P Czernichow

Centre Hospitalier Universitaire Rouen, Rouen, Upper Normandy, France

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Publications (435)1303.13 Total impact

  • Diabetologia 07/2012; 55(10):2845-7. · 6.49 Impact Factor
  • The Journal of hospital infection 08/2011; 79(2):185-7. · 3.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Screening programs resulting in the early treatment of patients with congenital hypothyroidism (CH) have successfully improved neurodevelopmental outcome, but little is known about long-term health. The aim of the study was to assess health status, and socioeconomic attainment, for a population-based registry of young adult patients. All 1748 eligible patients diagnosed during the first decade after the introduction of neonatal screening in France were invited to participate in this study at a median age of 23.4 yr. Completed questionnaires were obtained from 1202 of the selected patients. The comparison group included 5817 subjects from the last French Decennial Health Survey. Health indicators including medical conditions, hearing and visual status, sociodemographic characteristics, and quality of life were measured. Patients with CH were significantly more likely than their peers to report associated chronic diseases (5.7 vs. 2.9%), hearing impairment (9.5 vs. 2.5%), visual problems (55.4 vs. 47.9%), and being overweight with a body mass index of at least 25 kg/m(2) (22.8 vs. 15.7%) (P < 0.0001). Furthermore, fewer patients attained the highest socioeconomic category (14.6 vs. 23.1%) and were in full-time employment (39.9 vs. 44.8%) (P < 0.0001). They were more likely to still be living with their parents and had a lower health-related quality of life than their healthy peers, particularly for mental dimensions, with a mean difference for the mental summary component of 0.35 SD score (P < 0.0001). CH severity at diagnosis, treatment adequacy, and the presence of other chronic health conditions were the main determinants of educational achievement and health-related quality of life scores. These findings highlight the need for careful monitoring of neurosensory functioning, weight, and long-term treatment adequacy throughout childhood and adulthood.
    The Journal of Clinical Endocrinology and Metabolism 03/2011; 96(6):1771-82. · 6.31 Impact Factor
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    ABSTRACT: This study was designed to estimate the percentage of growth hormone (GH)-treated children born small for gestational age (SGA), with serum IGF-1 >2 SDS before and after GH dose adaptation. SGA boys aged 4-9 and girls aged 4-7 with a height <-2 SDS and an annual growth rate below the mean received a subcutaneous GH dose of 57 μg/kg/day for 2 years. The GH dose was to be decreased by 30% in children with serum IGF-1 >2 SDS at 12 months and on the previous sample. The GH dose could be reduced a second time to 35 μg/kg·day. IGF-1 and IGFBP-3 dosages were centralized. Among the 49 (21 boys) children included in the study, 8 (16.3%) had an IGF-1 >2 SDS consecutively at 9 and 12 months (95% CI 7.3, 29.7). The GH dose was decreased in 6/8 children. However, IGF-1 levels were elevated at several nonconsecutive determinations in 45% (95% CI 28.4, 56.6) of the patients. A high IGF-1 level is observed in 45% of the GH SGA-treated children with a relatively high dose of GH. A 30% reduction in the GH dose causes a decrease in IGF-1 below 2 SDS in most children.
