Assessing the Adequacy of the Physical, Social and Attitudinal Environment to the Specific Needs of Young Adults with Cerebral Palsy: the European Adult Environment Questionnaire

Objectives: To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP). Design: Cross-sectional. Setting: Administrative regions in France, Germany, Italy, Portugal, and Sweden. Participants: Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20). Interventions: Not applicable. Main Outcome Measure(s): Physical, social, and attitudinal environment unmet needs. Results: Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants’ needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment. Conclusion: The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framewor

Postnatal Cytomegalovirus Exposure in Infants of Antiretroviral-Treated and Untreated HIV-Infected Mothers

HIV-1 and CMV are important pathogens transmitted via breastfeeding. Furthermore, perinatal CMV transmission may impact growth and disease progression in HIV-exposed infants. Although maternal antiretroviral therapy reduces milk HIV-1 RNA load and postnatal transmission, its impact on milk CMV load is unclear. We examined the relationship between milk CMV and HIV-1 load (4-6 weeks postpartum) and the impact of antiretroviral treatment in 69 HIV-infected, lactating Malawian women and assessed the relationship between milk CMV load and postnatal growth in HIV-exposed, breastfed infants through six months of age. Despite an association between milk HIV-1 RNA and CMV DNA load (0.39 log 10 rise CMV load per log 10 rise HIV-1 RNA load, 95% CI 0.13-0.66), milk CMV load was similar in antiretroviral-treated and untreated women. Higher milk CMV load was associated with lower length-for-age (−0.53, 95% CI: −0.96, −0.10) and weight-for-age (−0.40, 95% CI: −0.67, −0.13) Zscore at six months in exposed, uninfected infants. As the impact of maternal antiretroviral therapy on the magnitude of postnatal CMV exposure may be limited, our findings of an inverse relationship between infant growth and milk CMV load highlight the importance of defining the role of perinatal CMV exposure on growth faltering of HIV-exposed infants

EnCLASS: an innovative project merging 2 international surveys (HBSC/ESPAD) among French students

International audienceProblemFor two decades, France has taken part in two “competing” school-based, cross-national surveys exploring the health behaviors and well-being of adolescent (Health Behavior in School-aged Children (HBSC) survey, 11-13-15 year-olds) and their substance use (European School Project on Alcohol and other Drugs (ESPAD), 15-16 year-olds).Description of problemSince 2010, French data is provided at national level by grade rather than age. This allowed providing a continuous observation of health behaviors among adolescents, looking at the temporal spread of substance use and providing a better understanding of the role of school as a setting for adolescents’ health. But the difficulty of participating every 4 years in two big surveys remained.Effects of changesIn 2018, France decided to conduct the 2 surveys in a unified and simultaneous way across middle- and high-school. This project is called ’National Survey in Middle- and High-school for Adolescents on Health and Substances’, EnCLASS, explicit acronym easy to pronounce and remember in French. If the main objective of “merging” these surveys is to improve the monitoring of health behaviours and substance use throughout adolescence, it also allows a significant gain regarding preparation, coordination and organization of the fieldwork, hence of overall costs, while ensuring perfect comparability of data at international level.Evolution of data visualization on substance use will be used to illustrate the challenges and improvements of such a process, based on data collected in 2018 among more than 20,000 representative secondary-school students.LessonsIn addition to a greater facility of interpreting and reading findings, presenting data throughout secondary school grades improves its impact and use in a public health perspective and allowing identifying operational targets for prevention and health promotion in schools, as classes are their main settings.Key messagesEnCLASS is unique in Europe, it ensures an excellent comparability of data at international level while providing an innovative national monitoring of adolescent health behavior, including drug use.Further, by its improved quality, perspective and relevance, EnCLASS can contribute to Public health policies analysis regarding school-students in France in a less expensive and better way

The emergency to tackle tobacco smoking by Lebanese adolescents

International audienceIn Lebanon, tobacco use by adolescents remains a problem and is higher than among adults. This study sought to assess the experimentation of tobacco smoking practices among adolescents in Lebanon, and further to link health promotion at school-level (measured with the Hat Questionnaire) to the smoking behaviour at students-level (measured with the HBSC questionnaire). We relied on a cross-sectional observational study, conducted in 50 schools across Lebanon. The students' ages ranged from 11 to 18 years old (6th to 12th grade). They filled-in a confidential, anonymous self-questionnaire in class. In parallel, the school administration filled in the assessment questionnaire for health promotion. STATA Software was used for statistical analysis.7133 students were included (mean age 15.24±2.00 years). Overall, 24.5% had ever experimented cigarette smoking alone, boys more than girls (31.95% vs. 19.14%; p < 0.001), mainly from Beirut (33.62%; p < 0.001) and with poor health perception (29.12% vs. 19.87%; p < 0.001). Overall, 33.98% had ever used water-pipe alone, again more boys (40.34% vs. 29.88%; p < 0.001), from Beirut (39.55%, p < 0.001), and with poor health perception (39.48% vs. 28.93%; p < 0.001). Finally, 22.28% experimented both cigarettes and water-pipe. Around 70% of the involved schools offered health-related courses in their curricula. 72 % of them included interventions on the harm of smoking but not as an integral part of the curriculum. Less than half of them had developed plans to improve health promotion and review data to ensure the effectiveness of their programs. This alarming rate of use of tobacco products constitutes a major public health issue for Lebanese adolescents that needs urgent intervention. Further analysis will focus on the school-level questionnaires. Already our results will serve to foster the reinforcement of health promoting schools in Lebanon by the ministry of Education, in line with international recommendations

