Growth monitoring of apparently healthy children aims at early detection of serious conditions through the use of both clinical expertise and algorithms that define abnormal growth. Optimization of ...growth monitoring requires standardization of the definition of abnormal growth, and the selection of the priority target conditions is a prerequisite of such standardization.
To obtain a consensus about the priority target conditions for algorithms monitoring children's growth.
We applied a formal consensus method with a modified version of the RAND/UCLA method, based on three phases (preparatory, literature review, and rating), with the participation of expert advisory groups from the relevant professional medical societies (ranging from primary care providers to hospital subspecialists) as well as parent associations. We asked experts in the pilot (n = 11), reading (n = 8) and rating (n = 60) groups to complete the list of diagnostic classification of the European Society for Paediatric Endocrinology and then to select the conditions meeting the four predefined criteria of an ideal type of priority target condition.
Strong agreement was obtained for the 8 conditions selected by the experts among the 133 possible: celiac disease, Crohn disease, craniopharyngioma, juvenile nephronophthisis, Turner syndrome, growth hormone deficiency with pituitary stalk interruption syndrome, infantile cystinosis, and hypothalamic-optochiasmatic astrocytoma (in decreasing order of agreement).
This national consensus can be used to evaluate the algorithms currently suggested for growth monitoring. The method used for this national consensus could be re-used to obtain an international consensus.
Both national and WHO growth charts have been found to be poorly calibrated with the physical growth of children in many countries. We aimed to generate new national growth charts for French children ...in the context of huge datasets of physical growth measurements routinely collected by office-based health practitioners.
We recruited 32 randomly sampled primary care paediatricians and ten volunteer general practitioners from across the French metropolitan territory who used the same electronic medical records software, from which we extracted all physical growth data for the paediatric patients, with anonymisation. We included measurements from all children born from Jan 1, 1990, and aged 1 month to 18 years by Feb 8, 2018, with birthweight greater than 2500 g, to which an automated process of data cleaning developed to detect and delete measurement or transcription errors was applied. Growth charts for weight and height were derived by using generalised additive models for location, scale, and shape with the Box-Cox power exponential distribution. We compared the new charts to WHO growth charts and existing French national growth charts, and validated our charts using growth data from recent national cross-sectional surveys.
After data cleaning, we included 1 458 468 height and 1 690 340 weight measurements from 238 102 children. When compared with the existing French national and WHO growth charts, all height SD and weight percentile curves for the new growth charts were distinctly above those for the existing French national growth charts, as early as age 1 month, with an average difference of −0·75 SD for height and −0·50 SD for weight for both sexes. Comparison with national cross-sectional surveys showed satisfactory calibration, with generally good fit for children aged 5–6 years and 10–11 years in height and weight and small differences at age 14–15 years.
We successfully produced calibrated paediatric growth charts by using a novel big-data approach applied to data routinely collected in clinical practice that could be used in many fields other than anthropometry.
The French Ministry of Health; Laboratoires Guigoz—General Pediatrics section of the French Society of Pediatrics—Pediatric Epidemiological Research Group; and the French Association for Ambulatory Pediatrics.
Human lead exposure has many sources. Relative importance of these sources varies widely according to geographic regions and human lifestyle. The impact of lead exposure on health has been well ...studied and public health interventions have been conducted.
The aim of this study was to evaluate current prevalence of lead burden in neonates, and seek for sources of maternal and fetal intoxication.
A prospective multicentre study was conducted by the "Réseau périnatal 92" on a population of pregnant women attending 3 maternal wards in the north of 'Hauts-de-Seine' department in France. Between December 2003 and May 2004, a total of 1021 pregnant women were included. All patients signed an informed consent before participating in the study. Cord blood samples were collected at delivery for lead measurements.
The mean cord blood lead concentration was 23.2 microg/l. Eighteen neonates over 1021 (1.8%) had lead levels above 100 microg/l. An environmental query was conducted by the social and public health office of the department (DDASS), and data were collected regarding the state of the housing and the lifestyle of the concerned family. Main sources of lead intoxication were 'tagine' food plates in 83.3% of cases, 'khôl' powder (used as eyeliner) in 88.9% of cases and substandard housings in 22.2% of cases. A specialized paediatric follow-up for the 18 neonates was performed.
With the exception of substandard housing (old lead painting), other sources of lead intoxication were discovered: 'tagine' plates and 'khôl' powder. Almost all of these products came from Morocco. A public health intervention would be able to inform the population about these yet unknown sources of lead intoxication.
