GRADE: Assessing the quality of evidence in environmental and occupational health.
GRADE: Assessing the quality of evidence in environmental and occupational health.
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DOI：
10.1016/j.envint.2016.01.004
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发表时间：
2016-07
影响因子：
11.8
通讯作者：
Schünemann HJ
中科院分区：
文献类型：
--
作者：
Morgan RL;Thayer KA;Bero L;Bruce N;Falck-Ytter Y;Ghersi D;Guyatt G;Hooijmans C;Langendam M;Mandrioli D;Mustafa RA;Rehfuess EA;Rooney AA;Shea B;Silbergeld EK;Sutton P;Wolfe MS;Woodruff TJ;Verbeek JH;Holloway AC;Santesso N;Schünemann HJ
在环境卫生方面，人们非常需要采用一种结构化的程序，在作出透明的决定和建议的同时，对证据进行评价和整合。建议评估、发展和评价分级（GRADE）框架有望满足这一需求。十多年来，GRADE已成功应用于临床医学、公共卫生和卫生政策领域，但GRADE在环境和职业卫生方面的经验才刚刚开始。环境和职业健康问题的重点是了解暴露是否是一种潜在的健康危害或风险，评估暴露以了解风险的范围和程度，并探索减轻暴露或风险的干预措施。虽然GRADE提供了许多优势，包括其灵活性和方法的严谨性，但环境和职业健康中使用的不同证据来源的特征需要进一步考虑，以评估方法改进的必要性。需要特别注意的一个问题是，在确定环境因素是否代表潜在的健康危害或风险时，评估和整合来自人类、动物、体外和计算机模拟（计算机建模）研究的证据。对暴露危害的评估可以产生用于GRADE证据-决策（EtD）框架的分析，为有关消除有害暴露或减轻风险的风险管理决策提供信息。EtD框架允许根据对证据确定性（也称为证据质量）的判断以及其他告知建议的因素（如社会价值观和偏好，资源影响和收益）对建议的强度进行分级。GRADE代表了环境和职业健康以系统和透明的方式提出循证建议的未开发机会。本文的目的是提供一个概述的等级，讨论等级的适用性，环境健康，并确定优先领域的方法评估和发展。
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 modelling) 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.