Structured expert judgement approach of the health impact of various chemicals and classes of chemicals.

INTRODUCTION: Chemical contamination and pollution are an ongoing threat to human health and the environment. The concern over the consequences of chemical exposures at the global level continues to grow. Because resources are constrained, there is a need to prioritize interventions focused on the greatest health impact. Data, especially related to chemical exposures, are rarely available for most substances of concern, and alternate methods to evaluate their impact are needed. STRUCTURED EXPERT JUDGMENT (SEJ) PROCESS: A Structured Expert Judgment (Research Outreach, 2021) process was performed to provide plausible estimates of health impacts for 16 commonly found pollutants: asbestos, arsenic, benzene, chromium, cadmium, dioxins, fluoride, highly hazardous pesticides (HHPs), lead, mercury, polycyclic-aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), Per- and Polyfluorinated Substances (PFAs), phthalates, endocrine disrupting chemicals (EDCs), and brominated flame retardants (BRFs). This process, undertaken by sector experts, weighed individual estimations of the probable global health scale health impacts of each pollutant using objective estimates of the expert opinions' statistical accuracy and informativeness. MAIN FINDINGS: The foremost substances, in terms of mean projected annual total deaths, were lead, asbestos, arsenic, and HHPs. Lead surpasses the others by a large margin, with an estimated median value of 1.7 million deaths annually. The three other substances averaged between 136,000 and 274,000 deaths per year. Of the 12 other chemicals evaluated, none reached an estimated annual death count exceeding 100,000. These findings underscore the importance of prioritizing available resources on reducing and remediating the impacts of these key pollutants. RANGE OF HEALTH IMPACTS: Based on the evidence available, experts concluded some of the more notorious chemical pollutants, such as PCBs and dioxin, do not result in high levels of human health impact from a global scale perspective. However, the chemical toxicity of some compounds released in recent decades, such as Endocrine Disrupters and PFAs, cannot be ignored, even if current impacts are limited. Moreover, the impact of some chemicals may be disproportionately large in some geographic areas. Continued research and monitoring are essential; and a preventative approach is needed for chemicals. FUTURE DIRECTIONS: These results, and potential similar analyses of other chemicals, are provided as inputs to ongoing discussions about priority setting for global chemicals and pollution management. Furthermore, we suggest that this SEJ process be repeated periodically as new information becomes available.

Gist Representations and Decision-Making Processes Affecting Antibiotic Prescribing for Children with Acute Otitis Media.

Objective. To test the predictions of fuzzy-trace theory regarding pediatric clinicians' decision-making processes and risk perceptions about antibiotics for children with acute otitis media (AOM). Methods. We conducted an online survey experiment administered to a sample of 260 pediatric clinicians. We measured their risk perceptions and prescribing decisions across 3 hypothetical AOM treatment scenarios. Participants were asked to choose among the following options: prescribe antibiotics immediately, watchful waiting ("hedging"), or not prescribing antibiotics. Results. We identified 4 gists based on prior literature: 1) "why not take a risk?" 2) "antibiotics might not help but can hurt," 3) "antibiotics do not have harmful side effects," and 4) "antibiotics might have harmful side effects." All 4 gists predicted risky choice (P < 0.001), and gist endorsements varied significantly between scenarios when antibiotics were indicated, F(2, 255) = 8.53, P < 0.001; F(2, 255) = 5.14, P < .01; and F(2, 255) = 3.56, P < 0.05 for the first 3 factors, respectively. In a logistic regression, more experienced clinicians were less likely to hedge (B = -0.05; P < 0.01). Conclusion. As predicted by fuzzy-trace theory, pediatric clinicians' prescription decisions are associated with gist representations, which are distinct from verbatim risk estimates. Implications. Antibiotic stewardship programs can benefit by communicating the appropriate gists to clinicians who prescribe antibiotics for pediatric patients. Highlights: We found clinicians' antibiotic prescription decisions were driven by gist representations of antibiotic risks for a given hypothetical patient scenario, and clinicians' gist representations and verbatim risk estimates about antibiotic-related risks were distinct from each other.We showed that the effect of patient scenarios on clinicians' antibiotic prescription decisions was mediated by clinicians' gist representations.Less experienced clinicians tend to "hedge" in their antibiotic prescription decisions compared with more experienced clinicians.The broader impact of our study is that antibiotic stewardship programs can benefit by communicating the appropriate gists to clinicians who prescribe antibiotics for pediatric patients, rather than solely focusing on closing potential knowledge deficits of the clinicians.