RESUMO
AIM: This study aims to compare three body mass index (BMI)-based classification systems of childhood obesity: the French, the International Obesity Task Force (IOTF) and the World Health Organization (WHO) references. METHODS: The study involved 1382 schoolchildren, recruited from the Lille Academic District in France in May 2009 aged 8.4±1.7 years (4.0-12.0 years). Their mean height and body mass were 131.5±10.9cm and 30.7±9.2kg, respectively, resulting in a BMI of 17.4±3.2kg/m(2). The weight status was defined according to the three systems considered in this study. The agreement between these references was tested using the Cohen's kappa coefficient. RESULTS: The prevalence of overweight was higher with the WHO references (20.0%) in comparison with the French references (13.8%; P<0.0001) and the IOTF (16.2%; P≤0.01). A similar result was found with obesity (WHO: 11.6% vs. IOTF: 6.7%; or French references: 6.7%; P<0.0001). Agreement between the three references ranged from "moderate" to "perfect" (0.43≤κ≤1.00; P<0.0001). Kappa coefficients were higher when the three references were used to classify children as obese (0.63≤κ≤1.00; P<0.0001) as compared to classification in the overweight (obesity excluded) category (0.43≤κ≤0.94; P<0.0001). When sex and age categories (4-6 years vs. 7-12 years) were considered to define the overweight status, the lowest kappa coefficient was found between the French and WHO references in boys aged 7-12 years (κ=0.28; P<0.0001), and the highest one in girls aged 7-12 years between the French references and IOTF (κ=0.97; P<0.0001). As for obesity, agreement between the three references ranged from 0.60 to 1.00 (P<0.0001), with the lowest values obtained in the comparison of the WHO references against French references or IOTF among boys aged 7-12 years (κ=0.60; P<0.0001). CONCLUSION: Overall, the WHO references yield an overestimation in overweight and/or obesity within this sample of schoolchildren as compared to the French references and the IOTF. The magnitude of agreement coefficients between the three references depends on of both sex and age categories. The French references seem to be in rather close agreement with the IOTF in defining overweight, especially in 7-12-year-old children.
Assuntos
Índice de Massa Corporal , Obesidade Infantil/classificação , Comitês Consultivos , Criança , Feminino , França , Humanos , Masculino , Sobrepeso/diagnóstico , Obesidade Infantil/diagnóstico , Valores de Referência , Organização Mundial da SaúdeRESUMO
OBJECTIVE: Validation of body adiposity index (BAI) in a paediatrics sample; and to develop, if necessary, a valid BAI for paediatrics (i.e. BAIp). METHODS: A total of 1615 children (52% boys) aged 5-12 years underwent anthropometry. Their body composition was assessed using a foot-to-foot bioimpedance. The validity of BAI = (Hip circumference/Height(1.5)) - 18 was tested by combining correlation and agreement statistics. Then, the sample was split into two sub-samples for the construction of BAIp. A regression was used to compute the prediction equation for BAIp-based percentage of body fat (%BF). RESULTS: The initial BAI over-estimated the %BF of children by 49% (29.6 ± 4.2% versus 19.8 ± 6.8%; p < 0.0001). The original methodology led to a BAIp = (Hip circumference/Height(0.8)) - 38 in children. When compared to BAI, BAIp showed both better correlation (r = 0.57; p < 0.01 versus r = 0.74; p < 0.0001) and agreement (ICC = 0.34; [95% CI = -0.19-0.65] versus ICC = 0.83; [95% CI = 0.81-0.84]). However, there were some systematic biases between the two values of %BF as exemplified by the large 95% limit of agreement [-9.1%; 8.8%] obtained. CONCLUSION: BAI over-estimates the %BF in children. In contrast, BAIp appears as a new index for children's body fatness, with acceptable accuracy. In its current form, this index is valid only for large-scale studies.
