[Social inequalities in health in 4 year-old children in the Hauts-de-Seine (France)]. / Inégalités sociales de santé à quatre ans dans les Hauts-de-Seine (France).

The social effects on health described in France on newborn and 5- to 6-year-old children suggest the existence of a social gradient among the youngest children. The favoured, though unequal, social situation of the department of the Hauts-de-Seine (France), makes it particularly adapted to this study. A survey, conducted in 2010 by the departmental service of maternal and infantile protection (PMI) on a representative sample of 1227 children, who received check-ups in their first or second year of nursery school, reveals a significant increase of overweight (from 4.6 to 16.5%), of language disorders (from 8.3 to 25.3%), of the orientations to specialized consultations (from 20.6 to 36.6%), according to the socioprofessional category of the father or the social affiliation of the children in the following subgroups: children speaking or understanding a foreign language (36.6% of the sample), children schooled in priority educational zones (equivalent to education achievement zones in UK, 13.6%), children with limited social health coverage (13.4%). In contrast, the BCG and hepatitis B vaccinal coverage is systematically higher in these various groups. The multivariate analysis investigates for each health problem its links with these various subgroups, and with previous child care experiences, and PMI medical consultations. This study suggests therefore further prospects for different actions according to health problems or regarding vaccinal strategy. The development of such routine indicators of disadvantage should allow territorial health services to target their actions towards the decrease of social disparities in health and to check a posteriori the efficiency of the public systems, which have been implemented.

Helicobacter pylori resistance to clarithromycin in Reunion Island.

OBJECTIVE: The increasing resistance of Helicobacter pylori to clarithromycin led to developing new eradication treatment regimens. The objective of our observational study was to determine the proportion of H. pylori strains resistant to clarithromycin in infected patients in Reunion Island and to suggest a first-line treatment in agreement with the local ecology. PATIENTS AND METHODS: We included 200 patients who underwent esophagogastroduodenoscopy at the University Hospital of Saint-Pierre from February to July 2014. H. pylori was isolated from 73 patients. RESULTS: A wild-type susceptibility profile to clarithromycin was observed in 64 isolates (87.7%) and nine isolates (12.3%) had a resistant mutation profile. CONCLUSION: With a proportion of resistant strains below the critical threshold of 15%, physicians in Reunion Island may continue to prescribe the usual treatment regimen as a first-line option (clarithromycin, amoxicillin, and proton pump inhibitor for 14 days).

3D parameter to quantify the anisotropy measurement of periodic structures on rough surfaces.

In this paper, a new 3D roughness parameter, Sreg, is proposed to quantify the regularity of a surface, independent of the amplitude and the scanning length units of the surface. The efficiency of this parameter is tested on noisy periodical surfaces with degrees of anisotropy. This parameter lies between zero (perfect noise) and 100% (a perfect periodic surface). This parameter enables the identification of the anisotropy directions of regularity for a given surface. For a periodical surface, the greater the noise, the lower the anisotropy. A direction function is proposed to analyse the direction of regularity of a rough surface, which then permits characterization of the directional regularity of the topography. The regularity parameter can be used for several purposes: to identify the direction of periodical structures formed by laser-pulsed radiations on the surface of solid workpieces; to examine the reproducibility of surface machining methods such as finishing process; and to identify the surface regularity produced by abrasive machining, such as precision surface grain, abrasive slotting, and lapping.

Covalent amphiphilic polyoxometalates for the design of biphasic microemulsion systems.

Covalent amphiphilic polyoxometalates generated from alkylphosphonic acids have been synthesized, characterized and monitored by multinuclear NMR spectroscopy. Among them, K3H[γ-SiW10O36(C12H25PO)2] has been successfully used as a surfactant for the stabilization of a Winsor I type microemulsion system.

[Health checkups for children of 3-4 years of age in the Hauts-de-Seine department (France): results and prospects]. / Bilans de santé à 3-4 ans dans le département des Hauts-de-Seine (France) : résultats et perspectives.

