Suchergebnisse

International audience ; Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY ...

International audience ; Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY ...

International audience ; Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY ...

International audience ; Background: Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies.Methods: This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data.Results: The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development.The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year.Conclusions:The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method ...

International audience ; Background: Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies.Methods: This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data.Results: The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development.The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year.Conclusions:The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method ...

International audience ; Background: Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies.Methods: This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data.Results: The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development.The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year.Conclusions:The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method ...

International audience ; Background: Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies.Methods: This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data.Results: The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development.The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year.Conclusions:The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method ...

L'objectif du projet Mapéru consistait à savoir s'il existait des formes de prises en charge professionnelles, des besoins et des trajectoires de la maladie d'Alzheimer spécifiques en milieu rural. Après vingt-quatre mois de recherche, le projet nous montre qu'à l'instar de son diagnostic, l'appréhension géographique de la maladie nous livre des réponses mais aussi des interrogations. La maladie d'Alzheimer est une maladie aux contours flous dont le diagnostic demeure probabiliste. Si à la faveur d'un effort politique, le diagnostic de la maladie en France présente sur le versant de l'offre une organisation et un maillage effectif (Ankri, 2013), les investigations mettent clairement en avant des décalages avec les besoins. En effet, la reconnaissance de la maladie d'Alzheimer ne se limite pas aux centres de diagnostic. Le projet nous montre à ce sujet, que contrairement aux distances géographiques, le médecin généraliste ainsi que les configurations familiales et sociales influencent l'accès au diagnostic. Dans ce jeu, on est en droit de s'interroger sur les conséquences en matière de diagnostic de la maladie, de la faible proportion de généraliste par habitant en milieu rural. Les taux de reconnaissance de la maladie sont sans équivoque et surtout corrélés positivement à la présence des médecins généralistes. Dans le même temps, les configurations sociales et familiales apparaissent des variables trop fluctuantes en campagne pour garantir un niveau de recours au diagnostic élevé dans ces espaces. C'est la raison pour laquelle on peut se questionner sur l'écart de détection entre malades reconnus et les personnes malades non reconnues. Enfin les investigations nous montre les limites de prise en charge de la maladie dans les territoires ruraux d'étude. Disposant d'un niveau élevé d'équipement médico-social, les territoires ruraux d'étude affichent dans le même temps un faible degré de spécialisation Alzheimer. Cette faible spécialisation est la résultante d'une coopération professionnelle déséquilibrée (concentration des liens vers les structures hospitalières locales et régionales) et d'une faible capacité locale à répondre aux appels à projets du Plan Alzheimer régulés par les nouvelles Agences Régionales de Santé. Or, ces carences ne sont pas sans conséquence sur les prises en charges de la maladie et les trajectoires des malades comme le montrent les entretiens menés dans le territoire rural Ouest. Les investigations auprès des aidants mettent clairement en avant une prise en charge qui oscille entre domicile et établissements selon la progression de la maladie. Dans ce sens, les mécanismes sociologiques et familiaux de repli du malade et de son entourage ainsi que le faible niveau de spécialisation professionnelle en milieu rural constituent les deux problématiques qui actent une inadaptation partielle de la prise en charge de la maladie d'Alzheimer. - Lors des situations d'urgence (rupture d'aide au domicile), elle se traduit pour les malades les mieux entourés (ceux de l'échantillon) par une inadaptation temporaire de la prise en charge dans des unités de longue durée ou des soins de suite et réadaptation de structures hospitalières ou bien dans des établissements éloignés géographiquement de l'ancien cadre de vie. Après quelques semaines d'attentes, ces malades sont pris en charge dans une maison de retraite médicalisée locale dont les besoins augmentent et la professionnalisation du personnel et l'aménagement de l'espace face à la maladie s'avèrent limités. - Pour la poignée de situations les plus vulnérables sur le plan familial et social, les entretiens avec les aidants montrent que la maladie accroît la vulnérabilité du malade et de l'aidant conduisant à des situations de repli et d'isolement. Dans ce sens, les décalages épidémiologiques relatés nous questionne sur le niveau de ces configurations de vulnérabilité, particulièrement dans un contexte excentré sur le plan géographique et social.

