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      Weight of Evidence for Hazard Identification: A Critical Review of the Literature

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          Abstract

          Background:

          Transparency when documenting and assessing weight of evidence (WOE) has been an area of increasing focus for national and international health agencies.

          Objective:

          The objective of this work was to conduct a critical review of WOE analysis methods as a basis for developing a practical framework for considering and assessing WOE in hazard identification in areas of application at the French Agency for Food, Environmental and Occupational Health and Safety (ANSES).

          Methods:

          Based on a review of the literature and directed requests to 63 international and national agencies, 116 relevant articles and guidance documents were selected. The WOE approaches were assessed based on three aspects: the extent of their prescriptive nature, their purpose-specific relevance, and their ease of implementation.

          Results:

          Twenty-four approaches meeting the specified criteria were identified from selected reviewed documents. Most approaches satisfied one or two of the assessed considerations, but not all three. The approaches were grouped within a practical framework comprising the following four stages: (1) planning the assessment, including scoping, formulating the question, and developing the assessment method; (2) establishing lines of evidence (LOEs), including identifying and selecting studies, assessing their quality, and integrating with studies of similar type; (3) integrating the LOEs to evaluate WOE; and (4) presenting conclusions.

          Discussion:

          Based on the review, considerations for selecting methods for a wide range of applications are proposed. Priority areas for further development are identified. https://doi.org/10.1289/EHP3067

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          Most cited references50

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          Causation and causal inference in epidemiology.

          Concepts of cause and causal inference are largely self-taught from early learning experiences. A model of causation that describes causes in terms of sufficient causes and their component causes illuminates important principles such as multi-causality, the dependence of the strength of component causes on the prevalence of complementary component causes, and interaction between component causes. Philosophers agree that causal propositions cannot be proved, and find flaws or practical limitations in all philosophies of causal inference. Hence, the role of logic, belief, and observation in evaluating causal propositions is not settled. Causal inference in epidemiology is better viewed as an exercise in measurement of an effect rather than as a criterion-guided process for deciding whether an effect is present or not.
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            External Validation of a Measurement Tool to Assess Systematic Reviews (AMSTAR)

            Background Thousands of systematic reviews have been conducted in all areas of health care. However, the methodological quality of these reviews is variable and should routinely be appraised. AMSTAR is a measurement tool to assess systematic reviews. Methodology AMSTAR was used to appraise 42 reviews focusing on therapies to treat gastro-esophageal reflux disease, peptic ulcer disease, and other acid-related diseases. Two assessors applied the AMSTAR to each review. Two other assessors, plus a clinician and/or methodologist applied a global assessment to each review independently. Conclusions The sample of 42 reviews covered a wide range of methodological quality. The overall scores on AMSTAR ranged from 0 to 10 (out of a maximum of 11) with a mean of 4.6 (95% CI: 3.7 to 5.6) and median 4.0 (range 2.0 to 6.0). The inter-observer agreement of the individual items ranged from moderate to almost perfect agreement. Nine items scored a kappa of >0.75 (95% CI: 0.55 to 0.96). The reliability of the total AMSTAR score was excellent: kappa 0.84 (95% CI: 0.67 to 1.00) and Pearson's R 0.96 (95% CI: 0.92 to 0.98). The overall scores for the global assessment ranged from 2 to 7 (out of a maximum score of 7) with a mean of 4.43 (95% CI: 3.6 to 5.3) and median 4.0 (range 2.25 to 5.75). The agreement was lower with a kappa of 0.63 (95% CI: 0.40 to 0.88). Construct validity was shown by AMSTAR convergence with the results of the global assessment: Pearson's R 0.72 (95% CI: 0.53 to 0.84). For the AMSTAR total score, the limits of agreement were −0.19±1.38. This translates to a minimum detectable difference between reviews of 0.64 ‘AMSTAR points’. Further validation of AMSTAR is needed to assess its validity, reliability and perceived utility by appraisers and end users of reviews across a broader range of systematic reviews.
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              Is Open Access

              The Navigation Guide Systematic Review Methodology: A Rigorous and Transparent Method for Translating Environmental Health Science into Better Health Outcomes

              Background: Synthesizing what is known about the environmental drivers of health is instrumental to taking prevention-oriented action. Methods of research synthesis commonly used in environmental health lag behind systematic review methods developed in the clinical sciences over the past 20 years. Objectives: We sought to develop a proof of concept of the “Navigation Guide,” a systematic and transparent method of research synthesis in environmental health. Discussion: The Navigation Guide methodology builds on best practices in research synthesis in evidence-based medicine and environmental health. Key points of departure from current methods of expert-based narrative review prevalent in environmental health include a prespecified protocol, standardized and transparent documentation including expert judgment, a comprehensive search strategy, assessment of “risk of bias,” and separation of the science from values and preferences. Key points of departure from evidence-based medicine include assigning a “moderate” quality rating to human observational studies and combining diverse evidence streams. Conclusions: The Navigation Guide methodology is a systematic and rigorous approach to research synthesis that has been developed to reduce bias and maximize transparency in the evaluation of environmental health information. Although novel aspects of the method will require further development and validation, our findings demonstrated that improved methods of research synthesis under development at the National Toxicology Program and under consideration by the U.S. Environmental Protection Agency are fully achievable. The institutionalization of robust methods of systematic and transparent review would provide a concrete mechanism for linking science to timely action to prevent harm. Citation: Woodruff TJ, Sutton P. 2014. The Navigation Guide systematic review methodology: a rigorous and transparent method for translating environmental health science into better health outcomes. Environ Health Perspect 122:1007–1014; http://dx.doi.org/10.1289/ehp.1307175
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                Author and article information

                Journal
                Environ Health Perspect
                Environ. Health Perspect
                EHP
                Environmental Health Perspectives
                Environmental Health Perspectives
                0091-6765
                1552-9924
                17 July 2018
                July 2018
                : 126
                : 7
                : 076001
                Affiliations
                [ 1 ]French Agricultural Research Centre for International Development (CIRAD) , Agroecology and sustainable intensification of annual crops (UPR AIDA), Montpellier, France
                [ 2 ]AIDA, CIRAD, Montpellier University , Montpellier, France
                [ 3 ]French Agency for Food, Environmental and Occupational Health and Safety (ANSES) , Maisons-Alfort, France
                [ 4 ]McLaughlin Center for Risk Science, University of Ottawa , Ottawa, Canada
                [ 5 ]WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Aging, Department of Public Health, Epidemiology, and Health Economics, University of Liège , Liège, Belgium
                [ 6 ]Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Institute for Health and Medical Research (INSERM, U1153), French National Institute of Research for Agriculture (INRA, U1125), National Conservatory of Arts and Crafts (CNAM), Paris University , Bobigny, France
                [ 7 ]Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Pasteur Institute, University of Paris-Saclay , Paris, France
                [ 8 ]UMR Agronomy, INRA, AgroParisTech, University of Paris-Saclay , Thiverval-Grignon, France
                Author notes
                Address correspondence to C. Bladier, Agence nationale de sécurité sanitaire, Direction Évaluation des Risques, 14 rue Pierre et Marie Curie 94701, Maisons-Alfort Cedex, France. Telephone: (+33) 1 49 77 26 06. Email: claire.bladier@ 123456anses.fr
                Article
                EHP3067
                10.1289/EHP3067
                6108859
                30024384
                0391545b-5b92-4cea-9ef9-2e7aa03309c7

                EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.

                History
                : 07 November 2017
                : 22 May 2018
                : 25 May 2018
                Categories
                Review

                Public health
                Public health

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