Issues associated with possible implementation of Non-Invasive Prenatal Testing (NIPT) in first-tier screening: A rapid scoping review

In recent years, as the implementation and use of Non-Invasive Prenatal Testing (NIPT) have increased, the cost of the test has been decreasing. The cost of NIPT is expected to fall further in the upcoming years. As a result of the decreasing cost of NIPT, many jurisdictions may change their prenatal screening policies toward abandoning serum-based screening and instead, implement and support NIPT as the first-tier screening for all women. There are several concerns in replacing first-trimester screening with NIPT. In this scoping review, we aimed to map the existing knowledge about possible issues in the systematic implementation of NIPT as the primary method of first-tier screening and to assess if any jurisdiction has altered its policy and discontinued serum-based prenatal screening in exchange for NIPT. The Medline database (Ovid) and Google Scholar was searched and all the studies discussing, investigating, or reporting on the systematic implementation of NIPT as the primary method of first-tier screening were included. All the studies went through a two-stage screening process and included full-text articles were reviewed. We did not find any articles indicating a country or region that replaced traditional prenatal screening by NIPT. The included articles were charted, and the data about the possible issues in the systematic implementation of NIPT as the primary method of first-tier screening are summarized narratively and presented in tables in four categories. The findings of this scoping review may be informative for stakeholders and policymakers regarding recent changes in NIPT implementation policies around the world and may aid with developing policy for NIPT implementation with a broader perspective.     

Book reviews

Making Cities Work: the role of local government in the urban environment. Richard Gilbert, Don Stevenson, Herbert Girardet &; Richard Stren, 1996, London, Earthscan, 203pp. ISBN 1 85383 354 1, £13.95 pbk

Environmental Policy in an International Context, Vols 1–3: Perspectives, Conflicts and Prospects. P. Glasbergen &; A. Blowers (Series Eds) London, Arnold

Rhetoric and Reality in Environmental Policy. M. Wintle &; R. Reeve (Eds), 1994, Aldershot, Avebury Studies in Green Research, 154 pp. ISBN 1 85628 927 3

FutureNatural: Nature, Science, Culture. G. Roberston et al. (Eds) 1996, London, Routledge, ISBN 0415 070139, £40.00 hbk

Environmental Policy with Political Integration: the European Union and the United States. New horizons in environmental economics. John B. Braden, Henk Folmer &; Thomas S. Ulen (Eds), 1996, Cheltenham, Elgar Publishing, 477 pp. ISBN 1 85898 217 0     

Fostering sustainability through sourcing from small businesses: public sector perspectives

This article examines the opportunities for fostering sustainable development through public sector sourcing from small- and medium-sized enterprises (SMEs). Buying from small businesses can make such contributions in a variety of forms, ranging from a contribution to local economic development through providing innovative green products and services, particularly in the food sector, to helping the public sector organisation to better align its operations with its community. Sourcing from small businesses also has implications for the governance of sourcing processes and can benefit from a partnership approach. Barriers to public sector sourcing from small businesses are discussed and suggestions made on how these can be overcome.     

Perceived and measured levels of environmental pollution: interdisciplinary research in the subarctic lowlands of northeast European Russia

Using interdisciplinary field research in the Usa Basin, northeast European Russia, we compared local inhabitants' perception of environmental problems with chemical and remote-sensing signatures of environmental pollution and their local impacts. Extensive coal mining since the 1930s around Inta and Vorkuta has left a legacy of pollution, detected by measuring snowpack, topsoil, and lichen chemistry, together with remote-sensing techniques and analysis of lake water and sediments. Vorkuta and its environs suffered the worst impacts, with significant metal loading and alkalization in lakes and topsoils, elevated metals and cations in terricolous (reindeer) lichens, and changes in vegetation communities. Although the coal industry has declined recently, the area boasts a booming oil and gas industry, based around Usinsk. Local perceptions and concerns of environmental pollution and protection were higher in Usinsk, as a result of increased awareness after a major oil spill in 1994, compared with Vorkuta's inhabitants, who perceived air pollution as the primary environmental threat. Our studies indicate that the principal sources of atmospheric emissions and local deposition within 25 to 40 km of Vorkuta were coal combustion from power and heating plants, coal mines, and a cement factory. Local people evaluated air pollution from direct observations and personal experiences, such as discoloration of snow and respiratory problems, whereas scientific knowledge played a minor role in shaping these perceptions.