Quantitative health impact of indoor radon in France.

Radon is the second leading cause of lung cancer after smoking. Since the previous quantitative risk assessment of indoor radon conducted in France, input data have changed such as, estimates of indoor radon concentrations, lung cancer rates and the prevalence of tobacco consumption. The aim of this work was to update the risk assessment of lung cancer mortality attributable to indoor radon in France using recent risk models and data, improving the consideration of smoking, and providing results at a fine geographical scale. The data used were population data (2012), vital statistics on death from lung cancer (2008-2012), domestic radon exposure from a recent database that combines measurement results of indoor radon concentration and the geogenic radon potential map for France (2015), and smoking prevalence (2010). The risk model used was derived from a European epidemiological study, considering that lung cancer risk increased by 16% per 100 becquerels per cubic meter (Bq/m3) indoor radon concentration. The estimated number of lung cancer deaths attributable to indoor radon exposure is about 3000 (1000; 5000), which corresponds to about 10% of all lung cancer deaths each year in France. About 33% of lung cancer deaths attributable to radon are due to exposure levels above 100 Bq/m3. Considering the combined effect of tobacco and radon, the study shows that 75% of estimated radon-attributable lung cancer deaths occur among current smokers, 20% among ex-smokers and 5% among never-smokers. It is concluded that the results of this study, which are based on precise estimates of indoor radon concentrations at finest geographical scale, can serve as a basis for defining French policy against radon risk.

Cancer incidence in adults living in the vicinity of nuclear power plants in France, based on data from the French Network of Cancer Registries.

Nuclear power plants (NPPs) release toxic emissions into the environment that may affect neighboring populations. This ecologic study was designed to investigate the possibility of an excess incidence of cancer in the vicinity of French NPPs by examining the incidence by municipality of 12 types of cancer in the population aged 15 years and older during the 1995-2011 period. Population exposure to pollution was estimated on the basis of distance from towns of residence to the NPP. Using regression models, we assessed the risk of cancer in a 20-km zone around NPPs and observed an excess incidence of bladder cancer (Relative Risk (RR), 95% Credibility Interval (95% CI)) in men and women (RRmen = 1.08; 95% CI: 1.00, 1.17 and RRwomen = 1.19; 95% CI: 1.02, 1.39). Women living within the 20-km proximity areas had a significantly reduced risk of thyroid cancer (RRwomen = 0.86; 95% CI: 0.77, 0.96). No excess risk of hematologic malignancies in either sex was seen. The higher than expected incidence of bladder cancer may be due to an excess incidence localized around the Flamanville NPP and the nearby La Hague nuclear waste treatment center, which is a source of chemical contaminants, many (including arsenic) of them known risk factors for bladder cancer. Differences in medical practices could explain the reduced risk of thyroid cancer. In this first study of adults living near NPPs in France, cancer incidence is significantly higher than in the references populations for one of the cancer types studied: bladder cancer.

Voluntary Health Registry of French Nationals after the Great East Japan Earthquake, Tsunami, and Fukushima Daiichi Nuclear Power Plant Accident: Methods, Results, Implications, and Feedback.

UNLABELLED: Introduction The 11th of March 2011, a magnitude 9.0 earthquake struck alongside the north-east coast of Honshu Island, Japan, causing a tsunami and a major nuclear accident. The French Institute for Public Health Surveillance (InVS) set up, within one week after the triple catastrophe, an Internet-based registry for French nationals who were in Japan at the time of the disasters. In this string of disasters, in this context of uncertainties about the nuclear risks, the aim of this registry was to facilitate the: (1) realization of further epidemiologic studies, if needed; and (2) contact of people if a medical follow-up was needed. The purpose of this report was to describe how the health registry was set up, what it was used for, and to discuss further utilization and improvements to health registries after disasters. METHODS: The conception of the questionnaire to register French nationals was based on a form developed as part of the Steering Committee for the management of the post-accident phase in the event of nuclear accident or a radiological emergency situation (CODIRPA) work. The questionnaire was available online. RESULTS: The main objective was achieved since it was theoretically possible to contact again the 1,089 persons who completed the form. According to the data collected on their space-time budget, to the result of internal contamination measured by the French Institute for Radiological Protection and Nuclear Safety (IRSN) and dosimetric expertise published by the World Health Organization (WHO), it was not suitable to conduct an epidemiologic follow-up of adverse effects of exposure to ionizing radiations among them. However, this registry was used to launch a qualitative study on exposure to stress and psychosocial impact of the Great East Japan Earthquake on French nationals who were in Japan in March 2011. CONCLUSION: Setting a registry after a disaster is a very important step in managing the various consequences of a disaster. This experience showed that it is quickly feasible and does not raise adverse side effects in involved people. Motreff Y , Pirard P , Lagrée C , Roudier C , Empereur-Bissonnet P . Voluntary health registry of French nationals after the Great East Japan Earthquake, tsunami, and Fukushima Daiichi Nuclear Power Plant accident: methods, results, implications, and feedback. Prehosp Disaster Med. 2016;31(3):326-329.

