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.

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.

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.

Efficacy of an appearance-based and a health-based sun protection intervention on summer vacationers' behaviours, PRISME cluster randomized crossover trial, France.

OBJECTIVES: Sun-seeking vacationers are particularly vulnerable to melanoma. Appearance-based interventions (ABi) showing skin damage of ultraviolet exposure may be a promising prevention tool to improve skin protection. This study aimed to measure and compare the efficacy of an ABi and a health-based intervention (HBi) on French summer vacationers' behaviours and to identify differences between subpopulations. DESIGN: A cluster randomized crossover trial with three intervention groups (control, ABi, HBi) was conducted in eight campsites on the French Mediterranean coast in summer 2019. METHODS: 1355 vacationers of both sexes and aged 12-55 years were included and followed up after 4 days (T1) and 14 months (T2). Efficacy of interventions was evaluated using multilevel mixed-effect models comparing groups on three outcomes: self-reported sun protection behaviours, sunbathing and skin colour measures. Protection behaviours were analysed according to subpopulations. RESULTS: Compared to controls, the ABi group had a higher protection and sunbathed for fewer hours at T1 and T2. In the HBi group, the skin colour was lighter than controls at T1. When comparing ABi to HBi, ABi participants had lower exposure than HBi at T1 and T2. The protection of people with a 3-years university degree was higher in the HBi group than in others groups while that of people with a secondary school certificate was higher in the ABi group. CONCLUSIONS: Our study provides further evidence of individual sun protection interventions effect in a touristic setting and highlights the relevance of ABi messages to supplement HBi messages, particularly in certain subpopulations with low to intermediate education levels.

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.

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.

Epidemiology of Childhood Hyperthyroidism in France: A Nationwide Population-Based Study.

Context: Hyperthyroidism affects all age groups, but epidemiological data for children are scarce. Objective: To perform a nationwide epidemiological survey of hyperthyroidism in children and adolescents. Design: A cross-sectional descriptive study. Setting: Identification of entries corresponding to reimbursements for antithyroid drugs in the French national insurance database. Participants: All cases of childhood hyperthyroidism (6 months to 17 years of age) in 2015. Main Outcome Measures: National incidence rate estimated with a nonlinear Poisson model and spatial distribution of cases. Results: A total of 670 cases of childhood hyperthyroidism were identified. Twenty patients (3%) had associated autoimmune or genetic disease, with type 1 diabetes and Down syndrome the most frequent. The annual incidence for 2015 was 4.58/100,000 person-years (95% CI 3.00 to 6.99/100,000). Incidence increased with age, in both sexes. This increase accelerated after the age of 8 in girls and 10 in boys and was stronger in girls. About 10% of patients were affected before the age of 5 years (sex ratio 1.43). There was an interaction between age and sex, the effect of being female increasing with age: girls were 3.2 times more likely to be affected than boys in the 10 to 14 years age group and 5.7 times more likely to be affected in the 15 to 17 years age group. No conclusions about spatial pattern emerged. Conclusion: These findings shed light on the incidence of hyperthyroidism and the impact of sex on this incidence during childhood and adolescence. The observed incidence was higher than expected from the results published for earlier studies in Northern European countries.

Prenatal exposure to lead in France: Cord-blood levels and associated factors: Results from the perinatal component of the French Longitudinal Study since Childhood (Elfe).

BACKGROUND: As a result of the ban on lead in gasoline on 2nd January 2000, the French population's exposure to lead has decreased in recent years. However, because of the acknowledged harmful cognitive effects of lead even at low levels, lead exposure remains a major public health issue. In France, few biomonitoring data are available for exposure to lead in pregnant women and newborn. The purpose of the perinatal component of the French human biomonitoring (HBM) program was to describe levels of various biomarkers of exposure to several environmental pollutants, including lead, among mother-baby pairs. In this paper, we aimed to describe the distribution of cord blood lead levels (CBLL) in French mother-baby pairs, and to estimate the contribution of the main lead exposure risk factors to these levels. METHOD: A total of 1968 mother-baby pairs selected from the participants of the perinatal component of the French HBM program were included in the study on lead. Lead levels were analyzed in cord blood collected at child delivery by inductively coupled plasma-mass spectrometry (ICP-MS). The data collected included biological sample, socio-demographic characteristics, environmental and occupational exposure, and information on dietary factors. RESULTS: CBLL were quantified for 99.5% of the sample. The CBLL geometric mean was 8.30 µg/l (95% CI [7.94-8.68]) with a 95th percentile of 24.3 µg/l (95% CI [20.7-27.1]). Factors significantly associated with CBLL were tap water consumption, alcohol consumption, shellfish consumption, vegetable consumption, bread consumption, smoking, and the mother being born in countries where lead is often used. CONCLUSION: This study provides the first reference value for CBLL in a random sample of mother-baby pairs not particularly exposed to high levels of lead (24.3 µg/l). A substantial decrease in CBLL over time was observed, which confirms the decrease of exposure to lead among the general population. CBLL observed in this French study were in the range of those found in recent surveys conducted in other countries.

