Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
ABSTRACT: BACKGROUND: Climate change poses unprecedented challenges, ranging from global and local policy challenges to personal and social action. Heat-related deaths are largely preventable, but interventions for the most vulnerable populations need improvement. Therefore, the prior identification of high risk areas at the community level is required to better inform planning and prevention. We aimed to demonstrate a simple and flexible conceptual framework relying upon satellite thermal data and other digital data with the goal of easily reproducing this framework in a variety of urban configurations. RESULTS: The study area encompasses Rennes, a medium-sized French city. A Landsat ETM + image (60 m resolution) acquired during a localized heatwave (June 2001) was used to estimate land surface temperature (LST) and derive a hazard index. A land-use regression model was performed to predict the LST. Vulnerability was assessed through census data describing four dimensions (socio-economic status, extreme age, population density and building obsolescence). Then, hazard and vulnerability indices were combined to deliver a heatwave health risk index. The LST patterns were quite heterogeneous, reflecting the land cover mosaic inside the city boundary, with hotspots of elevated temperature mainly observed in the city center. A spatial error regression model was highly predictive of the spatial variation in the LST (R2 = 0.87) and was parsimonious. Three land cover descriptors (NDVI, vegetation and water fractions) were negatively linked with the LST. A sensitivity analysis (based on an image acquired on July 2000) yielded similar results. Southern areas exhibited the most vulnerability, although some pockets of higher vulnerability were observed northeast and west of the city. The heatwave health risk map showed evidence of infra-city spatial clustering, with the highest risks observed in a north--south central band. Another sensitivity analysis gave a very high correlation between 2000 and 2001 risk indices (r = 0.98, p < 10-12). CONCLUSIONS: Building on previous work, we developed a reproducible method that can provide guidance for local planners in developing more efficient climate impact adaptations. We recommend, however, using the health risk index together with hazard and vulnerability indices to implement tailored programs because exposure to heat and vulnerability do not require the same prevention strategies.
ISSN: 1476-072X

inserm-00762303
http://www.hal.inserm.fr/inserm-00762303
http://www.hal.inserm.fr/inserm-00762303/document
http://www.hal.inserm.fr/inserm-00762303/file/1476-072X-11-38.pdf
DOI : 10.1186/1476-072X-11-38

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Increasingly, health risk assessment is addressing multiple pathway exposures to multiple contaminants. We reviewed aggregated exposure and cumulative risk approaches for contemporary and ubiquitous semivolatile organic compounds (SVOC). We identified 22 studies aggregating exposure pathways, and 31 cumulating risk. Exposure aggregation is based on the addition of pathway-specific doses, using kinetic modeling where it exists, and classic external dose equations otherwise. In most cases, exposure is dominated by a single route or source of exposure - mainly the oral pathway - via dietary or non-dietary exposure. Preferential routes and sources of exposure are influenced by SVOC physical-chemical properties such as vapor pressure. The cumulative risk approach for contaminants is based on dose addition. Simple sum of hazard quotient (Hazard Index: HI) is the most commonly used cumulative risk assessment approach, while Relative Potency Factor (RPF) appeared to the best suited – although this calls for a level of toxicological information that limits the number of compounds that can be studied simultaneously. Where both were performed, moving from HI to more refined approach produced similar results. In conclusion, both approaches - exposure aggregation and cumulative risk - rely on simple assumptions. Nevertheless, they allow uncertainty to be reduced, in comparison with source-by-source or chemical-by-chemical approaches.
ISSN: 0013-9351

hal-01635759
https://hal.archives-ouvertes.fr/hal-01635759
https://hal.archives-ouvertes.fr/hal-01635759/document
https://hal.archives-ouvertes.fr/hal-01635759/file/Pelletier%202017%20Review%20%20rev2.pdf
DOI : 10.1016/j.envres.2017.06.022

