Navigation Guide
Strategy to bridge the gap between clinicians and environmental health

Navigation Guide

An Evidence-Based Medicine Methodology to Bridge the Gap Between Clinical and Environmental Health Sciences

The scientific evidence linking environmental exposures to adverse health outcomes has yet to be compiled using systematic methods with the capacity to inform effective healthcare and policy decision-making. The relevant evidence is largely unfamiliar to health professionals caring for women and men of childbearing age, patients, communities, consumers, and other impacted populations. There is currently no trusted reference or compendium that provides them with timely, evidence-based advice about exposure to environmental contaminants.

To bridge the gap between clinical and environmental health sciences, PRHE has undertaken an interdisciplinary collaboration to develop a systematic and transparent methodology to evaluate the quality of evidence and strength of recommendations about the relationship between the environment and reproductive health. The result of this collaboration---the Navigation Guide--- was published in the May 2011 issue of the journal Health Affairs. View the paper here.

Application of the Navigation Guide will result in uniform, simple, and transparent summaries that integrate the best practices of evaluation in environmental and clinical health sciences.

Publications on the Navigation Guide

Lam, J., Sutton, P., Kalkbrenner, A., Windham, G., Halladay, A., Koustas, E., ... & Woodruff, T. (2016). A Systematic Review and Meta-Analysis of Multiple Airborne Pollutants and Autism Spectrum Disorder. PLoS One11(9), e0161851. Read it here

Whaley P, Halsall C, Agerstrand M, Aiassa E, Benford D, Bilotta G, Coggon D, Collins C, Dempsey C, Duarte-Davidson R et al: Implementing systematic review techniques in chemical risk assessment: Challenges, opportunities and recommendations. Environ Int 2016, 92-93:556-564. Read it here.

Vandenberg LN, Ågerstrand M, Beronius A, Beausoleild C, Bergman A, Bero LA, Bornehag C, Boyer CS, Cooper GS, Cotgreave I et al: A proposed framework for the systematic review and integrated assessment (SYRINA) of endocrine disrupting chemicals. Environment Health 2016, In press. Read it here.

Stephens ML, Betts K, Beck NB, Cogliano V, Dickersin K, Fitzpatrick S, Freeman J, Gray G, Hartung T, McPartland J et al: The Emergence of Systematic Review in Toxicology. Toxicol Sci 2016, 152(1):10-16. Read it here.

Johnson PI, Koustas E, Vesterinen HM, Sutton P, Atchley DS, Kim AN, Campbell M, McDonald JM, Bero L, Sen S et al: Reproductive and developmental effects of exposure to triclosan. A systematic review of the evidence. 2016 In press Environment International. Read it here.

Sheehan MC, Lam J, Navas-Acien A, Chang HH: Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice. Environ Int 2016, 92-93:647-656. Read it here.

Rooney AA, Cooper GS, Jahnke GD, Lam J, Morgan RL, Boyles AL, Ratcliffe JM, Kraft AD, Schunemann HJ, Schwingl P et al: How credible are the study results? Evaluating and applying internal validity tools to literature-based assessments of environmental health hazards. Environ Int 2016, 92-93:617-629. Read it here.

Morgan RL, Thayer KA, Bero L, Bruce N, Falck-Ytter Y, Ghersi D, Guyatt G, Hooijmans C, Langendam M, Mandrioli D et al: GRADE: Assessing the quality of evidence in environmental and occupational health. Environ Int 2016, 92-93:611-616. Read it here.

Woodruff TJ: Making it real--the environmental burden of disease. What does it take to make people pay attention to the environment and health? J Clin Endocrinol Metab 2015, 100(4):1241-1244. Read it here.

Woodruff TJ, Sutton P: The Navigation Guide systematic review methodology: a rigorous and transparent method for translating environmental health science into better health outcomes. Environ Health Perspect 2014, 122(10):1007-1014. Read it here.

Vesterinen H, Johnson P, Atchley D, Sutton P, Lam J, Zlatnik M, Sen S, Woodruff T: The relationship between fetal growth and maternal glomerular filtration rate: a systematic review. J Maternal Fetal Neonatal Med 2014:1-6. Read it here.

Lam J, Sutton P, Koustas E, Johnson P, Atchley DS, Sen S, Robinson K, Axelrad DA, Woodruff TJ: The Navigation Guide—evidence-based medicine meets environmental health: integration of animal and human evidence for PFOA effects on fetal growth. Environ Health Perspect 2014, 122(10):1041-1051. Read it here.

Koustas E, Lam J, Sutton P, Johnson PI, Atchley DS, Sen S, Robinson KA, Axelrad DA, Woodruff TJ: The Navigation Guide—evidence-based medicine meets environmental health: systematic review of nonhuman evidence for PFOA effects on fetal growth. Environ Health Perspect 2014, 122(10):1015-1027. Read it here.

Johnson PI, Sutton P, Atchley DS, Koustas E, Lam J, Sen S, Robinson KA, Axelrad D, TJ W: The Navigation Guide—evidence-based medicine meets environmental health: systematic review of human evidence for PFOA effects on fetal growth. Environ Health Perspect 2014, 122(10):1028-1039. Read it here.

Vesterinen HM, Johnson PI, Koustas E, Lam J, Sutton P, Woodruff TJ: In Support of EHP’s Proposal to Adopt the ARRIVE Guidelines. Environ Health Perspect 2013, 121(11-12):A325-A325. Read it here.

Sutton P, Woodruff TJ: Risk communication and decision tools for children's health protection. Birth Defects Research Part C: Embryo Today: Reviews 2013, 99(1):45-49. Read it here.

Krauth D, Woodruff TJ, Bero L: Instruments for assessing risk of bias and other methodological criteria of published animal studies: a systematic review. Environ Health Perspect 2013, 121(9):985-992. Read it here.

Woodruff TJ, Sutton P, The Navigation Guide Work Group: An Evidence-Based Medicine Methodology To Bridge The Gap Between Clinical And Environmental Health Sciences. Health Aff (Millwood) 2011, 30(5):931-937. Read it here.

Sutton P, Woodruff TJ, Vogel S, Bero LA: Conrad and Becker’s “10 Criteria” Fall Short of Addressing Conflicts of Interest in Chemical Safety Studies. Environ Health Perspect 2011, 119(12). Read it here.

Sutton P, Conry J, Rodriguez, P, Woodruff TJ. The Navigation Guide. The Science Behind Practice. San Francisco Medicine. Journal of the San Francisco Medical Society. April 2010. Volume 85, Number 5. Read it here.

Woodruff TJ, Sutton P: Pulling back the curtain: improving reviews in environmental health. Environ Health Perspect 2010, 118(8):a326-327. Read it here.

Case Study Protocols

#1.  Application of the Navigation Guide: Case Study of PFOA Effects on Fetal Growth

#2. Triclosan Protocol

#3. Glomerular Filtration Rate and Fetal Growth Protocol

#4. Developmental Exposures to Ambient Air Pollution and Autism

#5. Developmental Exposures to PBDEs and Human Neurodevelopment

#6. Formaldehyde Exposure and Asthma


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