A Risk-Benefit Analysis of French High Fish Consumption: A QALY Approach

The health risk and the nutritional benefit of a food are usually assessed separately. Toxicologists recommend limiting the consumption of certain fish because of methylmercury; while nutritionists recommend eating more oily fish because of omega 3. A common evaluation is imperative to provide coherent recommendations. In order to evaluate the risks along with the benefits related to fish consumption, a common metric based on the quality-adjusted life year (QALY) method has been used. The impact of a theoretical change from a medium n-3 PUFAs intake to a high intake is studied, in terms of the cardiovascular system (CHD mortality, stroke mortality and morbidity) and on fetal neuronal development (IQ loss or gain). This application can be considered as a sensitive analysis of the model used and looks at the impact of changing the dose-response relationships between cardiovascular diseases and n-3 PUFAs intakes. Results show that increasing fish consumption may have a beneficial impact on health. However, the confidence interval of the overall estimation has a negative lower bound, which means that this increase in fish consumption may have a negative impact due to MeHg contamination. Some limits of the QALY approach are identified. The first concerns determination of the dose-response relationships. The second concerns the economic origins of the approach and of individual preferences. Finally, since only one beneficial aspect and one risk element were studied, consideration should be given to how other beneficial and risk components may be integrated in the model.     

Family members’ experiences and management of resident-to-resident abuse in long-term residential care

ABSTRACT

Objectives: Resident-to-resident (RRA) abuse is increasingly recognized as a significant problem in long-term residential care.Families have a constant presence in this setting, yet their inclusion in research about RRA is minimal. The purpose of this study was to examine family members’ experiences and management of RRA. Methods: The methodology was critical ethnography.Twelve family members participated in in-depth interviews and 56 hours of participant observation were conducted. Data were analyzed thematically. Results: The main themes illuminate families’ experiences of RRA in a context that largely normalizes it.In the absence of formal supports, families developed a range of management strategies, ranging from passive to active intervention.Organizational factors, such as staffing levels and mix, and the physical environment also contributed to RRA. Discussion: Families are actively managing RRA in long-term residential care. Policies and programs, including educational supports, should be developed to validate and support families.     

Quantitative Risk Assessment Relating to Adventitious Presence of Allergens in Food: A Probabilistic Model Applied to Peanut in Chocolate

Peanut allergy is a public health concern, owing to the high prevalence in France and the severity of the reactions. Despite peanut-containing product avoidance diets, a risk may exist due to the adventitious presence of peanut allergens in a wide range of food products. Peanut is not mentioned in their ingredients list, but precautionary labeling is often present. A method of quantifying the risk of allergic reactions following the consumption of such products is developed, taking the example of peanut in chocolate tablets. The occurrence of adventitious peanut proteins in chocolate and the dose-response relationship are estimated with a Bayesian approach using available published data. The consumption pattern is described by the French individual consumption survey INCA2. Risk simulations are performed using second-order Monte Carlo simulations, which separately propagates variability and uncertainty of the model input variables. Peanut allergens occur in approximately 36% of the chocolates, leading to a mean exposure level of 0.2 mg of peanut proteins per eating occasion. The estimated risk of reaction averages 0.57% per eating occasion for peanut-allergic adults. The 95% values of the risk stand between 0 and 3.61%, which illustrates the risk variability. The uncertainty, represented by the 95% credible intervals, is concentrated around these risk estimates. Children have similar results. The conclusion is that adventitious peanut allergens induce a risk of reaction for a part of the French peanut-allergic population. The method developed can be generalized to assess the risk due to the consumption of every foodstuff potentially contaminated by allergens.     

Quantitative Assessment of Exposure to the Mycotoxin Ochratoxin A in Food

This article presents the methodology and the simulation results concerning the quantitative assessment of exposure to the fungus toxin named Ochratoxin A (OA) in food, in humans in France. We show that is possible to provide reliable calculations of exposure to OA with the conjugate means of a nonparametric-type method of simulation, a parametric-type method of simulation, and the use of bootstrap confidence intervals. In the context of the Monte Carlo simulation, the nonparametric method takes into account the consumptions and the contaminations in the simulations only via the raw data whereas the parametric method depends on the random samplings from distribution functions fitted to consumption and contamination data. Our conclusions are based on eight types of food only. Nevertheless, they are meaningful due to the major importance of these foodstuffs in human nourishment in France. This methodology can be applied whatever the food contaminant (pesticides, other mycotoxins, Cadmium, etc.) when data are available.     

Test of Normality Against Generalized Exponential Power Alternatives

The family of symmetric generalized exponential power (GEP) densities offers a wide range of tail behaviors, which may be exponential, polynomial, and/or logarithmic. In this article, a test of normality based on Rao's score statistic and this family of GEP alternatives is proposed. This test is tailored to detect departures from normality in the tails of the distribution. The main interest of this approach is that it provides a test with a large family of symmetric alternatives having non-normal tails. In addition, the test's statistic consists of a combination of three quantities that can be interpreted as new measures of tail thickness. In a Monte-Carlo simulation study, the proposed test is shown to perform well in terms of power when compared to its competitors.     

On the boundary properties of Bernstein polynomial estimators of density and distribution functions

For density and distribution functions supported on [0,1], Bernstein polynomial estimators are known to have optimal mean integrated squared error (MISE) properties under the usual smoothness conditions on the function to be estimated. These estimators are also known to be well-behaved in terms of bias: they have uniform bias over the entire unit interval. What is less known, however, is that some of these estimators do experience a boundary effect, but of a different nature than what is seen with the usual kernel estimators.