Background. - Epidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. A first step focused on describing the indicators.Methods. - The literature on indicators of self-reported health was reviewed, leading to a discussion on data collection, selection of health effects, data processing, and construction of indicators.Results. - The literature review concerned 51 articles. The use of self-reported health indicators allowed the studies to take into account the health concerns and complaints of populations exposed to environmental pollution. Various indicators of self-reported health were used in the studies. They measured physical, psychological and general dimensions of health. Standardized questionnaires were used less often than ad hoc questionnaires (78% of studies) developed to fit the needs of a given study. Three standardized questionnaires were used more frequently: the MOS Short-Form Health Survey (SF-36) to measure general health perceptions, the General Health Questionnaire (GHQ), and the Symptoms Checklist (SCL-90) to measure psychological distress.Conclusion. - The choice of self-reported health indicators is a compromise between specificity of the studied health issues within a given environment and standardization of the questionnaires used to measure them. Such standardization is necessary to ensure the validity and the reliability of the information collected across time and situations. The psychometric properties of the measuring questionnaires are rarely estimated or verified when they are used. (C) 2013 Elsevier Masson SAS. All rights reserved.

Epidemiological studies have investigated the health impacts of local sources of environmental pollution using as an outcome variable self-reported health, reflecting the overall perception interviewed people have of their own health. This work aims at analyzing the advantages and the results of this approach. This second part presents the results of the studies.Based on a literature review (51 papers), this article presents an analysis of the contribution of self-reported health to epidemiological studies investigating local sources of environmental pollution. It discusses the associations between self-reported health and exposure variables, and other risk factors that can influence health reporting.Studies using self-reported health showed that local sources can be associated with a wide range of health outcomes, including an impact on mental health and well-being. The perception of pollution, especially sensory information such as odors, affects self-reported health. Attitudes referring to beliefs, worries and personal behaviors concerning the source of pollution have a striking influence on reported health. Attitudes can be used to estimate the reporting bias in a biomedical approach, and also constitute the main explanatory factors in biopsychosocial studies taking into account not only the biological, physical, and chemical factors but also the psychological and social factors at stake in a situation of environmental exposure.Studying self-reported health enables a multifactorial approach to health in a context of environmental exposure. This approach is most relevant when conducted within a multidisciplinary framework involving human and social sciences to better understand psychosocial factors. The relevance of this type of approach used as an epidemiological surveillance tool to monitor local situations should be assessed with regard to needs for public health management of these situations.

In France, regulatory analysis of the environment and human health potential consequences is implemented for an isolated industrial activity that requests an authorization to operate using the health risk assessment method. To date, the question is enlarged to the impact of the combination of multiple sources of pollution on the same territory. The main conclusions of the work launched by the French High Council of Public Health focus on four key points: (i) the utility of conducting such an analysis at a territory scale, (ii) the delimitation of the area, (iii) the conditions for the different stakeholders' involvement, and (iv) the methodological specificities of the zone health risk assessment. The work encompassed literature reviews, seminars, and interviews of stakeholders. The utility of a Z-HRA is the central objective for the management of risk. It can no longer be conducted only for itself. The delimitation of the zone entails economic, political, environmental, and population aspects. Stakeholders become key actors in a steering and monitoring committee. Among methodological specificities, cumulative exposure comes first. Interpretation of the results should focus on risk management objectives. Finally, inclusion of Z-HRAs in flexible regulations that can be adapted to the local context is recommended.

Environmental threats to public health and warning systems: Conceptualization and stakes In 2009, the French Institute for Public Health Surveillance, a major actor in health alerts, listed 106 environmental threats to public health. The aim of this article is to extend this census by identifying the warning systems that exist in environmental health, to describe their functions, their structure, their organizational methods and finally their utility for the stakeholders. This study, based initially on a consultation of the websites of the principal countries working in this field and interviews with those managing them (industries, public authorities, associations, etc), enabled us to conduct an analysis aimed at illuminating the often polysemic concepts of threat, surveillance/monitoring and alert/warning. It provides avenues for understanding the similarities of surveillance and warning systems developed throughout the world. By modeling this system, we produced a classification useful for understanding the stakes of public action. The control theory of engineering science suggests that these systems can be modeled as loops that command environmental or health status by control mechanisms fed by measurements of environmental or health indicators. This generic representation is completed by the concept of temporality, which distinguishes the immediate reaction from delayed action and the immediate variability from that distant from the event. It is not easy to interpret surveillance system results, especially because of the difficulty in identifying the attributable risk fraction for one or more given agents. This theoretical model, by distinguishing known from unknown threats and chronic from acute exposure, allows a better analysis of the ways of monitoring environmental health and of designing warning systems for action. Three categories were identified: environmental surveillance for health purposes, specific health surveillance in environmental health and generic health surveillance. Two perspectives can be mentioned. The first is based on an approach that integrates environmental and health indicators for a detailed identification of risks. The second aims at ranking exposure situations by risk level.