Assuntos
Adiposidade , Antropometria/métodos , Impedância Elétrica , Composição Corporal , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , França , Humanos , Masculino , Análise de RegressãoRESUMO
Melissa officinalis L. (Lamiaceae) (lemon balm) is used in folk medicine for nervous complaints, lower abdominal disorders and, more recently, for treating Herpes simplex lesions. In this work the antiviral activity of a hydroalcoholic extract of lemon balm leaves against the Herpes simplex virus type 2 (HSV-2) was assessed by the cytopathic effect inhibition assay on Vero cells (ATCC CCL-81), in comparison with acyclovir. The cytotoxicity of the extract on Vero cells was previously tested by evaluating the cellular death and was confirmed by the Trypan blue test. Lemon balm showed to reduce the cytopathic effect of HSV-2 on Vero cells, in the range of non-toxic concentrations of 0.025-1 mg mL(-1) (with reference to the starting crude herbal material). The maximum inhibiting effect (60%) was obtained with 0.5 mg mL(-1). The viral binding assay showed that the extract does not prevent the entry of HSV-2 in the cells, thus suggesting a mechanism of action subsequent to the penetration of the virus in the cell. The extract was also chemically characterised by NMR and HPLC analysis; it showed to contain cinnamic acid-like compounds, mainly rosmarinic acid (4.1% w/w). Our experiments support the use of lemon balm for treating Herpes simplex lesions and encourage clinical trials on this medicinal plant.
Assuntos
Antivirais/farmacologia , Herpesvirus Humano 2/efeitos dos fármacos , Melissa/química , Plantas Medicinais/química , Animais , Antivirais/química , Ácidos Cafeicos/química , Ácidos Cafeicos/farmacologia , Chlorocebus aethiops , Células Vero , Ácido RosmarínicoRESUMO
The aim of the present study was to determine the relationship between tracheotomy and ventilator-associated pneumonia (VAP). The study used a retrospective case-control study design based on prospective data. All nontrauma immunocompetent patients, intubated and ventilated for >7 days, were eligible for inclusion in the study. A diagnosis of VAP was based on clinical, radiographical and microbiological criteria. Four matching criteria were used, including duration of mechanical ventilation (MV). The indication and timing of tracheotomy were at the discretion of attending physicians. Univariate and multivariate analyses were performed to determine risk factors for VAP in cases (patients with tracheotomy) and controls (patients without tracheotomy). In total, 1,402 patients were eligible for inclusion. Surgical tracheotomy was performed in 226 (16%) patients and matching was successful for 177 (78%). The rate of VAP (22 versus 14 VAP episodes.1,000 MV-days(-1)) was significantly higher in controls than in cases. The rate of VAP after tracheotomy in cases, or after the corresponding day of MV in controls, was also significantly higher in control than in case patients (9.2 versus 4.8 VAP episodes.1,000 MV-days(-1)). In multivariate analysis, neurological failure (odds ratio (95% confidence interval) 2.7 (1.3-5)), antibiotic treatment (2.1 (1.1-3.2)) and tracheotomy (0.18 (0.1-0.3)) were associated with VAP. In summary, the present study demonstrates that tracheotomy is independently associated with decreased risk for ventilator-associated pneumonia.
Assuntos
Infecção Hospitalar/etiologia , Pneumonia/etiologia , Respiração Artificial/efeitos adversos , Traqueotomia/efeitos adversos , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Infecção Hospitalar/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Ventiladores MecânicosRESUMO
BACKGROUND: The aim of this study was to determine the impact of nosocomial tracheobronchitis (NTB) related to new bacteria on the outcome in patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: A prospective observational case-control study was conducted in medical COPD patients requiring intubation and mechanical ventilation for more than 48 hours. Patients with nosocomial pneumonia were excluded. Six matching criteria were used, including the duration of mechanical ventilation before NTB occurrence. RESULTS: 81 matched case-control pairs were studied. Although the mortality rate was similar (40% vs 34%; p = 0.48), median duration of mechanical ventilation (20 vs 12 days; p = 0.015) and intensive care unit (ICU) stay (25 vs 18 days; p = 0.022) were higher in cases than in controls. NTB was independently associated with a longer than median period of mechanical ventilation among case and control patients (OR = 4.7 [95%CI = 2-10.9]; p < 0.001). In cases with appropriate antibiotic treatment compared with those who did not receive antibiotics, a shorter median duration of mechanical ventilation (12 vs 23 days; p = 0.006) and ICU stay (16 vs 29 days; p = 0.029) were observed. CONCLUSION: NTB is associated with an increased duration of mechanical ventilation and ICU stays. Further studies are required to determine whether antibiotics could improve the outcome of patients with NTB.
