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1.
Can J Afr Stud ; 53(2): 295-315, 2019.
Article in English | MEDLINE | ID: mdl-31435076

ABSTRACT

This paper provides a glimpse of Islamic scholarship in Mirriah, Niger Republic, at a particular point in time, 1974-1975, before some of the latest currents of religious unrest erupted in West Africa. Through interviews with local scholars, it examines the degree to which they participated in a West African "core curriculum" shared with other Islamic scholars across the Sahel. It also explores the history of the malamai class in Mirriah, noting significant ties to the Bornu empire. Both the ruling dynasty and Mirriah itself also exemplify the process of "becoming Hausa": people of diverse origins have come to define themselves as Hausa, adopting the Hausa language and the religion of Islam.

2.
Health Aff (Millwood) ; 37(8): 1331, 2018 08.
Article in English | MEDLINE | ID: mdl-30080466

ABSTRACT

Lessons from fighting HIV may help low- and middle-income countries address the growing burden of noncommunicable diseases.


Subject(s)
Developing Countries , Health Resources/supply & distribution , Health Services Accessibility , Noncommunicable Diseases/epidemiology , Surveys and Questionnaires
3.
Nat Nanotechnol ; 13(5): 427-433, 2018 05.
Article in English | MEDLINE | ID: mdl-29610530

ABSTRACT

The potential for maternal nanoparticle (NP) exposures to cause developmental toxicity in the fetus without the direct passage of NPs has previously been shown, but the mechanism remained elusive. We now demonstrate that exposure of cobalt and chromium NPs to BeWo cell barriers, an in vitro model of the human placenta, triggers impairment of the autophagic flux and release of interleukin-6. This contributes to the altered differentiation of human neural progenitor cells and DNA damage in the derived neurons and astrocytes. Crucially, neuronal DNA damage is mediated by astrocytes. Inhibiting the autophagic degradation in the BeWo barrier by overexpression of the dominant-negative human ATG4BC74A significantly reduces the levels of DNA damage in astrocytes. In vivo, indirect NP toxicity in mice results in neurodevelopmental abnormalities with reactive astrogliosis and increased DNA damage in the fetal hippocampus. Our results demonstrate the potential importance of autophagy to elicit NP toxicity and the risk of indirect developmental neurotoxicity after maternal NP exposure.


Subject(s)
Astrocytes/metabolism , Models, Biological , Nanoparticles/toxicity , Neurons/metabolism , Neurotoxicity Syndromes/metabolism , Placenta/pathology , Pregnancy Complications/metabolism , Animals , Astrocytes/pathology , Cell Line , Female , Humans , Male , Mice , Neurodevelopmental Disorders/chemically induced , Neurodevelopmental Disorders/metabolism , Neurodevelopmental Disorders/pathology , Neurons/pathology , Neurotoxicity Syndromes/pathology , Pregnancy , Pregnancy Complications/chemically induced , Pregnancy Complications/pathology
4.
Health Aff (Millwood) ; 36(11): 1937, 2017 11.
Article in English | MEDLINE | ID: mdl-29137524

ABSTRACT

Together, data scientists and microfinance institutions are bringing vital health products to Haiti's rural communities.


Subject(s)
Financial Support , Poverty/economics , Rural Population , Child , Dietary Supplements/economics , Dietary Supplements/supply & distribution , Haiti , Humans , Pilot Projects , Rural Health , Socioeconomic Factors
5.
Health Aff (Millwood) ; 35(10): 1791, 2016 10 01.
Article in English | MEDLINE | ID: mdl-27702950

ABSTRACT

In the successful treatment of cataracts in India, researchers find valuable lessons for countries around the world.


