Science and Decisions National Research Council; Division on Earth and Life Studies; Board on Environmental Studies and Toxicology
09/2009
eBook
Open access
Risk assessment has become a dominant public policy tool for making choices, based on limited resources, to protect public health and the environment. It has been instrumental to the mission of the ...U.S. Environmental Protection Agency (EPA) as well as other federal agencies in evaluating public health concerns, informing regulatory and technological decisions, prioritizing research needs and funding, and in developing approaches for cost-benefit analysis.
However, risk assessment is at a crossroads. Despite advances in the field, risk assessment faces a number of significant challenges including lengthy delays in making complex decisions; lack of data leading to significant uncertainty in risk assessments; and many chemicals in the marketplace that have not been evaluated and emerging agents requiring assessment.
Science and Decisions makes practical scientific and technical recommendations to address these challenges. This book is a complement to the widely used 1983 National Academies book, Risk Assessment in the Federal Government (also known as the Red Book). The earlier book established a framework for the concepts and conduct of risk assessment that has been adopted by numerous expert committees, regulatory agencies, and public health institutions. The new book embeds these concepts within a broader framework for risk-based decision-making. Together, these are essential references for those working in the regulatory and public health fields.
Genetic engineering has a wide range of cultural, economic, and ethical implications, yet it has become almost an article of faith that regulatory decisions about biotechnology be based only on ...evidence of specific quantifiable risks; to consider anything else is said to "politicize" regulation. In this study of social protest against genetically engineered food, Abby Kinchy turns the conventional argument on its head. Rather than consider politicization of the regulatory system, she takes a close look at the scientization of public debate about the "contamination" of crops resulting from pollen drift and seed mixing. Advocates of alternative agriculture confront the scientization of this debate by calling on international experts, carrying out their own research, questioning regulatory science in court, building alternative markets, and demanding that their governments consider the social and economic impacts of the new technologies. Kinchy focuses on social conflicts over canola in Canada and maize in Mexico, drawing out their linkages to the global food system and international environmental governance. The book ultimately demonstrates the shortcomings of dominant models of scientific risk governance, which marginalize alternative visions of rural livelihoods and sustainable food production.The hardcover edition does not include a dust jacket.
Summary Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease ...analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability YLD and years of life lost YLL) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% 95% uncertainty interval 6·2–7·7 of global DALYs), tobacco smoking including second-hand smoke (6·3% 5·5–7·0), and household air pollution from solid fuels (4·3% 3·4–5·3). In 1990, the leading risks were childhood underweight (7·9% 6·8–9·4), household air pollution from solid fuels (HAP; 6·8% 5·5–8·0), and tobacco smoking including second-hand smoke (6·1% 5·4–6·8). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2–10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4–1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, Andean Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, most of Latin America, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. Funding Bill & Melinda Gates Foundation.
Fungicides are indispensable to global food security and their use is forecasted to intensify. Fungicides can reach aquatic ecosystems and occur in surface water bodies in agricultural catchments ...throughout the entire growing season due to their frequent, prophylactic application. However, in comparison to herbicides and insecticides, the exposure to and effects of fungicides have received less attention. We provide an overview of the risk of fungicides to aquatic ecosystems covering fungicide exposure (i.e., environmental fate, exposure modeling, and mitigation measures) as well as direct and indirect effects of fungicides on microorganisms, macrophytes, invertebrates, and vertebrates. We show that fungicides occur widely in aquatic systems, that the accuracy of predicted environmental concentrations is debatable, and that fungicide exposure can be effectively mitigated. We additionally demonstrate that fungicides can be highly toxic to a broad range of organisms and can pose a risk to aquatic biota. Finally, we outline central research gaps that currently challenge our ability to predict fungicide exposure and effects, promising research avenues, and shortcomings of the current environmental risk assessment for fungicides.
Summary
Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis.
Introduction
The International Osteoporosis ...Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting.
Methods
Systematic reviews were updated.
Results
The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment.
Conclusions
A platform is provided on which specific guidelines can be developed for national use.
Soil heavy metal pollution has been becoming serious and widespread in China. To date, there are few studies assessing the nationwide soil heavy metal pollution induced by industrial and agricultural ...activities in China. This review obtained heavy metal concentrations in soils of 402 industrial sites and 1041 agricultural sites in China throughout the document retrieval. Based on the database, this review assessed soil heavy metal concentration and estimated the ecological and health risks on a national scale. The results revealed that heavy metal pollution and associated risks posed by cadmium (Cd), lead (Pb) and arsenic (As) are more serious. Besides, heavy metal pollution and associated risks in industrial regions are severer than those in agricultural regions, meanwhile, those in southeast China are severer than those in northwest China. It is worth noting that children are more likely to be affected by heavy metal pollution than adults. Based on the assessment results, Cd, Pb and As are determined as the priority control heavy metals; mining areas are the priority control areas compared to other areas in industrial regions; food crop plantations are the priority control areas in agricultural regions; and children are determined as the priority protection population group. This paper provides a comprehensive ecological and health risk assessment on the heavy metals in soils in Chinese industrial and agricultural regions and thus provides insights for the policymakers regarding exposure reduction and management.
