Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND: Few studies have considered using environmental amenities to explain social health inequalities.Nevertheless, Green spaces that promote good health may have an effect on socioeconomic health inequalities. In developed countries, there is considerable evidence that green spaces have a beneficial effect on the health of urban populations and recent studies suggest they can have a positive effect on pregnancy outcomes. To investigate the relationship between green spaces and the spatial distribution of infant mortality taking account neighborhood deprivation levels. METHODS: The study took place in Lyon metropolitan area, France. All infant deaths that occurred between 2000 and 2009 were geocoded at census block level. Each census block was assigned greenness and socioeconomic deprivation levels. The spatial--scan statistic was used to identify high risk cluster of infant mortality according to these neighborhood characteristics. RESULTS: The spatial distribution of infant mortality was not random with a high risk cluster in the south east of the Lyon metropolitan area (p<0.003). This cluster disappeared (p=0.12) after adjustment for greenness level and socioeconomic deprivation, suggesting that these factors explain part of the spatial distribution of infant mortality. These results are discussed using a conceptual framework with 3 hypothetical pathways by which green spaces may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway. CONCLUSIONS: These results add some evidence to the hypothesis that there is a relationship between access to green spaces and pregnancy outcomes but further research is required to confirm this.
BMC Pregnancy and Childbirth

hal-00876083
https://hal.archives-ouvertes.fr/hal-00876083
https://hal.archives-ouvertes.fr/hal-00876083/document
DOI : 10.1186/1471-2393-13-191

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND: Few studies have considered using environmental amenities to explain social health inequalities.Nevertheless, Green spaces that promote good health may have an effect on socioeconomic health inequalities. In developed countries, there is considerable evidence that green spaces have a beneficial effect on the health of urban populations and recent studies suggest they can have a positive effect on pregnancy outcomes. To investigate the relationship between green spaces and the spatial distribution of infant mortality taking account neighborhood deprivation levels. METHODS: The study took place in Lyon metropolitan area, France. All infant deaths that occurred between 2000 and 2009 were geocoded at census block level. Each census block was assigned greenness and socioeconomic deprivation levels. The spatial--scan statistic was used to identify high risk cluster of infant mortality according to these neighborhood characteristics. RESULTS: The spatial distribution of infant mortality was not random with a high risk cluster in the south east of the Lyon metropolitan area (p<0.003). This cluster disappeared (p=0.12) after adjustment for greenness level and socioeconomic deprivation, suggesting that these factors explain part of the spatial distribution of infant mortality. These results are discussed using a conceptual framework with 3 hypothetical pathways by which green spaces may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway. CONCLUSIONS: These results add some evidence to the hypothesis that there is a relationship between access to green spaces and pregnancy outcomes but further research is required to confirm this.
ISSN: 1471-2393

inserm-00878362
http://www.hal.inserm.fr/inserm-00878362
http://www.hal.inserm.fr/inserm-00878362/document
http://www.hal.inserm.fr/inserm-00878362/file/1471-2393-13-191.pdf
DOI : 10.1186/1471-2393-13-191

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Introduction Evidence has accumulated that exposure to ambient air pollution during pregnancy may influence preterm birth (PTB) in urban settings. Conversely, this relation has barely been investigated in rural areas where individual characteristics (demographic, socioeconomic, and psychosocial factors) and environmental co-exposures may differ. Objective We examined the association between prenatal exposure to traffic-related air pollution and PTB among pregnant women from the PELAGIE mother–child cohort (Brittany, France, 2002–2006) living in urban (n=1550) and rural (n=959) settings. Methods Women’s residences were classified as either urban or rural according to the French census bureau rural–urban definitions. Nitrogen dioxide (NO2) concentrations at home addresses were estimated from adjusted land-use regression models as a marker of traffic-related pollution. Associations between NO2 concentrations and PTB were assessed with logistic regression models. Results Prevalence of PTB was similar among women living in urban (3.2%) and in rural (3.5%) settings. More positive socioeconomic characteristics and health behaviors but more single-parent families were observed among urban women. NO2 exposure averaged 20.8±6.6 µg m−3 for women residing in urban areas and 18.8±5.6 µg m−3 for their rural counterparts. A statistically significant increased risk of PTB was observed among women exposed to NO2 concentrations ≥16.4 µg m−3 and residing in urban areas but not among their rural counterparts. Discussion The results of this study, conducted in a region with interspersed urban–rural areas, are in line with previous findings suggesting an increased risk of PTB associated with higher NO2 concentrations for women living in urban areas. The absence of association among their rural counterparts for whom exposure levels were similar suggests that environmental mixtures and psychosocial inequalities might play a role in this heterogeneity
ISSN: 0013-9351

