Carbonne A.,CCLIN Paris Nord |
Arnaud I.,CCLIN Paris Nord |
Maugat S.,InVS |
Marty N.,University Hospital |
And 11 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2013
Background: In the mid-1990s, the prevalence rate of multidrug-resistant bacteria (MDRB) in French hospitals was high and control of MDRB spread then became a major priority in the national infection control programme (ICP). Methods: To evaluate the impact of the ICP, a national coordination of MDRB surveillance was set up in 2002. Data were collected 3months a year in healthcare facilities (HCFs) on a voluntary basis. All clinical specimens of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) were prospectively included. Incidences per 1000 patient days (PDs) were calculated and trends in incidence from 2003 to 2010 were assessed. Results: Participation in the surveillance increased from 478 HCFs in 2002 to 933 in 2010. In 2010, MRSA incidence was 0.40/1000 PDs: 1.14 in intensive care units (ICUs), 0.48 in acute care facilities (ACFs) and 0.27 in rehabilitation and long-term care facilities (RLTCFs). ESBLE incidence was 0.39/1000 PDs: 1.63 in ICUs, 0.46 in ACFs and 0.23 in RLTCFs. MRSA incidence significantly decreased from 0.72/1000 PDs in 2003 to 0.41/1000 PDs in 2010 (P < 10-3); in contrast, ESBLE incidence significantly increased from 0.17/1000 PDs to 0.48/1000 PDs (P < 10-3). The most prevalent ESBLE were Enterobacter aerogenes (34%) and Escherichia coli (25%) in 2003 and E. coli (60%) and Klebsiella pneumoniae (18%) in 2010. Conclusion: These results demonstrate the positive impact of the national ICP on MRSA rates. In contrast, ESBLE incidence, especially ESBL-producing E. coli, is increasing dramatically and represents a serious threat for hospitals and for the community that deserves specific control actions. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Mienne A.,InVS |
Mandereau-Bruno L.,InVS |
Isnard H.,InVS |
Environnement, Risques et Sante | Year: 2014
The soil and vegetables of family gardens located in Aubervilliers have moderate pollution due to trace metal contamination. This presents potential health risks in a worst-case scenario of high levels of consumption from these gardens. A survey of vegetable production over the past 12 months and the eating habits of the gardeners and their families was conducted to estimate their use of their homegrown products, look for factors encouraging consumption of homegrown products, and study these practices in urban areas. The study of 58 gardeners shows the importance of vegetable products in the diet of urban gardeners. During the harvest season, the high median homegrown-consumption rate (86%) and the high percentage of gardeners (57%) with a consumption rate of at least 80%, as well as the existence of totally self-sufficient people, resemble behavior observed in rural areas. Three factors related to high homegrown consumption (≥ 80%) were highlighted : the age of the garden, the time spent in the garden during winter, and the number of species cultivated.
Lucas J.-P.,French Scientific and Technical Center for Building |
Lucas J.-P.,University of Nantes |
Le Bot B.,University of Paris Pantheon Sorbonne |
Le Bot B.,French Institute of Health and Medical Research |
And 9 more authors.
Environmental Research | Year: 2012
Lead in homes is a well-known source of childhood lead exposure, which is still of concern due to the health effects of low lead doses. This study aims to describe lead contamination in the homes of children aged 6 months to 6 years in France (without overseas).Between October 2008 and August 2009, 484 housing units were investigated. Lead in tap water and total and leachable lead levels from floor dust, outdoor soils and paint chips were measured. X-ray fluorescence measurements were carried out on non-metallic and metallic substrates. Nationwide results are provided. The indoor floor dust lead (PbD) geometric mean (GM) was 8.8 μg/m2 (0.8 μg/ft2) and 6.8 μg/m2 (0.6 μg/ft2) for total and leachable lead respectively; 0.21% of homes had an indoor PbD loading above 430.5 μg/m2 (40 μg/ft2). The outdoor play area concentration GM was 33.5. mg/kg and 21.7. mg/kg in total and leachable lead respectively; 1.4% of concentrations were higher than or equal to 400. mg/kg. Outdoor floor PbD GM was 44.4 μg/m2 (4.1 μg/ft2) that was approximately 3.2 times higher than the GM of indoor PbD. Lead-based paint (LBP) was present in 25% of dwellings, LBP on only non-metallic substrates was present in 19% of homes and on metallic substrates in 10% of dwellings. The GM of lead concentrations in tap water was below 1 μg/L; 58% of concentrations were lower than 1 μg/L and 2.9% were higher than or equal to 10 μg/L. The age cut-off for homes with lead would be 1974 for paint and 1993 for indoor floor dust. This study provides, for the first time, a look at the state of lead contamination to which children are exposed in French housing. Moreover, it provides policy makers an estimate of the number of French dwellings sheltering children where abatement should be conducted. © 2012 Elsevier Inc.
