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.

Identifying profiles of people aged 65 and over who fall at home and associated falling-induced injuries: The French ChuPADom study.

BACKGROUND: Falls in older people are a major public health problem due to associated morbidity and mortality. Their origin is most often multifactorial. OBJECTIVE, DESIGN AND SUBJECTS: The objective of the present study, called ChuPaDom, was to identify patterns or profiles of home fallers (HF) - understood here as people who fall in their place of residence - among a sample of persons aged 65 and over who were hospitalized after a fall, and to study their association with falling-induced injuries using data from the ChuPAdom study. METHODS: Multiple correspondence analysis and Hierarchical Clustering on Principal Components were performed. Multivariate logistic regression was used to test for associations between HF profiles and injuries. RESULTS: The sample comprised 1467 patients (69% female, average age = 84.5 years). Five profiles were identified: youngest seniors who took risks and fell from a raised height, youngest seniors with specific health problems who fell down a stairs, autonomous seniors who fell because they lost their balance or fell from their own height, dependent seniors who fell during low-intensity activities, very old seniors for whom missing data were frequent. Fractures were more frequent among the first profile than the last two profiles constituted with more dependent individuals (p < 0.001). CONCLUSION: These results highlight the heterogeneity of the circumstances in which older people fall. A greater understanding of these circumstances is needed to implement targeted prevention actions.

Syndromic surveillance: A key component of population health monitoring during the first wave of the COVID-19 outbreak in France, February-June 2020.

BACKGROUND: The French syndromic surveillance (SyS) system, SurSaUD®, was one of the systems used to monitor the COVID-19 outbreak. AIM: This study described the epidemiological characteristics of COVID-19-related visits to both emergency departments (EDs) and the network of emergency general practitioners known as SOS Médecins (SOSMed) in France from 17 February to 28 June 2020. METHODS: Data on all visits to 634 EDs and 60 SOSMed associations were collected daily. COVID-19-related visits were identified using ICD-10 codes after coding recommendations were sent to all ED and SOSMed doctors. The time course of COVID-19-related visits was described by age group and region. During the lockdown period, the characteristics of ED and SOSMed visits and hospitalisations after visits were described by age group and gender. The most frequent diagnoses associated with COVID-19-related visits were analysed. RESULTS: COVID-19 SyS was implemented on 29 February and 4 March for EDs and SOSMed, respectively. A total of 170,113 ED and 59,087 SOSMed visits relating to COVID-19 were recorded, representing 4.0% and 5.6% of the overall coded activity with a peak in late March representing 22.5% and 25% of all ED and SOSMed visits, respectively. COVID-19-related visits were most frequently reported for women and those aged 15-64 years, although patients who were subsequently hospitalised were more often men and persons aged 65 years and older. CONCLUSION: SyS allowed for population health monitoring of the COVID-19 epidemic in France. As SyS has more than 15 years of historical data with high quality and reliability, it was considered sufficiently robust to contribute to defining the post-lockdown strategy.

[Sport accidents in Haute-Savoie: Results from the EPAC 2004-2013 survey]. / Accidents de sport en Haute-Savoie : données de l'Enquête EPAC 2004-2013.

Regular physical activity and sport have many health benefits but they can also result in injury, which can be quite severe. Data recorded from 2004 to 2013 in an Haute-Savoie emergency department for the home and leisure injuries survey (EPAC) were analyzed in order to describe the characteristics of sport related injuries in an area particularly attractive for winter and air sports. A total of 43,505 sport related injuries were recorded: team sports (30%), winter sports (25%) and cycling (23%) accounted for the most accidents. Men were more at risk than women (sex ratio = 2.3), and the age group 10-14 years were mostly injured (21% of all injuries). Overall, falls were the most frequent mechanism of injury. Climbing, winter sports and air sports led to the most hospitalizations. The risk of hospitalization following a sport related injury was higher in men, when age increased and when the place of residence was located outside Haute-Savoie. Complementary surveys are necessary to estimate the impact on injury incidence of the use of protective equipment (helmet, gloves), the level of sporting proficiency, level of supervision, or whether or not the victim was a member of a sport club.

Assessment of 16-month Sequelae Due to Dog Bites Originally Studied in a French Multicenter Survey from 2009 to 2011.