hal-01165108
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01165108
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01165108/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01165108/file/Air%20pollution%20%26%20preterm%20birth%20PELAGIE_HAL-accepted.pdf
PUBMED : 26092808

Éditeur(s) : HAL CCSD
Résumé : poster presentation, 22nd European Meeting on Hypertension and Cardiovascular protection, London,26-29 April 2012
OBJECTIVE: Several studies demonstrate that the perception of overweight is associated with attempts at weight control in overweight subjects. Our objective is to describe the factors associated with the perception of overweight in an adult Caribbean population, and in particular, to assess the relationship between the perception of overweight and previous medical diagnosis of overweight. METHOD AND DESIGN: Consant was a cross-sectional study carried out in 2007 on a representative sample of the adult Guadeloupean population. Included were 1,005 subjects aged 25-74 years, drawn from stratified random sampling, and interviewed at home. The perception of overweight was evaluated by the question: "Do you consider yourself to be overweight?" with a binary response. RESULTS: Among overweight subjects (Body Mass Index ≥ 25 kg/m2, n = 576), 38.6% provided an incorrect assessment of their weight status. This proportion falls to 17.4% in those who stated to have previously received a medical diagnosis of overweight. However, only 48.8% of overweight subjects stated to have received such a diagnosis. A logistic regression shows that the underestimation of weight status is associated with the absence of previous diagnosis for overweight (OR: 5.35 - p < 10-3), as well as an age greater than or equal to 55 years (OR: 2.91 - p < 10-3), a BMI of less than 30 kg/m² (OR: 2.26 - p: 0.001), the male sex (OR: 1.86 - p: 0.004), and a low income level (OR: 1.62 - p: 0.030), but not a lack of awareness regarding the role of weight control in the prevention of cardiovascular diseases. Similar results are observed if waist circumference is taken as a factor instead of BMI. CONCLUSION: In this population, the lack of medical diagnosis of overweight was the leading factor associated with misperception of overweight. Screening for overweight therefore appears to be one of the preconditions to weight management, and remains a fundamental but often unused element in the fight against obesity.
https://hal.univ-antilles.fr/hal-00739785

Droits : info:eu-repo/semantics/OpenAccess
hal-00739785
https://hal.univ-antilles.fr/hal-00739785
https://hal.univ-antilles.fr/hal-00739785/document
https://hal.univ-antilles.fr/hal-00739785/file/The_lacksur screening_is_the_leading_factor_associated_with_the_misperceptionsur overweight_cor.pdf

