The excess mortality during the 2006 heat wave, which was markedly lower than that predicted by the model, may be interpreted as a decrease in the population's vulnerability to heat, together with, since 2003, increased awareness of the risk related to extreme temperatures, preventive measures and the set-up of the warning system.

As the men were selected without a priori knowledge regarding their semen quality characteristics, the results are expected to be close to the values in the general French population. The very large sample size and the robustness of the results confer great statistical power and credibility to the results. To our knowledge, it is the first study concluding a severe and general decrease in sperm concentration and morphology at the scale of a whole country over a substantial period. This constitutes a serious public health warning. The link with the environment particularly needs to be determined.

In accordance with other studies, our results indicate that the coarse fraction may have a stronger effect than the fine fraction on some morbidity endpoints, especially respiratory diseases.

No abstract

Long-term exposure to fine particles, nitrogen dioxide, sulfur dioxide and benzene is associated with an increased risk of non-accidental mortality in France. Our results strengthen existing evidence that outdoor air pollution is a significant environmental risk factor for mortality. Due to the limited sample size and the nature of our study (occupational), further investigations are needed in France with a larger representative population sample.

No abstract

We propose a simple method to provide a rapid and robust estimate of the short-term impacts of heat waves on mortality, to be used for communication within a heat warning system. The excess mortality during a heat wave is defined as the difference between the observed mortality over the period and the observed mortality over the same period during the N preceding years. This method was tested on 19 French cities between 1973 and 2007. In six cities, we compared the excess mortality to that obtained using a modelling of the temperature-mortality relationship. There was a good agreement between the excess mortalities estimated by the simple indicator and by the models. Major differences were observed during the most extreme heat waves, in 1983 and 2003, and after the implementation of the heat prevention plan in 2006. Excluding these events, the mean difference between the estimates obtained by the two methods was of 13 deaths [1:45]. A comparison of mortality with the previous years provides a simple estimate of the mortality impact of heat waves. It can be used to provide early and reliable information to stakeholders of the heat prevention plan, and to select heat waves that should be further investigated.

Heat-related deaths should be somewhat preventable. In France, some prevention measures are activated when minimum and maximum temperatures averaged over three days reach city-specific thresholds. The current thresholds were computed based on a descriptive analysis of past heat waves and on local expert judgement. We tested whether a different method would confirm these thresholds. The study was set in the six cities of Paris, Lyon, Marseille, Nantes, Strasbourg and Limoges between 1973 and 2003. For each city, we estimated the excess in mortality associated with different temperature thresholds, using a generalised additive model, controlling for long-time trends, seasons and days of the week. These models were used to compute the mortality predicted by different percentiles of temperatures. The thresholds were chosen as the percentiles associated with a significant excess mortality. In all cities, there was a good correlation between current thresholds and the thresholds derived from the models, with 0°C to 3°C differences for averaged maximum temperatures. Both set of thresholds were able to anticipate the main periods of excess mortality during the summers of 1973 to 2003. A simple method relying on descriptive analysis and expert judgement is sufficient to define protective temperature thresholds and to prevent heat wave mortality. As temperatures are increasing along with the climate change and adaptation is ongoing, more research is required to understand if and when thresholds should be modified.