Teaching 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. For more than a decade, PRHE has provided Navigation Guide trainings and seminars on this methodology to the medical, environmental, and academic communities.
Application of the Navigation Guide teachings will result in uniform, simple, and transparent summaries that integrate the best practices of evaluation in environmental and clinical health sciences.
- Learn more about the Working Groups strategy and approach to encourage uptake of the Navigation Guide
- Explore a timeline of major accomplishments
This guidance document recommends that EPA adopt the Navigation Guide systematic review method and other scientifically rigorous methods to evaluate chemical risks.
This study, which evaluated evidence using the Navigation Guide method, found that people who work more than 55 hours/week are at significantly higher risk of heart disease and stroke.
PRHE developed an evidence map that includes research on respiratory virus infections like the coronavirus (COVID-19) and conditions that may increase susceptibility to COVID-19, like asthma.
Published Papers
Environmental exposures, including widespread industrial pollution, impact human health and are amplified in more highly exposed communities. Policy and regulatory frameworks for making decisions and recommendations on interventions to mitigate or prevent exposures tend to narrowly focus on exposure and some health-related data related to risks.
Systematic reviews were first developed in clinical medicine to evaluate the effectiveness of interventions. Systematic review methods are now increasingly being used to inform environmental health decisions, and they have a direct, long-term effect on health equity due to improved consistency, greater transparency, and reduced bias when evaluating the scientific evidence.
Schaefer and colleagues at the U.S. Food and Drug Administration (FDA) conducted a systematic review to identify candidate studies for development of a toxicological reference value (TRV) for oral cadmium exposure. We are encouraged that FDA is utilizing systematic review, and strongly support its ongoing use.
Welding fumes have been classified as carcinogenic to humans (Group 1) by the WHO International Agency for Research on Cancer (IARC) in IARC Monograph 118; this assessment found sufficient evidence from studies in humans that welding fumes are a cause of lung cancer. In this article, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from trachea, bronchus, and lung cancer attributable to occupational exposure to welding fumes, to inform the development of WHO/ILO Joint Estimates on this burden of disease (if considered feasible).
Systematic reviews of studies estimating the prevalence of exposure to selected occupational risk factors have been conducted to provide input data for estimations of the number of exposed workers. A critical part of systematic review methodology is to assess the quality of evidence across studies. In this article, we present the approach applied in these WHO/ILO systematic reviews for performing such assessments on studies of prevalence of exposure. It is called the Quality of Evidence in Studies estimating Prevalence of Exposure to Occupational risk factors (QoE-SPEO) approach. We describe QoE-SPEO’s development to date, demonstrate its feasibility reporting results from pilot testing and case studies, note its strengths and limitations, and suggest how QoE-SPEO should be tested and developed further.
Systematic reviews are routinely used to synthesize current science and evaluate the evidential strength and quality of resulting recommendations. For specific events, such as rare acute poisonings or preliminary reports of new drugs, we posit that case reports/studies and case series (human subjects research with no control group) may provide important evidence for systematic reviews.
Systematic reviews are fast increasing in prevalence in the toxicology and environmental health literature. However, how well these complex research projects are being conducted and reported is unclear.