Exposure of the general French population to metals and metalloids in 2014-2016: Results from the Esteban study.

BACKGROUND: The purpose of the Esteban study was to describe levels of various biomarkers of exposure to several environmental pollutants, including metals and metalloids, among the French population. This paper describes the distribution of concentrations of 28 metals and metalloids in two different populations, and estimates the main determinants of exposure to total arsenic, the sum of inorganic arsenic (iAs) and its two metabolites monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), cadmium, chromium, copper, mercury and nickel. METHODS: Esteban is a cross-sectional study conducted between 2014 and 2016 on a random sample of 2503 adults (18-74 years old) and 1104 children (6-17 years old) from the general population. The data collected included biological samples (blood, hair, and urines), socio-demographic characteristics, environmental and occupational exposure, and information on dietary factors and lifestyle. The geometric mean and percentiles of the distribution were estimated for each metal. Multivariate analyses were performed to identify the determinants of exposure using a generalized linear model. RESULTS: Only four metals had a quantification rate below 90% in adults (beryllium, iridium, palladium, and platinum), and three metals in children (beryllium, iridium, and platinum). The concentrations of total arsenic, cadmium, chromium and mercury were higher than those found in most international studies. The determinants significantly associated with exposure were mainly diet and smoking. CONCLUSIONS: Esteban provided a nationwide description of 28 metal and metalloid exposure levels for adults (some never measured before) and for the first time in children. The study results highlighted widespread exposure to several metals and metalloids. These results could be used to advocate public health decisions for continued efforts to reduce harmful exposure to toxic metals. The Reference values (RV95) built from Esteban could also be used to support future government strategies.

Exposure of the general French population to herbicides, pyrethroids, organophosphates, organochlorines, and carbamate pesticides in 2014-2016: Results from the Esteban study.

Esteban is a nationwide cross-sectional study conducted in France in 2014-2016, including 2503 adults aged 18-74 years old and 1104 children aged 6-17 years old, as part of the French Human Biomonitoring programme. The present paper describes the biological levels of five families of pesticides analysed on random sub-samples of 900 adults and 500 children for urine concentrations, and 759 adults and 255 children for serum concentrations, and the determinants of exposure. Organophosphates, carbamates and herbicides were measured in urine by UPLC-MS/MS; chlorophenols and pyrethroids were measured in urine by GC-MS/MS; specific organochlorines were measured in serum by GC-HRMS. Multivariate analyses were performed to identify the determinants of exposure using a generalized linear model. Pyrethroid metabolites were quantified in 99% of adults and children, with the exeption of F-PBA, which was quantified in 31% of adults and 27% of children, respectively. Carbamates and some specific organophosphates were barely or not quantified. DMTP was quantified in 82% of adults and 93% of children, and γ-HCH (lindane) was quantified in almost 50% of adults and children. Concentration levels of pesticide biomarkers were consistent with comparable international studies, except for ß-HCH, DMTP, and the deltamethrin metabolite Br2CA, whose levels were sometimes higher in France. Household insecticide use and smoking were also associated with higher levels of pyrethroids. All pyrethroids concentration levels were below existing health-based HBM guidance values, HBM-GVsGenPop, except for 3-PBA, for which approximately 1% and 10% of children were above the lower and upper urine threshold values of 22 µg/L and 6.4 µg/L, respectively. Esteban provides a French nationwide description of 70 pesticide biomarkers for the first time in children. It also describes some pesticide biomarkers for the first time in adults, including glyphosate and AMPA. For the latter, urine concentration levels were overall higher in children than in adults. Our results highlight a possible beneficial impact of existing regulations on adult exposure to organochlorine and organophosphate pesticides between 2006 and 2016, as concentration levels decreased over this period.

Assessment of multi-chemical exposure using human biomonitoring data from the French Esteban study using exposure load method.

