Intégration scolaire d'enfants diabétiques de type 1 en classe de primaire dans la région Nord-Pas-de-Calais en 2007 (analyse de la situation, perspectives)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Différents aspects de la prise en charge et du suivi de l'enfant diabétique au Centre Hospitalier Régional Universitaire de Lille

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Dental carie as chronic disease, a new therapeutic approach.]

International audienceFor many decades, oral health has been improving considerably in France. Caries indicators have decreased strongly. However, some "high risk" populations accumulate the majority of tooth decay. For them, health education and public health policies are inefficient. Tooth decay starts early and continues throughout their lives. Describing dental caries as a chronic pathology enables us to envisage alternative therapies, such as therapeutic patient education

L’exercice aérobie continu apparaît protecteur contre les hyperglycémies de récupération précoce, en période post-absorptive, en comparaison de l’exercice intermittent intense, chez des enfants et adolescents atteints d’un diabète de type 1

International audienceINTRODUCTION-QUESTIONDès le plus jeune âge, l’exercice est une clé de la prise en charge du diabète de type 1 (DT1). Néanmoins, la peur de l’hypoglycémie est un frein majeur à l’activité physique (Livny et coll. 2019). Chez l’adulte atteint de DT1, l’ajout de répétitions de séquences intenses lors d’un exercice continu modéré semble limiter la baisse de glycémie (Guelfi et coll. 2005). L’objectif est d’évaluer l’impact de l’intensité et de la modalité d’exercice sur les excursions glycémiques au décours de l’exercice chez l’enfant/adolescent atteint de DT1.MATERIELS ET METHODESCinq garçons et 7 filles atteints de DT1 (9,8±1,4ans; HbA1c 7 ,5±0,7%) réalisent en période post-absorptive, sur ergocycle, en ordre randomisé (visites espacées de >48h), un exercice continu modéré (CONT) et un exercice intermittent intense (INT) de durée et charge mécanique totale identiques [20min; 50%PWC170 vs. 15sec(150%PWC170)/30sec récupération passive). Lesvariations glycémiques (glycémie capillaire pendant l’exercice et glucose interstitiel à la récupération) sont comparées entre les types d’exercice et une condition sédentaire (SED), en prenant en compte la glycémie initiale, les glucides et l’insuline (covariables dans les modèles mixtes linéaires).RESULTATSAucune hypoglycémie symptomatique n’est survenue. Alors que la glycémie capillaire diminuait à l’exercice pour CONT (−26,5mg/dL), elle restait stable pour INT (différence inter-condition, P<0,05) à partir de valeurs élevées (respectivement de 192,8±39,4 et 179,2±78,3mg/dL, non différentes entre les conditions). Plus les glycémies initiales étaient élevées, plus lesexcursions hyperglycémiques étaient importantes en récupération précoce, mais avec un effet protecteur de l’exercice CONT vs. INT (P<0,05) et vs. SED (P200mg/dL, respectivement 0(0;51,6); 83(0;100) et 100(10;100)%]. Aucun effet des conditions n’est apparu en récupération tardive (8h post-exercice).DISCUSSION-CONCLUSIONLes enfants et adolescents atteints de DT1, pour lesquels la 1ère barrière à l’exercice était pourtant la peur de l’hypoglycémie (score BAPAD1: 4,1±1,6), ont souffert d’excursions hyperglycémiques dans les conditions sédentaire et exercice intermittent intense, alors que l’exercice continu modéré apparaissait protecteur. Les travaux futurs devraient considérer la problématique du risque hyperglycémique à l’exercice, au même titre que celle de l’hypoglycémie.Déclaration d'intérê

Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions.

