How do territorial characteristics affect spatial inequalities in the risk of coronary heart disease?

BACKGROUND: Cardiovascular diseases remain the leading cause of death and disabilities worldwide, with coronary heart diseases being the most frequently diagnosed. Their multifactorial etiology involves individual, behavioral and territorial determinants, and thus requires the implementation of multidimensional approaches to assess links between territorial characteristics and the incidence of coronary heart diseases. CONTEXT AND OBJECTIVES: This study was carried out in a densely populated area located in the north of France with multiple sources of pollutants. The aim of this research was therefore to establish complex territorial profiles that have been characterized by the standardized incidence, thereby identifying the influences of determinants that can be related to a beneficial or a deleterious effect on cardiovascular health. METHODS: Forty-four variables related to economic, social, health, environment and services dimensions with an established or suspected impact on cardiovascular health were used to describe the multidimensional characteristics involved in cardiovascular health. RESULTS: Three complex territorial profiles have been highlighted and characterized by the standardized incidence rate (SIR) of coronary heart diseases after adjustment for age and gender. Profile 1 was characterized by an SIR of 0.895 (sd: 0.143) and a higher number of determinants that revealed favorable territorial conditions. Profiles 2 and 3 were characterized by SIRs of respectively 1.225 (sd: 0.242) and 1.119 (sd: 0.273). Territorial characteristics among these profiles of over-incidence were nevertheless dissimilar. Profile 2 revealed higher deprivation, lower vegetation and lower atmospheric pollution, while profile 3 displayed a rather privileged population with contrasted territorial conditions. CONCLUSION: This methodology permitted the characterization of the multidimensional determinants involved in cardiovascular health, whether they have a negative or a positive impact, and could provide stakeholders with a diagnostic tool to implement contextualized public health policies to prevent coronary heart diseases.

Data for the assessment of vulnerability and resilience in the field of environmental health in the north of France.

The integration of multidimensional data is necessary to improve the understanding of environmental and social inequalities in health. The challenge is to define a dataset that provides the most holistic description possible of the territory. This article presents a relevant dataset to characterize the territorial accumulation of health determinants in the second most densely populated region of metropolitan France (Hauts-de-France Region, in the north of France). The multidimensional dataset combines data related to the economic, social, environment, services, health and policy dimensions at fine scale (i.e., each municipality). Data outlining a negative impact on health inequalities (e.g. anthropogenic pressures, socioeconomics factors related to vulnerability, etc.) are considered to be as important as data outlining a positive impact on health inequalities (e.g. natural resources, diversity and economic drive, etc.). The proposed theoretical framework relies on data reuse. Over one hundred variables covering a time frame from 2008 to 2017 were collected from a dozen public and national database providers. The use of official organizations ensured the quality of the collected data. The Geographic Information System, designed to map and catalogue ready-to-use data, was used to generate new data or to deal with missing data. Finally, 50 variables, including mostly quantitative but also qualitative data, were selected after application of inclusion and exclusion criteria. The resulting dataset provides a broad characterisation of the 3,817 municipalities in the Hauts-de-France Region. These data will help to discriminate the distribution pattern of vulnerability and resilience levels in this region. This novel approach is described in the paper "How can we analyse environmental health resilience and vulnerability? A joint analysis with composite indices applied to the north of France", which provides a detailed description of the methodology used to develop composite indices. This research could therefore be of use to researchers, policy makers and stakeholders in the field of environmental health seeking to identify the weaknesses but also the strengths of municipalities.

Impact of cadmium on forage kale (Brassica oleracea var. viridis cv "Prover") after 3-,10- and 56-day exposure to a Cd-spiked field soil.

Cadmium (Cd) is a highly toxic element for living organisms and is widespread in metal-contaminated soils. As organisms which can grow up on these polluted areas, plants have some protection mechanisms against Cd issues. Among the plant kingdom, the Brassicaceae family includes species which are known to be able to tolerate and accumulate Cd in their tissues. In this study, Brassica oleracea var. viridis cv "Prover" was exposed to a range of artificially Cd-contaminated soils (from 2.5 up to 20 mg kg-1) during 3, 10, and 56 days and the effects on life traits, photosynthesis activity, antioxidant enzymatic activities were studied. Metal accumulation was quantified, as well as DNA damage, by means of the comet assay and immunodetection of 8-OHdG levels. Globally, B. oleracea was relatively tolerant to those Cd exposures. However, comet assay and detection of 8-OHdG revealed some DNA damage but which are not significant. According to metal accumulation analysis, B. oleracea var. viridis cv Prover could be a good candidate for alternative growing in contaminated areas.

How can we analyze environmental health resilience and vulnerability? A joint analysis with composite indices applied to the north of France.

