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D Zmirou

Publications and source records attributed to D Zmirou.

At least 55 records · Page 3Linked to original sources
PubMed1996

Short term effects of air pollution on mortality in the city of Lyon, France, 1985-90.

OBJECTIVE: The short term association between daily mortality and ambient air pollution in the city of Lyon, France (population, 410,000) between 1985 and 1990 was assessed using time series analysis. DESIGN: This study followed the standardised design and statistical analysis (Poisson regression) that characterise the APHEA project. METHODS: Four categories of cause of death were studied: total (minus external causes), respiratory, cardiovascular, and digestive causes (as a control condition). RESULTS: No association was found with any cause of death for nitrogen dioxide (NO2) and ozone (O3), nor, for any pollutant, for digestive conditions. Sulphur dioxide (SO2) and, to a much lesser degree, suspended particles (PM13), were significantly related to mortality from respiratory and cardiovascular conditions. The relative risk (RR) of respiratory deaths associated with a 50 micrograms/m3 increment of mean daily SO2 over the whole period was 1.22 (95% CI 1.05, 1.40); the RR for cardiovascular deaths was 1.54 (1.22, 1.96). The corresponding RRs for PM13 were 1.04 (1.00, 1.09) for respiratory mortality and 1.04 (0.99, 1.10) for cardiovascular deaths. CONCLUSIONS: The effects of particulates were slightly increased during the cold season. When particulates concentrations were greater than 60 micrograms/m3, the joint SO2 effect was increased, suggesting some interaction between the two pollution indicators. These results agree with other studies showing an association between particulate pollution and daily mortality; however, they also suggest the noxious effect of SO2.

Air Pollutants↗
PubMed1995

Hazard to man and the environment posed by the use of urban waste compost: a review.

This review presents the current state of knowledge on the relationship between the environment and the use of municipal waste compost in terms of health risk assessment. The hazards stem from chemical and microbiological agents whose nature and magnitude depend heavily on the degree of sorting and on the composting methods. Three main routes of exposure can be determined and are quantified in the literature: (i) The ingestion of soil/compost mixtures by children, mostly in cases of pica, can be a threat because of the amount of lead, chromium, cadmium, PCDD/F and fecal streptococci that can be absorbed. (ii) Though concern about contamination through the food chain is weak when compost is used in agriculture, some authors anticipate accumulation of pollutants after several years of disposal, which might lead to future hazards. (iii) Exposure is also associated with atmospheric dispersion of compost organic dust that convey microorganisms and toxicants. Data on hazard posed by organic dust from municipal composts to the farmer or the private user is scarce. To date, microorganisms are only measured at composting plants, thus raising the issue of extrapolation to environmental situations. Lung damage and allergies may occur because of organic dust, Gram negative bacteria, actinomycetes and fungi. Further research is needed on the risk related to inhalation of chemical compounds.

Agriculture↗
PubMed1995

Case-control assessment of the short-term health effects of an industrial toxic waste landfill.

An industrial waste landfill located within a residential area received 400,000 tons of toxic wastes between 1980 and mid 1988, in Montchanin, France. Triggered by odor nuisances caused by emissions of volatile organic compounds (VOCs), an intense local community concern led to the decision to close the site. A physician's practice-based case-control study was conducted in order to evaluate the short-term health impact of the remaining VOC emissions. Eight hundred and sixteen questionnaires were collected, divided into 432 cases (patients with conditions associated with the dump emissions) and 384 controls (other patients). Individual exposure was assessed using a combination of statistical modeling of airborne toxicants along with the determination of the time-activity patterns of the subjects throughout the study area. After adjustment for confounding factors (age, smoking, alcohol consumption, date of moving to town), nonspecific irritative respiratory symptoms occurred more frequently among the exposed subjects, with a positive trend across the three exposure categories [OR1 = 1.54; 95% CI = (0.69-3.41), OR2 = 2.09 (1.0-4.38)], and appeared to be related to long-lasting (prevalent) conditions. Psychiatric disorders were also found to be related to the exposure indexes [OR1 = 2.1 (1.01-4.37); OR2 = 2.52 (1.21-5.26)], but this association could be biased by the negative perception of the waste site. Similar findings were described in other toxic waste site-related studies.