International audienceEver since the first research on barriers to physical activity (PA) highlighting fear of hypoglycemia as a major barrier, many studies have attempted to understand their demographic and behavioural determinants. However, no research has been conducted on whether these perceived barriers toward PA are based on real-life-experienced adverse glycemic effects of exercise. Sixty-two adults and 53 children/adolescents living with type 1 diabetes along with their parents completed the Barriers to Physical Activity in Type 1 Diabetes-1 (BAPAD-1) questionnaire on barriers to PA. Continuous glucose-monitoring data were collected during 1 week of everyday life for 26 adults and 33 children/adolescents. Multiple linear regressions were used to explore links between BAPAD-1 scores and glycemic excursions experienced during and after everyday-life self-reported PA sessions, controlling for behavioural (accelerometry) and demographic confounders. In children/adolescents, the more time spent in hypoglycemia on nights after PA sessions, the more they reported hypoglycemic risk as a barrier (ß=+0.365, p=0.034). Conversely, in adults, the higher the proportion of PA sessions accompanied by a drop in blood glucose, the less hypoglycemia was a barrier (ß=-0.046, p=0.004). In parents, BAPAD-1 scores were unrelated to children/adolescents' everyday-life exercise-induced hypo/hyperglycemia. In children/adolescents, fear of hypoglycemia was predominant in those exposed to nocturnal hypoglycemia associated with PA sessions. In adults, fewer barriers may mean they accept a bigger drop in their glycemia during PA. This shows the importance of finding and promoting age-specific solutions to prevent exercise-induced hypoglycemia

Clinical lessons learned in constitutional hypopituitarism from two decades of experience in a large international cohort

International audienceContextThe international GENHYPOPIT network collects phenotypical data and screens genetic causes of non‐acquired hypopituitarism.AimsTo describe main phenotype patterns and their evolution through life.DesignPatients were screened according to their phenotype for coding sequence variations in 8 genes: HESX1, LHX3, LHX4, PROP1, POU1F1, TBX19, OTX2 and PROKR2.ResultsAmong 1213 patients (1143 index cases), the age of diagnosis of hypopituitarism was congenital (24%), in childhood (28%), at puberty (32%), in adulthood (7.2%) or not available (8.8%). Noteworthy, pituitary hormonal deficiencies kept on evolving during adulthood in 49 of patients. Growth Hormone deficiency (GHD) affected 85.8% of patients and was often the first diagnosed deficiency. AdrenoCorticoTropic Hormone deficiency rarely preceded GHD, but usually followed it by over 10 years. Pituitary Magnetic Resonance Imaging (MRI) abnormalities were common (79.7%), with 39.4% pituitary stalk interruption syndrome (PSIS). The most frequently associated extrapituitary malformations were ophthalmological abnormalities (16.1%). Prevalence of identified mutations was 7.3% of index cases (84/1143) and 29.5% in familial cases (n = 146). Genetic analysis in 449 patients without extrapituitary phenotype revealed 36 PROP1, 2 POU1F1 and 17 TBX19 mutations.ConclusionThis large international cohort highlights atypical phenotypic presentation of constitutional hypopituitarism, such as post pubertal presentation or adult progression of hormonal deficiencies. These results justify long‐term follow‐up, and the need for systematic evaluation of associated abnormalities. Genetic defects were rarely identified, mainly PROP1 mutations in pure endocrine phenotypes

Dissertatio historica de initiis monarchiae Babyloniorum, quam, cum cons. ampliss. Colleg. Philos. in Reg. Acad. Upsal. sub praesidio ... Jacobi Arrhenii ... publico examini modeste subjicit Petrus Hagberg Gestr. In audit. Gustav. maj. ad d. 25. Maji. Anni MDCCV.

International audienceBackground : The incidence of childhood type 1 diabetes (T1D) incidence is rising in many countries, supposedlybecause of changing environmental factors, which are yet largely unknown. The purpose of the study was tounravel environmental markers associated with T1D. Methods : Cases were children with T1D from the French Isis-Diab cohort. Controls were schoolmates or friends ofthe patients. Parents were asked to fill a 845-item questionnaire investigating the child’s environment before diagnosis.The analysis took into account the matching between cases and controls. A second analysis used propensity scoremethods. Results : We found a negative association of several lifestyle variables, gastroenteritis episodes, dental hygiene, hazelnutcocoa spread consumption, wasp and bee stings with T1D, consumption of vegetables from a farm and death of a petby old age. Conclusions : The found statistical association of new environmental markers with T1D calls for replication in othercohorts and investigation of new environmental areas

Additional file 1: of Association of environmental markers with childhood type 1 diabetes mellitus revealed by a long questionnaire on early life exposures and lifestyle in a case–control study

The questionnaire used in the current study. (PDF 620 kb