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.

Response to Tsuda et al. "demonstrating the undermining of science and health policy after the Fukushima nuclear accident by applying the toolkit for detecting misused epidemiological methods".

BACKGROUND: The SHAMISEN (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) European project was conducted in 2015-2017 to review the lessons learned from the experience of past nuclear accidents and develop recommendations for preparedness and health surveillance of populations affected by a nuclear accident. Using a toolkit approach, Tsuda et al. recently published a critical review of the article by Cléro et al. derived from the SHAMISEN project on thyroid cancer screening after nuclear accident. MAIN BODY: We address the main points of criticism of our publication on the SHAMISEN European project. CONCLUSION: We disagree with some of the arguments and criticisms mentioned by Tsuda et al. We continue to support the conclusions and recommendations of the SHAMISEN consortium, including the recommendation not to launch a mass thyroid cancer screening after a nuclear accident, but rather to make it available (with appropriate information counselling) to those who request it.

Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study.

BACKGROUND: The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack ('bystander exposure') who may or may not have provided care to attack victims subsequently, or as care providers to victims only ('professional exposure only'). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with 'professional exposure only', and to assess their use of psychological support resources. METHOD: An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category ('bystanders to the attack'; 'professional exposure only'; 'unexposed'); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis. RESULTS: 804 staff members' questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were 'bystanders to the attack', 285 had 'professional exposure only'. The staff with 'professional exposure only' reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the 'professional exposure only' category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19-6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30-11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18-7.85; p = 0.022). Lastly, 70.6% of the staff with 'professional exposure only' with full PTSD did not seek psychological support. CONCLUSION: Despite a significant impact on mental health, few staff with 'professional exposure only' sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks. STUDY REGISTRATION: Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812-51).

Non-participation and attrition in a longitudinal study of civilians exposed to the January 2015 terrorist attacks in Paris, France.

BACKGROUND: Non-participation and attrition are rarely studied despite being important methodological issues when performing post-disaster studies. A longitudinal survey of civilians exposed to the January 2015 terrorist attacks in Paris, France, was conducted 6 (Wave 1) and 18 months (Wave 2) after the attacks. We described non-participation in Wave 1 and determined the factors associated with attrition in Wave 2. METHODS: Multivariate logistic regression models were used to compare participants in both waves with those who participated in the first wave only. Analyses were performed taking the following factors into account: socio-demographic characteristics, exposure to terror, peri-traumatic reactions, psychological support, perceived social support, impact on work, social and family life, and mental health disorders. Characteristics of new participants in Wave 2 were compared with participants in both waves using a chi-square test. RESULTS: Of the 390 persons who were eligible to participate in the survey, 190 participated in Wave 1 (participation rate: 49%). The most frequently reported reason for non-participation was to avoid being reminded of the painful event (32%, n = 34/105). In Wave 2, 67 were lost to follow-up, 141 people participated, of whom 123 participated in Wave 1 (re-participation rate: 65%) and 18 were new. Attrition in Wave 2 was associated with socio-demographic characteristics (age, French origin) and location during the attacks, but not with terror exposure or mental health disorders. Compared with those who participated in both waves, new participants declared less social and psychological support since the attacks. CONCLUSIONS: Attrition at 6 months was not associated with exposure to terror or mental health disorders, which indicates that any bias in future analyses on IMPACTS on mental health outcomes will be limited. Our findings suggest the importance of adapting similar surveys for people of foreign origin and of improving strategies to avoid attrition of younger people, for example by using social media, peers, and the educational environment. The present study also revealed that a high level of exposure to terror and a lack of social and psychological support after a terrorist event could impede individuals' participation in similar surveys in the short term.

Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris.

BACKGROUND: The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD). METHODS: Santé publique France conducted a web-based survey of civilians 8-11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims' or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use. RESULTS: Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps. CONCLUSION: Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.

Health outcomes of the July 14, 2016 Nice terror attack among hospital-based professionals and students: the « ECHOS de Nice ¼ health survey protocol.