Adolescent↗
PubMed1995

Short-term effects of air pollution on health: a European approach using epidemiological time-series data. The APHEA project: background, objectives, design.

Recent studies investigating the adverse health effects of air pollution indicate that effects exist around and below the current national and international air quality guidelines and standards. However, the difficult methodological issues involved, and the diversity of analytical techniques so far applied, hinder direct between-study comparability and the drawing of clear conclusions. The APHEA (Air Pollution on Health: European Approach) project is an attempt to provide quantitative estimates of the short-term health effects of air pollution, using an extensive data base from 10 different European countries, which represent various social, environmental and air pollution situations. Within the framework of the project, the methodology of analysing epidemiological time series data, as well as that of performing meta-analysis, are further developed and standardized. Data have been collected from 15 European cities with a total population exceeding 25 million. The exposure data consist of daily measurements of black smoke, sulphur dioxide, suspended particles, nitrogen dioxide and ozone (each available in several, though not all, cities) from already existing monitoring networks. There is substantial variability in air pollution mixtures and air pollutant levels in participating cities. The mean (24 h) levels of SO2 range 27-327 micrograms.m-3 in the winter season, and those of black smoke range 15-292 micrograms.m-3. The mean (1 h) levels of ozone in the summer season range 32-166 micrograms.m-3. The outcome data are daily counts of total and cause-specific deaths and hospital emergency admissions. Data on potential confounders (mainly meteorological and chronological variables) are also used. There is large diversity in the climatic conditions in the different cities.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants↗
PubMed1995

[Uncertainty, expertise and decision making: the lessons from the Montchanin landfill].

Three epidemiological studies were conducted at the urgent request of the administrative authority of the French department of Saône-et-Loire, in order to assess the health impact of volatile emissions from an industrial wastes dump situated in the vicinity of dwellings in the city of Montchanin, France (6,000 inhabitants). These studies were implemented in the context of deep concern within the local population. Two dealt with the diagnosed morbidity before (retrospective follow-up study), or after (case-control study) the closure of the site. The third one dealt with mortality, for several causes of death liable to be related to the gazes emitted by the landfill (SMR analysis). Due to the small size of the population, these studies had limited statistical power. Despite these uncertainties, the authors claim that the decision to close the site was based on sound health considerations and recommend that the site be cleaned up. This experience illustrates the usefulness and the limitations of field epidemiological evaluations of environmental nuisances.

Bias↗
PubMed1995

[POLAIR: software and methodological guide for the epidemiological investigation of a point source atmospheric pollution].

The POLAIR software is designed to guide the user along a methodological approach to assess the health consequences of an accidental or chronic point source atmospheric pollution. This article presents the two components of the software, i.e. the gaussian modelization of the pollution contour lines on the territory around the emission source that allows to calculate an exposure index for every individual with a space-time ponderation factor, and the implementation, by using the EPI-INFO software, of a case-control or historical cohort epidemiological study among the population living in the vicinity of the source. Standardized questionnaires for the collection of data in the field are proposed, and the steps of the data analysis are commented upon, on the basis of an illustrative example.

Air Pollution↗
PubMed1993

Epidemiology, development and treatment of end-stage renal failure in type 2 (non-insulin-dependent) diabetes mellitus. The case of mainland France and of overseas French territories.

The prevalence of diabetes mellitus among patients treated for end-stage renal failure by dialysis in France was studied in two stages (UREMIDIAB Study). The first stage consisted of a questionnaire which was mailed to all dialysis centres in mainland France. The response rate was 80.8%, resulting in a study population of 12,903 patients. Of these patients 884 were declared diabetic (6.9%). Later 295 of them were interviewed by seven specially-trained physicians who checked the medical records together with the nephrologist in charge. Plasma C-peptide was measured in almost all of the patients. Effectively, 1.4% were found to have Type 1 diabetes and 5.5%, Type 2. Diabetic nephropathy was found to be the only primary renal diagnosis among 93.9% of Type 1 diabetic patients and 36.8% of Type 2. Of the latter 51.6% had a non-diabetic cause of renal failure. In the second stage a survey was later conducted in 13 of 14 dialysis centres located in the remote overseas French territories. Among 934 patients 1.04% were Type 1 diabetic and 19.67% Type 2 (22.9% altogether). Type 2 diabetic patients treated overseas were essentially non-Caucasians (92.6%). The sex ratio was 0.54 in the overseas territories vs 1.4 in the mainland. We conclude that the prevalence of diabetes among people on dialysis is low in mainland France. But there are striking differences in the prevalence of Type 2 diabetes among dialysis patients in mainland France and its overseas territories. These differences are not related to access to dialysis facilities.

