title: Newborns health in the Danube Region: Environment, biomonitoring, interventions and economic benefits in a large prospective birth cohort study.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark. Electronic address: zorana.andersen@sund.ku.dk.
authors.forename: Zorana J
authors.initials: ZJ
authors.lastname: Andersen
authors.affiliation: Institute of Experimental Medicine, AS CR Videnska 1083, 142 20 Prague 4, Czech Republic. Electronic address: sram@biomed.cas.cz.
authors.forename: Radim J
authors.initials: RJ
authors.lastname: Sram
authors.affiliation: Charles University in Prague, Environment Center, Jose Martiho 2, 162 00 Prague 6, Czech Republic. Electronic address: milan.scasny@czp.cuni.cz.
authors.forename: Milan
authors.initials: M
authors.lastname: Ščasný
authors.affiliation: The Environmental Health Center, Busuiocului 58, 400240 Cluj Napoca, Romania. Electronic address: egurzau@ehc.ro.
authors.forename: Eugen S
authors.initials: ES
authors.lastname: Gurzau
authors.affiliation: Institute for Medical Research and Occupational Health, Ksaverska c 2, 10000 Zagreb, Croatia. Electronic address: afucic@imi.hr.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Fucic
authors.affiliation: EC DG Joint Research Centre, Institute for Health and Consumer Protection, TP 260, Via E. Fermi, 2749 21027 Ispra, Italy. Electronic address: Laura.GRIBALDO@ec.europa.eu.
authors.forename: Laura
authors.initials: L
authors.lastname: Gribaldo
authors.affiliation: Institute of Experimental Medicine, AS CR Videnska 1083, 142 20 Prague 4, Czech Republic. Electronic address: prossner@biomed.cas.cz.
authors.forename: Pavel
authors.initials: P
authors.lastname: Rossner
authors.affiliation: Institute of Experimental Medicine, AS CR Videnska 1083, 142 20 Prague 4, Czech Republic. Electronic address: andrearo@biomed.cas.cz.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossnerova
authors.affiliation: Charles University in Prague, Environment Center, Jose Martiho 2, 162 00 Prague 6, Czech Republic. Electronic address: Marketa.Braun.Kohlova@czp.cuni.cz.
authors.forename: Markéta Braun
authors.initials: MB
authors.lastname: Kohlová
authors.affiliation: Charles University in Prague, Environment Center, Jose Martiho 2, 162 00 Prague 6, Czech Republic. Electronic address: vojtech.maca@czp.cuni.cz.
authors.forename: Vojtěch
authors.initials: V
authors.lastname: Máca
authors.affiliation: Charles University in Prague, Environment Center, Jose Martiho 2, 162 00 Prague 6, Czech Republic. Electronic address: iva.zverinova@czp.cuni.cz.
authors.forename: Iva
authors.initials: I
authors.lastname: Zvěřinová
authors.affiliation: Regional Public Health Authority, Ipelska 1, 040 11 Kosice, Slovak Republic. Electronic address: dagmargajdosova@yahoo.com.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Gajdosova
authors.affiliation: Institut Umwelt-Hygiene, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria. Electronic address: hanns.moshammer@meduniwien.ac.at.
authors.forename: Hanns
authors.initials: H
authors.lastname: Moshammer
authors.affiliation: National Center for Public Health, Budapest, Hungary. Electronic address: rudnai.peter@oki.antsz.hu.
authors.forename: Peter
authors.initials: P
authors.lastname: Rudnai
authors.affiliation: Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark. Electronic address: liek@sund.ku.dk.
authors.forename: Lisbeth E
authors.initials: LE
authors.lastname: Knudsen
mesh_terms: D002648:Child; D002657:Child Development; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis / Q000706:statistics & numerical data; D004782:Environmental Health / Q000191:economics / Q000379:methods*; D004784:Environmental Monitoring / Q000379:methods*; D004787:Environmental Pollution / Q000009:adverse effects* / Q000032:analysis / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D047109:Fetal Development; D006304:Health Status; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018811:Maternal Exposure; D011446:Prospective Studies; D011634:Public Health / Q000191:economics / Q000379:methods
keywords: Air pollution; Biomonitoring; Birth cohort; Childhood health; Danube region; Environment