Catherine Cavalin

Socioenvironmental factors of communicable and non-communicable diseases

From a clinical case of a tuberculosis diagnosed in Rennes in a Congolese patient, we highlight the need for new socioenvironmental variables to apprehend hazards in social contexts. Beyond the traditional aggregate variables describing socioeconomic characteristics, a collaboration between epidemiology, clinical care, immunology and the social sciences helps rethink a contagious disease as a social one. From industrial fatigue in the 19th factories to other forms of hardship in the 21st century.

Silica-associated systemic sclerosis in 2017: 60 years after Erasmus, where do we stand?

Dear Editor, We read with interest the article entitled BOccupational and environmental scleroderma. Systematic review and metaanalysis^ by Rubio-Rivas et al. [1] which constitutes one of the largest meta-analysis ever done before in occupational and environmental systemic sclerosis (SSc) and concludes that crystalline silica (silicon dioxide, SiO2) and solvents are the two most likely substances related to the pathogenesis of SSc. From these results, authors hypothesize that while silica is involved in particular jobs, solvents are widespread and more people are therefore at risk of having incidental contact with them. This conclusion seems to play down SiO2 involvement in SSc. We would like to discuss this statement. Although it is well recognized that SiO2 is an ubiquitous air contaminant, occupational exposure to this chemical substance probably remains largely underestimated. Its use in many industrial fields and processes may be rather invisible which can contribute to conceal its hazard [2]. Beyond mining industries, exposure to crystalline silica appears to be significant in other sectors such as building activities, agriculture, foundries, or textile transformation (denim sandblasting) [3, 4]. The building collapses due to the attacks on the World Trade Center exposed thousands of rescue/recovery workers and residents to inorganic dusts, leading to a major occurrence of autoimmune disorders in the highly exposed groups [5]. The growing use of high-silica-content (> 90% SiO2) materials in manufacturing artificial stone products, has entailed local clusters of silicosis-associated autoimmune diseases, including silica-associated SSc [6]. Para-occupational and non-occupational exposures to crystalline silica also do exist and include daily life activities such as non-occupational use of scouring powder, handling and washing of dusty clothes, and do-it-yourself hobbies practiced repetitively without protections. These activities are almost never recorded in questionnaires used for case-control or cohort studies [1]. As SiO2 constitutes the major mineral component of earth crust, with heterogeneous silica contents in different types of soils, some authors have suggested that these geological differences could explain some spatial heterogeneity in SSc prevalence, subsequent to different passive environmental exposures by inhalation [7]. In rheumatologic and pathophysiological perspectives, recent studies have highlighted the association between exposure to SiO2 and visceral manifestations of SSc, such as pulmonary fibrosis and diffuse cutaneous involvement [8]. However, in these studies, as in all studies included in Rubio-Rivas’meta-analysis [1], the classification criteria used to select SSc patients were the 1980 ACR or LeRoy’s classification criteria for SSc. The updated 2013 ACR/EULAR classification criteria for SSc offer higher specificity and sensitivity to select patients earlier in the disease process and with a smaller visceral involvement [9]. New cohort studies based on the 2013 criteria are needed to precise the role of SiO2 in * Alain Lescoat alain.lescoat@chu-rennes.fr

From (re-)framing NCDs to shaping public health policies on NCDs and communicable diseases

A senior adviser to the Global Fund taught Richard Horton (July 22, p 346)1 some lessons that were drawn from the struggle against three communicable diseases—tuberculosis, malaria, and AIDS—that keep scourging global health. To raise funds to combat noncommunicable diseases (NCDs), one should “translate [one’s] evidence into clear and simple political (not technical) messages”, “articulate why [one] need[s] money—what exactly will [one] spend it on and what will be the results of that investment”, “break down [one’s] broad global demands into tangible country-specific needs”, and “connect [one’s] case to the big political picture—give it meaning”.

Gender and health: between nomenclatures and continuums

Addressing transgender health in a Lancet Series and in The Lancet Psychiatry1 constitutes a milestone for health professionals and social scientists. I draw conclusions from some of these papers on how we consider health, disease, and gender, and on the purpose of the nomenclatures we have developed and use.

Sarcoïdose et empoussièrement pulmonaire : l’analyse minéralogique (AM) en microscopie optique (MO)

L’entité de la sarcoïdose ou maladie de Besnier-Boeck-Schaumann s’est constituée entre 1888 et 1915 pour aboutir à la notion d’une maladie granulomateuse systémique affectant principalement le poumon et le système lymphatique dont la cause reste inconnue depuis environ un siècle. Parmi les facteurs étiologiques possibles de la maladie (Newman et Newman, 2012), celui de l’exposition aux poussières minérales inorganiques en particulier la silice, les silicates et les métaux est envisagé depuis une quinzaine d’années. Dans cette hypothèse, le développement de méthodes évaluant les surcharges en particules inorganiques dans les prélèvements biologiques permet d’éclaircir leur rôle dans la survenue de la sarcoïdose. Nous présentons le potentiel de l’analyse numérique d’image pour décrire la charge en particules du liquide de Lavage BronchoAlvéolaire (LBA). Il s’agit d’une étude rétrospective testant le lien entre l’empoussièrement pulmonaire et la sarcoïdose.