Éditeur(s) : HAL CCSD
Résumé : International audience
BACKGROUND: Several studies suggest that exposure to organophosphate insecticides (OP) during pregnancy impairs neurodevelopment in children. OBJECTIVES: We evaluated associations between biomarkers of prenatal and postnatal OP exposure and cognitive function of 6-year-olds in a French longitudinal birth cohort. METHODS: In 2002-2006, the PELAGIE mother-child cohort enrolled pregnant women from Brittany. For a random subcohort, we measured nonspecific dialkylphosphate metabolites (DAP) of OP in one maternal urine sample, collected before 19 weeks' gestation, and in one urine sample collected from their 6-year-old children. Six subtests of the Wechsler Intelligence Scale for Children-4th edition (WISC-IV) was administered at 6 years to evaluate cognitive function (n=231). Linear regression models controlling for factors including maternal intelligence and the Home Observation for Measurement of the Environment score were used. RESULTS: WISC-IV scores were not significantly associated with prenatal or childhood total DAP metabolites. WISC verbal comprehension score was significantly higher in association with the highest maternal urinary concentrations of diethylphosphate metabolites (DE) (5.5; 95% CI: 0.8, 10.3 for extgreater 13.2 nmol/L versus extlessLOQ), while WISC working memory score was significantly lower in association with the highest urinary concentrations of DE metabolites at age 6 years (-3.6; 95% CI: -7.8, -0.6 for extgreater 11.1 nmol/L versus extlessLOD). CONCLUSION: This study found no evidence that prenatal OP exposure adversely affected cognitive function in 6-year-olds, perhaps because of the higher population's socioeconomic status than in previous studies though other causal and non-causal explanations are also possible. The negative association between WISC score and concurrent DE urinary concentrations requires replication by longitudinal studies investigating childhood OP exposure
Environmental Health Perspectives

hal-01207282
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01207282
DOI : 10.1289/ehp.1409472
PUBMED : 26394442

Éditeur(s) : HAL CCSD
Résumé : oral presentation, 22nd European Meeting on Hypertension and Cardiovascular protection, London, 26-29 april 2012
To assess the relationship between socioeconomic factors and the expression of multiple cardiovascular risk factors in an adult Caribbean population.
https://hal.univ-antilles.fr/hal-00739783

Droits : info:eu-repo/semantics/OpenAccess
hal-00739783
https://hal.univ-antilles.fr/hal-00739783
https://hal.univ-antilles.fr/hal-00739783/document
https://hal.univ-antilles.fr/hal-00739783/file/High_cardiovascular_risk_cor.pdf

Éditeur(s) : HAL CCSD MDPI
Résumé : International audience
Infant and neonatal mortality indicators are known to vary geographically, possibly as a result of socioeconomic and environmental inequalities. To better understand how these factors contribute to spatial and temporal patterns, we conducted a French ecological study comparing two time periods between 2002 and 2009 for three (purposefully distinct) Metropolitan Areas (MAs) and the city of Paris, using the French census block of parental residence as the geographic unit of analysis. We identified areas of excess risk and assessed the role of neighborhood deprivation and average nitrogen dioxide concentrations using generalized additive models to generate maps smoothed on longitude and latitude. Comparison of the two time periods indicated that statistically significant areas of elevated infant and neonatal mortality shifted northwards for the city of Paris, are present only in the earlier time period for Lille MA, only in the later time period for Lyon MA, and decrease over time for Marseille MA. These city-specific geographic patterns in neonatal and infant mortality are largely explained by socioeconomic and environmental inequalities. Spatial analysis can be a useful tool for understanding how risk factors contribute to disparities in health outcomes ranging from infant mortality to infectious disease-a leading cause of infant mortality.
ISSN: 1660-4601

hal-01359563
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01359563
DOI : 10.3390/ijerph13060624
PUBMED : 27338439

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: Adolescent obesity is prevalent in Pacific region ethnic groups (European, Melanesian and Polynesian) living in both urban and rural areas. Although body perception is an important factor of weight gain or loss, little is known about the body self-perceptions of Pacific region adolescents. This study therefore evaluated adolescent perceptions of body weight according to ethnicity (European, Melanesian or Polynesian), socioeconomic status (low, intermediate or high) and living area (rural or urban) in New Caledonia.Methods: Sociodemographic and anthropomorphic data from 737 adolescents (351 boys and 386 girls) with ages ranging from 11 to 16 years were collected and analysed. The International Obesity Task Force (IOTF) standards were used to define weight status as normal-weight, underweight or overweight/obese. Weight perception was assessed from detailed questionnaires, with adolescents rating their own weight with the following descriptors: 'about the right weight', 'too heavy', or 'too light'.Results: Results showed that only 8.5% of normal-weight adolescents (7% boys and 10% girls) identifying themselves as ‘too heavy’. Normal-weight Melanesian adolescents were less likely than their European counterparts to assess themselves as too heavy (OR = 0.357). However, half the overweight/obese adolescents underestimated their weight status (53% boys and 48% girls). Weight misperception was associated with ethnicity, socioeconomic status and living area, with gender-specific differences.Conclusions: The results of this study suggest that these sociodemographic factors should be taken into account when designing public health policies and health education school programmes in New Caledonia and, more broadly, the Pacific regio
ISSN: 1471-2458