INTRODUCTION: A mission of the department's State Maternal and Child Welfare Service is to organize the first checkups for children attending nursery schools. Here, we present the data of the Hauts-de-Seine department (France). PATIENTS AND METHOD: All of the PMI physicians who carry out checkups of children aged 3 to 4 years in the nursery schools of the department, contributed in this study by random drawing a sample of 1914 children, born in 2001, who were in the 1st year of nursery school in 2004-2005. The data gathered concern the children's way of living, their personal and family antecedents, vaccinations, the results of the clinical examination, tests of hearing, vision, and language, the existence of special health or educational programs for children with handicaps or illnesses (PPS and PAI), as well as the types of health insurance coverage the children have. RESULTS: The median age of the children at the time of the checkups was 3 years and 8 months. Half of the children had had some kind of childcare from before the age of 1 year. Two-thirds of the children spend more than 25h a week at school. Twenty-seven percent of the children had already been hospitalized, due to accidents in 5 % of the cases. One child out of 20 lives in a nuclear family that has experienced a serious familial disease. Thirty percent of the children speak or understand a second language. Fifteen percent of the children have poor health insurance coverage. 8.5 % of the children were overweight, 1.6 % were obese, 3.9 % were too thin. 2.5 % were in school with PAI programs,and 0.4 % with PPS programs. As a result of the checkups, 30.1 % of the children were referred (28.3 % for children who have both social security and mutual insurance), including 4.7 % for hearing tests, 13.7 % for vision, 4.4 % for dental checkups, 6.3 % for anomalies of the general examination, 2.7 % for psychological difficulties, 2.6 % for serious language difficulties. 28.9 % of the parents received advice (26.4 % for children who have both social security and mutual insurance) for psychological difficulties, language issues, DTCPH (diphtheria, tetanus, whooping cough, poliomyelitis and hemophilus) and Measles, Mumps, Rubella (MMR) vaccination boosters, and 56.1 % when we add the recommended hepatitis B vaccination. Children who are in schools in priority education zones represent 12.1 % of them. These 2 subgroups are distinguished for a large number of variables, which reflect the very early appearance of social inequalities in terms of health care. Children who went to the Child Welfare Service represented 35 % of the sample, children who are in schools in priority education zones represent 12.1 % of them. CONCLUSION: The complete and systematic medical exam for children in nursery school at the age of 3-4 years old, the key age for screening, give occasion to appreciate global children's health. There should be thinking on the national level about how to group the results of the departments.

[Monitoring infant growth: comparative use of WHO standards and French national reference curves]. / Usage comparé des courbes de l'Organisation mondiale de la santé et des courbes françaises dans le suivi de la croissance pondérale des jeunes nourrissons.

The WHO curves published in 2006 reflect the exact growth of infants who are exclusively breast-fed for at least 4 months. These curves are universal but not widely used in France. At 2-3 months, they have a much higher level than the curves of the Personal Child Health Record. The aim of our study was to evaluate whether the choice of the type of curve influenced the interpretation of infant growth and the advice given, and whether WHO curves could be used for all infants. Initially, 22 physicians retrospectively interpreted the WHO and Personal Child Health Record weight gain curves of 20 infants who were exclusively breast-fed. All of the curves were interpreted twice. In a second step, we drew the WHO curves from 0 to 3 months for the 151 infants monitored by the consultation. At 2 months, there is a very clear discordance in the interpretations of the French and WHO curves (weighted kappa = -0.26 CI 95% [-0.62; 0.18]), contrasting with the satisfactory concordance of the WHO interpretations (weighted kappa = 0.71 CI 95% [0.25; 0.89]) and Personal Child Health Record (weighted kappa = 0.58 CI 95% [0.09; 0.81]) curves. By overestimating the weight gain during the first weeks, in one-third of the infants use of the French curves leads to either inappropriate suggestions of restrictions or their insufficient weight not being taken into account. Moreover, the weight gain at 2-3 months for 151 infants of all categories is within the limits of the WHO curves, without going below the percentile lines for the non-breast-fed infants, except premature babies. Broader use of the WHO curves could be proposed in order to optimize the care of infants, regardless of how they are fed.

[Early visual screening appears essential to detect complete amblyopia risk and to treat strabismus earlier]. / Dépistage précoce des troubles visuels : expérience du service départemental de la Protection maternelle et infantile dans les Hauts-de-Seine.

INTRODUCTION: Early medical examinations performed in 2-, 4-, 9-, and 24-month-olds need to set up a technique adapted to infants and children. The aim of this study was to describe the technique and the results of screening performed by physicians of the Hauts-de-Seine district in 2004. PATIENTS AND METHODS: Over 1 year, 17 participating centers of the Maternal and Infant Welfare department of the Hauts-de-Seine district (France) included 1366 children at the 9- and 24-month medical consultation. This standardized procedure looked for personal and family risk factors and sought to detect ocular anomalies, strabismus, and amblyopia. Depending on the results, the patient was oriented toward appropriate care. RESULTS: At inclusion, only 10% of the children had already consulted an ophthalmologist with insufficient numbers in the risk groups although the difference between groups was significant. Of the children included, 30.2% had a family history of visual impairment and 7% a personal risk. During the examination, a risk of visual impairment was suspected for 12.5% of the children. At the end of the consultation, 39.7% of the children were oriented to an ophthalmic consultation, with the history or the results of the examination. One of these children out of two underwent a consultation. Finally, 31 children were prescribed corrective glasses compared to only eight wearing glasses initially and 65 children were followed up as opposed to only seven children before the study. CONCLUSION: This screening has led to quadrupling the number of children wearing corrective lenses and monitoring the others presenting visual abnormalities, confirming the advantages of early visual screening for children under 3 years of age.

