A matrix for bridging the epidemiology and risk assessment gap

Assessment of Health Risk and Presence of Metals in Water and Fish Samples from Doce River, Brazil, After Fundão Dam Collapse

The rupture of the Fundão dam released about 50 million m³ of mining tailings in the Doce river basin. To assess the potential for environmental contamination and the risks of residual exposure of the human population generated by these tailings, water and fish samples from the Doce river were collected 25 days after the accident and analyzed the physicochemical parameters of the water and levels of metals by ICP-MS, in addition to the temporal variability of the concentration of these elements through other studies. This was the first study to carry out an assessment of the health risk associated with the consumption of fish contaminated by metals from the areas affected by the disaster. The values of turbidity (5460 NTU), electrical conductivity (74.8 μS cm^-1), total dissolved solids (892 mg L^-1) and total suspended solids (772 mg L^-1) were above the maximum limit allowed by Brazilian legislation, due to the presence of large amounts of solid materials released after the dam rupture. The analysis of metals in water samples indicated high concentrations of Al (1,906.71 μg L^-1), Mn (370.32 μg L^-1), Fe (8,503.50 μg L^-1) and Hg (34.25 μg L^-1), while for the fish samples, only As (1,033.98 μg kg^-1) and Hg (herbivorous: 505.32 μg kg^-1; predatory: 1,184.09 μg kg^-1) presented levels above those established by Brazilian legislation. The health risk assessment showed that the estimated daily intake for Hg was higher than the reference dose, reinforcing the need for monitoring the area affected by the disaster.

Systematic review of the association between long-term exposure to fine particulate matter and mortality

We used a transparent systematic review framework based on best practices for evaluating study quality and integrating evidence to conduct a review of the available epidemiology studies evaluating associations between long-term exposure to ambient concentrations of PM_2.5 and mortality (all-cause and non-accidental) conducted in North America. We found that while there is some consistency across studies for reporting positive associations, these associations are weak and several important methodological issues have led to uncertainties with regard to the evidence from these studies, including potential confounding by measured and unmeasured factors, exposue measurement error, and model misspecification. These uncertainties provide a plausible, alternative explanation to causality for the weakly positive findings across studies. Using a causality framework that incorporates best practices for making causal determinations, we concluded that the evidence for a causal relationship between long-term exposure to ambient PM_2.5 concentrations and mortality from these studies is inadequate.

'Omics in environmental epidemiological studies of chemical exposures: A systematic evidence map

BACKGROUND

Systematic evidence maps are increasingly used to develop chemical risk assessments. These maps can provide an overview of available studies and relevant study information to be used for various research objectives and applications. Environmental epidemiological studies that examine the impact of chemical exposures on various 'omic profiles in human populations provide relevant mechanistic information and can be used for benchmark dose modeling to derive potential human health reference values.

OBJECTIVES

To create a systematic evidence map of environmental epidemiological studies examining environmental contaminant exposures with 'omics in order to characterize the extent of available studies for future research needs.

METHODS

Systematic review methods were used to search and screen the literature and included the use of machine learning methods to facilitate screening studies. The Populations, Exposures, Comparators and Outcomes (PECO) criteria were developed to identify and screen relevant studies. Studies that met the PECO criteria after full-text review were summarized with information such as study population, study design, sample size, exposure measurement, and 'omics analysis.

RESULTS

Over 10,000 studies were identified from scientific databases. Screening processes were used to identify 84 studies considered PECO-relevant after full-text review. Various contaminants (e.g. phthalate, benzene, arsenic, etc.) were investigated in epidemiological studies that used one or more of the four 'omics of interest: epigenomics, transcriptomics, proteomics, and metabolomics . The epidemiological study designs that were used to explore single or integrated 'omic research questions with contaminant exposures were cohort studies, controlled trials, cross-sectional, and case-control studies. An interactive web-based systematic evidence map was created to display more study-related information.

CONCLUSIONS

This systematic evidence map is a novel tool to visually characterize the available environmental epidemiological studies investigating contaminants and biological effects using 'omics technology and serves as a resource for investigators and allows for a range of applications in chemical research and risk assessment needs.

The interpretation of chemical epidemiology studies requires integration with experts on the nature of the reported adverse outcome and toxicologists

Chemical Epidemiology Studies (CES) can be both protective for humans of adverse health effects of chemicals as well as cause alarm leading to unwarranted remedial action and litigation. Inherent problems in conducting CES especially related to the study design goals and assessment of exposure are recognized. Many CES report adverse health outcomes at very low exposure levels implying that humans are uniquely or especially sensitive to the toxicity of these chemicals. Such unique sensitivity to humans would be especially important to scientists in human physiology, medical and toxicology communities. CES are currently appearing in the open literature more frequently and it is expected that they will be appearing even more frequently in the future especially if animal toxicity testing is reduced or eliminated. Experts on the nature of the reported adverse health outcomes should be playing a more critical role in the interpretation of CES because they are best suited to understand the many factors affecting natural and induced variability. Should animal toxicity testing be reduced, the role of toxicologists in the interpretation of CES will need to evolve. This manuscript addresses the need for more uniform standards in conducting, reporting, and review by independent, fully focused experts if CES studies reported in the open literature will be included in the health risk characterization and litigation of chemicals.