Adult↗
PubMed1993

[Evaluation of an educational action on accident prevention in children].

A health education action for childhood injuries prevention took place from october 1988 to march 1989 in the town of Chambéry (Savoie), a town of 95,000 inhabitants. The health education concerned 21,950, 0 to 15 years old children and their close relatives (parents or educators). Two assessment means were applied: 1) a questionnaire submitted to the parents and the children before and after the intervention; 2) a comparison with the evolution of chosen indicators in a control town (Annecy, Haute-Savoie, 112,000 inhabitants), the informations being supplied by private doctors, hospital, clinics, pupils insurance and anti poison centres. The comparison between the action and the control areas shows a tendency towards a decrease in the action area of the frequency of home accidents and calls to the anti-poison centres. However the overall impact of the action looks weak and possible variations appears difficult to ascertain. This work highlights the methodological difficulties of the evaluation of community health education actions.

Accident Prevention↗
PubMed1992

Diabetes mellitus prevalence among dialysed patients in France (UREMIDIAB study).

The prevalence of diabetes mellitus among patients treated for end-stage renal failure was studied using a questionnaire mailed to all dialysis units of mainland France in 1989. With a response rate of 80.8%, the study population amounted to 12,903 dialysed patients of whom 884 were declared diabetic (6.9%). In a second phase, the study focused on the diabetic patients treated in the 63 largest units (those with at least four diabetic patients). Seven specially trained physicians completed questionnaires after having interviewed the patients and checked their medical records. All this material was reviewed by the same diabetologist. The conflict of diabetes type declared by both sources of information (the nephrologists and the diabetologist) showed a misclassification rate of 31.2%. Using these new data, the prevalence of type 1 diabetes mellitus was estimated at 1.4% of patients on dialysis therapy in mainland France, and 5.5% for type 2 diabetes mellitus. A north-south declining trend was suggested for type 2 diabetes mellitus. Diabetic nephropathy was the only primary renal diagnosis among 93.9% of type 1 diabetic patients, but only for 36.8% of type 2 diabetic patients. Of the latter, 51.6% had a non-diabetic cause of renal failure. These data show that the proportion of diabetics among patients receiving dialysis, while steadily increasing in France, remains lower than in other countries in Europe and in North America. However, the validity of international comparisons depends on diabetes ascertainment. Heterogeneity in selection of patients and in diabetes type classification by dialysis units may account to a considerable degree for the differences between diabetes mellitus prevalence across countries.

Adult↗
PubMed1992

Classification of diabetes in patients with end-stage renal disease. Validation of clinical criteria according to fasting plasma C-peptide.

An epidemiologic study of end-stage diabetic nephropathy in France (Uremidiab) was performed, aiming to establish the prevalence of both types of diabetes in dialysis patients. Because discrimination between type I and type II diabetes remains mostly clinical, our aim was to evaluate what the most fitted clinical criteria were. We studied 494 hemodialyzed diabetic patients. A first classification (Cn) was offered by the nephrologist. Clinical data of 472 patients (22 patients of the 494 have been excluded) were then collected with a standardized questionnaire, allowing one diabetologist of us to establish the diagnosis of type of diabetes (classification Cd). Plasma C-peptide at this stage of the disease was expected to be very discriminative, measured in 88 patients and defined classification Ccp (< or = 0.6 ng/ml = "negative C-peptide" = type I, > 0.6 ng/ml = "positive C-peptide" = type II). Classification Cd observed 98 type I and 374 type II diabetes. Cn overestimated type I diabetes, 37% of type II diabetes being misclassified because insulin-treated. Classification Ccp observed 74 positive C-peptide patients, classified as type II, among whom 45 were insulin-treated. Only 3 patients were discordant for classification Cd and Ccp. Predictive value of "negative C-peptide" and "positive C-peptide" were 100% and 96% respectively. Multiple regression analysis of the Ccp classification was performed with the clinical criteria and showed very significant correlation with: age at the time of diagnosis of diabetes (AGE), maximal body mass index ever reached (BMI MAX) and delay between diagnosis and consistent insulin use (DI).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Assessment of handicap in chronic dialysis diabetic patients (Uremidiab section study).