INTRODUCTION: Every year in France dog bites lead to several thousand visits to emergency departments and numerous hospital admissions. OBJECTIVE: This study aims to describe the sequelae 16 months after dog bites. MATERIALS AND METHODS: Following an initial epidemiological study on the severity of 485 dog bites carried out in 8 hospital emergency departments between May 1, 2009, and June 30, 2010, a second study investigating sequelae 16 months after the bite was conducted among 298 patients between September 2010 and December 2011. Data concerning patients' sequelae were collected by telephone or email. RESULTS: Almost half of respondents (47%) reported sequelae; of those patients, most of these reports were aesthetic (9/10). There were more sequelae when the bite was located in the head region or the lower limbs. Sequelae were more frequent among women, when the weight of the biting dog was higher, and when the initial severity of the bite was greater. On the other hand, the link between the patient and the dog, the sex of the dog, the type of aggression, and the age of the patient (< 15 years or ≥ 15 years) had no impact on the occurrence of sequelae. One patient in 7 still experienced pain 16 months after the bite; women were more likely to experience pain at that timepoint. No articles on dog bite sequelae were found in the literature. CONCLUSIONS: The dissemination of these results among professionals (veterinarians and doctors) and the general population will contribute to making dog owners more aware of the risk of bites and the means of avoiding them.

Developing a data-driven spatial approach to assessment of neighbourhood influences on the spatial distribution of myocardial infarction.

BACKGROUND: There is a growing understanding of the role played by 'neighbourhood' in influencing health status. Various neighbourhood characteristics-such as socioeconomic environment, availability of amenities, and social cohesion, may be combined-and this could contribute to rising health inequalities. This study aims to combine a data-driven approach with clustering analysis techniques, to investigate neighbourhood characteristics that may explain the geographical distribution of the onset of myocardial infarction (MI) risk. METHODS: All MI events in patients aged 35-74 years occurring in the Strasbourg metropolitan area (SMA), from January 1, 2000 to December 31, 2007 were obtained from the Bas-Rhin coronary heart disease register. All cases were geocoded to the census block for the residential address. Each areal unit, characterized by contextual neighbourhood profile, included socioeconomic environment, availability of amenities (including leisure centres, libraries and parks, and transport) and psychosocial environment as well as specific annual rates standardized (per 100,000 inhabitants). A spatial scan statistic implemented in SaTScan was then used to identify statistically significant spatial clusters of high and low risk of MI. RESULT: MI incidence was non-randomly spatially distributed, with a cluster of high risk of MI in the northern part of the SMA [relative risk (RR) = 1.70, p = 0.001] and a cluster of low risk of MI located in the first and second periphery of SMA (RR 0.04, p value  =  0.001). Our findings suggest that the location of low MI risk is characterized by a high socioeconomic level and a low level of access to various amenities; conversely, the location of high MI risk is characterized by a high level of socioeconomic deprivation-despite the fact that inhabitants have good access to the local recreational and leisure infrastructure. CONCLUSION: Our data-driven approach highlights how the different contextual dimensions were inter-combined in the SMA. Our spatial approach allowed us to identify the neighbourhood characteristics of inhabitants living within a cluster of high versus low MI risk. Therefore, spatial data-driven analyses of routinely-collected data georeferenced by various sources may serve to guide policymakers in defining and promoting targeted actions at fine spatial level.

Task-sharing of HIV care and ART initiation: evaluation of a mixed-care non-physician provider model for ART delivery in rural Malawi.

BACKGROUND: Expanding access to antiretroviral therapy (ART) in sub-Saharan Africa requires implementation of alternative care delivery models to traditional physician-centered approaches. This longitudinal analysis compares outcomes of patients initiated on antiretroviral therapy (ART) by non-physician and physician providers. METHODS: Adults (≥15 years) initiating ART between September 2007 and March 2010, and with >1 follow-up visit were included and classified according to the proportion of clinical visits performed by nurses or by clinical officers (≥ 80% of visits). Multivariable Poisson models were used to compare 2-year program attrition (mortality and lost to follow-up) and mortality by type of provider. In sensitivity analyses only patients with less severe disease were included. RESULTS: A total of 10,112 patients contributed 14,012 person-years to the analysis: 3386 (33.5%) in the clinical officer group, 1901 (18.8%) in the nurse care group and 4825 (47.7%) in the mixed care group. Overall 2-year program retention was 81.8%. Attrition was lower in the mixed care and higher in the clinical officer group, compared to the nurse group (adjusted incidence rate ratio [aIRR]=0.54, 95%CI 0.45-0.65; and aIRR=3.03, 95%CI 2.56-3.59, respectively). While patients initiated on ART by clinical officers in the mixed care group had lower attrition (aIRR=0.36, 95%CI 0.29-0.44) than those in the overall nurse care group; no differences in attrition were found between patients initiated on ART by nurses in the mixed care group and those included in the nurse group (aIRR=1.18, 95%CI 0.95-1.47). Two-year mortality estimates were aIRR=0.72, 95%CI 0.49-1.09 and aIRR=5.04, 95%CI 3.56-7.15, respectively. Slightly higher estimates were observed when analyses were restricted to patients with less severe disease. CONCLUSION: The findings of this study support the use of a mixed care model with well trained and regularly supervised nurses and medical assistants to provide HIV care in countries with high HIV prevalence.

