Financial Considerations for Health and Safety in the Australian Dairy Industry

Objective: This study aimed to quantify the burden of fatal and workers’ compensation–related injuries on the dairy sector in Australia and to assess current financial inputs for work health and safety actions. Methods: The first and second phases entailed a review of the financial costs associated with fatal (2001–2013) and workers’ compensation cases (2008–2009 to 2012–2013). The third element was a case-study approach focusing on actual production and cost data from a small sample of dairy farms (n = 6) to ascertain an estimate for current financial inputs to work health and safety. Results: The estimated financial impact was approximately AUD$12.4 million each year, comprising AUD$6.8 million for fatalities and AUD$5.6 million for compensable injuries. All sample businesses were investing in health and safety initiatives; however, this was modest and on average represented 0.4% of total expenditure (AUD$4,472) or <AUD$0.02 of the costs per kilogram of milk solids produced. When projected nationally, the inputs were around AUD$13.2 million annually. Conclusions: Despite data limitations, there is a compelling financial case to increase strategic investments into work health and safety by dairy farmers in Australia. Increased investment has the potential to not only minimize the burden of injury and costs to dairy farmers, but will also significantly reduce the devastating impacts that these incidents have on individuals, their families and communities.     

Why invest in a national public health program for stroke?: An example using Australian data to estimate the potential benefits and cost implications

OBJECTIVES: Stroke is the world's second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money. METHODS: Lifetime costs and outcomes were calculated for additional cases that would benefit if 'current practice' was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews. Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered. RESULTS: Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion. CONCLUSIONS: Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke is warranted.     

The economic cost of preventable disease in Australia: a systematic review of estimates and methods

Objective : The aim of this literature review was to establish the economic burden of preventable disease in Australia in terms of attributable health care costs, other costs to government and reduced productivity. Methods : A systematic review was conducted to establish the economic cost of preventable disease in Australia and ascertain the methods used to derive these estimates. Nine databases and the grey literature were searched, limited to the past 10 years, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis) guidelines were followed to identify, screen and report on eligible studies. Results : Eighteen studies were included. There were at least three studies examining the attributable costs and economic impact for each risk factor. The greatest costs were related to the productivity impacts of preventable risk factors. Estimates of the annual productivity loss that could be attributed to individual risk factors were between $840 million and $14.9 billion for obesity; up to $10.5 billion due to tobacco; between $1.1 billion and $6.8 billion for excess alcohol consumption; up to $15.6 billion due to physical inactivity and $561 million for individual dietary risk factors. Productivity impacts were included in 15 studies and the human capital approach was the method most often employed (14 studies) to calculate this. Conclusions : Substantial economic burden is caused by lifestyle‐related risk factors. Implications for public health : The significant economic burden associated with preventable disease provides an economic rationale for action to reduce the prevalence of lifestyle‐related risk factors. New analysis of the economic burden of multiple risk factors concurrently is needed.     

Consumption of dairy products and risk of Parkinson's disease

The authors prospectively investigated the association between intake of dairy products and risk of Parkinson's disease among 57,689 men and 73,175 women from the American Cancer Society's Cancer Prevention Study II Nutrition Cohort. A total of 250 men and 138 women with Parkinson's disease were identified during follow-up (1992-2001). Dairy product consumption was positively associated with risk of Parkinson's disease: Compared with the lowest intake quintile, the corresponding relative risks for quintiles 2-5 were 1.4, 1.4, 1.4, and 1.6 (95 percent confidence interval (CI): 1.1, 2.2; p for trend = 0.05). A higher risk among dairy product consumers was found in both men and women, although the association in women appeared nonlinear. Meta-analysis of all prospective studies confirmed a moderately elevated risk of Parkinson's disease among persons with high dairy product consumption: For extreme intake categories, relative risks were 1.6 (95 percent CI: 1.3, 2.0) for both sexes, 1.8 for men (95 percent CI: 1.4, 2.4), and 1.3 for women (95 percent CI: 0.8, 2.1). These data suggest that dairy consumption may increase the risk of Parkinson's disease, particularly in men. More studies are needed to further examine these findings and to explore underlying mechanisms.     

