Etude épidémiologique régionale de la toxoplasmose congénitale et contribution au pôle sérologie du Centre National de Référence

National audienc

Modelling of impaired cerebral blood flow due to gaseous emboli

Bubbles introduced to the arterial circulation during invasive medical procedures can have devastating consequences for brain function but their effects are currently difficult to quantify. Here we present a Monte-Carlo simulation investigating the impact of gas bubbles on cerebral blood flow. For the first time, this model includes realistic adhesion forces, bubble deformation, fluid dynamical considerations, and bubble dissolution. This allows investigation of the effects of buoyancy, solubility, and blood pressure on embolus clearance. Our results illustrate that blockages depend on several factors, including the number and size distribution of incident emboli, dissolution time and blood pressure. We found it essential to model the deformation of bubbles to avoid overestimation of arterial obstruction. Incorporation of buoyancy effects within our model slightly reduced the overall level of obstruction but did not decrease embolus clearance times. We found that higher blood pressures generate lower levels of obstruction and improve embolus clearance. Finally, we demonstrate the effects of gas solubility and discuss potential clinical applications of the model

Usefulness of Parent-Completed ASQ for Neurodevelopmental Screening of Preterm Children at Five Years of Age.

International audienceINTRODUCTION: Preterm children are at greater risk of developmental impairment and require close follow-up for early and optimal medical care. Our goal was to examine use of the parent-completed Ages and Stages Questionnaire (ASQ) as a screening tool for neurodevelopmental disabilities in preterm infants at five years of age.PATIENTS AND METHODS: A total of 648 preterm children (285 were not distinctive for mild delay or normal development. In children with developmental delay, no difference was found when ASQ scores according to maternal education levels were analyzed.CONCLUSIONS: ASQ at five years is a simple and cost-effective tool that can detect severe developmental delay in preterm children regardless of maternal education level, while its capacity to identify children with mild delay appears to be more limited

The Global School Adaptation score: a new neurodevelopmental assessment tool for very preterm children at five years of age

Objective To determine the usefulness of a neurodevelopmental assessment tool consisting of a questionnaire administered to teachers to measure the Global School Adaptation (GSA) scores of very preterm children at the age of 5 years. Study design A sample of 445 very preterm children (<35 weeks of gestation) was assessed at 5 years of age using GSA and IQ scores. According to the consistency between the scores, children were determined to be well classified, intermediately classified, or misclassified. The differences between groups were assessed through univariate and multivariate logistic regression. Results The GSA score was highly or intermediately consistent with the IQ score for 89.2% of the children, and 10.8% were considered misclassified. Children with a higher GSA than IQ score had more autonomy and self-confidence (P < .01), and those with a lower GSA than IQ score had more behavioral problems (P < .01). Analysis by logistic regression showed that sex and gestational age significantly affected the consistency between the 2 scores. Thus, girls were less likely to have a lower GSA than IQ score (aOR = 0.45; 95% CI: 0.24-0.84; P = .01), and a lower gestational age significantly increased the likelihood of having a higher GSA than IQ score (for children born between 24 and 28 weeks of gestation: aOR = 2.70; 95% CI: 1.23-5.92; P = .01). Conclusions The GSA score is a simple, inexpensive, and reliable screening tool for assessing neurodevelopment in very preterm children at 5 years of age

Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola

BACKGROUND: Malnutrition constitutes a public health problem throughout the world and particularly in developing countries. AIMS: The objective of the study is to assess the impact of an elementary integrator composed of Spiruline (Spirulina platensis) and Misola (millet, soja, peanut) produced at the Centre Medical St Camille (CMSC) of Ouagadougou, Burkina Faso, on the nutritional status of undernourished children. MATERIALS AND METHODS: 550 undernourished children of less than 5 years old were enrolled in this study, 455 showed severe marasma, 57 marasma of medium severity and 38 kwashiorkor plus marasma. We divided the children randomly into four groups: 170 were given Misola (731 ± 7 kcal/day), 170 were given Spiruline plus traditional meals (748 ± 6 kcal/day), 170 were given Spiruline plus Misola (767 ± 5 kcal/day). Forty children received only traditional meals (722 ± 8 kcal/day) and functioned as the control group. The duration of this study was eight weeks. RESULTS AND DISCUSSION: Anthropometrics and haematological parameters allowed us to appreciate both the nutritional and biological evolution of these children. The rehabilitation with Spiruline plus Misola (this association gave an energy intake of 767 ± 5 kcal/day with a protein assumption of 33.3 ± 1.2 g a day), both greater than Misola or Spiruline alone, seems to correct weight loss more quickly. CONCLUSION: Our results indicate that Misola, Spiruline plus traditional meals or Spiruline plus Misola are all a good food supplement for undernourished children, but the rehabilitation by Spiruline plus Misola seems synergically favour the nutrition rehabilitation better than the simple addition of protein and energy intake

