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Kidney cancer epidemiology in a French Afro-descendant population: high prevalence of papillary renal cell carcinoma
No full textInternational audiencePurpose: Ethnic disparities in renal cell carcinoma (RCC) subtypes have been well documented in the United States (US), but no comparable data exist for Afro-descendant populations living within a European healthcare system. In the US, several studies have shown a significantly higher incidence of papillary renal cell carcinoma among populations of African descent. The aim of this study is to analyze the epidemiology of kidney cancer in a French Caribbean population, mainly of African descent.Methods: This retrospective study included all patients who underwent total or partial nephrectomy, or renal biopsy at the University Hospital of Guadeloupe between January 2016 and October 2022. Data on clinical features, tumor characteristics, biology, histology and survival were collected. Statistical analyses were performed using StatView version 5.0 software.Results: A total of 126 patients had been included between January 2016 and October 2022. The median age at diagnosis was 66.0 years [IQR: 57.2–71.8]. Overall, 70% of patients had arterial hypertension, 12% were on dialysis and 5.6% had a history of kidney transplantation. Clear cell renal cell carcinoma accounted for 43% of cases and Papillary renal cell carcinoma for 36% of cases.Conclusion: These findings highlight unique epidemiological patterns in a French Afro-descendant populations and emphasize the need for molecular and clinical research focused on papillary RCC. These findings suggest potential environmental and genetic influences in the development of PRCC
The diverging role of increasing wildfire smoke to ambient PM2.5 exposure disparity in California, 2006 to 2018
No full textInternational audienceExposure to ambient fine particulate matter (PM 2.5 ) varies by structural determinants of health, through mechanisms such as racism and material deprivation. These disparities are well documented in the US across individual and community-level race and ethnicity (RE) and socioeconomic status (SES). Since 2000, California air quality has generally improved, and disparities have narrowed, tentatively attributed by previous studies to air regulations. In parallel, wildfires became major contributors to ambient PM 2.5 , with different exposure patterns from traditional emission sources. To explore wildfires’ contribution to exposure disparities, we tracked the temporal trend in total ambient PM 2.5 exposure disparities in California from 2008 to 2006 and disentangled the role of wildfire smoke. We evaluated the population-weighted and rank-ordered temporal change in total, wildfire, and non-wildfire PM 2.5 exposure across California census tracts and by RE and SES groups. We confirmed an absolute decrease in total PM 2.5 over time and fluctuations in wildfire PM 2.5 with peaks in 2008 and 2018. Census tracts with historically high total PM 2.5 exposure in 2006 were less exposed in 2018, but this rank-ordered temporal change was mostly driven by increased wildfire PM 2.5 in some tracts. Across the study period, community disparities in total PM 2.5 existed among RE and SES groups, with higher exposure among socioeconomically disadvantaged and non-Hispanic Black and Hispanic populations. Community disparities in total PM 2.5 narrowed from 2006 to 2018, yet these reductions were 9.4% to 59.5% attributable to increased wildfire PM 2.5 exposure among socioeconomically affluent or non-Hispanic populations. In summary, wildfire PM 2.5 has exaggerated the progress in reducing inequities in traditional sources of PM 2.5 , especially across racial groups and in years with severe wildfire like 2018. Additional targeted efforts are needed to reduce persistent inequities in PM 2.5 exposure from traditional sources, which can be masked by increases in wildfire PM 2.5 in an era of climate change
Cross-sectional evaluation of exposure to ozone, nitrogen dioxide, and particulate mass levels on circulating immune markers in women in the California Teachers Study