Assuntos
Bronquite/complicações , Infecção Hospitalar/terapia , Doença Pulmonar Obstrutiva Crônica/complicações , Respiração Artificial/estatística & dados numéricos , Doenças da Traqueia/complicações , Idoso , Antibacterianos/uso terapêutico , Bronquite/tratamento farmacológico , Bronquite/patologia , Estudos de Casos e Controles , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/patologia , Doenças da Traqueia/tratamento farmacológico , Doenças da Traqueia/patologia , Resultado do TratamentoRESUMO
OBJECTIVES: Determine the risk factors and germs responsible for early-onset (E) and late-onset (L) nosocomial broncho-pulmonary infections (NBPI), in order to improve preventive strategies and the choice of initial antibiotherapy. METHODS: An observational prospective study conducted in an intensive care unit of 30 beds, from March 1993 to September 1999. The patients presenting with an ENBPI and those with an LNBPI were compared with patients without NBPI using univariate and then multivariate analysis. RESULTS: 517 (14%) of early-onset NBPI were diagnosed, but the majority of NBPI were late-onset (87%). Multiresistant bacteria predominated. The similarity in the germs responsible for the early and late onset forms of NBPI was probably related to the large number of patients transferred from other departments (82%) and having already received antibiotics before their admission to the intensive care unit (49%). Multivariate analysis identified anti-ulcer and long term corticosteroid treatments as common risk factors for early and late onset forms of NBPI, digestive failure, tracheotomy and kidney failure as risk factors for ENBPI and the number of antibiotics used in intensive care and the duration of mechanical ventilation as factors of risk for LNBPI. CONCLUSION: The limited use of antibiotics and anti-ulcer agents could improve the prevention of early and late onset forms of NBPI. The distinction in intensive care between the two forms of NBPI must be emphasized by the notion of prior hospitalization.
Assuntos
Broncopatias/microbiologia , Infecção Hospitalar/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Unidades de Terapia Intensiva , Pneumopatias/microbiologia , Antibacterianos/uso terapêutico , Broncopatias/tratamento farmacológico , Broncopatias/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Resistência a Múltiplos Medicamentos , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Incidência , Pneumopatias/tratamento farmacológico , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
The aim of this study was to determine the incidence, the organisms responsible for and the impact on outcome of nosocomial tracheobronchitis (NTB) in the intensive care unit (ICU). This prospective observational cohort study was conducted in a 30-bed medical/surgical ICU over a period of 6.5 yrs. All patients ventilated for >48 h were eligible. Patients with nosocomial pneumonia (NP) without prior NTB were excluded. Patients with first episodes of NTB were compared with those without NTB by univariate analysis. The study diagnosed 201 (10.6%) cases of NTB. Pseudomonas aeruginosa was the most common bacteria. NP rates were similar in patients with NTB compared with patients without NTB. Even in the absence of subsequent NP, NTB was associated with a significantly higher length of ICU stay and duration of mechanical ventilation in both surgical and medical populations. Mortality rates were similar in NTB patients without subsequent NP compared with patients without NTB. Antimicrobial treatment in NTB patients was associated with a trend to a better outcome. Nosocomial tracheobronchitis is common in mechanically ventilated intensive care unit patients. In this population, nosocomial tracheobronchitis was associated with longer durations of intensive care unit stay and mechanical ventilation. Further studies are needed to determine the impact of antibiotics on outcomes of patients with nosocomial tracheobronchitis.
