Different phenotypes of wheezing have been described to date but not in early life. We aim to describe wheezing phenotypes between the ages of two months and one year, and assess risk factors ...associated with these wheezing phenotypes in a large birth cohort.
We studied 18,041 infants from the ELFE (French Longitudinal Study of Children) birth cohort. Parents reported wheezing and respiratory symptoms at two and 12 months, and answered a complete questionnaire (exposure during pregnancy, parental allergy).
Children with no symptoms (controls) accounted for 77.2%, 2.1% had had wheezing at two months but no wheezing at one year (intermittent), 2.4% had persistent wheezing, while 18.3% had incident wheezing at one year. Comparing persistent wheezing to controls showed that having one sibling (ORa = 2.19) or 2 siblings (ORa = 2.23) compared to none, nocturnal cough (OR = 5.2), respiratory distress (OR = 4.1) and excess bronchial secretions (OR = 3.47) at two months, reflux in the child at 2 months (OR = 1.55), maternal history of asthma (OR = 1.46) and maternal smoking during pregnancy (OR = 1.57) were significantly associated with persistent wheezing. These same factors, along with cutaneous rash in the child at 2 months (OR = 1.13) and paternal history of asthma (OR = 1.32) were significantly associated with increased odds of incident wheezing. Having one sibling (ORa = 1.9) compared to none, nocturnal cough at 2 months (OR = 1.76) and excess bronchial secretions at 2 months (OR = 1.65) were significantly associated with persistent compared to intermittent wheezing.
Respiratory symptoms (cough, respiratory distress, and excessive bronchial secretion) were significantly associated with a high risk of persistent wheezing at one year. Smoking exposure during pregnancy was also a risk factor for persistent and incident wheezing.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Many factors act simultaneously in childhood to influence health status, life chances and well being, including pre-birth influences, the environmental pollutants of early life, health status but ...also the social influences of family and school. A cohort study is needed to disentangle these influences and explore attribution.
Elfe will be a nationally representative cohort of 20 000 children followed from birth to adulthood using a multidisciplinary approach. The cohort will be based on the INSEE Permanent Demographic Panel (EDP) established using census data and civil records. The sample size has been defined in order to match the representativeness criteria and to obtain some prevalence estimation, but also to address the research area of low exposure/rare effects. The cohort will be based on repeated surveys by face to face or phone interview (at birth and each year) as well as medical interview (at 2 years) and examination (at 6 years). Furthermore, biological samples will be taken at birth to evaluate the foetal exposition to toxic substances, environmental sensors will be placed in the child's homes. Pilot studies have been initiated in 2007 (500 children) with an overall acceptance rate of 55% and are currently under progress, the 2-year survey being carried out in October this year.
The longitudinal study will provide a unique source of data to analyse the development of children in their environment, to study the various factors interacting throughout the life course up to adulthood and to determine the impact of childhood experience on the individual's physical, psychological, social and professional development.
The study aims to describe the output of routine health screening performed in French nursery schools by the maternal and child health services among children aged 3-4 years and to quantify the level ...of early socioeconomic health disparities.
In 30 participating
, data on screening for vision and hearing impairments, overweight and thinness, dental health, language, psychomotor development, and immunizations were collected for children born on specific dates in 2011 and enrolled in nursery school in 2014-2016. Information was collected on the children, their socioeconomic characteristics and on the school attended. Odds of abnormal screening results were compared for each socioeconomic factor by logistic regressions adjusted for age, sex, prematurity and bilingualism.
Among the 9,939 children screened, prevalence of disorders was 12.3% for vision, 10.9% for hearing, 10.4% for overweight, 7.3% for untreated caries, 14.2% for language and 6.6% for psychomotricity. Newly detected visual disorders were more frequent in disadvantaged areas. Children with unemployed parents were three time more likely to have untreated caries and twice as likely to present language or psychomotor impairments; 52% were referred to a health professional following screening compared to 39% of children with employed parents. Except for children in disadvantaged areas, vaccine coverage was lower among disadvantaged groups.
The prevalences of impairments, which are higher among disadvantaged children, highlight the potential preventive impact of systematic screening under the comprehensive maternal and child healthcare program. These results are important to quantify early socioeconomic inequalities in a Western country known for its generous social welfare system. A more holistic approach to child health is needed with a coherent system involving families and aligning primary care, local child health professionals, general practitioners, and specialists. Further results are needed to evaluate its impact on later child development and health.
Most professional and international organizations recommend folic acid supplementation for women planning pregnancy. Various studies have shown high levels of non-compliance with this recommendation. ...This study aimed to identify sociodemographic characteristics related to this compliance. The analyses were based on 16,809 women from the French nationwide ELFE cohort (Etude Longitudinale Française depuis l'Enfance). Folic acid supplementation was assessed at delivery, and sociodemographic characteristics were collected at two months postpartum. The association between sociodemographic characteristics and compliance with recommendations on folic acid supplementation (no supplementation, periconceptional supplementation, and supplementation only after the periconceptional period) was examined using multivariate multinomial logistic regression. Only 26% of French women received folic acid supplementation during the periconceptional period, 10% of women received supplementation after the periconceptional period, and 64% received no supplementation. Young maternal age, low education level, low family income, multiparity, single parenthood, maternal unemployment, maternal overweight, and smoking during pregnancy were related to lower likelihood of folic acid supplementation during the periconceptional period compared to no supplementation. These associations were not explained by unplanned pregnancy. Immigrant and underweight women were more likely to receive folic acid supplementation after the periconceptional period. Our study confirms great social disparities in France regarding the compliance with the recommendations on folic acid supplementation.
