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International audience; Throughout their professional careers, workers can potentially be exposed to multiple health risk factors simultaneously. As part of the French 2016-2020 National Occupational Health Plan, specific initiatives aimed to improve consideration of multiple exposures and how to avoid them, a major challenge in the field of occupational health, safety, and prevention. To this end, an initial review listed the measures taken to address the question of multiple exposures at institutional level in France and in other countries in Europe and North America. A subsequent analysis phase, based on the exploitation of the 2017 Sumer survey results (Medical surveillance of employees’ exposure to occupational risks), identified a range of homogeneous profiles of workers with multiple exposures into which almost all French employees fall.; Tout au long de leur carrière professionnelle, les travailleurs sont susceptibles d’être exposés simultanément à de multiples facteurs de risque sanitaires. Dans le cadre du Plan santé au travail (PST) 2016-2020, une action spécifique visait l’amélioration de la prise en compte de la polyexposition, un défi majeur pour l’ensemble des acteurs de la sécurité sanitaire et de la prévention. À ce titre, un premier état des lieux a recensé les principales actions conduites sur la question de la polyexposition au niveau institutionnel en France et dans d’autres pays en Europe et en Amérique du Nord. Une seconde phase d’analyse, fondée sur l’exploitation des résultats de l’enquête Sumer 2016-2017 (Surveillance médicale des expositions des salariés aux risques professionnels), a permis l’identification de profils homogènes de travailleurs polyexposés. Ces profils objectivent des situations de polyexpositions qui concernent la quasi-totalité des salariés français.

Key Message Hybrid saplings were more reactive to soil water deficit than Japanese and European larch. European larch had hydraulically safer wood and anisohydric behavior, Japanese and hybrid larch showed isohydric strategy. Abstract Deciduous larch species could be an alternative to evergreen conifers in reforestation, but little is known about drought sensitivity of their saplings. The effect of an experimental drought on hydraulics and quantitative wood anatomy was tested on saplings of European larch (EL, Larix decidua), Japanese larch (JL, Larix kaempferi) and their hybrid (HL). Across species, biomass, transpiration rate and relative water content were higher in controls than in drought stressed trees, but transpiration efficiency was lower. JL had the highest transpiration efficiency under drought, and EL the lowest, coinciding with slower growth of EL. Wood of EL formed before drought was hydraulically safer as shown by higher wall/lumen ratio and lower pit cavity area. EL neither had a significant increase in transpiration efficiency nor a reduction in transpiration rate under drought, suggesting that the stomata remained open under soil water deficit. HL saplings were the most reactive to water shortage, indicated by intra-annual density fluctuations and a decrease in relative water content of the sapwood. Significant reduction in transpiration by HL suggested a higher stomatal sensitivity, while the same leaf surface area was maintained and radial growth was still similar to its best parent, the JL. The latter showed a significantly lower leaf surface area under drought than controls. EL, with its hydraulically safer wood, followed an anisohydric behavior, while JL and HL revealed an isohydric strategy. Altogether, our results suggest species dependent acclimations to drought stress, whereby HL followed the strategy of JL rather than that of EL.

This work aims to assess the exposure to permethrin of the adult French population from available contamination measurements of outdoor air, indoor air, and settled dust. Priority is given to the assessment of chronic exposure, given the potential of permethrin to induce cancers and/or endocrine disorders. A statistical method was devised to calculate exposure to permethrin by different pathways (inhalation, indirect dust ingestion, and dermal contact). This method considers anthropometric parameters, the population's space-time budget, and recent methods for calculating dermal exposure. Considering the media of interest, our results pointed to house dust as the main environmental source of permethrin exposure, followed by indoor and outdoor air. Dermal contact and indirect dust ingestion may be more important exposure pathways than inhalation. A sensitivity analysis indicated that exposure estimates were mainly affected by variability within contamination data. This study is the first step in aggregated exposure and risk assessment due to pyrethroid exposure. Outdoor air, indoor air, and settled dust may constitute significant exposure sources, in addition to diet, which could be important. The next step entails assessing internal doses and estimating the proportion of each exposure source and pathway relative to internal exposure.