Trends in the quality of care for elderly people with type 2 diabetes: the need for improvements in safety and quality (the 2001 and 2007 ENTRED Surveys).

AIM: This study aimed to characterize the sociodemographic data, health status, quality of care and 6-year trends in elderly people with type 2 diabetes. METHODS: This study used two French cross-sectional representative surveys of adults of all ages with all types of diabetes (Entred 2001 and 2007), which combined medical claims, and patient and medical provider questionnaires. The 2007 data in patients with type 2 diabetes aged 65 years or over (n=1766) were described and compared with the 2001 data (n=1801). RESULTS: Since 2001, obesity has increased (35% in 2007; +7 points since 2001) while written nutritional advice was less often provided (59%; -6 points). Mean HbA(1c) (7.1%; -0.2%), blood pressure (135/76 mmHg; -4/-3 mmHg) and LDL cholesterol (1.04 g/L; -0.21 g/L) declined, while the use of medication increased: at least two OHAs, 34% (+4 points); OHA(s) and insulin combined, 10% (+4 points); antihypertensive treatment, 83% (+4 points); and statins 48% (+26 points). Severe hypoglycaemia remained frequent (10% had an event at least once a year). The overall prevalence of complications increased. Renal complications were not monitored carefully enough (missing value for albuminuria: 42%; -4.5 points), and 46% of those with a glomerular filtration rate less than 60 mL/min/1.73 m² were taking metformin. CONCLUSION: Elderly people with type 2 diabetes are receiving better quality of care and have better control of cardiovascular risk factors than before. However, improvement is still required, in particular by performing better screening for complications. In this patient population, it is important to carefully monitor the risks for hypoglycaemia, hypotension, malnutrition and contraindications related to renal function.

Association of socioeconomic status with overall overweight and central obesity in men and women: the French Nutrition and Health Survey 2006.

BACKGROUND: Identification of subpopulations at high risk of overweight and obesity is crucial for prevention and management of obesity in different socioeconomic status (SES) categories. The objective of the study was to describe disparities in the prevalence of overweight and obesity across socioeconomic status (SES) groups in 18-74 year-old French adults. METHODS: Analyses were based on a multistage stratified random sample of non-institutionalized adults aged 18-74-years-old from the French Nutrition and Health Survey (ENNS), a cross-sectional national survey carried out in 2006/2007. Collected data included measured anthropometry (weight, height and waist circumference (WC)), demographic and SES data (occupation, education and frequency of holiday trips as a marker of family income). SES factors associated with overweight (BMI > or = 25) and central obesity (WC above gender-specific references) were identified using multiple logistic regression. RESULTS: Almost half (49.3%) of French adults were overweight or obese and 16.9% were obese. In men, the risk of overall overweight or obesity was associated with occupation (p < 0.05), whereas the risk of central obesity was independently associated with occupation (p < 0.05) and frequency of holiday trips (p < 0.01). In women, both overall and central overweight and obesity were independently associated with educational level (respectively p < 10(-3) and p < 10(-3)) and frequency of holiday trips (respectively p < 0.05 and p < 10-3). CONCLUSION: The prevalence of overweight and obesity was found to be similar to that of several neighbouring western European countries, and lower than the UK and eastern Europe. Risk of being overweight or obese varied across SES groups both in men and women, but associations were different between men and women, indicating differing determinants.

Dietary intake, physical activity and nutritional status in adults: the French nutrition and health survey (ENNS, 2006-2007).

