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ABSTRACT: AimTo study whether breech presentation is a risk factor for cerebral palsy (CP).
MethodsPerinatal data of 177,272 children born in breech or vertex presentation in Norway during 1996 to 1998 were retrieved from
the Medical Birth Registry of Norway. Data were collected between 1 January 2003 and 31 March 2006. Data on 245 children with
CP were recorded in the Norwegian Cerebral Palsy Registry. Odds ratios (OR) with 95% confidence intervals (CI) for CP among
children born in breech compared with vertex presentation were calculated. Confounding was addressed in logistic regression
and stratified analyses.
ResultsAmong the 245 children with CP (46.5% females and 53.5% males), 31% had unilateral, 49% bilateral, 7% dyskinetic, 5% the ataxic
subtype and 8% of cases were unclassified. Among children born in breech, the OR for CP was 3.6 (95% CI: [2.4ΓÇô5.3]). The
increased risk was reduced when adjusted for preterm birth, plurality and smallness for gestational age. Among singletons
born in breech by vaginal delivery at term, the OR for CP was 3.9 (95% CI: [1.6ΓÇô9.7]). Severity or subtype of CP did not
differ between breech and vertex presentation.
InterpretationBreech delivery is a significant risk factor for CP, in particular among singletons born by vaginal delivery at term.
ButDéterminer si la présentation du siège est un facteur de risque de paralysie cérébrale (PC).
MéthodesLes données périnatales de 177 272 enfants nés par présentation du siège ou du sommet en Norvège, de 1996 à 1998, ont été
récupérées dans le Medical Birth Registry of Norway (MBRN). Les données ont été collectées entre le 1er janvier 2003 et le 31 mars 2006. Les données sur 245 enfants atteints de PC étaient enregistrées dans le registre norvégien
des PC. Les rapports de cotes (odd ratio: [OR]) avec intervalles de confiance (IC) à 95 % de PC ont été calculés et comparés
entre les enfants nés par présentation du siège versus présentation du sommet. Il a été tenu compte des facteurs de confusion
par régression logistique et analyses stratifiées.
RésultatsParmi les 245 enfants avec PC (46,5 % de filles et 53,5 % de garçons), on a relevé les sous-types de PC suivants: 31 % unilatérales,
49 % bilatérales, 7 % dyskinésiques et 5 % ataxiques; 8 % des cas étaient non classifiés. Parmi les enfants nés par présentation
du siège, l’OR de PC était de 3,6 (IC 95 %: [2,4–5,3]). Le surcroît de risque était réduit après ajustement tenant compte
de la naissance prématurée, de la pluralité et de la petitesse pour l’âge gestationnel. Parmi les « singletons » en présentation
du siège, nés par délivrance vaginale à terme, l’OR de PC était de 3,9 (IC 95 %: [1,6–9,7]). La sévérité ou le sous-type de
PC n’était pas différent selon que l’enfant était né par présentation du siège ou du sommet.
InterprétationLa présentation du siège est un facteur de risque significatif de PC, en particulier chez les « singletons » nés par délivrance
vaginale à terme.
KeywordsCerebral palsy-Breech presentation-Mode of delivery-Caesarean section-Risk factors
Mots clésParalysie cérébrale-Présentation du siège-Mode d’accouchement-Césarienne-Facteurs de risque
Revue de médecine périnatale 04/2012; 2(3):158-160.
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Revue de médecine périnatale 04/2012; 2(4):161-164.
