Unite DEpidemiologie Clinique
Unite DEpidemiologie Clinique
Bamberger S.,Service de Gastroenterologie Pediatrique |
Vinson C.M.,Service de Gastroenterologie Pediatrique |
Mohamed D.,Unite DEpidemiologie Clinique |
Mohamed D.,French Institute of Health and Medical Research |
And 6 more authors.
PLoS ONE | Year: 2016
Inflammation contributes to growth failure associated with inflammatory bowel diseases. Anti-TNFα therapy induces sustained remission and short-Term improvements in height velocity and/or height standard deviation score (H-SDS) patients with Crohn's disease. The purpose of this study was to evaluate growth and adult height in patients with Crohn's disease taking maintenance infliximab or adalimumab therapy.This university-hospital based retrospective study included 61 patients, with a median follow-up of 2.6 years (2.0; 3.3). 38 patients (62%) reached their adult height. H-SDS was collected at diagnosis and together with disease activity markers (Harvey-Bradshaw Index, albumin, and C-reactive protein) at treatment initiation (baseline), and follow-up completion. Wilcoxon's signed-rank test was chosen for comparisons. Median H-SDS decreased from diagnosis to baseline (-0.08 [-0.73; +0.77] to-0.94 [-1.44; +0.11], p<0.0001) and then increased to follow-up completion (-0.63 [-1.08; 0.49], p = 0.003 versus baseline), concomitantly with an improvement in disease activity. Median adult H-SDS was within the normal range (-0.72 [-1.25; +0.42]) but did not differ from baseline H-SDS and was significantly lower than the target H-SDS (-0.09 [-0.67; +0.42], p = 0.01). Only 2 (6%) males had adult heights significantly below their target heights (10.5 and-13.5 cm [-1.75 and-2.25 SD]). In conclusion, anti-Tumor necrosis factor α (TNF) therapy prevented loss of height without fully restoring the genetic growth potential in this group of patients with CD. Earlier treatment initiation might improve growth outcomes in these patients. © 2016 Bamberger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PubMed | Unite dEpidemiologie Clinique and Service de Gastroenterologie Pediatrique
Type: Journal Article | Journal: PloS one | Year: 2016
Inflammation contributes to growth failure associated with inflammatory bowel diseases. Anti-TNF therapy induces sustained remission and short-term improvements in height velocity and/or height standard deviation score (H-SDS) patients with Crohns disease. The purpose of this study was to evaluate growth and adult height in patients with Crohns disease taking maintenance infliximab or adalimumab therapy.This university-hospital based retrospective study included 61 patients, with a median follow-up of 2.6 years (2.0; 3.3). 38 patients (62%) reached their adult height. H-SDS was collected at diagnosis and together with disease activity markers (Harvey-Bradshaw Index, albumin, and C-reactive protein) at treatment initiation (baseline), and follow-up completion. Wilcoxons signed-rank test was chosen for comparisons. Median H-SDS decreased from diagnosis to baseline (-0.08 [-0.73; +0.77] to -0.94 [-1.44; +0.11], p<0.0001) and then increased to follow-up completion (-0.63 [-1.08; 0.49], p = 0.003 versus baseline), concomitantly with an improvement in disease activity. Median adult H-SDS was within the normal range (-0.72 [-1.25; +0.42]) but did not differ from baseline H-SDS and was significantly lower than the target H-SDS (-0.09 [-0.67; +0.42], p = 0.01). Only 2 (6%) males had adult heights significantly below their target heights (10.5 and -13.5 cm [-1.75 and -2.25 SD]). In conclusion, anti-tumor necrosis factor (TNF) therapy prevented loss of height without fully restoring the genetic growth potential in this group of patients with CD. Earlier treatment initiation might improve growth outcomes in these patients.
Meas T.,French Institute of Health and Medical Research |
Meas T.,University Paris - Sud |
Deghmoun S.,French Institute of Health and Medical Research |
Alberti C.,University Paris - Sud |
And 5 more authors.