A health risk assessment linked to the inhalation of formaldehyde by the general population in France was conducted according to the standardized four-step process of risk assessment: hazard identification, dose-response assessment, exposure assessment and risk characterization. The originality of this work consisted in assessing both acute exposure during or after using household products, and chronic exposure through exposure situations in various, regularly frequented places. The quantitative risk assessment was conducted on the basis of toxicity reference values (TRVs) for acute and chronic exposure and a range of hazard quotients (HQ) was calculated in both contexts. For almost all of the consumer products, tested in normal conditions of use, acute inhaled formaldehyde concentrations are lower than the TRVs calculated to protect against ocular and nasal irritation. However, for three domestic products, acute TRVs are reached or exceeded, and exposures are thus capable of causing ocular and nasal irritation. Regarding chronic exposure, the time spent in the home leads to inhaled concentrations exceeding the chronic TRVs protecting against long-term ocular and nasal irritation. The dose-effect relationship does not indicate the occurrence of other non-carcinogenic effects, even for the highest inhaled concentrations and for the worst case scenario. It appears that the highest inhaled concentrations are at only one tenth of the levels for which irritations might trigger nasopharyngeal cancer.

A cross sectional study using environmental and biological samples was undertaken to assess the association between arsenic (As) soil concentrations and urinary As levels of children living in an area where the soil is naturally As rich, during summer and winter. Twenty-nine children aged between 2 and 7 years from 21 dwellings in the summer study, and 23 of the 29 previous children from 17 dwellings in the winter study, were recruited. Housing characteristics, living conditions and individual characteristics were collected by questionnaire, and urine samples were collected for iAs+MMA+DMA measurement. Soil total As content and bioaccessibility were measured. Urinary As concentrations revealed that the children were not overexposed. Low bioaccessibility combined with moderately high levels in soil could explain this result. The concentration of arsenic in soil and soil-related factors appeared to contribute to the children's impregnation in summer but not in winter, which could be related to the children's behavior. This study highlights the need for additional studies of children to better understand their behavior, and obtain reference values in this particular population.

La politique relative a la gestion des sols pollues mise en place avec la circulaire du 8 fevrier 2007 met en avant la necessite d’approcher les situations de pollution des sols d’un point de vue environnemental et sanitaire. Le site pilote de Saint-Laurent-le-Minier (Gard) a ete l’occasion d’illustrer la mise en œuvre et l’importance d’une telle necessite pour l’optimisation des mesures de gestion environnementale et d’accompagnement sanitaire des populations. Cette commune a connu par le passe des activites minieres d’extraction et de traitement de minerai Pb/Zn, et se caracterise par des sols au fond geochimique eleve en element traces, notamment en surface. Parallelement, un depistage du saturnisme a revele des concentrations elevees de plomb dans le sang d’enfants de la commune. Cette double evaluation independante a conduit a une premiere serie de mesures de gestion environnementale et sanitaire mises en œuvre egalement de maniere independante. Il s’agissait d’interdictions lourdes, tant pour l’interet communal que particulier, demandant une analyse de la pertinence du maintien de ces mesures et une reflexion sur le suivi sanitaire des populations. La combinaison des expertises environnementale et sanitaire a alors ete proposee tant dans l’evaluation que dans la gestion du risque. Cette imbrication des approches met en avant leur complementarite pour ameliorer la comprehension des expositions et l’adaptation des mesures permettant de les reduire. La notion d’exposition est au carrefour des enjeux environnementaux et sanitaires.

Approach to the social context during investigation of local environmental health investigations: Adapting public health interventions to the local situationLocal environmental health problems sometimes result in conflict. Healthcare professionals, who intervene in these situations, must grasp the conflictual nature of the situation and identify its sensitivity. Institut de veille sanitaire (InVS) proposes an approach to this social context as part of its analysis of environmental health settings, in order to adapt the procedures by which it intervenes across the country. The approach is divided into four stages. The first step is to identify the participants involved. The second consists in describing the participants' characteristics in terms of stakes, representations, role, social demands related to the situation. Analysis of these data in the third stage is aimed at discriminating those who might have a particular sensitivity relative to the situation, especially in terms of divergences between the different participants in the field. The fourth stage allows the epidemiologists or public health professionals above and beyond their position in assessing the extent of the health concerns, based on their own analysis of the situation - to determine the attitude they should adopt towards the balance between the public health question and the importance of the social context. This approach sets clear limits between the analysis possible for non-sociologist public health professionals and the in-depth analysis of the social context, which requires specific competence in the social sciences.