Chronic respiratory symptoms of poultry farmers and model-based estimates of long-term dust exposure.

OBJECTIVES: The airborne contaminant exposure levels experienced by poultry farmers have raised concerns about the possible health hazards associated with them. Thus, a longitudinal project was instituted in France to monitor these exposures in poultry workers and to evaluate the long-term effect on health. METHOD: Sixty-three workers in two different poultry housing systems were included (33 from floor-based systems and 30 from cage-based systems). Personal dust concentrations (over 2 days) and activity patterns (over 14 days) were collected and then modeled to obtain average long-term estimates. Health data were collected by questionnaire. RESULTS: The mean daily time spent in the cage system was more than 2 hours longer than in the floor system. Two main common tasks accounted for ~70% of this time. Dust concentrations were higher in the floor system than in the cage system. The concentrations for the 14 days of known activity patterns estimated using the statistical model agreed well with the measured values. Several chronic respiratory symptoms were significantly associated with the high levels of long-term exposure estimated by the model. The highest risk was for chronic bronchitis symptoms (>4-fold higher for exposures of 0.1 mg/m(3) of respirable dust). CONCLUSION: The presented modeling strategy can be used to estimate the long-term average personal exposure to respirable dust, and to study the association between dust exposure and chronic respiratory symptoms. This population of workers will be followed-up in subsequent examinations (3 years later) to determine whether the predictive model is valid, and whether long-term dust exposure is related to the incidence of respiratory symptoms and changes in pulmonary functions.

A new air quality perception scale for global assessment of air pollution health effects.

Despite improvements in air quality in developed countries, air pollution remains a major public health issue. To fully assess the health impact, we must consider that air pollution exposure has both physical and psychological effects; this latter dimension, less documented, is more difficult to measure and subjective indicators constitute an appropriate alternative. In this context, this work presents the methodological development of a new scale to measure the perception of air quality, useful as an exposure or risk appraisal metric in public health contexts. On the basis of the responses from 2,522 subjects in eight French cities, psychometric methods are used to construct the scale from 22 items that assess risk perception (anxiety about health and quality of life) and the extent to which air pollution is a nuisance (sensorial perception and symptoms). The scale is robust, reproducible, and discriminates between subpopulations more susceptible to poor air pollution perception. The individual risk factors of poor air pollution perception are coherent with those findings in the risk perception literature. Perception of air pollution by the general public is a key issue in the development of comprehensive risk assessment studies as well as in air pollution risk management and policy. This study offers a useful new tool to measure such efforts and to help set priorities for air quality improvements in combination with air quality measurements.

A new endpoint definition improved clinical relevance and statistical power in a vaccine trial.

OBJECTIVE: Endpoints used for the evaluation of immunogenicity in vaccine trials are often the proportion of individuals with immune response or geometric means of antibody concentrations for each serotype. When a vaccine includes several types of the same species, we illustrate how an endpoint combining all responses may improve clinical relevance and statistical power. STUDY DESIGN AND SETTINGS: The motivating example was the ANRS 114 Pneumovac trial where the effect of two vaccine strategies against Streptococcus pneumoniae was assessed in adults infected by the Human Immunodeficiency Virus. The power associated with several endpoints was calculated in the example and in simulations. A new endpoint based on four ordered levels is formulated and analyzed by using a proportional odds model. RESULTS AND CONCLUSION: The analysis of this new endpoint led to an odds ratio allowing detection of improvement and detriment. In the simulation study, this endpoint was associated with the largest statistical power by increasing the amount of information used as compared with usual endpoints. We recommend this new endpoint formulation in the formal development of a new vaccination regimen, whenever applicable.

Influence of socioeconomic deprivation on the relation between air pollution and beta-agonist sales for asthma.

BACKGROUND: Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting beta-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations. METHODS: The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 microm [PM(10)]), nitrogen dioxide (NO(2)), and ozone (O(3)) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis. RESULTS: Increased of 10 microg/m(3) in ambient PM(10), NO(2), and O(3) concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, - 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations. CONCLUSION: The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions.

Air pollution, asthma attacks, and socioeconomic deprivation: a small-area case-crossover study.