Subject(s)
Cataract Extraction/economics , Cost-Benefit Analysis , Quality of Health Care , Cataract Extraction/methods , Developing Countries , Global Health , Humans , India , International Cooperation , Lens Implantation, Intraocular/economics , Lens Implantation, Intraocular/methods
6.
Med Phys ; 43(9): 5020, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27587032

ABSTRACT

PURPOSE: To make an adaptable, head shaped radionuclide phantom to simulate molecular imaging of the brain using clinical acquisition and reconstruction protocols. This will allow the characterization and correction of scanner characteristics, and improve the accuracy of clinical image analysis, including the application of databases of normal subjects. METHODS: A fused deposition modeling 3D printer was used to create a head shaped phantom made up of transaxial slabs, derived from a simulated MRI dataset. The attenuation of the printed polylactide (PLA), measured by means of the Hounsfield unit on CT scanning, was set to match that of the brain by adjusting the proportion of plastic filament and air (fill ratio). Transmission measurements were made to verify the attenuation of the printed slabs. The radionuclide distribution within the phantom was created by adding (99m)Tc pertechnetate to the ink cartridge of a paper printer and printing images of gray and white matter anatomy, segmented from the same MRI data. The complete subresolution sandwich phantom was assembled from alternate 3D printed slabs and radioactive paper sheets, and then imaged on a dual headed gamma camera to simulate an HMPAO SPECT scan. RESULTS: Reconstructions of phantom scans successfully used automated ellipse fitting to apply attenuation correction. This removed the variability inherent in manual application of attenuation correction and registration inherent in existing cylindrical phantom designs. The resulting images were assessed visually and by count profiles and found to be similar to those from an existing elliptical PMMA phantom. CONCLUSIONS: The authors have demonstrated the ability to create physically realistic HMPAO SPECT simulations using a novel head-shaped 3D printed subresolution sandwich method phantom. The phantom can be used to validate all neurological SPECT imaging applications. A simple modification of the phantom design to use thinner slabs would make it suitable for use in PET.


Subject(s)
Brain/diagnostic imaging , Phantoms, Imaging , Printing, Three-Dimensional , Tomography, Emission-Computed, Single-Photon/instrumentation , Magnetic Resonance Imaging
7.
Nanomedicine (Lond) ; 11(16): 2049-57, 2016 08.
Article in English | MEDLINE | ID: mdl-27465012

ABSTRACT

AIM: In this study, chlorhexidine hexametaphosphate (CHX-HMP) is investigated as a persistent antimicrobial coating for wound care materials. MATERIALS & METHODS: CHX-HMP was used as a wound care material coating and compared with chlorhexidine digluconate materials with respect to antimicrobial efficacy, toxicity and wound closure. RESULTS: Antimicrobial efficacy at day 1, 3 and 7 was observed with experimental and commercial materials. CHX-HMP coated materials had less toxic effect on human placental cells than commercial chlorhexidine dressings. CHX-HMP in pluronic gel did not delay healing but reduced wound colonization by E. faecalis. CONCLUSION: CHX-HMP could become a useful component of wound care materials with sustained antimicrobial efficacy, lower toxicity than chlorhexidine digluconate materials, and reduction in wound colonization without affecting closure.


Subject(s)
Anti-Infective Agents, Local/pharmacology , Bacteria/drug effects , Bacterial Infections/prevention & control , Chlorhexidine/pharmacology , Coated Materials, Biocompatible/pharmacology , Wound Healing/drug effects , Animals , Anti-Infective Agents, Local/chemistry , Cell Line , Chlorhexidine/analogs & derivatives , Coated Materials, Biocompatible/chemistry , Humans , Mice, Inbred C57BL , Phosphates/chemistry , Phosphates/pharmacology
8.
Nanotoxicology ; 9 Suppl 1: 57-65, 2015 May.
Article in English | MEDLINE | ID: mdl-25923348