BACKGROUND: The terror attack of July 14, 2016, in Nice, France, resulted in 86 deaths, including children, and several hundred wounded, with a major psychological impact on the population. Hospital staff had to cope with exceptional circumstances which made them vulnerable to detrimental effects on their own health. This paper describes the method that was selected for the survey entitled "ECHOS de Nice 14 Juillet" which aimed to assess the impact of the attack on the psychological, psycho-traumatic and somatic health condition of the Nice University and Lenval hospital staff who were directly or indirectly exposed to the attack, and also to describe the support and care facilities they were offered. METHOD: ECHOS de Nice 14 juillet is an observational, cross-sectional, multicentre study focusing on all the hospital staff and students of both institutions, i.e. 10,100 persons in June 2017. A web-based questionnaire based on the model developed by Santé Publique France (IMPACTS and ESPA 13 novembre 2015) was adapted to the contexts of the healthcare professionals and students employed in these healthcare institutions in Nice and published on line from June 21 to October 30, 2017. The paper describes the tools that were used to meet the aims of the study, i.e. identification of exposure categories ('civilian' exposure for those present during the attack and/or 'professional' exposure); indicators of psychological impact (anxiety, depression, burnout, compassion fatigue, suicidal states, tobacco and alcohol use, self-medications), psycho-traumatic and somatic impact; professional and social impact. Lastly, awareness of availability and use of psychological support and care-follow-up facilities by professionals were investigated. Respondents could include extensive qualitative comments on the various themes explored in the questionnaire, with text analysis complementing that of quantitative data. DISCUSSION: The benefits and limitations of the selected methodology are discussed, in view of contributing useful information to help anticipate and manage health issues among hospital staff who have been victims of traumatic events.

Healthcare provision and the psychological, somatic and social impact on people involved in the terror attacks in January 2015 in Paris: cohort study.

BACKGROUND: Terrorist attacks occurred in Paris in January 2015. Aims To assess the mental health impact and the access to psychomedical care of people exposed to the attacks. METHOD: We implemented an open-cohort design 6 and 18 months after the attacks. Exposed civilians and rescue workers were included according to the exposure criteria A for post-traumatic stress disorder (PTSD) in DSM-5. A face-to-face questionnaire conducted by trained psychologists was used to collect sociodemographic characteristics, exposure level, scores on psychometric scales, an international neuropsychiatric interview and access to care. RESULTS: Six months after the attacks, 18% of civilians reported symptoms of PTSD, 31% had anxiety disorders and 11% depression. Among rescue workers, 3% reported symptoms of PTSD and 14% anxiety disorders. During the 48 h following the attacks, 53.2% of civilian had access to psychomedical care v. 35% of rescue and police staff. CONCLUSIONS: We found severe psychological consequences, even in people who were less exposed. Declaration of interest None.

An International Comparison of the Instigation and Design of Health Registers in the Epidemiological Response to Major Environmental Health Incidents.

CONTEXT: Epidemiological preparedness is vital in providing relevant, transparent, and timely intelligence for the management, mitigation, and prevention of public health impacts following major environmental health incidents. A register is a set of records containing systematically collected, standardized data about individual people. Planning for a register of people affected by or exposed to an incident is one of the evolving tools in the public health preparedness and response arsenal. OBJECTIVE: We compared and contrasted the instigation and design of health registers in the epidemiological response to major environmental health incidents in England, France, Italy, the Netherlands, and the United States. DESIGN: Consultation with experts from the 5 nations, supplemented with a review of gray and peer-reviewed scientific literature to identify examples where registers have been used. SETTING: Populations affected by or at risk from major environmental health incidents in England, France, Italy, the Netherlands, and the United States. METHODS: Nations were compared with respect to the (1) types of major incidents in their remit for considering a register; (2) arrangements for triggering a register; (3) approaches to design of register; (4) arrangements for register implementation; (5) uses of registers; and (6) examples of follow-up studies. RESULTS: Health registers have played a key role in the effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear, as well as natural, more prolonged incidents. Value has been demonstrated in the early and rapid deployment of health registers, enabling the capture of a representative population. CONCLUSION: The decision to establish a health register must ideally be confirmed immediately or soon after the incident using a set of agreed criteria. The establishment of protocols for the instigation, design, and implementation of health registers is recommended as part of preparedness activities. Key stakeholders must be aware of the importance of, and protocols for, establishing a register.Agencies will find value in preparing and implementing registers as part of an effective public health response to major environmental incidents, including sudden chemical, biological, radiological, or nuclear incidents, as well as natural, more prolonged incidents.