In environmental health, vulnerability reflecting the cumulative harmful constraints and nuisances to which populations are subjected and resilience defined as the capacity of a territory to cope with health inequalities have been little extensively investigated together with the same importance. Besides the diversity of factors involved, there is no consensual framework to develop composite indices, one recognized methodology to deal with a multifaceted issue. Therefore, this research aims to establish a new transferable approach to assess the spatial heterogeneity of territorial inequalities. This new strategy relies on the simultaneous evaluation of resilience and vulnerability and the joint analysis based on the cross-interpretation of the spatialized composite indices of resilience and vulnerability. A case study was conducted to demonstrate the feasibility of this methodology, using the municipality as a spatial unit of analysis within a region in the north of France. To provide the most holistic description possible of the 3817 studied municipalities, 50 variables related to the economic, environment, policy, health, services and social dimensions were used to develop the composite indices. The vulnerability Index has a median value of 0.151 with an IQR of [0.126-0.180] and the Resilience Index has a median value of 0.341 with an IQR of [0.273-0.401]. The joint analysis was conducted to classify each municipality among four defined typologies: 1687 municipalities (44.2%) belong to the "To monitor" category, 1646 (43.1%) to the "Resilient" category, 329 (8.6%) to the "Have resources" category and 155 (4.1%) to the "Territorial blackspot" category. The methodology herein may be a diagnostic tool to identify and prioritize municipalities that could benefit from the implementation of specifically tailored public health policies.

Crohn's disease and environmental contamination: Current challenges and perspectives in exposure evaluation.

Although the incidence of Crohn's disease has increased worldwide over the past 30 years, the disorder's exact causes and physiological mechanisms have yet to be determined. Given that genetic determinants alone do not explain the development of Crohn's disease, there is growing interest in "environmental" determinants. In medical science, the term "environment" refers to both the ecological and social surroundings; however, most published studies have focused on the latter. In environmental and exposure sciences, the term "environment" mostly relates to contamination of the biotope. There are many unanswered questions on how environmental hazards might contribute to the pathogenesis of Crohn's disease. Which pollutants should be considered? Which mechanisms are involved? And how should environmental contamination and exposure be evaluated? The objective was to perform a systematic review of the literature on Crohn's disease and environmental contamination. We searched the PubMed, Google Scholar, Scopus, ISI Web of Science and Prospero databases. We considered all field studies previous to April 2019 conducted on human health indicators, and evaluating exposure to all type of physical, biological and chemical contamination of the environment. The lack of clear answers to date can be ascribed to the small total number of field studies (n = 16 of 39 publications, most of which were conducted by pioneering medical scientists), methodological differences, and the small number of contaminants evaluated. This make it impossible to conduct a coherent and efficient meta-analysis. Based on individual analysis of available studies, we formulated five recommendations on improving future research: (i) follow up the currently identified leads - especially metals and endocrine disruptors; (ii) explore soil contamination; (iii) gain a better knowledge of exposure mechanisms by developing transdisciplinary studies; (iv) identify the most plausible contaminants by developing approaches based on the source-to-target distance; and (v) develop registries and cohort-based analyses.

Exposure to multiple air pollutants and the incidence of coronary heart disease: A fine-scale geographic analysis.

Geographical variations in cardiovascular disease rates have been linked to individual air pollutants. Investigating the relation between cardiovascular disease and exposure to a complex mixture of air pollutants requires holistic approaches. We assessed the relationship between exposure to multiple air pollutants and the incidence of coronary heart disease (CHD) in a general population sample. We collected data in the Lille MONICA registry (2008-2011) on 3268 incident cases (age range: 35-74). Based on 20 indicators, we derived a composite environmental score (SEnv) for cumulative exposure to air pollution. Poisson regression models were used to analyse associations between CHD rates on one hand and SEnv and each single indicator on the other (considered in tertiles, where T3 is the most contaminated). We adjusted models for age, sex, area-level social deprivation, and neighbourhood spatial structure. The incidence of CHD was a spatially heterogeneous (p=0.006). There was a significant positive association between SEnv and CHD incidence (trend p=0.0151). The relative risks [95%CI] of CHD were 1.08 [0.98-1.18] and 1.16 [1.04-1.29] for the 2nd and 3rd tertile of SEnv exposure. In the single pollutant analysis, PM10, NO2, cadmium, copper, nickel, and palladium were significantly associated with CHD rates. Multiple air pollution was associated with an increased risk of CHD. Single pollutants reflecting road traffic pollution were the most strongly associated with CHD. Our present results are consistent with the literature data on the impact of road traffic on the CHD risk in urban areas.

The comet assay in higher terrestrial plant model: Review and evolutionary trends.

The comet assay is a sensitive technique for the measurement of DNA damage in individual cells. Although it has been primarily applied to animal cells, its adaptation to higher plant tissues significantly extends the utility of plants for environmental genotoxicity research. The present review focuses on 101 key publications and discusses protocols and evolutionary trends specific to higher plants. General consensus validates the use of the percentage of DNA found in the tail, the alkaline version of the test and root study. The comet protocol has proved its effectiveness and its adaptability for cultivated plant models. Its transposition in wild plants thus appears as a logical evolution. However, certain aspects of the protocol can be improved, namely through the systematic use of positive controls and increasing the number of nuclei read. These optimizations will permit the increase in the performance of this test, namely when interpreting mechanistic and physiological phenomena.

