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Resolving health inequalities continues to be a priority in improving quality of life around the world. Their impact is of increasing concern to public health governance, which considers the issue of environmental health inequalities to be paramount. To meet this challenge, we have developed a methodology based on the development of spatial composite index in order to assess these inequalities while also providing an alternative to classic approaches that are solely based on territory weaknesses. The aggregation of the widest possible range of factors involved in environmental health provide a clear picture of a territory. This study uses different cases to understand how the change of scale influences the analysis of environmental health inequalities. Our analysis is based on a densely populated area located in a region in the north of France where the standardized mortality ratio is higher than the national average. Multidimensional composite indices were developed simultaneously from datasets collected for different administrative units, and were used to compare levels of resilience and vulnerability within the geographical area. Joint analysis of composite indices led to the identification of territorial blackspots. Indices could therefore enable stakeholders to prioritize certain administrative units, implementing specific measures according to the specificities of each administrative unit. The study discusses the consequences of the choice of a spatial unit and a geographical area in the assessment of territorial inequalities in health, particularly in terms of accessibility, availability and exhaustivity of data. The selection criteria also depend on the jurisdictional fields of action stakeholders. • Consequences of the spatial unit choice on resilience and vulnerability indices. • Comparative analysis of strengths and weaknesses related to spatial scale. • Accessibility, availability and exhaustivity in territorial inequalities assessment. • Management of environmental health issues through aggregation of multifaceted data. • Associate rather than oppose territorial issue, spatial scale and data choice. [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]

The environmental health research carried out on a broad scale does not provide decision-makers with tools for managing environmental and social inequalities in health on a fine scale. The goal of the present study was to develop a method for neighborhood-level territorial diagnosis that decision-makers can use to incorporate health issues into their planning policies. The primary objective was to analyze composite spatial vulnerability and resilience indices in the Lille metropolitan area in northern France. The secondary objective was to refine these results by taking account of neighborhood-level characteristics. The study highlights the interest of transdisciplinary research and collaboration with local experts to effectively evaluate and address environmental health issue (more than 30 experts gathered and 12 thematic workshops organized). The results showed that the proposed method allows for the comparison of neighborhoods; however, certain specificities may be underestimated. The real importance of certain variables linked to specific contexts can be minimized, which can distort our understanding of the challenges these neighborhoods face. Analyzing the environmental and social inequalities in health in the metropolitan area's center vs. its belt made it possible to take better account of the characteristics of the areas studied. • Spatialized composite indices as a decision-making tool for local planning policies. • More than 30 local experts gathered and 12 thematic workshops organized. • Multidimensional methodology applicable to urban, peri-urban and rural neighborhoods. • Contrasting profiles discriminated by joint analysis of resilience and vulnerability. [ABSTRACT FROM AUTHOR]

[Display omitted] • A nationwide fine-scale spatial study of different degrees of preterm-birth in France. • Proposed a composite air pollution score for multiple exposure. • Found positive association between preterm birth and air pollution score. • The greater the degree of prematurity, the stronger the association. [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]

Graphical abstract Highlights • Spatial heterogeneity of environmental justice can be mapped at neighborhood scale. • Socio-economic, demographic and environmental determinants could be cumulated. • A matrix combined with radar charts provides a clear picture of these determinants. • A same level of vulnerability can be related to different profiles of determinants. • Composite index emphasises on the biological susceptibility to air pollution. Abstract Differential and not fair exposure to environmental risk factors across socio-demographic groups, called environmental justice (EJ), may contribute to inequalities in health and most often put disadvantaged groups at higher risk for environmental health effects. Main literature has difficulties to consider the potential exposure of populations to different levels of air pollutants. Cumulative and long-term exposures are still seldom considered. We propose a comprehensive EJ methodology to prioritize and characterize neighborhoods which takes into account the cumulative impact of health determinants. For this purpose, the use of environmental biomonitoring is an innovative approach to consider the integrated and long-term exposure to complex air pollution. Cumulative Impact Screening (CIS) methodology was used for two contrasted living areas of France. CIS is based on synthetic and composite index construction. Three scores were attributed to each neighborhood according to a cumulative calculation of key parameters: environmental score (using 3 air biomonitoring parameters: trace elements loads in lichens, lichenic biodiversity and dust deposition on poplar leaves), socioeconomic deprivation score and susceptible population score. Each score can be considered as a dimension of health vulnerability. CIS analysis and maps highlighted the unequal spatial distribution of EJ. After the multi-criteria hierarchization of spatial units, the influence of each dimension was characterized in each neighborhood with radar charts. The study was carried out in two living areas in the north of France: a costal industrial zone, the Dunkerque Urban Community and a densely populated area located at the crossroads of Europe, the European Lille Metropolis. Three neighborhoods of the highest vulnerability level were identified in each area. We highlighted a same level of vulnerability can be related to different profiles of determinants. This multidimensional approach was able to discriminate neighborhoods with a gradient level of vulnerability in each area, despite different environmental, demographic and economic contexts. This cross-use constitutes a preliminary validation in order to assess the replicability of the methodology. This step showed that this approach could be replicated in countries or regions which would have different characteristics: it is both specific to a given context and well suited for different contexts. We demonstrated that environmental biomonitoring is a smart approach to fill the lack of available data on multiple air pollution at the local scale. The tool developed is specific to the territory and transposable and communicant, which facilitate adoption by a variety of community agency and other regulatory stakeholders, and prioritization of public health actions. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases remain the leading cause of death and disabilities worldwide, with coronary heart diseases being the most frequently diagnosed. Their multifactorial etiology involves individual, behavioral and territorial determinants, and thus requires the implementation of multidimensional approaches to assess links between territorial characteristics and the incidence of coronary heart diseases., Context and Objectives: This study was carried out in a densely populated area located in the north of France with multiple sources of pollutants. The aim of this research was therefore to establish complex territorial profiles that have been characterized by the standardized incidence, thereby identifying the influences of determinants that can be related to a beneficial or a deleterious effect on cardiovascular health., Methods: Forty-four variables related to economic, social, health, environment and services dimensions with an established or suspected impact on cardiovascular health were used to describe the multidimensional characteristics involved in cardiovascular health., Results: Three complex territorial profiles have been highlighted and characterized by the standardized incidence rate (SIR) of coronary heart diseases after adjustment for age and gender. Profile 1 was characterized by an SIR of 0.895 (sd: 0.143) and a higher number of determinants that revealed favorable territorial conditions. Profiles 2 and 3 were characterized by SIRs of respectively 1.225 (sd: 0.242) and 1.119 (sd: 0.273). Territorial characteristics among these profiles of over-incidence were nevertheless dissimilar. Profile 2 revealed higher deprivation, lower vegetation and lower atmospheric pollution, while profile 3 displayed a rather privileged population with contrasted territorial conditions., Conclusion: This methodology permitted the characterization of the multidimensional determinants involved in cardiovascular health, whether they have a negative or a positive impact, and could provide stakeholders with a diagnostic tool to implement contextualized public health policies to prevent coronary heart diseases., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article., (Copyright © 2023. Published by Elsevier B.V.)