Éditeur(s) : Pergamon-elsevier Science Ltd
Résumé : Society's needs for a network of in situ ocean observing systems cross many areas of earth and marine science. Here we review the science themes that benefit from data supplied from ocean observatories. Understanding from existing studies is fragmented to the extent that it lacks the coherent long-term monitoring needed to address questions at the scales essential to understand climate change and improve geo-hazard early warning. Data sets from the deep sea are particularly rare with long-term data available from only a few locations worldwide. These science areas have impacts on societal health and well-being and our awareness of ocean function in a shifting climate. Substantial efforts are underway to realise a network of open-ocean observatories around European Seas that will operate over multiple decades. Some systems are already collecting high-resolution data from surface, water column, seafloor, and sub-seafloor sensors linked to shore by satellite or cable connection in real or near-real time, along with samples and other data collected in a delayed mode. We expect that such observatories will contribute to answering major ocean science questions including: How can monitoring of factors such as seismic activity, pore fluid chemistry and pressure, and gas hydrate stability improve seismic, slope failure, and tsunami warning? What aspects of physical oceanography, biogeochemical cycling, and ecosystems will be most sensitive to climatic and anthropogenic change? What are natural versus anthropogenic changes? Most fundamentally, how are marine processes that occur at differing scales related? The development of ocean observatories provides a substantial opportunity for ocean science to evolve in Europe. Here we also describe some basic attributes of network design. Observatory networks provide the means to coordinate and integrate the collection of standardised data capable of bridging measurement scales across a dispersed area in European Seas adding needed certainty to estimates of future oceanic conditions. Observatory data can be analysed along with other data such as those from satellites, drifting floats, autonomous underwater vehicles, model analysis, and the known distribution and abundances of marine fauna in order to address some of the questions posed above. Standardised methods for information management are also becoming established to ensure better accessibility and traceability of these data sets and ultimately to increase their use for societal benefit. The connection of ocean observatory effort into larger frameworks including the Global Earth Observation System of Systems (GEOSS) and the Global Monitoring of Environment and Security (GMES) is integral to its success. It is in a greater integrated framework that the full potential of the component systems will be realised. Crown Copyright (C) 2011 Published by Elsevier Ltd. All rights reserved.
Progress In Oceanography (0079-6611) (Pergamon-elsevier Science Ltd), 2011-10 , Vol. 91 , N. 1 , P. 1-33

Droits : 2011 Published by Elsevier Ltd. All rights reserved.
http://archimer.ifremer.fr/doc/00044/15557/15923.pdf
DOI:10.1016/j.pocean.2011.05.001
http://archimer.ifremer.fr/doc/00044/15557/

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Humans are exposed to a large number of contaminants, many of which may have similar health effects. This paper presents a framework for identifying pollutants to be included in a cumulative risk assessment approach. To account for the possibility of simultaneous exposure to chemicals with common toxic modes of action, the first step of the traditional risk assessment process, i.e. hazard identification, is structured in three sub-steps: (1a) Identification of pollutants people are exposed to, (1b) identification of effects and mechanisms of action of these pollutants, (1c) grouping of pollutants according to similarity of their mechanism of action and health effects. Based on this exposure-based grouping we can derive "multi-pollutant" toxicity reference values, in the "dose-response assessment" step. The approach proposed in this work is original in that it is based on real exposures instead of a limited number of pollutants from a unique chemical family, as traditionally performed. This framework is illustrated by the case study of semi-volatile organic compounds in French dwellings, providing insights into practical considerations regarding the accuracy of the available toxicological information. This case study illustrates the value of the exposure-based approach as opposed to the traditional cumulative framework, in which chemicals with similar health effects were not always included in the same chemical class.
ISSN: 0013-9351

hal-00982315
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00982315
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00982315/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00982315/file/An_exposure-based_framework_for_grouping_pollutants_accepted.pdf
DOI : 10.1016/j.envres.2014.01.007

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
This study aimed to compare the relative survival of patients with invasive breast cancer between women from French Guiana (a French territory in South America) and metropolitan France. No study hadever compared survival of breast cancer on the basis of immigrant status in France. Our study underlined that access to care for migrants is challenging whichwgenerates health inequalities. Background The prognosis of breast cancer in French Guiana is worse than in France with 23 deaths per 100 incident cases against 17 per 100 in metropolitan France. This study aimed to compare relative survival of patients with invasive breast cancer (IBC) between women from French Guiana and metropolitan France and to determine risk factors influencing breast cancer survival in French Guiana.Materials and methods Data were collected from the Cancer registry of French Guiana. We comparedthe relative survival of women with IBC between French Guiana and metropolitan France. We used Cox's proportional hazard regression to evaluate the effect of prognostic factors on cancer-specific mortality in French Guiana. Results We included all 269 cases of IBC in women diagnosed in French Guiana between 2003 and 2009. The overall 5-year relative survival rate of patients with IBC was 79% in French Guiana and 86% in metropolitan France. The place of birth (foreign country versus French territory), the tumor stage at the time of diagnosis, the mode of diagnosis (symptoms versus screening), the presence of hormone receptors in the tumor and the histologic type were the variables associated with survival differences. None of the other study variables were significantly associated with prognosis. Conclusion Access to care for migrants is challenging,which leads to health inequalities. Early detection through prevention programs is crucial to increaseIBC survival notably for foreign-born patients.
ISSN: 1526-8209

