoided by removing dangerous chemicals from the workplace or limiting occupational exposure. Approximately, 10 major risk factors account for 85% of all occupational cancers. This scoping review study aimed to determine the most important chemical carcinogens related to 5 known occupational cancers. Methods: In this scoping review, we followed Arksey and O'Malley's 5-step framework. Four databases (PubMed, Web of Science, Google Scholar, Scopus) were systematically reviewed for relevant published papers from January 2000 to September 2021. Studies were included in this scoping review, which examined the effect of carcinogenic (definite and probable) chemical exposures on 5 known occupational cancers (lung, bladder, laryngeal, leukemia, and liver). We reported the types of occupational carcinogens, the geographical diversity of studies, extraction of relative risks (RRs), hazard ratios (HRs), or odds ratios (ORs), and identified gaps in the existing literature. Results: The highest number of studies was related to lung cancer (LC) (n = 26), bladder cancer (BC) (n = 11), laryngeal cancer (LaC) (n = 8), leukemia (LeC) (n = 3), and primary liver cancer (PLC) (n = 2), respectively. Most studies were performed in France and Canada (n = 8), Germany (n = 4), Finland (n = 3), Netherlands (n = 2), and Finland (n = 2), respectively. Furthermore, the most common occupational chemical carcinogens associated with the 5 known occupational cancers were asbestos, benzene, crystalline silica, polycyclic aromatic hydrocarbons (PAH), and diesel motor exhausts (DME). Conclusion: Although the attributable risk of occupational cancers in developing countries is much higher, a small proportion of studies were performed in these countries.
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Affiliation(s)
- Ahmad Naghibzadeh-Tahami
- Department of Biostatistics and Epidemiology, School of Public Health, Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Yahya Khosravi
- Department of Occupational Health and Safety Engineering, School of Health, Research Center for Health, Safety and Environment, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahboubeh Es'haghi
- Department of Occupational Health Engineering, School of Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali-Akbar Haghdoost
- Department of Biostatistics and Epidemiology, School of Public Health, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran,Corresponding author: Dr Ali-Akbar Haghdoost,
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7
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Oza HH, Lee MG, Boisson S, Pega F, Medlicott K, Clasen T. Occupational health outcomes among sanitation workers: A systematic review and meta-analysis. Int J Hyg Environ Health 2021; 240:113907. [PMID: 34942466 PMCID: PMC8837624 DOI: 10.1016/j.ijheh.2021.113907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/16/2021] [Accepted: 12/14/2021] [Indexed: 01/09/2023]
Abstract
Background Sanitation workers are essential to global public health and societal wellbeing. However, the health risks and outcomes associated with exposure to occupational risk factors among sanitation workers are neither well understood nor well quantified. We undertook a systematic review to (1) identify occupational risk factors among sanitation workers and (2) assess the effect of occupational exposure to human fecal sludge and wastewater on selected health outcomes among these workers. Methods We searched four databases (i.e., PubMED, MEDLINE, EMBASE, and LILACS) for eligible studies from inception through to January 01, 2020. The included population was workers ≥15 years engaged, formally or informally, in installing, operating, servicing, cleaning or emptying a sanitation technology at any step of the sanitation chain. The included comparator was workers in other occupations or the general population. Eligible outcomes were: mortality (any or all causes), gastroenteritis, occupational injuries, respiratory diseases, musculoskeletal disorders, and mental and social health conditions. Risk of bias was assessed separately on exposure assessment and health outcome using a modified Liverpool Quality Assessment Tool (LQAT). We pooled sufficiently homogenous studies using inverse variance meta-analysis with random effects. Results A total of 65 studies (9 cohort studies, 56 cross-sectional studies) met the inclusion criteria. One quarter of studies (n = 15) were from middle-income countries. Few studies assessed occupational risk factor exposures directly; most assigned exposure via proxy of occupation of sanitation worker. We judged nearly all studies to have “high risk of bias” in exposure and outcome assessment. Despite these limitations, the consistency of the overall evidence suggests that sanitation workers are at increased risk of gastroenteritis and respiratory conditions, and may be at increased risk of musculoskeletal disorders and mental/social health conditions. The pooled odds ratio for hepatitis A--the only outcome deemed suitable for meta-analysis--was 2.09 (95% Predicted Interval: 1.39–3.00, 12 studies). There was conflicting evidence from studies of increased risk of mortality; only one study reported on injuries. Conclusion Despite a large number of studies, there is limited evidence to date of the health risks faced by sanitation workers, particularly among groups that may be at particular risk-- women, informal workers and those living in low-income countries. Nevertheless, the research to date provides suggestive evidence of elevated occupational risk among sanitation workers across a range of health condition. More research is needed to improve the current bodies of evidence for all included health outcomes to be able to quantify disease burden among this occupational group.