A cross sectional study using environmental and biological samples was implemented to assess the association between arsenic (As) concentrations in the environment and urinary As levels of residents living in an area where the soil is naturally As rich As was measured in drinking water, atmospheric particulate matter, and soil and a geographic information system was used to assign environmental concentrations closest to the participants' dwellings and the sum of inorganic As and metabolites in urine samples The only potential source of As environmental contamination was from soil with a range of 13-131 mg As/kg of dry matter As(V) was the only species present among As extracted from the analyzed soil samples The chemical extraction showed a poor mobility of As soil There was no difference between child and teenager, and adult urinary As concentrations, though men had higher urinary As concentrations than women (p<0 001).Given the important differences in lifestyle between 7-18 year olds, men, and women, these groups were analyzed separately Whilst we were unable to find a stable model for the 7-18 year old group, for the adult men group we found that seafood consumption in the 3 days prior to the investigation (p = 0 02), and beer (p = 0 03) and wine consumption in the 4 days before the study, were associated with As urinary levels ((mu g/L) In adult women, creatinine was the only variable significantly associated with As urinary concentration (mu g/L)The concentrations we measured in soils were variable and although high, only moderately so and no link between As concentrations in the soil and urinary As concentrations could be found for either men or women. Some individual factors explained half of the variability of adult men urinary As levels The unexplained part of the variability should be searched notably in As mobility in soil and uncharacterized human behavior. (C) 2010 Elsevier B V All rights reserved

Dans un grand nombre de signalements de problemes de sante attribues a l’environnement qui parviennent a l’Institut de veille sanitaire (InVS), l’experience montre qu’il s’avere necessaire d’apprehender et de cerner les elements de contexte afin de pouvoir repondre au mieux. De nombreux facteurs sont susceptibles de generer des problemes sanitaires, reels ou percus, qui ne peuvent etre attribues au seul champ sanitaire ; ils ont egalement pour origine l’environnement social, psychosocial, voire meme le psychisme. Le departement sante environnement a entrepris de rechercher les disciplines des sciences de l’homme et de la societe susceptibles d’elargir son analyse. Des specialistes de la neuropsychiatrie, de la psychanalyse, de la psychosociologie, de la sociologie et de l’anthropologie ont ete interroges. L’exemple des phenomenes collectifs aigus d’origine inexpliquee est utilise comme support pour degager les atouts de ces collaborations car ces situations combinent le besoin d’ouverture scientifique avec la necessite de reagir et de se mobiliser tres rapidement. Les elements cles recueillis mettent en avant l’interdisciplinarite incontournable, la necessite d’apprivoiser les methodes et la capacite de chacun a s’inscrire dans une reactivite partagee pour analyser les premiers elements de la situation. Ces differents points sont les maillons indispensables a une concretisation operationnelle des collaborations, permettant de mieux cerner les legitimites et places respectives au sein d’une intervention.

Les syndromes collectifs inexpliqués et les mesures de surveillance de la qualité de l’air intérieur dans les écoles s’accroissent aujourd’hui. Les interrogations sanitaires associées demandent des réponses appropriées que les investigations classiques ne permettent pas d’apporter. La DGS et l’InVS ont développé, en association avec de nombreux acteurs institutionnels et universitaires, deux guides méthodologiques d’évaluation et de gestion de ces situations avec le souci de donner de la cohérence aux modalités proposées dans ces deux ouvrages. Ils soulignent tous deux fortement la nécessité d’un travail interdisciplinaire pour, d’une part, favoriser le croisement des regards scientifiques et, d’autre part, assumer une vraie interface avec la décision et l’action qui doit s’en suivre. Parmi les éléments marquants de ces documents, il convient de noter l’apport des sciences sociales, la constitution d’une cellule de coordination, la structuration de la communication quel que soit le moment de la situation et l’importance de l’état de préparation des acteurs locaux, notamment au travers de la nomination d’un référent de la qualité de l’air intérieur.