hal-01288657
https://hal.archives-ouvertes.fr/hal-01288657
https://hal.archives-ouvertes.fr/hal-01288657/document
https://hal.archives-ouvertes.fr/hal-01288657/file/2016%2C%20Roue%20-%20Predictive%20factors%20of%20the%20survival%20of%20women%20with%20invasive%20breast%20cancer%20in%20French%20Guiana.pdf

Éditeur(s) : HAL CCSD
Résumé : Report
The Canadian coastline is the longest of any country in the world, and is at risk from tsunamis generated in three oceans. The current state of knowledge precludes a complete probabilistic tsunami hazard assessment, which would require quantification of a wide range of possible scenarios for each tsunami source, coupled with modelling that incorporates fine-resolution bathymetry and onland topography to adequately assess potential runup at the coast. This preliminary assessment presents a first attempt to quantify the tsunami hazard on the Canadian Pacific, Atlantic and Arctic coastlines from local and far-field, earthquake and large landslide sources. For each source considered, we calculate the probability that tsunami runup at the coast will exceed 1.5 m (threshold for potential damage) and 3 m (significant damage potential), in a 50-year period. For each coastal region, we then combine the relative hazard from each source to calculate the overall probability that the coastline in question will experience tsunami runup exceeding 1.5 m (and 3 m) within a 50-year period, from any geological source. We also consider the maximum runup levels expected to occur within time periods of 100, 500, 1000, and 2500 years.
https://hal.archives-ouvertes.fr/hal-00856677

hal-00856677
https://hal.archives-ouvertes.fr/hal-00856677
DOI : 10.4095/292067

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Purpose: Active surveillance is a treatment option for favorable risk prostate cancer. However, data are missing on populations of African descent. We evaluated the safety and benefit of active surveillance in an African Caribbean cohort with favorable risk prostate cancer. Materials and Methods: Between 2005 and 2016, a single center, prospective cohort study was performed in Guadeloupe, French West Indies, including patients on active surveillance who had low risk prostate cancer (prostate specific antigen 10 ng/ml or less and Gleason score 6 or less) or favorable intermediate risk prostate cancer (prostate specific antigen 10 to 20 ng/ml, Gleason score 3 + 4 or less and life expectancy less than 10 years). Treatment was recommended in case of grade progression, increased tumor volume, prostate cancer doubling time less than 36 months or patient wish. Overall survival, disease specific survival and duration of active surveillance were calculated with the KaplanMeier method. Multivariate analysis was performed using the Cox proportional hazards model to identify predictors of active surveillance termination. Results: A total of 234 patients with a median age of 64 years were enrolled in study. Median followup was 4 years (IQR 2.3-5.5). Overall survival at 30 months, 5 years and 10 years was 99.5%, 98.5% and 90.7%, respectively. Disease specific survival at 30 months, and 5 and 10 years was 100%. At 30 months, 5 years and 10 years 72.7%, 52.6% and 40.4% of patients, respectively, remained untreated and on active surveillance. Age (HR 0.96 per additional year, 95% CI 0.93-0.99) and prostate specific antigen density (HR 1.52 per additional 0.1 ng/ml, 95% CI 1.20-1.89) were found to be independent predictors of active surveillance termination. Conclusions: Active surveillance is safe and beneficial for highly selected African Caribbean patients. It seems to be feasible for patients at low risk and intermediate favorable risk. Prostate specific antigen density could help better select these patients.
ISSN: 0022-5347

hal-01519251
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01519251
DOI : 10.1016/j.juro.2016.12.047
PUBMED : 27993665