As part of a large epidemiological study concerning 494 diabetic patients undergoing dialysis throughout France--the so-called Uremidiab section study--we collected data with the aim of describing objective as well as subjective aspects of quality of survival. Questionnaires were completed from medical records and from direct interviews by trained collectors. The data included: (a) medical status and impairments; (b) functional status with the Barthel index for basic activities of daily living; (c) subjective aspects through self-estimation of fatigue, pain, care burden, quality of life and working capacity. Only 21% of the patients had type 1 diabetes and more than 71% were currently insulin-treated. Among the various long-term complications registered, visual impairment was a prominent feature: 25% of the patients were blind and the best eye vision scored 0.8 or more for only 20%. The differences found between the two types of diabetes are discussed. As a result of these impairments, functional status was poor even when considering basic activities, with a mean Barthel index (BI) of 80 +/- 19. Type 2 patients and those patients undergoing continuous ambulatory peritoneal dialysis had significantly lower BI. The results are discussed in the light of the literature. Compared with a group of 121 non-dialyzed diabetics, patients scored higher for fatigue and pain, but not for care burden and quality of life.

Activities of Daily Living↗
PubMed1991

[Epidemiologic and economic impact of child accidents: intensive care and accident consequences in Savoie].

In the context of a descriptive study of accidents occurring to children aged less than 16 yr old conducted in 1986 in Savoie, France (333,200 inhabitants; 74,400 children), the present survey focuses on their consequences during an 18-month period after hospitalization. The authors evaluate both the epidemiological impact of the accidents (14.2% of hospitalized children had mid-term consequences; 6.4% had sequelae, one-third of which were serious) and their economic impact: the medical and social costs of the consequences amounted to 1.4 million francs, totalizing almost 10.5 millions francs for the global cost of the accident after 18 months, in the Savoie department. The authors emphasize the difficulties of making such evaluations.

Accidents↗
PubMed1991

[The joint effects of various atmospheric pollutants: a meta-analysis].

Epidemiological and experimental papers on respiratory effects of air pollution published between 1980 and 1988 were reviewed, using a meta-analytical approach. Forty epidemiological papers dealing with sulfur dioxide (SO2) and total suspended particles (TSP) were used to scrutinize the interaction between the two pollutants, and suggested that the effect of the acid gas was enhanced by the joint presence of TSP. Oxidant pollution combining O3 and NO2 was also found more noxious than ozone alone, using 32 experimental design papers. These results stem from the multivariate modelization of the relationship between the relative risk of cough or the relative decrease of FEV1.0, and the pollutants concentration, and illustrated some of the advantages of this quantitative approach to literature review. Underlying physiopathological processes are discussed, in the light of the important literature available on this topic.

Air Pollutants↗
PubMed1990

[Evaluation of microbial indicators of health risk related to river swimming places].

A retrospective follow-up study was conducted among 5,737 tourists in 8 holiday camps, during the 1986 summer, in the Ardèche river basin, in order to study the relationship between the bacteriological water quality and the morbidity that occurred to swimmers. Total morbidity was more frequent among bathers than non-bathers (Risk Ratio = 1.7 [95% confidence interval = 1.4-2.1]); gastro-intestinal illness was the major type of morbidity (RR = 2.8 [1.8-4.4] for "objective gastro-intestinal diseases). After screening for the germs that were best correlated with gastro-intestinal and skin diseases, using simple linear regression, logistic regression models allowed confirmation that fecal streptococci best predicted gastro-intestinal morbidity; it significantly exceeded the risk observed among non-bathers above a concentration of 20 SF/100 ml ("objective" gastro-intestinal morbidity). The relationship with fecal coliforms was less clear. However, they are good indicators of skin diseases risk. These results should help re-evaluation of the current microbiological standards concerning recreational waters.