Exposure to chemical substances is common and comes from several sources (environmental, food, and occupational). It is often studied using a substance-by-substance approach. Although this method helps identify the determinants of exposure to a single chemical, it cannot accurately reflect exposure to multiple chemicals. In this study, we used the concept of exposure load (EL) to evaluate multi-chemical exposure in a representative sample of the general French population. EL corresponds to the number of substances (or metabolites) measured in body fluids above a defined concentration threshold. EL was calculated for adults and children separately for two groups of substances: those currently found in domestic environments (Group A) and pesticides (Group B). Although the EL does not assess the health impact linked to multi-chemical exposure, it does aid in the identification of particularly vulnerable populations. Accordingly, preventive actions specifically aimed at these subgroups could be useful. In Group A, we found that multi-chemical exposure was generalized since all the adults and children had an EL greater than or equal to 13 (out of 22 substances studied) when the LOQ (limit of quantification) was considered as the discretization threshold. In adults, men, smokers and people of working age (i.e., people under 60 years old) had a higher EL. In Group B, multi-chemical exposure was also generalized, since all the adults (15 substances studied) and children (13 substances studied) had a mean EL almost equal to 6 when the LOQ was considered as the discretization threshold. In adults, persons with occupational exposure to pesticide dust had a higher EL when the P90 was considered as the discretization threshold. This study highlights widespread multi-chemical exposure in adults and children in France, and the major impact of occupational exposure (Group B) and tobacco smoking (Group A) on EL.

Estimation of blood lead levels in the French population using two complementary approaches: Esteban (2014-2016) as part of the human biomonitoring program and the national surveillance system for childhood lead poisoning (2015-2018).

BACKGROUND: Used widely for centuries, lead is a common environmental pollutant. As a cumulative toxic, its presence in the body is always evidence of exposure, and health effects occur without threshold. Though regulated by European directives, lead requires close monitoring due to its environmental persistence and toxicity. METHODS: The first data source was the French surveillance system for monitoring childhood lead poisoning, which records the screening results of children (-18 years), providing data on their temporal and geographical distribution, characteristics, and risk factors. The second data source was Esteban, a cross-sectional study conducted in 2014-2016 on a random sample of the French population as part of the human biomonitoring program. The Esteban lead study concerns 904 children (6-17 years) and 999 adults (18-74 years), providing data on biological samples, sociodemographic characteristics, occupational exposure, environmental and dietary factors. RESULTS: The surveillance system highlighted that lead poisoning affected 10% of children screened between 2015 and 2018. The main risk factor remains housing. Esteban confirmed this observation, finding a general mean of blood lead level (BLL) at 9.9 and 18.5 µg/L for children and adults, respectively. In children, parents' occupation increased BLLs. In adults, the greatest exposure factors were smoking, age, place of residence, alcohol, bread-based products, and homegrown livestock products. In both, drinking tap water and year of housing construction increased BLLs. CONCLUSIONS: The surveillance system showed a high number of children with lead poisoning despite the implementation of prevention measures, which mainly concern lead paints in old and degraded homes. To help identify children at risk, healthcare providers need to know about exposure from housing and the emerging sources identified in the Esteban survey. Despite lower BLLs, the well-known risk factors of lead exposure persist, meaning prevention efforts must continue in order to limit their impact on the population.

[Prevalence of chronic kidney disease in France, Esteban study 2014-2016]. / Prévalence de la maladie rénale chronique en France, Esteban 2014­2016.

BACKGROUND: The epidemiology of chronic kidney disease remains poorly described in France despite its burden. The objective of our study was to provide an estimate of the prevalence of chronic kidney disease stades 3-5 (without replacement therapy) in France. METHOD: The data come from the Esteban study carried out in France between 2014 and 2016 on a representative sample of the French population. This study included 3,021 adults between 18 and 74 years old. Of these, 2422 adults (80.2%) had serum creatinine assay and were included in this analysis. Renal function was estimated by calculating glomerular filtration rate using the Chronic kidney disease epidemiology collaboration (CKD-Epi) and European Kidney function consortium (EKFC) equations. RESULTS: The means glomerular filtration rate in our population were respectively 97.5 and 89.0 mL/min/1.73 m2 with the CKD-EPI and EKFC equations. The prevalence of chronic renal failure, defined by a glomerular filtration rate less than 60 mL/min/1.73 m2 was 1.5% with the CKD-EPI formula and 2.1% with the EKFC formula in adults aged 18 to 74 years. The prevalence was higher in women than in men and increased with age, reaching 6.5% and 9.9% in 65-74 years with the CKD-EPI and EKFC equations, respectively. After extrapolation to the French population, the number of adults with chronic kidney disease stades 3-5 without renal replacement therapy was around 1.6 million. CONCLUSION: In France, the prevalence of chronic kidney disease stades 3-5 without renal replacement therapy was between 1.5 and 2.1% of the adult population aged 18 to 74.