Kermarec F.,InVS |
Environnement, Risques et Sante | Year: 2010
Experience has shown that, for many reports of health problems attributed to the environment that arrive at the French Institute of Public Health Surveillance, optimal response requires understanding and identifying their background and context. Numerous factors can engender real or perceived health problems that cannot be attributed to medical factors alone; other sources include the social and psychosocial environments and even the individual psychic state. The environmental health department has sought to identify the social science disciplines likely to help expand its analysis. We have discussed these issues with specialists in neuropsychiatry, psychoanalysis, psychosociology, sociology and anthropology. Acute collective phenomena (such as sick building syndrome or mass psychogenic illnesses) of unexplained origin are an excellent example for drawing out the advantages of these collaborations, for such situations combine the requirement of scientific openness with the need to react and respond rapidly. The key points demonstrate the ineluctability of interdisciplinary work, the need to master these methods, and the ability of each field to participate in a communal responsive to analyse the initial elements of the situation. These different points are the essential links in the chain making possible the operational concretisation of these collaborations and the more accurate pinpointing of their respective roles within a given intervention.
Mandin C.,University Paris Est Creteil |
Dor F.,InVS |
Boulanger G.,Anses |
Cabanes P.-A.,Électricité de France |
Environnement, Risques et Sante | Year: 2012
A health risk assessment linked to the inhalation of formaldehyde by the general population in France was conducted according to the standardized four-step process of risk assessment: hazard identification, dose-response assessment, exposure assessment and risk characterization. The originality of this work consisted in assessing both acute exposure during or after using household products, and chronic exposure through exposure situations in various, regularly frequented places. The quantitative risk assessment was conducted on the basis of toxicity reference values (TRVs) for acute and chronic exposure and a range of hazard quotients (HQ) was calculated in both contexts. For almost all of the consumer products, tested in normal conditions of use, acute inhaled formaldehyde concentrations are lower than the TRVs calculated to protect against ocular and nasal irritation. However, for three domestic products, acute TRVs are reached or exceeded, and exposures are thus capable of causing ocular and nasal irritation. Regarding chronic exposure, the time spent in the home leads to inhaled concentrations exceeding the chronic TRVs protecting against long-term ocular and nasal irritation. The dose-effect relationship does not indicate the occurrence of other non-carcinogenic effects, even for the highest inhaled concentrations and for the worst case scenario. It appears that the highest inhaled concentrations are at only one tenth of the levels for which irritations might trigger nasopharyngeal cancer.
Venier A.-G.,Bordeaux University Hospital Center |
Venier A.-G.,French Institute of Health and Medical Research |
Lavigne T.,Service dHygiene Hospitaliere |
Jarno P.,Rennes University Hospital Center |
And 4 more authors.
Clinical Microbiology and Infection | Year: 2012
Individual and ward risk factors for P. aeruginosa-induced urinary tract infection in the case of nosocomial urinary tract infection in the intensive care unit were determined with hierarchical (multilevel) logistic regression. The 2004-2006 prospective French national intensive care unit nosocomial infection surveillance dataset was used and 3252 patients with urinary tract infection were included; 16% were infected by P. aeruginosa. Individual risk factors were male sex, duration of stay, antibiotics at admission and transfer from another intensive care unit. Ward risk factors were patient turnover and incidence of P. aeruginosa-infected patients. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.
Lucas J.-P.,French Scientific and Technical Center for Building |
Lucas J.-P.,University of Nantes |
Bellanger L.,French National Center for Scientific Research |
Le Strat Y.,InVS |
And 8 more authors.
Science of the Total Environment | Year: 2014
Evidence of the impact of exposure to low levels of lead on children's health is increasing. Residential floor dust is the assumed origin of lead exposure by young children. In this study, we estimate the contribution of different lead sources to household interior floor dust contamination. We also estimate the within-home variability of interior floor dust lead loadings. A multilevel model was developed based on data collected in a French survey in 2008-2009 (484 housing units, 1834 rooms). Missing data were handled by multiple imputation using chained equations. The intra-home correlation between interior floor Log dust lead loadings was approximately 0.6. Dust lead from the landing of an apartment, mostly originating outside the building, was the major contributor to interior floor dust lead. Secondary contributors included the lead-based paint on exterior railings, track-in of the exterior soil of the children's play area into the dwelling, smoking inside the home, demolition of nearby old buildings and sites of pollution in the vicinity. Interior lead-based paint contaminated interior floor dust only in old and non-renovated dwellings. To reduce interior floor dust lead levels in the general population of dwellings, common areas should be maintained, and track-in from the outside should be limited as much as possible. © 2013 Elsevier B.V.