ABSTRACT

Nanogenotoxicity is a crucial endpoint in safety testing of nanomaterials as it addresses potential mutagenicity, which has implications for risks of both genetic disease and carcinogenesis. Within the NanoTEST project, we investigated the genotoxic potential of well-characterised nanoparticles (NPs): titanium dioxide (TiO2) NPs of nominal size 20 nm, iron oxide (8 nm) both uncoated (U-Fe3O4) and oleic acid coated (OC-Fe3O4), rhodamine-labelled amorphous silica 25 (Fl-25 SiO2) and 50 nm (Fl-50 SiO) and polylactic glycolic acid polyethylene oxide polymeric NPs - as well as Endorem® as a negative control for detection of strand breaks and oxidised DNA lesions with the alkaline comet assay. Using primary cells and cell lines derived from blood (human lymphocytes and lymphoblastoid TK6 cells), vascular/central nervous system (human endothelial human cerebral endothelial cells), liver (rat hepatocytes and Kupffer cells), kidney (monkey Cos-1 and human HEK293 cells), lung (human bronchial 16HBE14o cells) and placenta (human BeWo b30), we were interested in which in vitro cell model is sufficient to detect positive (genotoxic) and negative (non-genotoxic) responses. All in vitro studies were harmonized, i.e. NPs from the same batch, and identical dispersion protocols (for TiO2 NPs, two dispersions were used), exposure time, concentration range, culture conditions and time-courses were used. The results from the statistical evaluation show that OC-Fe3O4 and TiO2 NPs are genotoxic in the experimental conditions used. When all NPs were included in the analysis, no differences were seen among cell lines - demonstrating the usefulness of the assay in all cells to identify genotoxic and non-genotoxic NPs. The TK6 cells, human lymphocytes, BeWo b30 and kidney cells seem to be the most reliable for detecting a dose-response.


Subject(s)
Mutagenicity Tests/methods , Mutagens/toxicity , Nanoparticles/chemistry , Nanoparticles/toxicity , Polymers/toxicity , Animals , Cell Line , Cells, Cultured , Chlorocebus aethiops , Comet Assay , Humans , Metal Nanoparticles/chemistry , Metal Nanoparticles/toxicity , Mutagens/chemistry , Polymers/chemistry , Rats
10.
Nanotoxicology ; 9 Suppl 1: 13-24, 2015 May.
Article in English | MEDLINE | ID: mdl-23889211

ABSTRACT

Given the multiplicity of nanoparticles (NPs), there is a requirement to develop screening strategies to evaluate their toxicity. Within the EU-funded FP7 NanoTEST project, a panel of medically relevant NPs has been used to develop alternative testing strategies of NPs used in medical diagnostics. As conventional toxicity tests cannot necessarily be directly applied to NPs in the same manner as for soluble chemicals and drugs, we determined the extent of interference of NPs with each assay process and components. In this study, we fully characterized the panel of NP suspensions used in this project (poly(lactic-co-glycolic acid)-polyethylene oxide [PLGA-PEO], TiO2, SiO2, and uncoated and oleic-acid coated Fe3O4) and showed that many NP characteristics (composition, size, coatings, and agglomeration) interfere with a range of in vitro cytotoxicity assays (WST-1, MTT, lactate dehydrogenase, neutral red, propidium iodide, (3)H-thymidine incorporation, and cell counting), pro-inflammatory response evaluation (ELISA for GM-CSF, IL-6, and IL-8), and oxidative stress detection (monoBromoBimane, dichlorofluorescein, and NO assays). Interferences were assay specific as well as NP specific. We propose how to integrate and avoid interference with testing systems as a first step of a screening strategy for biomedical NPs.


Subject(s)
In Vitro Techniques/methods , Nanoparticles/toxicity , Toxicity Tests/methods , Animals , Chlorocebus aethiops , Humans , Rats
11.
Nanotoxicology ; 9 Suppl 1: 66-78, 2015 May.
Article in English | MEDLINE | ID: mdl-23927440

ABSTRACT

Despite the rapid ongoing expansion in the use of nanomaterials, we still know little about their biological interaction and biodistribution within the human body. If medically relevant nanoparticles can cross specific cell barriers they may disseminate through the body beyond the original target and may reach particularly sensitive areas such as the foetus. This study utilised an in vitro barrier model of the placenta to explore toxicity, uptake and transport of iron oxide and silica nanoparticles. The findings indicate that these nanoparticles can transfer extensively across the placental barrier model but physico-chemical characteristics such as surface chemistry impact upon both uptake and transport. Iron oxide cytotoxicity was evident at lower doses and shorter exposure compared with silica and may be of clinical relevance. In vivo correlation of in vitro findings is essential but in vitro models may provide worst case-exposure estimates to help reduce the amount of testing required.


