Health-related quality of life 1 year after a large-scale industrial fire among exposed inhabitants of Rouen, France: 'The Post Fire 76 Health' study.

BACKGROUND: A large-scale industrial fire occurred in Rouen, France, in 2019. This study assessed the health-related quality of life of people exposed to its consequences 1 year later. METHODS: The study population comprised inhabitants of the exposed area and a non-exposed area. A representative sample was randomly selected using a stratified design. Data were collected using a standardized questionnaire to describe fire exposure and to calculate three health-related quality of life scores according to the SF12-v2 scale. After adjustment, descriptive and multivariate analyses were conducted. RESULTS: The sample comprised 4773 participants (response rate 47.7%). In the exposed area, the average mental, physical and overall health scores were 47.5, 52.0 and 73.8 out of 100, respectively. Mean mental and overall health scores were higher in the non-exposed area (49.0 and 76.0, respectively). After adjustment, a lower mental health score was associated with a higher number of perceived types of exposure, reaching -3.72 points [-5.41; -2.04] for five or more different types of perceived exposure. A lower mental health score was associated with soot deposits (-1.04 [-1.70; -0.39]), perceiving odours [(-2.04 [-3.22; -0.86]) up to the day of data collection], and having seen, heard or been awakened by the fire (-1.21 [-1.90; -0.52]). A slightly lower physical health score was associated with soot deposits (-0.57 [-1.07; -0.08]). CONCLUSION: This study highlighted associations between exposure to the consequences of the industrial fire in Rouen and a deterioration of perceived health-related quality of life 1 year later, particularly the mental health dimension.

Analyse et évolution des dispositifs participatifs à Santé publique France autour des investigations locales en santé environnement.

Santé publique France has been developing participatory approaches in the field of local environmental health investigations for around twenty years. An initial assessment of this activity was carried out in 2016. Comparing four types of participatory process implemented on different polluted sites, this work aims to reflect on the contributions and limits of such approaches. Local stakeholders’ involvement has allowed those involved to voice their health concerns and their expectations about the studies to be conducted, as well as for points of disagreement or misunderstanding, and questions about the results obtained to be expressed. In some cases, it has led to improving the quality of the scientific results produced, by integrating local knowledge and taking into account the needs expressed. It has also sometimes increased the acceptability of environmental pollution management options. The outcome of the process depends on a combination of multiple factors in which the subjectivity of those involved and the type of solicitation play a major role. The agency has since set up new modes of participation based on co-construction processes initiated ahead of investigations. Citizen workshops have been set up to design and promote, with committed and non-committed stakeholders, the health perception study that will be carried out around the Lacq industrial basin. Santé publique France is also developing various methods aimed in particular at evaluating its participatory processes.

[Horizon scanning in preparation for future health threats: a pilot exercise conducted by the French Institute for Public Health Surveillance in 2014]. / La veille prospective, une démarche de préparation aux futures menaces de la santé publique : exercice mené à l'Institut de veille sanitaire en 2014.

Background: Health surveillance is a reactive process, with no real hindsight for dealing with signals and alerts. It may fail to detect more radical changes with a major medium-term or long-term impact on public health. To increase proactivity, the French Institute for Public Health Surveillance has opted for a prospective monitoring approach.Methods: Several steps were necessary: 1) Identification of public health determinants. 2) Identification of key variables based on a combination of determinants. Variables were classified into three groups (health event trigger factors, dissemination factors and response factors) and were submitted to future development assumptions. 3) Identification, in each of the three groups, of micro-scenarios derived from variable trends. 4) Identification of macro-scenarios, each built from the three micro-scenarios for each of the three groups. 5) Identification of issues for the future of public health.Results: The exercise identified 22 key variables, 17 micro-scenarios and 5 macro-scenarios. The topics retained relate to issues on social and territorial health inequalities, health burden, individual and collective responsibilities in terms of health, ethical aspects, emerging phenomena, 'Big data', data mining, new health technologies, interlocking of analysis scales.Conclusions: The approach presented here guides the programming of activities of a health safety agency, particularly for monitoring and surveillance. By describing possible future scenarios, health surveillance can help decision-makers to influence the context towards one or more favourable futures.

Risk of cancer in the vicinity of municipal solid waste incinerators: importance of using a flexible modelling strategy.

