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Assessing environmental exposure to pollution is a challenging task, and scientists often use distance-based or proximity indicators when field or modeled data are unavailable. Although buffers are commonly used to represent the impact of a pollution source on neighboring populations, they can result in high-exposure misclassification. Euclidean distance-based indicators offer a promising alternative, but practices vary significantly in the literature. In this study, we aimed to compare several distance-based indicators for multiple environmental contaminants in an industrial and urban area. At the population's grid cell resolution of 200 × 200 m, we compared the distance to the closest source, the average or median distance to all sources, or a restricted number of nearby sources for six types of sources (industries, railways, rail areas, roadways, road crossings, and agricultural patches) against environmental contamination data (PM10, NO2, and multimetallic contamination in lichens). Our findings revealed that the representativeness of contamination by indicators is significantly affected by the type and number of nearby sources considered. Specifically, we found that considering the distance to the nearest source or the average distance to all sources can lead to exposure misclassifications. The optimal correlation between distance indicators and pollutant levels was observed when considering 10–14 of the closest industrial sources, located within a 4.9- to 5.5-km radius. For rail areas, the optimal number was two to three sources within a 5.4- to 7.4-km radius. For main roads, intersections, and railways, the optimal number of sources varied depending on the pollutant, generally falling within a 3- to 9.4-km radius. Environmental contamination is influenced by the diversity of nearby sources, and considering only one source increases the risk of misclassification. Our results suggest that proximity models are still appropriate for study areas where the etiology of existing health effects is unclear, providing an exploratory analysis before more sophisticated research. [ABSTRACT FROM AUTHOR]

Résumé: Véritable enjeu de santé publique, les particules atmosphériques véhiculent un « cocktail » de polluants adsorbés à leur surface et jouent un rôle déterminant dans la toxicité de la pollution. L'objectif de cet article sont d'étudier la pertinence des outils d'évaluation et de gestion de l'impact des particules atmosphériques sur la santé humaine. Pour explorer les pratiques actuelles et définir les besoins futurs, nous avons mené des entretiens avec des chercheurs, des ingénieurs de bureaux d'études et des acteurs institutionnels reconnus dans différents domaines d'expertises liées aux particules. Une analyse qualitative de leurs réponses a permis d'obtenir une carte heuristique représentant les catégories d'idées/de concepts. Les experts se sont principalement exprimés sur deux méthodologies actuellement utilisées mais optimisables : (i) l'évaluation des risques sanitaires qui ne peut pas être appliquée pour les particules atmosphériques, par manque de valeur toxicologique de référence, rendant incontournable l'approche « substance par substance » ; et (ii) l'évaluation qualitative d'impact sanitaire pour laquelle les efforts doivent se focaliser sur le développement de nouveaux indicateurs sanitaires et sur l'homogénéisation de la méthodologie appliquée. De nouveaux points de réflexion ont ainsi été mis en avant comme celui d'ouvrir la voie à de nouveaux projets transdisciplinaires. Atmospheric particles pose a real public health problem: they carry a "cocktail" of pollutants adsorbed on their surface and play a major role in the toxicity of pollution. The objective of this article is to study the relevance of tools for assessing and managing the health impact of these particles. To explore current practices and define future needs, we conducted interviews with researchers, engineers, and institutional players recognized in various fields of expertise related to particles. A qualitative analysis of their responses yielded a mind map representing categories of the main ideas and concepts. The experts mainly expressed their opinions on two currently used but perfectible methodologies: (i) health risk assessments, which cannot currently be applied directly to atmospheric particles (the approach can be applied separately for components of particles for which toxicological reference values exist), and (ii) qualitative health impact assessments, which need to focus more on developing new health indicators and standardizing the methodology used. Among the new points for consideration put forward was the introduction of new cross-disciplinary projects. [ABSTRACT FROM AUTHOR]

Cadmium (Cd) is a highly toxic element for living organisms and is widespread in metal-contaminated soils. As organisms which can grow up on these polluted areas, plants have some protection mechanisms against Cd issues. Among the plant kingdom, the Brassicaceae family includes species which are known to be able to tolerate and accumulate Cd in their tissues. In this study, Brassica oleracea var. viridis cv "Prover" was exposed to a range of artificially Cd-contaminated soils (from 2.5 up to 20 mg kg−1) during 3, 10, and 56 days and the effects on life traits, photosynthesis activity, antioxidant enzymatic activities were studied. Metal accumulation was quantified, as well as DNA damage, by means of the comet assay and immunodetection of 8-OHdG levels. Globally, B. oleracea was relatively tolerant to those Cd exposures. However, comet assay and detection of 8-OHdG revealed some DNA damage but which are not significant. According to metal accumulation analysis, B. oleracea var. viridis cv Prover could be a good candidate for alternative growing in contaminated areas. [ABSTRACT FROM AUTHOR]