Exposure of the French population to bisphenols, phthalates, parabens, glycol ethers, brominated flame retardants, and perfluorinated compounds in 2014-2016: Results from the Esteban study.

BACKGROUND: As part of the French Human Biomonitoring (HBM) programme, the Esteban study described, among other things, biomarkers levels of various chemicals in adults (18-74 years old) and children (6-17 years old). This paper describes the design of the study and provides, for the first time, data on the biological exposure of the general French population to a wide range of contaminants posing a threat to human health which are currently found in domestic environments. METHODS: Esteban is a cross-sectional study conducted on a nationwide sample of the French general population. Exposure biomarkers of six families of contaminants deemed detrimental to adults' and children's health were measured in biological samples collected either at participants' homes by a nurse, or brought to a National Health Insurance examination centre. All participants were randomly selected (2503 adults and 1104 children). The geometric mean and percentiles of the distribution of levels were estimated for each biomarker. Most of the descriptive statistical analyses were performed taking into account the sampling design. RESULTS: Results provided a nationwide description of biomarker levels. Bisphenols (A, S and F), and some metabolites of phthalates and perfluorinated compounds (PFCs) (specifically, PFOS and PFOA) were quantified in almost all the biological samples analysed. Higher levels were observed in children (except for PFCs). Levels were coherent with international studies, except for bisphenols S and F, brominated flame retardants (BFRs) and parabens (with higher levels reported in the USA than in France). CONCLUSION AND PERSPECTIVES: This study is the first to provide a representative assessment of biological exposure to domestic contaminants at the French population level. Our results show that the French general population was exposed to a wide variety of pollutants in 2014-2016, and identify the determinants of exposure. These findings will be useful to stakeholders who wish to advocate an overall reduction in the French population's exposure to harmful substances. Similar future studies in France will help to measure temporal trends, and enable public policies focused on the reduction of those chemicals in the environment to be evaluated.

Effects of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors on COVID-19: a narrative review of the literature / Efectos de bloqueadores del receptor de angiotensina II e inhibidores de la enzima convertidora de angiotensina en COVID-19: una revisión narrativa de la literatura / Efeitos dos bloqueadores do receptor da angiotensina II e inibidores da enzima de conversão da angiotensina no COVID-19: uma revisão narrativa da literatura

Introduction: An outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is currently affec-ting worldwide. The association between this virus and the upregulation of Angiotensin-Converting Enzyme 2 (ACE2) has been suggested as a potential as an important factor in the development of Coronavirus Disease- 19 (COVID-19). Objective: To describe the relationship between some antihypertensive treatments and COVID-19. Methods: A research was conducted with the components of the PIO (Population, Intervention, Outcomes) strate-gy, including the literature of the last 20 years available in central PubMed, Web of Science, Scopus, and Embase databases. All relevant articles that assessed the epidemiological relationship between SARS-CoV-2 and hyperten-sion, the treatment and outcomes of the patients who have this comorbidity, as well as the relationship between the RAA axis and COVID-19 were included in the analysis. Results: A total of 292 items were found in the databases. After a thorough analysis, 17 papers were selected, including in vitro and in vivo tests, clinical trials, and epidemiological studies related to the topic analyzed. Conclusion: Due to the systemic benefits of antihypertensive drugs targeting the RAA axis, and the lack of eviden-ce of these treatments being a risk factor, It is not recommended to withdraw these medications from hypertensive patients infected with SARS-CoV 2, unless there is a clinical indication.