No full textInternational audienceAbstract Exposure to ambient air pollutants, specifically ozone (O 3 ), nitrogen dioxide (NO 2 ), ultrafine, fine or coarse particulate matter (PM 0.1 , PM 2.5 , and PM 10 ), has been linked to a number of adverse health outcomes, including cardiovascular disease. Changes in immune response may be a key mechanism underlying these effects. Within the California Teachers Study cohort, we conducted a cross-sectional analysis of 1,898 women to assess the associations between exposure to O 3 , NO 2 , PM 0.1 , PM 2.5 , and PM 10 and 15 immune markers measured from serum samples collected in 2015. Daily residential exposures to O 3 , NO 2 , PM 0.1 , PM 2.5 , and PM 10 were estimated by a validated chemical transport model and averaged over 12-, 3-, and 1-month periods prior to blood draw. Fifteen immune markers (categorized as quartiles) were estimated per interquartile range (IQR) of air pollutant exposures using multivariable ordinal logistic regressions adjusted for age, body mass index, and respective pollutants. Immune markers were also grouped into immune pathways (pro-inflammatory/macrophage activation, B-cell activation, and T-cell activation). After applying Bonferroni correction, elevated exposure to O 3 levels at all three exposure windows were associated with elevated circulating levels of IL-1β (interleukin-1 beta), IL-8 (interleukin 8), sTNFR2 (soluble tumor necrosis factor receptor 2), and sgp130 (soluble glycoprotein 130). Elevated O 3 at 3- and 1-month periods were associated with increased levels of sCD27 (soluble cluster of differentiation 27) and BAFF (B-cell activating factor). In pathway analyses, O 3 was consistently and significantly associated with the pro-inflammatory/macrophage activation pathway (12-month OR = 1.49, 3-month OR = 1.57, 1-month OR = 1.54) and with B-cell activation at all three exposure windows (12-month OR = 1.24, 3-month OR = 1.53, 1-month OR = 1.41). NO 2 was positively associated with TNFα at the 3- and 1-month exposure windows. For the PM size fractions, sporadic, mainly inverse, associations with immune markers were observed. Elevated O 3 exposure up to one year prior to blood draw was associated with elevated immune markers related to pro-inflammatory response, macrophage activation, and B cell activation. These findings suggest potential immunologic pathways linking air pollution to adverse health outcomes in women
Paracetamol (N-Acetyl-Para-Aminophenol) Disrupts Early Embryogenesis by Cell Cycle Inhibition
No full textInternational audienceA large percentage of pregnancies end in miscarriage or stillbirth, with estimates showing that 10% to 40% of embryos fail to implant and an additional 10% implanting but failing before clinical recognition of the pregnancy. Genetic studies have shown that up to 50% of losses can be linked to aneuploidy and other chromosomal abnormalities, demonstrating that environmental factors also play a role. N-acetyl-para-aminophenol (APAP) is a commonly used over the counter pain relieving medication (also known as acetaminophen); as many as 50% of pregnant women globally report using APAP, and high environmental background exposure through rivers and waterways has been found in several countries in Europe. This study was designed to assess whether APAP interferes with cell division and preimplantation development (PID). The mechanism of APAP’s influence on PID and cell division is thought to be related to DNA replication; DNA replication stress can be caused by the inhibition of ribonucleotide reductase (RNR), as reported in several previous studies. In this study, the effect of APAP on RNR was tested using 3 strains of fission yeast, and results showed an increased sensitivity to chemical RNR inhibition compared with controls as well as decreased proliferation. Subsequent to these experiments, further models were performed in recombinant S. pombe strain models, more correctly simulating APAP interactions with its target cells in humans, and these experiments likewise showed sensitivity to APAP, providing evidence for an inhibition of RNR. In experiments using human somatic cells and embryonic stem cells, exposure to APAP resulted in decreased total cell numbers without affecting cell function, as well as a reduction in DNA synthesis compared with controls. This was similarly true in in vitro experiments, which also showed that NAPQI is unlikely to be responsible for disruption of meiosis, thus indicating a direct effect of APAP exposure. Mouse models of APAP exposure add further evidence to this claim, as early PID in mice was disrupted at 24 and 48 hours after exposure to APAP. This disruption mainly consisted of reduced cell number and slowed development to the blastocyst stage. This effect was also dose-dependent in these models, with higher exposure dosage resulting in more drastic effects. Late PID was also disrupted with APAP exposure, but this disruption consisted of reduced numbers of cells in the ICM compared with controls. Further experiments were conducted in mouse models of pregnancy, and APAP exposure resulted in significantly decreased implantation rates as well as the number of live fetuses, and this relationship was again