Résumé: La mobilisation de toutes les politiques publiques est indispensable pour agir sur les inégalités environnementales et sociales de santé (IESS). Le paradigme actuel décrit ces inégalités territoriales comme une accumulation de déterminants de santé défavorables dans une zone géographique donnée, généralement entendue comme la vulnérabilité d'un territoire. L'absence quasi-systématique des déterminants ayant un impact positif sur la santé dans les modèles ne permet pas d'obtenir une vision réaliste de l'impact global de l'environnement sur la santé des populations. L'intégration de la résilience, comme la capacité des territoires à gérer les IESS, devient alors indispensable pour inclure les efforts déployés pour améliorer le cadre de vie des habitants. Validée dans la région des Hauts-de-France, l'analyse conjointe d'un indice composite spatialisé de vulnérabilité et d'un indice composite spatialisé de résilience permet de décrire la balance résilience/vulnérabilité à l'échelle des communes. Cette démarche permettra in fine de mieux caractériser les IESS, d'affiner les connaissances sur les dynamiques territoriales en jeu et d'orienter de nouvelles réflexions en termes de gestion politique et territoriale des risques sanitaires. All public policies should together battle environmental and social inequalities in health. The current paradigm describes these territorial inequalities as an accumulation of adverse health determinants in a given geographic area, generally understood as its vulnerability. The quasi-systematic absence of determinants that have a positive impact on health in the models prevents a realistic vision of the global impact of the environment on the population's health. The inclusion of resilience factors, such as the ability of territories to deal with environmental and social inequalities in health, is therefore needed and must include efforts to improve the inhabitants' living conditions. As seen in the northern France region, analysing a spatialized composite vulnerability index together with a spatialized composite resilience index makes it possible to describe the resilience/vulnerability balance at the municipal level. This approach will help researchers to better characterize environmental and social inequalities in health, improve knowledge of the territorial dynamics involved, and guide further examination of political and territorial management of health risks. [ABSTRACT FROM AUTHOR]

Résumé: Le pharmacien d'officine est reconnu comme un acteur de la prévention et de l'éducation thérapeutique. Un projet pédagogique mené dans les officines du Nord-Pas-de-Calais et coordonné par la faculté de pharmacie de Lille avec le réseau Néphronor nous a permis de collecter des données permettant d'évaluer l'intérêt d'une évaluation pharmaceutique officinale de la MRC. Nous rapportons ici le résultat de l'intervention réalisée dans 109 pharmacies d'officine. Les entretiens pharmaceutiques ont concerné 2 populations de patients. Le groupe A concerne des patients se connaissant porteurs d'une IRC (entretien pharmaceutique d'optimisation thérapeutique). Le groupe B regroupe des patients à risque de MRC pour lesquels est proposée une stratégie de dépistage. Ainsi, 354 patients ont été inclus dans le groupe A, majoritairement des femmes (51,2 %), en stade 3 d'IRC, d'âge moyen 73 ans, diabétiques (44 %). Environ 70 % des patients avaient déjà été vus par un néphrologue et 45 % d'entre eux présentaient une bonne adhésion thérapeutique selon le questionnaire de Morisky Green. Par ailleurs, 20 % des patients n'avaient pas de traitement néphroprotecteur en stades 3 et 4 de la MRC et plus de la moitié ne connaissaient pas les situations à risque d'insuffisance rénale aiguë. Le groupe B a inclus 532 patients (âge moyen 70 ans). L'intervention pharmaceutique a permis de dépister 10 % de patients avec un DFG < 60 mL/min/1,73 m2. L'entretien pharmaceutique en officine a permis d'optimiser la prise en charge thérapeutique et l'information des patients IRC, ainsi que le dépistage précoce chez certains patients à risque. Chronic kidney disease (CKD) is a major concern of public health. The pharmacist is known as a health practitioner involved in prevention and therapeutic education. Our study aimed at defining the impact of community pharmacists' interventions for preventing and screening CKD. In our observational prospective study of 5 months conducted in 109 community pharmacy, we included 2 groups of patients: A (therapeutic optimization): CKD patients and B (CKD screening): population at risk. In group A, we included 354 patients, mainly women (51.2%), in stage 3 of CKD, mean age 73 years old, with hypertension alone (40.6%) or associated with diabetes (44%). About 70% of the patients had a follow up by a nephrologist and 45% of them were good adherent according to the Morisky Green self-report. However, approximately 20% of patients did not have nephroprotective treatments in their regimen although they were on stage 3 or 4 CKD patients, and about half of them were not aware of medical situations at risk. Concerning group B, 532 patients were included. The pharmaceutical interventions screened 10 % of patients with a GFR < 60 mL/min/1.73m2. The community pharmacists' interventions helped to optimize the therapeutic management of CKD patients and in the early screening of patients at risk. More studies are needed to extrapolate our observations to a larger population. [ABSTRACT FROM AUTHOR]