Subject(s)
Nanoparticles/metabolism , Nanoparticles/toxicity , Placenta/cytology , Placenta/metabolism , Biological Transport , Cell Line , Female , Humans , Magnetite Nanoparticles/chemistry , Magnetite Nanoparticles/toxicity , Models, Biological , Nanoparticles/chemistry , Placenta/drug effects , Pregnancy , Silicon Dioxide/chemistry , Silicon Dioxide/metabolism , Silicon Dioxide/toxicity , Tissue Distribution
13.
Environ Health ; 11 Suppl 1: S3, 2012 Jun 28.
Article in English | MEDLINE | ID: mdl-22759503

ABSTRACT

BACKGROUND: The FP6 EU HENVINET project aimed at synthesizing the scientific information available on a number of topics of high relevance to policy makers in environment and health. The goal of the current paper is to reflect on the methodology that was used in the project, in view of exploring the usefulness of this and similar methodologies to the policy process. The topics investigated included health impacts of the brominated flame retardants decabrominated diphenylether (decaBDE) and hexabromocyclododecane (HBCD), phthalates highlighting di(2-ethylhexyl)phthalate (DEHP), the pesticide chlorpyrifos (CPF), nanoparticles, the impacts of climate change on asthma and other respiratory disorders, and the influence of environment health stressors on cancer induction. METHODS: Initially the focus was on identifying knowledge gaps in the state of the art in scientific knowledge. Literature reviews covered all elements that compose the causal chain of the different environmental health issues from emissions to exposures, to effects and to health impacts. Through expert elicitation, knowledge gaps were highlighted by assessing expert confidence using calibrated confidence scales. During this work a complementary focus to that on knowledge gaps was developed through interdisciplinary reflections. By extending the scope of the endeavour from only a scientific perspective, to also include the more problem solving oriented policy perspective, the question of which kind of policy action experts consider justifiable was addressed. This was addressed by means of a questionnaire. In an expert workshop the results of both questionnaires were discussed as a basis for policy briefs. RESULTS: The expert elicitation, the application of the calibrated confidence levels and the problem solving approach were all experienced as being quite challenging for the experts involved, as these approaches did not easily relate to mainstream environment and health scientific practices. Even so, most experts were quite positive about it. In particular, the opportunity to widen one's own horizon and to interactively exchange knowledge and debate with a diversity of experts seemed to be well appreciated in this approach. Different parts of the approach also helped in focussing on specific relevant aspects of scientific knowledge, and as such can be considered of reflective value. CONCLUSIONS: The approach developed by HENVINET was part of a practice of learning by doing and of interdisciplinary cooperation and negotiation. Ambitions were challenged by unforeseen complexities and difference of opinion and as no Holy Grail approach was at hand to copy or follow, it was quite an interesting but also complicated endeavour. Perfection, if this could be defined, seemed out of reach all the time. Nevertheless, many involved were quite positive about it. It seems that many felt that it fitted some important needs in current science when addressing the needs of policy making on such important issues, without anyone really having a clue on how to actually do this. Challenging questions remain on the quality of such approach and its product. Practice tells us that there probably is no best method and that the best we can do is dependent on contextual negotiation and learning from experiences that we think are relevant.


Subject(s)
Environmental Health , Health Policy , Advisory Committees , Climate Change , Environmental Pollutants/toxicity , Europe , European Union , Expert Testimony , Humans , Nanoparticles/toxicity , Neoplasms/etiology , Respiratory Tract Diseases/etiology
14.
Environ Health ; 11 Suppl 1: S5, 2012 Jun 28.
Article in English | MEDLINE | ID: mdl-22759505