BACKGROUND: We conducted an ecological study in four French administrative departments and highlighted an excess risk in cancer morbidity for residents around municipal solid waste incinerators. The aim of this paper is to show how important are advanced tools and statistical techniques to better assess weak associations between the risk of cancer and past environmental exposures. METHODS: The steps to evaluate the association between the risk of cancer and the exposure to incinerators, from the assessment of exposure to the definition of the confounding variables and the statistical analysis carried out are detailed and discussed. Dispersion modelling was used to assess exposure to sixteen incinerators. A geographical information system was developed to define an index of exposure at the IRIS level that is the geographical unit we considered. Population density, rural/urban status, socio-economic deprivation, exposure to air pollution from traffic and from other industries were considered as potential confounding factors and defined at the IRIS level. Generalized additive models and Bayesian hierarchical models were used to estimate the association between the risk of cancer and the index of exposure to incinerators accounting for the confounding factors. RESULTS: Modelling to assess the exposure to municipal solid waste incinerators allowed accounting for factors known to influence the exposure (meteorological data, point source characteristics, topography). The statistical models defined allowed modelling extra-Poisson variability and also non-linear relationships between the risk of cancer and the exposure to incinerators and the confounders. CONCLUSION: In most epidemiological studies distance is still used as a proxy for exposure. This can lead to significant exposure misclassification. Additionally, in geographical correlation studies the non-linear relationships are usually not accounted for in the statistical analysis. In studies of weak associations it is important to use advanced methods to better assess dose-response relationships with disease risk.

The French approach to deriving toxicity reference values: an example using reprotoxic effects.

Following the French health and environment action plan, the French Agency for Environmental and Occupational Health and Safety set up a workgroup to standardise a method of deriving toxicity reference values (TRVs). Over the last few decades, there has been increasing concern about the effect of exposure to chemicals on reproductive function, leading the group to take an interest in reprotoxic effects. This article presents the recommendations of the workgroup regarding specific reprotoxic effects. Abnormal development of foetuses and infants, together with impairment of reproduction were considered to be critical effects. Where critical windows of exposure were concerned, quantitative analysis suggested the need for several types of toxicity reference value, as a function of exposure duration: reprotoxic effects may result from acute or chronic exposure at any time of life, whilst developmental effects may occur after exposure during the pregnancy or during the lactation period. The choice of a critical study is based on epidemiological or toxicological quality criteria. The working group recommends the use of the benchmark dose approach in estimating the critical dose. Finally, the working group considered the application of uncertainty factors typically used to take into account the variability between animal and human, between different individuals, and the availability of the data.

Risk for non Hodgkin's lymphoma in the vicinity of French municipal solid waste incinerators.

BACKGROUND: Dioxin emissions from municipal solid waste incinerators are one of the major sources of dioxins and therefore are an exposure source of public concern. There is growing epidemiologic evidence of an increased risk for non-Hodgkin's lymphoma (NHL) in the vicinity of some municipal solid waste incinerators with high dioxin emission levels. The purpose of this study was to examine this association on a larger population scale. METHODS: The study area consisted of four French administrative departments, comprising a total of 2270 block groups. NHL cases that had been diagnosed during the period 1990-1999, and were aged 15 years and over, were considered. Each case was assigned a block group by residential address geocoding. Atmospheric Dispersion Model System software was used to estimate immissions in the surroundings of 13 incinerators which operated in the study area. Then, cumulative ground-level dioxin concentrations were calculated for each block group. Poisson multiple regression models, incorporating penalized regression splines to control for covariates and dealing with Poisson overdispersion, were used. Five confounding factors were considered: population density, urbanisation, socio-economic level, airborne traffic pollution, and industrial pollution. RESULTS: A total of 3974 NHL incident cases was observed (2147 among males, and 1827 among females) during the 1990-1999 time period. A statistically significant relationship was found at the block group level between risk for NHL and dioxin exposure, with a relative risk (RR) of 1.120 (95% confidence interval [CI] 1.002 - 1.251) for persons living in highly exposed census blocks compared to those living in slightly exposed block groups. Population density appeared positively linked both to risk for NHL and dioxin exposure. Subgroup multivariate analyses per gender yielded a significant RR for females only (RR = 1.178, 95% CI 1.013 - 1.369). CONCLUSION: This study, in line with previous results obtained in the vicinity of the incinerator located in Besançon (France), adds further evidence to the link between NHL incidence and exposure to dioxins emitted by municipal solid waste incinerators. However, the findings of this study cannot be extrapolated to current incinerators, which emit lower amounts of pollutants.

Voluntary Health Registry of French Nationals after the Great East Japan Earthquake, Tsunami, and Fukushima Daiichi Nuclear Power Plant Accident: Methods, Results, Implications, and Feedback.

UNLABELLED: Introduction The 11th of March 2011, a magnitude 9.0 earthquake struck alongside the north-east coast of Honshu Island, Japan, causing a tsunami and a major nuclear accident. The French Institute for Public Health Surveillance (InVS) set up, within one week after the triple catastrophe, an Internet-based registry for French nationals who were in Japan at the time of the disasters. In this string of disasters, in this context of uncertainties about the nuclear risks, the aim of this registry was to facilitate the: (1) realization of further epidemiologic studies, if needed; and (2) contact of people if a medical follow-up was needed. The purpose of this report was to describe how the health registry was set up, what it was used for, and to discuss further utilization and improvements to health registries after disasters. METHODS: The conception of the questionnaire to register French nationals was based on a form developed as part of the Steering Committee for the management of the post-accident phase in the event of nuclear accident or a radiological emergency situation (CODIRPA) work. The questionnaire was available online. RESULTS: The main objective was achieved since it was theoretically possible to contact again the 1,089 persons who completed the form. According to the data collected on their space-time budget, to the result of internal contamination measured by the French Institute for Radiological Protection and Nuclear Safety (IRSN) and dosimetric expertise published by the World Health Organization (WHO), it was not suitable to conduct an epidemiologic follow-up of adverse effects of exposure to ionizing radiations among them. However, this registry was used to launch a qualitative study on exposure to stress and psychosocial impact of the Great East Japan Earthquake on French nationals who were in Japan in March 2011. CONCLUSION: Setting a registry after a disaster is a very important step in managing the various consequences of a disaster. This experience showed that it is quickly feasible and does not raise adverse side effects in involved people. Motreff Y , Pirard P , Lagrée C , Roudier C , Empereur-Bissonnet P . Voluntary health registry of French nationals after the Great East Japan Earthquake, tsunami, and Fukushima Daiichi Nuclear Power Plant accident: methods, results, implications, and feedback. Prehosp Disaster Med. 2016;31(3):326-329.