The rapid industrialization and urbanization of intra- and peri-urban areas at the world scale are responsible for the degradation of the quality of edible crops, because of their contamination with airborne pollutants. Their consumption could lead to serious health risks. In this work, we aim to investigate the phytotoxicity induced by foliar transfer of atmospheric particles of industrial/urban origin. Leaves of cabbage plants (Brassica oleracea var. Prover) were contaminated with metal-rich particles (PbSO4 CuO and CdO) of micrometer size. A trichloroacetic acid (TCA) treatment was used to inhibit the synthesis of the epicuticular waxes in order to investigate their protective role against metallic particles toxicity. Besides the location of the particles on/in the leaves by microscopic techniques, photosynthetic activity measurements, genotoxicity assessment, and quantification of the gene expression have been studied for several durations of exposure (5, 10, and 15 days). The results show that the depletion of epicuticular waxes has a limited effect on the particle penetration in the leaf tissues. The stomatal openings appear to be the main pathway of particles entry inside the leaf tissues, as demonstrated by the overexpression of the BolC.CHLI1 gene. The effects of particles on the photosynthetic activity are limited, considering only the photosynthetic Fv/Fm parameter. The genotoxic effects were significant for the contaminated TCA-treated plants, especially after 10 days of exposure. Still, the cabbage plants are able to implement repair mechanisms quickly, and to thwart the physiological effects induced by the particles. Finally, the foliar contamination by metallic particles induces no serious damage to DNA, as observed by monitoring the BolC.OGG1 gene. [ABSTRACT FROM AUTHOR]

Background: Work-related stress and burnout syndromes are unfortunately common comorbidities found in health professionals. However, burnout syndrome has only been partly and episodically assessed for community pharmacists whereas these professionals are exposed to patients’ demands and difficulties every day. Prevalence of burnout, associated comorbidities and coping strategies were assessed in pharmacy teams (pharmacists and pharmacy technicians) in French community pharmacies. Methods: This online survey was performed by emails sent to all French community pharmacies over 3 months. The survey assessed the prevalence of burnout (Maslach Burnout Inventory—MBI—questionnaire), anxiety, depression and strategies for coping with work-related stress. Results: Of the 1,339 questionnaires received, 1,322 were completed and useable for the analysis. Burnout syndrome was detected in 56.2% of respondents and 10.5% of them presented severe burnout syndrome. Severe burnout syndrome was significantly associated with men, large urban areas and the number of hours worked. Depression and anxiety were found in 15.7% and 42.4% of respondents, respectively. These co-morbidities were significantly associated with severe burnout syndrome. Higher MBI scores were significantly associated with medical consultations and medicinal drug use. Conversely, respondents suffering from burnout syndrome declared they resorted less to non-medical strategies to manage their work-related stress (leisure, psychotherapy, holidays and time off). Conclusion: This study demonstrated that community pharmacists and pharmacy technicians presented high prevalence of burnout syndrome, such as many healthcare professionals. Unfortunately, burnout syndrome was associated with several comorbidities (anxiety, depression and alcohol abuse) and the consumption of health resources. The psychological suffering of these healthcare professionals underlines the necessity to deploy a strategy to detect and manage burnout in community pharmacy. [ABSTRACT FROM AUTHOR]

Background: Strong geographic variations in the incidence of end-stage renal disease (ESRD) are observed in developed countries. The reasons for these variations are unknown. They may reflect regional inequalities in the population's sociodemographic characteristics, related diseases, or medical practice patterns. In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region. This area, with a high population density and homogeneous healthcare provision, represents a geographic situation which is quite suitable for the study, over small areas, of spatial disparities in the incidence of ESRD, together with their correlation with a deprivation index and other risk factors. Methods: The Renal Epidemiology and Information Network is a national registry, which lists all ESRD patients in France. All cases included in the Nord-Pas-de-Calais registry between 2005 and 2011 were extracted. Adjusted and smoothed standardized incidence ratio (SIR) was calculated for each of the 170 cantons, thanks to a hierarchical Bayesian model. The correlation between ESRD incidence and deprivation was assessed using the quintiles of Townsend index. Relative risk (RR) and credible intervals (CI) were estimated for each quintile. Results: Significant spatial disparities in ESRD incidence were found within the Nord-Pas-de-Calais region. The sex- and age-adjusted, smoothed SIRs varied from 0.66 to 1.64. Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00–1.34] for Q2; 1.28, 95% CI [1.11–1.47] for Q3; 1.30, 95% CI [1.14–1.51] for Q4; 1.44, 95% CI [1.32–1.74] for Q5). Conclusion: For the first time at this aggregation level in France, this study reveals significant geographic differences in ESRD incidence. Unlike the time of renal replacement care, deprivation is certainly a determinant in this phenomenon. This association is probably independent of the patients' financial ability to gain access to healthcare. [ABSTRACT FROM AUTHOR]