Diabetologia | Year: 2010
Aims/hypothesis: Insulin resistance (IR) and the metabolic syndrome (MS) have been reported in adults as a consequence of being born small for gestational age (SGA). The process seems to be initiated early in life; however, little is known about the progression of MS and IR in young adults. We hypothesised that being born SGA would promote a greater progression over time of IR and MS, reflecting not only the gain in weight and fat mass but also the extension of the fetal programming process. Methods: Participants were selected from a community-based cohort and born full-term either SGA (birthweight <10th percentile) or appropriate for gestational age (25th
Napoleon B.,Hopital Prive Jean Mermoz |
Gincul R.,Service dHepatogastroenterologie |
Ponchon T.,Service dHepatogastroenterologie |
Berthiller J.,Unite dEpidemiologie Clinique |
And 11 more authors.
Endoscopy | Year: 2014
Background and study aims: Endoscopic papillectomy of early tumors of the ampulla of Vater is an alternative to surgery. This large prospective multicenter study was aimed at evaluating the long-term results of endoscopic papillectomy. Patients and methods: Between September 2003 and January 2006, 10 centers included all patients referred for endoscopic papillectomy and meeting the inclusion criteria: biopsies showing at least adenoma, a uT1N0 lesion without intraductal involvement at endoscopic ultrasound (EUS), and no previous treatment. A standardized endoscopic papillectomy was done, with endoscopic monitoring with biopsies 4-8 weeks later where complications were recorded and complementary resection performed when necessary. Follow-up with duodenoscopy, biopsies, and EUS was done at 6, 12, 18, 24 and 36 months. Therapeutic success was defined as complete resection (no residual tumor found at early monitoring) without duodenal submucosal invasion in the resection specimen in the case of adenocarcinoma and without relapse during follow-up. Results: 93 patients were enrolled. Mortality was 0.9% and morbidity 35%, including pancreatitis in 20%, bleeding 10%, biliary complications 7%, perforation 3.6%, and papillary stenosis in 1.8%. Adenoma was not confirmed in the resection specimen in 14 patients who were therefore excluded. Initial treatment was insufficient in 9 cases (8 carcinoma with submucosal invasion; 1 persistence of adenoma). During follow-up, 5 patients had tumor recurrence and 7 died from unrelated diseases without recurrence. Finally, 81.0% of patients were cured (95% confidence interval 72.3%-89.7%). Conclusion: Endoscopic papillectomy of selected ampullary tumors is curative in 81.0% of cases. It must be considered to be the first-line treatment for early tumors of the ampulla of Vater without intraductal invasion. © Georg Thieme Verlag KG Stuttgart · New York.
PubMed | Unite depidemiologie clinique, hopital Robert Debre, French Institute of Health and Medical Research, Paris-Sorbonne University and Service daccueil des urgences
Type: Journal Article | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2016
Medication errors including inappropriate prescriptions and drug omissions are one of the causes of adverse drug events in children. Our aim was to develop a preliminary screening tool to detect omissions and inappropriate prescriptions in pediatrics based on French and international guidelines.Disease classification was based on the prevalence rate of pathology and hospital statistics. The criteria were obtained by reviewing many French and international references. The Delphi consensus technique was used to establish the content validity of POPI. The level of agreement and the proposals of healthcare professionals was noted on a nine-point Likert scale.The criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology, and miscellaneous). They were distributed to 16 French pediatric panelists (eight pharmacists, eight pediatricians who were hospital-based [50%] or working in the community [50%]). After two rounds of the Delphi process, 101 of 108 criteria were chosen with strong consensus (76 inappropriate prescriptions and 25 omissions).POPI is the first screening tool to detect inappropriate prescriptions and omissions in pediatrics. It is now necessary to conduct a prospective study to determine inter-rater reliability and the tools detection capacity.