An evaluation of the socio-economic costs of indoor air pollution can facilitate the development of appropriate public policies. For the first time in France, such an evaluation was conducted for six selected pollutants: benzene, trichloroethylene, radon, carbon monoxide, particles (PM2.5 fraction), and environmental tobacco smoke (ETS). The health impacts of indoor exposure were either already available in published works or were calculated. For these calculations, two approaches were followed depending on the available data: the first followed the principles of quantitative health risk assessment, and the second was based on concepts and methods related to the health impact assessment. For both approaches, toxicological data and indoor concentrations related to each target pollutant were used. External costs resulting from mortality, morbidity (life quality loss) and production losses attributable to these health impacts were assessed. In addition, the monetary costs for the public were determined. Indoor pollution associated with the selected pollutants was estimated to have cost approximately €20 billion in France in 2004. Particles contributed the most to the total cost (75%), followed by radon. Premature death and the costs of the quality of life loss accounted for approximately 90% of the total cost. Despite the use of different methods and data, similar evaluations previously conducted in other countries yielded figures within the same order of magnitude. Keywords: Health impact assessment, Burden of disease, Cost of illness, Decision making

The objective of this study was to evaluate the interest of using ropivacaine for outpatient laparoscopic cholecystectomy. The use of local anesthesia by instillation and infiltration could reduce pain and increase the number of outpatient cholecystectomies. A one-center randomized prospective clinical trial compared the use of ropivacaine during outpatient laparoscopic cholecystectomy to the control group of outpatients for laparoscopic cholecystectomy between April 2014 and May 2015. One hundred twenty-four were eligible, and 100 patients were randomized. Patients with outpatient cholecystectomy were randomized into 2 groups: ropivacaine group (Rop group) and control group (control group). We performed a ropivacaine intraperitoneal instillation and wound infiltration for the ropivacaine group at the end of the procedure. The primary observation was authorization for home discharge. The patient was evaluated by the surgeon using the Chung score. Secondary observations included postoperative pain at 2 h post-surgery, at 6 h post-surgery and the day following surgery. Ninety-eight were able to leave on the evening of surgery. At 6 h post-surgery, the Chung score was identical for both groups (p = 0.73). At 2 and 6 h post-surgery and the day following surgery, there was no significant difference in pain levels (p = 0.63; p = 0.61; p = 0.98). Analgesic consumption was no significant difference in the groups. The use of ropivacaine does not increase the rate of home discharge and does not change the postoperative pain of outpatient cholecystectomy.

Background Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are often discovered at a small size. No clear consensus exists on the management of NF-PNETs ≤ 2 cm. The aim of our study was to determine the prognostic value of indicators of malignancy in sporadic NF-PNETs ≤ 2 cm. Methods Eighty patients were evaluated retrospectively in 7 French University Hospital Centers. Patients were managed by operative resection (operative group [OG]) or observational follow-up (non-OG [NOG]). Pathologic characteristics and outcomes were analyzed. Results Sixty-six patients (58% women) were in the OG (mean age, 59 years; 95% CI, 56.0–62.3; mean tumor size, 1.6 cm; 95% CI, 1.5–1.7); 14 (72% women, n = 10) were in the NOG (mean age, 63 years; 95% CI, 56–70; mean tumor size, 1.4 cm; 95% CI, 1.0–1.7). All PNETs were ranked using the European Neuroendocrine Tumor Society grading system. Fifteen patients (19%) had malignant tumors defined by node or liver metastasis (synchronous or metachronous). The median disease-free survival was different between malignant and nonmalignant PNETs, respectively: 16 (range, 4–72) versus 30 months (range, 1–156; P = .03). On a receiver operating characteristic (ROC) curve, tumor size had a significant impact on malignancy (area under the curve [AUC], 0.75; P = .03), but not Ki-67 (AUC, 0.59; P = .31). A tumor size cutoff was found on the ROC curve at 1.7 cm (odd ratio, 10.8; 95% CI; 2.2–53.2; P = .003) with a sensitivity of 92% and a specificity of 75% to predict malignancy. Conclusion Based on our retrospective study, the cutoff of 2 cm of malignancy used for small NF-PNETs could be decreased to 1.7 cm to select patients more accurately.