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.

Introduction: A growing body of evidence suggests that long-term exposure to air pollutants like nitrogen oxides (NO x ) and particulate matter (PM) is associated with the prevalence and incidence of type 2 diabetes mellitus. Serum glucose and glycosylated hemoglobin (HbA1c) levels are biomarkers of glucose homeostasis. Data on the association between glucose homeostasis biomarkers and air pollution are scarce. HbA1c and fasting blood glucose (FBG) concentrations have been linked to PM and NO 2 exposure in Taiwan, where mean pollution levels are 3 to 7 times higher than the guideline maximum annual mean values of 40 μg/m 3 (for NO 2 ) and 20 μg/m 3 (for PM10) set by the World Health Organization (WHO). However, this association is not consistently reported at lower levels of pollution. The objective of the present study was to investigate the relationships between long-term exposure to air pollution at the place of residence, diabetes biomarkers, and prevalent diabetes in two cities with relatively low level of pollution., Methods: Data were recorded for 2895 adults (aged 40 to 65) having participated in the 2011-2013 ELISABET cross-sectional survey of the Lille and Dunkirk urban areas in northern France. Using multiple logistic and generalized linear regression models, we analyzed the associations between individual exposure to pollution on one hand and HbA1c, FBG and prevalent diabetes mellitus (DM) on the other. An atmospheric dispersion modelling system was used to assess annual exposure at the place of residence to coarse particulate matter (PM10), NO 2 , and sulfur dioxide (SO 2 )., Results: The median pollutant levels were 21.96 μg/m 3 for NO 2 , 26.75 μg/m 3 for PM10, and 3.07 μg/m 3 for SO 2 . A 2 μg/m 3 increment in PM10 was associated with an HbA1c increment [95% confidence interval] of 0.044% [0.021; 0.067]. This association was still statistically significant after adjustment for the neighborhood's characteristics. A 5 μg/m 3 increment in NO 2 was associated with an HbA1c increment of 0.031% [0.010; 0.053]. Associations between DM or FBG and air pollution did not achieve statistical significance., Conclusion: Our study of a middle-aged, urban population evidenced an association between elevated HbA1c levels and long-term exposure to PM10 and NO 2 pollution levels that were relatively low but close to the WHO's guideline maximum values., (Copyright © 2018. Published by Elsevier Ltd.)

Introduction: The objective of the present study was to investigate the relationship between sources of household air pollution, respiratory symptoms and lung function., Methods: 3039 adults aged from 40 to 65 participated in the 2011-2013 ELISABET cross-sectional survey in northern France. Lung function was measured using spirometry. During a structured interview, respiratory symptoms, household fuels, exposure to moulds, and use of ventilation were recorded on a questionnaire., Results: The self-reported presence of mould in at least two rooms (not including the bathroom and the kitchen) was associated with a 2.5% lower predicted forced expiratory volume in 1 s (95% confidence interval, -4.7 to -0.29; p-trend <0.05) and a higher risk of wheezing (p-trend < 0.001). Visible condensation was associated with wheezing (p < .05) and chronic cough (p < .05). There were no significant associations with the type of household fuel or inadequate ventilation/aeration. Similar results were found when the analyses were restricted to participants without known respiratory disease., Conclusion: Our results suggest that the presence of mould (known to be associated with more severe asthma symptoms) could also have an impact on respiratory symptoms and lung function in the general population and in populations without known respiratory disease., (Copyright © 2018 Elsevier Inc. All rights reserved.)

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.

Correlations between terricolous bryophyte- and lichen- vegetation and edaphic parameters (pH, organic matter, nitrogen, Carbon/nitrogen ratio, Cation Exchange Capacity, and Cd, Pb and Zn soil contents) of soils submitted to a gradient of metal contamination in northern France were performed using statistical analysis. Six classes can be distinguished according to the low-, intermediate- and high-trace metal levels respectively, leading to the conclusion that bryophyte- and lichen-groupings have a strong bioindicative value of the heavy metal pollution of soils.