What is an adverse effect? A possible resolution of clinical and epidemiological perspectives on neurobehavioral toxicity

Environmental Research
D C David C Bellinger

Abstract

The sizes of the effects observed in studies that rely on neurobehavioral endpoints are often small. Because the mean deficits implied are more modest in magnitude than are those that correspond to the clinical criteria used to diagnose "disease," some observers dismiss them as inconsequential. Other observers argue that the mean deficits take on greater import when viewed as effects on a population rather than on individual members of the population. Several considerations germane to an effort to reconcile these perspectives are discussed: (1) the relative sensitivity of clinical diagnoses and continuously distributed scores on neurobehavioral tests as indices of adverse effect, (2) the syndromal nature of many diagnoses in pediatric neurology and neuropsychology and the implications of shifting nosology, (3) neurobehavioral test-score changes as surrogates or as prodromes for clinically significant deficits, (4) the distinction between individual risk and population risk, and (5) the tendency of the distribution of a risk factor in a population to move up and down as a whole. The clinical and epidemiological perspectives are complementary rather than incompatible.

References

Sep 1, 1991·Circulation·G Rose
Nov 3, 1990·BMJ : British Medical Journal·G Rose, S Day
Apr 23, 1987·The New England Journal of Medicine·D BellingerM Rabinowitz
Mar 1, 1985·International Journal of Epidemiology·G Rose
Jul 1, 1995·Nature Genetics·T W Glover
Jun 1, 1993·Journal of Clinical Epidemiology·M S Ellman, A R Feinstein
Feb 13, 2001·Journal of Epidemiology and Community Health·U LaaserB Hoffmann
Dec 5, 2002·The Psychiatric Clinics of North America·Lewis L JuddHagop S Akiskal
Feb 18, 2003·Journal of Child Psychology and Psychiatry, and Allied Disciplines·Edwin J C G van den OordIrwin D Waldman
Mar 15, 2003·Journal of Child Psychology and Psychiatry, and Allied Disciplines·Tobias BanaschewskiAribert Rothenberger
May 2, 2003·Perspectives in Biology and Medicine·Howard I KushnerJane C Burns

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Citations

May 17, 2005·International Archives of Occupational and Environmental Health·Roberto LucchiniLorenzo Alessio
Sep 7, 2007·Journal of Exposure Science & Environmental Epidemiology·Carlos José Sousa PassosDonna Mergler
Dec 18, 2012·International Journal of Epidemiology·Cheng HuangZhiwen Li
Mar 12, 2008·Current Opinion in Pediatrics·Susan A Korrick, Sharon K Sagiv
Feb 5, 2011·Current Opinion in Pediatrics·Joe M Braun, Russ Hauser
Jun 15, 2007·Journal of Epidemiology and Community Health·Susan A Korrick, David C Bellinger
Apr 6, 2006·The Journal of Clinical Investigation·David C Bellinger, Andrew M Bellinger
Feb 3, 2012·Journal of Attention Disorders·Sharon K SagivSusan A Korrick
Oct 21, 2005·Environmental Health : a Global Access Science Source·Martin PeperRudolf Morgenstern
Mar 16, 2012·Endocrine Reviews·Laura N VandenbergJohn Peterson Myers
Jun 26, 2013·Environmental Health Perspectives·Teresa M Attina, Leonardo Trasande
Jul 18, 2012·Pediatrics·Nancy N MaserejianDavid C Bellinger
Jan 6, 2010·Environmental Health Perspectives·Joe M BraunBruce P Lanphear
Jan 22, 2013·Metabolomics : Official Journal of the Metabolomic Society·Gita SudamaJames D Willett
Jun 10, 2008·Neurotoxicology·Diane S RohlmanChristoph van Thriel
Apr 9, 2008·Neurotoxicology·Monika Meyer-BaronChristoph van Thriel
Aug 20, 2009·Paediatric and Perinatal Epidemiology·Joe M BraunJoyce S Nicholas
Jul 1, 2015·Neurotoxicology·Vicente MustielesMariana F Fernández
Apr 18, 2015·The Journal of Pediatrics·Samrat YeramaneniErin N Haynes
Jan 23, 2015·Environmental Health : a Global Access Science Source·Sharon K SagivDavid C Bellinger
Jun 29, 2004·Environmental Research·Michael Gilbertson, David O Carpenter
Jun 30, 2016·Pediatric Research·Talia Jacobi-PolishookMandy B Belfort
Nov 7, 2016·Environmental Research·José G Dórea
Jun 29, 2017·Environmental Health Perspectives·Joseph M BraunBruce P Lanphear
Mar 1, 2014·Environmental Health Perspectives·Roni W KobroslyShanna H Swan
Feb 22, 2008·Environmental Health Perspectives·Todd A JuskoRichard L Canfield
Oct 6, 2007·American Journal of Industrial Medicine·Lorenzo AlessioRoberto Lucchini
Sep 30, 2009·Journal of Occupational and Environmental Medicine·Robert M ParkHarry A Roels
Mar 21, 2006·Alcohol and Alcoholism : International Journal of the Medical Council on Alcoholism·Eirini I VasilakiW Miles Cox
Apr 28, 2007·Journal of Speech, Language, and Hearing Research : JSLHR·Maura Jones MoyleMary J Lindstrom
Dec 10, 2015·Journal of Developmental and Behavioral Pediatrics : JDBP·Mandy B BelfortEmily Oken

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