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Résumé: Dans le cadre du congrès de la Société francophone de santé et environnement (SFSE) qui a eu lieu du 15 au 26 novembre 2021, une session a été consacrée à la place de l'expertise dans la crise en santé-environnement. En son sein, une table ronde a réuni différent acteurs autour de la question « Entre connaissance scientifique et prise de décision : deux approches complémentaires mais différentes ». En relation avec cette question, l'objectif est ici de préciser, au travers d'un exemple, quelle peut être la place des services techniques des collectivités territoriales dans les processus qui intègrent, en santé environnementale, les connaissances scientifiques disponibles en vue de la prise de décision à l'échelle locale, et d'ouvrir quelques pistes de réflexions sur ces processus eux-mêmes. During the congress of the Société francophone de santé et environnement, which took place from November 15 to 26, 2021, a session was devoted to the place of scientific expertise in the context of environmental health crises. Within this session, a round table brought together different participants around the topic: "Between scientific knowledge and decision-making: two complementary but different approaches." One response to this question used an example that explored the place of a local authority to integrate scientific knowledge into the decision-making processes in the field of environmental health. It also presented some reflections on these processes themselves. [ABSTRACT FROM AUTHOR]

Résumé: Des audits environnementaux sont réalisés gratuitement depuis 20 ans par le Service parisien de santé environnementale (SPSE) de la Ville de Paris, sur prescription médicale, au domicile de Parisiens dont la pathologie est suspectée être liée à leur environnement intérieur. Ces audits, complétés par la mesure si nécessaire de polluants chimiques et microbiologiques, permettent de proposer des conseils aux patients pour qu'ils réduisent leur exposition aux polluants incriminés. Le SPSE a diversifié ses activités en mettant en place des consultations (sans déplacement à domicile) depuis 2017 : consultations avec un conseiller médical en environnement intérieur (CMEI) permettant aux bénéficiaires de disposer d'une évaluation des facteurs de risque dans leur logement et de conseils pour leur permettre de réduire les expositions identifiées ; consultations bilan-environnement pour l'évaluation des expositions domestiques et professionnelles afin de déterminer si un audit est nécessaire. Cet article décrit l'évolution des 765 interventions (391 audits, 374 consultations) menées entre 2015 et 2019 et caractérise principalement les médecins prescripteurs. Un total de 391 audits a concerné 426 Parisiens, dont 39 % d'enfants, prescrits en grande partie par des pneumologues et des pédiatres pratiquant principalement à Paris, en secteurs hospitalier et libéral. Pour les médecins prescripteurs, ces audits permettent de connaître l'exposition de leurs patients à domicile et de leur apporter des conseils adaptés à leur situation. Depuis 2017, 58 consultations CMEI ont été délivrées au SPSE à 64 Parisiens, dont 30 % d'enfants, prescrites en majorité par des médecins généralistes libéraux et de centres de santé situés à Paris également. Depuis 2018, 202 consultations CMEI et 114 consultations bilan-environnement ont été délivrées à 248 patients adultes, parisiens ou franciliens, du service de pneumologie de l'hôpital Tenon (Paris, 20e). Les actions de prévention constituées par ces interventions, ciblées sur la réduction des expositions domestiques, pourraient être plus nombreuses si elles étaient mieux connues et si les moyens permettant leur mise en œuvre étaient augmentés. For the past 20 years, the Paris municipal environmental health department (Service parisien de santé environnementale, SPSE) has been providing onsite free-of-charge, environmental interventions (audits) to Parisians whose physicians prescribe them for patients with a disease associated with their home environment. When necessary, these audits include measurements of chemical and microbiological pollutants so that patients can receive advice about reducing their exposure to the pollutants identified. Since 2017, the SPSE has added consultations at sites other than the patient's home to the range of its services of medical indoor environment counseling (MIEC): MIEC consultations provide the clientele with both an assessment of the risk factors that may be present in their homes and advice aimed at reducing the identified exposures, while environmental appraisals assess both home and occupational exposures to determine if a home-based audit is necessary. This article describes the changes over time of the 765 interventions (391 audits and 374 consultations) that took place from 2015 through 2019 and characterizes the prescribing physicians. In all, 391 audits have been performed for 426 Parisians, 39% of them children; they were prescribed mainly by pulmonologists and pediatricians, working both in hospitals and private practice, mainly in Paris. These doctors report that these audits enable them to know their patients' domestic exposure and thus provide them with appropriate advice. Since 2017, 64 Parisians, 30% of them children, have received 58 MIEC consultations, most often prescribed by general practitioners from private practice and community health centers in Paris. Since 2018, a partnership with Tenon Hospital (Paris, 20th district) has made it possible to provide 202 MIEC consultations and 114 environmental appraisals to 248 adult patients of the hospital's pulmonary department, living in Paris or its region. These interventions are preventive actions aiming to reduce exposure to indoor air pollution in homes. Public health would benefit from an increase in physicians' awareness of these services and their greater availability. [ABSTRACT FROM AUTHOR]