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ABSTRACT: Cerebral palsy is the commonest cause of motor impairment in childhood. Parents of children with this particular neurodevelopmental disorder face many problems encountered by disabled children's parents. The aim of the present paper is to report the current knowledge on this parental impact, highlighting consensus and disagreement. A literature search was conducted using the key words "Cerebral palsy" and "Parents/Father/Mother" and "Adapt/Adjust/Cost/Economic/Impact/Well-being" in the Medline and PsycInfo databases searching for articles published between 1989 and 2009. Seven parental impact dimensions were distinguished: time spent, occupational restrictions, social relationships, family relationships, psychological well-being, physical health, and financial burden. Of 40 selected references, the studies were mostly cross-sectional, although longitudinal surveys highlighted the causal relationship between factors. Despite various methodologies, this review confirms that parents of CP children have greater risk of experiencing a sense of burden than parents of typically normally developing children. Time spent caring for the child appears to be an important factor that depends on the child's autonomy. The 7 impact dimensions seem to be related to each other and to child's and caregiver's characteristics. The severity of motor impairment is not unanimously viewed as a worsening factor: however, the child's behavioral problems influence the impact experienced by the parents. The level of intellectual impairment also has a negative influence on family relationships and on the parent's psychological well-being. The child's developmental stage seems to be related to the level of parental impact, but there is no agreement on the dimensions involved. We also observed that the mother and father do not experience this situation in the same way, probably because of the role played by each one in the family. The current literature lacks data on caregiver characteristics, identifying families at risk of burden, and the environmental context that would allow for a less negative impact on parents. In addition, the tools measuring the impact lack standardization. No questionnaire covering all 7 dimensions exists, but useful validated questionnaires for different dimensions were identified. We consider that the caregiver's occupation and physical health needs further research. The current knowledge is insufficient for proposing an overall model taking all the dimensions into account. Research is needed before a complete model of the CP child's impact on parents can be tested in view of providing guidelines to professionals for identifying families with a risk of maladaptation and suggesting solutions to decrease the negative impact.
Archives de Pédiatrie 02/2011; 18(2):204-14. · 0.30 Impact Factor
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ABSTRACT: To estimate the contribution of rare diseases (RD) to severe impairment in 7-year-old children.
Data from a morbidity register of childhood impairments in a single French region were used. Impairments were classified as a mental, sensorial, neuromuscular (skeletal or movement-related) impairment (MSN_I) according to the International Classification of Functioning. Details of children born from 1980 to 1994 and resident in the county under study when they were 7 years old were recorded. A rare disease was defined as a prevalence rate of <1 per 2000 general population.
26% of children with severe MSN_I had a rare disease; in 36% the MSN_I was of unknown origin. The proportion of impairments that were due to a rare disease varied according to the type of impairment: 3.3% for severe psychiatric disorders; 16.0% for intellectual impairment; 37.2% for hearing impairment; 41.2% for neuromuscular, skeletal and movement impairment; and 81.1% for visual impairment. The overall prevalence rate of rare diseases was 2.1 per 1000 (459/218 283), and it increased significantly over time (p = 0.003). The latter increase was not associated with a decrease in the proportion of impairments of unknown origin, indicating an improvement in the survival of the children with a rare disease.
In this study, a rare disease was at the origin of 26% of cases of severe MSN_I. This proportion remained stable over time, whereas the prevalence rate, as well as the prevalence rate of MSN_I disability, increased over time.
Archives of Disease in Childhood 03/2008; 93(2):115-8. · 2.88 Impact Factor
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ABSTRACT: Several studies have reported an increasing incidence of childhood parapneumonic empyemas in various countries.
The aim of our study was to estimate the annual incidence of complicated community-acquired pneumonias in children during a 9-year period in a French area and to describe the epidemiological and clinical characteristics of these complications.
We have listed the children from 28 days to 15 years old, hospitalized in the 2 children hospitals of the Isere district for a community-acquired pneumonia complicated with a pleural empyema or a pulmonary abscess from 1995 to 2003.
During the study period, 90 children were hospitalized for a complicated pneumonia including 83 pleural empyemas and 7 isolated lung abscess. The average number of cases was 4 per year from 1995 to 1998 then increased since 1999 to reach 34 cases in 2003, according to a linear model (P<0,001). The incidence of the complicated pneumonia, plotted to the paediatric population of the area has gone up from 0.5 per 100000 to 13 per 100000 children between 1995 and 2003.
The incidence of the complicated pneumonias in children increased since 1999 in a French area. Additional investigations are necessary to identify the causes of this increase.