Éditeur(s) : HAL CCSD John Libbey Eurotext
Résumé : International audience
The diversity of chemicals used in hospitals (detergents-disinfectants, alcohol-based hand sanitizers, drugs, etc.) and recent developments in indoor air quality regulation of public access buildings require a better understanding of chemical risks in this particular environment. We developed a methodology for semi-quantitative chemical risk assessments in this environment to prioritize inhalation risks by sector and chemical. This methodology is based on a similar approach in the workplace that defines classes of exposures and of hazards. Their combination produces a risk matrix. Four criteria were used to determine the exposure classes: quantity and frequency of the chemical's use, volatility (vapor pressure), and the type of collective protective equipment associated with each area. The hazard class is also derived from four criteria: classification as carcinogenic, mutagenic, or toxic to reproduction, the existence of a toxicity reference value, occupational exposure limit values, and risk phrases (official risk descriptions, on labels, data sheets, etc). This methodology was tested in the Rennes University Hospital (Rennes, France) in five different hospital areas, with a specific survey undertaken to collect data about chemicals in each area. The results show the spatial specificity of chemical risks. Among the various sites analysed, the chemical risks of two require priority attention: the parasitology-mycology laboratory and patients' rooms. Because of their wide use in the hospital and the volatility of some of their components (alcohols), detergents-disinfectants contribute to increasing risk levels in all areas. The model is therefore discriminatory in terms of areas and substances.
ISSN: 1635-0421

hal-00952349
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00952349
DOI : 10.1684/ers.2013.0659

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
This study aims to assess the evidence on adverse pregnancy outcome associated with living close to polluted industrial sites, and identify the strengths and weaknesses of published epidemiological studies. A systematic literature search has been performed on all epidemiological studies published in developed countries since 1990, on the association between residential proximity to industrial sites (hazardous waste sites, industrial facilities and landfill sites) and adverse pregnancy outcome (low birth weight, preterm birth, small for gestational age, intrauterine growth retardation, infant mortality, congenital malformation). Based on 41 papers, our review reveals an excess risk of reproductive morbidity. However, no studies show significant excess risk of mortality including fetal death, neonatal or infant mortality and stillbirth. All published studies tend to show an increased risk of congenital abnormalities, yet not all are statistically significant. All but two of these studies revealed an excess risk of low birth weight. Results for preterm birth, small for gestational age and intrauterine growth retardation show the same pattern. There is suggestive evidence from the post-1990 literature that residential proximity to polluted sites (including landfills, hazardous waste sites and industrial facilities) might contribute to adverse reproductive outcomes, especially congenital malformations and low birth weight—though not mortality. This body of evidence has limitations that impede the formulation of firm conclusions, and new, well-focused studies are called for. The review findings suggest that continued strengthening of rules governing industrial emissions as well as industrial waste management and improved land use planning are needed.
ISSN: 1476-072X

Droits : http://creativecommons.org/licenses/by/
hal-01547817
http://hal.upmc.fr/hal-01547817
http://hal.upmc.fr/hal-01547817/document
http://hal.upmc.fr/hal-01547817/file/s12942-017-0091-y.pdf
DOI : 10.1186/s12942-017-0091-y

Éditeur(s) : HAL CCSD John Libbey Eurotext
Résumé : International audience
Environmental health risk assessment is commonly used in France for risk management purposes. The Methodology section of the "Société française de santé environnement" (French Society for Environmental Health) seeks to improve the utility and implementation of risk assessment in France. An initial operational objective is to make a list of short-, intermediate- and long-term improvements. This inventory is based in part on the experience and expertise of society members in this area and in part on their analysis of "Science and Decisions: Advancing Risk Assessment" (National Research Council 2009). In this paper, the Society recommends modifications in the indications for and use of risk assessments, during each of the four stages of the process: hazard identification and dose-response assessment, exposure assessment, risk characterization, and results interpretation. Some may be implemented now, while others need consensus building or research because of gaps in knowledge. Environmental health risk assessment must be understood as a decision tool for risk management in situations of uncertainly. Thus, appropriate linkage is required between decision making and assessment, and between the methods and the expected results.
L'évaluation des risques sanitaires est fréquemment utilisée en France dans les processus de décision en santé environnementale. La section " Méthodologie d'évaluation des risques sanitaires " de la Société française de santé environnement (SFSE) s'est donnée pour objectif de proposer des éléments de réflexion et des outils méthodologiques en vue d'améliorer l'utilité et les pratiques de l'évaluation des risques sanitaires. Un premier objectif opérationnel est l'inventaire des améliorations possibles à court, moyen et long termes à apporter à la démarche et à son utilisation. Ce travail s'est fondé, d'une part, sur la pratique et l'expertise des membres de la section, et, d'autre part, sur une lecture critique du rapport " Science and Decisions : Advancing Risk Assessment " publié en 2009 par le National Research Council et portant également sur les évolutions de la démarche. Dans cet article, la section restitue les conclusions de cet inventaire critique et propose un certain nombre d'améliorations en termes d'indications et d'utilisations de l'évaluation des risques sanitaires pour chacune des quatre étapes : identification des dangers et relation dose-réponse ; évaluation de l'exposition ; caractérisation des risques ; et interprétation des résultats. Certaines recommandations peuvent être mises en oeuvre immédiatement ; d'autres, en préalable à leur mise en oeuvre, nécessitent un consensus ou encore de la recherche car les connaissances manquent. En conclusion, la section insiste sur le fait que l'évaluation des risques sanitaires doit être comprise comme une aide à la décision en situation d'incertitude ; l'articulation entre le contexte décisionnel et l'évaluation, sa méthodologie et les résultats attendus est donc primordiale.
ISSN: 1635-0421