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Affiliation(s)
- Hemali Harish Oza
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Madison Gabriella Lee
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sophie Boisson
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Frank Pega
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Kate Medlicott
- Department of Environment, Climate Change and Health, World Health Organization, Geneva, Switzerland
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Zeraatkar D, Kohut A, Bhasin A, Morassut RE, Churchill I, Gupta A, Lawson D, Miroshnychenko A, Sirotich E, Aryal K, Azab M, Beyene J, de Souza RJ. Assessments of risk of bias in systematic reviews of observational nutritional epidemiologic studies are often not appropriate or comprehensive: a methodological study. BMJ Nutr Prev Health 2021; 4:487-500. [PMID: 35028518 PMCID: PMC8718856 DOI: 10.1136/bmjnph-2021-000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called 'nutritional epidemiologic studies') assess risk of bias. OBJECTIVE To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies. METHODS We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018-Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies. RESULTS Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%). CONCLUSION Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
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Affiliation(s)
- Dena Zeraatkar
- Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alana Kohut
- McMaster University, Hamilton, Ontario, Canada
| | - Arrti Bhasin
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Isabella Churchill
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daeria Lawson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maria Azab
- McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, 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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Hosseini B, Hall AL, Zendehdel K, Kromhout H, Onyije FM, Moradzadeh R, Zamanian M, Schüz J, Olsson A. Occupational Exposure to Carcinogens and Occupational Epidemiological Cancer Studies in Iran: A Review. Cancers (Basel) 2021; 13:3581. [PMID: 34298794 PMCID: PMC8305339 DOI: 10.3390/cancers13143581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The extent of exposure to occupational carcinogens is not well characterized in Iran, and little is known about the burden of occupational cancer. OBJECTIVES This study aimed to describe exposure to occupational carcinogens and occupational epidemiology studies in Iran. METHODS Relevant studies up to January 2021 in Iran were identified through three databases (PubMed, Web of Science, and Google Scholar). RESULTS Forty-nine publications from 2009 to 2020 (one cohort, 11 case-control, 34 exposure monitoring studies, and three cancer burden studies) were included. The exposure monitoring studies were conducted mainly in the petroleum industry, metal industry, manufacturing of electronics, manufacturing of plastics, construction industry, and service industry. A few of the case-control studies also reported increased risk of cancers in relation to work in those industries. CONCLUSIONS Occupational cancer epidemiology in Iran is at an early stage. Both epidemiological and exposure monitoring studies are generally limited in size to provide robust evidence of occupational cancer risks. A coherent strategy to estimate the occupational cancer burden in Iran should start with conducting epidemiological studies along with systematic monitoring of occupational carcinogens for use in hazard control and research.
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Affiliation(s)
- Bayan Hosseini
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), CEDEX 08, 69372 Lyon, France; (B.H.); (F.M.O.); (J.S.)
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran 1419733141, Iran;
| | - Amy L. Hall
- Government of Canada, Charlottetown, PE C1A 1N3, Canada;
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran 1419733141, Iran;
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, 3584 CL Utrecht, The Netherlands;
| | - Felix M. Onyije
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), CEDEX 08, 69372 Lyon, France; (B.H.); (F.M.O.); (J.S.)
| | - Rahmatollah Moradzadeh
- Department of Epidemiology, School of Public Health, Arak University of Medical Sciences, Arak 3819693345, Iran; (R.M.); (M.Z.)
| | - Maryam Zamanian
- Department of Epidemiology, School of Public Health, Arak University of Medical Sciences, Arak 3819693345, Iran; (R.M.); (M.Z.)
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), CEDEX 08, 69372 Lyon, France; (B.H.); (F.M.O.); (J.S.)
| | - Ann Olsson
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), CEDEX 08, 69372 Lyon, France; (B.H.); (F.M.O.); (J.S.)