Archives de Pédiatrie 12/2007; 14(11):1298-303. · 0.30 Impact Factor
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ABSTRACT: A meta-analysis about subtle ultrasonographic signs in second trimester of pregnancy.
196 articles dealing with the subject--from 1985 to July 2002--were studied. Data on the 11 reported signs were collected from 92 theoretically and/or statistically valid studies. Then, the studies were selected according to several criteria: isolated characteristic, defined thresholds, calculable sensitivity and specificity. After checking for homogeneity, a likelihood ratio was calculated for some of the signs.
This meta-analysis of the second trimester ultrasonographic signs of Down's syndrome enabled us to estimate the likelihood ratio (LHR) of six signs. At 22 weeks'gestation (WG) these signs are: pyelectasis equal to or greater than 5 mm; nuchal fold thickness equal to or greater than 6 mm; persistence of choroid plexus cysts; shortness of the femur and humerus below the tenth percentile; hyperechogenic bowe; and nasal bone length less than 2.5 mm.
These validated ultrasonographic signs are independent of nuchal translucency thickness at 12 WG and of maternal serum biochemistry. This allows to calculate a combinate risk for nuchal translucency, maternal serum biochemistry and second trimester ultrasonographic signs when they are validated.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 06/2005; 34(3 Pt 1):215-31. · 0.42 Impact Factor
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ABSTRACT: There is an unexplained excess of cerebral palsy among male babies. There is also variation in the proportion of more severe cases by birth weight. It has recently been shown that the rate of cerebral palsy increases as intrauterine size deviates up or down from an optimum about one standard deviation heavier than population mean weight-for-gestation.
To determine whether the gender ratio or the severity of cases also varies with intrauterine size.
A total of 3454 cases of cerebral palsy among single births between 1976 and 1990 with sufficient data to assign case severity (based on intellectual impairment and walking ability) and to compare weight-for-gestation at birth to sex specific fetal growth standards, were aggregated from nine separate registers in five European countries.
The greater the degree to which growth deviates either up or down from optimal weight-for-gestation at birth, the higher is the rate of cerebral palsy, the larger is the proportion of male cases, and the more severe is the functional disability. Compared to those with optimum growth the risk of more severe cerebral palsy in male babies is 16 times higher for those with a birth weight below the 3rd centile and four times higher when birth weight is above the 97th centile. In contrast, for mild cerebral palsy in female babies the excess risks at these growth extremes are about half these magnitudes.
Among singleton children with cerebral palsy, abnormal intrauterine size, either small or large, is associated with more severe disability and male sex.
Archives of Disease in Childhood 06/2005; 90(5):474-9. · 2.88 Impact Factor
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ABSTRACT: This study was performed in order to provide a description of indications for induced elective terminations of pregnancy (ETOP), their characteristics (e.g. gestational age), and their evolution over time.
This is an epidemiological study. The geographic area covered is the French county of 'Isère', which represents a mean of 14 000 births per year over the study period.
Data on ETOPs were collected actively from medical records by a register of childhood deficiencies and adverse perinatal events in this county. Between 1989 and 2000, 996 ETOPs were notified.
Four main grounds for ETOPs were identified: (1) morphological anomalies with normal karyotype (39%), (2) chromosomal anomalies (35%), (3) other fetal grounds (16%), and (4) maternal indications (10%). Prevalence rates for the first two grounds increased significantly over the study period respectively from 2.0 to 2.9 and from 1.4 to 2.7 per 1000. Among the ETOPs carried out because of fetal indications, the percentage of late ETOPs (from 24 weeks of gestation) was 34.6%, and remained stable over the studied period. In some cases, a medical consensus was not reached with respect to indications for termination (sex chromosome anomalies, limb defects). We estimated the percentage of these cases as being 2.7% of the figure for fetal indications, without any variation in prevalence over the whole period (p = 0.59). The increasing number of ETOPs that occurred in the chromosomal aberrations group during the study period is thought to be due to an increase in diagnostic sensitivity. The increase that occurred in the morphological anomalies group is thought to be due both to an increase in sensitivity and to a widening of the field with respect to indications, some of which have an uncertain prognosis (e.g. agenesis of the corpus callosum).