International audience; Vertical banded gastroplasty (VBG), introduced by Mason in 1982, is now discarded because of important long-term complications and technical difficulties to do revisional surgery. We investigated the long-term complications of VBG in our center and compared it with the literature data. Patients who underwent an open VBG at the University Hospital of Nantes between October 1991 and May 2006 were included. We reviewed preoperative clinical data, long-term outcome in weight loss, complications, and revisional surgeries with a long follow-up. Sixty-three patients (52 women and 11 men) were included, with a mean age of 43 ± 10 years and a body mass index of 46.7 ± 8.3 kg/m². The mean follow-up was 8.2 ± 4.2 years. At the end of follow-up, the mean excess weight loss (EWL) was 29.8%. Long-term success (excess weight loss > 50%) of the procedure was observed in 25 patients (39.7%). A second intervention was performed in 15 patients (23.8%), and three needed a third redo procedure. Six patients (40%) had this new intervention for late complications, and nine (60%) for weight regain. Weight loss is satisfying in the long term although the rate of reintervention is high. Long-term complication can be severe, especially with gastric stenosis that could lead to esophageal cancer. A second reintervention could be technically demanding, especially by laparoscopy, and the patients should be referred to a specialized center.

This study aims to test if CO 2 concentration could be used as a proxy for indoor air quality. It focuses on the observed correlations between concentrations of carbon dioxide (CO 2 ) and indoor air pollutants within two measurement campaigns in France (567 dwellings and 310 nurseries, kindergartens and elementary schools). In dwellings, the weekly averaged concentration of CO 2 was positively and significantly correlated with formaldehyde, acetaldehyde, acrolein, benzene and particulate matter (PM 2.5 and PM 10 fractions). In schools, similar significant correlations were observed between CO 2 and both formaldehyde and benzene. With high concentration of CO 2 in dwellings and schools, the probability to exceed the pollutant health guideline values for long term exposure increased. CO 2 concentration was used as a diagnosis test to predict the probability to exceed a guideline value. The real gain in exceedance detection probability was at best +33% for acetaldehyde (guideline value of 9 μg/m 3 ) in dwellings and +23% for formaldehyde (guideline value of 10 μg/m 3 ) in schools. The optimum CO 2 concentration threshold that maximizes exceedance detection probability ranges from 660 ppm to 890 ppm depending on the pollutant. However, limiting CO 2 concentration is not enough to prevent exceedances to occur. CO 2 as a tracer of some pollution sources cannot be considered as a unique indoor air quality indicator. CO 2 is also often considered as a surrogate of ventilation rate. Hence, this study confirms that even with good ventilation conditions (i.e. low CO 2 level), the reduction of pollutant sources remains necessary to achieve a satisfactory indoor air quality.

This work aims to assess the exposure to permethrin of the adult French population from available contamination measurements of outdoor air, indoor air, and settled dust. Priority is given to the assessment of chronic exposure, given the potential of permethrin to induce cancers and/or endocrine disorders. A statistical method was devised to calculate exposure to permethrin by different pathways (inhalation, indirect dust ingestion, and dermal contact). This method considers anthropometric parameters, the population's space-time budget, and recent methods for calculating dermal exposure. Considering the media of interest, our results pointed to house dust as the main environmental source of permethrin exposure, followed by indoor and outdoor air. Dermal contact and indirect dust ingestion may be more important exposure pathways than inhalation. A sensitivity analysis indicated that exposure estimates were mainly affected by variability within contamination data. This study is the first step in aggregated exposure and risk assessment due to pyrethroid exposure. Outdoor air, indoor air, and settled dust may constitute significant exposure sources, in addition to diet, which could be important. The next step entails assessing internal doses and estimating the proportion of each exposure source and pathway relative to internal exposure.