Stochastic predictive control with adaptive model maintenance

The closed-loop performance of model-based controllers often degrades over time due to increased model uncertainty. Some form of model maintenance must be performed to regularly adapt the system model using closed-loop data. This paper addresses the problem of control-oriented model adaptation in the context of predictive control of stochastic linear systems. A stochastic predictive control approach is presented that integrates stochastic optimal control with control-oriented input design in order to confer some degree of probing effect to the control inputs. The probing effect will enable generating informative closed-loop data for (online) control-oriented model maintenance. In a simulation study, the performance of the proposed stochastic predictive control approach with integrated input design is demonstrated on a atmospheric-pressure plasma jet with potential biomedical applications

Jeux d’asphyxie chez les élèves de CE1 et CE2

International audienc

When merging two international surveys (HBSC/ESPAD) leads to better monitoring at national level

International audienceIn France, since 1994, adolescents' substance use was measured among 11-13-15 year-olds with the Health Behavior in School-aged Children (HBSC) & among 16-year-olds with the European School Project on Alcohol and other Drugs (ESPAD). Since 2018, with EnCLASS, (National Survey in Middle- and High-school for Adolescents on Health and Substances), France conducts those 2 surveys in a unified way across middle- & high-school, improving the monitoring of health behaviours, substance use included throughout adolescence at national level, while ensuring optimum comparability internationally. Our paper will summarise substance use by secondary students in France with a focus on preventive interventions on substances organised in class. Data collected in 2018 in 1137 classes; nationally representative sample of 20 128 secondary-school students (grade 6-12); confidential & anonymous online self-questionnaire. Schools, parents & students could refuse to participate. Inclusion rate: 74%. Secondary school is the main period where alcohol, tobacco & cannabis are experimented. With subsequent timing: Alcohol, mainly initiated during middle school, is still the first substance used during adolescence, followed by tobacco. The consumption of cannabis tends to begin at the end of middle school, with experimentation & use developing & strengthening during high school. Overall, 10% of 6th grade students report having had an intervention on substance use, up to half in 9th grade. Regarding speakers, 1/2 report external experts, 1/3 teachers & 1/4 school nurses. It seems that alcohol, tobacco & cannabis are discussed at the same occasion. Such findings show a rather good coherence between school intervention & prevalence of substance use EnCLASS by merging HBSC & ESPAD ensures an excellent comparability of data internationally while providing a strong national monitoring of French adolescents' substance use throughout secondary school

Use of emergency contraceptive pill by 15-year-old girls: results from the international health behaviour in school-aged children (hbsc) study

Objective To describe emergency contraceptive pill (ECP) use and variation across countries/regions; and to explore personal and contextual factors associated with ECP use and differences across countries/regions. Design Data were obtained from 11 countries/regions in the 2006 Health Behaviour in School-aged Children cross-sectional study. Setting Data were collected by self-report questionnaire in school classrooms. Population The analysis is based on 2118 sexually active 15-year-old girls. Methods Contraceptive behaviours were compared across countries/regions by chi-square tests. Individual factors related to ECP use were investigated with separate logistic regression models. Multilevel random-intercept models allowed the investigation of individual and contextual effects, by partitioning the variance into student, school and country/region levels. Main outcome measures ECP use at last sexual intercourse. Results ECP use rate varied significantly across countries/regions. Poor communication with at least one adult (odds ratio [OR] 1.62 [1.12-2.36], P = 0.011) and daily smoking (OR 1.46 [1.00-2.11], P = 0.048) were independently associated with ECP use in comparison with condom and/or birth-control pill use. Sexual initiation at 14 years or later (OR 2.02 [1.04-3.93], P = 0.039), good perceived academic achievement (OR 1.69 [1.04-2.75], P = 0.035) and daily smoking (OR 1.63 [1.01-2.64], P = 0.045) were associated with higher levels of ECP use in comparison with unprotected girls. The country-level variance remained significant in both comparisons. Conclusions These data document the large heterogeneity in rates of ECP use between countries/regions. These differences could not be explained by individual or contextual factors, and raise further questions in relation to ECP access for adolescents and their education in its appropriate use