Résumé: Afin d'identifier et de réduire les inégalités de santé sur le territoire, le Service parisien de santé environnementale (SPSE) a développé deux outils de pilotage des politiques publiques, qui prennent en compte les situations de multi-expositions et de vulnérabilités de la population. Le premier est un outil cartographique qui identifie les zones de cumul de défaveurs au moyen d'indicateurs cartographiés à une échelle spatiale fine, portant sur les nuisances environnementales (pollution de l'air, bruit, habitat à risque, carence en végétation), les vulnérabilités de la population (âge, état de santé, revenus) et la carence en aménités urbaines (accessibilité aux espaces verts et aux médecins généralistes). Une dizaine de secteurs ont ainsi été identifiés à Paris. Le deuxième outil est la démarche d'évaluation d'impact sur la santé (EIS) appliquée aux projets d'aménagements urbains, par exemple sur le secteur de « Gare des Mines » situé dans le nord-est parisien, qui permet d'intensifier les effets positifs du projet urbain sur la santé et d'en minimiser les éventuels effets négatifs. Ces deux outils complémentaires permettent de prioriser l'action publique au regard des différents déterminants de santé et d'améliorer la transversalité au sein des services et avec les partenaires extérieurs. The Paris environmental health department (SPSE) has developed tools for steering policies aimed at reducing health inequities in the city by taking into account situations of multiple exposure and population vulnerabilities. The first tool is a mapping process that identifies areas of cumulative disadvantage by mapping environmental risk factors (air pollution, noise, at-risk housing, lack of vegetation), population vulnerabilities (age, health status, income), and the lack of urban amenities (access to green spaces and general practitioners) on a fine scale. About ten sectors in Paris have thus been identified as requiring urgent public action. The second tool is the health impact assessment (HIA) approach applied to urban development projects, for example, in the "Gare des Mines" area. This makes it possible to intensify the positive effects of urban projects on health and minimize their negative effects. These two complementary tools help to prioritize public action regarding the various determinants of health and to improve cross-disciplinary initiatives within departments and with external partners. [ABSTRACT FROM AUTHOR]

Abstract Background The present study aimed at developing a standardized heat wave definition to estimate and compare the impact on mortality by gender, age and death causes in Europe during summers 1990-2004 and 2003, separately, accounting for heat wave duration and intensity. Methods Heat waves were defined considering both maximum apparent temperature and minimum temperature and classified by intensity, duration and timing during summer. The effect was estimated as percent increase in daily mortality during heat wave days compared to non heat wave days in people over 65 years. City specific and pooled estimates by gender, age and cause of death were calculated. Results The effect of heat waves showed great geographical heterogeneity among cities. Considering all years, except 2003, the increase in mortality during heat wave days ranged from + 7.6% in Munich to + 33.6% in Milan. The increase was up to 3-times greater during episodes of long duration and high intensity. Pooled results showed a greater impact in Mediterranean (+ 21.8% for total mortality) than in North Continental (+ 12.4%) cities. The highest effect was observed for respiratory diseases and among women aged 75-84 years. In 2003 the highest impact was observed in cities where heat wave episode was characterized by unusual meteorological conditions. Conclusions Climate change scenarios indicate that extreme events are expected to increase in the future even in regions where heat waves are not frequent. Considering our results prevention programs should specifically target the elderly, women and those suffering from chronic respiratory disorders, thus reducing the impact on mortality.