Droits : info:eu-repo/semantics/OpenAccess
hal-01678909
https://hal.univ-antilles.fr/hal-01678909
https://hal.univ-antilles.fr/hal-01678909/document
https://hal.univ-antilles.fr/hal-01678909/file/Misperception%20of%20weight%20status%20in%20the%20pacific-%20preliminary%20findings%20in%20rural%20and%20urban%2011-%20to%2016-year-olds%20of%20New%20Caledonia%20Ste%CC%81phane%20Frayon%20et%20al%202017.pdf
DOI : 10.1186/s12889-016-3982-0

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
STUDY QUESTION: Is there evidence at the population level of associations between different male genital disorders, outside Scandinavian countries? SUMMARY ANSWER: At an international scale, there is evidence for a number of correlations between rates of four male reproductive disorders (hypospadias, cryptorchidism, testicular cancer and low sperm concentration). WHAT IS KNOWN ALREADY: Some associations between these outcomes have been shown in studies focusing on individuals and mainly in Nordic European countries. These associations, together with histological evidence of a dysgenesis pattern in testicular tissue specimens, have generated the concept of the existence of a 'testicular dysgenesis syndrome' originating in utero. STUDY DESIGN, SIZE, DURATION: This is a geographical correlation study using cancer, malformations rates and sperm quality data collected between the years 1998 and 2005. PARTICIPANTS/MATERIALS, SETTING, METHODS: Incidence rates of testicular cancer were extracted from International Agency for Research on Cancer registries and Globocan, while cryptorchidism and hypospadias prevalence rates were obtained from EUROCAT and International Clearinghouse for Birth Defects Surveillance and Research registries. Sperm concentration data were extracted from recent studies using standardized methodology. A total of 39 registries and 9 sperm studies were selected. Non-parametric Spearman correlation tests were used to test the association between these four disorders. Correlations were computed for all registries together, for registries with high-quality matching coverage only and by continents. Sensitivity analyses were also conducted using data from prospective clinical studies to take into account potential bias related mainly to ascertainment of malformation rates. MAIN RESULTS AND THE ROLE OF CHANCE: We found positive correlations between testicular cancer and hypospadias (r = 0.32, P = 0.05) and between hypospadias and cryptorchidism (r = 0.70, P = 0.008). Stronger correlations were observed when using registries with high-quality matching coverage. Among these registries, differences between Europe and the rest of the world appeared (the positive correlation between testicular cancer and cryptorchidism was stronger outside Europe, r = 0.83, P = 0.01 compared with 0.40, P = 0.60 for European registries). A negative correlation between testicular cancer and sperm concentration was observed (r = -0.88, P = 0.002). These correlations support our initial hypothesis but remain only suggestive due to the intrinsic limitations in the study design (i.e. geographical correlation study) and do not allow causal inference. LIMITATIONS, REASONS FOR CAUTION: Differences in the ascertainment of malformations rates (definition, length of follow-up) make the international comparison difficult. The small number of registries for some conditions (cryptorchidism) or of studies (for sperm quality) and the absence of information about major risk factors such as ethnicity and socioeconomic status in the registries are also limitations. WIDER IMPLICATIONS OF THE FINDINGS: Our findings are in agreement with results of studies focusing on individuals and suggest that shared risk factors are present in the populations studied.
ISSN: 0268-1161

inserm-00863412
http://www.hal.inserm.fr/inserm-00863412
DOI : 10.1093/humrep/det111
PUBMED : 23670171