Implementation of a Novel Epidemiological Surveillance System for Children's Mental Health and Well-Being in France: Protocol for the National "Enabee" Cross-Sectional Study.

BACKGROUND: Children's mental health, including their well-being, is a major public health concern, as the burden of related disorders may last throughout one's life. Although epidemiological mental health surveillance systems for children and adolescents have been implemented in several countries, they are sorely lacking in France. OBJECTIVE: This study aims to describe the first step of the implementation of a novel surveillance system in France called Enabee (Etude nationale sur le bien-être des enfants), which focuses on the issue of mental health in children. The system aims to (1) describe the temporal trends in the population-based prevalence of the main mental health disorders and well-being in children aged 3 to 11 years, (2) explore their major determinants, and (3) assess mental health care use by this population. To do this, Enabee will rely on results from a recurrent national cross-sectional homonymous study. This paper presents the protocol for the first edition of this study (called Enabee 2022), as well as initial results regarding participation. METHODS: Enabee 2022 is a national cross-sectional study that was implemented in French schools in 2022. It used a probabilistic, multistage, stratified, and balanced sampling plan as follows: first, schools were randomly drawn and stratified according to the type of school. Up to 4 classes per school were then randomly drawn, and finally, all the pupils within each class were selected. The study covered children from preschool and kindergarten (aged 3 to 6 years, US grading system) to fifth grade (aged 6 to 11 years). Children from first to fifth grades provided a self-assessment of their mental health using 2 validated self-administered questionnaires: the Dominic Interactive (DI) and the KINDL. Parents and teachers completed a web-based questionnaire, including the Strengths and Difficulties Questionnaire. Parents also answered additional questions about their parenting attitudes; their own mental health; known social, economic, and environmental determinants of mental health in children; and their child's life habits. Health, education, and family stakeholders were involved in designing and implementing the study as part of a large consultation group. RESULTS: Data were collected from May 2, 2022, to July 31, 2022, in 399 schools across metropolitan France. Teachers completed questionnaires for 5721 pupils in preschool and kindergarten and for 15,263 pupils from first to fifth grades. Parents completed questionnaires for 3785 children in preschool and kindergarten and for 9227 children from first to fifth grades. Finally, 15,206 children from first to fifth grades completed the self-administered questionnaire. CONCLUSIONS: Enabee 2022 constitutes the first milestone in the development of a novel national epidemiological surveillance system, paving the way for improved children's mental health policies in France.

Increase in psychotropic drug deliveries after the Xynthia storm, France, 2010.