ineris-00963325
https://hal-ineris.archives-ouvertes.fr/ineris-00963325
DOI : 10.1684/ers.2011.0435
INERIS : EN-2012-016

Éditeur(s) : HAL CCSD International Medical Press
Résumé : International audience
BACKGROUND: Psychiatric disorders are relatively common among HIV-infected patients. However, there are few studies about their potential risk factors. This analysis aimed to measure the incidence of severe psychiatric events (PE) among patients receiving combination antiretroviral therapy (cART) of the French APROCO-COPILOTE (ANRS CO8) cohort, and to identify the medical and socio-behavioural correlates of their first episode of depression, suicide or suicide attempt (D/S/SA). METHODS: APROCO-COPILOTE is a cohort of patients started on a protease inhibitor regimen between 1997 and 1999, with prospective medical standardized records and self-administered questionnaires collecting socio-demographic and socio-behavioural data. This analysis included all 11-year follow-up visits for 1,095 patients having completed baseline self-administered questionnaires. A proportional hazard Cox model was used to identify the correlates of a first D/S/SA event. RESULTS: The overall prevalence of severe PE remained low: 50 patients experienced 67 events (incidence rate [95% CI] =1.04 [0.82, 1.32] per 100 person-years). Depression (n=16), suicides (n=5) and suicide attempts (n=14) were the most frequently diagnosed PE (0.54 [0.39, 0.76] per 100 person-years) among 25 patients. Multivariate results showed that unemployment, unstable housing, detectable viral load and smoking more than 20 cigarettes/day were independently associated with D/S/SA. CONCLUSIONS: Although the incidence of severe PE remained relatively low among the patients of APROCO-COPILOTE cohort, this study's results underline a clinically important problem in HIV-infected patients receiving cART. Furthermore, our findings not only emphasize the importance of comprehensive care, especially for socially vulnerable patients, but may also help future studies designed to assess the effectiveness of interventions in reducing the risk of PE during cART.
ISSN: 1359-6535

hal-00875183
https://hal.archives-ouvertes.fr/hal-00875183
DOI : 10.3851/IMP2102
PUBMED : 22544079

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Cyanobacteria and their toxins are known as a health hazard in recreative and distributed waters. Monitoring data from 2004 to 2011 were collected at regional scale to characterize exposition parameters to microcystins in Brittany (Western France). The data show that cyanobacteria populations are experiencing a composition shift leading to a longer duration of cell densities higher than WHO alert levels 2 and 3. Microcystins however appear to be more frequently detected with subacute concentrations in low cell density samples than in high cell density samples or during bloom episodes. Positive relations are described between microcystin concentrations, detection frequencies and cyanobacteria biovolumes, allowing for a novel definition of alert levels and decision framework following WHO recommendations
ISSN: 1438-4639

hal-01255825
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01255825
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01255825/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01255825/file/Improving%20microcystin%20monitoring%20relevance%20in%20recreative%20waters%20A%20regional%20case-study%20%28Brittany%2C%20Western%20France%2C%20Europe%29.pdf
DOI : 10.1016/j.ijheh.2015.12.004