L'objectif du projet Mapéru consistait à savoir s'il existait des formes de prises en charge professionnelles, des besoins et des trajectoires de la maladie d'Alzheimer spécifiques en milieu rural. Après vingt-quatre mois de recherche, le projet nous montre qu'à l'instar de son diagnostic, l'appréhension géographique de la maladie nous livre des réponses mais aussi des interrogations. La maladie d'Alzheimer est une maladie aux contours flous dont le diagnostic demeure probabiliste. Si à la faveur d'un effort politique, le diagnostic de la maladie en France présente sur le versant de l'offre une organisation et un maillage effectif (Ankri, 2013), les investigations mettent clairement en avant des décalages avec les besoins. En effet, la reconnaissance de la maladie d'Alzheimer ne se limite pas aux centres de diagnostic. Le projet nous montre à ce sujet, que contrairement aux distances géographiques, le médecin généraliste ainsi que les configurations familiales et sociales influencent l'accès au diagnostic. Dans ce jeu, on est en droit de s'interroger sur les conséquences en matière de diagnostic de la maladie, de la faible proportion de généraliste par habitant en milieu rural. Les taux de reconnaissance de la maladie sont sans équivoque et surtout corrélés positivement à la présence des médecins généralistes. Dans le même temps, les configurations sociales et familiales apparaissent des variables trop fluctuantes en campagne pour garantir un niveau de recours au diagnostic élevé dans ces espaces. C'est la raison pour laquelle on peut se questionner sur l'écart de détection entre malades reconnus et les personnes malades non reconnues. Enfin les investigations nous montre les limites de prise en charge de la maladie dans les territoires ruraux d'étude. Disposant d'un niveau élevé d'équipement médico-social, les territoires ruraux d'étude affichent dans le même temps un faible degré de spécialisation Alzheimer. Cette faible spécialisation est la résultante d'une coopération professionnelle déséquilibrée ...

L'objectif du projet Mapéru consistait à savoir s'il existait des formes de prises en charge professionnelles, des besoins et des trajectoires de la maladie d'Alzheimer spécifiques en milieu rural. Après vingt-quatre mois de recherche, le projet nous montre qu'à l'instar de son diagnostic, l'appréhension géographique de la maladie nous livre des réponses mais aussi des interrogations. La maladie d'Alzheimer est une maladie aux contours flous dont le diagnostic demeure probabiliste. Si à la faveur d'un effort politique, le diagnostic de la maladie en France présente sur le versant de l'offre une organisation et un maillage effectif (Ankri, 2013), les investigations mettent clairement en avant des décalages avec les besoins. En effet, la reconnaissance de la maladie d'Alzheimer ne se limite pas aux centres de diagnostic. Le projet nous montre à ce sujet, que contrairement aux distances géographiques, le médecin généraliste ainsi que les configurations familiales et sociales influencent l'accès au diagnostic. Dans ce jeu, on est en droit de s'interroger sur les conséquences en matière de diagnostic de la maladie, de la faible proportion de généraliste par habitant en milieu rural. Les taux de reconnaissance de la maladie sont sans équivoque et surtout corrélés positivement à la présence des médecins généralistes. Dans le même temps, les configurations sociales et familiales apparaissent des variables trop fluctuantes en campagne pour garantir un niveau de recours au diagnostic élevé dans ces espaces. C'est la raison pour laquelle on peut se questionner sur l'écart de détection entre malades reconnus et les personnes malades non reconnues. Enfin les investigations nous montre les limites de prise en charge de la maladie dans les territoires ruraux d'étude. Disposant d'un niveau élevé d'équipement médico-social, les territoires ruraux d'étude affichent dans le même temps un faible degré de spécialisation Alzheimer. Cette faible spécialisation est la résultante d'une coopération professionnelle déséquilibrée ...

Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs) contribute substantially to disease and disability. Objective: The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU). Design: A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphi method to make decisions on the strength of the data. Results: Expert panels achieved consensus at least for probable (>20%) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, childhood obesity, adult obesity, adult diabetes, cryptorchidism, male infertility, and mortality associated with reduced testosterone. Accounting for probability of causation and using the midpoint of each range for probability of causation, Monte Carlo simulations produced a median cost of (sic)157 billion (or $ 209 billion, corresponding to 1.23% of EU gross domestic product) annually across 1000 simulations. Notably, using the lowest end of the probability range for each relationship in the Monte Carlo simulations produced a median range of (sic)109 billion that differed modestly from base case probability inputs. Conclusions: EDC exposures in the EU are likely to contribute substantially to disease and dysfunction across the life course with costs in ...

