Studying the impact of early life exposures to pesticides on the risk of testicular germ cell tumors during adulthood (TESTIS project): study protocol.

BACKGROUND: The incidence of testicular germ cell tumors (TGCT), the most common cancer in men aged 15 to 45 years, has doubled over the last 30 years in developed countries. Reasons remain unclear but a role of environmental factors, especially during critical periods of development, is strongly suspected. Reliable data on environmental exposure during this critical time period are sparse. Little is known on whether it could be a combined effect of early and later-life exposures. METHODS/DESIGN: Our research aims to study the association between TGCT risk and pesticide exposures (domestic, occupational and environmental) during critical time periods of development and combined early and later-life exposures. The study design, developed during a 2-year pilot study, is a multicenter case-control study of 500 cases (ascertained through histology) and 1000 fertile/fecund controls recruited through 21 French 'Centres d'Etude et de Conservation des Œufs et de Sperme humain' (CECOS). Trained professional interviewers interview the subjects and their mothers by phone. Using a geographic information system developed and tested for application in this study design, environmental pesticides exposure assessment is based on life-time residential history. Occupational pesticides exposures are assessed by an industrial hygienist based on parents' occupations and tasks. Exposures during the prenatal period, early childhood and puberty are focused. A blood sample is collected from each participant to assess genetic polymorphisms known to be associated with TGCT risk, as well as to explore gene-environment interactions. DISCUSSION: The results of our study will contribute to better understanding the causes of TGCT and the rapid increase of its incidence. We explore the effect of combined early and later-life pesticides exposure from multiple sources, as well as potential gene-environment interactions that have until now been rarely studied for TGCT. Our design allows future pooled studies and the bio-bank allows additional genetic or toxicological analyses.

Patients' and relatives' views on unmet mental health care needs through a qualitative study: Symptoms are a major barrier.

Unmet needs in mental health care are a prominent issue and concern almost half of people with such disorders. Psymobile is a mobile outreach psychiatric team whose objective is to facilitate access to psychiatric services. Its intervention is at the request of relatives or social workers, making it possible to encounter situations of long-standing unmet needs. Our objective was to understand the barriers to accessing mental health care as perceived by patients and their relatives. We conducted a qualitative study with patients and their relatives using face-to-face semi-structured interviews and a hierarchical thematic analysis. Four major themes were identified: psychological and behavioural barriers, socio-economic barriers, structural barriers and physical barriers. Anosognosia or lack of insight is cited as a primary barrier, as are fear of stigma, and former negative experiences. The complexity of the French care system and the lack of literacy about mental illnesses were also emphasized by the participants. Physical determinants, such as the distance to healthcare facilities, were rarely mentioned. As a conclusion, outreach teams appear to be an appropriate way to address the issue of unmet mental health care needs when they provide psychiatric care.

Agricultural and domestic pesticides in house dust from different agricultural areas in France.

Pesticides have been associated with various pathologies, and there is growing evidence of pesticide presence in domestic environments. However, most available studies focused on a limited number of pesticides or households, and few have been conducted in Europe. We aimed to assess indoor pesticide contamination by screening the prevalence of 276 pesticides and ten pesticide metabolites, in French households from different agricultural and urban areas. We sampled indoor dust from 239 households in 2012, proximate to orchards (n = 69), cereals (n = 66) and vineyard (n = 68) crops, or from urban area (n = 36). we used cellulose wipes moistened with isopropanol and polypropylene dust traps to collect recent (7 and 30 days, respectively) and settled dust (> 6 months). Overall, 125 pesticides and piperonyl butoxide were detected at least once in households, mostly at low prevalence: 97 in recent dust, and 111 in settled dust. In recent dust, the most prevalent compounds were o-phenylphenol (168 households, 70%), pentachlorophenol (86, 36%), and piperonyl butoxide (82, 34%). In addition to agricultural pesticides, we found a high proportion of domestic and banned compounds in recent and settled house dust. Several pesticides were identified in house dust, from different pesticide groups and sources. Our results suggest that domestic usage and persistence of banned pesticides may contribute substantially to indoor pesticide contamination. Graphical abstract 97 pesticides detected in households' recent indoor dust.

[Testicular germ cell tumours and early exposures to pesticides: The TESTEPERA pilot study]. / Tumeurs germinales du testicule et expositions précoces aux pesticides : étude pilote TESTEPERA.

Testicular germ cell tumors (TGCT) represent the most frequent cancer in men aged between 15 and 45 years. Current hypotheses are focusing on environmental exposures occurring during prenatal periods. However, very few studies have explored intra-uterine environmental exposure related to TGCT. TESTEPERA is a pilot case-control study aiming to determine the effectiveness of different recruitment approaches in the French context and to verify our ability to collect relevant data on their prenatal periods. Between 2011 and 2012, 150 male subjects were contacted in the Rhône-Alpes region (58 cases from a cancer center and 92 controls from a regional maternity). Participation rate varied from 33% for cases diagnosed in 2008 vs 68% for cases diagnosed in 2010. Participation rate of controls varied depending on modalities of contact (13% for face-to-face recruitment; 0% for contact by phone only; 50% for face-to-face contact with phone reminder). Data collection allowed precise job identification and geolocation of subjects' addresses. Precision of geolocation was dependent upon the level of urbanization (p < 0.001) but not on the time period (p = 0.52). Our results support the feasibility of a case-control study focusing on the relation between TGCT and environmental pesticide exposures during early and later life.