La récupération de l état de santé et le stress post-traumatique chez les enfants accidentés de la route (une étude de cohorte)

Cette thèse étudie les facteurs prédictifs et les facteurs associés à la récupération de l état de santé et au stress post-traumatique chez l enfant après un accident de la route. Il s agit d une étude de cohorte prospective mise en place en 2004 composée de 204 enfants de moins de 16 ans, hospitalisés dans les hôpitaux publiques et privés du département du Rhône à la suite d un accident de la route. Un an après l accident, parmi les 127 enfants évalués par questionnaires, 78 (75,0 %) enfants légèrement ou modérément blessés et 8 (34,8%) enfants gravement blessés estimaient avoir complétement récupéré leur état de santé. Après ajustement, le score de gravité (M-AIS>=3) et les lésions des membres inférieurs (AIS>1) étaient associés à la non récupération de l état de santé : Odds Ratio pondérés (ORw) respectifs de 4,3 [IC 95%, 1,3-14,6] et 6,5 [IC 95%, 1,9-21,7]. L état de récupération était significativement corrélé au score physique de la qualité de vie (r=0,46) et dans une moindre mesure au score psychosocial de qualité de vie (r=0,21). D importants symptômes de stress post-traumatique étaient présents chez 26 (27,7%) enfants un an après un accident de la route et cela indépendamment de la gravité des lésions initiales. Dans cette cohorte pédiatrique d accidentés de la route, les enfants ayant des lésions graves (M-AIS>=3) ou des lésions des membres inférieurs avaient une moins bonne récupération de l état de santé à un an. Un état de santé altéré était associé à une qualité de vie plus faible à un an. Il parait important de ne pas négliger les conséquences que peuvent avoir les accidents de la route sur la santé physique et psychique des enfants légèrement blessés.The aim of this thesis was to evaluate predictive factors of recovery and post-traumatic stress in children one year after road traffic injuries. This prospective cohort study was composed of 204 children aged =3) and lower limb injury (AIS>=2) were associated with no full recovery of health status: Weighted Odds Ratio (ORw) : 4.3 [95% Confidence Interval (95% CI) : 1.3-14.6] and ORw : 6.5 [95% CI : 1.9-21.7] respectively. The recovery status was significantly correlated to quality of life Physical scores (r=0.46) especially to Body Pain (r=0.48) and Role/Social physical (r=0.50) and to a lesser extent to quality of life Psychosocial scores (r=0.21). Important post-traumatic stress symptoms were present in 27.7% of children one year after a road traffic accident. In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are more likely to not fully recover their health status at 1 year. Altered health status was associated with a lower physical quality of life score at 1 year. It seems important to consider psychological consequences road traffic accidents may have on children even after mild or moderate injuries.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Total hip arthroplasty using direct anterior approach and dual mobility cup: safe and efficient strategy against post-operative dislocation

AIM: We hypothesize that a dual mobility cup can be safely used via the direct anterior approach, without increasing the risk of complications or incorrect positioning. MATERIALS AND METHODS: This retrospective study compared 201 primary total hip arthroplasties using a dual mobility cup performed via direct anterior approach without a traction table, to 101 arthroplasties performed via posterolateral approach. Implant positioning, function scores, and early complications were recorded. RESULTS: Implant positioning was appropriate in both groups, with a higher cup anteversion in direct anterior approach. The complications rates were similar in both groups, with no dislocation or infection. CONCLUSION: The direct anterior approach without traction table associated with a dual mobility cup does not increase the risk of complications or non-optimal positioning of implants. This strategy is interesting for patients with high risk of post-operative dislocation

Teaching complex grammar: Do less advanced learners prefer examples?

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Teaching complex grammar: Do less advanced learners prefer examples?

