National Accounts ESA. Aggregates 1970-1975. 1976

<p>Model 3 multiple logistic regression analysis for burnout diagnosis.</p

ETUDE DES TROUBLES PSYCHOTRAUMATIQUES CHEZ LES AGENTS DE CONDUITE CONFRONTES A UN ACCIDENT DE PERSONNE DANS UNE ENTREPRISE DE TRANSPORT FERROVIAIRE

ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Sleep and COVID-19. A Case Report of a Mild COVID-19 Patient Monitored by Consumer-Targeted Sleep Wearables

Since its first description in Wuhan, China, the novel Coronavirus (SARS-CoV-2) has spread rapidly around the world. The management of this major pandemic requires a close coordination between clinicians, scientists, and public health services in order to detect and promptly treat patients needing intensive care. The development of consumer wearable monitoring devices offers physicians new opportunities for the continuous monitoring of patients at home. This clinical case presents an original description of 55 days of SARS-CoV-2-induced physiological changes in a patient who routinely uses sleep-monitoring devices. We observed that sleep was specifically affected during COVID-19 (Total Sleep time, TST, and Wake after sleep onset, WASO), within a seemingly bidirectional manner. Sleep status prior to infection (e.g., chronic sleep deprivation or sleep disorders) may affect disease progression, and sleep could be considered as a biomarker of interest for monitoring COVID-19 progression. The use of habitual data represents an opportunity to evaluate pathologic states and improve clinical care

Correspondence: An appraisal of the effects on human health and the environment of using light-emitting diodes

International audienc

Correspondence: An appraisal of the effects on human health and the environment of using light-emitting diodes

International audienc

Effects on human health and the environment (fauna and flora) of systems using light-emitting diodes (LEDs