    Hormone Research in Paediatrics 01/2011; 76(6):419-27. · 1.55 Impact Factor
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    ABSTRACT: CONTEXT AND AIM: Depression is a quite common condition, and its treatment is mainly provided by General Practitioner (GP). It is already known that detection and treatment requires significant improvement. The well known and high consumption of antidepressant drugs in France, the highest of all other European countries, requires specific studies. The causes of this situation are not clear and seem to be numerous: Patient's demands, social claims; lack of initial and continuous medical education, bad GP demographic trends, and lack of them in rural areas; pharmaceutical company pressure; and organisation of the health care system. GP are the main medical actors of the primary care system in France. The aim of this study was to survey GP perceptions on secondary care services, seek the views and barriers to the provision of good services, and ask them about perceptions and solutions they could suggest. A structured postal questionnaire was sent to all GP of the north-west region of France, asking physicians about obstacles perceived when taking care of depressive patients; factors influencing the use of services, specialised advice, treatments, access to psychiatrists and psychological care. Their psychiatric knowledge and demographic data were also assessed. Quantitative data were analysed using Epi-Info software, and qualitative data were transcribed and coded manually. A total of 25% of the GP returned the questionnaire (n=2097 in 8709). The sample profile was the same as the studied population. Less than a third of the GP (28%) were aware of the clinical guidelines on depression, and less than a fifth (18%) had clinical experience of psychiatry during their studies. Lack of time was not the main obstacle assessed by the GP. Their complaints were about lack of mental health services, difficulty in accessing services, and about general liaison between primary and secondary health care services: they reported difficulties obtaining quick and good response from the specialist either for emergency or non emergency cases. Regarding secondary care, they mainly referred to the psychiatrist, rather than to the psychologist, probably because this second option is not reimbursed by the social security system. Not surprisingly, medication was cited as the most frequently used treatment, followed by psychotherapy and cognitive behavioral therapy (CBT), and almost never self help literature and self help groups. Trained GP considered they were much more comfortable coping with depressed patients, less frequently using secondary care providers, and easily alternative solutions rather than antidepressant drugs. This situation suggests the usefulness of medical education, and is attested by many qualitative answers. It is not sure that the low rate of knowledge of the guidelines should be judged only as a lack of professionalism. According to the "French Society of Primary Care", clinical guidelines need updating, and it is known that those available could be useful only for half of the situations encountered in primary care. Operational propositions urgently need to be proposed. Recent questioning of the real interest of pharmaceutical options in the treatment of depression is another argument. Nor can we wait for a hypothetic rise in the demographic situation. The GP have several propositions to improve these problems, e.g. continuous medical education (CME) focusing on "patient centred therapy", dedicated hotline or circuit for depressed people, and an adapted sociomedical directory. They also feel that political awareness about lack of physicians is required, but say that improving quality of care does not rely only on improving demographics. They ask for funds for psychological care. When thinking about the circuit of care, the role of all care providers, and their communication, a global vision appears unavoidable, which would get rid of the divisions between out-patients and the hospital. Despite an unavoidable questioning on the dysfunctions of the health care system, quality of care and probably pharmaceutical consumption for the depressed patient might be improved by simple tools, such as adapted CME for primary care physicians, and communication improvement between secondary and primary care systems.
    L Encéphale 06/2010; 36 Suppl 2:D73-82. · 0.49 Impact Factor
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    ABSTRACT: French legislation makes mandatory for healthcare providers the disclosure of hospital infection (HI) risk and actual occurrence to the patient. Given the specific diseases encountered in psychiatry, some difficulties may be expected in practical application of this regulation. The aim of our study was to describe the knowledge, declared practices and opinions of healthcare workers (HCW) in psychiatry concerning information for patients about HI. We randomly selected doctors, nurses and head nurses from four hospitals with psychiatric activity in Normandy. The HCW were asked to self-complete an anonymous questionnaire, including data describing the responding HCW and questions aiming at describing his/her knowledge, attitude in routine daily practice and opinion about information to patients about HI. One hundred and forty-one HCW were initially selected, of which 114 (80.9%) eventually agreed to complete the questionnaire. Only eight HCW (7.0%) were considered to have a correct overall knowledge of legal obligations. Main errors concerned the obligation to inform the patient of the HI risk according to the medical procedures that are to be performed (43.9% of correct answers) and the obligation to inform the patient of the HI risk according to his/her medical condition (46.5%). The obligation to inform the patient of the occurrence of a HI was largely known (84.2%). HCW usually giving information about the risk of HI to patients without HI accounted for 5.3%. Main reasons advocated for not informing patients were a low level risk of HI in psychiatry (80.4%) and the lack of patients' demand (59.8%). In the case of HI occurrence, the percentage of HCW routinely informing patients was 13.2%. HCW systematically informing the patient's family about the occurrence of HI accounted for 9.6%. A large proportion of HCW supported delivering information to patients about HI (86.0%). HCW expected from information better approval of prevention programs by the patients (87.7%) but feared an increased anxiety in patients (75.4%) and a higher rate of care refusal (48.2%). Whereas a very large proportion of HCW in psychiatry support delivering information to patients about HI, our study shows HCW's lack of awareness of regulations and lack of declared practices. Among factors explaining this contrast, a lower perceived HI risk and severity level are to be mentioned. Training programs focusing on risk and mechanisms of HI could be offered to professionals in psychiatry. The issue of specific communication difficulties with psychiatric patients should be addressed as well. In order to develop information on HI, specific methods suited to those patients should be developed.