Association between long-term exposure to air pollution and mortality in France: A 25-year follow-up study.

INTRODUCTION: Long-term exposure to air pollution (AP) has been shown to have an impact on mortality in numerous countries, but since 2005 no data exists for France. OBJECTIVES: We analyzed the association between long-term exposure to air pollution and mortality at the individual level in a large French cohort followed from 1989 to 2013. METHODS: The study sample consisted of 20,327 adults working at the French national electricity and gas company EDF-GDF. Annual exposure to PM10, PM10­2.5, PM2.5, NO2, O3, SO2, and benzene was assessed for the place of residence of participants using a chemistry-transport model and taking residential history into account. Hazard ratios were estimated using a Cox proportional-hazards regression model, adjusted for selected individual and contextual risk factors. Hazard ratios were computed for an interquartile range (IQR) increase in air pollutant concentrations. RESULTS: The cohort recorded 1967 non-accidental deaths. Long-term exposures to b aseline PM2.5, PM10-25, NO2 and benzene were associated with an increase in non-accidental mortality (Hazard Ratio, HR = 1.09; 95% CI: 0.99, 1.20 per 5.9 µg/m3, PM10-25; HR=1.09; 95% CI: 1.04, 1.15 per 2.2 µg/m3, NO2: HR=1.14; 95% CI: 0.99, 1.31 per 19.3 µg/m3 and benzene: HR=1.10; 95% CI: 1.00, 1.22 per 1.7 µg/m3).The strongest association was found for PM10: HR = 1.14; 95% CI: 1.05, 1.25 per 7.8 µg/m3. PM10, PM10-25 and SO2 were associated with non-accidental mortality when using time varying exposure. No significant associations were observed between air pollution and cardiovascular and respiratory mortality. CONCLUSION: Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.

Study on polychlorobiphenyl serum levels in French consumers of freshwater fish.

INTRODUCTION: Polychlorobiphenyls (PCBs) are persistent pollutants that are widespread in the environment and in foodstuffs, particularly in freshwater fish, which frequently exceed the maximum levels set by European regulations. OBJECTIVES: First, we describe the consumption of freshwater fish and serum PCB levels in French anglers, a population expected to have the highest level of dietary PCB exposure. Second, we investigated whether there is a statistical relationship between serum PCB levels and the angler consumption of freshwater fish with high PCB bioaccumulation potential (PCB-BP(+) freshwater fish) in order to make recommendations with regard to safe consumption of freshwater fish. METHODS: We conducted a survey of anglers from six sites with contrasting PCB contamination levels. The survey included a food consumption frequency questionnaire and blood samples were taken to assess serum PCB levels. We used a regression model to determine the main factors contributing to serum PCB levels. RESULTS: Consumption of PCB-BP(+) freshwater fish was relatively infrequent. Serum PCB levels of the study population and of women of childbearing age were in the same range as those observed in the French population and in neighbouring European countries, but higher than in the North American population. The two factors with the highest positive association with serum PCB levels were age (R(2)=61%) and the consumption of PCB-BP(+) freshwater fish (R(2)=2%). Using the regression model, we calculated, for several scenarios depending on the age and gender of the population, the maximum annual frequencies for PCB-BP(+) freshwater fish consumption that do not exceed the critical body burden threshold. CONCLUSION: Following the results of this study, the French agency for food, environmental and occupational health and safety (ANSES) issued an opinion and recommended some specific maximum freshwater fish consumption frequencies to protect the French general population.

Serum levels of organochlorine pesticides in the French adult population: the French National Nutrition and Health Study (ENNS), 2006-2007.

