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P-100 Occupational exposure and co-exposure to physical constraints and neurotoxic chemicals in French workers: results from the SUMER study
No full textInternational audienceIntroductionGiven the high incidence of carpal tunnel syndrome in the working population and the co-exposure of workers, it is necessary to improve knowledge of the joint effects of physical and chemical exposures in order to improve prevention strategies. The aim of this study was to assess the prevalence of occupational exposure and co-exposure to physical constraints and neurotoxic chemicals. MethodsThe study sample was composed of 26,444 workers included in the French cross-sectional survey SUMER 2017s. Occupational exposure within the previous week of work were assessed using a questionnaire during face-to-face interviews with occupational physicians. Four physical constraints were studied: manual handling of loads, forceful joints exertion, repetitive movement and hand-arm transmitted vibrations. Nineteen neurotoxic chemicals were studied: perchloroethylene, trichloroethylene, white-spirit, formaldehyde, etc. Analyses were conducted using weighted data. ResultsApproximately 24% of men and 11% of women were exposed to at least one physical constraint, and 14% of men and 12% of women were exposed to at least one neurotoxic chemical. About 6% of men and 3% of women were co-exposed to physical constraints and neurotoxic chemicals. Male and female workers under 30 years old and blue-collar workers were more co-exposed than other workers. Male workers in the construction were more co-exposed than other male workers. DiscussionDespite the frequency of co-exposures, very few data are available in the literature on the combined effects of physical and neurotoxic chemical exposures on the risk of CTS. ConclusionOccupational co-exposure to physical constraints and neurotoxic chemicals was observed in a significant proportion of French workers
La géographie des établissements et des services médico-sociaux : entre exigence d’équité territoriale et héritages historiques locaux
No full textInternational audience- Un secteur historiquement peu encadré à la gouvernance complexe :- 1975 : le choix d’une régulation a minima pour inciter l’initiative locale et la création de places,- 1986 : une gouvernance partagée entre l’État et les départements - Les années 2000 : entre régionalisation et centralisation :- La création de nouvelles agences, nationale et régionales, pour amorcer un rééquilibrage territorial, - L’introduction d’outils et d’instruments de régulation pour anticiper et contrôler le développement de l’offre - Une localisation des établissements médico-sociaux : des logiques nationales travaillées par des enjeux locaux anciens, politiques et économiques :- La localisation : entre logique de contrôle des coûts, multiplication des échelles décisionnelles et enjeux politiques locaux, - Des enjeux nationaux travaillés par des logiques locales : l’exemple de la Lozère
Évaluer l’impact environnemental des soins : l’exemple de la dépression
No full texthttps://theconversation.comSaviez-vous que le système de santé contribue de manière significative au changement climatique, puisqu'il est responsable d'environ 5 % du total des émissions de carbone dans le monde ? Ce fait attire de plus en plus l'attention
An Analysis of the Health Effects of Physical Activity due to Active Travel Policies in Rennes, France
No full textInternational audienceBackground Rennes, a midsize city in France, features many opportunities for active travel. City officials seek to increase walking and cycling by 2030 to improve public health. Physical inactivity, a leading risk factor for premature mortality around the globe, has been shown to be associated with many chronic diseases including heart disease, type 2 diabetes, and cancer. Methods Using the 2018 household travel survey of Rennes residents, we apply the Health-Oriented Transportation statistical model to assess health impacts associated with population-level rates of walking and cycling. We consider two proposed mobility and climate objectives which outline sustainable transportation goals by 2030. These include a shift in transportation mode share to increase walking and cycling trips, as well as a broad reduction in vehicle miles traveled (VMT) across the metropolitan area. Results Our regression analysis demonstrated that factors of household car access and inner-city residency were predictors of prevalence (observed one-day proportion engaging in walking or cycling), participation (weekly proportion), and intensity (mean individual physical activity achieved through walking/cycling) of active travel. Age and education were additionally associated with prevalence. The 2030 mobility objective (mode share: 9% cycle, 35% walk) was associated with a reduction of 1,051 DALYs (disability-adjusted life-years), translating to 23-26 million (62) and 15-$121) saved, respectively. Conclusions Rennes residents experience high participation in active travel, particularly those in the inner city. If residents achieve the city’s active travel goals for 2030, there is potential for a large reduction in health burden and subsequent costs. Reaching these goals may require significant investment in transportation programming and infrastructure to improve active travel opportunities
Chapitre 6 « Le lobbying de la filière alcool : un frein au déploiement des mesures de prévention efficaces »
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Analyse temporelle des concentrations de pesticides dans l'air breton : un aperçu historique des mesures
No full textInternational audience"Pesticide" comes from the Latin Pestis: plague and Caedere: to kill. In conventional agriculture, pesticides aremost often applied by spraying the soil and plants. Transfers into the air can occur via drift during application,volatilization from soil and plants, and wind erosion in the form of dust from treated soil. Once in the atmosphere,these substances are found in both gaseous and particulate form, the distribution between these two phasesdepending on their physicochemical properties (vapour pressure). Since 2003, Air Breizh has been carrying outmeasurement campaigns across Brittany, in various agricultural production contexts (field crops, livestock farming,market gardening). A total of 11 different sites have been the subject of one or more measurement campaigns, inthe form of weekly samplings using a Partisol on the PM10 or TSP fractions of particles, at a flow rate of 1 m3/h.Processing of this database brings out results in terms of concentration levels encountered, changes over time,dominant category (herbicides), impact of distance, and impact of regulation.« Pesticide » vient du latin Pestis : fléau et Caedere : tuer. En agriculture conventionnelle, les pesticides sont le plus souvent appliqués via une pulvérisation sur le sol et les plantes. Les transferts dans l’air peuvent s’effectuer par dérive au moment de l’application, par volatilisation à partir des sols et des plantes, et par érosion éolienne sous forme de poussière de sols traités. Une fois dans l’atmosphère, on retrouve ces substances à la fois sous forme de gaz et de particules, la répartition entre ces deux phases dépendant de leurs propriétés physicochimiques (pression de vapeur). Depuis 2003 Air Breizh mène des campagnes de mesure sur le territoire breton dans différents contextes de production agricole (grandes cultures, élevage, maraîchage). Au total 11 sites différents ont fait l’objet d’une ou plusieurs campagnes de mesure, sous la forme de prélèvements hebdomadaires réalisés à l’aide d’un Partisol sur les fractions PM10 ou TSP des particules, pour un débit d’1 m3/h. Le traitement de cette base de données fait ressortir des résultats notamment en termes de niveaux de concentration rencontrés, d’évolution dans le temps, de catégorie dominante (les herbicides), d’impact de la distance, et d’impact de la réglementation
