The open epidemiology journal最新文献

{"title":"Benefits and Barriers to Using Epidemiology Data in Environmental Risk Assessment","authors":"K. Raffaele, S. Vulimiri, T. Bateson","doi":"10.2174/1874297101104010099","DOIUrl":"https://doi.org/10.2174/1874297101104010099","url":null,"abstract":"Over the past three decades, a formal risk assessment process has been developed to provide consistent and transparent methods for the assessment of potential human health risks from exposure to environmental chemicals. Given a focus on risk to human health, epidemiological studies that identify associations between exposure to environmental chemicals and adverse health effects in humans have the potential to provide critically important information to this process. For many chemicals, however, available epidemiology studies have been found to have limited utility in informing human health risk assessments. In order to investigate this paradox, we have used several case examples to explore the utility of various types of epidemiological data in informing key elements of the risk assessment process (hazard identification, exposure-response assessment, and exposure assessment). Examples from the epidemiologic literature on environmental chemicals are used to illustrate the issues that arise in using available studies for various types of chemical risk assessments. The case examples illustrate several advantages in using epidemiology data, but also identify a number of barriers to its use, frequently related to limitations in exposure assessment. The examples also highlight ways in which the utility of both toxicology and epidemiology data can be enhanced by considering the data in combination, and integrating the results across study categories. Recent scientific developments offer hope for improving the utility of both types of data, and thus enhancing the reliability of future risk assessment efforts.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"99-105"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Health Impacts and Economic Burden Arising from Proposed New Air Quality Objectives in a High Pollution Environment","authors":"H. Lai, C. Wong, S. McGhee, A. Hedley","doi":"10.2174/1874297101104010106","DOIUrl":"https://doi.org/10.2174/1874297101104010106","url":null,"abstract":"We conducted a health impact assessment of the government's proposed new air quality objectives (AQO) in Hong Kong, a high pollution environment. We based this on the World Health Organization (WHO) 2005 Air Quality Guidelines (AQG) and used a lognormal probability density function to model possible changes in annual mean pollutant levels resulting from the new AQO. All of the proposed short-term AQO were based on WHO interim targets (IT) or AQG, but allowed additional exceedances of these single limit values. Compliance with these short-term AQO may reduce (18-30%) the current annual mean concentrations but the distribution proportions exceeding the annual or annualized AQG remain high (83-100%). For SO2, the proposed 24-hr AQO of 125 μg m -3 , with 3 days exceedances, cannot ensure reduction of the current annual mean but may legally permit an increase of the pollutant concentration distribution. If the proposed legal limits of AQO are fully exploited by polluters, we estimated the annual number of avoidable deaths at 1860, and avoidable health care events at 5.2 million doctor visits and 92745 hospital bed-days with a total annual community cost of US$2.6 billion. The proposed AQO may only reduce the current air pollution health impacts by 17% but could achieve 41% reduction if additional exceedances were not permitted. An epidemiologic approach should be adopted to assess external costs arising from modifications of WHOAQG and support accountability in air quality management. This analysis of the WHOAQG in a high pollution setting demonstrates problems arising from the absence of annual limits for some pollutants and the discordance between the short-term and annual AQG, suggesting that revisions based on a lognormal probability model should be considered.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"106-122"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Epidemiological Data for Cancer Risk Assessment: Approaches, Concepts, and Issues","authors":"V. Bencko","doi":"10.2174/1874297101104010094","DOIUrl":"https://doi.org/10.2174/1874297101104010094","url":null,"abstract":"Traditional approaches and study designs in cancer epidemiology have not been very successful identifying and evaluating potential risks and/or protective factors associated with disease. Failure is often due to small study sample size and inadequate exposure information. In this paper, we discuss issues and approaches relevant to these two challenges. Multicenter study design is proposed as a way to increase study size and to mitigate criticism of meta-analysis of independent studies. Individual studies from a multicenter study can be either pooled using original data, or combined by meta analysis of summarized results. A multicenter study of large cohort or case-control studies also offers an exciting opportunity to study the contribution of epigenetic events that may be associated with life-style and environmental risk factors for human health. Optimizing methods for exposure assessment and reduction of exposure misclassification represent difficult components in epidemiological studies. Biomarkers present a potentially useful approach for improving exposure estimates. An example is provided to demonstrate how biomarkers of exposures can provide valuable information in addition to traditional exposure measurements in epidemiological studies. Finally, it is argued that risk assessment and the precautionary principle should not be viewed as conflicting paradigms but, rather, as a complementary approach according to the data available. Together they may be used for developing appropriate policies to address risks posed by exposure to carcinogens and a wide spectrum of other health hazards.