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Saint-Maurice-la-Clouère, France

Chevignard M.P.,rue du Val dOsne | Chevignard M.P.,Paris-Sorbonne University | Chevignard M.P.,French National Center for Scientific Research | Chevignard M.P.,French Institute of Health and Medical Research | And 2 more authors.
Pediatric Radiology | Year: 2014

Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15–64%); epilepsy, often intractable (11–32%); microcephaly with corticosubcortical atrophy (61–100%); visual impairment (18–48%); language disorders (37–64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23–59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child’s impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates. © 2014, Springer-Verlag Berlin Heidelberg.


Mouly D.,InVS Cire Auvergne | Berat B.,rue du Val dOsne | Goria S.,rue du Val dOsne | Stempfelet M.,rue du Val dOsne | Beaudeau P.,rue du Val dOsne
Environnement, Risques et Sante | Year: 2012

The International Agency for Research on Cancer has classified inorganic arsenic as carcinogenic for humans (group 1). The geologic features of Auvergne result in the presence of natural arsenic in its water. In 2001, more than 140,000 people were served by water networks in which arsenic concentrations exceeded 10 mg/L (maximum contaminant level in effect since 2003). The objective of this study was to look for a link between chronic exposure to low-level doses of arsenic in drinking water and the occurrence of some cancers. This ecological study was conducted among the population living in three districts of Auvergne. The exposure and health indicators were collected at the municipality level. The cancer sites selected for study were the skin (melanoma), kidneys, bladder and urinary tract, and lungs. A relation between cancer and exposure to arsenic in drinking water was sought by a spatial analysis applying a Poisson regression model. The results showed a significant relation between the incidence of lung cancer in men and the presence of arsenic in water intended for human consumption. No association was observed among women for any of the cancers studied, and no other associations were observed among men.

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