Éditeur(s) : HAL CCSD National Institute of Environmental Health Sciences
Résumé : International audience
BACKGROUND: Glycol ethers are present in a wide range of occupational and domestic products. Animal studies have suggested that some of them may affect ovarian function. OBJECTIVE: To study the relation between women's exposure to glycol ethers and time to pregnancy. METHODS: Urine from randomly selected women in the PELAGIE mother-child cohort who had samples collected before 19 weeks of gestation was tested to measure eight glycol ether metabolites by chromatography coupled to mass spectrometry. Time to pregnancy was collected at the beginning of the pregnancy by asking women how many months they took to conceive. Associations between metabolite levels and time to pregnancy were estimated in 519 women with complete data using discrete-time Cox proportional hazards models to adjust for potential confounders. RESULTS: Glycol ether metabolites were detected in 6% (for ethoxyacetic acid) to 93% (for phenoxyacetic and butoxyacetic acids) of urine samples. Phenoxyacetic acid was the only metabolite with a statistically significant association with longer time to pregnancy (fecundability OR 0.82; 95% CI: 0.63, 1.06 for the second and third quartile combined; fecundability OR 0.70; 95% CI: 0.52, 0.95 for a fourth-quartile (≥1.38 mg/L) vs. first-quartile concentration (<0.14 mg/L)). This association remained stable after multiple sensitivity analyses. CONCLUSION: Phenoxyacetic acid, which was present in most of the urine samples tested in our study, was associated with increased time to pregnancy. This metabolite and its main parent compound, 2-phenoxyethanol, are plausible causes of decreased fecundability, but may also be surrogates for potential co-exposures frequently present in cosmetics.
ISSN: 0091-6765

hal-00866023
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00866023
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00866023/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00866023/file/Urinary_Glycol_Ether-accepted.pdf
DOI : 10.1289/ehp.1206103

Éditeur(s) : HAL CCSD American College of Physicians
Résumé : International audience
BACKGROUND: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. OBJECTIVE: To identify the optimal CD4 cell count at which cART should be initiated. DESIGN: Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. SETTING: HIV clinics in Europe and the Veterans Health Administration system in the United States. PATIENTS: 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. MEASUREMENTS: Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. RESULTS: Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. CONCLUSION: Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.
ISSN: 0003-4819

hal-00875307
https://hal.archives-ouvertes.fr/hal-00875307
PUBMED : 21502648
DOI : 10.7326/0003-4819-154-8-201104190-00001

Éditeur(s) : HAL CCSD
Résumé : International audience
BACKGROUND: Africa faces a number of unique environmental challenges. Unfortunately, it lacks the infrastructure needed to support the comprehensive environmental studies that could provide the scientific basis to inform environmental policies. There are a number of known sources of endocrine-disrupting chemicals (EDCs) and other hazardous chemicals in Africa. However, a coordinated approach to identify and monitor these contaminants and to develop strategies for public health interventions has not yet been made. OBJECTIVES: This commentary summarizes the scientific evidence presented by experts at the First African Endocrine Disruptors meeting. We describe a "call to action" to utilize the available scientific knowledge to address the impact of EDCs on human and wildlife health in Africa. DISCUSSION: We identify existing knowledge gaps about exposures to EDCs in Africa and describe how well-designed research strategies are needed to address these gaps. A lack of resources for research and a lag in policy implementation slows down intervention strategies and poses a challenge to advancing future health in Africa. CONCLUSION: To address the many challenges posed by EDCs, we argue that Africans should take the lead in prioritization and evaluation of environmental hazards, including EDCs. We recommend the institution of education and training programs for chemical users, adoption of the precautionary principle, establishment of biomonitoring programs, and funding of community-based epidemiology and wildlife research programs led and funded by African institutes and private companies. https://doi.org/10.1289/EHP1774.
Environmental Health Perspectives

hal-01616487
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01616487
DOI : 10.1289/EHP1774
PUBMED : 28935616

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
BACKGROUND: The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. METHODS: Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates. RESULTS: Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308; 95% confidence interval [CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328; adjusted hazard ratio, 1.138; 95% CI, .802-1.650). CONCLUSIONS: There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.
ISSN: 1058-4838

hal-00875143
https://hal.archives-ouvertes.fr/hal-00875143
DOI : 10.1093/cid/cis878
PUBMED : 23074311