Beydon N.,University Paris Est Creteil |
Robbe M.,Ecole de Lasthme |
Lebras M.-N.,Ecole de Lasthme |
Marchand V.,Ecole de Lasthme |
And 4 more authors.
Sante Publique | Year: 2012
Therapeutic patient education (TPE) has been standard practice in France for roughly 20 years. However, TPE has only recently been officially recognized and has rarely been assessed. The objective of this study was to assess the impact of TPE on passive smoking exposure and asthma outcomes in young patients referred to a hospital school for children with asthma. A prospective cohort study was conducted to determine the socio-economic status, environmental exposure (including parental tobacco consumption) and medical history of children starting out on a TPE course. The study measured quality of life and urinary cotinine. Asthma control was also assessed. Out of a total of 54 children (median age 8.6 years), 35 and 26 children attended three or at least four TPE sessions, respectively. Uncontrolled asthma and a history of hospitalization for exacerbation of asthma were frequent (43% and 61%, respectively). In utero passive smoke exposure was more frequent in the hospitalization group (p = 0.07). Urinary cotinine levels were similar in children exposed and not exposed to tobacco smoke (259 vs 141 nMol.L-1, p = 0.15), but only decreased in the group of exposed children. In 34 children, quality of life improved significantly between the first and the third or fourth sessions (n = 23, median increase 1.06, p = 0.1), while asthma control improved in 64% of the patients (n = 33, p = 0.01) and emergency attendances decreased (n = 34, p = 0.001). The positive effects of TPE on asthma control and quality of life were quickly visible but did not prevent children from withdrawing from the program. Urinary cotinine was not useful for detecting exposure to tobacco smoke, but may be useful as an indicator of exposure to tobacco smoke. The results indicate an improvement in quality of life and asthma control as TPE proceeded. © S.F.S.P. Tous droits réservés pour tous pays.
Garel C.,Service de Radiologie |
Cont I.,Service de Radiologie |
Alberti C.,Unite dEpidemiologie Clinique |
Alberti C.,University Paris Diderot |
And 5 more authors.
American Journal of Neuroradiology | Year: 2011
BACKGROUND AND PURPOSE: The availability of data relating to the biometry of the CC in children that are easy to use in daily practice is limited. We present a reference biometry of the CC in MR imaging in a large cohort of children. MATERIALS AND METHODS: Cerebral MR imaging studies of children with normal examination findings were selected retrospectively. Children born preterm and those with or at risk of developing cerebral malformations were excluded. The following parameters were measured: FOD, APD, LCC, GT, BT, IT, ST, and the S/T. Inter- and intraobserver agreement and sex effect were evaluated. RESULTS: Six hundred twenty-two children were included (320 boys, 302 girls), ranging from 1 day to 15 years of age. Normal values (from the 3rd to 97th percentile) are provided for each parameter. All parameters showed rapid growth up to 3 years of age followed by slower (FOD, APD, LCC, GT and ST) or absent (S/T) growth. Growth of BT and IT was completed by 7-8 years. CC modeling (IT/ST) was completed by 3 years. FOD was larger in boys from the age of 1 year (statistically significant). The other parameters did not show any sex effect. Inter- and intraobserver agreement was excellent for all parameters except for IT. CONCLUSIONS: As measured, our data result in easy and reproducible MR imaging biometry of the CC in children.
Jones P.,University College London |
Peters M.J.,University College London |
Pinto da Costa N.,Reanimation Pediatrique |
Kurth T.,Institute National Of La Sante Et Of La Recherche Medical |
And 9 more authors.
