Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes.

[First paragraph] A clearly-framed question creates the structure and delineates the approach to defining research objectives, conducting systematic reviews and developing health guidance (Guyatt et al., 2011; Armstrong et al., 2007). To assess the association between exposures and outcomes, including in the field of nutrition, environmental and occupational health, the concept of defining the Population (including animal species), Exposure, Comparator, and Outcomes (PECO) as pillars of the question is increasingly accepted (Morgan et al., 2016; Morgan et al., n.d.). Thus, the PECO defines the objectives of the review or guideline. Furthermore, the PECO informs the study design or inclusion and exclusion criteria for a review, as well as facilitating the interpretation of the directness of the findings based on how well the actual research findings represent the original question.

[1]  J. Ioannidis,et al.  Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials , 2014, BMJ : British Medical Journal.

[2]  Gábor L. Lövei,et al.  Application of Systematic Review Methodology to Food and Feed Safety Assessments to Support Decision Making , 2010 .

[3]  David E Newby,et al.  Short term exposure to air pollution and stroke: systematic review and meta-analysis , 2015, BMJ : British Medical Journal.

[4]  Elizabeth Waters,et al.  Guidelines for systematic reviews of health promotion and public health interventions. , 2005 .

[5]  Jonathan L. Snare,et al.  PART 1926—SAFETY AND HEALTH REGULATIONS FOR CONSTRUCTION , 2006 .

[6]  Gordon H Guyatt,et al.  GRADE guidelines: 2. Framing the question and deciding on important outcomes. , 2011, Journal of clinical epidemiology.

[7]  Thais C Morata,et al.  Interventions to prevent occupational noise induced hearing loss. , 2009, The Cochrane database of systematic reviews.

[8]  H. Schünemann,et al.  Epidemiologic evidence linking antioxidant vitamins to pulmonary function and airway obstruction. , 2001, Epidemiologic reviews.

[9]  D. Norbäck,et al.  Hearing status among commercial pilots in a Swedish airline company , 2008, International journal of audiology.

[10]  Nancy Santesso,et al.  GRADE: Assessing the quality of evidence in environmental and occupational health. , 2016, Environment international.

[11]  Tracey J. Woodruff,et al.  The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Human Evidence for PFOA Effects on Fetal Growth , 2014, Environmental health perspectives.

[12]  Tracey J. Woodruff,et al.  The Navigation Guide Systematic Review Methodology: A Rigorous and Transparent Method for Translating Environmental Health Science into Better Health Outcomes , 2014, Environmental health perspectives.

[13]  L. Rylander,et al.  Maternal Occupational Exposure to Noise during Pregnancy and Hearing Dysfunction in Children: A Nationwide Prospective Cohort Study in Sweden , 2015, Environmental health perspectives.

[14]  Paula I. Johnson,et al.  The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Systematic Review of Nonhuman Evidence for PFOA Effects on Fetal Growth , 2014, Environmental health perspectives.

[15]  L. Thabane,et al.  Posing the research question: not so simple , 2009, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[16]  H. Schünemann,et al.  The relation of serum levels of antioxidant vitamins C and E, retinol and carotenoids with pulmonary function in the general population. , 2001, American journal of respiratory and critical care medicine.

[17]  H. Schünemann,et al.  Lung function in relation to intake of carotenoids and other antioxidant vitamins in a population-based study. , 2002, American journal of epidemiology.

[18]  J. Higgins,et al.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, International Coaching Psychology Review.

[19]  J. Higgins Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration , 2011 .

[20]  Matthew L. Thomas,et al.  Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015 , 2017, The Lancet.