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•402 industrial and 1041 agricultural sites are reviewed.•Pollution and risks in industrial regions were severer than agricultural regions.•30% of industrial sites pose potential non-carcinogenic risk.•The majority of As carcinogenic risks are at a relatively unacceptable range.•The priority control components were identified.
Informing Decisions in a Changing Climate National Research Council; Division of Behavioral and Social Sciences and Education; Committee on the Human Dimensions of Global Change ...
06/2009
eBook
Open access
Everyone-government agencies, private organizations, and individuals-is facing a changing climate: an environment in which it is no longer prudent to follow routines based on past climatic averages. ...State and local agencies in particular, as well as the federal government, need to consider what they will have to do differently if the 100-year flood arrives every decade or so, if the protected areas for threatened species are no longer habitable, or if a region can expect more frequent and more severe wildfires, hurricanes, droughts, water shortages, or other extreme environmental events. Both conceptually and practically, people and organizations will have to adjust what may be life-long assumptions to meet the potential consequences of climate change. How and where should bridges be built? What zoning rules may need to be changed? How can targets for reduced carbon emissions be met? These and myriad other questions will need to be answered in the coming years and decades.
Informing Decisions in a Changing Climate examines the growing need for climate-related decision support-that is, organized efforts to produce, disseminate, and facilitate the use of data and information in order to improve the quality and efficacy of climate-related decisions. Drawing on evidence from past efforts to organize science for improved decision making, it develops guidance for government agencies and other institutions that will provide or use information for coping with climate change. This volume provides critical analysis of interest to agencies at every level, as well as private organizations that will have to cope with the world's changing climate.
Only recently has the environment been clearly implicated in the risk of antibiotic resistance to clinical outcome, but to date there have been few documented approaches to formally assess these ...risks.
We examined possible approaches and sought to identify research needs to enable human health risk assessments (HHRA) that focus on the role of the environment in the failure of antibiotic treatment caused by antibiotic-resistant pathogens.
The authors participated in a workshop held 4-8 March 2012 in Québec, Canada, to define the scope and objectives of an environmental assessment of antibiotic-resistance risks to human health. We focused on key elements of environmental-resistance-development "hot spots," exposure assessment (unrelated to food), and dose response to characterize risks that may improve antibiotic-resistance management options.
Various novel aspects to traditional risk assessments were identified to enable an assessment of environmental antibiotic resistance. These include a) accounting for an added selective pressure on the environmental resistome that, over time, allows for development of antibiotic-resistant bacteria (ARB); b) identifying and describing rates of horizontal gene transfer (HGT) in the relevant environmental "hot spot" compartments; and c) modifying traditional dose-response approaches to address doses of ARB for various health outcomes and pathways.
We propose that environmental aspects of antibiotic-resistance development be included in the processes of any HHRA addressing ARB. Because of limited available data, a multicriteria decision analysis approach would be a useful way to undertake an HHRA of environmental antibiotic resistance that informs risk managers.
The ecosystem services approach has gained broad interest in regulatory and policy circles for use in ecological risk assessment. Whilst identifying several challenges, scientific experts from ...European regulatory authorities, the chemical industry and academia considered the approach applicable to all chemical sectors and potentially contributing to greater ecological relevance for setting and assessing environmental protection goals compared to current European regulatory frameworks for chemicals. These challenges were addressed in workshops to develop a common understanding across stakeholders on how the ecosystem services concept might be used in chemical risk assessment and what would need to be done to implement it. This paper describes the consensus outcome of those discussions. Knowledge gaps and research needs were identified and prioritised, exploring the use of novel approaches from ecology, ecotoxicology and ecological modelling. Where applicable, distinction is made between prospective and retrospective ecological risk assessment. For prospective risk assessment the development of environmental scenarios accounting for chemical exposure and ecological conditions was designated as a top priority. For retrospective risk assessment the top priority research need was development of reference conditions for key ecosystem services and guidance for their derivation. Both prospective and retrospective risk assessment would benefit from guidance on the taxa and measurement endpoints relevant to specific ecosystem services and from improved understanding of the relationships between measurement endpoints from standard toxicity tests and the ecosystem services of interest (i.e. assessment endpoints). The development of mechanistic models, which could serve as ecological production functions, was identified as a priority. A conceptual framework for future chemical risk assessment based on an ecosystem services approach is presented.
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•The ecosystem services (ES) approach has potential to enhance ecological and societal relevance in ERA.•Stakeholders in EU regulation, industry, academia and NGOs agreed on priority research needs.•A framework for future chemical risk assessment based on an ES approach is presented.•Further development may benefit from recent progress in other disciplines.
Despite significant progress in primary prevention, the rate of MI has not declined in young adults.
The purpose of this study was to evaluate statin eligibility based on the 2013 American College of ...Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age.
The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation.
Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001).
The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.
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