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Dorne J.L.,Emerging Risks Unit | Amzal B.,LA SER Europe Ltd | Bois F.,Compiegne University of Technology | Bois F.,INERIS | And 3 more authors.
Methods in Molecular Biology | Year: 2012

Chemical risk assessment for human health requires a multidisciplinary approach through four steps: hazard identification and characterization, exposure assessment, and risk characterization. Hazard identification and characterization aim to identify the metabolism and elimination of the chemical (toxicokinetics) and the toxicological dose-response (toxicodynamics) and to derive a health-based guidance value for safe levels of exposure. Exposure assessment estimates human exposure as the product of the amount of the chemical in the matrix consumed and the consumption itself. Finally, risk characterization evaluates the risk of the exposure to human health by comparing the latter to with the health-based guidance value. Recently, many research efforts in computational toxicology have been put together to characterize population variability and uncertainty in each of the steps of risk assessment to move towards more quantitative and transparent risk assessment. This chapter focuses specifically on modeling population variability and effects for each step of risk assessment in order to provide an overview of the statistical and computational tools available to toxicologists and risk assessors. Three examples are given to illustrate the applicability of those tools: derivation of pathway-related uncertainty factors based on population variability, exposure to dioxins, dose-response modeling of cadmium. © 2012 Springer Science+Business Media, LLC.


Grimaldi-Bensouda L.,Institute Pasteur Paris | Engel P.,LA SER | Massol J.,University of Franche Comte | Guillemot D.,Institute Pasteur Paris | And 11 more authors.
BMJ Open | Year: 2012

Objectives: To describe and compare patients seeking treatment for sleep, anxiety and depressive disorders (SADD) from physicians in general practice (GPs) with three different practice preferences: strictly conventional medicine (GP-CM), mixed complementary and conventional medicine (GP-Mx) and certified homeopathic physicians (GP-Ho). Design and setting: The EPI3 survey was a nationwide, observational study of a representative sample of GPs and their patients, conducted in France between March 2007 and July 2008. Participants: 1572 patients diagnosed with SADD. Primary and secondary outcomes: The patients' attitude towards complementary and alternative medicine; psychotropic drug utilisation. Results: Compared to patients attending GP-CM, GP-Ho patients had healthier lifestyles while GP-Mx patients showed similar profiles. Psychotropic drugs were more likely to be prescribed by GP-CM (64%) than GP-Mx (55.4%) and GP-Ho (31.2%). The three groups of patients shared similar SADD severity. Conclusion: Our results showed that patients with SADD, while differing principally in their sociodemographic profiles and conventional psychotropic prescriptions, were actually rather similar regarding the severity of SADD in terms of comorbidities and quality of life. This information may help to better plan resource allocation and management of these common health problems in primary care.


Rossignol M.,McGill University | Rossignol M.,Center for Risk Research | Begaud B.,University of Bordeaux Segalen | Engel P.,LA SER | And 14 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2012

Objective: The objective of this study was to assess the effect of physician practicing preferences (PPP) in primary care for homeopathy (Ho), CAM (Complementary and alternative medicines) with conventional medicine (Mx) or exclusively conventional medicine (CM) on patients with musculoskeletal disorders (MSDs), with reference to clinical progression, drug consumption, side effects and loss of therapeutic opportunity. Methods: The EPI3-MSD study was a nationwide observational cohort of a representative sample of general practitioners (GP) and their patients in France. Recruitment of GP was stratified by PPP, which was self-declared. Diagnoses and comorbidities were recorded by GP at inclusion. Patients completed a standardized telephone interview at inclusion, one, three and twelve months, including MSD-functional scales and medication consumption. Results: 1153 MSD patients were included in the three PPP groups. Patients did not differ between groups except for chronicity of MSDs (>12 weeks), which was higher in the Ho group (62.1%) than in the CM (48.6%) and Mx groups (50.3%). The twelve-month development of specific functional scores was identical across the three groups after controlling for baseline score (p>0.05). After adjusting for propensity scores, NSAID use over 12 months was almost half in the Ho group (OR, 0.54; 95%CI, 0.38-0.78) as compared to the CM group; no difference was found in the Mx group (OR, 0.81; 95% CI: 0.59-1.15). Conclusion: MSD patients seen by homeopathic physicians showed a similar clinical progression when less exposed to NSAID in comparison to patients seen in CM practice, with fewer NSAID-related adverse events and no loss of therapeutic opportunity. © 2012 John Wiley & Sons, Ltd.


Grimaldi-Bensouda L.,LA SER | Rossignol M.,Center for Risk Research Inc. | Rossignol M.,McGill University | Aubrun E.,LA SER | And 4 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2012

Purpose: The use of prescription records for the assessment of exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) does not capture over-the-counter drug use. This study compared patients' self-reported use to physician's prescriptions for NSAIDs and other drugs used to treat musculoskeletal disorders (MSDs). Methods: The international Pharmacoepidemiologic General Research eXtension database includes a network of general practitioners recruiting patients without reference to diagnoses or prescriptions. Data on all drug use across France within the 2 years preceding the date of inclusion (index date) were obtained from both patients' self-reports (PSRs) and physicians' prescription reports (PPRs). Patients' reports were obtained using a structured telephone interview combined with an interview guide containing a list of drugs commonly used. Comparisons were made on exposure to four categories of MSD drugs and three time windows up to 24months before the index date. Results: Agreement between physician and patient reports was assessed on 4152 patient-physician pairs. Bias- and prevalence-adjusted kappa values showed fair agreement for nonaspirin NSAIDs, moderate to fair for nonnarcotic analgesics, high for osteoarthritis and moderate to substantial for muscle relaxants. Over-the-counter drug use was associated with greater disagreement (OR=2.21, 95%CI=1.05-1.38). Age was not associated with disagreement. Conclusion: Differences between PSR and PPR in estimating the prevalence of MSD drug use varied by the type of drug and the elapsed time from the index date. The patient-assisted interview method used in this study showed better agreement with PPR compared with standard interviews, especially for long time windows and patients older than 65years. © 2012 John Wiley & Sons, Ltd.


Aiassa E.,Assessment and Methodological Support Unit | Higgins J.P.T.,University of Bristol | Frampton G.K.,University of Southampton | Greiner M.,Leibniz University of Hanover | And 11 more authors.
Critical Reviews in Food Science and Nutrition | Year: 2015

Food and feed safety risk assessment uses multi-parameter models to evaluate the likelihood of adverse events associated with exposure to hazards in human health, plant health, animal health, animal welfare, and the environment. Systematic review and meta-analysis are established methods for answering questions in health care, and can be implemented to minimize biases in food and feed safety risk assessment. However, no methodological frameworks exist for refining risk assessment multi-parameter models into questions suitable for systematic review, and use of meta-analysis to estimate all parameters required by a risk model may not be always feasible. This paper describes novel approaches for determining question suitability and for prioritizing questions for systematic review in this area. Risk assessment questions that aim to estimate a parameter are likely to be suitable for systematic review. Such questions can be structured by their “key elements” [e.g., for intervention questions, the population(s), intervention(s), comparator(s), and outcome(s)]. Prioritization of questions to be addressed by systematic review relies on the likely impact and related uncertainty of individual parameters in the risk model. This approach to planning and prioritizing systematic review seems to have useful implications for producing evidence-based food and feed safety risk assessment. © 2015, Copyright © Taylor & Francis Group, LLC.

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