20 research outputs found
Financial and relational impact of having a boy with posterior urethral valves
IntroductionChildhood chronic diseases affect family functioning and well-being. The aim of this study was to measure the impact of caring for a child with PUV, and the factors that most impact the burden of care.Patients and methodWe gave a questionnaire on the familial impact of having a child with posterior urethral valves to all parents of a child included in the CIRCUP trial from 2015 onwards. The questionnaire included questions about the parents' demographics, health, professional, financial and marital status and how these evolved since the child's birth as well as the âimpact on family scaleâ (IOFS), which gives a total score ranging from 15 (no impact) to 60 (maximum impact). We then analyzed both the results of the specific demographic questions as well as the factors which influenced the IOFS score.ResultsWe retrieved answers for 38/51 families (74.5% response rate). The average IOFS score was 23.7 (15â51). We observed that the child's creatinine level had an effect on the IOFS score (pâ=â0.02), as did the parent's gender (pâ=â0.008), health status (pâ=â0.015), being limited in activity since the birth of the child (pâ=â0.020), being penalized in one's job (pâ=â0.009), being supported in one's job (pâ=â0.002), and decreased income (pâ=â0.004). Out of 38 mother/father binomials, 8/33 (24.2%) declared that they were no longer in the same relationship afterwards.ConclusionIn conclusion, having a boy with PUV significantly impacts families. The risk of parental separation and decrease in revenue is significant. Strategies aiming to decrease these factors should be put in place as soon as possible
The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design
Abstract
Background
Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease. A major issue in the management of PUV is prenatal prediction of postnatal renal function. Fetal ultrasound and fetal urine biochemistry are currently employed for this prediction, but clearly lack precision. We previously developed a fetal urine peptide signature that predicted in utero with high precision postnatal renal function in fetuses with PUV. We describe here the objectives and design of the prospective international multicentre ANTENATAL (multicentre validation of a fetal urine peptidome-based classifier to predict postnatal renal function in posterior urethral valves) study, set up to validate this fetal urine peptide signature.
Methods
Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until 2023 in >30 European centres endorsed and supported by European reference networks for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The endpoint will be renal/patient survival at 2 years postnatally. Assuming αâ=â0.05, 1âÎČâ=â0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400 patients need to be enrolled to validate the previously reported sensitivity and specificity of the peptide signature.
Results
In this largest multicentre study of antenatally detected PUV, we anticipate bringing a novel tool to the clinic. Based on urinary peptides and potentially amended in the future with additional omics traits, this tool will be able to precisely quantify postnatal renal survival in PUV pregnancies. The main limitation of the employed approach is the need for specialized equipment.
Conclusions
Accurate risk assessment in the prenatal period should strongly improve the management of fetuses with PUV
Les urétérostomies cutanées inguinales temporaires (bénéfices et controverses)
OBJECTIFS : Evaluer les bénéfices de l'urétérostomie cutanée dans la prise en charge temporaire des uropathies malformatives chez le petit enfant. PATIENTS ET METHODES : Etude rétrospective unicentrique de 18 dossiers (12 reflux vésico-urétéraux, dont 1 sur valves de l'urÚtre postérieur, et 6 mégauretÚres obstructifs) d'enfants suivis entre 1989 et 2011, qui présentaient des pyélonéphrites récidivantes malgré l'antibioprophylaxie, une incertitude sur la valeur fonctionnelle du rein sous-jacent ou l'association des deux conditions. RESULTATS : L'analyse des dossiers s'est faite en 5 points. L'urétérostomie : - diminue l'incidence des pyélonéphrites récidivantes, - ne permet pas une meilleure évaluation de la valeur fonctionnelle du rein sous-jacent, - ne diminue pas significativement le nombre de remodelages, - allonge la durée opératoire d'une réimplantation, - est relativement supportable pour la famille. CONCLUSION : L'urétérostomie est une technique utile dans la prévention des pyélonéphrites récidivantes du nourrisson quand l'antibioprophylaxie est insuffisante. C'est une dérivation bien supportée par la famille.OBJECTIVES : To evaluate cutaneous ureterostomy advantages in temporary treatment of malformative uropathies in young children. PATIENTS AND METHODS : Retrospective, unicentric analysis of 18 cases (12 vesico-ureteric reflux, of which 1 on posterior uretral valves, and 6 megaureters) followed between 1989 and 2011. Children were presenting recurrent urinary tract infections under antibioprophylaxis, doubtful functional value of the overlying kidney or both of the conditions. RESULTS : Analysis was conducted under 5 points. It shows that ureterostomy : - decreases recurrent pyelonephritis incidence, - does not allow a better evaluation of the overlying kidney function, - does not significantly decrease tailoring rate during reimplantation, - lengthens operative time of reimplantation, - is socially acceptable for parents. CONCLUSION : Ureterostomy can be a useful technique in preventing recurrent pyelonephritis in infant when antibioprophylaxis is insufficient. This is a well-tolerated urinary diversion for parents.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF
Les traumatismes fermes du rein chez l'enfant (étude des facteurs prédictifs d'une série de 13 cas)
BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Transport médicalisé terrestre ou aérien et risque d'hémorragie intraventriculaire chez le nouveau-né
BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF
Les agriculteurs et leurs rÎles sur les paysages emblématiques de leur produit : méthode d'analyse à partir d'une étude sur le fromage Saint Nectaire
Many agricultural production sectors seek to affirm the taking root of their product in the territory displaying "a product of quality in an environment of quality", but the nature of the links between products and landscapes give rise to interrogations. An analysis approach of these links is presented here, starting from the identification of the landscape objects used for the promotion of a product with a guarantee of origin, and following with the analysis of the farming practices related to these objects. It was developed for a French AOC cheese. This reveals that the landscape elements retained for promotion are different according to actors' concerned, and that the contributions of the farms to this link product-landscape are variable according to their production system. There it is a first exploratory step of research to consolidate and widen in terms of products, producers and spaces considered.De nombreuses filiÚres de produits agricoles cherchent à affirmer l'ancrage de leur produit dans le territoire prÎnant « un produit de qualité dans un environnement de qualité », mais la nature des liens entre produits et paysages suscite des interrogations. Une démarche d'analyse de ces liens est ici présentée à partir de l'identification des objets paysagers mis en avant pour la promotion d'un produit sous signe de qualité, et de l'analyse des pratiques des producteurs liées à ces objets. Elle a été développée pour le fromage de Saint Nectaire. Il en ressort que les éléments paysagers retenus pour la promotion sont différents selon les acteurs concernés, et que les contributions des exploitations à ce lien produit-paysage sont variables selon leur type de fonctionnement. Il s'agit là d'une premiÚre phase de recherche exploratoire à conforter et élargir en termes de produits, producteurs et espaces considérés
Le rÎle des pratiques agricoles face à une double exigence de qualité des paysages et des produits : analyse sur le cas du fromage AOC Saint Nectaire
Depuis une quinzaine d'annĂ©es, les produits agricoles sous signe de qualitĂ© se dĂ©veloppent et reprĂ©sentent un enjeu Ă©conomique, social, voire environnemental, fort pour l'agriculture et les espaces ruraux. Dans le mĂȘme temps, les demandes de services environnementaux de l'agriculture augmentent et conditionnent de plus en plus la gestion et l'Ă©conomie agricole. Pour Ă©tudier les rĂ©ponses Ă cette double exigence de qualitĂ© des produits et des paysages, les produits sous signe de qualitĂ© utilisant les paysages pour leur promotion sont un support d'Ă©tude intĂ©ressant. Dans cette perspective, un travail sur le fromage AOC Saint Nectaire vise Ă identifier les pratiques agricoles impliquĂ©es dans les qualitĂ©s recherchĂ©es du produit et du paysage ; les points d'analyse sont : 1) les Ă©lĂ©ments paysagers mis en avant pour promouvoir ce produit ? 2) les lieux, les exploitations agricoles, les pratiques sur l'espace correspondant Ă ces Ă©lĂ©ments dans la zone AOC ? 3) la compatibilitĂ© entre la prĂ©sence de ces Ă©lĂ©ments et les Ă©volutions du cahier des charges concernant les pratiques. A partir de photographies de promoteurs et de producteurs, et Ă l'aide de mĂ©thodes empruntĂ©es Ă la gĂ©ographie, des Ă©lĂ©ments paysagers emblĂ©matiques du produit sont identifiĂ©s. Des enquĂȘtes en exploitations et des relevĂ©s de terrain sur deux communes distinctes de la zone AOC permettent de dĂ©gager des lieux, des pratiques et des Ă©leveurs contribuant Ă maintenir ces Ă©lĂ©ments paysagers, et permettant Ă court et moyen terme de rĂ©pondre Ă une double exigence de qualitĂ© du produit et du paysage
Testing socioeconomic development scenarios: an approach for assessing agricultural sustainability at territorial scale: Case study: the Abondance Valley (Haute-Savoie, France)
The aim of our research is to assess patterns of change in agricultural sustainability at territorial scale without losing links with the farm and food supply chain levels. The study focused on the Abondance Valley in the French Northern Alps, through a threeâstrand approach: (i) surveys on farming systems and recent projects, (ii) extrapolation to all the farms recorded in the valley and building farm typology, (iii) prospective scenarios. Models and indicators were designed and used for the extrapolation phase. Three scenarios were developed ('as usual', and two 'what If' scenarios with more or less favourable local and international socioeconomic contexts), defining and mapping out patterns of change in key structural variables. Rules simulating adaptive changes were defined according to farm type and scenario. Agricultural sustainability was assessed according to these three scenarios and was characterized through indicators to grasp different factors: farming jobs, farm workload and economic viability of the farm fabric in the valley, environmental and landscape issues tied to the agroâpastoral land uses, and the dairy processing sector issues (forage autonomy and milk volume collected). The scenario simulations highlighted the issues for label of origin sector and land use (landscape closure, manure management). In particular, the workload of the livestock farmers makes it difficult to improve grassland upkeep and preservation, whereas collective organizations would appear better placed as a solution for ensuring that all manure produced gets spread. Local stakeholders qualified the importance of the various environmental issues, and are in the process of envisaging collective actions
Transformations des exploitations agricoles et Ă©volutions possibles de la durabilitĂ© de l'Ă©levage en vallĂ©e dâAbondance (Haute-Savoie) selon diffĂ©rents scĂ©narios.