ABSTRACT

BACKGROUND: Organophosphate pesticides are widely used on food crops grown in the EU. While they have been banned from indoor use in the US for a decade due to adverse health effects, they are still the most prevalent pesticides in the EU, with Chlorpyrifos (CPF) being the most commonly applied. It has been suggested CPF affects neurodevelopment even at levels below toxicity guidelines. Younger individuals may be more susceptible than adults due to biological factors and exposure settings. METHODS: A literature review was undertaken to assess the evidence for CPF contributing to neurodevelopmental disorders in infants and children. Other literature was consulted in order to formulate a causal chain diagram showing the origins, uptake, and neurological effects of animal and human exposure to CPF.The causal chain diagram and a questionnaire were distributed online to scientific experts who had published in relevant areas of research. They were asked to assess their confidence levels on whether CPF does in fact contribute to adverse neurodevelopment outcomes and rate their confidence in the scientific evidence. A second questionnaire queried experts as to which kind of policy action they consider justifiable based on current knowledge. In a special workshop session at the EuroTox congress in Dresden in 2009 the results of both questionnaires were further discussed with invited experts, as a basis for a policy brief with main messages for policy makers and stakeholders. RESULTS: Most experts who responded to the first questionnaire felt that there was already enough evidence to support a ban on indoor uses of CPF in the EU. However, most felt additional research is still required in several areas. The responses from the first questionnaire were used to formulate the second questionnaire addressing the feasibility of government action. In turn, these expert participants were invited to attend a special session at the EuroTox congress in Dresden in 2009. CONCLUSIONS: Some of the evidence that CPF contributes to neurodevelopmental disorders is still disputed among experts, and the overall sense is that further research and public awareness are warranted. There have been campaigns in North America making the potential exposure concerns known, but such information is not widely known in the EU. The ability of government action to produce change is strongly felt in some quarters while others believe better knowledge of consumer use trends would have a greater impact.


Subject(s)
Chlorpyrifos/toxicity , Environmental Exposure , Expert Testimony , Health Policy , Insecticides/toxicity , Nervous System/drug effects , Child , Child Development/drug effects , Chlorpyrifos/metabolism , Environmental Health , European Union , Female , Humans , Insecticides/metabolism , Male , Pregnancy , Prenatal Exposure Delayed Effects/chemically induced , Prenatal Exposure Delayed Effects/epidemiology
15.
Int J Nanomedicine ; 7: 497-510, 2012.
Article in English | MEDLINE | ID: mdl-22334780

ABSTRACT

BACKGROUND: Advances in biomedical nanotechnology raise hopes in patient populations but may also raise questions regarding biodistribution and biocompatibility, especially during pregnancy. Special consideration must be given to the placenta as a biological barrier because a pregnant woman's exposure to nanoparticles could have significant effects on the fetus developing in the womb. Therefore, the purpose of this study is to optimize an in vitro model for characterizing the transport of nanoparticles across human placental trophoblast cells. METHODS: The growth of BeWo (clone b30) human placental choriocarcinoma cells for nanoparticle transport studies was characterized in terms of optimized Transwell(®) insert type and pore size, the investigation of barrier properties by transmission electron microscopy, tight junction staining, transepithelial electrical resistance, and fluorescein sodium transport. Following the determination of nontoxic concentrations of fluorescent polystyrene nanoparticles, the cellular uptake and transport of 50 nm and 100 nm diameter particles was measured using the in vitro BeWo cell model. RESULTS: Particle size measurements, fluorescence readings, and confocal microscopy indicated both cellular uptake of the fluorescent polystyrene nanoparticles and the transcellular transport of these particles from the apical (maternal) to the basolateral (fetal) compartment. Over the course of 24 hours, the apparent permeability across BeWo cells grown on polycarbonate membranes (3.0 µm pore size) was four times higher for the 50 nm particles compared with the 100 nm particles. CONCLUSION: The BeWo cell line has been optimized and shown to be a valid in vitro model for studying the transplacental transport of nanoparticles. Fluorescent polystyrene nanoparticle transport was size-dependent, as smaller particles reached the basal (fetal) compartment at a higher rate.


Subject(s)
Fluorescent Dyes/pharmacokinetics , Nanoparticles/chemistry , Placenta/metabolism , Transcytosis/drug effects , Cell Line, Tumor , Cell Survival/drug effects , Choriocarcinoma/metabolism , Female , Fluorescent Dyes/chemistry , Fluorescent Dyes/pharmacology , Humans , Membrane Proteins/metabolism , Particle Size , Permeability , Phosphoproteins/metabolism , Placenta/cytology , Polycarboxylate Cement/chemistry , Polycarboxylate Cement/pharmacokinetics , Polyesters/chemistry , Polyesters/pharmacokinetics , Porosity , Pregnancy , Reproducibility of Results , Uterine Neoplasms/metabolism , Zonula Occludens-1 Protein
16.
Biomaterials ; 31(16): 4477-83, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20227759