    L Encéphale 04/2010; 36(2):132-8. · 0.49 Impact Factor
  • Article: Hypophyse
    J Léger, P Czernichow
    [Show abstract] [Hide abstract]
    ABSTRACT: Ante- and post-hypophysis are the two constituents of the hypophysis. The ante-hypophysis synthesizes and secretes mainly the growth hormone, thyrotropin, prolactin, adrenocorticotropic hormones and the gonadotrophins. The vasopressin and oxytocin hormones are secreted by the post-hypophysis. The hypophysis development and differentiation are controlled by a chain of different factors that involve numerous signalisation genes from adjacent structures, in addition to specific transcription factors, to date insufficiently known. The regulation and mode of action of the various hormones are now well identified. Activating and inhibiting hormones synthesized in the hypothalamus regulate the functioning of ante-hypophysis cells. They act through specific cellular receptors. In children, hypothalamus-hypophysis hypofunction is far more frequently observed than hyperfunction. Hypopituitarisms are serious diseases which, if untreated, may have irreversible consequences such as severe nanism in case of somatotropic insufficiency, mental retardation in case of thyrotropic insufficiency, lack of puberty development and sterility in case of gonadotropic insufficiency, and even death in case of corticotropic insufficiency. The diagnosis of hypophysis insufficiency is based on clinical data, and results of functional investigations, and brain magnetic resonance imaging. Treatments are substitutive, given for life, and concerned patients necessitate lifelong medical management. Hypophysis insufficiency may be either isolated or multiple, either acquired (mainly in relation with a tumoral or infiltrative process in the hypothalamus-hypophysis area), or congenital. Various types of human congenital insufficiency (isolated or combined) due to a genetic cause have been described these last years. However, the molecular mechanisms that produce the major part of genetic hypopituitarisms remain to be elucidated.
    EMC - Pédiatrie - Maladies infectieuses. 01/2010; 5(2).
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2010; 58.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2010; 58.
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    ABSTRACT: L’hypothyroïdie congénitale (HC) (1/3500) est due dans la majorité des cas à une dysgénésie thyroïdienne (athyréose ou ectopie). Lorsque la thyroïde est en place (GP), les dyshormonogenèses n’expliquent que 1/3 des cas. L’objectif de l’étude a été d’analyser l’étiologie et l’évolution des HC avec GP. Sujets : 131 enfants dépistés en Ile de France entre 2005 et 2008 ont été étudiés. Résultats : Une scintigraphie a été effectuée chez 84 enfants (64 %) et une dyshormonogenèse a été diagnostiqué dans 48 cas (37 %). 4 cas de faux positifs et 20 cas d’HC transitoire d’étiologie « classique » (prématurité, trouble iodé, anticorps antithyroïdiens et/ou PTU chez la mère) ont été observés. Lorsque l’étiologie était indéterminée et un traitement substitutif instauré (n = 44), un arrêt de traitement a été tenté chez 15 enfants (âge moyen 17 mois [2-46]) sans récidive de l’hypothyroïdie chez 13 d’entre eux (86 %). De même, 3 enfants avec dyshormonogenèse ont arrêté la L-Thyroxine avec succès. Au total, dans les cas d’HC avec GP d’étiologie indéterminée, un arrêt de traitement substitutif a été possible dans 86 % des cas testés et devrait donc être proposé plus systématiquement. Reste à définir les critères cliniques, biologiques et/ou radiologiques pour permettre des recommandations consensuelles.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/2010; 17(6):5-5.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2010; 58.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2010; 58.