Résumé: Plusieurs études, dans des conditions contrôlées en laboratoire, montrent des durées variables de persistance du virus SARS-CoV-2 sur les surfaces, selon la nature du matériau, la température, l'hygrométrie et l'inoculum viral initial. Si la transmission du virus par les mains touchant ces surfaces contaminées ne peut être exclue, l'emploi de produits désinfectants doit être toujours précédé d'un nettoyage et réservé à des situations particulières à risque, telles que définies dans les recommandations de bionettoyage par le Haut Conseil de la santé publique (HCSP), dans le contexte de l'épidémie de Covid-19. L'utilisation de tels produits biocides doit être adaptée à l'usage visé, qui doit être réalisé dans le strict respect des conditions d'emploi figurant sur l'étiquette afin de s'assurer de l'efficacité et de l'absence de risques inacceptables pour la santé et l'environnement. Available scientific studies show that, in controlled laboratory conditions, the SARS-CoV-2 virus can persist on surfaces for periods of time varying according to substrate, temperature, humidity, and quantity of virus initially present. In the context of the COVID-19 epidemic, while infection by hands touching contaminated surfaces cannot be excluded, disinfectants should only be used after thorough cleaning of the surfaces, and must be restricted to risk situations, as defined by the biocleaning recommendations issued by the French High Council for Public Health. More generally, biocidal products must only be used for their intended purpose, and as directed on the label, in order to ensure their effectiveness and absence of risks unacceptable for human health and the environment. [ABSTRACT FROM AUTHOR]

Résumé: L'objectif de cette étude est d'analyser les données récoltées au cours d'audits environnementaux d'habitat de patients parisiens afin de rechercher des liens entre l'environnement domestique et le diagnostic de pneumopathie interstitielle diffuse (PID). Une étude exploratoire cas-témoins a été effectuée à partir des données de 122 patients audités de 2011 à 2017 : 47 patients étaient atteints de PID et 75 patients témoins étaient atteints de pathologies extra-pulmonaires. Le diagnostic de PID est significativement corrélé à quatre des 14 facteurs examinés (données mesurées ou questionnaires) : présence de plantes dans l'habitat (odds ratio (OR) = 4,14 ; IC 95 % = [1,45 ; 11,81]), présence de pigeons dans l'environnement proche de l'habitat (OR = 3,9 ; IC 95 % = [1,56 ; 9,76]), présence majoritaire de Penicillium spp dans les prélèvements (air, poussière ou surface du logement) (OR = 3,33 ; IC 95 % = [1,41 ; 7,88]) et occupation du logement supérieure à 10 ans (OR = 3,06 ; IC 95 % = [1,34 ; 6,98]). L'audit sur site permet d'identifier des facteurs de risque présents dans l'habitat susceptibles d'affecter la santé des occupants et de préconiser des mesures d'éviction. This study analyzes the data collected during audits of the housing of Parisian patients to highlight links between elements in the habitat and a diagnosis of interstitial lung disease (ILD). An exploratory case-control study was performed with data from 122 patients interviewed from 2011 to 2017: 47 patients had ILD, 75 control patients had extrapulmonary conditions. The diagnosis of ILD was significantly correlated with four of the 14 factors examined (by measurement data and questionnaires): presence of plants in the dwelling (odds ratio (OR) = 4.14; 95% CI = [1.45;11.81]), presence of pigeons near the home (OR = 3.9; 95% IC = [1.56;9.76]), presence of Penicillium spp in the samples (air, dust, or surfaces) (OR = 3.33; 95% IC = [1.41;7.88]), and housing occupancy > 10 years (OR = 3.06; 95% IC = [1.34;6.98]). The on-site audit identified risk factors present in the habitat that could affect the health of the occupants possibly requiring eviction measures. [ABSTRACT FROM AUTHOR]