dose-dependent. In addition, APAP exposure was associated with an increased number of resorption points compared with controls, indicating a higher post-implantation embryonic mortality rate. Human embryos exposed to therapeutic doses of APAP experienced a slight delay in development compared with controls, as well as a reduced number of cells, indicating that these findings may be generalizable to humans. These results indicate that exposure to APAP may be related to early pregnancy loss due to the disruption of PID. This study was not adequate in scope to elucidate the exact mechanism of this disruption, though there are several possibilities that cannot yet be ruled out. Future research should focus on characterizing this mechanism as well as understanding if there are ways to reduce the impact of APAP on PID. In addition, future research should assess similar mechanisms of inhibition caused by other triggers that may contribute to early pregnancy loss. (Abstracted from Hum Reprod. 2025 Oct 1;40(10):1860-1876. doi: 10.1093/humrep/deaf116
Usagers fréquents des urgences : fondements théoriques et perspectives d’action
No full textInternational audienceLes usagers fréquents des services d’urgence (UFU) représentent, de par l’utilisation excessive qu’ils ont de ces services, un défi majeur pour les systèmes de santé du monde entier. Cette étude examine les comportements des UFU en France, en explorant les tendances longitudinales et en évaluant les facteurs individuels, organisationnels et territoriaux influençant leur utilisation. D’après les données du Système national de données de santé, les UFU représentaient 16 % des patients des structures d’urgences (SU) en 2021, mais 34 % des visites. Ces patients, qui souffrent fréquemment de troubles psychiatriques, respiratoires ou cardiovasculaires, ont des dépenses de santé considérablement plus élevées que les autres usagers des SU. Contrairement aux attentes, aucune association significative n’a été constatée entre un recours fréquent aux SU et un accès limité aux soins primaires. Nos résultats soulignent la nécessité d’une approche multidimensionnelle, combinant les perspectives individuelles et systémiques, pour améliorer la prestation de soins et optimiser l’allocation des ressources. Dans ce cadre, l’Agence régionale de santé du Grand Est a développé une solution de cartographie dynamique afin de mieux comprendre ce phénomène et de permettre des interventions ciblées. Parallèlement, le dispositif d’accompagnement des usagers multiples des urgences (DAUM) mis en place sur le Grand Nancy utilise des méthodes de détection et des stratégies d’accompagnement sur mesure. Bien que des difficultés persistent concernant l’engagement des patients et la qualité des données, les premiers résultats confirment l’utilité de profils d’intervention individualisés pour répondre aux besoins des UFU. Ces résultats ouvrent la voie à l’élaboration de stratégies efficaces de prévention primaire ciblant les facteurs de risque associés à une fréquentation fréquente des urgences
Energy and Waste
No full textThe Anthropocene epoch is defined by the profound impacts of human activity on natural ecosystems. Industrial processing of raw materials produces vast quantities of man-made matter including materials, wastes, and residues, which Harpet (2001) termed the rudosphere. Monsaingeon (2017) further introduced the term poubellocene to characterize this era of waste and a wasteful world (UNEP 2024). In France, the article L541-1 from the Environment Code defines waste as “any residue from a production, transformation, or use process, any substance, material, product, or more generally any good or piece of furniture that is abandoned or that its holder intends to abandon.” In other words, the term waste is generic, qualifying any element that is abandoned
Etude de la survie des microorganismes collectés par des filtres de centrales de traitement d'air
No full textInternational audienceSampling microbial aerosols may be difficult due to their low concentration. Air handling unit (AHU) filters, which accumulate these bioaerosols with large volumes of treated air, represent an alternative for studying the airborne microbiota in buildings. However, the survival of microorganisms on these filters remains poorly understood. This study proposes to analyze the viability within a microbial community on an AHU filter in the presence of model dust (corn starch powder). During a one-year study and under real-world conditions (full-scale AHU model), the survival and evolution of three model microorganisms were monitored: Aspergillus niger (spores), Bacillus subtilis (in spore form), and Staphylococcus epidermidis (in vegetative