L’effet du non-recours aux soins médicaux et dentaires sur les dépenses de santé des personnes ayant une maladie chronique

BackgroundPeople with chronic disease often have dental (especially periodontal) disorders. Nevertheless, people with chronic disease seek dental care less often than others. We wanted to know if there is a relationship between the consumption of medical care and the consumption of dental care, and if so if the relationship is especially strong for people with chronic disease.MethodsWe conducted a longitudinal study that combined two data-sets: consumption data from the French National Health Insurance Fund and health and socioeconomic welfare data collected with a dedicated national survey. We studied healthcare expenditure and analyzed the association between healthcare consumption, health status and healthcare expenditure over a four-year period (2010–2013).ResultsPeople who did not seek medical or dental care in 2010 exhibited irregular consumer behavior thereafter. This pattern was particularly evident among those with chronic disease whose healthcare expenditures did not stabilize during the study period compared with the rest of the study population. Among people who did not seek medical care in 2010, variation in average dental care expenditure was 91% in people with chronic disease versus 42% for those without chronic disease. Lack of medical care during the first year of the study was also associated with greater expenditure-delay in people with chronic disease (77%) compared with 15% in people without chronic disease.ConclusionThe lack of medical or dental care in 2010 for people with chronic disease did not lead to an increase in medical and dental consumption in the following years. The catch-up delay was longer than four years. This highlights a problem of monitoring and identifies a marginalized population within the healthcare system.     

1990－2010年中国5岁以下儿童低体重疾病负担分析

目的 分析1990－2010年我国5岁以下儿童低体重造成的疾病负担变化情况。方法 利用2010年全球疾病负担研究(GBD2010)中国部分的方法和结果,分析1990年和2010年我国5岁以下儿童归因于低体重的死亡情况、伤残损失寿命年(YLD)、早死损失寿命年(YLL)和伤残调整寿命年(DALY)及其变化情况。结果 2010年我国5岁以下儿童低体重造成的死亡人数共计2 271人,造成的DALY共计295.30千人年。与1990年相比,归因于低体重的死亡人数下降了96.75%,DALY下降了95.46%。2010年我国5岁以下儿童低体重造成的YLD为101.51千人年,YLL为193.79千人年。与1990年相比,低体重造成的YLD和YLL分别减少了444.80千人年和5 759.80千人年。结论 与1990年相比,2010年我国5岁以下儿童低体重造成的死亡及DALY均呈现明显下降趋势。考虑到低年龄组死亡对寿命损失影响的严重性,低体重对我国5岁以下儿童造成的健康影响及疾病负担依然不容忽视。     

Burden of Disease Associated with Dietary Exposure to Aflatoxins in China in 2020

Aflatoxins (AFTs), as a group 1 carcinogen, could lead to hepatocellular carcinoma (HCC). Dietary intake is the primary way of AFT exposure in humans. However, the contribution of foodborne AFT intake to the HCC burden remains unknown in recent years in China. Hence, the present study was conducted to estimate the burden of HCC attributed to foodborne AFT exposure by using disability-adjusted life years (DALYs). The risk assessment was used to estimate the incidence of HCC related to AFT exposure. Concentrations of AFTs in peanuts, peanut oil, corn, and corn products were retrieved from literature published between 2010 and 2020 in China. Corresponding daily food consumption data were obtained from two nationwide Chinese surveys. A direct approach was used to calculate DALY and DALY rates to quantify the HCC burden attributed to dietary AFT exposure. The total amount of AFT intake through peanut, peanut oil, corn, and corn products was 4.018 ng/kg bw/day resulting in 0.125 extra HCC cases per year/100,000 persons, corresponding to a DALY number and DALY rate of 21,625.08 and 1.53 per 100,000 population, respectively. Regionally, DALYs were high in Guangxi and Guangdong provinces, corresponding to 5948 and 5595 DALYs. A total of 1.5 DALYs/100,000 were lost due to the AFT exposure. DALYs per 100,000 population were higher in several coastal areas. Though the disease burden of HCC caused by dietary AFTs was low in the Chinese population, a high health risk was found in the residents of some areas with high AFT exposure. AFTs are still a health challenge for the Chinese people.     