In France, the present regulations on occupational exposure to asbestos fibers take into account fibers (FRp: fibers measured for industrial hygiene) with the following dimensions: L > 5 μm, D 3 where L is the length and D the diameter of the fiber. The limit value is set at 0.1 f/cm3 for 1 hr. By definition short asbestos fibers (SAFs) are the fibers with 0.5 μm < L< 5 μm, D < 3 μm, and L/D ≥ 3; thin asbestos fibers (TAFs) are the fibers with L ≥ 5 μm, D < 0.2 μm, and L/D ≥ 3. The aim assigned to the French Agency for Environmental and Occupational Health Safety (AFSSET) Occupational Exposure Limit (OEL) Committee, was essentially to evaluate the following elements: the relevance of the present French OEL, knowing that this limit excludes the counting of SAFs and TAFs; the consistency of the OEL in light of the different varieties of asbestos by studying possible differential toxicity according to the type of asbestos (chrysotile vs. amphiboles); and the assessment of different measurin...

1. Anthropogenic pressures have produced heterogeneous landscapes expected to influence diversity differently across trophic levels and spatial scales. 2. We tested how activity density and species richness of carabid trophic groups responded to local habitat and landscape structure (forest percentage cover and habitat richness) in 48 landscape parcels (1 km2) across eight European countries. 3. Local habitat affected activity density, but not species richness, of both trophic groups. Activity densities were greater in rotational cropping compared with other habitats; phytophage densities were also greater in grassland than forest habitats. 4. Controlling for country and habitat effects we found general trophic group responses to landscape structure. Activity densities of phytophages were positively correlated, and zoophages uncorrelated, with increasing habitat richness. This differential functional group response to landscape structure was consistent across Europe, indicated by a lack of a country × habitat richness interaction. Species richness was unaffected by landscape structure. 5. Phytophage sensitivity to landscape structure may arise from relative dependency on seed from ruderal plants. This trophic adaptation, rare in Carabidae, leads to lower phytophage numbers, increasing vulnerability to demographic and stochastic processes that the greater abundance, species richness, and broader diet of the zoophage group may insure against.

The fibrogenicity and carcinogenicity of asbestos fibers are dependent on several fiber parameters including fiber dimensions. Based on the WHO (World Health Organization) definition, the current regulations focalise on long asbestos fibers (LAF) (Length: L ≥ 5 μm, Diameter: D < 3 μm and L/D ratio > 3). However air samples contain short asbestos fibers (SAF) (L < 5 μm). In a recent study we found that several air samples collected in buildings with asbestos containing materials (ACM) were composed only of SAF, sometimes in a concentration of ≥10 fibers.L-1. This exhaustive review focuses on available information from peer-review publications on the size-dependent pathogenetic effects of asbestos fibers reported in experimental in vivo and in vitro studies. In the literature, the findings that SAF are less pathogenic than LAF are based on experiments where a cut-off of 5 μm was generally made to differentiate short from long asbestos fibers. Nevertheless, the value of 5 μm as the limit for length is not based on scientific evidence, but is a limit for comparative analyses. From this review, it is clear that the pathogenicity of SAF cannot be completely ruled out, especially in high exposure situations. Therefore, the presence of SAF in air samples appears as an indicator of the degradation of ACM and inclusion of their systematic search should be considered in the regulation. Measurement of these fibers in air samples will then make it possible to identify pollution and anticipate health risk. © 2014 Boulanger et al. licensee BioMed Central Ltd., SCOPUS: re.j, info:eu-repo/semantics/published