Introducción: el surgimiento y diseminación del coronavirus tipo 2 del síndrome respiratorio agudo severo (SARS-CoV-2), actualmente, afecta a la mayoría de los del mundo. La asociación entre este virus y la regulación positiva de la enzima convertidora de angiotensina 2 (ACE2) se ha sugerido como un factor potencial en el desarrollo de la enfermedad por coronavirus-19 (COVID- 19). Objetivo: describir la relación entre algunos tratamientos antihipertensivos y la COVID-19. Métodos: se revisaron los componentes de la estrategia PIO (población, intervención, resultados). Se incluyeron todos los artículos relevantes de los últimos 20 años disponibles en las bases de datos centrales PubMed, Web of Science, Scopus y Embase, que describen la relación epidemiológica entre SARS-CoV-2 e hipertensión, el tratamiento y el desenlace de los pacientes quienes tienen esta comor-bilidad, así como la relación entre el eje renina-angiotensina-aldosterona y COVID-19. Resultados: se encontraron inicialmente 292 artículos en las bases de datos, para finalmente seleccio-nar 17 artículos, incluyendo exámenes in vivo e in vitro, ensayos clínicos y estudios epidemiológicos relacionados con el tema analizado. Conclusión: debido a los beneficiosos efectos sistémicos del tratamiento antihipertensivo, cuyo blanco es el sistema renina-angiotensina- aldosterona, y a la falta de evidencia acerca de estos me-dicamentos en cuanto a la inducción de SARS-CoV-2, no se recomienda suspender o contraindicar el tratamiento con estos fármacos en pacientes hipertensos positivos para COVID-19, a menos que haya una indicación clínica

Introdução: Um surto de Síndrome Respiratória Aguda Grave Coronavirus 2 (SARS-CoV-2) está afe-tando atualmente em todo o mundo. A associação entre esse vírus e a suprarregulação da Enzima Conversora da Angiotensina 2 (ACE2) tem sido sugerida como um fator potencial importante no de-senvolvimento da Doença do Coronavírus-19 (COVID-19). Objetivo: Descrever a relação entre al-guns tratamentos anti-hipertensivos e COVID-19. Métodos: Foi realizada uma pesquisa com os com-ponentes da estratégia Population, Intervention, Resultados (PIR), incluindo a literatura dos últimos 20 anos disponível nas bases de dados centrais PubMed, Web of Science, Scopus e Embase. Todos os artigos relevantes que avaliaram a relação epide-miológica entre SARS-CoV-2 e hipertensão, o trata-mento e resultados dos pacientes que apresentam essa comorbidade, bem como a relação entre o eixo RAA e COVID-19 foram incluídos na análise. Resultados: Foram encontrados 292 itens nas bases de dados. Após análise aprofundada, foram selecionados 17 artigos, entre testes in vitro e in vivo, en-saios clínicos e estudos epidemiológicos relacionados ao tema analisado. Conclusão: Devido aos be-nefícios sistêmicos dos medicamentos anti-hipertensivos direcionados ao eixo RAA e à falta de evi-dência desses tratamentos serem um fator de risco, não é recomendado retirar esses medicamentos de pacientes hipertensos infectados com SARS-CoV 2, a menos que haja um indicação clínica.

[Hypertension management in France: where are we now?] / Prise en charge de l'HTA en France : où en est-on ?