INTRODUCTION: During the night of February 27 and the early morning of February 28, 2010, 15 coastal municipalities situated in two French departments, Vendée and Charente-Maritime, were violently stricken by a severe windstorm named "Xynthia." This storm caused the death of 12 individuals in Charente-Maritime and 29 people in Vendée. Houses, agricultural fields, and shellfish companies were severely flooded with seawater. Several thousand people temporarily had to leave their homes. The objective of this study was to estimate the short-term mental health impact of Xynthia, in terms of psychotropic drug delivery, on the resident population of the 15 coastal municipalities severely hit by the flooding. METHODS: The French national health insurance database was used to calculate a daily number of new psychotropic treatments from September 1, 2008 through December 24, 2010. New treatments were calculated for each of the following European Pharmaceutical Marketing Research Association (EphMRA) classes: tranquilizers (N05C), hypnotics (N05B), and antidepressants (N06A). A period of three weeks following the storm was defined as the exposure period. A generalized additive model with a Poisson distribution that allows for over-dispersion was used to analyze the correlation between the Xynthia variable and the number of new psychotropic treatments. RESULTS: With a relative risk (RR) of 1.54 (95% CI, 1.39-1.62) corresponding to an estimate of 409 new deliveries of psychotropic drugs during the three weeks following the storm, this study confirms the importance of the psychological impact of Xynthia. This impact is seen on all three classes of psychotropic drugs studied. The impact is greater for tranquilizers (RR of 1.78; 95% CI, 1.59-1.89) than for hypnotics (RR of 1.53; 95% CI, 1.31-1.67) and antidepressants (RR of 1.26; 95% CI, 1.06-1.40). The RR was higher for females than for males. CONCLUSION: This study shows the importance of the psychological impact of the storm as observed clinically by health workers who intervened in the field during the aftermath of Xynthia. It confirms that administrative databases can be used to show a health impact of a disaster even at a local level. This is one more step in the direction of a comprehensive strategy of collecting information to allow the assessment of the health impact of an extreme event, the detection of vulnerable populations, and the orientation of the short-, mid- and long-term public health response.

Post-traumatic stress disorder among civilians 6 and 18 months after the January 2015 terrorist attacks in the Paris region.

In the literature, the association between medium and long-term PTSD (post-traumatic stress disorder) after terrorist attack has rarely been described. The objective of our study was to identify the factors associated with PTSD in the medium and longer term among people exposed to a terrorist attack in France. We used data from a longitudinal survey of 123 terror-exposed people interviewed 6-10 (medium term) and 18-22 (long term) months after. Mental health was assessed by the Mini Neuropsychiatric Interview. PTSD in the medium term was associated with history of traumatic events, low levels of social support and severe peri-traumatic reactions, which were in turn associated with high levels of terror exposure. PTSD in the medium term was linked in turn to the presence of anxiety and depressive disorders, which was also linked to PTSD in the longer term. The factors leading to PTSD are different in the medium and long term. In order to improve future support for people exposed to distressing events, it is important to follow up people with intense peri-traumatic reactions, high levels of anxiety and depression and to measure reactions.

PTSD and Partial PTSD among First Responders One and Five Years after the Paris Terror Attacks in November 2015.

Following the Paris terror attacks in November 2015, a large number of first responders (FR) were mobilized and consequently were at risk of developing posttraumatic stress disorder (PTSD). Based on the ESPA 13 November survey, the objectives of this study were to 1) describe the prevalence of PTSD and partial PTSD in FR five years after the attacks, 2) describe the changes in PTSD and partial PTSD from one to five years after the attacks, and 3) examine factors associated with PTSD and partial PTSD five years after the attacks. Data were collected using an online questionnaire. PTSD and partial PTSD were measured using the Post-Traumatic Stress Disorder Checklist based on the DSM-5 (PCL-5). Gender, age, responder category, education level, exposure, mental health history, history of traumatic events, training, social support, concern about the COVID-19 epidemic, and somatic problems present after the attacks were all analyzed as potential factors associated with PTSD and partial PTSD using multinomial logistic regression. A total of 428 FR were included 5 years after the attacks, of which 258 had participated also 1 year after the attacks. Five years after the attacks, the prevalence of PTSD and partial PTSD were 8.6% and 22%, respectively. Presence of somatic problems after the attacks were associated with PTSD. Involvement in dangerous crime scenes was associated with a higher risk of partial PTSD. No awareness of psychological risks in the context of professional activity through specific training was associated with partial PTSD, in particular among participants aged 45 years or more. To mitigate PTSD for FR, monitoring mental health symptoms, providing mental health education, and providing treatment may be needed for several years after the attacks.

Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks.