ABSTRACT

Cobalt-chromium particles and ions can induce indirect DNA damage and chromosome aberrations in human cells on the other side of a cellular barrier in tissue culture. This occurs by intercellular signalling across the barrier. We now show that the threshold for this effect depends on the metal form and the particle composition. Ionic cobalt and chromium induced single strand breaks at concentrations equivalent to those found in the blood of patients with well functioning metal on metal hip prostheses. However, they only caused double strand breaks if the chromium was present as chromium (VI), and did not induce chromosome aberrations. Nanoparticles of cobalt-chromium alloy caused DNA double strand breaks and chromosome aberrations, of which the majority were tetraploidy. Ceramic nanoparticles induced only single strand breaks and/or alkaline labile sites when indirectly exposed to human fibroblasts. The assessment of reproductive risk from maternal exposure to biomaterials is not yet possible with epidemiology. Whilst the barrier model used here differs from the in vivo situation in several respects, it may be useful as a framework to evaluate biomaterial induced damage across physiological barriers.


Subject(s)
Alloys , Biocompatible Materials/pharmacology , Chromium/pharmacology , Cobalt/pharmacology , DNA Damage , DNA/drug effects , Orthopedics , Alloys/chemistry , Alloys/pharmacology , Animals , Arthroplasty, Replacement, Hip , Cells, Cultured , Ceramics/chemistry , Ceramics/pharmacology , Chromium/chemistry , Chromosome Aberrations/chemically induced , Cobalt/chemistry , Female , Fibroblasts/cytology , Fibroblasts/drug effects , Fibroblasts/physiology , Humans , Karyotyping , Materials Testing , Metal Nanoparticles/chemistry , Placenta/cytology , Placenta/drug effects , Placenta/metabolism , Pregnancy
17.
Nat Nanotechnol ; 4(12): 876-83, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19893513

ABSTRACT

The increasing use of nanoparticles in medicine has raised concerns over their ability to gain access to privileged sites in the body. Here, we show that cobalt-chromium nanoparticles (29.5 +/- 6.3 nm in diameter) can damage human fibroblast cells across an intact cellular barrier without having to cross the barrier. The damage is mediated by a novel mechanism involving transmission of purine nucleotides (such as ATP) and intercellular signalling within the barrier through connexin gap junctions or hemichannels and pannexin channels. The outcome, which includes DNA damage without significant cell death, is different from that observed in cells subjected to direct exposure to nanoparticles. Our results suggest the importance of indirect effects when evaluating the safety of nanoparticles. The potential damage to tissues located behind cellular barriers needs to be considered when using nanoparticles for targeting diseased states.


Subject(s)
DNA Damage , Nanoparticles/toxicity , Adenosine Triphosphate/metabolism , Cell Line, Tumor , Chromium/toxicity , Cobalt/toxicity , Connexins/metabolism , Extracellular Space/drug effects , Extracellular Space/metabolism , Fibroblasts/drug effects , Fibroblasts/metabolism , Humans , Models, Biological , Signal Transduction/drug effects , Transferrin/metabolism
18.
Article in English | MEDLINE | ID: mdl-20049824

ABSTRACT

The unique properties of nanoparticles (NP) are key to the excitement over their potential application to benefit many aspects of our lives, but are also the cause of concern over inadequate toxicological assessment of their possible impact on human health. Nanotechnology is a rapidly expanding area of industrial activity in which NP are being developed for a wide range of purposes. With some of these products already in use, and many more soon to follow, it is critically important that the potential risks from this new technology are properly assessed. There is a pressing need to understand how engineered NP can interact with the human body following exposure as consumers, in the workplace or from the environment and fundamental to this is the assessment of NP interactions at biological barriers, which control access to the whole organism and specific organs. The placenta is a barrier of particular interest because it determines exposure of the foetus that represents a vulnerable and sensitive subpopulation requiring additional consideration. Little is currently known about whether NP can cross the human placental barrier or interfere with placental function but suitable transport models have been developed which can be used to clarify the mechanisms of cellular interaction and transport across the placenta.