This study provides useful data for monitoring medical practice consistency within the field of prenatal diagnosis, and for the drive to keep medical practice within ethically acceptable limits.
Prenatal Diagnosis 12/2003; 23(11):877-83. · 2.11 Impact Factor
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Ultrasound in Obstetrics and Gynecology 08/2003; 22(S1):87 - 87. · 3.01 Impact Factor
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ABSTRACT: To describe trends over time and types of disability for children born in a French county from 1980 to 1991.
Data were collected from medical records of a morbidity register; disabled children with at least one severe deficiency have been included. Prevalence rates are given per 1000 resident children, over four three-year periods.
Overall, 7.73 per 1000 children (that is, 1360 children), had a severe childhood disability, and the prevalence rate had increased significantly since 1980. This increase was mainly owing to an increase in cerebral palsy and psychiatric disorder prevalence rates.
Future research aimed to explain these trends over time can be based on such data. The present knowledge is useful for planning purposes.
Archives of Disease in Childhood 03/2003; 88(2):114-7. · 2.88 Impact Factor
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ABSTRACT: The number of TOP for medical indications has increased regularly over the last ten years. At the same time, the methods used for TOP have evolved. The purpose of this study was to assess the frequency of complications after drug-induced termination of pregnancy in order to determine whether using this method for interrupting pregnancy during the second or third trimester adds further danger for the mother in terms of early severe risk (uterine rupture, hysterectomy) or less severe long-term risk (infection).
This metaanalysis included all articles devoted to pregnancy interruption from 12 gestation weeks retrieved from the Medline database and published between 1989 and 1999 in the United States, Canada, Australia, New Zealand, or the European Union. After excluding articles that included in utero death (n=8), isolated case reports and series involving a high-risk of maternal somatic complications (n=16), and surgical methods for pregnancy termination (n=4), we retained 23 articles for analysis. These articles had included 58,891 drug-induced terminations of pregnancy. For each article, we recorded the following complications: bleeding requiring transfusion, uterine rupture, ovular or placentar retention, and infection. A classical homogenicity test was performed for each type of complication. When this test was not significant, a mean rate, weighing by size of the study, was calculated.
One study reported maternal deaths (3/143000). The weighted mean rate for late retention (>24 hr) was 1.5 [CI95: 1.1%-1.9%]. For infections, the rates were very variable between studies (from 0.7% to 3.6% with one study reporting 8%). For bleeding with transfusion, the weighted mean rate was 0.7% [CI95: 0.5%-0.9%]. This rate was significantly higher than the rate observed in 1999 in France after delivery excepting medically terminated pregnancy (p<10(-3)) but probably is a reflection of the variable transfusion practices during the eighties in these different countries. Th rate of uterine rupture after medically terminated pregnancy was 0.1% [CI95: 0.07%-0.17%] and would be higher after delivery (excepting terminations) but not significantly (p=0.07).
This metaanalysis demonstrates that the risk of severe complications (uterine rupture and bleeding requiring transfusion) are rare but are more prevalent than after delivery except pregnancy termination. The metaanalysis approach is justified due to the low incidence of these severe complications. A prospective multicentric study of the complications using a geographical base would be useful to obtain unbiased data on risk level. A risk analysis by gestational age, maternal age, parity, and product used would thus be possible, as would long-term monitoring of maternal outcome.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 01/2003; 32(3 Pt 1):227-38. · 0.42 Impact Factor
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ABSTRACT: In France since 1995, information on diagnoses and care are routinely collected for each patient hospitalised in a public or private hospital, using the Diagnosis Related Group system. Information on birth events constitutes a good example of possible use of this information for other aims than economic activity evaluation. In this paper, in order to highlight possible epidemiological use, some recommendations are proposed for collecting data on stillbirths and pregnancy terminations. The lack of usual knowledge on these two adverse events is the reason for this choice. While the improvements in prenatal diagnosis lead to an increase in pregnancy terminations, a minimum common core of collected data should allow routine epidemiological monitoring of these adverse perinatal events.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 10/2001; 30(5):433-8. · 0.42 Impact Factor
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ABSTRACT: Asthma is one of the most frequently encountered chronic illnesses in children. The aim of the present study was to investigate the problem of integration of asthmatic subjects at school by assessing the reactions of parents and teachers, and also by considering the medical aspects.