BACKGROUND: Terrorist attacks can induce post-traumatic stress disorder (PTSD) and depression, which require multiple-session psychological care (MSPC). This study aims at investigating MSPC initiation and associated factors. METHODS: Data were collected from a web-based survey of civilians 8-12 months after their exposure to the November 2015 Paris terrorist attacks. Depression and partial and full PTSD were assessed using the Hospital Anxiety and Depression Scale and the PCL-5 checklist, respectively. Questionnaires collected data on socio-demographic variables, exposure to the attacks, psychological treatment history, social isolation, somatic problems, having received an outreach psychological support (OPS), consultations with a general practitioner, contact with an association for victims, MSPC initiation and, if not, reasons for not having initiated it. Logistic regressions were used to examine factors associated with MSPC initiation. RESULTS: Among the 450 respondents, 154 reported having initiated a MSPC after the attacks. Of the 134 who provided the MSPC initiation date, 50% did so during the first month. Among the respondents with at least one of the considered psychological disorders, 53% declared not having initiated yet a MSPC. The primary three reasons for not having initiated a MSPC among people with PTSD were "did not feel the need", "it was not the right time to talk about it", and "not offered". For people with at least one psychological disorder, MSPC initiation was associated with the number of somatic problems, type of exposure (witness, threatened, indirectly exposed), prior psychological treatment, being a woman, being in a relationship, having consulted a psychiatrist or a psychologist, having received an OPS, and being in contact with association for victims. CONCLUSION: The organization of adequate psychological care after a terror attack must take into account the need for healthcare that may emerge several months after the attack, and that witnesses seem less likely to receive MSPC than persons directly threatened despite their psychological disorder. Associations for victims and OPS seem to facilitate access to MSPC. Furthermore, our findings highlight the need to train physicians to screen for psychological disorders in persons exposed to terrorist attacks who present with somatic disorders.

Epidemiological surveillance linked to an outreach psychological support program after the Xynthia storm in Charente-Maritime, France, 2010.

INTRODUCTION: Following the Xynthia storm of February 2010 in France, an outreach program was initiated by the regional health authorities during the post-emergency phase to improve access to mental health care for the population exposed to the floods. The program was designed to complement routine health and social care services. It relied on a special telephone service and outreach consultations located in the town halls of the five most affected cities. The objective of this outreach service was to provide initial psychological counseling free of charge and without appointment. Another objective was to refer persons for appropriate treatment and follow-up by routine health care services. A surveillance program was developed to monitor the use of mental health services by first-time users, describe outreach service users with psychological manifestations, and provide timely information to decision makers. METHODS: Health providers working in affected towns were asked to complete an individual record sheet for each person who displayed psychological manifestations directly or indirectly linked with the storm on their first visit, and to send it to the regional health office. Participation was voluntary. Data analysis was performed monthly during the six-month surveillance period. RESULTS: Only mental health providers participated in the surveillance. A total of 227 individual files were sent from April 7 through September 19, 2010. New cases were mainly female adults, and one fifth had a past history of psychiatric illness. Depressive signs and anxiety were the most commonly reported symptoms, followed by signs of post-traumatic stress disorder. A total of five feedback reports were produced for surveillance participants (informants) and authorities. CONCLUSION: With initiation in the post-emergency phase of a disaster and timely regular feedback, the surveillance program enabled the authors to describe the occurrence of psychological distress, monitor mental health service use by first-time users, and provide guidance to health authorities. This research showed the advantages of integrating epidemiology in the development of strategy for mental health and psychosocial support in the aftermath of natural catastrophes.

Media Exposure and Post-traumatic Stress Symptoms in the Wake of the November 2015 Paris Terrorist Attacks: A Population-Based Study in France.