What they fill in today, may not be useful tomorrow: Lessons learned from studying Medical Records at the Women hospital in Tabriz, Iran

<p>Abstract</p> <p>Background</p> <p>The medical record is used to document patient's medical history, illnesses and treatment procedures. The information inside is useful when all needed information is documented properly. Medical care providers in Iran have complained of low quality of Medical Records. This study was designed to evaluate the quality of the Medical Records at the university hospital in Tabriz, Iran.</p> <p>Methods</p> <p>In order to get a background of the quality of documentation, 300 Medical Records were randomly selected among all hospitalized patient during September 23, 2003 and September 22, 2004. Documentation of all records was evaluated using checklists. Then, in order to combine objective data with subjective, 10 physicians and 10 nurses who were involved in documentation of Medical Records were randomly selected and interviewed using two semi structured guidelines.</p> <p>Results</p> <p>Almost all 300 Medical Records had problems in terms of quality of documentation. There was no record in which all information was documented correctly and compatible with the official format in Medical Records provided by Ministry of Health and Medical Education. Interviewees believed that poor handwriting, missing of sheets and imperfect documentation are major problems of the Paper-based Medical Records, and the main reason was believed to be high workload of both physicians and nurses.</p> <p>Conclusion</p> <p>The Medical Records are expected to be complete and accurate. Our study has unveiled that the Medical Records are not documented properly in the university hospital where the Medical Records are also used for educational purposes. Such incomplete Medical Records are not reliable resources for medical care too. Some influencing factors external to the structure of the Medical Records (i.e. human factors and work conditions) are involved.</p

Parent satisfaction with the Loire Infant Follow-up Team (LIFT) premature and at-risk infant network in the Pays-de-la-Loire area (France)

BACKGROUND: The Loire Infant Follow-up Team (LIFT) is a network for caring for premature infants whose gestational age is 34 WA or less and at-risk neonates in the Pays-de-la-Loire area in France. The network aims to screen for clinical anomalies early and to propose adapted care. Trained physicians follow the included children in a standardized manner at 3, 6, 9, 12, and 18 months and 2 years, with a specific examination by psychologists at 2 years. The aim of the study was to assess the satisfaction of the parents of the children followed.METHODS: To evaluate parent satisfaction, a questionnaire from the Consumer Satisfaction Survey (CSS) in its French version was sent to parents whose infants were 2 years old, stratifying on the presence of an anomaly. The questioner had 39 items, with 8 specific items on the network and 31 from the CSS. The questionnaire was mailed twice in September 2006. RESULTS: Out of 300 questionnaires mailed, 269 were returned (rate 89.7 %). The questionnaire was assessed using principal component analysis with 2 dimensions for the 30 items common to all children, one of which covered empathy with physicians and the other with the consulting psychologists at 2 years. The validity was good (Cronbach coefficient, 0.91). The answers to overall questions such as "We are satisfied with the care in the network" scored 16.1±0.7/20, with 90 % "totally agree" or "moderately agree" responses. The "The care is perfect" scored 14.6±0.7/20 with 78 % agreeing with the statement. The total score for 30 general questions was 14.6±3.1 (median, 14.9). The total score was lower for infants with anomalies: 13.7±3.3 versus 14.9±2.9 (P&lt;0.01). The answers with a low score (&lt;10) were given by 22 parents (8.2 %). There was no significant relation between the total score or the satisfaction score and neonatal events. CONCLUSION: A postal survey is helpful to know the views of parents on the follow-up of their infants. This good level of satisfaction seems to stem from the parents feeling they belong to the network, the quality of the relationships with personnel, and the doctors\u27 empathy, as well as the number of contacts between parents and the network coordinator