A cross-sectional random study was carried out during autumn 1994 including 4,251 primary school children aged between five and 14 years, and including teachers from 188 classes and 26 schools in Grenoble and its inner suburbs. The first screening questionnaire was completed by the parents, and data on 3,799 children were obtained; from this, 191 currently asthmatic children were identified. One hundred and forty-six parents of the identified asthmatics subsequently answered a second questionnaire on the severity of the illness and its effects on school attendance and educational activities. The 186 teachers from the schools involved were interviewed about their knowledge of the disorder, and about what they knew of the treatment and management of asthmatic children in school.
It was found that the cumulative prevalence of asthma amounted to 7.6%, and that the prevalence over the previous 12-month period was 4.3%. Sixteen percent of the asthmatic children reported an asthma-associated school absence of more than six days during the six preceding months. In 45.2% of cases, physical exercise was responsible for an asthmatic attack, but premedication was used in only 21% of cases. Nine percent of the children had obtained a medical certificate which exempted them from participating in sports activities and physical exercise. Seventy-three percent of the parents had informed the teachers of their child's illness, but the information communicated was incomplete. It was found that the teachers did not have a thorough knowledge of the disorder, but that many of them (92.7%) would appreciate further information on the subject and on its management. Eighty-three percent of the teaching staff were unaware that the ministerial circular No. 93-248 of 22 July 1993 had been issued on the proposed management of chronic disorders at school, advocating a combined effort on the part of the parents, the child's physician, the school doctors and the teachers in setting up a concerted plan of action.
This study has demonstrated that the school integration of asthmatic children remains problematical both as regards treatment and the pursuit of indoor and outdoor school activities. Integration could be improved by using parent-doctor-teacher liaison forms, thereby maintaining closer communication regarding the child's needs. When this is not sufficient, an individualized asthma management plan could be introduced in collaboration with the parents, doctors and teachers, which might result in improved treatment and integration of asthmatic children in school.
Archives de Pédiatrie 09/2000; 7(8):817-24. · 0.30 Impact Factor
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ABSTRACT: It should no longer be necessary to demonstrate the importance of knowing the completeness of ascertainment for a morbidity register, particularly with respect to the interpretation of prevalence rates and their trends, but also when using register data for etiological studies. Method: The study covered 9 generations of children born between 1980 and 1988. All of these children lived in the Isère department in SouthEast France, and each of them had at least one major deficiency, according to the inclusion criteria laid down by the RHEOP ("Registre des Handicaps de l'Enfant et Observatoire Périnatal", in French, or Childhood Handicap Register and Perinatal Observatory). These children were recruited from four different data sources. The completeness of ascertainment of the register was estimated first by means of the capturerecapture method, based on two sources that were shown to be independent by the Wittes method. Following this, loglinear models were used. The advantage of this was the absence of restrictions involved in adhering to the necessary validity conditions before applying the capture-recapture method, and the possibility of introducing heterogeneity variables, such as the number of deficiencies per child, for example.
The applied capturerecapture method, with two main sources that have been found to be independent, gives an overall completeness of ascertainment of 86% CI(95%)[8291], with a variation of between 76% CI(95%)[6787] and 97% CI(95%)[93100] when the number of deficiencies per child is taken into account. After application of the loglinear models, the results obtained are very close to those obtained with the capture-recapture method, both in the case of estimation of the overall completeness of ascertainment and in the case of the completeness of ascertainment that is estimated according to the number of deficiencies variable. The similarity of the results obtained by the two methods appears to support our empirical study, but is only possible because of the validity of certain conditions (the interactions of the order of three were not significant) which can only be verified using statistical tests in the linear log models.