The intense mass media coverage of the Paris terrorist attacks on November 13, 2015 exposed a majority of the French population to the attacks. Prior research has documented the association between media exposure to terrorism and post-traumatic stress symptoms (PTSS). The present study replicated and extended these findings in a French sample. A population-based sample (N = 1,760) was drawn from a national web-enabled panel in June 2016. Hours of attack-related media exposure (i.e., TV-watching, viewing internet images, engaging in social media exchanges) in the 3 days following the attacks were assessed. Multivariate regression models, adjusting for gender, age, direct exposure (i.e., witnessing in person or knowing someone injured or killed), residential area, social support, pre-attack mental health service utilization, and other adverse life events, examined the association between media exposure and PTSS (assessed using the self-report PCL-5). Compared to those reporting less than 2 hours of daily attack-related television exposure, those reporting 2-4 hours (ß = 3.1, 95% CI = 0.8-5.3) or >4 hours (ß = 4.7, 95% CI = 2.0-7.4) of media exposure reported higher attack-related PTSS. This finding was replicated with social media use: those with moderate (ß = 3.2, 95% CI = 0.9-5.5) or high (ß = 6.8, 95% CI = 1.9-11.7) use reported higher PTSS than those reporting no use. Subanalyses demonstrated that media exposure and PTSS were not associated in those directly exposed to the attacks. Results highlight the potential public health risk of extensive mass media exposure to traumatic events.

Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident.

Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.

Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015.

During the evening of 13 November 2015, the deadliest terror attacks in France in recent times occurred in the Paris area. Overall, 130 people were killed, 643 were physically injured and several thousands were psychologically impacted. Thousands of first responders, including health professionals, firefighters, affiliated volunteers and police officers were mobilized that night and during the subsequent weeks. The aims of our study were to measure the psychological impact on first responders in terms of post-traumatic stress disorder (PTSD) and partial PTSD as well as associated factors 12 months after the 13 November 2015 terrorist attacks. First responders who had intervened during the night and/or the aftermath of the terror attacks had the possibility of answering a web-based study 8-12 months after the attacks. They satisfied criterion A of the DSM 5 definition of PTSD. PTSD and partial PTSD were measured using the PCL-5. Gender, age, educational level, exposure, first responder category, mental health and traumatic event history, training and social support were all analysed as potential factors associated with PTSD and partial PTSD, using multinomial logistic regression. Overall, 663 participants were included in this analysis. Prevalence of PTSD in our sample went from 3.4% among firefighters to 9.5% among police officers and prevalence of partial PTSD from 10.4% among health professionals to 23.2% among police officers. Low educational level and social isolation were associated with PTSD and partial PTSD. Intervention on unsecured crime scenes and lack of training were associated with PTSD. Special attention should be given to first responders living in social isolation, those with low educational levels and those who intervene in unsecured crime scenes. Education and training about the potential mental health consequences of mass trauma intervention should be developed.

The 2015 and 2016 terrorist attacks in France: was there a short-term impact on hospitalizations for cardiovascular disease?

BACKGROUND: The terrorist attacks in Paris and Nice in 2015 and 2016 generated widespread emotional stress in France. Given that acute emotional stress is a well-known trigger for cardiovascular disease, we investigated whether these attacks had any short-term impact on hospitalizations for acute cardiovascular disease in France. METHODS: Annual hospital discharge data from 2009 to 2016 were extracted from the French Hospital Discharge Database. All hospitalizations with a primary diagnosis of acute coronary syndrome, heart failure, or stroke were selected. Generalized additive Poisson models were used to differentiate "unusual" variations in daily hospitalization numbers in the 15 days following the attacks from the expected background hospitalization rate. RESULTS: The average daily number of hospitalizations was 396.4 for acute coronary syndrome, 598.6 for heart failure, and 334.6 for stroke. The daily mean number of hospitalizations for heart failure and stroke was higher in the 15 days following each attack compared with the reference periods. However, multivariate analysis showed no significant variation in the risk of hospitalization in the days following the attacks. INTERPRETATION: Watching events unfold on television, no matter how dramatic, was not a sufficiently potent trigger for cardiovascular disease, although it may have led to an increase in hospitalizations for stress or anxiety. The 2015 and 2016 terrorist attacks do not seem to have had any measurable short-term impact on hospitalizations for cardiovascular disease either in the Paris and Nice regions or in the rest of France.

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.