The French National Programme on Nutrition and Health (Programme national nutrition santé (PNNS)), the aim of which is to reduce nutrition-related chronic diseases, necessitates monitoring of nutritional characteristics. Our objective was to describe dietary intake, physical activity and nutritional status in a national sample of adults, especially according to current French recommendations. The study is based on a cross-sectional population-based survey using a multistage sampling design (Etude nationale nutrition santé (ENNS)). Between February 2006 and March 2007, 3115 18-74-year-old adults were included (participation rate 59.7 %). Energy, macronutrient and food consumption were estimated through three randomly distributed 24 h recalls, and compared to PNNS recommendations; physical activity was described using International Physical Activity Questionnaire guidelines; anthropometry, blood pressure and biochemical measurements were assessed according to national and international references. When compared to current recommendations, intake of carbohydrates (>50 % energy intake without alcohol: 26.4 %), SFA ( < 35 % total lipids: 18.5 %) and total fibre (>25 g/d: 13.7 %) was frequently unsatisfactory. While overall consumption of 'meat, seafood and eggs' was satisfactory, that of fruits and vegetables ( > or = 400 g/d: 43.8 %) and seafood (two or more servings per week: 29.9 %) was frequently too low. The physical activity level was satisfactory at 63.2 %. Overweight was observed in 49.3 % of adults, while 30.9 % were hypertensive and 44.1 % had dyslipidaemia. Vitamin and iron-poor status was found to affect less than 10 % of the population. Based on the ENNS survey, overall nutrition remains a problem in France. Comparison of these data with those of other countries could contribute to a better understanding of variations in nutrition-related diseases.

Estimation of the radiation dose from thoracic CT scans in a cystic fibrosis population.

OBJECTIVE: To determine the radiation exposure associated with CT scans in a population of patients with cystic fibrosis (CF). METHODS: We reviewed the medical charts of patients with typical CF who received regular medical management in a reference center from birth to March 31, 2004. RESULTS: Among 80 patients with a total follow-up time of 1,231 person-years, 79 patients received a total of 269 CT scans, including 249 thoracic CT scans. The full parameters of the examination were available for 185 thoracic CT scans, allowing the effective dose (ED) and organ doses to be calculated. The ED was determined by the number of slices and the type of CT scans. The ED per thoracic CT scan was asymmetrically distributed (mean ED, 6.5 mSv; range 1.5 to 29.3 mSv). The mean doses delivered to the four most strongly exposed organs (lungs, breasts, bone marrow, and thyroid gland) were 18.6, 16.9, 5.2, and 3.5 mGy, respectively. The mean lifetime number of CT scans per patient was 3.2 (range, 0 to 13 scans), and the average lifetime ED was 19.5 mSv per patient (range, 2.2 to 75.8 mSv). Age at the first CT scan fell over the years, from 20 years for patients born before 1980 to 1.9 years for patients born after 1997. CONCLUSION: The mean ED per CT scan in CF patients is about 6.5 mSv. Age at the first CT scan is lower in the most recent generation of patients. The lifetime ED of radiation received by CF patients, especially in the most recent generation, warrants long-term follow-up.

[Incidence of radiodermatitis following interventional radiology. Results of a feasibility study among members of the French Dermatology Society]. / Incidence des radiodermites secondaires à un geste de radiologie interventionnelle. Résultat d'une étude de faisabilité auprès des dermatologues français adhérents de la Société française de dermatologie.

INTRODUCTION: Radiodermatitis due to fluoroscopically guided interventional radiology procedures was reported, mostly by dermatologists, several times between 1992 and 2000, but less frequently since 2000. TYPE OF STUDY AND OBJECTIVE: This feasibility study sought to determine whether radiodermatitis secondary to interventional radiology was still occurring recently (2003-2004). METHODS: During summer 2004, we sent a questionnaire to the 1450 dermatologists belonging to the French Dermatology Society (société française de dermatologie), asking them to report any cases of radiodermatitis related to fluoroscopically guided interventional radiology between 1 September 2003 and 31 August 2004. RESULTS: Responses from 218 dermatologists reported ten cases of radiodermatitis. Median age at diagnosis was 56 years. The procedures involved interventional neuroradiology (n=1), interventional cholangiography (n=1), pacemaker insertion (n=1), and interventional cardiology (n=7). Median time from the fluoroscopic procedure to first symptoms was 2 months and from procedure to radiodermatitis diagnosis 7.5 months. Plastic surgery was necessary for two patients. CONCLUSION: Radiodermatitis related to interventional radiology still occurs. We recommend the development of a reporting system for this adverse effect as part of the optimization of interventional radiology practices, including dose reduction.

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.