The risk factors for postnatal depressive symptoms (PNDS) are numerous, but little is known about the protective factors or the interactions between different exposures. The present study explored ...the pathways between maternal, infant and parenthood vulnerabilities or risk/protective factors and PNDS at 2 months postpartum (PP) in a large sample of women from the general population.
We used data from the French ELFE cohort, a nationally representative cohort of children followed-up from birth. The available information about vulnerabilities or risk/protective factors for PNDS was collected during the maternity ward stay (mother or medical records) and at 2 months PP (mother by phone). PNDS were evaluated with the Edinburgh Postnatal Depression Scale (EPDS) at 2 months. A measurement model was built based on the psychosocial model for PNDS of Milgrom and colleagues using exploratory factor analysis. The Structural Equation Model was used to investigate the pathways between vulnerability, risk/protective factors and PNDS at 2 months PP.
In the study sample (
= 11,583), a lack of a partner's perceived antenatal emotional support, consultation with a mental health specialist before pregnancy, family financial difficulties, prenatal psychological distress and a difficult pregnancy experience were directly associated with the severity of maternal PNDS at 2 months PP, as well as lack of perceived postnatal support. Family financial difficulties and consultation with a mental health specialist before pregnancy were also indirectly associated with the intensity of PNDS through a lack of perceived antenatal emotional support, a difficult pregnancy experience, prenatal psychological distress and a lack of perceived postnatal support. Regarding infant and parenthood characteristics, infant self-regulation difficulties, maternal difficulty in understanding infant crying and infant hospitalisation were directly associated with PNDS severity at 2 months PP, while maternal difficulty in understanding an infant's cries was also indirectly associated with infant self-regulation difficulties.
Perinatal professional support should begin antenatally and target the couple's prenatal functioning, with particular attention to women presenting a history of psychiatric disorders, especially those of low socioeconomic status. After delivery, addressing infant and parenthood characteristics is also recommended.
General practitioners (GP) play a key role in children’s medical care in France. Maternal and Child Protection Services (MCP) provide preventive pediatric care and may host GP interns during their ...curriculum. The purpose of this research is to cross stakeholders’ viewpoints on MCP internships.
In 2019, a declarative cross-sectional survey was conducted in metropolitan France among GP, MCP and departments of general practice (DGP) in medical schools. Data was collected concerning the organization, contents and pediatric expected results of GP internships in MCP.
Questionnaires completed by 286 GP, 77 MCP and 16 DGP were collected. GP describe a non-standardized internship practice in terms of duration, the type of supervision, the medical acts carried out and the tools provided. Their answers, however, show a clear consensus on the skill in screening/prevention acts development (significantly higher for internships based on four-day weeks), on the support for parenthood, and on the awareness of the child’s living environment and of the various professionals in the health, psychological and educational field. These skill acquisitions are incomplete in child protection, and insufficient in the management of acute pathologies. Links between DCP and MCP appear poor.
Internships in MCP provide GPs with significant experience in prevention and daily pediatrics, but they require a better coordination between DGP and MCP and the construction of joint internships especially with hospital pediatrics.
Introduction : Les médecins généralistes jouent un rôle essentiel dans la prise en charge médicale des enfants en France. Les services de Protection Maternelle et Infantile (PMI) déclinent des soins ...pédiatriques de prévention et accueillent en stage des internes médecins généralistes (MG). L’objectif de ce travail est de croiser les regards des parties prenantes des stages PMI. Méthode : Nous avons conduit une étude transversale déclarative en France métropolitaine en 2019 auprès des MG, PMI et départements de médecine générale des facultés (DMG) et recueilli des données sur l’organisation, le contenu et les attendus pédiatriques du stage pour les MG en PMI. Résultats : Les réponses de 286 MG, 77 PMI et 16 DMG ont été collectées. Les MG décrivent une pratique de stage non standardisée pour la durée, le type de supervision, les actes réalisés et les outils mis à disposition. Leurs réponses dégagent pourtant un consensus net sur l’acquisition de compétences (significativement supérieures pour les stages de 4 jours hebdomadaires) concernant le dépistage et la prévention ; le soutien à parentalité ; la découverte de l’environnement de l’enfant et des autres professionnels du champ sanitaire, psychologique et éducatif. Ces acquisitions sont partielles en protection de l’enfance, et insuffisantes pour la prise en charge des pathologies aigües. Les liens entre DMG et PMI apparaissent médiocres. Conclusion : Les stages en PMI apportent aux MG une expérience importante en prévention et pédiatrie du quotidien, mais nécessitent une meilleure concertation entre DMG et PMI, et la construction de stages mixtes notamment avec la pédiatrie hospitalière.
ELFE is the first French national birth cohort. Its objective is to study determinants of the development, health and socialization of children from birth to adulthood through a multidisciplinary ...approach. A total of 18 329 children were recruited at birth in a random sample of maternity units in metropolitan France during 25 selected days of 2011 spread over the year. Follow-up in the first 5 years consisted of telephone interviews of both parents of the child at age 2 months and 1 year and 2 years, and of one parent at age 3.5 years; a home visit at age 3.5 years; questionnaires to the child’s physician at age 2 years, the child’s nursery school doctor at age 3 to 4 years, and the child’s nursery schoolteacher at age 4 years. Participation rates at the age 2-month, 1- and 2-year and 3.5-year parental interviews were 92%, 86%, 82% and 80%, espectively, of contacted participants. The main categories of data collected concern: sociodemographic characteristics; family life; parental health, behaviour and life values; child development and health; child school performance, behaviour, and socialization; day care and school; and childhood environmental exposures. The ELFE has an open-data policy after an 18-month exclusivity period following each release of new data. The data-access policy, study protocols, questionnaires and data catalogue can be found online: https://www.ELFE-france.fr/en/
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