International audience ; Background: Due to global mercury pollution and the adverse health effects of prenatal exposure to methylmercury (MeHg), an assessment of the economic benefits of prevented developmental neurotoxicity is necessary for any cost-benefit analysis.Methods: Distributions of hair-Hg concentrations among women of reproductive age were obtained from the DEMOCOPHES project (1,875 subjects in 17 countries) and literature data (6,820 subjects from 8 countries). The exposures were assumed to comply with log-normal distributions. Neurotoxicity effects were estimated from a linear dose-response function with a slope of 0.465 Intelligence Quotient (IQ) point reduction per μg/g increase in the maternal hair-Hg concentration during pregnancy, assuming no deficits below a hair-Hg limit of 0.58 μg/g thought to be safe. A logarithmic IQ response was used in sensitivity analyses. The estimated IQ benefit cost was based on lifetime income, adjusted for purchasing power parity.Results: The hair-mercury concentrations were the highest in Southern Europe and lowest in Eastern Europe. The results suggest that, within the EU, more than 1.8 million children are born every year with MeHg exposures above the limit of 0.58 μg/g, and about 200,000 births exceed a higher limit of 2.5 μg/g proposed by the World Health Organization (WHO). The total annual benefits of exposure prevention within the EU were estimated at more than 600,000 IQ points per year, corresponding to a total economic benefit between €8,000 million and €9,000 million per year. About four-fold higher values were obtained when using the logarithmic response function, while adjustment for productivity resulted in slightly lower total benefits. These calculations do not include the less tangible advantages of protecting brain development against neurotoxicity or any other adverse effects.Conclusions: These estimates document that efforts to combat mercury pollution and to reduce MeHg exposures will have very substantial economic benefits in Europe, mainly ...

International audience ; Background: Due to global mercury pollution and the adverse health effects of prenatal exposure to methylmercury (MeHg), an assessment of the economic benefits of prevented developmental neurotoxicity is necessary for any cost-benefit analysis.Methods: Distributions of hair-Hg concentrations among women of reproductive age were obtained from the DEMOCOPHES project (1,875 subjects in 17 countries) and literature data (6,820 subjects from 8 countries). The exposures were assumed to comply with log-normal distributions. Neurotoxicity effects were estimated from a linear dose-response function with a slope of 0.465 Intelligence Quotient (IQ) point reduction per μg/g increase in the maternal hair-Hg concentration during pregnancy, assuming no deficits below a hair-Hg limit of 0.58 μg/g thought to be safe. A logarithmic IQ response was used in sensitivity analyses. The estimated IQ benefit cost was based on lifetime income, adjusted for purchasing power parity.Results: The hair-mercury concentrations were the highest in Southern Europe and lowest in Eastern Europe. The results suggest that, within the EU, more than 1.8 million children are born every year with MeHg exposures above the limit of 0.58 μg/g, and about 200,000 births exceed a higher limit of 2.5 μg/g proposed by the World Health Organization (WHO). The total annual benefits of exposure prevention within the EU were estimated at more than 600,000 IQ points per year, corresponding to a total economic benefit between €8,000 million and €9,000 million per year. About four-fold higher values were obtained when using the logarithmic response function, while adjustment for productivity resulted in slightly lower total benefits. These calculations do not include the less tangible advantages of protecting brain development against neurotoxicity or any other adverse effects.Conclusions: These estimates document that efforts to combat mercury pollution and to reduce MeHg exposures will have very substantial economic benefits in Europe, mainly ...

International audience ; Background: Due to global mercury pollution and the adverse health effects of prenatal exposure to methylmercury (MeHg), an assessment of the economic benefits of prevented developmental neurotoxicity is necessary for any cost-benefit analysis.Methods: Distributions of hair-Hg concentrations among women of reproductive age were obtained from the DEMOCOPHES project (1,875 subjects in 17 countries) and literature data (6,820 subjects from 8 countries). The exposures were assumed to comply with log-normal distributions. Neurotoxicity effects were estimated from a linear dose-response function with a slope of 0.465 Intelligence Quotient (IQ) point reduction per μg/g increase in the maternal hair-Hg concentration during pregnancy, assuming no deficits below a hair-Hg limit of 0.58 μg/g thought to be safe. A logarithmic IQ response was used in sensitivity analyses. The estimated IQ benefit cost was based on lifetime income, adjusted for purchasing power parity.Results: The hair-mercury concentrations were the highest in Southern Europe and lowest in Eastern Europe. The results suggest that, within the EU, more than 1.8 million children are born every year with MeHg exposures above the limit of 0.58 μg/g, and about 200,000 births exceed a higher limit of 2.5 μg/g proposed by the World Health Organization (WHO). The total annual benefits of exposure prevention within the EU were estimated at more than 600,000 IQ points per year, corresponding to a total economic benefit between €8,000 million and €9,000 million per year. About four-fold higher values were obtained when using the logarithmic response function, while adjustment for productivity resulted in slightly lower total benefits. These calculations do not include the less tangible advantages of protecting brain development against neurotoxicity or any other adverse effects.Conclusions: These estimates document that efforts to combat mercury pollution and to reduce MeHg exposures will have very substantial economic benefits in Europe, mainly ...