The objective of the expert appraisal undertaken by ANSES was to update knowledge on the health effects related to exposure to lighting systems using LEDs. The request focused more specifically on assessing the risks associated with exposure to LED systems for the general population andworkers, distinguishing between the different types of applications of LED lighting systems and objects (domestic lighting, professional uses, vehicle lights, toys, screens, etc.) and taking into account real situations of exposure. Moreover, a review of the potential environmental risksassociated with these systems throughout their life cycle was requested.Pursuant to Directive 2005/32/EC on the eco-design of energy-using products, known as the “EuP” Directive, the planned withdrawal of incandescent lamps (spread out between 2009 and 2012) and conventional halogen lamps (set for September 2018) from the lighting market has led to a sharp increase in LED lighting systems on the consumer market, thus increasing the population's exposure to lighting systems using this technology. The scope of LED systems has expanded: it now includes not only a large number of applications for professional use, but also applications for public use including displays and signs, as well as certain objects and devices (toys, decorative objects, etc.), backlighting in screens (mobile telephones, tablets, televisions, etc.) and indoor and outdoor lighting.When publishing its first Opinion on the health effects associated with LEDs (ANSES’s collective expert appraisal report published in 20101), the Agency drew attention to the retinal toxicity of blue light. Indeed, LEDs are unique in that they emit light rich in short wavelengths: this is known as blue rich light. On this occasion, ANSES issued recommendations relating, among other things, to the placing on the market of LEDs and the provision of information to consumers. The potential health effects associated with exposure to the light emitted by LEDs are now betterdocumented. Since the Opinion issued by the Agency in 2010, new experimental data, obtained in animals in particular, have been published regarding the phototoxicity associated with long-term exposure to blue light. New data have also been published relating to the disruptive effects of blue light on the biological clock, glare, and the health effects associated with temporal light modulation (light-intensity fluctuations in lighting that may be visually perceived depending on frequency). Regarding the possible effects on the environment, there are data that raise questions about potentially induced imbalances in ecosystems, which may have consequences for fauna and flora as well as for humans and human health.Adding or substituting artificial light to/for natural sunlight raises the issue of the potential health effects this may cause, due to the accumulation or modification of the lighting environment. Over the past few decades, humans have considerably increased their exposure to blue light in the evening with artificial lighting and backlights rich in blue light. Previously, the lighting systems used had tended to be yellow-orange in colour (candles, incandescent lamps). The update of the expert appraisal considered all of the effects on human health and the environment(fauna and flora) that could be associated with exposure to the light of LED lamps.Recommendations for the public authorities to protect the population and the environment The CES recommends developing actions and information regarding: the need to limit exposure to blue-rich light (from LEDs and other technologies), by favouring the use of warm-coloured lighting (colour temperature below 3000 K) before going to bed and during the night, especially for certain population groups: children, adolescents andpregnant women (see lists by health effect in Section 3). In particular, the CES recommends not using blue-rich night-lights for infants and children and limiting the exposure of children and adolescents to blue-rich light sources (computer, tablet, mobile telephone screens, etc.)at night and before going to bed; the importance of enhancing the light contrast between daytime and night-time by increasing exposure to natural light during the day and limiting exposure to artificial light before bedtime and at night; the phototoxic effects of light associated with exposure to certain LED lighting devices (handheld lamps, head torches, toys, vehicle lights, blue-light decorative string lights) available on the market, especially for the most susceptible population groups such as children; the widely varying effectiveness of the protective devices currently proposed with regard to the adverse health effects associated with exposure to LEDs.In order to protect against the harmful effects of light pollution on humans and their environment, the CES recommends: undertaking actions to limit intrusive light in homes and thus reduce the risk of circadian disruption;limiting the number of illuminated outdoor facilities, keeping the surface areas of illuminated zones to a minimum, improving control of their directivity and promoting their sound management; conducting, wherever lighting is necessary, a study of its impact on the local ecosystem in natural and suburban areas; creating protected spaces, without any artificial lighting.Recommendations for employers and occupational physicians to protect workers considering the phototoxic effects of blue light and the potential effects of temporal light modulation, the CES reiterates the obligation to limit the exposure of workers to these light sources and inform them of the related hazards; moreover, given the effects observed on foetal development in animals related to maternal exposure to light at night, the CES recommends limiting the exposure of pregnant women to light during the night.Recommendations regarding the regulatory and normative frameworks with the aim of protecting human health and the environment At national level, the CES recommends enforcing the regulations on the switching-off of interior lighting with exterior emission and the illumination of building façades (Ministerial Order22 of 25 January 2013 on the nocturnal lighting of non-residential buildings in order to limit light pollution and energy consumption) as well as those on the switching-off of advertising signs (Decree no. 2012-11823 on outdoor advertising and signs).At European level, regarding normative changes to be made, the CES recommends: revising the exposure limits for optical radiation proposed by ICNIRP, so as to make them sufficiently protective against phototoxic risks. They should take into account