Soil-to-root transfer and translocation of polycyclic aromatic hydrocarbons by vegetables grown on industrial contaminated soils.

Polycyclic aromatic hydrocarbons (PAHs) are possible contaminants in some former industrial sites, representing a potential risk to human health if these sites are converted to residential areas. This work was conducted to determine whether PAHs present in contaminated soils are transferred to edible parts of selected vegetables. Soils were sampled from a former gasworks and a private garden, exhibiting a range of PAH concentrations (4 to 53 to 172 to 1263 and 2526 mg PAHs kg-1 of dry soil), and pot experiments were conducted in a greenhouse with lettuce (Lactuca sativa L. var. Reine de Mai), potato (Solanum tuberosum L. var. Belle de Fontenay), and carrot (Daucus carota L. var. Nantaise). At harvest, above- and below ground biomass were determined and the PAH concentrations in soil were measured. In parallel, plates were placed in the greenhouse to estimate the average PAH-dust deposition. Results showed that the presence of PAHs in soils had no detrimental effect on plant growth. Polycyclic aromatic hydrocarbons were detected in all plants grown in contaminated soils. However, their concentration was low compared with the initial soil concentration, and the bioconcentration factors were low (i.e., ranging from 13.4 x 10(-4) in potato and carrot pulp to 2 x 10(-2) in potato and carrot leaves). Except in peeled potatoes, the PAH concentration in vegetables increased with the PAH concentration in soils. The PAH distribution profiles in plant tissues and in soils suggested that root uptake was the main pathway for high molecular weight PAHs. On the opposite, lower molecular weight PAHs were probably taken up from the atmosphere through the leaves as well as by roots.

France's heat health watch warning system.

In 2003, a Heat Health Watch Warning System was developed in France to anticipate heat waves that may result in a large excess of mortality. The system was developed on the basis of a retrospective analysis of mortality and meteorological data in fourteen pilot cities. Several meteorological indicators were tested in relation to levels of excess mortality. Computations of sensibility and specificity were used to choose the meteorological indicators and the cut-offs. An indicator that mixes minimum and maximum temperatures was chosen. The cut-offs were set in order to anticipate events resulting in an excess mortality above 100% in the smallest cities and above 50% in Paris, Lyon, Marseille and Lille. The system was extended nationwide using the 98th percentile of the distribution of minimum and maximum temperatures. A national action plan was set up, using this watch warning system. It was activated on 1st June 2004 on a national scale. The system implies a close cooperation between the French Weather Bureau (Météo France), the National Institute of Health Surveillance (InVS) and the Ministry of Health. The system is supported by a panel of preventive actions, to prevent the sanitary impact of heat waves.

Validation of multimedia models assessing exposure to PAHs--the SOLEX study.

Polluted soils have become a public health problem. While population exposure to soil pollutants is generally quantified using multimedia models, their estimations have not been validated, and studies that attempted to do so are scarce. The objective of the SOLEX study was to compare the predictions of pyrene exposure levels (converted into 1 hydroxypyrene) computed by several models with the results of urinary 1-hydropyrene (1-HOP) assays among 110 employees working at three sites polluted during their past use as manufactured gas plants. Four models were used: AERIS (Canada), CalTOX (California, USA), CLEA (UK), and HESP (The Netherlands). Three occupational exposure scenarios--with office, mixed, and outdoor workers--were constructed, based upon job activities during two measurement campaigns, one in winter and one in summer. The exposure levels estimated by the four models could differ markedly (from 7 up to 80 times) according to the exposure scenario. Also, the predominant exposure routes differed according to the model (direct soil ingestion for HESP and CalTOX, inhalation for AERIS, and dermal absorption for CLEA). The predictions of CalTOX are consistent with the 1-HOP measurements for all the scenarios. For HESP, the consistency is observed for the scenarios, office and mixed, for which the pyrene level in the soil is low. AERIS and CLEA yield results that are systematically above the 1-HOP measurements. This study confirms that validation of the models is crucial and points out to the need to proceed to assess components of the models that are the most influential using appropriate statistical analysis in combination with true field data.