Résumé: L'autorisation de mise sur le marché (AMM) des pesticides, en particulier produits phytosanitaires et biocides, est encadrée par des textes nationaux et européens. Le présent article, après avoir défini ce qu'est un produit phytosanitaire et un produit biocide, présente les grandes lignes de ce cadre réglementaire et les acteurs impliqués dans ces processus. The marketing authorization (MAA) of pesticides, in particular plant protection products and biocides, is governed by national and European legislation. This paper provides a definition of plant protection products and biocides, and explains the broad outlines of this regulatory framework and the actors involved in these processes. [ABSTRACT FROM AUTHOR]

Following similar events in other European countries, some cases of dermatitis related to contact with China-imported furniture possibly treated with dimethyl(E)-butenedioate (dimethylfumarate [DMF]) were reported to the French institute for public health surveillance at the beginning of September 2008. An active multisource case collection was conducted in order to provide an epidemiological description of this outbreak. Results of this investigation show that, in France, mainly during the 4th quarter of 2008, a large number of people presented dermatological symptoms at least plausibly due to a contact with DMF-treated consumer products. The products involved were mostly shoes and sofa (94% of cases). This work offers an example of a multipartner investigation in the field of environmental health. It also shows how the results obtained contributed to decision-making and resulted in the limitation of DMF-treated products in France and in Europe. [ABSTRACT FROM PUBLISHER]

Background: Air pollution triggers asthma attacks hours to days after exposure. It remains unclear whether socioeconomic deprivation modulates these effects. Investigation of these interactions requires adequate statistical power, obtainable by using either a sufficient number of observations or very sensitive indicators of asthma attacks. Using a small-area temporal ecologic approach, we studied the short-term relations between ambient air pollution and sales of short-acting beta-agonist (SABA) drugs, a frequent and specific treatment for control of asthma attacks in children and young adults, and then tested the influence of deprivation on these relations.Methods: The study took place in Strasbourg, France in 2004. Health insurance funds provided data on 15,121 SABA sales for patients aged 0 to 39 years. Deprivation was estimated by small geographic areas using an index constructed from census data. Daily average ambient concentrations of particulate matter (particles with an aerodynamic diameter < 10 microm [PM(10)]), nitrogen dioxide (NO(2)), and ozone (O(3)) were modeled on a small-area level. Adjusted case-crossover models were used for statistical analysis.Results: Increased of 10 microg/m(3) in ambient PM(10), NO(2), and O(3) concentrations were associated, respectively, with increases of 7.5% (95% confidence interval [CI], 4 to 11.2%), 8.4% (95% CI, 5 to 11.9%), and 1% (95% CI, - 0.3 to 2.2%) in SABA sales. Deprivation had no influence on these relations.Conclusion: The associations observed are consistent with those reported by studies focusing on SABA use. Similar studies in other settings should confirm whether the lack of interaction with deprivation is due to specific local conditions. [ABSTRACT FROM AUTHOR]

Introduction: Short term associations between air pollution indicators and hospitalizations for cardiovascular diseases have been suggested by epidemiological and clinical studies. The present study aims at estimating the association between particles with diameter <10 μm (PM10>), nitrogen dioxide (NO2>) and ozone and hospitalizations for cardiovascular diseases in eight French cities during the 1998–2003 period. Methods: The daily number of hospitalizations in each city was extracted from the French hospital information system (PMSI) for cardiovascular diseases, cardiac diseases, ischemic heart diseases and stroke. Excess relative risks (ERRs) of hospitalization associated with a 10 μg/m3> increase in pollutant levels were estimated in each city by fitting a Poisson regression model, controlling for well-known confounding factors and temporal trends. City-specific results were then combined by inverse variance weighting. Results: Daily number of hospitalizations for cardiovascular diseases was associated with PM10> levels (for a 10 μg/m3> increase, ERR=0.8%, 95% CI: [0.2, 1.5]), with NO2> (1.1%, [0.6, 1.6]) but not with ozone (0.1% [−0.2%, 0.5%]). Associations were stronger in people aged 65 years and over, and when only hospitalizations for ischemic heart diseases were considered. No association was found between strokes and air pollution levels. Discussion: Our study suggests that the ambient levels of air pollutants currently experienced in the eight French cities, which are close to European air quality guidelines, are yet linked to a short term increase of hospitalizations for cardiovascular diseases. These results are consistent with epidemiological and toxicological data on the cardiovascular effects of air pollution. [Copyright &y& Elsevier]