If the application conditions of the capture-recapture method are carefully adhered to, it becomes possible, without the help of software, to produce a correct estimate of the number of missing cases. Nevertheless, it would be unreasonable to continue using this method alone since log linear models have been found to be independent of these validity conditions.
Revue d Épidémiologie et de Santé Publique 02/2000; 48(1):41-51. · 0.78 Impact Factor
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ABSTRACT: Despite the definition of new screening policies for fetal trisomies, based on nuchal translucency thickness (NT) or maternal serum, the prevalence of trisomy 21 remains high. We propose a strategy based on a combination of maternal age, gestational age and NT, measured at the first trimester ultrasound examination, for the assessment of risk.
We present, in this paper, a characterisation of the physiological increase of fetal NT between the 10th and the 14th week of gestation, in a preliminary study of 266 echographic examinations. Next we propose a calculation of the simultaneous risk of trisomy 21 based on marginal risks for maternal age and increased NT values available in the literature.
We propose to define a high-risk group associated to the NT marker by using a cut-off risk of 1/250 for the simultaneous risk. This criteria may, as well, be expressed by a pathological threshold of NT varying with maternal age and gestational age. Without questioning that women aged of 38 years or older are a high-risk group, this approach should allow an improvement of the prenatal screening for trisomy 21.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 10/1999; 28(5):439-45. · 0.42 Impact Factor
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ABSTRACT: The purpose of this study, through a retrospective epidemiological survey carried out over three geographical areas in France, was to characterize the aetiological factors involved in severe mental retardation (SMR) within a geographically defined population of children with disabilities aged between 7 and 16 years. The inclusion criteria for SMR (IQ<50) were met by 1150 children born between 1976 and 1985. Of these children, aetiology was known in 25%, suspected (or unclear) in 26%, and unknown in 49%. These rates of known and suspected aetiology varied between the groups of children with CP and those without CP. An analysis of factors associated with SMR was undertaken among the 144 subjects with SMR, of suspected or unknown aetiology, who had been referred to a neonatal care unit with or without intensive care (NCU) during their neonatal period. These subjects with SMR were compared with 864 children without SMR (control children) who were also referred to an NCU during their neonatal period. The main specific associated factors were a prolonged intubation of more than 24 hours, a very low birthweight (<1500 g) for children with an associated clinical feature of CP, and the presence of isolated neonatal fits and a time of transfer to the NCU of more than 4 hours after birth for children without an associated clinical feature of CP. Although common associated factors were encountered in the children with SMR with CP and the children with SMR without CP, the results of this study suggest differences in the underlying pathogenic factors.
Developmental Medicine & Child Neurology 05/1999; 41(4):233-9. · 2.92 Impact Factor
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ABSTRACT: Recent literature has revealed different percentages of prenatal detection of congenital heart disease. Therefore we chose to analyse the sensitivity of this screening in Isère county and to scrutinize to which extent factors like severity of the anomaly, extracardiac anomalies and maternal age influence the sensitivity. This retrospective study covers the period from 1989 to 1995. All the pregnancies with congenital heart disease in Isère county in France were reviewed and analysed, which was possible thanks to our registry of congenital anomalies. In this period, 316 cases were registered in the central database. We obtained an overall sensitivity of 34.8 per cent. By splitting the different malformations into two groups we got a detection rate of 53.7 per cent for major malformations and 26.7 per cent for other abnormalities. This difference is significant. Nevertheless, the sensitivity remains quite low. This result stresses the need for better education of investigators in primary care units, particularly because the prenatal diagnosis of congenital heart disease has a major impact on the outcome of pregnancy, which can be seen in the increased number of abortions in this group.