BACKGROUND: Although most organochlorine (OC) pesticides were banned in France in the 1970s and 1980s, they remain a source of public concern. Because of their high persistence in the environment, they are still detected in foodstuffs, leading to continued human exposure. The purpose of this study was to assess the distribution of serum organochlorine (OC) pesticides in the French adult population and to identify the main risk factors for p,p'-dichlorodiphenyl dichlorethylene (DDE), ß-hexachlorocyclohexane (ß-HCH) and hexachlorobenzene (HCB). METHOD: The selected OC pesticides (HCB, DDE, DDT, α-HCH, ß-HCB and γ-HCH) were measured in serum samples collected in 2006-2007 from 386 persons (aged 18-74 years) randomly selected among the participants in the clinical and biological component of the French Nutrition and Health Survey (Etude Nationale Nutrition Santé [ENNS]), a cross-sectional survey carried out in the general population. Collected data included biological samples, socio-demographic characteristics, and data about environmental and occupational exposure factors. RESULTS: Of the six OC pesticides investigated, the highest concentrations were observed for HCB, ß-HCH and DDE. Median serum concentrations were as follows: 22.8 ng/g lipid for HCB, 0.74 and 27.0 ng/g lipid, respectively, for α- and ß-HCH, and 3.8 and 104.6 ng/g lipid, respectively, for DDT and DDE. Lindane (γ-HCH) was detected in approximately 10% of the sample. OC pesticide levels in serum in French adults were higher (except for DDT and DDE) than those observed in American, Canadian and German populations and generally lower than or in the same range as those observed in other European countries. The low serum DDT/DDE ratio in the present study (3.7%) would suggest that the concentrations observed for these two OC pesticides were mainly the result of past exposure. The most important predictors of serum DDE, HCB and ß-HCH concentrations among the French adult population included individual factors (age, gender, BMI, etc.), dietary factors of animal and vegetable origin, and domestic use of pesticides (in vegetable gardens and/or fruit trees). CONCLUSION: For the first time in France, a human biomonitoring study has shown that exposure to OC pesticides remains common in the population. French concentrations were higher (except for DDT and DDE) or were similar to those observed in other developed countries.

A time series study of gastroenteritis and tap water quality in the Nantes area, France, 2002-2007.

In the Nantes area, 410,000 inhabitants are supplied with water pumped from the Loire River. The treatment of this water is carried out through a process of complete clarification and disinfection. During the study period (2002-07), the quality of drinking water complied with European microbial standards and mean turbidity in finished water was 0.05 NTU (nephelometric turbidity units). We aimed to characterize the link between produced water turbidity and other operational data and the incidence of acute gastroenteritis (AGE) in the Nantes area. The daily number of medical prescriptions for AGE was drawn from the French national health insurance system's drug reimbursement data. We modeled this time series using Poisson regression within the framework of a Generalized Additive Model. We showed that an interquartile range turbidity degradation (0.042-0.056 NTU) was connected to a 4.2% (CI95=(1.5%; 6.9%)) increase in the risk of AGE in children and a 2.9% (CI95=(0.5%; 5.4%)) increase in adults. The slope of the turbidity risk function was higher during both high- and low-water conditions of the river. High values of daily flow of produced water were also associated with higher endemic levels of AGE.

Urinary arsenic levels in the French adult population: the French National Nutrition and Health Study, 2006-2007.

The French Nutrition and Health Survey (ENNS) was conducted to describe dietary intakes, nutritional status, physical activity, and levels of various biomarkers for environmental chemicals (heavy metals and pesticides) in the French population (adults aged 18-74 years and children aged 3-17 years living in continental France in 2006-2007). The aim of this paper was to describe the distributions of total arsenic and the sum of iAs+MMA+DMA in the general adult population, and to present their main risk factors. In the arsenic study, 1500 and 1515 adults (requested to avoid seafood intake in the previous 3 days preceding urine collection) were included respectively for the analysis of the sum of inorganic arsenic (iAs) and its two metabolites, monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), and for the total arsenic. Results were presented as geometric means and selected percentiles of urinary arsenic concentrations (µg/L) and creatinine-adjusted urinary arsenic (µg/g of creatinine) for total arsenic, and the sum of inorganic arsenic and metabolites (iAs+MMA+DMA). The geometric mean concentration of the sum of iAs+MMA+DMA in the adult population living in France was 3.34 µg/g of creatinine [3.23-3.45] (3.75 µg/L [3.61-3.90]) with a 95th percentile of 8.9 µg/g of creatinine (10.68 µg/L). The geometric mean concentration of total arsenic was 11.96 µg/g of creatinine [11.41-12.53] (13.42 µg/L [12.77-14.09]) with a 95th percentile of 61.29 µg/g of creatinine (72.75 µg/L). Urinary concentrations of total arsenic and iAS+MMA+DMA were influenced by sociodemographic and economic factors, and by risk factors such as consumption of seafood products and of wine. In our study, covariate-adjusted geometric means demonstrated several slight differences, due to consumption of fish, shellfish/crustaceans or wine. This study provides the first reference value for arsenic in a representative sample of the French population not particularly exposed to high levels of arsenic (10 µg/g of creatinine). It shows that urinary arsenic concentrations in the French adult population (in particular concentrations of iAs+MMA+DMA) were relatively low compared with foreign data.