Nourishing the Human Holobiont to Reduce the Risk of Non-Communicable Diseases: A Cow’s Milk Evidence Map Example

The microbiome revolution brought the realization that diet, health, and safety for humans in reality means diet, health, and safety for the human holobiont/superorganism. Eating healthier means much more than just feeding human cells. Our diet must also nourish the combination of our microbiome and our connected physiological systems (e.g., the microimmunosome). For this reason, there has been an interest in returning to ancestral “complete” unprocessed foods enriched in microbes, including raw milks. To contribute to this inevitable “nourishing the holobiont” trend, we introduce a systematic risk–benefit analysis tool (evidence mapping), which facilitates transdisciplinary state-of-the-science decisions that transcend single scientific disciplines. Our prior paper developed an evidence map (a type of risk–benefit mind map) for raw vs. processed/pasteurized human breast milk. In the present paper, we follow with a comprehensive evidence map and narrative for raw/natural vs. processed/pasteurized cow’s milk. Importantly, the evidence maps incorporate clinical data for both infectious and non-communicable diseases and allow the impact of modern agricultural, food management, and medical and veterinary monitoring outcomes to be captured. Additionally, we focus on the impact of raw milks (as “complete” foods) on the microimmunosome, the microbiome-systems biology unit that significantly determines risk of the world’s number one cause of human death, non-communicable diseases.

A human biomonitoring (HBM) Global Registry Framework: Further advancement of HBM research following the FAIR principles

Data generated by the rapidly evolving human biomonitoring (HBM) programmes are providing invaluable opportunities to support and advance regulatory risk assessment and management of chemicals in occupational and environmental health domains. However, heterogeneity across studies, in terms of design, terminology, biomarker nomenclature, and data formats, limits our capacity to compare and integrate data sets retrospectively (reuse). Registration of HBM studies is common for clinical trials; however, the study designs and resulting data collections cannot be traced easily. We argue that an HBM Global Registry Framework (HBM GRF) could be the solution to several of challenges hampering the (re)use of HBM (meta)data. The aim is to develop a global, host-independent HBM registry framework based on the use of harmonised open-access protocol templates from designing, undertaking of an HBM study to the use and possible reuse of the resulting HBM (meta)data. This framework should apply FAIR (Findable, Accessible, Interoperable and Reusable) principles as a core data management strategy to enable the (re)use of HBM (meta)data to its full potential through the data value chain. Moreover, we believe that implementation of FAIR principles is a fundamental enabler for digital transformation within environmental health. The HBM GRF would encompass internationally harmonised and agreed open access templates for HBM study protocols, structured web-based functionalities to deposit, find, and access harmonised protocols of HBM studies. Registration of HBM studies using the HBM GRF is anticipated to increase FAIRness of the resulting (meta)data. It is also considered that harmonisation of existing data sets could be performed retrospectively. As a consequence, data wrangling activities to make data ready for analysis will be minimised. In addition, this framework would enable the HBM (inter)national community to trace new HBM studies already in the planning phase and their results once finalised. The HBM GRF could also serve as a platform enhancing communication between scientists, risk assessors, and risk managers/policy makers. The planned European Partnership for the Assessment of Risk from Chemicals (PARC) work along these lines, based on the experience obtained in previous joint European initiatives. Therefore, PARC could very well bring a first demonstration of first essential functionalities within the development of the HBM GRF.

Environmental Health Risk Assessment in the Federal Government: A Visual Overview and a Renewed Call for Coordination

In the United States (U.S.), chemical evaluations and assessments are conducted by seven federal agencies responding to distinct statutory requirements and focusing on different exposure scenarios. While risk assessment is a fundamental concept in public health practice and policy, there is no clear, central, and concise summary of these processes. The novel infographic presented here depicts more than 30 different evaluation and assessment processes conducted by federal agencies for chemicals found in the environment, workplace, consumer products, hazardous waste sites, food, and/or cosmetics. The majority of these assessments are statutorily required. Most serve as sources of authoritative information to provide public health guidance or recommendations. Less than half directly result in risk management actions or regulations. Understanding these roles and processes can facilitate engagement from the broader community, including by highlighting priority areas for research to inform public health policy. This infographic also illustrates the opportunity and need for further intra- and interagency collaboration and coordination - including a particular focus on aggregate risk assessment, given that the population regularly experiences exposures from multiple sources crossing agency domains.