The role of physicians in the identification of child abuse is essential. The changes introduced by the Act of March 2007 created new procedures that practitioners must be aware of and be able to ...implement. Thus, in addition to reporting to judicial authorities, the law establishes the concept of "information that is cause for concern" and its evaluation by the CRIP (Departmental Unit for Gathering and Evaluating Reports Citing Concern). The relative isolation of independent physicians in these situations adds to their difficulties. Comprehensive knowledge of available tools should help them in their practice.
The screening of the visual and auditive sensory disorders is a significant stake of public health in France. Those are still too late and do not allow the assumption of responsibility early ...necessary. Between 0 and 3 years the issue is to avoid the two principal problems: irreversible amblyopia and language acquisition disorders by auditive deficit. It is thus advisable to find strategies which improve this situation. Pragmatic medical attitude and usual tests, usable in daily practice of the doctors who have really contact with the children, should be suggested.
The control of temperature during operation of zero power research reactors participates to the overall control of experimentation conditions and reveals itself of a major importance when measuring ...neutronic parameters such as multiplication factors. Within the framework of the refurbishment of the MASURCA facility, the development of a new temperature measurement system based on the optical fiber Bragg grating (FBG) technology is under consideration. In a first step, a series of FBGs is irradiated in the EOLE critical facility with the aim to select the most appropriate. Online temperature measurements are performed during a set of irradiations that should allow reaching a fast neutron fluence of nearly 5·10 14 n.cm -2 and a total gamma dose lower than 4 kGy. The results obtained, especially the Bragg wavelength shifts during the irradiation campaign, are discussed in this paper and compared to data from standard PT100 temperature sensors to highlight possible radiation effects on sensor performances. Work to be conducted during the second step of the project, aiming to a feasibility demonstration using a MASURCA assembly, is also presented.
Aims Obesity can modify the pharmacokinetics of lipophilic drugs. As β‐adrenoceptor blockers (BB) are often prescribed for obese patients suffering from hypertension or coronary heart disease, this ...study compares the pharmacokinetics of lipophilic β‐adrenoceptor blockers in obese and control subjects.
Methods Nine obese (157±24% of ideal body weight (IBW) mean±s.d.) and nine non‐obese healthy volunteers (98±10% IBW), aged 32±9 years, were included in the study. Subjects were randomly given a single i.v. infusion of one of the following racemic β‐adrenoceptor blockers, whose doses (expressed as base per kg of IBW) were: propranolol (0.108 mg), labetalol (0.99 mg) and nebivolol (0.073 mg). The plasma concentrations of unchanged drugs were measured by h.p.l.c. The ionisation constants and lipophilicity parameters of β‐adrenoceptor blockers were assessed.
Results The pharmacokinetic data for the three drugs were qualitatively similar. There was a trend towards a greater total distribution volume (Vss ) in obese patients than in controls. However, Vss expressed per kg body weight was slightly smaller in obese patients. The relationship between Vss and lipophilicity of five β‐adrenoceptor was studied by combining the current results with those previously obtained with a moderately lipophilic drug (bisoprolol) and a hydrophilic one (sotalol). The Vss of the five drugs was positively and well‐correlated (r2=0.90; P<0.01) with their distribution coefficient at pH 7.4 (log D7.4 ), but not with their partition coefficients. The linear regression coefficients for lean and obese subjects were very similar.
Conclusions Lipophilic β‐adrenoceptor blockers seem to diffuse less into adipose than into lean tissues. All electrical forms of the drugs (i.e. cations, neutral forms, or zwitterions) present at physiological pH contribute to their tissue distribution, in both obese and lean subjects.Their tissue distribution in obese patients could be restricted by the sum of hydrophobic forces and hydrogen bonds they elicit with macromolecules in lean tissues.
A group of 36 patients in the hematology department of Saint-Antoine Hospital, Paris, France, was on chemotherapy. The patients were also given antiacid drugs to prevent gastrointestinal toxicity and ...itraconazole as prophylaxis against aspergillosis. The antifungal drug was given as 100-mg capsules three times a day shortly after meals. The plasma itraconazole and hydroxyitraconazole concentrations were measured by high-performance liquid chromatography at steady state. Of 36 patients, 29 (81%) had adequate plasma itraconazole concentrations (> or = 250 ng/ml) after 8 +/- 2 days. The 7 patients with low plasma itraconazole concentrations were given 200 mg three times a day. Of the 36 patients, 34 (94%) had effective plasma concentrations within 2 weeks of the beginning of treatment. The two remaining patients were lost to follow-up. The proposed itraconazole regimen provides effective prophylaxis against aspergillosis and represents a substantial economic advantage over a single daily dose of 400 to 600 mg. The marked intrapatient and interpatient variations in plasma itraconazole indicate the need for regular therapeutic drug monitoring to ensure effective plasma itraconazole concentrations in all neutropenic patients.
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