A time series study of drug sales and turbidity of tap water in Le Havre, France.

The 80,000 inhabitants of the lower part of Le Havre obtain their water supply from two karstic springs, Radicatel and Saint-Laurent. Until 2000, the Radicatel water was settled when turbidity exceeded 3 NTU, then filtered and chlorinated, whereas the Saint-Laurent water was simply chlorinated. Our study aimed to characterize the link between water turbidity and the incidence of acute gastroenteritis (AGE). Records on drug sales used for the treatment of AGE were collected from January 1994 to June 1996 (period 1) and from March 1997 to July 2000 (period 2). Daily counts of drug sales were modeled using a Poisson Regression. We used data set 2 as a discovery set, identifying relevant (i.e. both significant and plausible) exposure covariates and lags. We then tested this model on period 1 as a replication dataset. In period 2, the daily drug sales correlated with finished water turbidity at both resources. Settling substantially modified the risk related to turbidity of both raw and finished waters at Radicatel. Correlations were reproducible in period 1 for water from the Radicatel spring. Timeliness of treatment adaptation to turbidity conditions appears to be crucial for reducing the infectious risk due to karstic waters.

The impact of heat islands on mortality in Paris during the August 2003 heat wave.

BACKGROUND: Heat waves have a drastic impact on urban populations, which could increase with climate change. OBJECTIVES: We evaluated new indicators of elderly people's exposure to heat in Paris, from a public health prevention perspective, using satellite thermal images. METHODS: We used a time series of 61 images from the satellites of the National Oceanic and Atmospheric Administration's (NOAA) Advanced Very High Resolution Radiometer (AVHRR) taken from 1 to 13 August 2003 to produce thermal indicators of minimum, maximum, and mean surface temperatures and diurnal temperature amplitude, with different lags between the meteorological data and the health impact. Health data came from a case-control study involving 241 people ≥ 65 years of age who died in the city of Paris or the nearby suburban area of Val-de-Marne during the August 2003 heat wave, and 241 controls who were matched to cases on age, sex, and residential zone. For each person, we integrated the thermal indicators in a conditional logistic regression model, adjusted for age and other potential confounders. We computed odds ratios (ORs) comparing the 90th and 50th percentiles of the temperature differences between cases and controls for various indicators. RESULTS: Mortality risk was significantly associated with exposure for two indicators: minimum temperatures averaged for 1-13 August [for a 0.41°C increase, OR = 2.17; 95% confidence interval (CI): 1.14, 4.16] and minimum temperature averaged on the day of death and the 6 preceding days (for a 0.51°C increase: OR = 2.24; 95% CI: 1.03, 4.87). CONCLUSIONS: Our results support the influence of night temperatures on the health impact of heat waves in urban areas. Urban heat exposure indicators based on satellite imagery have the potential to identify areas with higher risk of death, which could inform intervention decisions by key stakeholders.

Blood lead levels in the adult population living in France the French Nutrition and Health Survey (ENNS 2006-2007).

BACKGROUND: The French Nutrition and Health Survey (ENNS) was conducted in order to describe food consumption and levels of various biomarkers in the general population. In this paper, we aimed to assess the distribution of blood lead levels (BLL) in the adult population living in France. METHOD: ENNS was a cross-sectional survey carried out in the general population. Participants (18-74years of age) were sampled using a three-stage probability design stratified by geographical areas and degrees of urbanization. Collected data included biochemical samples, anthropometric measurements, socio-demographic characteristics, and environmental and occupational exposure. RESULTS: In 2006/2007, 2029 adults were included in the survey on lead. The blood lead geometric mean (GM) in the population living in France was 25.7µg/L [24.9-26.5]. The overall prevalence of elevated BLL (>100µg/L) was 1.7% [1.1-2.3%]. Levels were significantly higher in males than in females, and increased with age, smoking status and alcohol consumption. Other factors significantly associated with BLL were leisure activities, occupational category, age of housing unit, birth place and shellfish/crustacean consumption. CONCLUSION: For the first time a survey provides national estimates of BLL for the adult population in France. Comparison with results from a previous study among men aged 18-28years showed that the GM dropped more than 60% in the last 10years. The distribution of BLL in France was quite similar to that observed in other European countries.

Variations in trihalomethane levels in three French water distribution systems and the development of a predictive model.