With few exceptions, studies of short-term health effects of air pollution use pollutant concentrations that are averaged citywide as exposure indicators. They are thus prone to exposure misclassification and consequently to bias. Measurement of the relations between air pollution and health, generally and in specific populations, could be improved by employing more geographically precise exposure estimates. The authors investigated short-term relations between ambient air pollution estimated in small geographic areas (French census blocks) and asthma attacks in Strasbourg, France, in 2000-2005--in the general population and in populations with contrasting levels of socioeconomic deprivation. Emergency health-care networks provided data on 4,683 telephone calls made for asthma attacks. Deprivation was estimated using a block-level index constructed from census data. Hourly concentrations of particulate matter less than 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, nitrogen dioxide, and ozone were modeled by block with ADMS-Urban software. Adjusted case-crossover analyses showed that asthma calls were positively but not significantly associated with PM(10) (for a 10-microg x m(-3) increase, odds ratio (OR) = 1.035, 95% confidence interval (CI): 0.997, 1.075), sulfur dioxide (OR = 1.056, 95% CI: 0.979, 1.139), and nitrogen dioxide (OR = 1.025, 95% CI: 0.990, 1.062). No association was observed for ozone (OR = 0.998, 95% CI: 0.965, 1.032). Socioeconomic deprivation had no significant influence on these relations.

Immunological efficacy of a prime-boost pneumococcal vaccination in HIV-infected adults.

OBJECTIVE: To evaluate whether a strategy combining a prime with a 7-valent conjugate pneumococcal vaccine (PCV) followed by a boost with the 23-valent polysaccharide vaccine (PPV) would improve immunogenicity against Streptococcus pneumoniae polysaccharides in HIV-infected patients. DESIGN: Randomized controlled phase II trial. METHODS: Two-hundred and twelve patients with CD4 cell counts of 200-500 cells/mul and HIV RNA< 4 log10 copies/ml, regardless of antiretroviral treatment, were randomized to receive either PCV at week 0 and PPV at week 4 (n = 106) or PPV alone at week 4 (n = 106). The proportion of responders to 0, 1-2, 3-4, 5-7 serotypes shared by the two vaccines was evaluated at week 8 and compared using a proportional odds model allowing for adjustment for CD4 cell count, HIV RNA and antiretroviral treatment. RESULTS: At week 8, the profile of response was better in the prime-boost group compared to the PPV group, as determined by the frequency of patients who reached both a twofold increase of serotype-specific IgG levels and IgG level >/= 1 mug/ml [proportional odds ratio (OR), 2.09; 95% confidence interval (CI), 1.25-3.51; P = 0.005]. No differences in responders were found 4 weeks after PCV or PPV alone, suggesting that PCV primed for response to PPV. Early differences between groups remained significant at week 24 (proportional OR, 2.14; 95% CI, 1.30-3.54; P = 0.003). CONCLUSIONS: In a setting of practical care, a PCV prime-PPV boost strategy enhances the frequency, breadth and magnitude of antibody responses against SPP in HIV-infected adults.

Changes in the peripheral blood mtDNA levels in naive patients treated by different nucleoside reverse transcriptase inhibitor combinations and their association with subsequent lipodystrophy.

Nucleoside reverse transcriptase inhibitors (NRTIs) differ in the type and severity of adverse effects resulting from mitochondrial abnormalities. mtDNA in peripheral blood mononuclear cells (PBMCs) was measured during the first 12 months of different NRTIs combinations and its association with clinical lipodystrophy was estimated. Extended follow-up of a randomized trial, ALBI-ANRS 070, including antiretroviral naive patients was conducted. Total DNA was extracted from available cryopreserved PBMCs at baseline and months 6 and 12. Nuclear and mitochondrial genes were amplified using a real-time PCR assay. Clinical lipodystrophy was assessed 30 months after randomization using a standardized questionnaire. A logistic regression analysis assessed the value of mtDNA to predict lipodystrophy. Mean mtDNA level (copies/cell) significantly decreased from 5847 at baseline to 3176 at month 12 (p < 0.0001). In the zidovudine + lamivudine (ZDV + 3TC) arm (n = 37), the mean mtDNA was 6098, 6807, and 3725 copies/cell for baseline, month 6, and month 12, respectively. In the stavudine + didanosine (d4T + ddI) arm (n = 40), the mean values were 5616, 5731, and 2648 copies/cell, respectively. The proportion of patients in the lowest quartile of mtDNA (<1421 copies/cell) at month 12 was higher in 18 patients with lipodystrophy (44%) than in 28 without lipodystrophy (7%) (p = 0.008). At 12 months, a larger reduction of mtDNA from baseline was observed in those started on the d4T + ddI arm. Furthermore, a low mtDNA level at month 12 was associated with the subsequent development of lipodystrophy. This marker may be of value for the early prevention of lipodystrophy in treated HIV-infected patients.