[Visual screening in 3- to 5-year-old preschool children: Maternal and Infant Welfare evaluation program in the Hauts-de-Seine district, France]. / Dépistage des troubles visuels entre 3 et 5 ans: expérience du service départemental de la Protection Maternelle et Infantile dans les Hauts-de-Seine.

INTRODUCTION: Prevalence of visual impairment is estimated at 15% at the age of 5 years. Early visual screening is essential to prevent the risk of amblyopia and treat strabismus. The Maternal and Infant Welfare department of the Hauts-de-Seine district (France) organized a systematic visual screening during a routine health check-up in 3- to 4-year-old preschool children. In this population, 4% of children were wearing corrected lenses before check-up and 12% of children were referred to an ophthalmic consultant. The aim of this study was to document the performance and limitations of two visual acuity measurement tests: the Stycar test (separated presentation of letters) and Cadet letters test (grouped presentation). PATIENTS AND METHODS: Twelve physicians conducting check-ups in 56 of the department's preschools constituted two random samples of representative children. The first sample of 201 children included 3- to 4-year-olds with a positive visual screening on the Cadet or Stycar test and the results and recommendations were collected. The second sample included 238 children who had a first negative visual screening at 3-4 years old with the Stycar test. We then conducted a second visual screening at 4-5 years-old with the Cadet letters test and collected results. RESULTS: In the first sample of 201 children, 73 were lost to follow-up, 40 had a normal documented ophthalmic examination, 63 needed glasses and 25 needed follow-up. The positive predictive value (PPV) of the Stycar test was much higher than the PPV of the Cadet test (79% versus 48%, p<10-4). After this first screening, prevalence of visual impairment at 3-4 years old was estimated at 8%. In the second sample of 238 children, four children were recently lens adapted and 36 were referred to an ophthalmic consultant. Of these 36 children, 11 were lost to follow-up (of these children, two had a very low visual acuity (2/10 and 3/10), four had a normal ophthalmic examination, 13 needed glasses, and eight needed a follow-up. Of the total sample, 10.5% of the children had a documented visual insufficiency on the primary Stycar test screening. The PPV of the Cadet letters test was 84% (IC95%[70%; 98%]). Results of the Cadet letters test was independent of the delay between the two tests. CONCLUSION: Although one-third of the children did not follow the recommendations for follow-up consultation, we demonstrate that visual acuity evaluation was insufficient at 3-4 years of age, and the problems were caught at 4-5 years of age with the Cadet test. Physicians must be aware of the difficulty of the Cadet test at 3-4 years of age but also that screening is inadequate when the Stycar test is normal. A second visual screening, taking into account separating problems on the Cadet test is justified at 4-5 years of age The Stycar test must be discontinued after 4-5 years of age when compliance and the predictive value of the Cadet letters test become excellent.

Reduction of dioxygen by a dimanganese unit bonded inside a cavity provided by a pyrrole-based dinucleating ligand.

A novel class of dinucleating ligands has been introduced into manganese chemistry to study the reactivity of this metal towards dioxygen under strictly controlled conditions. Such N4 ligands combine some of the major peculiarities of tetradentate Schiff bases and the porphyrin skeleton. They are derived from the condensation between 2-pyrrolaldehyde and ethylenediamine or o-phenylenediamine, leading to pyrenH2 (LH2, 1), pyrophenH2 (L'H2, 2) and Me2pyrophenH2, (L"H2, 3), respectively. Their metallation with [Mn3-(Mes)6] (Mes = 2,4,6-trimethylphenyl) led to [Mn2L2] (4), [MnL'(thf)2] (5) and [MnL"(thf)2] (6). Complex 4 displays a double-stranded helical structure, while 5 and 6 are mononuclear complexes containing hexacoordinated metals. Regardless of their structure, complexes 5 and 6 behave in a similar manner to 4 in their reaction with dioxygen, namely, as a dimetallic unit inside a cavity defined by two dinucleating ligands. These reactions led to dinuclear MnIII/MnIV oxo-hydroxo derivatives, [Mn2L2(mu-O)(mu-OH)] (7), [Mn2L'2(mu-O)(mu-OH)] (8) and [Mn2L"2(mu-O)(mu-OH)] (9), in which the two Mn ions are strongly antiferromagnetically coupled [J = -53 (7), J = -64 (8), J = -60 cm(-1) (9)]. The crystal structure of 7 could only be solved with synchrotron radiation as the crystals diffracted very poorly and suffered from twisting and disorder. The formation of 7-9 has been proposed to occur through the formation of an intermediate dinuclear hydroperoxo species.