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Context and aim Depression is a quite common condition, and its treatment is mainly provided by General Practitioner (GP). It is already known that detection and treatment requires significant improvement. The well known and high consumption of antidepressant drugs in France, the highest of all other European countries, requires specific studies. The causes of this situation are not clear and seem to be numerous: Patient's demands, social claims; lack of initial and continuous medical education, bad GP demographic trends, and lack of them in rural areas; pharmaceutical company pressure; and organisation of the health care system. GP are the main medical actors of the primary care system in France. The aim of this study was to survey GP perceptions on secondary care services, seek the views and barriers to the provision of good services, and ask them about perceptions and solutions they could suggest. Methods A structured postal questionnaire was sent to all GP of the north-west region of France, asking physicians about obstacles perceived when taking care of depressive patients; factors influencing the use of services, specialised advice, treatments, access to psychiatrists and psychological care. Their psychiatric knowledge and demographic data were also assessed. Quantitative data were analysed using Epi-Info software, and qualitative data were transcribed and coded manually. Results A total of 25% of the GP returned the questionnaire (n = 2097 in 8709). The sample profile was the same as the studied population. Less than a third of the GP (28%) were aware of the clinical guidelines on depression, and less than a fifth (18%) had clinical experience of psychiatry during their studies. Lack of time was not the main obstacle assessed by the GP. Their complaints were about lack of mental health services, difficulty in accessing services, and about general liaison between primary and secondary health care services: they reported difficulties obtaining quick and good response from the specialist either for emergency or non emergency cases. Regarding secondary care, they mainly referred to the psychiatrist, rather than to the psychologist, probably because this second option is not reimbursed by the social security system. Not surprisingly, medication was cited as the most frequently used treatment, followed by psychotherapy and cognitive behavioral therapy (CBT), and almost never self help literature and self help groups. Trained GP considered they were much more comfortable coping with depressed patients, less frequently using secondary care providers, and easily alternative solutions rather than antidepressant drugs. This situation suggests the usefulness of medical education, and is attested by many qualitative answers. Discussion It is not sure that the low rate of knowledge of the guidelines should be judged only as a lack of professionalism. According to the “French Society of Primary Care”, clinical guidelines need updating, and it is known that those available could be useful only for half of the situations encountered in primary care. Operational propositions urgently need to be proposed. Recent questioning of the real interest of pharmaceutical options in the treatment of depression is another argument. Nor can we wait for a hypothetic rise in the demographic situation. The GP have several propositions to improve these problems, e.g. continuous medical education (CME) focusing on “patient centred therapy”, dedicated hotline or circuit for depressed people, and an adapted sociomedical directory. They also feel that political awareness about lack of physicians is required, but say that improving quality of care does not rely only on improving demographics. They ask for funds for psychological care. When thinking about the circuit of care, the role of all care providers, and their communication, a global vision appears unavoidable, which would get rid of the divisions between out-patients and the hospital. Conclusion Despite an unavoidable questioning on the dysfunctions of the health care system, quality of care and probably pharmaceutical consumption for the depressed patient might be improved by simple tools, such as adapted CME for primary care physicians, and communication improvement between secondary and primary care systems.
    Encephale-revue De Psychiatrie Clinique Biologique Et Therapeutique - ENCEPHALE. 01/2010; 36.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2010; 58.
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2010; 58.