Real-time quantitative PCR is nowadays a standard method to study gene expression variations in various samples and experimental conditions. However, to interpret results accurately, data normalization with appropriate reference genes appears to be crucial. The present study describes the identification and the validation of suitable reference genes in Brassica oleracea leaves. Expression stability of eight candidates was tested following drought and cold abiotic stresses by using three different softwares (BestKeeper, NormFinder and geNorm). Four genes ( BolC.TUB6, BolC.SAND1, BolC.UBQ2 and BolC.TBP1) emerged as the most stable across the tested conditions. Further gene expression analysis of a drought- and a cold-responsive gene ( BolC.DREB2A and BolC.ELIP, respectively), confirmed the stability and the reliability of the identified reference genes when used for normalization in the leaves of B. oleracea. These four genes were finally tested upon a benzene exposure and all appeared to be useful reference genes along this toxicological condition. These results provide a good starting point for future studies involving gene expression measurement on leaves of B. oleracea exposed to environmental modifications. [ABSTRACT FROM AUTHOR]

The purpose of this research is to present toxic effects of some heavy metals (cadmium, lead and zinc) on lichen physiology. In the North of France, those metals are concentrated for example in industrial polluted soils near metallurgic plants and waste dumps. Our investigations were conducted on Diploschistes muscorum (Scop.) R. Sant, a terricolous lichen growing on previously quoted soils as well as on non-contaminated ones. Different stress parameters were investigated as potassium leakage – which is related to the loss of membrane integrity – and oxidative stress through following parameters: malondialdehyde (MDA), glutathione (GSH) and superoxide dismutase (SOD). It seems, therefore, that heavy metals induce oxidative stress in this lichen, in which we found membrane damage and enhancement of SOD activity and GSH concentrations. With regard to very high concentrations of Cd, Pb and Zn, a resistance involving antioxidant mechanisms limits the expected damage. Those mechanisms involve GSH, SOD as well as secondary metabolites, which have this resistance property. This study is a first step of investigation to use – in the future – physiological parameters as tool for environment assessment. [ABSTRACT FROM AUTHOR]

The impact on the environment of Cd, Pb and Zn emissions from the A1 motorway, one of the busiest in France, was based on a simultaneous analysis of lichens, fungi and soil. The study was conducted in 12 rest areas located along a 55 km stretch of the motorway. Cd, Pb and Zn concentrations in the top soil horizon (0–10 cm) largely exceeded their concentrations at the control site. The Cd-, Pb- and Zn levels in fruiting bodies of fungi Armillaria mellea, Coprinus comatus, Marasmius oreades and Paxillus involutus were highly variable between sites. The contamination degree of transplanted thalli of Parmelia caperata was well correlated to the cumulated traffic on the western side. On the eastern side, heavy metals originated from the traffic but also from neighbouring sources (urbanization and agricultural practices). Although lead levels are decreasing, leaded petrol is still on offer and lead remains an indicator of vehicle pollution. [ABSTRACT FROM AUTHOR]

Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients' bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives ("Z-drugs"), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient's sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications. [ABSTRACT FROM AUTHOR]

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Background: The community pharmacist is a key player in medication reviews of older outpatients. However, it is not always clear which individuals require a medication review. The objective of the present study was to identify high-priority older patients for intervention by a community pharmacist.Methods: As part of their final-year placement in a community pharmacy, pharmacy students conducted 10 interviews each with older adults (aged 65 or over) taking at least five medications daily. The student interviewer also offered to examine the patient's home medicine cabinet. An interview guide was developed by an expert group to assess the difficulties in managing and taking medications encountered by older patients.Results: The 141 students interviewed a total of 1370 patients (mean age: 81.5; mean number of medications taken daily: 9.3). Of the 1370 interviews, 743 (54.2%) were performed in the patient's home, and thus also included an examination of the home medicine cabinet. Adverse events were reported by 566 (42.0%) patients. A total of 378 patients (27.6%) reported difficulties in preparing, administering and/or swallowing medications. The inspections of medicine cabinets identified a variety of shortcomings: poorly located cabinets (in 15.0% of inspections), medication storage problems (21.7%), expired medications (40.7%), potentially inappropriate medications (15.0%), several different generic versions of the same drug (19.9%), and redundant medications (20.4%).Conclusions: In a community pharmacy setting, high-priority older patients for intervention by a community pharmacist can be identified by asking simple questions about difficulties in managing, administering, taking or storing medications. [ABSTRACT FROM AUTHOR]