Assuntos
Bronquite/epidemiologia , Infecção Hospitalar/epidemiologia , Infecções por Pseudomonas/epidemiologia , Respiração Artificial , Traqueíte/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Bronquite/etiologia , Estudos de Coortes , Infecção Hospitalar/etiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traqueíte/etiologiaRESUMO
OBJECTIVE: To investigate whether home visits by a occupational therapist reduces the risk of falling and improves the autonomy of older patients hospitalized for falling. DESIGN: In this randomized, controlled trial set in a geriatric hospital, 60 patients (mean age, 83.5 yr) who were hospitalized for falling were recruited from the acute medicine department. A home visit from an occupational therapist and an ergotherapist assessed patients' homes for environmental hazards and recommended modifications. The outcomes measured were falls, autonomy, hospitalization for falling, institutionalization, and death. RESULTS: During the follow-up period, the rate of falls, hospitalization for falls, institutionalization, and death were not significantly different between the two groups. Both groups had a loss of dependence at 12 mo. This loss of dependence was significant in the control group but not in the intervention group. CONCLUSIONS: Home visits from occupational therapists during hospitalization of older patients at risk for falling can help to preserve the patient's autonomy.
Assuntos
Acidentes por Quedas/prevenção & controle , Atividades Cotidianas , Serviços Hospitalares de Assistência Domiciliar , Terapia Ocupacional/métodos , Ferimentos e Lesões/reabilitação , Idoso , Idoso de 80 Anos ou mais , Feminino , França , Humanos , Masculino , Alta do Paciente , Estatísticas não Paramétricas , Ferimentos e Lesões/etiologiaRESUMO
Although leuko-araiosis is a common finding on computed tomographic (CT) scans of the brain, its pathogenesis remains uncertain. To investigate the association between blood pressure (BP) disturbances and leuko-araiosis, we retrospectively reviewed CT scans and 24-hour ambulatory blood pressure monitorings of 79 elderly patients (57 women and 22 men; mean age: 83.3 +/- 6.4 years). Of the 79 patients, 50 were demented (30 had Alzheimer's disease and 18 vascular dementia) and 29 were not demented. The leuko-araiosis score (LA score) was determined by using Rezek's scale. To evaluate short-term variation of BP, we determined (1) the variability of systolic and diastolic BPs (SBP, DBP; within-subject standard deviation of all readings over a 24-hour period), (2) the coefficient of variability (variability of BP/mean BP) and (3) the maximal variation of BP (difference between the maximum and minimum 24-hour BPs). Higher LA scores were associated with higher SBPs in 24-hour, diurnal and nocturnal periods, higher maximal variation of SBP, greater variability of SBP during 24-hour, diurnal and nocturnal periods and greater coefficient of variability of SBP during sleep. Our study suggests that elevations and short-term variations of SBP may contribute to the pathogenesis of white matter lesions in elderly persons.
Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Demência Vascular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Monitorização Ambulatorial da Pressão Arterial , Diagnóstico Diferencial , Feminino , Humanos , MasculinoRESUMO
OBJECTIVES: This study was designed (1) to identify characteristics of patients and their treatment and aspects of care that may be associated with satisfaction, and (2) to investigate the way these factors contribute to the degree of satisfaction expressed after treatment of ectopic pregnancy. Our ultimate goal in so doing was to determine how to improve ectopic pregnancy management. STUDY DESIGN: We used data from a register of ectopic pregnancy established in an urban area (Communauté Urbaine de Lille) in northern France. Two months after ectopic pregnancy, a self-administered satisfaction questionnaire was completed by 192 women treated between January 1995 and July 1996. We searched which factors were associated with satisfaction by a logistic regression model. RESULTS: Greater satisfaction was significantly associated with average education. Women were more satisfied when pregnancy was an expected event, and when fallopian tube was unruptured. Patients satisfied with the way they were received, the comfort, the willingness to listen and provide explanations, were more satisfied overall. Physical pain, anxiety for later fertility, and need of psychological support were associated with lesser degrees of satisfaction. When adjusted for these factors, the following factors remained significant: level of education; conditions of conception; pain; reception and willingness to listen. CONCLUSION: This study should increase awareness amongst health care professionals of the importance of a compassionate approach when dealing with patients following an ectopic pregnancy, since patients value this aspect of care.