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    ABSTRACT: Obesity and type 2 diabetes (T2DM) in children and adolescents are increasing in developed and developing countries. We have every reason to fear, already, a parallel epidemic in France. We discussed the phenotypic characterization of diabetes in children and adolescent (type 1 diabetes, MODY mainly MODY3, and true T2DM), which have clinical and therapeutic implications, a distinction not always easy. Familial history of T2DM, initial BMI, body weight loss, severity of hyperglycemia and a ketonuria are often not sufficient to determine the etiologic diagnosis. The search for specific islet-cell autoantibodies and for MODY3, are often necessary for classification, and to guide therapeutic strategies. This review presents preliminary French data, based on the comparison of the annual frequency of T2DM between two periods (2001-2003 vs. 1993-1998), in our pediatric diabetes department. A significant increase of T2DM has been found: 14/271 new cases of diabetes (age <16 yrs) in 2001-2003 were T2DM vs. 8/370 in 1993-98 (i.e. 5.2% vs. 2.2%). By contrast with other countries, most of these young T2DM patients are Caucasians. The treatment allows a good glycemic control when diet and physical advices are well followed, and supported by the pediatric team. A monotherapy with metformin is usually sufficient for treating these patients after a short and transient insulin therapy.
    Médecine des Maladies Métaboliques. 03/2009; 3(2).
  • Source
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    ABSTRACT: The impact on patients' attitudes of quality report cards on infection control in hospitals has never previously been studied. In 2006, the French government implemented a mandatory report card on infection control activity (ICALIN) in all hospitals. This approach was aimed at encouraging professionals to change their routine practices in case they should lose patients due to a low ICALIN score. Our objective was to assess what impact ICALIN could have on patients' attitude as regards hospital choice. We performed a survey of patients and visitors in 14 randomly selected hospitals of various ICALIN scores. A convenience sample of 381 patients and visitors completed an anonymous questionnaire on ICALIN, their reasons for choosing a hospital and attitude in the event of a low ICALIN score. Factors associated with interest in ICALIN and impact of ICALIN on hospital choice were assessed by logistic regression. Our results showed that 77% of participants were interested in ICALIN. ICALIN was ranked sixth as a reason for choosing a hospital. In the case of a low ICALIN, 24.1% of participants would refuse admission and 54.9% would seek advice from their general practitioner. Sociodemographic factors had no influence on patients' attitude. In conclusion, our survey suggests that patients take note of poor performance on infection control report cards. As most patients rely on their general practitioner to interpret these report cards, there is a definite need for further communication with general practitioners on this issue.
    Journal of Hospital Infection 02/2009; 71(3):263-8. · 2.86 Impact Factor
  • American journal of infection control 11/2008; 36(8):606-7. · 3.01 Impact Factor
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    ABSTRACT: Cases of Mycoplasma hominis infections after allograft are rare. We report a case of M. hominis wound infection after a vascular allograft. The allograft was positive before having any contact with the recipient, and our investigation suggests that M. hominis may have been transmitted from the donor to the recipient. It is not clear, however, whether specific diagnosis of M. hominis should be performed on tissue before grafting in order to prevent such donor-to-host transmission.
    The Journal of infection 09/2008; 57(3):272-4. · 4.13 Impact Factor
  • Revue D Epidemiologie Et De Sante Publique - REV EPIDEMIOL SANTE PUBL. 01/2008; 56(5):293-293.

Publication Stats

7k Citations
1,303.13 Total Impact Points

Institutions

  • 1995–2011
    • Centre Hospitalier Universitaire Rouen
      • • Department of Epidemiology and Public Health
      • • Service d'Urologie
      Rouen, Upper Normandy, France
  • 2010
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France
    • Université de Rouen
      • Département de Médecine Générale
      Rouen, Haute-Normandie, France
  • 1999–2010
    • Army Center for Epidemiology and Public Health
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1989–2009
    • Hôpital Universitaire Robert Debré
      • Service d’Endocrinologie et de Diabétologie Pédiatriques
      Lutetia Parisorum, Île-de-France, France
  • 1989–2005
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1994–2001
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2000
    • University of Ljubljana
      Lubliano, Ljubljana, Slovenia
    • Institut de Recherche contre les Cancers de l'Appareil Digestif
      Strasburg, Alsace, France
  • 1997–1999
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Saint-Vincent-de-Paul – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • Cornell University
      Ithaca, New York, United States
  • 1986–1998
    • Hôpital Charles-Nicolle
      Tunis-Ville, Tūnis, Tunisia