Subject(s)
Maternal-Fetal Exchange , Nanoparticles , Female , Humans , Nanotechnology/methods , Pregnancy
19.
J Toxicol Environ Health B Crit Rev ; 12(4): 225-49, 2009 Apr.
Article in English | MEDLINE | ID: mdl-20183522

ABSTRACT

The purposes of this review are to (1) evaluate human and experimental evidence for adverse effects on reproduction and development in humans, produced by exposure to phthalates, and (2) identify knowledge gaps as for future studies. The widespread use of phthalates in consumer products leads to ubiquitous and constant exposure of humans to these chemicals. Phthalates were postulated to produce endocrine-disrupting effects in rodents, where fetal exposure to these compounds was found to induce developmental and reproductive toxicity. The adverse effects observed in rodent models raised concerns as to whether exposure to phthalates represents a potential health risk to humans. At present, di(2-ethylhexyl) phthalate (DEHP), di-n-butyl phthalate (DBP), and butyl benzyl phthalate (BBP) have been demonstrated to produce reproductive and developmental toxicity; thus, this review focuses on these chemicals. For the general population, DEHP exposure is predominantly via food. The average concentrations of phthalates are highest in children and decrease with age. At present, DEHP exposures in the general population appear to be close to the tolerable daily intake (TDI), suggesting that at least some individuals exceed the TDI. In addition, specific high-risk groups exist with internal levels that are several orders of magnitude above average. Urinary metabolites used as biomarkers for the internal levels provide additional means to determine more specifically phthalate exposure levels in both general and high-risk populations. However, exposure data are not consistent and there are indications that secondary metabolites may be more accurate indicators of the internal exposure compared to primary metabolites. The present human toxicity data are not sufficient for evaluating the occurrence of reproductive effects following phthalate exposure in humans, based on existing relevant animal data. This is especially the case for data on female reproductive toxicity, which are scarce. Therefore, future research needs to focus on developmental and reproductive endpoints in humans. It should be noted that phthalates occur in mixtures but most toxicological information is based on single compounds. Thus, it is concluded that it is important to improve the knowledge of toxic interactions among the different chemicals and to develop measures for combined exposure to various groups of phthalates.


Subject(s)
Dibutyl Phthalate/toxicity , Diethylhexyl Phthalate/toxicity , Environmental Pollutants/toxicity , Growth and Development/drug effects , Phthalic Acids/toxicity , Reproduction/drug effects , Animals , Dibutyl Phthalate/pharmacokinetics , Diethylhexyl Phthalate/pharmacokinetics , Environmental Exposure , Environmental Pollutants/pharmacokinetics , Humans , Phthalic Acids/pharmacokinetics , Sex Factors
20.
Int J Health Plann Manage ; 23(4): 373-97, 2008.
Article in English | MEDLINE | ID: mdl-18438981

ABSTRACT

Since the 1993 publication of Disease Control Priorities in Developing Countries and World Development Report: Investing in Health, micronutrient fortification and supplementation interventions have been recognized as being among the most cost-effective public health interventions. This paper reviews nearly 100 studies of the cost of micronutrient interventions. The literature contains enormous variation in the estimated costs of these programs due to differences in program structure, delivery systems and a host of country-specific factors, differences in the studies' objectives, designs and costing methodologies. The most diverse estimates reported are those of vitamin A supplementation programs, where estimates vary by a factor of more than 1000. The costs of fortification programs, too, vary substantially from a factor of two for iodine, six for iron, and 15 for vitamin A fortification. As the magnitude of these variations suggests, the bulk of these studies are idiosyncratic, and their results are not directly comparable. The review highlights the need for greater specificity in discourse about these programs, and for greater transparency about cost estimation methods. The review provides several insights: (1) average costs are several-fold higher than has traditionally been maintained; (2) fortificants account for 80% of annual, incremental costs of vitamin A fortification; (3) whereas 70% of those of vitamin A supplementation programs are personnel; (4) the imprecision of food fortification coverage and impact estimates owes primarily to the paucity of food consumption data. Addressing the food consumption information gap is an essential next step to improving micronutrient program policies: to better targeting programs and to devising more cost-effective program portfolio mixes. Cost studies have a largely unrealized potential role to play in increasing program efficiency, coverage, and effectiveness.


Subject(s)
Health Policy , Micronutrients/economics , Micronutrients/therapeutic use , Costs and Cost Analysis , Humans
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