Seniors: Developing one’s balance and muscle strength is effective

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).Sport seniors activités physique


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 Paris, inhabitants of disadvantaged areas are more vulnerable to the effects of atmospheric pollution

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.Carte de Paris catégories socio-pro

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

Carte de Paris pollution

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.

In 40 years the French have adapted their behaviour to climate change

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.

[1] Collected by Inserm’s CépiDc (epidemiological centre for medical causes of death) with authorisation from the French Commission for Data Protection (CNIL)

Lack of consensus on obstetric practices between countries of the European Union

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.

The EURO-PERISTAT project ( is a collaboration between 26 Member States of the European Union, together with Norway, Iceland and Switzerland. It is led by Jennifer Zeitlin, a researcher at the French National Health and Medical Research Institute (Inserm), Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (EPOPé) (http://www.epopé

Long-term consequences of stress experienced in childhood

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.

The pill might reduce the risk of thyroid cancer in women

Until the 2000s, the only established risk factor for thyroid cancer was exposure to moderate or high doses of ionising radiation during childhood or early adulthood. In order to better understand all the other factors that may be involved in thyroid cancer risk, a case-control study was conducted in eastern France. The study included 805 cases of thyroid cancer diagnosed between 2002 and 2006, and 876 control individuals. The researchers focused on hormonal and reproductive factors in women (633 cases and 679 controls). According to the results obtained, the risk of developing thyroid cancer was associated with a high number of pregnancies, the use of a drug to suppress lactation, or early age of menarche. Conversely, breastfeeding or a late first pregnancy was associated with a lower risk. The most innovative result of this study relates to the use of the contraceptive pill, which was also associated with a 30-40% reduction in the risk of thyroid cancer in these young women. Interpretation of this result will require better knowledge of the complex relationships that exist between endogenous and exogenous oestrogens, as well as better knowledge of thyroid function.x-ray  illustration of the female thyroid gland


Post-menopause Treatment: Persistent Excess Risk of Breast Cancer

It has been known for about ten years that some oestrogen/progestin menopausal hormone therapies (MHT) are associated with an increased risk of breast cancer. Studies have nonetheless suggested that this risk is rapidly attenuated or even eliminated in 2-5 years if the patients stop their treatment. However, questions remain regarding this attenuation, and its relationship to the initial duration of treatment and with the types of drugs administered. The Inserm “Nutrition, Hormones and Women’s Health team at the Centre for Research in Epidemiology and Population Health (U1018, CESP, Villejuif) has studied these questions using data from the E3N cohort.

Cancer sein Fournier

© Fotolia

In a study published last April, the researchers succeeded in showing that women given MHT remain at higher risk of getting breast cancer several years after finishing their treatment compared with women who have never had MHT.

This risk would apply only to women who have been treated for a long period, i.e. longer than 5 years, with a combined MHT that includes oestrogen and a progestin other than micronised progesterone or dydrogesterone.

“Our study shows that if the risk of getting breast cancer is twice as high for women at the time of treatment, it remains 1.4 times as high in the 5 years following interruption of treatment, and for 5-10 years after. After 10 years following cessation, the risk remained higher for women who had been treated, but the results were based on insufficient numbers and insufficient statistical significance,” explains Agnès Fournier.

The team concludes this study by saying that “additional studies are needed,” to find out exactly how long this excess risk persists over time.

Since its beginnings in 1990, the E3N cohort study has received sustained support from the French National Cancer League and its departmental committees. Besides the League, the other three founding partners are Inserm, Gustave Roussy Institute and MGEN (mutual insurance company). IReSP (French Public Health Research Institute) helped to fund the present project.

Excess body weight: a risk factor for a second cancer

Excess body weight (overweight and obesity) currently concerns nearly one in two French adults. It is associated with an increased risk of several primary cancers, including postmenopausal breast cancer.

Researchers at an Inra-Inserm-Cnam-Université Paris 13 joint research unit, part of NACRe(1), worked with a team from Imperial College London to carry out the first systematic review and meta-analysis of the results of prospective studies on the relationship between excess body weight and the risk of second cancers following breast cancer.

Their results show that obesity at diagnosis of a first breast cancer increases the risk of developing a second cancer in the same or other breast, in the endometrium or the colon/rectum. The results stress the importance of implementing preventive measures to reduce the prevalence of overweight and obesity.

(1) NACRe (the French food and cancer research network)


© Inserm/T.Depardieu via Serimedis.

Infertility treatments and retinoblastoma: a low risk

Retinoblastoma is the most common eye tumor in children, with an occurrence rate of one for every 15 to 20,000 births. Even today, little is known about the risk factors for this cancer. Recent studies have suggested an increased risk of retinoblastoma in children conceived using in vitro fertilization (IVF), but these results were contradicted by other research studies.

Researchers from Inserm unit 953 (Epidemiologic research into perinatal health and the health of women and children), in collaboration with the Institut Curie and the Research Centre into epidemiology and population health (CESP), have just published the results of the EPIRETINO study into the risk of retinoblastoma associated with infertility treatments (IVF, ovarian stimulation or intrauterine insemination); the results were published in the Human Reproduction review.

The results obtained from 244 non-hereditary forms of retinoblastoma compared with 28,170 births (representative of French births) did not demonstrate an increased risk of retinoblastoma. However, high maternal ages and hypofertility (with two-year periods taken to conceive) are risk factors for retinoblastoma.