Arsenic (As) is a ubiquitous element ranked at the top of the priority list of hazardous substances established in 2007 in the United States. The International Agency for Research on Cancer classifies it as carcinogenic in humans, implicated in cancers of the bladder, skin and lungs. Overall exposure can be assessed by measuring the internal dose. Of the various biomarkers, urinary arsenic is measured most often. Few authors have reported the contribution of media other than water to arsenic exposure. The objective of this paper is to report the state of knowledge about the urinary exposure levels of populations without any occupational exposure and their possible associations with soil concentrations. The authors show that people living in contaminated zones have urinary arsenic concentrations higher than those residing in uncontaminated areas. Arsenic concentrations in soils vary widely from site to site (from 18,8 mg/kg to 333 mg/kg dry matter). The few available results do not allow us to reach a clear conclusion about the relationship between arsenic concentrations in soil and urine. However, a link is reported when the arsenic concentration in soil exceeds 100 mg/kg, and the soil appears to contribute to this exposure, although this contribution cannot be quantified easily. Although it is difficult to measure the health significance of urinary arsenic, the mean concentration of inorganic arsenic and its metabolites together is higher than the generally accepted levels of 10 mu g/L or 10 mu g/g creatinine in nearly all studies, but remains below the thresholds recommended in occupational populations.

La qualité de l’air à l’intérieur des locaux a pris une réelle dimension ces dernières années avec plusieurs opérations d’envergure dont la création de l’observatoire de la qualité de l’air intérieur (OQAI), l’inscription de plusieurs actions prioritaires dans les Plans nationaux santé environnement (PNSE) 1 et 2, la loi Grenelle 2 et le développement de valeurs guides spécifiques à l’air intérieur (VGAI). L’enjeu de santé publique est fort car l’ensemble de la population est exposé aux polluants présents dans l’atmosphère des environnements clos. Les problèmes de santé résultant sont nombreux et recouvrent des manifestations cliniques très diverses, qui, pour la plupart, ne sont pas spécifiques des polluants détectés. Pour certains, comme par exemple la fumée de tabac environnementale, le radon et le monoxyde de carbone, les effets sur la santé sont bien connus. Par ailleurs, des études récentes établissent un lien entre une mauvaise qualité de l’air intérieur et une baisse des performances en milieu scolaire et en milieu du travail. La demande de fixation de seuils pour les polluants présents dans ces espaces clos est devenue forte et a été engagée par l’Afsset. Après une phase de hiérarchisation ayant identifié 11 polluants prioritaires, une méthode d’élaboration des VGAI a été bâtie, consistant, pour chacun des polluants, à analyser la robustesse des VGAI et VTR nationales et supranationales disponibles afin de sélectionner la plus appropriée. Plusieurs VGAI ont été proposées en fonction des durées d’exposition et de la nature des effets. Fondées sur des critères sanitaires, elles n’ont pas un statut de valeur de gestion, notamment réglementaire. La commission spécialisée du HCSP en charge de l’environnement saisie par la DGS propose des « valeurs repères pour l’aide à la gestion de la qualité de l’air intérieur ». L’OMS s’est engagée dans une même dynamique ; ses recommandations devraient être proposées d’ici la fin de l’année 2010.

The bioavailability of contaminants is a widely used notion in the management of contaminated soils that makes it possible to optimize the risk assessment procedure. There is, however, confusion between bioavailability and bioaccessibility, which makes it difficult to integrate either concept into the monitoring and management of sites or to select a measurement protocol. The aim of this synthesis is to define the oral bioavailability and bioaccessibility of soil pollutants in humans, to assess the associations between them, to describe protocols to estimate them, and, finally, to review the international utilization of these estimates.

L'effet toxique d'un polluant du sol vis-a-vis des organismes sera fonction de la concentration totale de ce polluant dans le sol et de sa biodisponibilite. Ce dernier parametre definit la fraction d'un contaminant qui sera reellement absorbee par un organisme. De nombreux travaux issus de la litterature internationale insistent sur l'importance de considerer la biodisponibilite d'un polluant en vue d'en evaluer l'impact reel sur un organisme. L'essentiel de ces travaux portent sur les vegetaux (on parle alors de phytodisponibilite) ou les microorganismes du sol. Ces dernieres annees, des recherches ont egalement ete menees pour estimer la biodisponibilite des polluants pour l'Homme via l'ingestion de terre contaminee, une des voies d'exposition majeure pour l'evaluation du risque dans ce domaine. Toutefois, en France, l'application de ce concept est relativement limitee. Ceci conduit a une estimation conservatoire de l'exposition humaine aux contaminants pour la voie " ingestion de terre ". L'objectif de cette communication est de definir la notion de biodisponibilite orale d'un polluant pour l'Homme et de presenter les methodes de mesure disponibles pour caracteriser chacun de ces parametres. Ensuite, les possibilites et les limites d'integration de ces notions dans la gestion des sites et sols pollues sont abordees.