Les plantes transgéniques (OGM végétaux) : connaissances et inconnues sur les risques d'allergénicité…

Much attention is now being focused on foods from genetically modified plants because of the risk of allergenicity. No such risk has been reported for the first generation of GM plants made resistant to herbicides and insect larvae. Current experiments with hypoallergenic GM plants are reported and discussed in the present paper. The second generation of GM plants will improve the nutritional aspects of natural foods. Transgenic proteins could reach from 4 up to 8% of the total protein content in these foods. Any potential difference in allergenicity between second generation GM plants and the natural varieties must be examined with respect to the risk for food allergy caused by food products made from these plants and the risk for respiratory allergies in the people living near the crops caused by airborne pollen originating from the plants. WHO–FAO directives as well as the Codex Alimentarius proposals and the European Food Safety Authority (EFSA) guidelines recommend that transgenic proteins be screened for homology (by in silico study) and cross-reactivity with known allergens, as well as being examined carefully for modifications of host-plant proteomes. In vivo animal studies are also to be carried out to assess any potential immunogenicity. Lacking adequate safety data, the absence of potential allergenicity of transgenic plants cannot be ruled out. This is why data that do not meet the recommended safety criteria required for commercialization of GM plants do not allow us to rule out absolutely the risk that may be associated with products that are going to be commercialized. Therefore, it is essential that commercialized GM plants be monitored. We propose the establishment of public reference serum banks based on up-to-date WHO–FAO recommendations concerning the selection of sera according to precise criteria. We also propose establishing a system of allergovigilance linking national and European health and food safety agencies and a network of university hospital-based clinical and laboratory reference centres, together with a network of clinical allergists, responsible for the creation of the serum banks. Allergists working through these networks would be able to identify new sensitizations to transgenic foods in the population, just as they now identify new types of food allergies, which, in this case, would be GM foods. Such a project is now being established in France.     

Electrophysiological measures of conflict and reward processing are associated with decisions to engage in physical effort

Anterior cingulate cortex (ACC), a key brain region involved in cognitive control and decision making, is suggested to mediate effort- and value-based decision making, but the specific role of ACC in this process remains debated. Here we used frontal midline theta (FMT) and the reward positivity (RewP) to examine ACC function in a value-based decision making task requiring physical effort. We investigated whether (1) FMT power is sensitive to the difficulty of the decision or to selecting effortful actions, and (2) RewP is sensitive to the subjective value of reward outcomes as a function of effort investment. On each trial, participants chose to execute a low-effort or a high-effort behavior (that required squeezing a hand-dynamometer) to obtain smaller or larger rewards, respectively, while their brainwaves were recorded. We replicated prior findings that tonic FMT increased over the course of the hour-long task, which suggests increased application of control in the face of growing fatigue. RewP amplitude also increased following execution of high-effort compared to low-effort behavior, consistent with increased valuation of reward outcomes by ACC. Although neither phasic nor tonic FMT were associated with decision difficulty or effort selection per se, an exploratory analysis revealed that the interaction of phasic FMT and expected value of choice predicted effort choice. This interaction suggests that phasic FMT increases specifically under situations of decision difficulty when participants ultimately select a high-effort choice. These results point to a unique role for ACC in motivating and persisting at effortful behavior when decision conflict is high.     

条件价值法在医院院誉价值评估中的应用——最大意愿支付额影响因素分析

对最大支付意愿的数额进行分析是应用条件价值法评估医院院誉价值的重要内容。在对Tobit模型进行简要介绍的基础上，通过模型回归对影响最大支付意愿额的因素进行分析发现，年龄、年龄的二次方、是否更愿意来该医院、对风险的态度、受教育程度、家庭大小和家庭总收入水平对最大支付意愿额有显著影响，同时对各因素的影响强度进行了探讨，并对模型的相关问题进行了简单讨论。     

The “employability” of disabled people in France: A labile and speculative notion to be tested against the empirical data from the 2008 “Handicap-Santé” study

Following the passage of the French law of 2005 on equal rights and opportunities, the issue of the “employability” of disabled people became a matter of public discussion. To clarify the debate, the article briefly presents the evolution of this notion and its various meanings, from the social sphere to employment policies. The concept of “employability” is then examined without any preconceived definition using empirical data from the national “Handicap-Santé” (disability-health) survey carried out in 2008 on the general population in France. Five groups illustrate employment patterns, social protection devices and types of disability: remaining employed until retirement; being employed thanks to social systems; leaving employment through “incapacity for work” systems; being employed through one's own resources; and being in sheltered employment or inactive. This construct provides keys to understand how “employability” manifests itself. The results show that, unlike the vision of employability that is focused on individual characteristics and promoted by employment policies in Europe, addressing employability in the domain of disability is only meaningful when considering individuals in their environments. The results also show that disability systems encourage forms of employability but still appear to favour access to inactivity through “incapacity for work”.     

Economic implications of nonadherence to highly active antiretroviral treatment in HIV patients

Until now, the economic implications of nonadherence to drug therapies have been mostly assessed in a cost perspective and understood as the impact of nonadherence behaviours on the cost-effectiveness ratios of particular therapies. In HIV disease, some modelling approaches have suggested that high adherence levels might improve the cost-effectiveness of highly active antiretroviral treatment regimens. However, there is an urgent need for research directly observing and measuring the costs of nonadherence behaviours. In addition to this cost perspective, the authors argue that the economic impact of nonadherence should also be studied in a microeconomic – patient-oriented – perspective. Major implications of this microeconomic perspective are drawn. First, the microeconomic approach highlights that nonadherence may often be a rational choice of the patient, thus suggesting new ways for improving adherence. Second, it implies that the adherence behaviour can be interpreted as an indicator of patients’ subjective valuation of highly active antiretroviral treatment therapies; in particular, higher levels of adherence are associated with higher patient well-being. Third, it shows that the adherence behaviour cannot be regarded as an exogenous variable when the impact of adherence on health outcome or on cost-effectiveness ratios is studied, thus requiring the use of specific statistical or econometric methods.     

The Subjective Well‐Being Method of Valuation: An Application to General Health Status

Objective

To introduce the subjective well‐being (SWB) method of valuation and provide an example by valuing health status. The SWB method allows monetary valuations to be performed in the absence of market relationships.

Data Sources

Data are from the 1975–2010 General Social Survey.

Study Design

The value of health status is determined via the estimation of an implicit derivative based on a happiness equation. Two‐stage least‐squares was used to estimate happiness as a function of poor‐to‐fair health status, annual household income adjusted for household size, age, sex, race, marital status, education, year, and season. Poor‐to‐fair health status and annual household income are instrumented using a proxy for intelligence, a temporal version of the classic distance instrument, and the average health status of individuals who are demographically similar but geographically separated. Instrument validity is evaluated.

Principal Findings

Moving from good/excellent health to poor/fair health (1 year of lower health status) is equivalent to the loss of $41,654 of equivalized household income (2010 constant dollars) per annum, which is larger than median equivalized household income.

Conclusion

The SWB method may be useful in making monetary valuations where fundamental market relationships are not present.