Enterococcus faecalis↗
PubMed1990

[Passive smoking respiratory risk. A quantitative synthesis of the literature].

Fifty nine scientific papers had been published in english or french literature, by 1988, on the matter of respiratory health effects of environmental tobacco smoke exposure (ETS). Fifteen dealt with lung cancer. An original meta-analytical approach was used in order to assess the consistency of these results, where the quality of the papers contributes to the weighing scheme, along with the traditional precision parameters. Lung cancer studies converge towards a point estimate of the relative risk (RR) near 1.5, contrasting non smokers exposed during a long time to ETS (mostly at home) and non exposed non smokers (95% confidence interval = 1.3-1.6). Important methodological difficulties did not allow, to date, to show consistent dose-effect relationship with duration or intensity of exposure. Chronic infections of lower respiratory tract related to ETS have been frequently observed (RR = 1.3; 1.2-1.4) as well among adults as among children. Wheezing and asthma are likewise more frequent among children exposed to ETS at home (RR = 1.2; 1.1-1.4). A modest, although statistically significant decrease of Forced Expiratory Volume at One Second is associated with passive smoking among children (mean effect = -0.5%). Health risk related to passive smoking are much lower than those caused by active smoking. However, this hazard should not be underlooked, since ETS is universally present in everyday life and since anyone may be exposed, including children, the elderly and those who suffer from chronic respiratory diseases. Many research needs are underscored by this meta-analysis. It remains that the current state of knowledge on health risks associated with passive smoking warrants that strong preventive action, educative or statutory, be promoted.

Adolescent↗
PubMed1989

Epidemiological significance of microbiological pollution criteria for river recreational waters.

A retrospective follow-up study was conducted during the summer of 1986 in the French Ardèche basin in order to assess the relationship between swimming-related morbidity and the bacteriological quality of the recreational water. 5737 tourists in eight holiday camps were questioned as to the occurrence of illness and their bathing habits during the week preceding the interviews. The rate-ratio contrasting swimmers and non-swimmers for total morbidity is 2.1 (1.8-2.4) = 95% confidence interval); gastrointestinal illness is the major type of morbidity and differs significantly between the two groups (RR = 2.4 (1.9-3.0) for total gastrointestinal cases; RR = 2.3 (1.7-3.2) for 'objective' gastrointestinal cases). Faecal streptococci (FS) are best correlated to gastrointestinal morbidity, using direct linear regression models. Faecal coliforms (FC) are not as good predictors of the risk. The concentration of faecal streptococci above which the 'objective' gastrointestinal morbidity among bathers is significantly greater than among non-bathers is 20 FS/100 ml. Swimmers suffer skin ailments much more frequently than non-swimmers (RR = 3.7 (2.4-5.7]; although the relationship may be artefactual, this type of morbidity is well correlated with the concentration of faecal coliforms, aeromonas and pseudomonas. This study provides epidemiological data on which to base microbiological standards for river recreational waters dependent on what might be considered as an 'acceptable' risk.

Adolescent↗
PubMed1989

A controlled evaluation of a homoeopathic preparation in the treatment of influenza-like syndromes.

1. A controlled clinical trial was conducted to assess the effectiveness of a homoeopathic preparation in the treatment of influenza-like syndromes. 2. 237 cases received the test drug and 241 were assigned to placebo. Patients recorded their rectal temperature twice a day, and the presence or absence of five cardinal symptoms (headache, stiffness, lumbar and articular pain, shivers) along with cough, coryza and fatigue. 3. Recovery was defined as a rectal temperature less than 37.5 degrees C and complete resolution of the five cardinal symptoms. 4. The proportion of cases who recovered within 48 h of treatment was greater among the active drug group than among the placebo group (17.1% against 10.3%, P = 0.03). 5. The result cannot be explained given our present state of knowledge, but it calls for further rigorously designed clinical studies.

Adult↗