Résumé : Sea fish farms with production of more than 20 tons per year in France must obtain two operating licences: (i) one for Sea Farming (AECM), with the aim of ensuring that the granted site and use of the maritime public domain for exploitation will respect all restrictions of general interest; (ii) one for regulating Facilities Classified for the Protection of the Environment (ICPE). Although the first one requires a relatively simple licence request file, the second one demands a very complete file, which includes, beyond the notice of exploitation information, a complete impact study, as well as a hazards study and a health and safety notice. In this context, petitioners in Corsica (adjustment of status or new exploitation) are faced with the same difficulties, which highlighted the need for a methodological guide adapted to each region's specific situation, assembling in particular the necessary baseline data (legal, zootechnical, geographical, climatic, socio-economic, ecological...) as well as recognised methods for evaluating the potential effects of the farm on the environment. Development of this guide was supported by ADEC and supervised by a steering committee composed of representatives from the administrations concerned, fish farmers and scientific bodies. The significant aspects dealt with the effects of fish farming on Posidonie herbarium, a protected species very present in Corsica and with coordinating the two AECM and ICPE procedures. For each part of the ICPE file, the guide introduces the technical or scientific context and, depending upon the case, the state of the art, sources of available data, acquisition and methods of acquiring measurements and of assessing the potential effects, as well as practical editing recommendations. Finally, the guide is made complete by a model schedule of conditions designed to help petitioners to have a specialist research department incorporate all or part of the file. This guide primarily concerns first-time marine facilities for exploitation in Corsica, conceived of as in the open sea rather than in confined spaces. Nonetheless, any fish farmer or future fish farmer needing to process a request for an exploitation licence may find it useful.
Les piscicultures marines de plus de 20 t/an de production sont soumises en France à l'obtention de deux autorisations d'exploiter : (i) celle au titre des Cultures Marines (AECM), visant à s'assurer que le site concédé et l'usage du domaine public maritime pour l'exploitation permettent de respecter l'ensemble des contraintes d'intérêt général ; (ii) celle au titre de la réglementation des Installations Classées pour la Protection de l'Environnement (ICPE). Si la première nécessite un dossier de demande d'autorisation relativement simple, la seconde requiert un dossier très complet, qui comprend, outre une notice de renseignements sur l'exploitation, une étude d'impact complète, ainsi qu'une étude des dangers et une notice d'hygiène et de sécurité. Dans ce contexte, les demandeurs en Corse (régularisation ou exploitation nouvelle) sont confrontés aux mêmes difficultés, ce qui a mis en évidence le besoin d'un guide méthodologique adapté aux spécificités régionales, rassemblant en particulier les données de base nécessaires (juridiques, zootechniques, géographiques, climatiques, socio-économiques, écologiques...) ainsi que les méthodes reconnues de l'évaluation des effets potentiels de la ferme sur l'environnement. L'élaboration de ce guide a été soutenue par l'ADEC et suivie par un comité de pilotage composé de représentants des administrations concernées, des pisciculteurs et d'organismes scientifiques. Les aspects importants ont porté sur les effets de la pisciculture sur l'herbier de Posidonie, espèce protégée très présente en Corse et sur la coordination entre les deux procédures AECM et ICPE. Pour chaque partie du dossier ICPE, le guide présente le contexte technique ou scientifique et selon le cas, l'état de l'art, les sources de données disponibles, les méthodes d'acquisition des mesures et d'évaluation des effets potentiels, ainsi que des recommandations pratiques de rédaction. Enfin, le guide est complété par un cahier des charges type destiné à aider les demandeurs à confier à un bureau d'étude spécialisé la réalisation de tout ou partie de la constitution du dossier. Ce guide concerne prioritairement les installations marines de nouvelles exploitations en Corse, envisagées en mer ouverte plutôt que dans des espaces confinés. Néanmoins tout pisciculteur ou futur pisciculteur devant instruire une demande d'autorisation d'exploiter peut y trouver intérêt.

Droits : info:eu-repo/semantics/openAccess
http://archimer.ifremer.fr/doc/2004/rapport-2188.pdf
http://archimer.ifremer.fr/doc/00000/2188/