Work was carried out in order to evaluate how agricultural sustainability could evolve at territorial scale, linking with farms and agrofood processing industry levels. The case study was the Abondance valley (French Northern Alps), which has a large tourist influence. Several approach levels were used: (i) characterising farm functioning and recent projects diversity from surveys, (ii) extrapolation to all the registered farms in the valley and building farm typology, (iii) elaborating prospective scenarios. Models were developed and sustainability indicators were defined for the extrapolation phase. Three scenarios were developed (âforecastsâ, and two âwhat-ifâ scenarios according to more or less favourable contexts). Rules simulating changes were defined according to farm types and scenarios. The agriculture sustainability was assessed according to various scenarios. Landscape closure and waste management issues were particularly highlighted through the simulations. Local stakeholders' reactions lead to qualify the importance of different environmental issues and to consider possible collective actions.Notre objectif est dâĂ©valuer comment peut Ă©voluer la durabilitĂ© de l'agriculture Ă l'Ă©chelle d'un territoire, sans perdre le lien avec les niveaux d'organisation de l'exploitation et de la filiĂšre. L'Ă©tude porte sur la vallĂ©e dâAbondance en Haute-Savoie. Plusieurs niveaux dâapproche sont mis en Ćuvre : (i) enquĂȘtes sur les fonctionnements des exploitations et leurs projets rĂ©cents, (ii) extrapolation Ă lâensemble des exploitations et typologie des exploitations, (iii) scĂ©narios prospectifs. DiffĂ©rents modĂšles et indicateurs ont Ă©tĂ© mis au point et utilisĂ©s pour lâextrapolation. Trois scĂ©narios sont Ă©laborĂ©s (« fil de lâeau », contextes international et local plus ou moins favorables) avec dĂ©finition et Ă©volutions de variables structurelles clĂ©s. Des rĂšgles simulant les adaptations envisagĂ©es sont dĂ©finies selon les types d'exploitation et les scĂ©narios. La durabilitĂ© de l'agriculture est Ă©valuĂ©e selon les scĂ©narios. Les simulations soulignent notamment les enjeux de fermeture de lâespace et de maĂźtrise de la gestion des fumiers. Les rĂ©actions des acteurs locaux conduisent Ă nuancer l'importance des diffĂ©rents enjeux environnementaux et Ă rĂ©flĂ©chir Ă d'Ă©ventuelles actions collectives
Testing socioeconomic development scenarios: an approach for assessing agricultural sustainability at territorial scale. Case study: the Abondance Valley (Haute-Savoie, France)
International audienceThe aim of our research is to assess patterns of change in agricultural sustainability at territorial scale without losing links with the farm and food supply chain levels. The study focused on the Abondance Valley in the French Northern Alps, through a three-strand approach: (i) surveys on farming systems and recent projects, (ii) extrapolation to all the farms recorded in the valley and building farm typology, (iii) prospective scenarios. Models and indicators were designed and used for the extrapolation phase. Three scenarios were developed ('as usual', and two 'what If' scenarios with more or less favourable local and international socioeconomic contexts), defining and mapping out patterns of change in key structural variables. Rules simulating adaptive changes were defined according to farm type and scenario. Agricultural sustainability was assessed according to these three scenarios and was characterized through indicators to grasp different factors: farming jobs, farm workload and economic viability of the farm fabric in the valley, environmental and landscape issues tied to the agro-pastoral land uses, and the dairy processing sector issues (forage autonomy and milk volume collected). The scenario simulations highlighted the issues for label of origin sector and land use (landscape closure, manure management). In particular, the workload of the livestock farmers makes it difficult to improve grassland upkeep and preservation, whereas collective organizations would appear better placed as a solution for ensuring that all manure produced gets spread. Local stakeholders qualified the importance of the various environmental issues, and are in the process of envisaging collective actions