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: Despite intensive research over several decades, the etiology of multiple sclerosis (MS) remains poorly understood, although environmental factors are supposedly implicated. Our goal was to identify spatial clusters of MS incident cases at the small-area level to provide clues to local environmental risk factors that might cause or trigger the disease. Methods: A population-based and multi-stage study was performed in the French Brittany region to accurately ascertain the clinical onset of disease during the 2000-2004 period. The municipality of residence at the time of clinical onset was geocoded. To test for the presence of MS incidence clusters and to identify their approximate locations, we used a spatial scan statistic. We adjusted for socioeconomic deprivation, known to be strongly associated with increased MS incident rates, and scanned simultaneously for areas with either high or low rates. Sensitivity analyses (focusing on relapsing-remitting forms and/or places of residence available within the year following clinical onset) were performed. Results: A total of 848 incident cases of MS were registered in Brittany, corresponding to a crude annual incidence rate of 5.8 per 100,000 inhabitants. The spatial scan statistic did not find a significant cluster of MS incidence in either the primary analysis (p value >= 0.56) or in the sensitivity analyses (p value >= 0.16). Conclusion: The findings of this study indicate that MS incidence is not markedly affected across space, suggesting that in the years preceding the first clinical expression of the disease, no environmental trigger is operative at the small-area population level in the French Brittany region.
ISSN: 1476-072X

hal-01616063
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01616063
DOI : 10.1186/s12942-017-0108-6
PUBMED : 28934989

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
Background: An environmental health inequality is a major public health concern in Europe. However just few studies take into account a large set of characteristics to analyze this problematic. The aim of this study was to identify and describe how socioeconomic, health accessibility and exposure factors accumulate and interact in small areas in a French urban context, to assess environmental health inequalities related to infant and neonatal mortality.Methods: Environmental indicators on deprivation index, proximity to high-traffic roads, green space, and healthcare accessibility were created using the Geographical Information System. Cases were collected from death certificates in the city hall of each municipality in the Nice metropolitan area. Using the parental addresses, cases were geocoded to their census block of residence. A classification using a Multiple Component Analysis following by a Hierarchical Clustering allow us to characterize the census blocks in terms of level of socioeconomic, environmental and accessibility to healthcare, which are very diverse definition by nature. Relation between infant and neonatal mortality rate and the three environmental patterns which categorize the census blocks after the classification was performed using a standard Poisson regression model for count data after checking the assumption of dispersion.Results: Based on geographic indicators, three environmental patterns were identified. We found environmental inequalities and social health inequalities in Nice metropolitan area. Moreover these inequalities are counterbalance by the close proximity of deprived census blocks to healthcare facilities related to mother and newborn. So therefore we demonstrate no environmental health inequalities related to infant and neonatal mortality.Conclusion: Examination of patterns of social, environmental and in relation with healthcare access is useful to identify census blocks with needs and their effects on health. Similar analyzes could be implemented and considered in other cities or related to other birth outcomes.
ISSN: 1476-069X

halshs-01366285
https://halshs.archives-ouvertes.fr/halshs-01366285
https://halshs.archives-ouvertes.fr/halshs-01366285/document
https://halshs.archives-ouvertes.fr/halshs-01366285/file/art_10.1186_s12940-016-0163-7.pdf
PUBMED : 27449640

