Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
Institute of Experimental Medicine, AS CR Videnska 1083, 142 20 Prague 4, Czech Republic.
Environ Int. 2016 Mar;88:112-122. doi: 10.1016/j.envint.2015.12.009. Epub 2015 Dec 29.
The EU strategy for the Danube Region addresses numerous challenges including environment, health and socioeconomic disparities. Many old environmental burdens and heavily polluted areas in Europe are located in the Danube Region, consisting of 14 countries, with over 100 million people. Estimating the burden of environmental exposures on early-life health is a growing research area in Europe which has major public health implications, but the data from the Danube Region are largely missing.
This review presents an inventory of current environmental challenges, related early-life health risks, and knowledge gaps in the Danube Region, based on publicly available databases, registers, and literature, as a rationale and incentive for a new integrated project. The review also proposes the concept for the project aiming to characterize in utero exposures to multiple environmental factors and estimate their effect on early-life health, evaluate economic impact, as well as identify interventions with a potential to harness social norms to reduce emissions, exposures and health risks in the Danube Region.
Experts in environmental epidemiology, human biomonitoring and social science in collaboration with clinicians propose to establish a new large multi-center birth cohort of mother-child pairs from Danube countries, measure biomarkers of exposure and health in biological samples at birth, collect centrally measured climate, air and water pollution data, conduct pre- and postnatal surveys on lifestyle, indoor exposures, noise, occupation, socio-economic status, risk-averting behavior, and preferences; and undertake clinical examinations of children at and after birth. Birth cohort will include at least 2000 newborns per site, and a subset of at least 200 mother-child pairs per site for biomonitoring. Novel biomarkers of exposure, susceptibility, and effect will be applied, to gain better mechanistic insight. Effects of multiple environmental exposures on fetal and child growth, respiratory, allergic, immunologic, and neurodevelopmental health outcomes will be estimated. Parent's willingness to pay for reducing health risks in children will be elicited by survey, while values of cost-of-illness will be gathered from literature and national statistics. Effects of risk reducing interventions will be examined.
The proposed project would provide novel estimates of the burden of early childhood diseases attributable to environmental exposures and assess health impacts of different intervention scenarios in the Danube Region, in an integrated approach combining human biomonitoring, epidemiological and social science research.
欧盟多瑙河地区战略应对诸多挑战，包括环境、健康和社会经济差异。欧洲许多旧的环境负担和重污染地区都位于多瑙河地区，该地区由 14 个国家组成，拥有超过 1 亿人口。评估环境暴露对生命早期健康的负担是欧洲一个日益增长的研究领域，具有重大的公共卫生意义，但多瑙河地区的数据在很大程度上仍存在空缺。
本研究基于公开数据库、登记册和文献，介绍了多瑙河地区当前环境挑战、相关生命早期健康风险和知识空白，以此作为开展一个新的综合项目的理由和激励。该研究还提出了项目概念，旨在描述胎儿期对多种环境因素的暴露情况，并评估其对生命早期健康的影响，评估经济影响，以及确定具有利用社会规范减少多瑙河地区排放、暴露和健康风险潜力的干预措施。
环境流行病学、人体生物监测和社会科学专家与临床医生合作，提议在多瑙河国家建立一个新的大型多中心母婴队列，在出生时测量生物样本中的暴露和健康生物标志物，集中测量气候、空气和水污染数据，开展产前和产后生活方式、室内暴露、噪音、职业、社会经济地位、避险行为和偏好调查，并对儿童进行出生前后的临床检查。每个地点的队列将至少包括 2000 名新生儿，每个地点的子队列至少包括 200 对母婴进行生物监测。将应用新型暴露、易感性和效应生物标志物，以获得更好的机制见解。将估计多种环境暴露对胎儿和儿童生长、呼吸、过敏、免疫和神经发育健康结果的影响。将通过调查了解父母对降低儿童健康风险的意愿支付意愿，同时从文献和国家统计数据中收集疾病成本的价值。将研究减少风险干预措施的效果。
该项目将提供新型估计，说明环境暴露导致的儿童早期疾病负担，并以综合方法评估多瑙河地区不同干预情景的健康影响，该方法结合了人体生物监测、流行病学和社会科学研究。