Éditeur(s) : HAL CCSD MDPI
Résumé : International audience
Cyanobacteria are a component of public health hazards in freshwater environments because of their potential as toxin producers. Eutrophication has long been considered the main cause of cyanobacteria outbreak and proliferation, whereas many studies emphasized the effect of abiotic parameters (mainly temperature and light) on cell growth rate or toxin production. In view of the growing concerns of global change consequences on public health parameters, this study attempts to enlighten climate influence on cyanobacteria at regional scale in Brittany (NW France). The results show that homogeneous cyanobacteria groups are associated with climatic domains related to temperature, global radiation and pluviometry, whereas microcystins (MCs) occurrences are only correlated to local cyanobacteria species composition. As the regional climatic gradient amplitude is similar to the projected climate evolution on a 30-year timespan, a comparison between the present NW and SE situations was used to extrapolate the evolution of geographical cyanobacteria distribution in Brittany. Cyanobacteria composition should shift toward species associated with more frequent Microcystins occurrences along a NW/SE axis whereas lakes situated along a SW/NE axis should transition to species (mainly Nostocales) associated with lower MCs detection frequencies.
ISSN: 2072-6651

hal-01122236
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01122236
PUBMED : 24476711
DOI : 10.3390/toxins6020509
PUBMEDCENTRAL : PMC3942748

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND: Socioeconomic inequalities in cancer mortality have been observed in different European countries and the US until the end of the 1990s, with changes over time in the magnitude of these inequalities and contrasted situations between countries. The aim of this study is to estimate relative and absolute educational differences in cancer mortality in France between 1999 and 2007, and to compare these inequalities with those reported during the 1990s. METHODS: Data from a representative sample including 1% of the French population were analysed. Educational differences among people aged 30--74 were quantified with hazard ratios and relative indices of inequality (RII) computed using Cox regression models as well as mortality rate difference and population attributable fraction. RESULTS: In the period 1999--2007, large relative inequalities were found among men for total cancer and smoking and/or alcohol related cancers mortality (lung, head and neck, oesophagus). Among women, educational differences were reported for total cancer, head and neck and uterus cancer mortality. No association was found between education and breast cancer mortality. Slight educational differences in colorectal cancer mortality were observed in men and women. For most frequent cancers, no change was observed in the magnitude of relative inequalities in mortality between the 1990s and the 2000s, although the RII for lung cancer increased both in men and women. Among women, a large increase in absolute inequalities in mortality was observed for all cancers combined, lung, head and neck and colorectal cancer. In contrast, among men, absolute inequalities in mortality decreased for all smoking and/or alcohol related cancers. CONCLUSION: Although social inequalities in cancer mortality are still high among men, an encouraging trend is observed. Among women though, the situation regarding social inequalities is less favourable, mainly due to a health improvement limited to higher educated women. These inequalities may be expected to further increase in future years.
ISSN: 1471-2458

inserm-00868759
http://www.hal.inserm.fr/inserm-00868759
http://www.hal.inserm.fr/inserm-00868759/document
http://www.hal.inserm.fr/inserm-00868759/file/1471-2458-13-823.pdf
DOI : 10.1186/1471-2458-13-823

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Dietary exposure to pesticide residues may present a risk to public health, especially for sensitive populations such as pregnant women. To characterize this risk, this study assessed chronic dietary exposure to pesticide residues based on the French ELFE cohort. A self-administered food frequency questionnaire (FFQ) about the last three months of pregnancy filled in by pregnant women in 2011 was used in combination with occurrence data from French Total Diet Studies completed by the results of national monitoring programs on pesticide residues in food. The dietary intake of pesticides (μg/kg of body weight/day) was estimated for 14,099 pregnant women with a complete FFQ, for 317 substances under two occurrence scenarios to handle left-censored data: a lower-bound scenario (LB), where undetected results were set to zero, and an upper-bound scenario (UB), where undetected results were set to the detection limit if the substance was expected to be found in food and zero if it was not. The risk was assessed for 284 substances with a toxicological reference value (TRV) and a good coverage level of the diet potentially contributing to pesticide intake. The cumulative risk was also assessed for seven effects on nervous and thyroid systems using the hazard index and the Cumulative Assessment Groups defined by EFSA. Substances with the highest exposure levels under the LB scenario were, in decreasing order, imazalil, piperonyl butoxide, chlorpropham, thiabendazole, iprodione and propargite. Under the LB scenario, only for lindane did women have a statistically significant probability of exceeding the TRV (2.4%). Under the UB scenario, risk could not be excluded for nine other substances. A better management of left-censored data and more sensitive analyses of the main food contributors might help to refine the UB exposure and risk assessments. A statistically significant cumulative risk was found for neurochemical effects related to high intake levels of three organophosphate insecticides (chlorpyrifos, pirimiphos-methyl and dimethoate) mainly detected in fruits and cereals
ISSN: 0160-4120

hal-01319892
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01319892
DOI : 10.1016/j.envint.2016.04.007
PUBMED : 27187793