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
Well-designed and effectively managed networks of marine reserves can be effective tools for both fisheries management and biodiversity conservation. Connectivity, the demographic linking of local populations through the dispersal of individuals as larvae, juveniles or adults, is a key ecological factor to consider in marine reserve design, since it has important implications for the persistence of metapopulations and their recovery from disturbance. For marine reserves to protect biodiversity and enhance populations of species in fished areas, they must be able to sustain focal species (particularly fishery species) within their boundaries, and be spaced such that they can function as mutually replenishing networks whilst providing recruitment subsidies to fished areas. Thus the configuration (size, spacing and location) of individual reserves within a network should be informed by larval dispersal and movement patterns of the species for which protection is required. In the past, empirical data regarding larval dispersal and movement patterns of adults and juveniles of many tropical marine species have been unavailable or inaccessible to practitioners responsible for marine reserve design. Recent empirical studies using new technologies have also provided fresh insights into movement patterns of many species and redefined our understanding of connectivity among populations through larval dispersal. Our review of movement patterns of 34 families (210 species) of coral reef fishes demonstrates that movement patterns (home ranges, ontogenetic shifts and spawning migrations) vary among and within species, and are influenced by a range of factors (e.g. size, sex, behaviour, density, habitat characteristics, season, tide and time of day). Some species move <0.1–0.5 km (e.g. damselfishes, butterflyfishes and angelfishes), <0.5–3 km (e.g. most parrotfishes, goatfishes and surgeonfishes) or 3–10 km (e.g. large parrotfishes and wrasses), while others move tens to hundreds (e.g. some groupers, emperors, snappers and jacks) or thousands of kilometres (e.g. some sharks and tuna). Larval dispersal distances tend to be <5–15 km, and self-recruitment is common. Synthesising this information allows us, for the first time, to provide species, specific advice on the size, spacing and location of marine reserves in tropical marine ecosystems to maximise benefits for conservation and fisheries management for a range of taxa. We recommend that: (i) marine reserves should be more than twice the size of the home range of focal species (in all directions), thus marine reserves of various sizes will be required depending on which species require protection, how far they move, and if other effective protection is in place outside reserves; (ii) reserve spacing should be <15 km, with smaller reserves spaced more closely; and (iii) marine reserves should include habitats that are critical to the life history of focal species (e.g. home ranges, nursery grounds, migration corridors and spawning aggregations), and be located to accommodate movement patterns among these. We also provide practical advice for practitioners on how to use this information to design, evaluate and monitor the effectiveness of marine reserve networks within broader ecological, socioeconomic and management contexts.
ISSN: 1464-7931

Droits : http://creativecommons.org/licenses/by-nc-nd/
hal-01334353
https://hal-univ-perp.archives-ouvertes.fr/hal-01334353
https://hal-univ-perp.archives-ouvertes.fr/hal-01334353/document
https://hal-univ-perp.archives-ouvertes.fr/hal-01334353/file/Green_et_al-2015-Biological_Reviews.pdf
DOI : 10.1111/brv.12155

Éditeur(s) : HAL CCSD BMJ Publishing Group
Résumé : International audience
OBJECTIVE: To investigate the role of occupational exposure to chlorinated solvents in lung cancer aetiology. METHODS: ICARE (Investigation of occupational and environmental CAuses of REspiratory cancers) is a French, multicentre, population-based, case-control study. Information on the lifelong work history of 2926 cases and 3555 controls was collected using standardised questionnaires. Occupational exposures were assessed using job-exposure matrices for five chlorinated solvents. Solvents were studied separately and in combinations. ORs were computed using unconditional logistic regression models adjusted for classic risk factors, including a history of cigarette smoking and exposure to asbestos. Adjustment for socioeconomic status (SES) was also made. RESULTS: After adjustment for exposure to asbestos, we observed a positive, statistically significant association with lung cancer for men and women exposed to a combination of perchloroethylene (PCE), trichloroethylene and dichloromethane (DCM). Further adjustment for SES slightly decreased this association. In contrast, no statistically significant associations were found for other solvent combinations. CONCLUSIONS: These results suggest that exposure to PCE may constitute a risk factor for lung cancer, especially among women, who seem to have a higher prevalence of exposure than men.
ISSN: 1351-0711

hal-01063908
https://hal.archives-ouvertes.fr/hal-01063908
DOI : 10.1136/oemed-2014-102182
PUBMED : 25015929

