Towards a framework for systematic reviews of the prevalence of exposure to environmental and occupational risk factors

Abstract

Exposure prevalence studies (as here defined) record the prevalence of exposure to environmental and occupational risk factors to human health. Applying systematic review methods to the synthesis of these studies would improve the rigour and transparency of normative products produced based on this evidence (e.g., exposure prevalence estimates). However, a dedicated framework, including standard methods and tools, for systematically reviewing exposure prevalence studies has yet to be created. We describe the need for this framework and progress made towards it through a series of such systematic reviews that the World Health Organization and the International Labour Organization conducted for their WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates).We explain that existing systematic review frameworks for environmental and occupational health cannot be directly applied for the generation of exposure prevalence estimates because they seek to synthesise different types of evidence (e.g., intervention or exposure effects on health) for different purposes (e.g., identify intervention effectiveness or exposure toxicity or carcinogenicity). Concepts unique to exposure prevalence studies (e.g., “expected heterogeneity”: the real, non-spurious variability in exposure prevalence due to exposure changes over space and/or time) also require new assessment methods. A framework for systematic reviews of prevalence of environmental and occupational exposures requires adaptation of existing methods (e.g., a standard protocol) and development of new tools or approaches (e.g., for assessing risk of bias and certainty of a body of evidence, including exploration of expected heterogeneity).As part of the series of systematic reviews for the WHO/ILO Joint Estimates, the World Health Organization collaborating with partners has created a preliminary framework for systematic reviews of prevalence studies of exposures to occupational risk factors. This included development of protocol templates, data extraction templates, a risk of bias assessment tool, and an approach for assessing certainty of evidence in these studies. Further attention and efforts are warranted from scientific and policy communities, especially exposure scientists and policy makers, to establish a standard framework for comprehensive and transparent systematic reviews of studies estimating prevalence of exposure to environmental and occupational risk factors, to improve estimates, risk assessments and guidelines.

Systematic Review and Meta-Analysis on the Use of LCA to Assess the Environmental Impacts of the Composting Process

“…This systematic review was developed considering three phases: planning, execution and summarization [23,24]. In the first phase, planning, a protocol was created containing valuable information for the systematic review, such as the databases to be searched, the keywords used as search terms, the inclusion and exclusion criteria, quality and information extraction and other topics of interest.…”

Consensus on the definition and assessment of external validity of randomized controlled trials: A Delphi study

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“…Furthermore, data on measurement properties are not reported or considered unsatisfactory for most tools 3 . In many evidence synthesis methods, external validity is currently evaluated at the level of the body of evidence, with the indirectness domain of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach 7 . However, the indirectness domain is not considered the perfect solution to assess external validity 8 and could not be recommended for the assessment of external validity of RCTs due to insufficient evidence regarding its development process and measurement properties 3 …”