chronic exposure and consider other indicators, especially those relating to infra-clinical toxicity24; creating an effectiveness index and requiring its labelling on devices providing protection against blue light (accounting for the attenuation rate); developing a metrological standard, at European level, specifying conditions for measuring temporal modulation and calculating the related indices;Regarding regulatory changes to be made, the CES recommends: requiring the labelling of the photobiological risk group (assessed according to Standard NF ISO 62471) for domestic lighting as well as for LED objects; restricting the sale of LED systems (lamps, luminaires, objects and especially toys) to the general public to those in risk group 1 or lower; harmonising the regulatory framework by amending the regulations specific to LED systems other than lamps and luminaires, in order to take into account the photobiological risk, in particular:o Directive 2009/48/EC on the safety of toys;o UNECE25 (United Nations Economic Commission for Europe) Regulations R112 and R113 on prescriptions for light sources from vehicles. limiting the luminance of vehicle lights (without necessarily reducing the overall flux and therefore the range of vision); taking into account, in the regulations, the specific characteristics of bare LED strips and matrices in devices sold to the general public (bare LED aggregates on the same base); establishing, at European level, limits for temporal light modulation, in order to limit the biological and health effects associated with the light emitted by LED lamps and luminaires; amending the current regulations in order to take into account the risks associated with temporal modulation, in particular:o Directive 2006/25/EC of the European Parliament on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (artificial optical radiation);o the UNECE regulations, requiring a minimum modulation frequency of around 2 kHz when the lamps (front lamps and rear lamps) of vehicles are used in pulse width modulation26 (PWM) mode. This recommendation will limit the visibility of the phantom array effect, which is a source of proven visual disturbances; introducing the option to automatically lower the colour temperature (switch to warm white) and brightness of mobile telephone and tablet screens before bedtime.Research recommendationsWhile numerous data are available on the health effects of light, especially blue light, the scientific data are still incomplete with regard to the specific effects of LEDs depending on their geometry and spectral quality. Therefore, the CES insists on the need to improve the quantitative assessment of the impact of a general shift to LED technology on human health and the environment. The CES encourages the implementation and intensification of research into light-induced circadian rhythm disruption and the resulting effects on vigilance, sleep, mood, well-being, cognition and health. Two aspects for which there is still little documentation should particularly be taken into account in humans and diurnal animal models: the impact of the maternal light environment on foetal development; for children and adolescents, the impact of the light environment, depending on the period (day, night), on biological rhythm synchronisation and health, particularly considering higher light transmission due to a clearer lens and a more open pupil.Since potentially beneficial effects of a strong light contrast between daytime and night-time have been described in the scientific literature, it will be necessary to: confirm the effects of exposure to sufficient daytime light intensities on quality of life, sleep, well-being and health, especially for people with circadian rhythm disorders (elderly subjects, hospitalised patients, people with dementia, etc.); improve knowledge of the ability of exposure to blue light in the morning to correct circadian desynchronisation and assess the associated ocular risks; for night workers, study the relevance of favouring exposure to certain wavelengths depending on the time of day, to promote vigilance on the one hand and recovery on the other hand while minimising the negative side effects.The CES recommends improving the assessment of the risk of eye dryness and ocular diseases occurring in relation to exposure to light in the phototoxic range, especially in the long term. Special attention should be paid to certain susceptible population groups (children, adolescents, people with ocular diseases, aphakic individuals, etc.). The CES also recommends studying the factors that may be involved in the phototoxicity of light, such as the time of exposure, the possible associated temporal modulation, and risk factors related to ocular diseases. It would also be advisable to study to what extent phototoxicity results obtained in rodents can be extrapolated to humans.Since temporal light modulation appears to be a major flaw of certain LEDs and LED systems, the CES recommends improving knowledge of its visual, biological and health effects. In particular, it recommends conducting: studies to better identify inter-individual variations in sensitivity to temporal contrasts and better understand the prevalence and incidence of effects related to temporal light modulation in the general population; studies enabling the risk of accidents arising from exposure to a stroboscopic effect or phantom array effect to be quantified.The various health effects of LEDs mentioned above make it necessary to improve the assessment of exposure in populations. The CES recommends taking precise measurements of luminance distribution, spectral energy distributions and temporal modulation for a wide range of LED devices to which the population is exposed.The CES recommends better taking account of the environmental impact of a general shift to LED technology, by improving knowledge regarding the effects of light pollution on fauna and flora and the ecosystem as a whole. Lastly, the CES recommends considering the entire life cycle of LEDs, in particular: accessing detailed data on the products used in the manufacture of LEDs (raw materials, manufacturing processes) and those released into the air, water and soil during the manufacture of LEDs; documenting end-of-life for LEDs: recovery and sorting of used products, recovery of raw materials, recycling of certain LED components, treatment of final waste

Quelle est l'évidence montrant que la lumière nocture peux affecter la santé humaine?

This study was supported by the Agence Nationale de Sécurité Sanitaire de l’Alimentation, de l’Environnement et du Travail.International audienceno abstrac