Evidence map›Paper›PMID 26827182›Full record

ArticleEnvironment international

GRADE: Assessing the quality of evidence in environmental and occupational health.

Rebecca L Morgan, Kristina A Thayer, Lisa Bero, Nigel Bruce, Yngve Falck-Ytter, Davina Ghersi, Gordon Guyatt, Carlijn Hooijmans, Miranda Langendam, Daniele Mandrioli and 12 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Environment international. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 119 papers, 47 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
119citing papers in PubMed, 47 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

119 citing papers in PubMed, 47 syntheses or guidelines pooled it.

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  14. Benzene Exposure and Lung Cancer Risk: A Systematic Review and Meta-Analysis of Human Studies.International journal of environmental research and public health · 2024
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  15. Quality of life after necrotizing enterocolitis: an integrative review.Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo · 2024
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59 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Rebecca L MorganDepartment of Clinical Epidemiology & Biostatistics, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Electronic address: morganrl@mcmaster.ca.
Kristina A ThayerDivision of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC 27709, USA. Electronic address: thayer@niehs.nih.gov.
Lisa BeroCharles Perkins Centre, The University of Sydney, D17, The Hub, 6th floor, New South Wales, 2006, Australia. Electronic address: lisa.bero@sydney.edu.au.
Nigel BruceDepartment of Public Health and Policy, University of Liverpool, L69 3GB, United Kingdom. Electronic address: ngb@liv.ac.uk.
Yngve Falck-YtterDivision of Gastroenterology, Case Western Reserve University and Louis Stokes VA Medical Center, 10701 East Blvd., Cleveland, OH 44106, USA. Electronic address: Yngve.Falck-Ytter@case.edu.
Davina GhersiSydney Medical School, University of Sydney, New South Wales 2006, Australia; National Health and Medical Research Council, 16 Marcus Clarke Street, Canberra City, ACT 2601, Australia. Electronic address: davina.ghersi@nhmrc.gov.au.
Gordon GuyattDepartment of Clinical Epidemiology & Biostatistics, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Electronic address: guyatt@mcmaster.ca.
Carlijn HooijmansDepartments of SYRCLE and Anesthesiology, Radboud University Medical Centre, Geert Grooteplein-Noord 29, Route 231, 6525 GA Nijmegen, The Netherlands. Electronic address: Carlijn.Hooijmans@radboudumc.nl.
Miranda LangendamDepartment of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Room J1B-211, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.w.langendam@amc.uva.nl.
Daniele MandrioliCesare Maltoni Cancer Research Center, Ramazzini Institute, Via Saliceto 3, Bentivoglio, Bologna, P.O. Box 40133, Italy. Electronic address: mandriolid@ramazzini.it.
Reem A MustafaDepartment of Clinical Epidemiology & Biostatistics, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; Departments of Medicine/Nephrology and Biomedical & Health Informatics, University of Missouri-Kansas City, School of Medicine, M4-303, 2411 Holmes St., Kansas City, Missouri 64108-2792, USA. Electronic address: ramustafa@gmail.com.
Eva A RehfuessInstitute for Medical Informatics, Biometry and Epidemiology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: rehfuess@ibe.med.uni-muenchen.de.
Andrew A RooneyDivision of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC 27709, USA. Electronic address: andrew.rooney@nih.gov.
Beverley SheaBruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. Electronic address: bevshea@uottawa.ca.
Ellen K SilbergeldDepartment of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6644, Baltimore, MD 21205, USA. Electronic address: esilber2@jhu.edu.
Patrice SuttonProgram on Reproductive Health and the Environment, University of California-San Francisco, 550 16th Street, San Francisco, CA 94143, USA. Electronic address: patrice.sutton@ucsf.edu.
Mary S WolfeDivision of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, P.O. Box 12233, Mail Drop K2-02, Research Triangle Park, NC 27709, USA. Electronic address: wolfe@niehs.nih.gov.
Tracey J WoodruffProgram on Reproductive Health and the Environment, University of California-San Francisco, 550 16th Street, San Francisco, CA 94143, USA. Electronic address: tracey.woodrfuff@ucsf.edu.
Jos H VerbeekFinnish Institute of Occupational Health, Cochrane Work, PO Box 310, 70101 Kuopio, Finland. Electronic address: Jos.Verbeek@ttl.fi.
Alison C HollowayDepartment of Obstetrics and Gynecology, McMaster University, Health Sciences Centre, Room 3N52A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Electronic address: hollow@mcmaster.ca.
Nancy SantessoDepartment of Clinical Epidemiology & Biostatistics, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Electronic address: santesna@mcmaster.ca.
Holger J SchünemannDepartment of Clinical Epidemiology & Biostatistics, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; Department of Medicine, McMaster University, Health Sciences Centre, Room 2C14, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada. Electronic address: schuneha@mcmaster.ca.

Funding

Integrated Health Assessments for the National Toxicology ProgramZIAES103317 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI ROONEY, ANDREW · 2016 to 2019
$24.4M
The UCSF Pregnancy Exposures to Environmental Chemicals (PEEC) Children's CenterP01ES022841 · NIEHS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI WOODRUFF, TRACEY J. · 2013 to 2018
$3.9M
Analysis activities for the National Toxicology Program (NTP)ZIAES103226 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI BUCHER, JOHN · 2014 to 2014
$622k
Project 2: Assessing the Effects on BPA Exposure on Early Human DevelopmentP20ES018135 · NIEHS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI WOODRUFF, TRACEY J. · 2010 to 2012
$617k
Intramural NIH HHS ZIA ES103226NIEHS NIH HHS P01 ES022841NIEHS NIH HHS P20 ES018135
6 · The paper itself

Abstract

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. Environmental and occupational health questions focus on understanding whether an exposure is a potential health hazard or risk, assessing the exposure to understand the extent and magnitude of risk, and exploring interventions to mitigate exposure or risk. Although GRADE offers many advantages, including its flexibility and methodological rigor, there are features of the different sources of evidence used in environmental and occupational health that will require further consideration to assess the need for method refinement. An issue that requires particular attention is the evaluation and integration of evidence from human, animal, in vitro, and in silico (computer modeling) studies when determining whether an environmental factor represents a potential health hazard or risk. Assessment of the hazard of exposures can produce analyses for use in the GRADE evidence-to-decision (EtD) framework to inform risk-management decisions about removing harmful exposures or mitigating risks. 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.

Indexed as

Environmental HealthEpidemiologic Research DesignOccupational HealthReview Literature as TopicEvidence-Based MedicineHumansReproducibility of ResultsEnvironmental healthEvidence-basedGRADERecommendationsRisk assessmentRisk of bias

Identifiers

PMID26827182
PMCPMC4902742

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.