Increase in psychotropic drug deliveries after the Xynthia storm, France, 2010.

INTRODUCTION: During the night of February 27 and the early morning of February 28, 2010, 15 coastal municipalities situated in two French departments, Vendée and Charente-Maritime, were violently stricken by a severe windstorm named "Xynthia." This storm caused the death of 12 individuals in Charente-Maritime and 29 people in Vendée. Houses, agricultural fields, and shellfish companies were severely flooded with seawater. Several thousand people temporarily had to leave their homes. The objective of this study was to estimate the short-term mental health impact of Xynthia, in terms of psychotropic drug delivery, on the resident population of the 15 coastal municipalities severely hit by the flooding. METHODS: The French national health insurance database was used to calculate a daily number of new psychotropic treatments from September 1, 2008 through December 24, 2010. New treatments were calculated for each of the following European Pharmaceutical Marketing Research Association (EphMRA) classes: tranquilizers (N05C), hypnotics (N05B), and antidepressants (N06A). A period of three weeks following the storm was defined as the exposure period. A generalized additive model with a Poisson distribution that allows for over-dispersion was used to analyze the correlation between the Xynthia variable and the number of new psychotropic treatments. RESULTS: With a relative risk (RR) of 1.54 (95% CI, 1.39-1.62) corresponding to an estimate of 409 new deliveries of psychotropic drugs during the three weeks following the storm, this study confirms the importance of the psychological impact of Xynthia. This impact is seen on all three classes of psychotropic drugs studied. The impact is greater for tranquilizers (RR of 1.78; 95% CI, 1.59-1.89) than for hypnotics (RR of 1.53; 95% CI, 1.31-1.67) and antidepressants (RR of 1.26; 95% CI, 1.06-1.40). The RR was higher for females than for males. CONCLUSION: This study shows the importance of the psychological impact of the storm as observed clinically by health workers who intervened in the field during the aftermath of Xynthia. It confirms that administrative databases can be used to show a health impact of a disaster even at a local level. This is one more step in the direction of a comprehensive strategy of collecting information to allow the assessment of the health impact of an extreme event, the detection of vulnerable populations, and the orientation of the short-, mid- and long-term public health response.

[The current state of mental health surveillance in France]. / État des lieux de la surveillance de la santé mentale en France.

UNLABELLED: The purpose of health surveillance is to contribute to health planning, information and prevention. Surveillance involves repeated data collections based on epidemiological studies and follow-up of data collected from medical-administrative databases. This paper provides an overview of mental health surveillance in France and examines the relevance and limitations of the collected data. METHOD: The prevalence of major depressive episodes (MDE) in the general population was recently examined in seven studies. Among these studies, the Health Barometers involved two data collections at a five-year interval using the same method. Mortality and hospitalization data are important for suicide and suicide attempt (SA) surveillance. Health insurance databases provide key information about psychotropic drug use and serious psychiatric illnesses defined as long-term. RESULTS: The prevalence of 12­month MDE remained stable at 7.8% between 2005 and 2010. Mortality data show a suicide rate of 16 per 100,000 inhabitants. Hospital data show that the rate of hospitalization for SAs is approximately ten times that of suicide. Data from emergency wards indicate that approximately 220,000 SAs are admitted to hospital emergency services every year. Currently, depressive disorders are the primary reason for new admissions under the ALD23. DISCUSSION: A comparison of data from different sources is required to provide a basis for mental health surveillance in France and to help identify those populations that need to be targeted as a matter of priority by prevention measures.

[The practitioner's role in surveillance and information on environmental risks]. / Surveillance et information sur les risques environnementaux: le rôle du praticien.

Health scares have entailed an increasing concern about environmental risks for populations. Authorities' response was to set up a system for the analysis, surveillance and management of environmental risks. Practitioners have an important role to play in this system, as primary actors of surveillance and as a close source of information about the environmental risks for the population. Three examples are developed. Children's lead poisoning still exists and entails irreversible neuropsychic deficits. Its diagnosis rests upon the recognition of risk factors and the prescription of a test of blood lead level. Carbon monoxide poisoning is the first cause of mortality by acute poisoning in France and it causes several thousand hospitalizations every year. Notification of the cases of lead and carbon monoxide poisonings is indispensable to remove their causes. Links between cancer and environment are an important social concern and a public health issue. Practitioners have a key role to play not only in the communication on this subject, but also to notify disturbing sanitary events and participate in the local investigations.

Health risk assessment after decontamination of the beaches polluted by the wrecked ERIKA tanker.

Following the wreck of the oil tanker ERIKA off the north-west coast of France in December 1999, cleaning up of the beaches involved considerable work, which in any case could not be perfect. This raised the question of the short- and long-term health risks for the future bathers related to the toxicity of the remaining oil polycyclic aromatic hydrocarbons (PAHs). This risk assessment study was conducted to help health authorities plan risk management policies and inform the public. Thirty-six beaches were selected, representing a sample of the most frequently encountered topographic and beach usage situations; seven "control" beaches, unspoiled by ERIKA, were also investigated. Samples of water and sand were taken from each site, as well as from the surface of rocks. The 16 PAHs selected by the U.S. EPA were quantified in each environment. Several scenarios of exposure were contemplated: (1) a child between 2 and 4 years accidentally ingesting a small ball of fuel, (2) a child daily exposed throughout his holiday-time stay, (3) an adult (including a pregnant woman) spending his/her holidays on the coast, (4) an adult working on the beach, (5) and an adult practicing water sports. Among the available and significant toxicological values, the most conservative ones were selected for computing risks. The sand and water, after decontamination, were slightly polluted (respectively, 7.8 microg/kg and 23.3 ng/l of total 16 PAHs), with values similar to those found in the control beaches. By contrast, the rocky areas in some places were still highly polluted (up to 23 mg/kg on the surface layer). No lethal risk was found for a young child who had accidentally ingested a small ball of fuel. The life-long excess risks for skin cancer and for all other cancers were about 10-5 in scenarios including contact with the polluted rocks. In all other cases, excess risks were considerably lower. The hazard quotient for teratogenic effects was very small, except in scenarios where pregnant women would walk among rocks containing high pollution levels. In conclusion, exposure was mainly associated with polluted water among children, and with spoiled rocks for adults. Despite uncertainties, mainly dealing with the prediction of long-term risks following a short-term exposure, this study showed that beaches where pollution was no longer visible after decontamination did not entail any significant health risks and could be opened to the public.