Hoffmann Sebastian, Whaley Paul, Tsaioun Katya
Evidence-based Toxicology Collaboration (EBTC) at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lancaster Environment Centre, Lancaster University, UK.
ALTEX. 2022;39(2):175-182. doi: 10.14573/altex.2201131. Epub 2022 Jan 31.
Evidence-based methodology, in particular systematic review, is increasingly being applied in environmental, public, and occupational health to increase the transparency, comprehensiveness, and objectivity of the processes by which existing evidence is gathered, assessed, and synthesized in answering research questions. This development is also changing risk assessment practices and will impact the assessment of uncertainties in the evidence for risks to human health that are posed by exposure to chemicals. The potential of evidence-based methodology for characterizing uncertainties in risk assessment has been widely recognized, while its contribution to uncertainty reduction is yet to be fully elucidated. We therefore present some key aspects of the evidence-based approach to risk assessment, showing how they can contribute to the identification and the assessment of uncertainties. We focus on the pre-specification of an assessment methodology in a protocol, comprehensive search strategies, study selection using predefined eligibility criteria, critical appraisal of individual studies, and an evidence integration and uncertainty characterization process based on certainty of evidence frameworks that are well-established in health care research. We also provide examples of uncertainty in risk assessment and discuss how evidence-based methodology could address those. This perspective, which neither claims to be comprehensive nor complete, is intended to stimulate discussion of the topic and to motivate detailed exploration of how evidence-based methodology contributes to characterization of uncertainties, and how it will lead to uncertainty reduction in the conduct of health risk assessment.
循证方法，尤其是系统评价，越来越多地应用于环境、公共和职业健康领域，以提高在回答研究问题时收集、评估和综合现有证据的过程的透明度、全面性和客观性。这一发展也在改变风险评估实践，并将影响对接触化学品对人类健康造成风险的证据中的不确定性的评估。循证方法在表征风险评估中的不确定性方面的潜力已得到广泛认可，但其对减少不确定性的贡献尚未得到充分阐明。因此，我们介绍了基于证据的风险评估方法的一些关键方面，展示了它们如何有助于识别和评估不确定性。我们重点关注方案中评估方法的预先设定、全面的检索策略、使用预定义纳入标准的研究选择、对单个研究的批判性评价，以及基于医疗保健研究中已确立的证据确定性框架的证据整合和不确定性表征过程。我们还提供了风险评估中不确定性的示例，并讨论了循证方法如何解决这些问题。这一观点既不声称全面也不完整，旨在激发对该主题的讨论，并促使人们详细探讨循证方法如何有助于表征不确定性，以及它将如何在健康风险评估中减少不确定性。