Improving the cost-effectiveness of cardiovascular disease prevention in Australia: a modelling study

ABSTRACT: BACKGROUND: Cardiovascular disease is the leading cause of death worldwide. Like many countries, Australia is currently changing its guidelines for cardiovascular disease prevention from drug treatment for everyone with 'high blood pressure' or 'high cholesterol', to prevention based on a patient's absolute risk. In this research, we model cost-effectiveness of cardiovascular disease prevention with blood pressure and lipid drugs in Australia under three different scenarios: (1) the true current practice in Australia; (2) prevention as intended under the current guidelines; and (3) prevention according to proposed absolute risk levels. We consider the implications of changing to absolute risk-based cardiovascular disease prevention, for the health of the Australian people and for Government health sector expenditure over the long term. METHODS: We evaluate cost-effectiveness of statins, diuretics, ACE inhibitors, calcium channel blockers and beta-blockers, for Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Epidemiological changes and health care costs are simulated by age and sex in a discrete time Markov model, to determine total impacts on population health and health sector costs over the lifetime, from which we derive cost-effectiveness ratios in 2008 Australian dollars per quality-adjusted life year. RESULTS: Cardiovascular disease prevention based on absolute risk is more cost-effective than prevention under the current guidelines based on single risk factor thresholds, and is more cost-effective than the current practice, which does not follow current clinical guidelines. Recommending blood pressure-lowering drugs to everyone with at least 5% absolute risk and statin drugs to everyone with at least 10% absolute risk, can achieve current levels of population health, while saving $5.4 billion for the Australian Government over the lifetime of the population. But savings could be as high as $7.1 billion if Australia could match the cheaper price of statin drugs in New Zealand. CONCLUSIONS: Changing to absolute risk-based cardiovascular disease prevention is highly recommended for reducing health sector spending, but the Australian Government must also consider measures to reduce the cost of statin drugs, over and above the legislated price cuts of November 2010.     

A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk

Background  This review provides a reappraisal of the potential effects of dairy foods, including dairy fats, on cardiovascular disease (CVD)/coronary heart disease (CHD) risk. Commodities and foods containing saturated fats are of particular focus as current public dietary recommendations are directed toward reducing the intake of saturated fats as a means to improve the overall health of the population. A conference of scientists from different perspectives of dietary fat and health was convened in order to consider the scientific basis for these recommendations. Aims  This review and summary of the conference focus on four key areas related to the biology of dairy foods and fats and their potential impact on human health: (a) the effect of dairy foods on CVD in prospective cohort studies; (b) the impact of dairy fat on plasma lipid risk factors for CVD; (c) the effects of dairy fat on non-lipid risk factors for CVD; and (d) the role of dairy products as essential contributors of micronutrients in reference food patterns for the elderly. Conclusions  Despite the contribution of dairy products to the saturated fatty acid composition of the diet, and given the diversity of dairy foods of widely differing composition, there is no clear evidence that dairy food consumption is consistently associated with a higher risk of CVD. Thus, recommendations to reduce dairy food consumption irrespective of the nature of the dairy product should be made with caution.     

The case for action on socioeconomic differences in overweight and obesity among Australian adults: modelling the disease burden and healthcare costs

Objective : We aimed to quantify the extent to which socioeconomic differences in body mass index (BMI) drive avoidable deaths, incident disease cases and healthcare costs. Methods : We used population attributable fractions to quantify the annual burden of disease attributable to socioeconomic differences in BMI for Australian adults aged 20 to <85 years in 2016, stratified by quintiles of an area‐level indicator of socioeconomic disadvantage (SocioEconomic Index For Areas Indicator of Relative Socioeconomic Disadvantage; SEIFA) and BMI (normal weight, overweight, obese). We estimated direct healthcare costs using annual estimates per person per BMI category. Results : We attributed $AU1.06 billion in direct healthcare costs to socioeconomic differences in BMI in 2016. The greatest number (proportion) of cases and deaths attributable to socioeconomic differences in BMI was observed for type 2 diabetes among women (8,602 total cases [16%], with 3,471 cases [22%] in the most disadvantaged quintile [SEIFA 1]) and all‐cause mortality among men (2027 total deaths [4%], with 815 deaths [6%] in SEIFA 1). Conclusions : Socioeconomic differences in BMI substantially contribute to avoidable deaths, disease cases and direct healthcare costs in Australia. Implications for public health : Population‐level policies to reduce socioeconomic differences in overweight and obesity must be identified and implemented.     