Epidemiological studies have demonstrated that chlorination by-products in drinking water may cause some types of cancer in humans. However, due to differences in methodology between the various studies, it is not possible to establish a dose-response relationship. This shortcoming is due primarily to uncertainties about how exposure is measured-made difficult by the great number of compounds present-the exposure routes involved and the variation in concentrations in water distribution systems. This is especially true for trihalomethanes for which concentrations can double between the water treatment plant and the consumer tap. The aim of this study is to describe the behaviour of trihalomethanes in three French water distribution systems and develop a mathematical model to predict concentrations in the water distribution system using data collected from treated water at the plant (i.e. the entrance of the distribution system). In 2006 and 2007, samples were taken successively from treated water at the plant and at several points in the water distribution system in three French cities. In addition to the concentrations of the four trihalomethanes (chloroform, dichlorobromomethane, chlorodibromomethane, bromoform), many other parameters involved in their formation that affect their concentration were also measured. The average trihalomethane concentration in the three water distribution systems ranged from 21.6 µg/L to 59.9 µg/L. The increase in trihalomethanes between the treated water at the plant and a given point in the water distribution system varied by a factor of 1.1-5.7 over all of the samples. A log-log linear regression model was constructed to predict THM concentrations in the water distribution system. The five variables used were trihalomethane concentration and free residual chlorine for treated water at the plant, two variables that characterize the reactivity of organic matter (specific UV absorbance (SUVA), an indicator developed for the free chlorine consumption in the treatment plant before distribution δ) and water residence time in the distribution system. French regulations impose a minimum trihalomethane level for drinking water and most tests are performed on treated water at the plant. Applied in this context, the model developed here helps better to understand trihalomethane exposure in the French population, particularly useful for epidemiological studies.

Short-term effect of pollen exposure on antiallergic drug consumption.

BACKGROUND: Several studies have investigated the association between pollen exposure and asthma emergency admissions, but only 2 have investigated the effect of airborne allergens on consultations for rhinitis or conjunctivitis and none has used drug consumption as the health indicator. OBJECTIVE: To analyze the short-term association between pollen exposure and antiallergic drug consumption in the urban area of Clermont-Ferrand, France, taking into account the potentially confounding effect of air pollution and meteorological factors. METHODS: We used the French health insurance database to select all individuals from the Clermont-Ferrand urban area having benefited from reimbursement for antiallergic treatment from January 1, 2000, through December 31, 2001, and from January 1, 2003, through December 31, 2004. An episode of treated allergic rhinitis, rhinosinusitus, or conjunctivitis (ARC) was defined as the association of an oral antihistamine and a local antiallergic drug on the same prescription. The relations between daily changes in pollen concentrations and daily changes in the number of treated ARC cases were analyzed using a Poisson regression model with penalized spline functions. RESULTS: The risk of treated ARC associated with an interquartile increase in pollen concentration increased significantly for Poaceae (5%, P < .001), Fraxinus (7%, P < .001), Betula (7%, P < .001), and Corylus (2%, P < .02). This increase was significant in all age groups for Poaceae and Fraxinus pollen and in people younger than 65 years for Betula pollen. The effect was mainly concentrated on the present day, except for Poaceae pollens, for which the risk remained significantly (P < .001) increased until 3 days lag time. CONCLUSIONS: This study showed a significant increase in treated ARC cases related to Poaceae, Fraxinus, and Betula. Specific risks are difficult to evaluate for species that share the same pollination period. Time-series studies based on drug consumption are useful to highlight and to supervise pollen-related diseases requiring ambulatory care.

Cumulative effective doses delivered by radiographs to preterm infants in a neonatal intensive care unit.

OBJECTIVE: We sought to determine the number and distribution of radiographs and the cumulative effective radiograph doses (cED) received by a population of preterm infants (PIs) hospitalized in an NICU. STUDY DESIGN: We reviewed the files of all preterm infants (gestational age: <34 weeks) who were admitted to an NICU during an 18-month period and were discharged alive. A generalized additive model was used to study the relationship between cED and patient characteristics. RESULTS: Four hundred fifty files were analyzed. The median gestational age was 30.1 weeks (range: 24.1-33.9 weeks), and the median birth weight was 1250 g (range: 520-2760 g). The median number of radiographs per infant was 10.6 (range: 0-95), and the median cED was 138 microSv (range: 0-1450 microSv). The cumulative dose exceeded 500 microSv in 7.6% of the cases. Factors that influenced the cumulative effective dose were gestational age, birth weight, care procedures, and clinical adverse events. CONCLUSIONS: Given the potentially life-threatening complications of PIs, cumulative radiograph doses received in the ICU seem low with regard to environmental exposure and international recommendations. Additional studies are needed to evaluate the possible lifetime consequences of exposure to ionizing radiation at this age.