Éditeur(s) : HAL CCSD Lippincott, Williams & Wilkins
Résumé : International audience
BACKGROUND: Addressing vulnerability to heat-related mortality is a necessary step in the development of policies dictated by heat action plans. We aimed to provide a systematic assessment of the epidemiologic evidence regarding vulnerability to heat-related mortality. METHODS: Studies assessing the association between high ambient temperature or heat waves and mortality among different subgroups and published between January 1980 and August 2014 were selected. Estimates of association for all the included subgroups were extracted. We assessed the presence of heterogeneous effects between subgroups conducting Cochran Q tests. We conducted random effect meta-analyses of ratios of relative risks (RRR) for high ambient temperature studies. We performed random effects meta-regression analyses to investigate factors associated with the magnitude of the RRR. RESULTS: Sixty-one studies were included. Using the Cochran Q test, we consistently found evidence of vulnerability for the elderly ages extgreater85 years. We found a pooled RRR of 0.99 (95% confidence interval [CI] = 0.97, 1.01) for male sex, 1.02 (95% CI = 1.01, 1.03) for age extgreater65 years, 1.04 (95% CI = 1.02, 1.07) for age extgreater75 years, 1.03 (95% CI = 1.01, 1.05) for low individual socioeconomic status (SES), and 1.01 (95% CI = 0.99, 1.02) for low ecologic SES. CONCLUSIONS: We found strongest evidence of heat-related vulnerability for the elderly ages extgreater65 and extgreater75 years and low SES groups (at the individual level). Studies are needed to clarify if other subgroups (e.g., children, people living alone) are also vulnerable to heat to inform public health programs
ISSN: 1044-3983

hal-01197347
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01197347
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01197347/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01197347/file/Vulnerability%20to%20Heat-related%20Mortality%20A%20Systematic%20Review%2C%20Meta-analysis%2C%20and%20Meta-regression%20Analysis..pdf
DOI : 10.1097/EDE.0000000000000375

Résumé : Nous traiterons successivement des circonstances de l'émergence du Panama depuis la période précolombienne, les premières expéditions espagnoles à la recherche d'un détroit vers les Indes, de l'indépendance du Panama. Dans la première partie, nous traiteront de l'Isthme du Panama comme terre de passage et de son Canal de1880 à 1914, du rêve séculaire à la réalité où, successivement, nous étudierons son destin français, sa position entre intérêts français et aspirations américaines. Les États-Unis et le Panama nous conduiront à traiter de l'installation des Américains, la construction du Canal (1904-1914) ; les traités Carter-Torrijos, entre compromis et ambiguïtés. La deuxième partie traitera des stratégies de développement du Panama; l'importance des facteurs socioéconomiques et la dynamique des structures sociopolitiques seront mises en exergue. L'intégration des Antillais de Guadeloupe et de Martinique dans le cercle communautaire panaméen de 1914 à nos jours. Àcet égard, nous traiterons des apports de la culture antillaise dans la représentation panaméenne, un brassage culturel. En troisième lieu, leur contribution à l'essor de la nation. Il s'agira ici d'étudier les arts et la culture, la musique et les danses, la littérature et la linguistique de même que les revendications culturelles des minorités ethniques. Enfin, nous orienterons nos recherches sur la question de l'unité panaméenne à l'aube du Ille millénaire, l'organisation des diverses communautés et l'installation européenne au Panama.
We will successively deal with the circumstances of the emergence of Panama since the pre-Colum bian period, the first Spanish shipping expeditions in search of a strait towards India, and the independence of Panama. ln the first part, we shall deal with the Isthmus of Panama as a land of passage and with its Channel from 1880 to 1914, from the secular dream to reality where, successively, we shall study its French fate, its position in regards to French interests and American aspiration. The relationship between the United States and Panama will lead us to deal with the settling of the Americans, the construction of the Channel (1904-1914), the "Carter-Torrijos" treaties, between compromises and ambiguities. The second part will deal with strategies of development for Panama; the importance of socioeconomic factors and the dynamics of the sociopolitical structures will be highlighted. The integration of the people of Guadeloupe and Martinique in the Panamanian community circle from 1914 to nowadays. In this respect, we shall treat contributions of the French West Indian culture within the Panamanian representation; the cultural admixture. In the third part, their contribution at the development of the Panamanian nation. The issue will be to study arts and culture, music and dances, Iiterature and Iinguistics as weil as the cultural demands from ethnic minorities. Finally, we shall direct our researches towards the question of Panamanian unity at the dawn of the third millennium, the organization of the diverse communities and the European settling in Panama

http://www.theses.fr/2010AGUY0393/document