Hypertension management in france: where are we now? Hypertension remains the most common chronic disease in France. Its management, which has demonstrated its effectiveness on the occurrence of cardiovascular, renal and cognitive complications, is therefore of major interest for public health. Nevertheless, the results of the Esteban study conducted in 2015 show that the management of hypertension in France has not improved significantly since 2006, date of the last study conducted on a representative sample of the French population. In 2015, one in three adults was hypertensive in France. If the level of screening of hypertension remained high in France with more than 80% of adults who reported having had a blood pressure measurement in the year, about one in two hypertensives was not aware of its hypertension. Fewer than one in two hypertensives were pharmacologically treated and only one in two adults had a controlled blood pressure, less than 25% of all hypertensives. The situation has even deteriorated in women with a significant decrease in the use of pharmacological treatments. Adherence to antihypertensive therapy remained very low with only 64% of the days of the year covered by treatment. More than 40% of hypertensive patients had, in 2015, a home blood pressure monitor. The situation in France, particularly the level of awareness of hypertension among patients, remains below the levels observed in other european countries. There is an urgent need for effective action on this first step to significantly improve the management of hypertension in France. Finally, it seems necessary to understand the reasons for the significant decline in the proportion of women treated pharmacologically to avoid a potential loss of chance harmful to the health of these women.

Prise en charge de l'hypertension artérielle en france : où en est-on ? L'hypertension artérielle reste la maladie chronique la plus fréquente en France. Sa prise en charge, qui a démontré son efficacité sur la survenue des complications cardiovasculaires, rénales et cognitives, revêt donc un intérêt majeur pour la santé publique. Néanmoins, les résultats de l'étude Esteban conduite en 2015 montrent que la prise en charge de l'hypertension en France n'a connu aucune amélioration significative depuis 2006, date de la dernière étude conduite sur un échantillon représentatif de la population française. En 2015, un adulte sur trois était hypertendu en France. Si la fréquence du dépistage se maintenait à un niveau élevé en France avec plus de 80 % des adultes qui déclaraient avoir eu une mesure de la pression artérielle dans l'année, environ un hypertendu sur deux n'avait pas connaissance de son hypertension. Moins d'un hypertendu sur deux était traité pharmacologiquement et seulement un adulte traité sur deux avait une pression artérielle contrôlée, soit moins de 25 % de l'ensemble des hypertendus. La situation s'est surtout dégradée chez les femmes, avec une diminution importante du recours aux traitements pharmacologiques. L'observance des traitements antihypertenseurs était très faible, avec seulement 64 % des jours de l'année couverts par un traitement. Plus de 40 % des hypertendus avaient, en 2015, un appareil d'automesure tensionnelle. En France notamment, le niveau de connaissance de l'hypertension artérielle par les malades reste très inférieur aux niveaux observés dans les autres pays européens. Il semble aujourd'hui urgent d'agir efficacement sur cette première étape pour améliorer significativement la prise en charge de l'hypertension artérielle dans l'Hexagone. Enfin, il apparaît nécessaire de comprendre rapidement les raisons de la baisse importante de la proportion de femmes traitées pharmacologiquement pour éviter une potentielle perte de chance préjudiciable pour leur santé.

Contexto, desarrollo y alcances del primer curso de dietistas en Chile (1939) / Context, development and scope of the first dietitian course in Chile (1939)

RESUMEN El objetivo fue reconstruir la creación del primer curso de dietistas creado en Chile en 1939 y que a comienzos de la década de 1940 se transformó en escuela. Para ello se busca dar a conocer los dos modelos de formación de dietistas existentes en el periodo, señalando las razones de la contratación del húngaro Esteban Kémeny. Además, se ofrecen los diagnósticos críticos que se hicieron durante los años 1930 sobre la alimentación hospitalaria y la necesidad de capacitar al personal en la técnica dietética. El artículo muestra la fuerte vinculación existente entre la urgencia de reformar la cocina hospitalaria y la oferta académica del curso, el cual buscaba capacitar a las enfermeras y otras profesiones femeninas, las que se entendían como auxiliares del médico, sin autonomía profesional.

ABSTRACT The aim was to reconstruct the creation of the first course for dietitians created in Chile in 1939, which in the early 1940s became a school. Two models of training of dietitians in the period are presented, which indicate the reasons for the recruitment of the Hungarian, Esteban Kémeny. In addition, critical suggestions on hospital feeding and the need to train staff in the dietary technique were offered during the 1930s. The article shows the strong link between the urgency to reform the hospital kitchen and the academic offering of the course, which sought to train nurses and other female professionals, which were understood as auxiliaries of the physician, without professional autonomy.