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"94-98"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contrasting Assessed and Perceived Risk: A Case Study of Two Rapidly Increasing Cancers in Taiwan","authors":"C. Wen, Yi Chen Yang, M. Tsai, Yen-chen Chang","doi":"10.2174/1874297101104010078","DOIUrl":"https://doi.org/10.2174/1874297101104010078","url":null,"abstract":"There are unfortunate cases in public health where a scientifically determined assessment of risk presented to the public is neglected in favor of pre-conceived notions of risk. In clinical settings, risk perception is important but often ignored by practitioners. The consequences of this are varied and could be devastating. Most clinicians are not trained in communicating clinical risks, and patients may be forced to make decisions based on the risk they perceive rather than the actual risk. A rational decision would require full information expressed in terms of absolute risk as well as relative risk. As new media becomes more pervasive, the gap between assessed and perceived risk widens and society is paying a price for this phenomenon not being addressed. Two types of cancers are used to illustrate this point. Both have been increasing rapidly in the last 20 years in Taiwan for reasons related to risk perception. Risks from these two cancers were misread by the public, resulting in thousands of unnecessary deaths. Due to public misperceptions, the actual risk was mistakenly minimized in one instance, and unknowingly enhanced in another. Chewers of betel quid (BQ) belittle the risk of oral cancer, perceiving it is a known, future, familiar but controllable risk. Unfortunately, thousands die each year from BQ chewing because millions continue to chew. On the other hand, the fear of prostate cancer has led to screening tests that may cause physical and psychological harm. With the availability of PSA tests to detect prostate cancer, increasing numbers of elderly men pursue biopsy and treatment. Even though the actual risk from prostate cancer is small, the demand for zero risk has compelled worried patients to endure the agony of intervention and to suffer serious side effects because the treatment intended to reduce risk may instead increase morbidity and mortality. The fact that there may be substantial harm, with uncertain health benefits, from unnecessary treatment has been publicized, but clinicians have ignored fully communicating pros and cons of treatment to patients. Mainstream risk assessment, mostly for regulatory purposes, has focused on toxic substances often involving small risks at current occupational and environmental exposure levels. Most of these assessments address risk at a magnitude between one per thousand and one per million. Risks in clinical settings are often several orders of magnitude higher, such as the risk for smokers who have a one in three lifetime risk of dying from smok-ingrelated diseases. The irony is that the general public is far more concerned with risk from toxic substances than lifestyle or clinical risks. This discrepancy is a major health threat and should alarm risk assessors who are pursuing technological excellence on a continuing basis but neglecting risk communication. Effective risk communication in clinical settings should be a required discipline for clinicians. This training should address th","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"78-93"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging Epidemiology to Improve Risk Assessment","authors":"K. Nachman, M. Fox, M. Sheehan, T. Burke, J. Rodricks, T. Woodruff","doi":"10.2174/1874297101104010003","DOIUrl":"https://doi.org/10.2174/1874297101104010003","url":null,"abstract":"The field of environmental public health is at an important crossroad. Our current biomonitoring efforts document widespread exposure to a host of chemicals for which toxicity information is lacking. At the same time, advances in the fields of genomics, proteomics, metabolomics, genetics and epigenetics are yielding volumes of data at a rapid pace. Our ability to detect chemicals in biological and environmental media has far outpaced our ability to interpret their health relevance, and as a result, the environmental risk paradigm, in its current state, is antiquated and ill-equipped to make the best use of these new data. In light of new scientific developments and the pressing need to characterize the public health burdens of chemicals, it is imperative to reinvigorate the use of environmental epidemiology in chemical risk assessment. Two case studies of chemical assessments from the Environmental Protection Agency Integrated Risk Information System database are presented to illustrate opportunities where epidemiologic data could have been used in place of experimental animal data in dose-response assessment, or where different approaches, techniques, or studies could have been employed to better utilize existing epidemiologic evidence. Based on the case studies and what can be learned from recent scientific advances and improved approaches to utilizing human data for dose-response estimation, recommendations are provided for the disciplines of epidemiology and risk assessment for enhancing the role of epidemiologic data in hazard identification and dose-response assessment.