PLoS ONE | Year: 2013
Background: Atropine has is currently recommended to facilitate haemodynamic stability during critical care intubation. Our objective was to determine whether atropine use at induction influences ICU mortality. Methodology/Principal Findings: A 2-year prospective, observational study of all first non-planned intubations, September 2007-9 in PICU and Intensive Care Transport team of Hôpital Robert Debré, Paris, 4 other PICUs and 5 NICUs in the Paris Region, France. Follow-up was from intubation to ICU discharge. A propensity score was used to adjust for patient specific characteristics influencing atropine prescription. 264/333 (79%) intubations were included. The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95%CI 0.19-0.95, p = 0.04). One child died during intubation (1/264, 0.4%). Two age sub-groups of neonates (≤28 days) and older children (>28 days, <8 years) were examined. This difference in mortality arose from the higher mortality in children aged over one month when atropine was not used (propensity score adjusted OR 0.22, 95%CI 0.06-0.85, p = 0.028). No effect was seen in neonates (propensity score adjusted OR 1.3, 95%CI 0.31-5.1 p = 0.74). Using the propensity score, atropine maintained the mean heart rate 45.9 bpm above that observed when no atropine was used in neonates (95%CI 34.3-57.5, p<0.001) and 43.5 bpm for older children (95%CI 25.5-61.5 bpm, p<0.001). Conclusions/Significance: Atropine use during induction was associated with a reduction in ICU mortality in children over one month. This effect is independent of atropine's capacity to attenuate bradycardia during intubation which occurred similarly in neonates and older children. This result needs to be confirmed in a study using randomised methodology. © 2013 Jones et al.
Prot-Labarthe S.,Pharmacie |
Weil T.,Pharmacie |
Weil T.,University of Paris Descartes |
Angoulvant F.,Service dAccueil des Urgences |
And 8 more authors.
PLoS ONE | Year: 2014
Introduction: Rational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines. Methods: A selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary. Results: 108 explicit criteria (80 inappropriate prescriptions and 28 omissions) were obtained and submitted to a 16- member expert panel (8 pharmacists, 8 pediatricians hospital-based -50%- or working in community -50%-). Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous). Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references). Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions). Discussion Conclusion: POPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary. © 2014 Prot-Labarthe et al.
Sartor A.,University Paris Diderot |
Arthurs O.,Service dImagerie Pediatrique et Foetale |
Alberti C.,University Paris Diderot |
Belarbi N.,Service dImagerie Pediatrique et Foetale |
And 7 more authors.
Prenatal Diagnosis | Year: 2014
Objective: The objective of this study was to determine the reproducibility, the inter-hemispheric difference and the reference apparent diffusion coefficient (ADC) values of the fetal brain according to gestational age. Method: One hundred and one normal fetal brain (29.4-38.4weeks) were analysed with diffusion-weighted MR imaging. ADC was measured in frontal white matter (FWM), occipital white matter (OWM), centrum semi-ovale (CSO), basal ganglia (BG), cerebellar hemisphere (CBM) and pons. ADC ratios (fronto-occipital, fronto-cerebellar and occipito-cerebellar) were calculated. Inter-observer reproducibility was assessed on 27 studies, using intra-class correlation coefficient and Bland-Altman plot. Inter-hemispheric difference was evaluated with Bland-Altman plot. Gestation-specific reference intervals were estimated for each brain region. Results: Inter-observer bias was near zero. Limits of agreement (LOA) were clinically acceptable (-0.17; 0.20 to -0.38; 0.31×10-3mm2/s) for all brain regions except for CSO and pons. Inter-hemispheric bias was near zero. Smallest LOA were for FWM (±0.09mm2/s) and BG (±0.019mm2/s). ADC values decreased, whereas ADC ratio increased with gestational age, reflecting normal maturation. Fronto-occipital, fronto-cerebellar and occipito-cerebellar ratios were consistently above 0.8, 1 and 1, respectively. Conclusion: The fetal brain regions with the highest reproducibility and smallest inter-hemispheric differences are the frontal, occipital, cerebellar white matter and BG. ADC ratio could be useful to assess differential temporo-spatial maturation. © 2013 John Wiley & Sons, Ltd.