International audienc

Bacteremia caused by multidrug-resistant bacteria in a French university hospital center: 3 years of collection

International audienceBackground: The aim of the study was to describe the profile of patients and the characteristics of all bacteremias caused by multidrug-resistant (MDR) bacterial strains in a teaching hospital and to assess the mortality related to these events.Methods: A monocentric retrospective observational cohort study was conducted. All patients with bacteremia caused by MDR bacteria between 2011 and 2013 were included. The characteristics of patients and bacteremias, antibiotic therapy within the first day, and 30-day mortality were collected from the electronic medical records database.Results: A total of 228 patients were included with bacteremias caused by Enterobacteriaceae-producing extended-spectrum b-lactamase (n ¼ 102), Enterobacteriaceae overproducing AmpC b-lactamase (n ¼ 59), carbapenem-resistant Enterobacteriaceae (n ¼ 3), ceftazidime-or carbapenem-resistant Acinetobacter baumannii (n ¼ 2), ceftazidime-or carbapenem-resistant Pseudomonas aeruginosa (n ¼ 23), methicillin-resistant Staphylococcus aureus (n ¼ 40), and vancomycin-resistant Enterococcus (n ¼ 2). The median Charlson comorbidity score was 6. Inappropriate antibiotic therapy was prescribed in 41.7% of bacteremias, and 30-day mortality was 23%. For 20.9% of the patients who had had a positive bacteriologic sample in the preceding 2 months, the initial antibiotic therapy was inappropriate.Conclusion: In this cohort of bacteremia patients, a high rate of mortality and numerous patient comorbidities were observed. Taking greater account of antecedents of MDR bacterial infections could improve the rate of appropriate initial antibiotic therapy

Health status recovery at one year in children injured in a road accident: A cohort study

Despite the frequency of traumatic injuries due to road accidents and potential importance of identifying children at risk of impaired recovery one year after a road accident, there is a lack of data on long-term recovery of health status, except in children with severe traumatic brain injury. The aim of the present study was to evaluate predictive factors of recovery in children one year after road traffic injuries. The prospective cohort study was composed of children aged /=3) and lower limb injury (AIS>1) were associated with incomplete recovery of health status: weighted odds ratio (ORw), 4.3 [95% confidence interval (95% CI), 1.3-14.6] and ORw, 6.5 [95% CI, 1.9-21.7], respectively. Recovery status correlated significantly with quality of life physical scores (r=0.46), especially body pain (r=0.48) and role/social-physical (r=0.50) and, to a lesser extent, quality of life psychosocial scores (r=0.21). In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are less likely to recover full health status by 1 year. Impaired health status was associated with a lower physical quality of life score at 1 year

Stillbirth classification in population-based data and role of fetal growth restriction: the example of RECODE

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Multiparametric MR evaluation of the photoperiodic regulation of hypothalamic structures in sheep

International audienceMost organisms on earth, humans included, have developed strategies to cope with environmental day-night and seasonal cycles to survive. For most of them, their physiological and behavioral functions, including the reproductive function, are synchronized with the annual changes of day length, to ensure winter survival and subsequent reproductive success in the following spring. Sheep are sensitive to photoperiod, which also regulates natural adult neurogenesis in their hypothalamus. We postulate that the ovine model represents a good alternative to study the functional and metabolic changes occurring in response to photoperiodic changes in hypothalamic structures of the brain. Here, the impact of the photoperiod on the neurovascular coupling and the metabolism of the hypothalamic structures was investigated at 3T using BOLD fMRI, perfusion-MRI and pro-ton magnetic resonance spectroscopy (1H-MRS). A longitudinal study involving 8 ewes was conducted during long days (LD) and short days (SD) revealing significant BOLD, rCBV and metabolic changes in hypothalamic structures of the ewe brain between LD and SD. More specifically, the transition between LD and SD revealed neg-ative BOLD responses to hypercapnia at the beginning of SD period followed by significant increases in BOLD, rCBV, Glx and tNAA concentrations towards the end of the SD period. These observations suggest longitudinal mechanisms promoting the proliferation and differentiation of neural stem cells within the hypothalamic niche of breeding ewes. We conclude that multiparametric MRI studies including 1H-MRS could be promising non-invasive translational techniques to investigate the existence of natural adult neurogenesis in-vivo in gyrencephalic brains