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"3 - 29"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Making Epidemiologic Data More Useful for Quantitative Risk Assessment","authors":"K. Crump, B. Allen","doi":"10.2174/1874297101104010030","DOIUrl":"https://doi.org/10.2174/1874297101104010030","url":null,"abstract":"This paper discusses issues faced in using epidemiologic data to develop quantitative estimates of risk from specified patterns of exposure to a toxicant. We focus on use of data from cohort studies with binary endpoints (occurrence or non-occurrence of disease). Relative advantages of Cox regression and Poisson regression are presented. A general form of exposure metric is presented, and criteria for selecting an appropriate metric are discussed. Advantages and disadvantages of various dose-response models are discussed. It is argued that, unless low-dose linearity of the dose response can be ruled out on non-statistical grounds, then bounds for low-dose risk should incorporate low-dose linearity; a sequential procedure for computing such bounds is illustrated. Limitations in exposure data and their impact on risk assessments are discussed. Issues arising when using meta-analytic techniques to combine data from multiple epidemiologic studies are discussed. Limitations in risk assessments resulting from reliance upon published results alone are described. Methods for converting from measures of risk used in epidemiologic studies (e.g., relative risk) to measures appropriate for a risk assessment (e.g., additional lifetime probability of disease occurrence resulting from a specific exposure pattern) are described in detail. Several examples from the asbestos epidemiologic literature are presented to illustrate these issues.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"30-44"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Approach to Characterizing the Type of Combined Environmental Toxicity Based on Epidemiologically Assessed Exposure-Response Relationships","authors":"B. Katsnelson, L. Privalova, A. Varaksin, J. I. Kazmer, E. P. Kireyeva, V. Panov","doi":"10.2174/1874297101104010060","DOIUrl":"https://doi.org/10.2174/1874297101104010060","url":null,"abstract":"Using a dataset obtained in an earlier published epidemiological study that revealed the dependence of the probability of subclinical kidney damage in 260 children on the concentration of lead and cadmium in their urine, we have tested some methodological approaches to assessing the type of combined nephrotoxicity produced by these two metals. We have found that the environmentally caused damage to kidneys in children from lead and cadmium is less than additive (manifestation of toxicological antagonism). Given the subadditivity (antagonism) of the damaging effect of lead and cadmium on kidneys as demonstrated on the basis of epidemiological data, we believe that the summation of corresponding risks is a sufficiently conservative principle creating an additional margin of safety and limiting the uncertainty of risk assessment on the whole. Of theoretical interest is the demonstrated consistency of this assessment of the type of combined toxicity irrespective of whether it is carried out on the basis of the paradigm of effect additivity or dose additivity. This enables us to speak in favor of considering the so-called Bliss independence and Loewe additivity as complementary simplified models of the same fairly complex process rather than essentially different biological phenomena. The example studied suggests that approaches to the analysis of epidemiological data for the purpose of assessing combined risk should be tested using each of these models rather than restricting it to one of them based on an a priori choice.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"60-69"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monte Carlo Analysis of Impact of Underascertainment of Mesothelioma Cases on Underestimation of Risk","authors":"L. Kopylev, P. A. Sullivan, L. Vinikoor, T. Bateson","doi":"10.2174/1874297101104010045","DOIUrl":"https://doi.org/10.2174/1874297101104010045","url":null,"abstract":"The accuracy of cancer mortality data varies across different cancers. Mortality records and death certificates may not always reflect the true cause of death for various reasons (e.g., misdiagnosis, improper recording on the death certificate, miscoding of the cause of death recorded on the death certificate). Mesothelioma, a rare tumor which is caused by exposure to asbestos, is a special case. Until 1999 when the 10 th revision of the International Classification of Diseases (ICD-10) introduced a specific mesothelioma