Mismanagement of Plastic Waste through Open Burning with Emphasis on the Global South: A Systematic Review of Risks to Occupational and Public Health

Large quantities of mismanaged plastic waste threaten the health and wellbeing of billions worldwide, particularly in low- and middle-income countries where waste management capacity is being outstripped by increasing levels of consumption and plastic waste generation. One of the main self-management strategies adopted by 2 billion people who have no waste collection service, is to burn their discarded plastic in open, uncontrolled fires. While this strategy provides many benefits, including mass and volume reduction, it is a form of plastic pollution that results in the release of chemical substances and particles that may pose serious risks to public health and the environment. We followed adapted PRISMA guidelines to select and review 20 publications that provide evidence on potential harm to human health from open burning plastic waste, arranging evidence into eight groups of substance emissions: brominated flame retardants; phthalates; potentially toxic elements; dioxins and related compounds; bisphenol A; particulate matter; and polycyclic aromatic hydrocarbons. We semiquantitatively assessed 18 hazard-pathway-receptor combination scenarios to provide an indication of the relative harm of these emissions so that they could be ranked, compared and considered in future research agenda. This assessment overwhelmingly indicated a high risk of harm to waste pickers, a large group of 11 million informal entrepreneurs who work closely with waste, delivering a circular economy but often without protective equipment or a structured, safe system of work. Though the risk to human health from open burning emissions is high, this remains a substantially under-researched topic.

The role of epidemiology studies in human health risk assessment of polychlorinated biphenyls

Polychlorinated biphenyls (PCBs) are a public health concern given evidence that they persist and accumulate in the environment and can cause toxic effects in animals and humans. However, evaluating adverse effects of PCBs in epidemiologic studies is complicated by the characteristics of PCB exposure. PCBs exist as mixtures in the environment; the mixture changes over time due to degradation, and given physicochemical differences between specific PCB congeners, the mixture that an individual is exposed to (via food, air, or other sources) is likely different from that which can be measured in biological tissues. This is particularly problematic when evaluating toxicity of shorter-lived congeners that may not be measurable by the time biological samples are collected. We review these and other issues that arise when evaluating epidemiologic studies of PCBs and discuss how epidemiology data can still be used to inform both hazard identification and dose-response evaluation.

Development of a Range of Plausible Noncancer Toxicity Values for 2,3,7,8-Tetrachlorodibenzo-p-Dioxin Based on Effects on Sperm Count: Application of Systematic Review Methods and Quantitative Integration of Dose Response Using Meta-Regression

Regulatory agencies have derived noncancer toxicity values for 2,3,7,8-tetrachlorodibenzo-p-dioxin based on reduced sperm counts relying on single studies from a large body of evidence. Techniques such as meta-regression allow for greater use of the available data while simultaneously providing important information regarding the uncertainty associated with the underlying evidence base when conducting risk assessments. The objective herein was to apply systematic review methods and meta-regression to characterize the dose-response relationship of gestational exposure and epididymal sperm count. Twenty-three publications (20 animal studies consisting of 29 separate rat experimental data sets, and 3 epidemiology studies) met inclusion criteria. Risk of bias evaluation was performed to critically appraise study validity. Low to very low confidence precluded use of available epidemiological data as candidate studies for dose-response due to inconsistencies across the evidence base, high risk of bias, and general lack of biological coherence, including lack of clinical relevance and dose-response concordance. Experimental animal studies, which were found to have higher confidence following the structured assessment of confidence (eg, controlled exposure, biological consistency), were used as the basis of a meta-regression. Multiple models were fit; points of departure were identified and converted to human equivalent doses. The resulting reference dose estimates ranged from approximately 4 to 70 pg/kg/day, depending on model, benchmark response level, and study validity integration approach. This range of reference doses can be used either qualitatively or quantitatively to enhance understanding of human health risk estimates for dioxin-like compounds.

Cancer and occupational exposure to pesticides: an umbrella review

Purpose

The aim was to identify the scope of the epidemiology literature reviewed regarding the risk of cancer as related to occupational exposure to pesticides and to compare regulatory toxicity results where feasible.

Methods

Review studies of breast, lung, prostate, non-Hodgkin lymphoma, and colorectal cancer were identified from the published literature from 2010 to 2020 using a priori inclusion and exclusion criteria. Epidemiology observations were first assessed and then compared against carcinogenicity profiles derived from regulatory toxicology studies.

Results

Several active ingredients were associated with specific cancer but overall, there was neither strong nor consistent epidemiologic data supportive of a positive association between pesticide exposure in occupational settings and cancer. Authors noted common themes related to the heterogeneity of exposure, study design, control for confounders, and the challenge to collect these data reliably and validly with an adequate sample size. Toxicology studies in laboratory animals that assessed carcinogenic potential did not reveal cancer outcomes that were concordant with reported epidemiologic findings.

Conclusions

Farming and pesticides represent diverse exposures that are difficult to quantify in epidemiologic studies. Going forward, investigators will need creative and novel approaches for exposure assessment. Integration of epidemiologic and toxicological studies with attention to biological plausibility, mode of toxicological action and relevance to humans will increase the ability to better assess associations between pesticides and cancer.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-020-01638-y.

Translation of Exposure and Epidemiology for Risk Assessment: A Shifting Paradigm

Risk assessment is a well-established process used for various types of public health decision-making, such as setting chemical site clean-up levels, developing limits on exposures to chemicals in soil, water, air and food, and determining occupational exposure limits[...].