Prenatal Diagnosis 05/1999; 19(4):318-22. · 2.11 Impact Factor
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ABSTRACT: Epidemiology of paediatric respiratory allergic disorders allows the approach to causal and preventive risk factors by studying groups or sub groups of children in different locations and under different conditions. This is, however, complicated by the lack of consensus on disease definitions, which renders comparisons between studies difficult. Atopy is usually defined by the presence of positive skin tests (wheal size of at least a mean diameter > or = 3 mm), by the presence of specific IgE, or by the presence of increased total IgE (> or = 100 UI/mL). Infantile asthma is not well defined, complicated by the high prevalence of bronchiolitis; one thus questions between wheezing or wheezy bronchitis. Prevalence is high: among early wheezers, two populations will be defined by the medium term evolution: transient wheezers and persistent wheezers. Risk factors for these two conditions are different. Childhood asthma may be defined by the diagnosis of asthma (specific but fairly non-sensitive), by asthmatic symptoms (wheezing, waking by an attack of shortness of breath) (sensitive but not very specific), or by the combination of symptoms and airway hyperresponsiveness. The ISAAC study has standardised a questionnaire to assess the prevalence of asthma. The preliminary results show that there are wide variations across the world. The prevalence is low in Africa and Asia, intermediate in Europe, and high in Anglo-Saxon countries. The prevalence of asthma has gradually increased over the past 20 years in developed countries. Asthma and atopy are closely associated in children. Risk factors are genetic, associated with sex and environmental factors. Among these, allergic sensitisation is associated with the degree of exposure to allergens. Westernization of way of life is associated with increased prevalence of atopy, allergic rhinitis and asthma. Atopy seems inversely correlated to certain infections. Passive smoking is clearly associated with early wheezing. This and atmospheric pollution aggravate childhood asthma. However, the inducing role of pollution on asthma is still controversial.
Archives de Pédiatrie 01/1999; 6 Suppl 1:6S-13S. · 0.30 Impact Factor
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ABSTRACT: Regulations concerning services for handicapped children in France have defined the notion of multi-handicap. There are, however, divergences in the procedures for applying this definition, and differences in the prevalence in different areas. This study is aimed at clarifying these two points.
A survey in three French departments provided data about disabled children born between 1975 and 1985 who received services from the departmental committee for special education or from day hospitals. The data was systematically collected by a physician using medical files.
The results showed that the group of multi-handicapped children was heterogeneous. The most restrictive definition (motor disability with profound mental retardation, bed-ridden or restricted to a chair) resulted in a prevalence of 0.73%. A broader definition based on the concept of zero autonomy, but excluding mild or moderate mental retardation, resulted in a prevalence of 1.28%.
The importance of specifying the objectives of a definition selected for operational reasons is stressed in order to improve the estimation of specific needs.
Archives de Pédiatrie 08/1998; 5(7):739-44. · 0.30 Impact Factor
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ABSTRACT: The coexistence of an epidemiological register and a multidisciplinary centre for prenatal diagnosis promoted us to report data collected during six years (1990-1995) in Isère county on prenatally detected chromosomal aberrations. During the whole study period prenatal diagnosis strategy towards chromosome aberrations was based solely on maternal age and ultrasound examination. Results showed a respective contribution of one-third/two-thirds for the two detection modes (maternal age/ultrasound signs). From 1990 to 1995 a significant increase in the proportion of prenatally detected autosomal aneuploidy was observed, from 52 per cent to 75 per cent (P < 0.001). This significant variation was mainly due to an increase in the proportion of prenatally detected trisomy 21 cases, and to an increase in the proportion of aberrations which were detected through first trimester ultrasound examination. The highest positive predictive values were observed for polymalformation, cardiac anomalies and cystic hygroma ultrasound signs (51 per cent, 21 per cent and 26 per cent, respectively). Our results for trisomy 21 are close to those obtained in other studies, even when prenatal strategies are different. Their interest lies in the fact that they can be considered as a reference level of prenatal diagnosis efficiency due to a strategy based on maternal age and ultrasound signs, a level which has to be taken into account when evaluating the benefits of additional serum screening policies in other studies.
Prenatal Diagnosis 07/1998; 18(7):683-92. · 2.11 Impact Factor