Les fragments de clivage (FC) sont des particules minerales produites a partir de roches naturelles sous l’effet de contraintes mecaniques, notamment lors de travaux publics (enrobes routiers). Certains peuvent, par leur composition chimique et leurs dimensions, etre assimiles a des fibres d’amiante. Si les effets des fibres d’amiante sur la sante sont bien documentes, il existe des incertitudes sur la toxicite des FC. De plus, les methodes analytiques actuelles ne permettent pas toujours de distinguer de facon simple les FC des fibres d’amiante. Dans ce contexte, l’Anses a ete saisie par les ministeres en charge de la Sante, du Travail et de l’Environnement pour documenter les circonstances d’expositions professionnelles aux FC, les effets sanitaires en resultant et les methodes ou criteres permettant d’affiner les analyses de materiaux et d’air. Les FC d’interet sont ceux susceptibles d’etre comptabilises comme fibres d’amiante lors des analyses d’air, c’est-a-dire les FC d’amphiboles homologues des amiantes reglementes, a savoir l’actinolite, l’anthophyllite, la tremolite, la grunerite et la riebeckite, ayant les dimensions d’une fibre definies par l’Organisation mondiale de la sante (OMS) (L > 5 μm, D 3) et donc susceptibles d’etre inhalees. Les donnees concernant d’autres especes chimiques d’amphiboles ont egalement ete etudiees. Au vu des donnees analysees, il n’est pas possible d’exclure un risque pour la sante lie a l’exposition aux FC des 5 amphiboles precitees. Certaines donnees indiquent de plus des risques pour la sante similaires a ceux induits par l’amiante pour des silicates fibreux non reglementes a ce jour : des amphiboles (winchite, richterite, fluoro-edenite) et une zeolite (erionite). Aucune donnee d’exposition specifique aux FC n’a ete identifiee, en raison notamment de co-expositions avec des fibres d’amiante et des difficultes analytiques pour les distinguer formellement de celles-ci. D’autres methodes ou d’autres criteres permettent d’affiner l’analyse mais sont difficilement utilisables en routine. Dans ce contexte, l’Anses recommande une evolution du cadre reglementaire en vigueur afin de prendre en compte les effets sanitaires associes aux FC d’actinolite, d’anthophyllite, de tremolite, de grunerite et de riebeckite, et aux particules minerales de winchite, richterite, fluoro-edenite et erionite ayant les dimensions d’une fibre « OMS ». La mise en place de dispositions permettant le suivi et la surveillance des sites, ainsi que la tracabilite et la reduction des expositions professionnelles est egalement preconisee. Enfin, des mesures visant a homogeneiser le prelevement et l’analyse des particules minerales dans les materiaux naturels sont proposees.

National audience; Les changements de biodiversité se placent au cœœur des problématiques des changements globaux. L'’intensification et le changement d'usage des terres sont devenus des préoccupations constantes pour les décideurs politiques et l'’évaluation du risque de perte en biodiversité, lié à la transformation des paysages. L’'impact de l’'intensification de l’'usage du sol sur la faune du sol reste encore peu étudié. Celle-ci joue cependant un rôle important dans le fonctionnement du sol (recyclage de la matière organique, structuration du sol) et contribue à la fourniture de services écosystémiques (comme la séquestration de carbone). Cette étude mesure l'’impact de l'’intensification de l'’usage du sol sur la diversité biologique du sol le long d'’un gradient d'’intensification des pratiques agricoles dans le Nord du parc naturel régional du Morvan (centre-est de la France). Il se compose de 6 fenêtres paysagères d’'un km² distribuées depuis des paysages forestiers (semi-naturel et artificiel) à des paysages agricoles de plus en plus intensifs (clairière agricole en forêt, mosaïque agricole mixte, mosaïque prairiale et mosaïque céréalière). Les composantes de la diversité biologique du sol mesurées sont les carabes, la macrofaune du sol et les collemboles. Les échantillons de ces taxa sont spatialement emboîtés et distribués sur une même grille d'’échantillonnage dans les six fenêtres paysagères. L’'analyse portera sur une identification hiérarchique des facteurs environnementaux majeurs déterminant les variations de ces jeux de données en prenant en compte trois niveaux d’'analyse spatiale : le point d'’échantillonnage, le pattern des habitats dans un rayon de 100 m et le pattern des fenêtres paysagères. La discussion portera sur l'’impact de l’'anthropisation sur la faune du sol et ses implications en termes de fonctionnement écologique.