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11
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Visontay R, Sunderland M, Slade T, Wilson J, Mewton L. Are there non-linear relationships between alcohol consumption and long-term health? Protocol for a systematic review of observational studies employing approaches to improve causal inference. BMJ Open 2021; 11:e043985. [PMID: 33757947 PMCID: PMC7993196 DOI: 10.1136/bmjopen-2020-043985] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is a substantial literature finding that moderate alcohol consumption is protective against certain health conditions. However, more recent research has highlighted the possibility that these findings are methodological artefacts, caused by confounding and other biases. While modern analytical and study design approaches can mitigate confounding and thus enhance causal inference in observational studies, they are not routinely applied in research assessing the relationship between alcohol use and long-term health outcomes. The purpose of this systematic review is to identify observational studies that employ these analytical/design-based approaches in assessing whether relationships between alcohol consumption and health outcomes are non-linear. This review seeks to evaluate, on a per-outcome basis, what these studies find the strength and form of the relationship between alcohol consumption and health to be. METHODS AND ANALYSIS Electronic databases (MEDLINE, PsycINFO, Embase and SCOPUS) were searched in May 2020. Study selection will comply with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles will be screened against eligibility criteria intended to capture studies using observational data to assess the relationship between varying levels of alcohol exposure and any long-term health outcome (actual or surrogate), and that have employed at least one of the prespecified approaches to enhancing causal inference. Risk of bias of included articles will be assessed using study design-specific tools. A narrative synthesis of the results is planned. ETHICS AND DISSEMINATION Formal ethics approval is not required given there will be no primary data collection. The results of the study will be disseminated through published manuscripts, conferences and seminar presentations. PROSPERO REGISTRATION NUMBER CRD42020185861.
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Affiliation(s)
- Rachel Visontay
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Jack Wilson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Mewton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
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12
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Steenland K, Schubauer-Berigan M, Vermeulen R, Lunn R, Straif K, Zahm S, Stewart P, Arroyave W, Mehta S, Pearce N. Risk of Bias Assessments and Evidence Syntheses for Observational Epidemiologic Studies of Environmental and Occupational Exposures: Strengths and Limitations. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:95002. [PMID: 32924579 PMCID: PMC7489341 DOI: 10.1289/ehp6980] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Increasingly, risk of bias tools are used to evaluate epidemiologic studies as part of evidence synthesis (evidence integration), often involving meta-analyses. Some of these tools consider hypothetical randomized controlled trials (RCTs) as gold standards. METHODS We review the strengths and limitations of risk of bias assessments, in particular, for reviews of observational studies of environmental exposures, and we also comment more generally on methods of evidence synthesis. RESULTS Although RCTs may provide a useful starting point to think about bias, they do not provide a gold standard for environmental studies. Observational studies should not be considered inherently biased vs. a hypothetical RCT. Rather than a checklist approach when evaluating individual studies using risk of bias tools, we call for identifying and quantifying possible biases, their direction, and their impacts on parameter estimates. As is recognized in many guidelines, evidence synthesis requires a broader approach than simply evaluating risk of bias in individual studies followed by synthesis of studies judged unbiased, or with studies given more weight if judged less biased. It should include the use of classical considerations for judging causality in human studies, as well as triangulation and integration of animal and mechanistic data. CONCLUSIONS Bias assessments are important in evidence synthesis, but we argue they can and should be improved to address the concerns we raise here. Simplistic, mechanical approaches to risk of bias assessments, which may particularly occur when these tools are used by nonexperts, can result in erroneous conclusions and sometimes may be used to dismiss important evidence. Evidence synthesis requires a broad approach that goes beyond assessing bias in individual human studies and then including a narrow range of human studies judged to be unbiased in evidence synthesis. https://doi.org/10.1289/EHP6980.
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Affiliation(s)
- Kyle Steenland
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - R. Vermeulen
- Institute for Risk Assessment Science, University of Utrecht, Utrecht, Netherlands
| | - R.M. Lunn
- Division of the National Toxicology Program (NTP), NIEHS, Research Triangle Park, North Carolina, USA
| | - K. Straif
- Global Observatory on Pollution and Health, Boston College, Boston, Massachusetts, USA
- ISGlobal, Barcelona, Spain
| | - S. Zahm
- Shelia Zahm Consulting, Hermon, Maine, USA
| | - P. Stewart
- Stewart Exposure Assessments, LLC, Arlington, Virginia, USA
| | - W.D. Arroyave
- Integrated Laboratory Systems, Morrisville, North Carolina, USA
| | - S.S. Mehta
- Division of the National Toxicology Program (NTP), NIEHS, Research Triangle Park, North Carolina, USA
| | - N. Pearce
- London School of Hygiene and Tropical Medicine, London, UK
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