Mapping end-stage renal disease (ESRD): spatial variations on small area level in northern France, and association with deprivation.

BACKGROUND: Strong geographic variations in the incidence of end-stage renal disease (ESRD) are observed in developed countries. The reasons for these variations are unknown. They may reflect regional inequalities in the population's sociodemographic characteristics, related diseases, or medical practice patterns. In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region. This area, with a high population density and homogeneous healthcare provision, represents a geographic situation which is quite suitable for the study, over small areas, of spatial disparities in the incidence of ESRD, together with their correlation with a deprivation index and other risk factors. METHODS: The Renal Epidemiology and Information Network is a national registry, which lists all ESRD patients in France. All cases included in the Nord-Pas-de-Calais registry between 2005 and 2011 were extracted. Adjusted and smoothed standardized incidence ratio (SIR) was calculated for each of the 170 cantons, thanks to a hierarchical Bayesian model. The correlation between ESRD incidence and deprivation was assessed using the quintiles of Townsend index. Relative risk (RR) and credible intervals (CI) were estimated for each quintile. RESULTS: Significant spatial disparities in ESRD incidence were found within the Nord-Pas-de-Calais region. The sex- and age-adjusted, smoothed SIRs varied from 0.66 to 1.64. Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00-1.34] for Q2; 1.28, 95% CI [1.11-1.47] for Q3; 1.30, 95% CI [1.14-1.51] for Q4; 1.44, 95% CI [1.32-1.74] for Q5). CONCLUSION: For the first time at this aggregation level in France, this study reveals significant geographic differences in ESRD incidence. Unlike the time of renal replacement care, deprivation is certainly a determinant in this phenomenon. This association is probably independent of the patients' financial ability to gain access to healthcare.

Assessment of suitability of tree species for the production of biomass on trace element contaminated soils.

To alleviate the demand on fertile agricultural land for production of bioenergy, we investigated the possibility of producing biomass for bioenergy on trace element (TE) contaminated land. Soil samples and plant tissues (leaves, wood and bark) of adult willow (Salix sp.), poplar (Populus sp.), and birch (Betula pendula) trees were collected from five contaminated sites in France and Germany and analysed for Zn, Cd, Pb, Cu, Ca, and K. Cadmium concentration in tree leaves were correlated with tree species, whereas Zn concentration in leaves was site correlated. Birch revealed significantly lower leaf Cd concentrations (1.2-8.9 mg kg(-1)) than willow and poplar (5-80 mg kg(-1)), thus posing the lowest risk for TE contamination of surrounding areas. Birch displayed the lowest bark concentrations for Ca (2300-6200 mg kg(-1)) and K (320-1250 mg kg(-1)), indicating that it would be the most suitable tree species for fuel production, as high concentrations of K and Ca decrease the ash melting point which results in a reduced plant lifetime. Due to higher TE concentrations in bark compared to wood a small bark proportion in relation to the trunk is desirable. In general the bark proportion was reduced with the tree age. In summary, birch was amongst the investigated species the most suitable for biomass production on TE contaminated land.

White clover nodulation index in heavy metal contaminated soils- a potential bioindicator.

The morphological effects of heavy metal stress on the nodulation ability of Rhizobium spp. and growth of white clover (Trifolium repens L.) were studied in the laboratory under controlled conditions. Fourteen topsoils were collected from an area with elevated metal concentrations (Cd, Zn, and Pb). White clover was cultivated using a specialized "rhizotron" method to observe the development of root and nodule characteristics. Results show effects of increasing heavy metal concentrations on nodulation development, especially the nodulation index (i.e., the number of nodules per gram of the total fresh biomass). A significant decrease in nodulation index was observed at about 2.64 mg Cd kg(-1), 300 mg Zn kg(-1), and 130 mg Pb kg(-1) in these soils. The sensitivity of the nodulation index in relation to other morphological characteristics is discussed further. It is proposed that the nodulation index of white clover is a suitable bioindicator of increased heavy metal concentrations in soil.

Seasonal variations of cadmium and zinc in Arrhenatherum elatius, a perennial grass species from highly contaminated soils.

There is interest in studying bioaccumulation in plants because they form the base of the food chain as well as their potential use in phytoextraction. From this viewpoint, our study deals with the seasonal variation, from January to July, of Cd and Zn bioaccumulation in three metallicolous populations of Arrhenatherum elatius, a perennial grass with a high biomass production. In heavily polluted soils, while Zn bioaccumulation is weak, A. elatius accumulates more Cd than reported gramineous plants, with concentration of up to 100 microg g(-1). Our results also showed seasonal variations of bioaccumulation, underlying the necessity for in situ studies to specify the date of sampling and also the phenology of the collected plant sample. In our experimental conditions, accumulation is lower in June, leading us to the hypothesis of restriction in heavy metals translocation from roots to aerial parts during seed production.