form), using agar culture and molecular biology methods. The results show that spore-forming microorganisms accumulate and are able to grow on the filter, even when exposed to high air velocity. This growth is accompanied by an increase in the water content of the filter and is followed by a mortality phase (decrease in culture counts). The microorganisms in vegetative form are rapidly lysed and their DNA degraded. In conclusion, microbial growth is possible on the surface of AHU filters and depends heavily on the amount of water available and the nature of the microorganisms. The identification of microorganisms in filter samples, by culture or molecular biology, is strongly influenced by the nature of the microorganisms, as well as the humidity and temperature in the AHU.L'échantillonnage des aérosols microbiens peut-être difficile dans l'air en raison de leur faible concentration. Les filtres de centrales de traitement d'air (CTA), qui accumulent ces bioaérosols du fait des grands volumes d'air traités, représentent une alternative pour l'étude du microbiote aérien des bâtiments. Cependant, la survie des microorganismes sur ces filtres reste mal comprise. Cette étude propose d'analyser la viabilité au sein d'une communauté microbienne sur un filtre de CTA en présence d'une poussière modèle (poudre d'amidon de maïs). Pendant un an et en conditions réalistes (modèle de CTA à échelle 1), la survie et l'évolution de trois microorganismes modèles ont été suivies : Aspergillus niger (spores), Bacillus subtilis (sous forme sporulée) et Staphylococcus epidermidis (sous forme végétative), en utilisant la culture sur milieu gélosé et des méthodes de biologie moléculaire. Les résultats montrent que les microorganismes sporulés s'accumulent et sont capables de croître sur le filtre, même lorsqu'ils sont exposés à une vitesse d'air élevée. Cette croissance est concomitante à une augmentation de la teneur en eau du filtre et du gâteau de filtration et est suivie d'une phase de mortalité (diminution des dénombrements par culture). En revanche, les microorganismes sous forme végétative sont rapidement lysés et leur ADN dégradé. En conclusion, la croissance microbienne est possible à la surface des filtres de CTA et dépend fortement de la quantité d'eau disponible ainsi que de la nature des microorganismes. L'identification des microorganismes dans les échantillons de filtre, qu'elle soit par culture ou par biologie moléculaire, est donc fortement influencée par la nature des microorganismes, ainsi que l'humidité et la température dans la CTA
La transition écologique dans les organisations de santé : retour d’expérience d’une formation-action à l’EHESP
No full textInternational audienc
Intensive monitoring of workers’ health outcomes in a warming world: Opportunities and challenges
No full textInternational audienceIt is estimated that around 1 billion workers endure excessive heat exposure and more than one in three workers exposed to heat suffer from heat strain. Heat strain is broadly defined as the physical and psychological responses of the body caused by heat exposure. Heat strain increases the risk of work injuries and severe heat illness, that can ultimately cause death. With ongoing climate change, it is expected that the prevalence of heat strain will increase, reinforcing the need for effective prevention strategies
Santé environnementale et transition écologique du système de santé
No full textInternational audienceFace à l’urgence climatique et aux effets de l’environnement sur la santé, la transition écologique du système de santé est devenue un enjeu majeur. Cet ouvrage propose une synthèse structurée et opérationnelle des fondements de la santé environnementale et de leur application au champ sanitaire et médico-social.Il réunit les définitions essentielles des notions clés (santé environnementale, transition écologique, décarbonation des activités…), un état des lieux du cadre juridique, des politiques publiques et des connaissances actuelles (PNSE 4, feuille de route de planification écologique du système de santé), ainsi que des exemples concrets de démarches de transition mises en œuvre dans les établissements de santé et médico-sociaux.Une annexe méthodologique dédiée aux concours administratifs complète l’ouvrage, avec des conseils pratiques et des exemples de sujets.Initialement conçu pour les candidats aux concours d’entrée à l’EHESP, ce livre s’adresse également aux professionnels du système de santé souhaitant intégrer les enjeux environnementaux dans leurs pratiques, leurs décisions et leurs engagements, ainsi qu’à toutes celles et ceux désireux de concilier expertise sanitaire et responsabilité écologique