Ultrafine particles monitoring in Paris: from total number concentrations to size distributions measurements
No full textInternational audienceDue to their small size and ability to penetrate deeply into the respiratory system, ultrafine particles (UFP) pose a significant health risk. Their concentrations and sources are not consistently monitored and regulated in urban areas, including Paris. This study aims at presenting an overview of UFP measurements carried out in Paris from October 2019 to December 2022 using a mobility particle size spectrometer (MPSS). An averaged particle number concentration (PNC) of 8,100 ± 4,800 # cm-3 was recorded between 8 and 100 nm on the analysis period, which was consistent with UFP concentrations usually observed in urban background conditions (< 104 # cm-3). The maximum PNC often exceeded World Health Organization (WHO) indicative values (10,000 # cm-3 and 20,000 # cm-3 daily and hourly averages respectively), thus emphasizing the need for ongoing UFP monitoring in Paris city. At the annual scale, averaged UFP concentrations were lower in 2020 (6,600 ± 3,900 # cm-3) compared to 2021 and 2022 (8,100 ± 4,600 # cm-3 and 8,700 ± 4,700 # cm-3, respectively). This variability is depending on meteorological conditions and pollutant emissions, particularly during the first COVID-19 lockdown phase. UFP cycles can be attributed to anthropogenic emissions, mainly from road-traffic, with hourly maximum concentrations correlated with black carbon (BC, r = 0.50 with p < 0.05). A correlation analysis with other pollutants also allowed to confirm road-traffic as a major UFP source in Paris due to high UFP associations with nitrogen dioxide (NO2, r = 0.58 with p < 0.05) and organic matter (OM, r = 0.53 with p < 0.05). Concerning particle number size distribution (PNSD) measurements, a predominant particle mode between 20 and 30 nm (Aitken mode) was observed and linked to vehicular emissions. Finally, this study is worthwhile to support policymakers and to supply future epidemiological studies to better assess UFP health impacts with the ultimate aim of defining regulation thresholds
Establishing the effectiveness of complex health promotion interventions: Shining light on alternatives
No full textInternational audienceA large share of the programmes and policies developed by field workers to cater to the specific needs of local populations are not amenable to the evaluation methods and designs which are typically ranked at the top of the evidence pyramid and usually seek to study only one factor at a time, all other things being equal. This is a major impediment to the development and improvement of local programmes that are accounting for the specific resources and barriers found locally and that adopt a participatory strategy. In this pre-conference, we will reflect on the challenges facing health promotion practitioners and researchers in establishing the effectiveness of their programmes and policies and will explore alternatives to the traditional epistemological and methodological perspectives.Through presentations on the epistemological and methodological perspectives driving new evaluative approaches, discussions on real-life experiences, and small-group activities, this interactive preconference will offer a wealth of ideas and knowledge to public health professionals, researchers and policy makers and provide them with opportunities to build collaborations and expand their networks. Materials presented during this pre-conference and the consensus built among the participants will feed into the writing of a statement to be disseminated through the channels and networks of the organisers. This event is building on the Global Handbook of Health Promotion Research initiated by the UNESCO Chair Global Health & Education
Perception des néphrologues sur les recommandations de la Haute Autorité de Santé : une étude qualitative.
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Impact of multiple sclerosis on employment and income: Insights from a random sample representative of private sector employees in France using longitudinal administrative data
No full textInternational audienceIn France, few data sources are available to estimate the impact of multiple sclerosis (MS) on job retention and its consequences on the level of resources, especially in large representative samples. The aim of the present study was to measure impact of MS on employment rates, wages and income (including unemployment benefit, sickness benefit and disability pension) by comparing work trajectories of people living with MS with those of a matched control group. We used the HYGIE database, which is the result of the linkage of two administrative databases in the private sector for a random sample of over 900,000 people. In order to identify the causal effect of MS on employment after 1 to 20 years, the difference-in-differences method with matching (age, sex, career and health history) was used, overall and in subgroups. The year of entry in long-term disease status for MS was used to approximate the onset of MS. Overall, 946 people with MS were included. Their situation was fairly favorable before MS (88.1% in employment, resources higher than the median for the general population), but MS had strong and continuous negative effects. Indeed, at 10 years, the employment rate fell by 28.6 percentage points (pp) and the disability pension allowance increased by 50.5 pp; the wage percentile fell by 19.2 pp and the replacement income accounted for a growing share of total income (+ 39.7 pp). Although administrative data had several strengths, clinical information on the severity of the disease or on its therapeutic management was not available. In conclusion, this study shows that the effects of MS on the employed population in the private sector occur early in the disease course and are cumulative, and that replacement income helps to reduce the loss of resources thanks to the French health and social system