The economic burden of diabetes to French national health insurance: a new cost-of-illness method based on a combined medicalized and incremental approach

A better understanding of the economic burden of diabetes constitutes a major public health challenge in order to design new ways to curb diabetes health care expenditure. The aim of this study was to develop a new cost-of-illness method in order to assess the specific and nonspecific costs of diabetes from a public payer perspective. Using medical and administrative data from the major French national health insurance system covering about 59 million individuals in 2012, we identified people with diabetes and then estimated the economic burden of diabetes. Various methods were used: (a) global cost of patients with diabetes, (b) cost of treatment directly related to diabetes (i.e., ‘medicalized approach’), (c) incremental regression-based approach, (d) incremental matched-control approach, and (e) a novel combination of the ‘medicalized approach’ and the ‘incremental matched-control’ approach. We identified 3 million individuals with diabetes (5% of the population). The total expenditure of this population amounted to €19 billion, representing 15% of total expenditure reimbursed to the entire population. Of the total expenditure, €10 billion (52%) was considered to be attributable to diabetes care: €2.3 billion (23% of €10 billion) was directly attributable, and €7.7 billion was attributable to additional reimbursed expenditure indirectly related to diabetes (77%). Inpatient care represented the major part of the expenditure attributable to diabetes care (22%) together with drugs (20%) and medical auxiliaries (15%). Antidiabetic drugs represented an expenditure of about €1.1 billion, accounting for 49% of all diabetes-specific expenditure. This study shows the economic impact of the assumption concerning definition of costs on evaluation of the economic burden of diabetes. The proposed new cost-of-illness method provides specific insight for policy-makers to enhance diabetes management and assess the opportunity costs of diabetes complications’ management programs.     

Aplicación del benchmarking en la gestión de la cadena de aprovisionamiento sanitaria: efectos sobre el coste y la calidad de las compras

ObjectiveHealthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement.MethodsData were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products.ResultsThe use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%.ConclusionsThe use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality.     

A diet high in low-fat dairy products lowers diabetes risk in postmenopausal women

Some previous studies have suggested that consuming dairy products, particularly the low-fat variety, lowers the incidence of type 2 diabetes. However, no study to our knowledge has focused on an ethnically diverse group of postmenopausal women, a population with a high risk of this disease. We conducted a prospective cohort study of 82,076 postmenopausal women enrolled in the Women's Health Initiative Observational Study who did not report diabetes at enrollment. Total, low-fat, and high-fat dairy product and yogurt intakes were estimated from FFQ at baseline and 3 y of follow-up. Treated diabetes incidence was ascertained from annual follow-up questionnaires. During 8 y of follow-up, 3946 cases of incident treated diabetes were reported (annual incidence, 0.73%; cumulative incidence, 4.8%). After multivariable adjustment, low-fat dairy product consumption was inversely associated with the risk of type 2 diabetes. RR was roughly 0.5-0.6 in the upper quintiles compared with the lowest quintile (median servings/d, 2.8 in the 5th quintile and 1.5 in the 4th quintile vs. 0.05 in the first quintile; P-trend < 0.001). The inverse relationship was more pronounced in women with a higher BMI. High yogurt consumption was associated with a significant decrease in diabetes risk, whereas there was no relationship between high-fat dairy product consumption and diabetes risk. A diet high in low-fat dairy products is associated with lower diabetes risk in postmenopausal women, particularly those who are obese.     