Assuntos
Satisfação do Paciente , Gravidez Ectópica/terapia , Adolescente , Adulto , Ansiedade , Escolaridade , Doenças das Tubas Uterinas/etiologia , Doenças das Tubas Uterinas/terapia , Feminino , Fertilidade , França , Humanos , Modelos Logísticos , Dor , Gravidez , Gravidez Ectópica/psicologia , Ruptura Espontânea , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: We report the results of a Falls Consultation. DESIGN: Data concerning the first 150 patients are reported. Each patient was assessed by a geriatrician, a neurologist, and a physiatrist, who visited him or her at home, and was reassessed by the same geriatrician 6 mo later. RESULTS: Of the 150 patients, 135 patients completed the initial evaluation. Most of them were frequent fallers. The population was very heterogeneous regarding the health status and the degree of disability. In most cases, falls were the result of several interacting factors. The most frequent recommendations from the staff were physical therapy, environmental changes, and medication changes. Over the following 6 mo, approximately one out of four patients had experienced new falls. However, the risk of falling was significantly reduced (5.3 +/- 7.3 falls in 6 mo before vs. 0.8 +/- 1.6 falls in 6 mo after the intervention). The Activities of Daily Living score was a predictor of recurrent falls, hospitalization, and institutionalization. CONCLUSION: Our results show that a multidisciplinary falls consultation can be efficient in reducing the risk of falls in nonselected elderly fallers but suggest that differential strategies are needed to manage adequately the more vigorous and the frail old person as well.
Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao PacienteRESUMO
PURPOSE: Anticardiolipin antibodies may be associated with recurrent thromboembolic events in patients with myocardial infarction or stroke. We sought to determine the prevalence of anticardiolipin antibodies in patients with peripheral arterial disease and their association with subsequent thromboembolic events and mortality. METHODS: We ascertained anticardiolipin antibodies using a standardized enzyme-linked immunosorbent assay (immunoglobulin G [IgG] anticardiolipin > or =15 GPL units or IgM anticardiolipin > or =15 MPL units) in 232 patients with peripheral arterial disease and 100 control subjects. Patients were observed to determine overall and cardiovascular mortality, and incident thromboembolic events. RESULTS: IgG anticardiolipin antibodies were significantly more common in the patients with peripheral arterial disease (36 of 232 [16%]) than in the controls (7 of 100 [7%], P = 0.03). During a median follow-up of 3.5 years, 3 of the 232 patients were lost to follow-up and 56 (24%) died. Overall mortality was significantly greater in the IgG anticardiolipin-positive patients (16 of 35 [46%]) compared with those who were IgG anticardiolipin-negative (40 of 194 [21%], P = 0.0003), largely due to an increase in cardiovascular mortality among the IgG anticardiolipin-positive patients. In a multivariate proportional hazards analysis, IgG anticardiolipin antibodies were an independent risk factor for overall mortality (hazard ratio [HR] = 2.1, 95% confidence interval [CI]: 1.2 to 4.0) and cardiovascular mortality (HR = 4.4, 95% CI: 1.6 to 12). CONCLUSIONS: IgG anticardiolipin antibodies are common in patients with peripheral arterial disease and are associated with an increased risk of overall and cardiovascular mortality.