code, mesothelioma deaths were coded to other causes (e.g., cancer of the pleura, cancer of other or ill-specified sites). Even after the introduction of this mesothelioma code, researchers have shown that estimates of mesothelioma mortality based on death certificates are still biased downward. This article reviews available literature with quantitative information on mesothelioma underascertainment, in particular on different rates of underestimation for pleural and peritoneal mesotheliomas, and suggests two approaches to estimating downward bias in absolute risk estimates due to mesothelioma underascertainment. The choice of approach used depends on whether the information on the proportion of peritoneal mesotheliomas is available. Both approaches are demonstrated and evaluated using a cohort of asbestos workers from Libby, MT. The methods developed in this article may be used in analyses of other asbestos cohorts and in methodologies to predict future mesothelioma burden in populations. Similar approaches can be used to assess the impact of underascertainment of other cancers on risk estimates of other chemicals.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"45-53"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologic Implications from an Epidemiologic Study of Chromate Production Workers","authors":"H. Gibb, H. Hoffman, C. Haver","doi":"10.2174/1874297101104010054","DOIUrl":"https://doi.org/10.2174/1874297101104010054","url":null,"abstract":"This analysis of an epidemiologic study of chromate production workers evaluates several variables related to the biologic understanding of chromate-induced lung cancer. Age at hire was found to be negatively associated with lung cancer risk. Reducing exposure was found to have benefits that extended into older age, and the benefits were greater when the reduction began at an earlier age. The same cumulative exposure over a short period of time (30 days) had more effect than if the exposure occurred over 10 years. The greater carcinogenic effect among those exposed at an early working age is consistent with an ability to more efficiently reduce hexavalent chromium intracellularly at younger ages. The greater effect at younger ages may also explain why short-term cumulative hexavalent chromium exposure was found to have more effect than the equivalent cumulative exposure spread over a longer term. The SMR for lung cancer was highest in the decade following cessation of exposure and may reflect the extremely irritating nature of hexavalent chromium.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"54-59"},"PeriodicalIF":0.0,"publicationDate":"2011-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selected Health Conditions Among Overweight, Obese, and Non-Obese Veterans of the 1991 Gulf War: Results from a Survey Conducted in 2003-2005.","authors":"Steven S Coughlin, Han K Kang, Clare M Mahan","doi":"10.2174/1874297101104010140","DOIUrl":"10.2174/1874297101104010140","url":null,"abstract":"<p><p>BACKGROUND: Several health conditions and concerns have been reported to be increased among Gulf War veterans including post-traumatic stress disorder (PTSD), chronic fatigue syndrome (CFS), CFS-like illness, and unexplained multi-symptom illness (MSI). As the cohort of Gulf War veterans advance in age, they are likely to be at risk of not only certain deployment-related health conditions but also chronic diseases associated with lifestyle factors. METHODS: To clarify relationships between PTSD, CFS-like illness, MSI, and obesity, we analyzed data from a cross-sectional survey of health information among population-based samples of 15,000 Gulf War veterans and 15,000 veterans who served during the same era. Data had been collected from 9,970 respondents in 2003-2005 via a structured questionnaire or telephone survey. RESULTS: Based upon body mass index (BMI) estimated from self-reported information about height and weight, the percentages of Gulf War and Gulf Era veterans who were overweight (BMI 25 to ≤ 29.9), were 46.8% and 48.7%, respectively. The percentages who were obese (BMI ≥ 30) were 29.6% and 28.3%, respectively. Without adjustment for Gulf deployment status (Gulf War vs Gulf Era), age, sex, or other factors, PTSD, MSI, CFS-like illness, and other chronic health conditions were more common among obese veterans than those who were normal weight (BMI 18.5 to ≤ 24.9). In multivariate analyses, PTSD was positively associated with obesity after adjustment for age, sex, Gulf deployment status, rank, income, education, and current smoking. In the model for PTSD, the adjusted odds ratio for obesity was 1.5 (95% CI 1.2-1.8). No associations were observed between BMI categories and CFS-like illness or MSI in multivariate analysis. CONCLUSIONS: Gulf War and Gulf Era veterans who were obese were more likely to have certain chronic health conditions including PTSD. Associations between Gulf status and CFS-like illness and MSI identified in the 2003-2005 follow-up survey were not accounted for by group differences in the prevalence of overweight or obesity.</p>","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 ","pages":"140-146"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125597/pdf/nihms301670.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29985984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}