Mathieu-Huart A.,ANSES |
Archives des Maladies Professionnelles et de l'Environnement | Year: 2013
Purpose of the study In a context of uncertainties, when trying to determine a health risk for the population associated with exposure to a chemical, a health risk assessment method is required. This approach requires to organize the available knowledge concerning exposure-related adverse effects, appropriate TRVs (toxicological reference values) and in parallel to determine the exposure levels of the target population (adults and children). The data are then confronted for defining the necessary public health measures to be taken for this population. The choice of the TRV to be used according to the context is important in this approach. TRVs are developed by various agencies (US EPA, ATSDR, Health Canada, WHO, RIVM, EFSA, Anses) for a specific period of exposure (acute, subchronic and chronic) and for two types of toxic effects (threshold and non-threshold). Although human variability in susceptibility is taken into account for defining the most appropriate TRV, it is not possible to guarantee the inclusion of hypersensitive individuals for example. Also, many health risk assessors have raised concerns about the applicability of TRVs to specific populations, in particular to children because although in most cases, uncertainty factors, inter-species then intra-species, are taken into account (for substances with threshold toxic effects) in fact most of the toxicity studies used adult animals and not juvenile animals. Methods Through the review of the various documents developed by agencies, their points of view concerning the applicability to children of agencies TRVs are exposed. Results Concerning TRVs for threshold toxicity, points of view are divided between agencies. Some of them (US EPA, Health Canada and ATSDR) consider that TRVs are protective for the general population including children. Danish EPA, KEMI, RIVM consider that it is necessary to add factors to protect children. OEHHA and ECHA recommends to build a specific TRV and JECFA and FAO/WHO recommend to precise the age of TRV applicability. Concerning TRVs without threshold toxicity, the point of view of three agencies is available. UBA and US EPA recommend using an additional uncertainty factor for mutagenic carcinogens according to the age of the children. OEHHA recommends to use this factor for all carcinogenic substances (whether mutagenic or not). Discussion There is no international consensus for the applicability or not of TRVs to children. In France, ANSES considers that TRVs protect the whole population. © 2013 Elsevier Masson SAS. All rights reserved.
Goldberg S.,INCa |
Goldberg S.,Institute of Veille Sanitaire |
Rey G.,French Institute of Health and Medical Research |
Luce D.,University of Versailles |
And 5 more authors.
Occupational and Environmental Medicine | Year: 2010
Background: In population-based mesothelioma studies in industrialised countries, the incidence of mesothelioma without any identified asbestos exposure (IAE) is usually higher among women, while male incidence is mainly attributed to IAE. Through a comparison of the spatial distribution of male and female rates, and IAE and no IAE incidence, this study investigated whether mesotheliomas without IAE are in fact induced by nonrecognised asbestos exposure, mostly from environmental sources. Methods: We calculated mesothelioma mortality (SMR) and incidence (SIR) ratios by district in France, pooling 30 and 10 years of data, respectively. Using correlation coefficients, we compared geographical patterns of male and female mesothelioma ratios, and IAE and no IAE mesothelioma ratios. Results: The raw numbers of male and female mesothelioma cases were equivalent. Mesothelioma SMR (0.76) and SIR (0.80) geographical correlations between men and women were strongly positive. SIR correlation between occupationally IAE and no IAE cases was also positive (0.69). Correlation between occupationally IAE and no IAE cases was positive among women but not among men. Conclusions: Data analyses of mesothelioma mortality and incidence showed that female cases occur in the same geographical areas as male cases. Female mesotheliomas with no IAE occur in the same geographical areas as exposed cases, suggesting asbestos has a major influence on female mesothelioma, likely through environmental exposure.
PubMed | French Institute of Health and Medical Research, University of Paris Pantheon Sorbonne, University of Nantes, French National Center for Scientific Research and 3 more.
Type: | Journal: The Science of the total environment | Year: 2014
Evidence of the impact of exposure to low levels of lead on childrens health is increasing. Residential floor dust is the assumed origin of lead exposure by young children. In this study, we estimate the contribution of different lead sources to household interior floor dust contamination. We also estimate the within-home variability of interior floor dust lead loadings. A multilevel model was developed based on data collected in a French survey in 2008-2009 (484 housing units, 1834 rooms). Missing data were handled by multiple imputation using chained equations. The intra-home correlation between interior floor Log dust lead loadings was approximately 0.6. Dust lead from the landing of an apartment, mostly originating outside the building, was the major contributor to interior floor dust lead. Secondary contributors included the lead-based paint on exterior railings, track-in of the exterior soil of the childrens play area into the dwelling, smoking inside the home, demolition of nearby old buildings and sites of pollution in the vicinity. Interior lead-based paint contaminated interior floor dust only in old and non-renovated dwellings. To reduce interior floor dust lead levels in the general population of dwellings, common areas should be maintained, and track-in from the outside should be limited as much as possible.