New Insights into Handling Missing Values in Environmental Epidemiological Studies

International audienceMissing data are unavoidable in environmental epidemiologic surveys. The aim of this study was to compare methods for handling large amounts of missing values: omission of missing values, single and multiple imputations (through linear regression or partial least squares regression), and a fully Bayesian approach. These methods were applied to the PARIS birth cohort, where indoor domestic pollutant measurements were performed in a random sample of babies' dwellings. A simulation study was conducted to assess performances of different approaches with a high proportion of missing values (from 50% to 95%). Different simulation scenarios were carried out, controlling the true value of the association (odds ratio of 1.0, 1.2, and 1.4), and varying the health outcome prevalence. When a large amount of data is missing, omitting these missing data reduced statistical power and inflated standard errors, which affected the significance of the association. Single imputation underestimated the variability, and considerably increased risk of type I error. All approaches were conservative, except the Bayesian joint model. In the case of a common health outcome, the fully Bayesian approach is the most efficient approach (low root mean square error, reasonable type I error, and high statistical power). Nevertheless for a less prevalent event, the type I error is increased and the statistical power is reduced. The estimated posterior distribution of the OR is useful to refine the conclusion. Among the methods handling missing values, no approach is absolutely the best but when usual approaches (e.g. single imputation) are not sufficient, joint modelling approach of missing process and health association is more efficient when large amounts of data are missing

Exposition domestique à des polluants chimiques de l'air intérieur (modélisation et évaluation de l'impact sur la santé respiratoire chez le jeune enfant)

Problématique : La qualité de l air intérieur est devenue une préoccupation majeure de santé publique, en raison du temps passé à l intérieur des locaux et de la diversité des contaminants biologiques et des polluants chimiques présents. Objectifs : Il s agit de renseigner et de modéliser l exposition domestique à des polluants chimiques retrouvés dans l air intérieur et d en étudier le lien avec la morbidité respiratoire au cours de la première année de vie des nouveau-nés de la cohorte PARIS (Pollution and Asthma Risk : an Infant Study). Méthodes : À 1, 3, 6, 9 et 12 mois, des questionnaires sanitaires sont adressés aux parents pour renseigner la survenue des infections des voies respiratoires et des symptômes évocateurs d asthme (sifflements, toux sèche nocturne, etc.). Des questionnaires environnementaux sont envoyés en parallèle pour documenter le cadre et le mode de vie des enfants. Pour pallier l imprécision résultant d une évaluation de l exposition aux polluants de l air intérieur par simple questionnaire, des investigations environnementales complémentaires ont été conduites, à 1, 6, 9 et 12 mois, au domicile d un échantillon aléatoire de 196 nouveau-nés de la cohorte PARIS et dans des crèches parisiennes fréquentées par ces enfants. Les données issues des mesurages domestiques répétés ont été confrontées aux données recueillies par questionnaires afin d établir des modèles prédictifs s concentrations domestiques annuelles de polluants. Ces modèles ont ensuite été appliqués à l ensemble des logements fréquentés par les enfants de la cohorte afin de les classer au regard de leur exposition domestique annuelle pour étudier l impact sanitaire de cette exposition. Résultats : Les modèles prédictifs des concentrations mesurées ont permis d identifier les déterminants des niveaux de formaldéhyde, de dioxyde d azote, de toluène et de tétrachloroéthylène : les sources continues et leur caractère récent (panneaux de particules, parquet vitrifié, stratifié, flottant et peinture), les sources discontinues (combustion et proximité au pressing) et les paramètres d aération et de ventilation conditionnant l entrée ou la sortie du polluant selon leur origine dominante. Au cours de la première année de vie, près d un enfant sur deux présente une infection des voies respiratoires basses, 14,8 % une toux sèche nocturne. Concernant l impact sanitaire de l exposition aux polluants chimiques, après ajustement sur l ensemble des facteurs de risque, seule l exposition domestique au formaldéhyde majore la survenue des infections et plus particulièrement des infections sifflantes. L exposition au formaldéhyde est aussi associée à la toux sèche nocturne et plus particulièrement chez les enfants sans antécédents parentaux d allergie. Conclusion : Une exposition domestique aux polluants chimiques de l air intérieur, tels que le formaldéhyde, peut être associée à la morbidité respiratoire du jeune enfant. Ces résultats viennent appuyer les mesures prises par les pouvoirs publics concernant les émissions des matériauxThere is a growing public health concern about indoor air quality due to the time spent indoors and the presence of numerous biological and chemical pollutants. Aims: To assess indoor chemical pollutant levels, to model domestic exposure and to examine the impact of indoor chemical pollutants on the respiratory health of infants from the PARIS birth cohort, during their first year of life. Methods: Multiple self-administered questionnaires were used to gather information from parents about respiratory infections and asthma-like symptoms (wheezing, nocturnal dry cough. . . ) in their infants at ages 1, 3, 6, 9 and 12 months. Details about home characteristics and family living conditions were also collected by phone interview when the child was 1 month old, and mailed questionnaires captured changes at 3, 6, 9 and 12 months. Pollutant air sampling (aldehyde, volatile organic compound, nitrogendioxide and nicotine) were conducted at 1, 6, 9 and 12 months in the bedrooms of a subset of randomly selected 196infants. Repeated pollutant measurements were joined with interview and questionnaire information to construct annual pollutant exposure models for all infants. Furthermore, an environmental investigation was performed in Parisian child day care centers to document chemical exposure levels. Results: Formaldehyde, toluene, nitrogen dioxide and perchlororethylene level determinants: continuous sources (particleboard, varnished parquet floor, wall coating), discontinuous sources (combustion, dry cleaning facilities) and aeration parameters were identified. At one year, around half of babies experienced at least one lower respiratory infection, and nearly half of those infections included wheezing, 14,8 % of babies suffered from a nocturnal dry cough. After known risk factors were considered, lower respiratory infections were associated with estimated formaldehyde levels, and formaldehyde exposure is also related to nocturnal dry cough, especially in infants without parental history of allergy. Conclusion: This study shows that formaldehyde exposure in early life is associated with respiratory health in infants, promoting public actions regarding emissions from materialsPARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF

Effectiveness of the European chromium(vi) directive for cement implementation on occupational allergic contact dermatitis occurrence: assessment in France and the U.K.

International audienc

Formaldehyde Exposure and Lower Respiratory Infections in Infants: Findings from the PARIS Cohort Study

Background: Certain chemical pollutants can exacerbate lower respiratory tract infections (LRIs), a common childhood ailment. Although formaldehyde (FA) is one of the most common air pollutants found in indoor environments, its impact on infant health is uncertain

The Role of Tobacco Smoke in Bladder and Kidney Carcinogenesis: A Comparison of Exposures and Meta-analysis of Incidence and Mortality Risks.

Context Tobacco smoke includes a mix of carcinogens implicated in the etiology of bladder cancer (BC) and renal cell cancer (RCC). Objective We reviewed the impact of tobacco exposure on BCC and RCC incidence and mortality, and whether smoking cessation decreases the risk. Evidence acquisition A systematic review of original articles in English was performed in August 2013. Meta-analysis of risks was performed using adjusted risk ratios where available. Publication bias was assessed using Begg and Egger tests. Evidence synthesis We identified 2683 papers, of which 114 fulfilled our inclusion criteria, of which 90 studies investigated BC and 24 investigated RCC. The pooled relative risk (RR) of BC incidence was 2.57 (95% confidence interval [CI] 2.37–2.78) for all smokers, 3.37 (3.01–3.78) for current smokers, and 1.98 (1.76–2.22) for former smokers. The corresponding pooled RR of BC disease-specific mortality (DSM) was 1.79 (1.40–2.29), 1.89 (1.29–2.78) and 1.66 (1.10–2.52). The pooled RR of RCC incidence was 1.27 (1.18–135) for all smokers, 1.29 (1.14–1.46) for current smokers, and 1.14 (1.06–1.22) for former smokers. The corresponding RCC DSM risk was 1.20 (1.02–1.41), 1.32 (1.08–1.62), and 1.01 (0.85–1.18). Conclusions We present an up-to-date review of tobacco smoking and BC and RCC incidence and mortality. Tobacco smoking significantly increases the risk of BC and RCC incidence. BC incidence and DSM risk are greatest in current smokers and lowest in former smokers, indicating that smoking cessation confers benefit. We found that secondhand smoke exposure is associated with a significant increase in BC risk. Patient summary Tobacco smoking affects the development and progression of bladder cancer and renal cell cancer. Smoking cessation reduces the risks of developing and dying from these common cancers. We quantify these risks using the most up-to-date results published in the literature

Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study

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Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5)

Abstract Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

Abstract The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease

BUILDING BRIDGES FOR INNOVATION IN AGEING : SYNERGIES BETWEEN ACTION GROUPS OF THE EIP ON AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).Peer reviewe