Dairy food intake is positively associated with cardiovascular health: findings from Observation of Cardiovascular Risk Factors in Luxembourg study

Conflicting findings have been reported about dairy food consumption and risk for cardiovascular disease. Furthermore, few studies have examined dairy food intake in relation to cardiovascular health and the incorporation of lifestyle factors such as diet and physical activity. This study examined whether dairy food consumption was associated with cardiovascular health, recently defined by the American Heart Association. Data were analyzed from 1352 participants from the Observation of Cardiovascular Risk Factors in Luxembourg survey. A validated food frequency questionnaire was used to measure intakes of milk, yogurt, cheese, dairy desserts, ice cream, and butter. Seven cardiovascular health metrics were assessed: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose. A total cardiovascular health score (CHS) was determined by summing the total number of health metrics at ideal levels. It was hypothesized that greater dairy food consumption (both low fat and whole fat) would be associated with better global cardiovascular health, as indicated by a higher CHS. Total dairy food intake was positively associated with the CHS. Higher intakes of whole fat milk, yogurt, and cheese were associated with better cardiovascular health. Even when controlling for demographic and dietary variables, those who consumed at least 5 servings per week of these dairy products had a significantly higher CHS than those who consumed these products less frequently. Higher total whole fat dairy food intake was also associated with other positive health behaviors, including being a nonsmoker, consuming the suggested dietary intakes of recommended foods, and having a normal body mass index. Increased dairy food consumption was associated with better cardiovascular health.     

1990-2019年中国归因于饮食危险因素的结直肠癌疾病负担分析

目的 分析1990-2019年中国归因于饮食危险因素的结直肠癌的死亡率和伤残调整寿命年（DALY）的变化趋势。方法 基于2019全球疾病负担（GBD2019）中归因于饮食危险因素（加工肉制品摄入过量、红肉摄入过量、钙摄入不足、纤维摄入不足、牛奶摄入不足、全谷物摄入不足和总饮食危险因素）的中国结直肠癌死亡率和DALY率数据，利用Joinpoint回归模型描述变化趋势，应用年龄-时期-队列模型分析年龄、时期、队列效应。结果 Joinpoint回归分析结果显示，1990-2019年，归因于加工肉制品摄入过量、红肉摄入过量、牛奶摄入不足、全谷物摄入不足和总饮食危险因素的结直肠癌标化死亡率和标化DALY率整体呈上升趋势（P<0.05），归因于钙摄入不足和纤维摄入不足的结直肠癌标化死亡率和标化DALY率整体呈下降趋势（P<0.05）。65~79岁各年龄组归因于加工肉制品摄入过量、红肉摄入过量、牛奶摄入不足、全谷物摄入不足以及总饮食危险因素的结直肠癌死亡率和DALY率较25~64岁各年龄组上升速度更快，65~79岁各年龄组归因于钙摄入不足和纤维摄入不足较25~64岁各年龄组下降速度更慢。控制时期和队列效应后，归因于加工肉制品摄入过量、红肉摄入过量、钙摄入不足、纤维摄入不足、牛奶摄入不足、全谷物摄入不足和总饮食危险因素的结直肠癌死亡率和DALY率均随年龄增长呈上升趋势（P<0.05）。归因于加工肉制品摄入过量、红肉摄入过量、钙摄入不足、牛奶摄入不足、全谷物摄入不足、总饮食危险因素的结直肠癌死亡率和DALY率随时期、队列变化整体呈上升趋势，归因于纤维摄入不足随时期、队列变化整体呈下降趋势。各饮食危险因素的时期效应和队列效应均有统计学意义（P<0.001）。结论 归因于饮食危险因素的中国结直肠癌疾病负担总体呈上升趋势，老年人为高危人群，在结直肠癌防治工作中需加强饮食危险因素的科普教育。     

Correlates of Inadequate Consumption of Dairy Products among Adolescents

The objective of this study was to identify the sociodemographic, personal, psychosocial, and behavioral correlates of low consumption of dairy products among adolescents. A comprehensive, school-based health behavior survey was administered to 36,284 public school students in grades 7 through 12 in Minnesota. Students self-reported consumption of dairy products and items addressing various dimensions of health. The risk factors for low consumption of dairy foods included being female, nonwhite, and of low socioeconomic status. The psychosocial factors associated with low intake included low weight satisfaction, school grades less than or equal to C, and low family connectedness. Dieting was strongly associated with low consumption of dairy foods, and modest consistent associations were also found with other health-compromising behaviors such as binge eating and substance abuse. Interventions aimed at increased consumption of calcium-rich foods among youth need to address high-risk groups and should include both education and environmental components as part of a comprehensive school-based program. Future research should examine differences in intake patterns of calcium-rich foods and health implications of lower intakes among different ethnic groups.     

