Environment international
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Environment international · Jul 2016
Using GRADE to respond to health questions with different levels of urgency.
Increasing interest exists in applying the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to environmental health evidence. While ideally applied to evidence synthesized in systematic reviews and corresponding summary tables, such as evidence profiles, GRADE's correct application requires that "the evidence that was assessed and the methods that were used to identify and appraise that evidence should be clearly described." In this article, we suggest that GRADE could be applied to evidence assembled from narrative reviews, modelled (indirect) evidence, or evidence assembled as part of a rapid response, if the underlying judgments about the certainty in this evidence are based on the relevant GRADE domains and provided transparently. Health questions that require assessing the certainty in a body of evidence to provide trustworthy answers may range from hours, to days or weeks, to a few months to scenarios that allow assessing evidence without short-term time pressures. ⋯ Even without available full systematic reviews, expressing the certainty in the evidence can provide useful guidance for users of the evidence and those who evaluate certainty in effects. The ratings also help clarifying disagreement between organizations tackling similar questions about the evidence. Using the structured GRADE domains, narrative or other summaries of the evidence can be presented transparently.
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Environment international · Jul 2016
GRADE: Assessing the quality of evidence in environmental and occupational health.
There is high demand in environmental health for adoption of a structured process that evaluates and integrates evidence while making decisions and recommendations transparent. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework holds promise to address this demand. For over a decade, GRADE has been applied successfully to areas of clinical medicine, public health, and health policy, but experience with GRADE in environmental and occupational health is just beginning. ⋯ The EtD framework allows for grading the strength of the recommendations based on judgments of the certainty in the evidence (also known as quality of the evidence), as well as other factors that inform recommendations such as social values and preferences, resource implications, and benefits. GRADE represents an untapped opportunity for environmental and occupational health to make evidence-based recommendations in a systematic and transparent manner. The objectives of this article are to provide an overview of GRADE, discuss GRADE's applicability to environmental health, and identify priority areas for method assessment and development.
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Environment international · May 2016
Long-term exposure to fine particulate matter and incidence of diabetes in the Danish Nurse Cohort.
It has been suggested that air pollution may increase the risk of type 2 diabetes but data on particulate matter with diameter <2.5μm (PM2.5) are inconsistent. We examined the association between long-term exposure to PM2.5 and diabetes incidence. ⋯ Fine particulate matter may the most relevant pollutant for diabetes development among women, and non-smokers, obese women, and heart disease patients may be most susceptible.
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Environment international · Apr 2016
Investigating the traffic-related environmental impacts of hydraulic-fracturing (fracking) operations.
Hydraulic fracturing (fracking) has been used extensively in the US and Canada since the 1950s and offers the potential for significant new sources of oil and gas supply. Numerous other countries around the world (including the UK, Germany, China, South Africa, Australia and Argentina) are now giving serious consideration to sanctioning the technique to provide additional security over the future supply of domestic energy. However, relatively high population densities in many countries and the potential negative environmental impacts that may be associated with fracking operations has stimulated controversy and significant public debate regarding if and where fracking should be permitted. ⋯ Likewise, excess noise emissions appear negligible (<1dBA) when normalised over the completion period, but may be considerable (+3.4dBA) in particular hours, especially in night-time periods. Larger, regional scale modelling of pad development scenarios over a multi-decade time horizon give modest CO2 emissions that vary between 2.5 and 160.4kT, dependent on the number of wells, and individual well fracking water and flowback waste requirements. The TIM model is designed to be adaptable to any geographic area where the required input data are available (such as fleet characteristics, road type and quality), and we suggest could be deployed as a tool to help reach more informed decisions regarding where and how fracking might take place taking into account the likely scale of traffic-related environmental impacts.
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Environment international · Mar 2016
Associations between ultrafine and fine particles and mortality in five central European cities - Results from the UFIREG study.
Evidence on health effects of ultrafine particles (UFP) is still limited as they are usually not monitored routinely. The few epidemiological studies on UFP and (cause-specific) mortality so far have reported inconsistent results. ⋯ We observed positive but not statistically significant associations between prolonged exposures to UFP and respiratory mortality, which were independent of particle mass exposures. Further multi-centre studies are needed investigating several years to produce more precise estimates on health effects of UFP.