Du traitement précoce des sujets à risque aux risques du traitement précoce. Le dilemme de la prévention des troubles psychotiques [From early treatment of psychosis risk to the risks of early intervention: the dilemma of psychosis prevention].

While the development of early psychosis intervention programs have improved outcome of such disorders, primary prevention strategies are still out of reach. The elaboration, over the last 15 years, of scales and criteria to identify populations at high risk for psychosis is a real progress, but their low specificity is still a major obstacle to their use outside of research projects. For this reason, even if "ultra high risk", subjects present with real psychiatric disorders and sometimes significant decrease in functioning level, the fact that only a small proportion will eventually develop full blown psychosis will probably lead to the rejection of a "psychosis risk syndrom" from the future DSM-V classification.

Exhaled breath condensate as a matrix for combustion-based nanoparticle exposure and health effect evaluation

Health assessment and medical surveillance of workers exposed to combustion nanoparticles are challenging. The aim was to evaluate the feasibility of using exhaled breath condensate (EBC) from healthy volunteers for (1) assessing the lung deposited dose of combustion nanoparticles and (2) determining the resulting oxidative stress by measuring hydrogen peroxide (H2O2) and malondialdehyde (MDA). Methods: Fifteen healthy nonsmoker volunteers were exposed to three different levels of sidestream cigarette smoke under controlled conditions. EBC was repeatedly collected before, during, and 1 and 2 hr after exposure. Exposure variables were measured by direct reading instruments and by active sampling. The different EBC samples were analyzed for particle number concentration (light-scattering-based method) and for selected compounds considered oxidative stress markers. Results: Subjects were exposed to an average airborne concentration up to 4.3×10(5) particles/cm(3) (average geometric size ∼60-80 nm). Up to 10×10(8) particles/mL could be measured in the collected EBC with a broad size distribution (50(th) percentile ∼160 nm), but these biological concentrations were not related to the exposure level of cigarette smoke particles. Although H2O2 and MDA concentrations in EBC increased during exposure, only H2O2 showed a transient normalization 1 hr after exposure and increased afterward. In contrast, MDA levels stayed elevated during the 2 hr post exposure. Conclusions: The use of diffusion light scattering for particle counting proved to be sufficiently sensitive to detect objects in EBC, but lacked the specificity for carbonaceous tobacco smoke particles. Our results suggest two phases of oxidation markers in EBC: first, the initial deposition of particles and gases in the lung lining liquid, and later the start of oxidative stress with associated cell membrane damage. Future studies should extend the follow-up time and should remove gases or particles from the air to allow differentiation between the different sources of H2O2 and MDA.

Tabagisme passif et santé respiratoire de l'adulte: une menace bien réelle [ETS and respiratory health in adults: a real threat]

Hazards due to active smoking are known for a long time. On the other hand, the importance of the harmful effects of passive smoking are less recognized, having been shown initially mainly in the pediatric population. However, the importance of significant increased risks on various respiratory pathologies of the adult are well known today, in a Swiss society where the number of active smokers remains high, leading to a high prevalence of passive smoking exposure On the basis of recent publications and updates of various organizations, we propose a review of the history, noxious mechanisms and effects on various respiratory pathologies of the exposure to passive smoke in adults.

Prolonged fluconazole exposure leads to a shift to Candida species with decreased susceptibility in breakthrough candidemia: prospective survey of the Fungal Infection Network of Switzerland

Objectives: To compare the clinical characteristics, species distribution and antifungal susceptibility of Candida bloodstream isolates (BSI) in breakthrough (BTC) vs. non-breakthrough candidemia (NBTC) and to study the effect of prolonged vs. short fluconazole (F) exposure in BTC.Methods: Candida BSI were prospectively collected during 2004- 2006 from 27 hospitals (seven university, 20 affiliated) of the FUNGINOS network. Susceptibility to F, voriconazole (V) and caspofungin (C) was tested in the FUNGINOS mycology reference laboratory by microtitre broth dilution method with the Sensititre YeastOneTM test panel. Clinical data were collected using standardized CRFs. BTC was defined as occurring during antifungal treatment/prophylaxis of at least three days duration prior to the candidemia. Susceptibility of BSI was defined according to 2010/2011 CLSI clinical breakpoints.Results: Out of 567 candidemia episodes, 550 Candida BSI were available. Of these, 43 (7.6%) were from BTC (37/43, 86% were isolated after F exposure). 38 BTC (88.4%) and 315 NBTC (55.6%) occurred in university hospitals (P < 0.001). The majority of patients developing BTC were immunocompromised: higher proportions of haematological malignancies (62.8% in BTC vs. 47.1% in NBTC, P < 0.001), neutropenia (37.2% vs. 11.8%, P < 0.001), acute GvHD (14% vs. 0.2%, P < 0.001), immunosuppressive drugs (74.4% vs. 7.8%, P < 0.001), and mucositis (32.6% vs. 2.3%, P < 0.001) were observed. Other differences between BTC and NBTC were higher proportions of patients with central venous catheters in the 2 weeks preceding candidemia (95.3% vs. 83.4%, P = 0.047) and receiving total parenteral nutrition (62.8% vs. 35.9%, P < 0.001), but a lower proportion of patients treated with gastric proton pump inhibitors (23.3% vs. 72.1%, P < 0.001). Overall mortality of BTC and NBTC was not different (34.9% vs. 31.7%, P = 0.73), while a trend to higher attributable mortality in BTC was found (13.9% vs. 6.9%, P = 0.12). Species identification showed a majority of C. albicans in both groups (51.2% in BTC vs. 62.9% in NBTC, P = 0.26), followed by C. glabrata (18.6% vs. 18.5%), C. tropicalis (2.3% vs. 6.3%) and C. parapsilosis (7.0% vs. 4.7%). Significantly more C. krusei were detected in BTC versus NBTC (11.6% vs. 1.6%, P = 0.002). The geometric mean MIC for F, V and C between BTC and NBTC isolates was not significantly different. However, in BTC there was a significant association between duration of F exposure and the Candida spp.: >10 days of F was associated with a significant shift from susceptible Candida spp. (C. albicans, C. parapsilosis, C. tropicalis, C. famata) to non-susceptible species (C. glabrata, C. krusei, C. norvegensis). Among 21 BTC episodes occurring after £10 days of F, 19% of the isolates were non-susceptible, in contrast to 68.7% in 16 BTC episodes occurring after >10 days of F (P = 0.003).Conclusions: Breakthrough candidemia occurred more often in immunocompromised hosts. Fluconazole administered for >10 days was associated with a shift to non-susceptible Candida spp.. Length of fluconazole exposure should be taken into consideration for the choice of empirical antifungal treatment.

Sources d'exposition aux phtalates dans une unité de soins néonatals [Phthalate exposure in the neonatal intensive care unit].

There are growing concerns on long-term health consequences, notably on fertility rates, of plasticizers such as phthalates. While di(2-ethylhexyl)phthalate (DEHP) is currently used in several medical devices, newborns in the neonatal intensive care unit are both more exposed and more vulnerable to DEHP. The objectives of this study were to identify, count, and describe possible sources of DEHP in a neonatal care unit. Our method consisted in the listing and the inspection of the information on packaging, complemented by contact with manufacturers when necessary. According to the results, 6% of all products and 10% of plastic products contained some DEHP; 71% of these involved respiratory support devices. A vast majority of the items showed no information on the content of DEHP. Further research is needed, particularly to determine the effects of such an early exposure and to study and develop safer alternatives.

Letter health consultation : Air emissions from American Packaging Corporation, Story City, Iowa (2009)

A health consultation is a verbal or written response from ATSDR or ATSDR’s Cooperative Agreement Partners to a specific request for information about health risks related to a specific site, a chemical release, or the presence of hazardous material. In order to prevent or mitigate exposures, a consultation may lead to specific actions, such as restricting use of or replacing water supplies; intensifying environmental sampling; restricting site access; or removing the contaminated material. In addition, consultations may recommend additional public health actions, such as conducting health surveillance activities to evaluate exposure or trends in adverse health outcomes; conducting biological indicators of exposure studies to assess exposure; and providing health education for health care providers and community members. This concludes the health consultation process for this site, unless additional information is obtained by ATSDR or ATSDR’s Cooperative Agreement Partner which, in the Agency’s opinion, indicates a need to revise or append the conclusions previously issued.

Health consultation : Allied Products Corporation Targeted Brownfields Assessment 13th Avenue and E Street, Charles City, Floyd County, Iowa (2005)

The Iowa Department of Natural Resources (IDNR) has requested the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program to evaluate environmental data collected at former farm equipment manufacturing facility located in Charles City, Iowa. The site, most recently operated by Allied Products Corporation, is a 70-acre site located at 13th Street and E Street in Charles City, Iowa (Figure 1). The site is undergoing a Targeted Brownfields Assessment conducted by the Contaminated Sites Section of the IDNR. This health consultation addresses potential health risks to people from future exposure to the soil within the property boundary, and any health impacts resulting from contaminated groundwater beneath the site property. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Health consultation : Former Chamberlain Manufacturing Site 550 Esther Street Waterloo, Black Hawk County, Iowa (2012)

The United States Environmental Protection Agency (EPA) has requested the Iowa Department of Public Health (IDPH) to evaluate the health impacts associated with exposure to contaminants of concern that have been found at the former Chamberlain Manufacturing Site. The EPA has been involved in the investigation and remediation of the Former Chamberlain Manufacturing Site since 2005. As part of these investigative activities, on-site soil sampling and both on-and off-site groundwater sampling has been completed. In addition, sub-slab soil gas, indoor air, and ambient air sampling at properties located near the Former Chamberlain Manufacturing Site has been completed. This health consultation addresses potential health risks to the public from exposure to the soil, groundwater and potential vapors within homes or buildings at or near the Former Chamberlain Manufacturing Site. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Health consultation : Exposure to fluff material from the Shine Brothers and noise concerns -- Spencer, Iowa (2011)

This letter has been prepared as a consultation to determine some potential health concerns raised by a resident of Spencer from exposure to wire shredder fluff material emitted by Shine Brothers metal salvaging facility in Spencer, Iowa on July 10, 2011 and, a concern regarding the health impacts from the level of noise measured by a resident near the metal salvaging facility.

Health consultation : Chicago Milwaukee and St. Paul rail yard targeted brownields assessment, Spring Valley Township, Perry, Dallas County, Iowa (2007)

The Iowa Department of Natural Resources (IDNR) has requested the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program evaluate future health impacts of exposures at the formerly utilized Chicago Milwaukee St. Paul Rail Yard located on the west side of Perry, Iowa. This site has undergone a Targeted Brownfields Assessment conducted by the Contaminated Sites Section of the IDNR. This health consultation assesses potential health risks to people from future exposure to soil and surface water within the property boundary, and any health impacts resulting from contaminated groundwater beneath the site property from an evaluation of the data collected during the Targeted Brownfields Assessment. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Health consultation : IBP Inc./tire chop facility targeted brownfields assessment, 1525 "O" Avenue, Fort Dodge, Webster County, Iowa (2007)

The Iowa Department of Natural Resources (IDNR) has requested the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program to evaluate future health impacts of exposures at the formerly utilized IBP Inc./Tire Chop facility located at 1525 “O” Avenue, Fort Dodge, Iowa. This site has undergone a Targeted Brownfields Assessment conducted by the Contaminated Sites Section of the IDNR. This health consultation addresses potential health risks to people from future exposure to soil within the property boundary, and any health impacts resulting from contaminated groundwater beneath the site property from an evaluation of the data collected during the Targeted Brownfields Assessment. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.

Letter health consultation : Exposure to benzene from Equistar pyrolysis gasoline tank, Clinton, Iowa (2008)

The Iowa Department of Public Health (IDPH) has been asked by several citizens of Clinton, Iowa to evaluate potential health effects from exposure to benzene from an above ground tank located near a residential area. The above ground tank is managed by Equistar Chemicals, LP (Equistar) and is use to store pyrolysis gasoline prior to off-loading onto barges. The IDPH in cooperation with the Agency for Toxic Substances and Disease Registry (ATSDR) prepared this health consultation to review the air quality monitoring provided by Equistar and provide an evaluation of the health effects from exposure to benzene at the levels detected in ambient air near the tank. The information in this health consultation was current at the time of writing. Data that emerges later could alter this document’s conclusions and recommendations.