Economic costs of Shiga toxin-producing Escherichia coli infection in Australia

Shiga toxin-producing Escherichia coli (STEC) infections are an important cause of foodborne disease in Australia. Three percent to 7% of sporadic patients develop hemolytic uremic syndrome (HUS) and 40% of patients with HUS develop chronic complications. To examine costs associated with illness, we interviewed patients notified to the South Australian Department of Health with a structured questionnaire regarding severity of illness, medical treatment, time lost from work, hospitalization, and other costs. In 2003-2006, we interviewed 46 patients of STEC infection, 2 of whom developed HUS. The median duration of illness was 7 days (range 3-31 days) and 41% (19/46) of patients were admitted to hospital. The estimated total cost for the 46 STEC cases in South Australia was AUD$144,087, equating to a mean cost of AUD$3132 per case. We estimate that the annual total costs of STEC infection in South Australia and Australia are AUD$200,283 and AUD$2,633,181, respectively. We used linear regression to identify that STEC infection costs increase by AUD$608 per day regardless of severity, and that more severe illness is strong predictor of cost. This is the first Australian study to examine costs of STEC infection and highlights the significant impact of this illness.     

Effect of the Arizona tobacco control program on cigarette consumption and healthcare expenditures

This research investigates the relationship between per capita tobacco control expenditures, cigarette consumption, and healthcare expenditures in the state of Arizona. Arizona's tobacco control program, which was established in 1994, concentrates on youth uptake of smoking and avoids public policy and commentary on the tobacco industry. We use a cointegrating time series analysis using aggregate data on healthcare and tobacco control expenditures, cigarette consumption and prices and other data. We find there is a strong association between per capita healthcare expenditure and per capita cigarette consumption. In the long run, a marginal increase in annual cigarette consumption of one pack per capita increases per capita healthcare expenditure by $19.5 (SE $5.45) in Arizona. A cumulative increase of $1.00 in the difference between control state and Arizona per capita tobacco control expenditures increases the difference in cigarette consumption by 0.190 (SE 0.0780) packs per capita. Between 1996 and 2004, Arizona's tobacco control program was associated with a cumulative reduction in cigarette consumption of 200 million packs (95% CI 39.0 million packs, 364 million packs) worth $500 million (95% CI: $99 million, $896 million) in pre-tax cigarette sales to the tobacco industry. The cumulative healthcare savings was $2.33 billion (95% CI $0.37 billion, $5.00 billion) and the cumulative reduction in cigarette. Arizona's tobacco control expenditures are associated with reduced cigarette consumption and healthcare expenditures, amounting to about 10 times the cost of the program through 2004. This return on investment, while large, was less than the more aggressive California program, which did not limit its focus to youth and included tobacco industry denomalization messages.     

Milk and Dairy Products and Their Impact on Carbohydrate Metabolism and Fertility—A Potential Role in the Diet of Women with Polycystic Ovary Syndrome

Milk and dairy products are considered an important component of healthy and balanced diet and are deemed to exert a positive effect on human health. They appear to play a role in the prevention and treatment of carbohydrate balance disturbances. The products include numerous valuable components with a potential hypoglycemic activity, such as calcium, vitamin D, magnesium and probiotics. Multiple authors suggested that the consumption of dairy products was negatively associated with the risk of type 2 diabetes mellitus, insulin resistance and ovulation disorders. However, there are still numerous ambiguities concerning both the presumed protective role of dairy products in carbohydrate metabolism disorders, and the advantage of consuming low-fat dairy products over high-fat ones, especially in women with the risk of ovulation disorders. Therefore, this literature review aims at the presentation of the current state of knowledge concerning the relationship between dairy product consumption and the risk of insulin resistance, type 2 diabetes mellitus in women, and the potential effect on the course of polycystic ovary syndrome.     

Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation

Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals.