Following a programme of physical exercise based on balance and building muscle strength reduces the risk of injury from falls by nearly 20% in women aged over 75 years. This study, conducted by Patricia Dargent, has just been published in the British Medical Journal (BMJ).

©fotolia

Falls are very common in older people, with approximately one in three people over the age of 65 experiencing at least one fall per year. The resulting injuries often require medical care, and lead to a significantly altered quality of life and accelerated functional decline that can in turn lead to a progressive loss of autonomy and admission to a healthcare facility.

In total, 706 women aged 75-85 years (mean age 80), living in their own homes and with reduced balance and walking ability, participated in the Ossébo trial in 20 study centres distributed throughout France. Participants were randomly assigned to 2 groups, one group that underwent the exercise programme and a “control” group with no intervention.

The exercise programme[1]  involved weekly sessions in small groups supervised by a facilitator, supplemented by exercises to do at home at least once a week, all for a period of 2 years.

For the 2 years of the study, women in the “intervention” group had significantly fewer traumatic falls (falls causing moderate to severe injuries, requiring medical care or impeding activities of daily living for at least 3 days) than women in the control group. They also scored better on clinical tests of balance and walking, and considered themselves to be in better physical health than women in the control group.

These results also show that subjects living in disadvantaged areas are more vulnerable to even brief episodes of atmospheric pollution. Most importantly, they indicate that this population, although chronically exposed to high levels of nitrogen dioxide (like other populations), is at a still higher risk during peaks of pollution.

“We are seeing populations being continuously compromised by the effects of chronic pollution. People thus compromised then ‘succumb’ to peaks of pollution, and the less privileged social categories are the main victims,” explains Denis Zmirou, co-author of the study.

[1] Designed and established by Group Associatif Siel Bleu

In a new study published in the journal Plos One, researchers from Inserm have analysed the causes of 79,107 deaths of Paris inhabitants aged over 35 years between 2004 and 2009. Their objective was to explore whether or not a combination of neighbourhood characteristics (socioeconomic profile and daily exposure to pollution) modified the risk of mortality during episodes of pollution such as those experienced in France during the heatwave of early summer 2015.

The choice of Paris as a city was not a random one, since the French capital is characterised by average pollution concentrations that vary enormously depending on the area, and by a variety of districts that are home to populations with diverse socioeconomic profiles.

Two maps of the Paris districts were constructed. In the first, one can see the distribution of populations according to socioeconomic status of the residential districts (units known as IRIS). The second depicts the mean annual concentrations of nitrogen dioxide (NO₂) over the study period. In Paris, NO₂ in the outdoor air is mainly associated with heating buildings and car traffic.

Dwellings housing the most disadvantaged people (category 3) are mainly located in the east and north of the city, whereas categories 1 and 2 are found in the centre and west part of Paris

The most polluted regions are seen close to the main major traffic routes, along the Périphérique (ring road) and the Seine, and in northwest Paris.

The results of the study show that short-term variations in pollution and mortality are generally linked, and that there is a genuine risk of excess deaths during peaks of pollution.

These results also show that subjects living in disadvantaged areas are more vulnerable to even brief episodes of atmospheric pollution. Most importantly, they indicate that this population, although chronically exposed to high levels of nitrogen dioxide (like other populations), is at a still higher risk during peaks of pollution.

“We are seeing populations being continuously compromised by the effects of chronic pollution. People thus compromised then ‘succumb’ to peaks of pollution, and the less privileged social categories are the main victims,” explains Denis Zmirou, co-author of the study.

Against the current background of global warming, the relationship between the temperature and mortality is taking on a totally new significance. Are we getting used to rising temperatures over the years? This is the question that researchers in the Inserm Unit 1169 team ‘Epigenetics and Environment’ (Inserm/CEA/Paris-South University) are trying to answer. By analysing the link between the mortality of the elderly and daily temperature in France over 42 years, the scientists are providing evidence of our ability to adapt to temperature changes over time. This work is published in Environmental Health Perspectives.

During recent decades, the rise in temperatures has already been observed in France. Furthermore, climatic model forecast that this warming will continue in future years. This observation raises the question of our ability to acclimatise to these changes.

When we plot the change in mortality against temperature on a given day, the graph obtained is generally a parabola (‘U’-shaped). The lowest point of this curve is reached for a given value: the minimum mortality temperature (MMT), or the temperature at which the death rate is lowest. Nicolas Todd and Alain-Jacques Valleron based their analysis on these observations and on the examination of 16,000,000 death certificates[1] dated between 1968 and 2009.

Example of a graph showing the change in the risk of death against temperature. When the relative risk of death is 1, the death rate is at a minimum. If it is equal to 2 for a given temperature, the risk of death at this temperature is twice as high.

“This study of the link between temperature and mortality covers not only the longest period (42 years) but also the largest number of deaths ever studied on the subject”, emphasises Alain-Jacques Valleron, Emeritus Professor at the Pierre & Marie Curie University, and a member of the French Academy of Sciences.

To visualise the change in this relationship, the researchers divided this period into 3 parts: 1968 to 1981, 1982 to 1995 and 1996 to 2009. They quickly discovered that the minimum mortality temperature and the average temperature follow the same trend over these periods. During the 1968-1981 period (average temperature 17.6°C), the MMT rose to 17.5°C. In parallel, between 1982 and 1995 while the average temperature rose to 18.6°C, the MMT reached 17.8°C. Finally, from 1996 to 2009, the MMT followed the rise in average temperature (19.2°C) by reaching 18.2°C. These results suggest that the population has indeed been able to adapt to climate change.

“Although the mechanisms that explain this adaptation are not the purpose of this study, they are probably linked more to improvements in the insulation of homes, air-conditioning and preventive messages broadcast during heat waves than to physiological adaptation”, explains the researcher, also formerly the director of two Inserm units.

The rate of caesarean deliveries varies considerably throughout Europe, according to a new study from the EURO-PERISTAT project, published in BJOG: An International Journal of Obstetrics and Gynaecology.

We know that the likelihood of a caesarean delivery is greater for women in their first pregnancy, for women who have already had a caesarean section, and for women carrying twins or a baby in breech presentation. This study shows for the first time that these differences vary greatly from one country to another. For example, fewer than 50% of multiple births in Norway, Iceland, Finland and the Netherlands are by caesarean delivery, whereas this percentage reaches 90% in Malta and Cyprus. Similarly, fewer than three-quarters of breech births in Norway and Sweden are by caesarean delivery, in contrast to over 90% in the Czech Republic, Germany, Italy, Cyprus, Luxembourg, Malta, Scotland, Iceland and Switzerland.

France occupies an average position relative to the other countries, with a rather low overall caesarean rate, 21%.

According to the study’s conclusions, additional research is needed to explain the reasons for these differences, particularly by studying the impact of international differences in the organisation and funding of health systems and in the attitudes of parents and professionals regarding care at the time of delivery.

Exposure to stress during sensitive periods of development in childhood could alter the functioning of the various physiological systems and affect health in the long term. This has been revealed by a study conducted by the Inserm team led by Cyrille Delpierre, Inserm Research Fellow, and published in PNAS.

Adverse experiences in childhood may take the form of neglect, undernutrition, dysfunction at home, separation from parents or institutionalisation, or mental illness or alcohol use in the family, all of which generate stress for the child. Researchers from Inserm examined the data from 7,535 individuals born in Great Britain in 1958 and who had participated in the biomedical survey at 44 years of age, in order to explore the relationship between stress experienced during childhood and overall physiological wear and tear measured by an indicator known as allostatic load (AL).

Individuals who had experienced more than two traumatic or stressful psychosocial conditions in the family environment during their childhood had a higher AL at 44 years than those with no adverse experiences.

“Early psychosocial exposure may contribute to greater physiological wear and tear, especially via low socioeconomic status, high BMI, and the adoption of risk behaviours in adulthood,” explains Cyrille Delpierre, Inserm Research Fellow.

This wear and tear differs between men and women. In men, the increase observed in AL score was in most cases associated with risk behaviours (especially smoking), low level of education, and low wealth. In women, this wear and tear was also reflected by a high BMI.