RESUMO
BACKGROUND: Left ventricular thrombus (LVT) is a source of cardiogenic embolic stroke. Conflicting data exist in the literature regarding the utilization of intravenous thrombolysis (IVT) at the acute phase of stroke in presence of LVT. We sought to assess the efficacy and safety of reperfusion therapies (IVT and/or thrombectomy) in patients with LVT. METHODS: We retrospectively analyzed patients with acute ischemic stroke and proven LVT and divided them in two groups: an intervention group with patients treated by reperfusion therapies and a control group with untreated patients. RESULTS: Between 2009 and 2021, 3890 patients were treated by reperfusion therapies in the Lyon stroke center, 33 of whom (0.9%) had LVT. We identified 27 control patients. There were more embolic recurrences at six months in the intervention group than in the control group (nine recurrences versus three, P=0.03, OR=13.56, 95% CI [1.5;195]). Only two early embolic recurrences (< 24h) occurred, both in the IVT group. There was a 4.8-fold decrease in the median NIHSS score between baseline and 24h follow-up in the intervention group (P<0.0001), and the two groups exhibited similar six-month mortality. At stroke onset, cardiopathy was known in 70% of patients, while LVT was known in 30%. CONCLUSION: Acute reperfusion therapies seem to be effective in the context of stroke in patients with LVT. However, further studies are needed to support the hypothesis that stroke recurrence might be related to the use of IVT.
Assuntos
Ventrículos do Coração , AVC Isquêmico , Reperfusão , Trombose , Humanos , Estudos Retrospectivos , Masculino , Feminino , AVC Isquêmico/terapia , AVC Isquêmico/complicações , Idoso , Pessoa de Meia-Idade , Trombose/etiologia , Trombose/epidemiologia , Trombose/terapia , Resultado do Tratamento , Reperfusão/métodos , Idoso de 80 Anos ou mais , Estudos de Coortes , Terapia Trombolítica/métodos , Cardiopatias/complicações , Cardiopatias/epidemiologia , Trombectomia/métodos , RecidivaRESUMO
PURPOSE: Binge eating disorder (BED) is associated with higher psychopathology, including emotional and personality disorders, in the adult population, whether or not they are obese; although few data are available on adolescents, particularly among obese adolescents. OBJECTIVE: To explore the association of both emotional disorders and personality dimensions with BED in obese adolescents. METHODS: The sample consisted of 115 French adolescents enrolled at a clinical unit for the multidisciplinary care of their overweight or obesity. BED was defined using the Binge Eating Scale (BES). Emotional disorders and personality dimensions were assessed using the following tools: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Junior Temperament and Character Inventory (JTCI); impulsivity was determined by the Barratt Impulsiveness Scale (BIS) and the Toronto Alexithymia Scale (TAS). Associations between emotional disorders (BDI/BAI) and personality dimensions (TAS/BIS/JTCI), considered first separately and then jointly with BED were determined with multivariate analysis. RESULTS: More severe depression (ß=0.27, CI [0.06; 0.48], P=0.011), a higher level of excess weight (ß=1.91, CI [0.22; 3.59], P=0.027), older age (ß=1.28, CI [0.43; 2.14], P=0.003), and greater cooperativeness (ß=0.36, CI [0.07; 0.66], P=0.017) were independently significantly associated with the presence of BED. CONCLUSIONS: This cross-sectional study underlines the co-occurrence of emotional and personality disorders with BED. This points out the importance of a multidisciplinary approach and the relevance of a joint diagnosis of binge eating, emotional disorders, and personality dimensions in obese adolescents, for better prevention and treatment of pediatric obesity.
Assuntos
Transtorno da Compulsão Alimentar/epidemiologia , Depressão/epidemiologia , Obesidade/epidemiologia , Transtornos da Personalidade/epidemiologia , Adolescente , Transtorno da Compulsão Alimentar/psicologia , Estudos Transversais , Depressão/psicologia , Feminino , França/epidemiologia , Humanos , Masculino , Obesidade/psicologia , Transtornos da Personalidade/psicologia , Escalas de Graduação Psiquiátrica , Inquéritos e QuestionáriosRESUMO
AIM: The RePPOP Aquitaine network, which was established in south-west France to prevent and treat paediatric obesity, has developed a multidisciplinary approach based on multicomponent lifestyle interventions and family-based actions. This study assessed the impact of its care management programme and investigated the factors associated with better outcomes. METHODS: The impact of the RePPOP care management programme was assessed by changes in the body mass index (BMI) Z score, between baseline and the end-of-care management. We focused on 982 overweight or obese children (59.9% girls) with a mean age of 10.64 years and a range of 2.4-17.9 years. A multivariate analysis examined the independent factors associated with better outcomes. RESULTS: At the end-of-care management programme, 75.5% of children had decreased their BMI Z score. Initial characteristics significantly associated with better outcomes were as follows: the age at baseline between five years and 15 years of age, playing sport at a club, being followed up by RePPOP for longer than 10 months, no parental obesity and no academic difficulties. CONCLUSION: This study confirmed that multidisciplinary treatment had a significant positive effect on paediatric obesity and that social and individual factors affected the efficiency of the care management.
Assuntos
Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Administração dos Cuidados ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Obesidade Infantil/terapia , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Escolaridade , Feminino , França , Humanos , Masculino , Pais , Administração dos Cuidados ao Paciente/métodos , Equipe de Assistência ao Paciente/normas , Distribuição por Sexo , Classe Social , Esportes/estatística & dados numéricos , Fatores de TempoRESUMO
Within the Nutrition, Prevention, and Health Program for children and teenagers in Aquitaine, an experimental intervention was implemented in 2007-2008 in the middle and high schools in Aquitaine (southwest France). This intervention aimed to improve the eating habits of adolescents, combining actions to improve the food supply sold during recreational times (remove/limit fat and sugar products sold and promote the sale of fruits and bread) and health education actions to make adolescents aware of the concept of nutritional balance and steer their choice towards recommended products. The aim of this paper was to evaluate the impact of the intervention on the eating behavior of adolescents and the food supply sold during recreational times in middle and high schools in Aquitaine. A survey was conducted before and after the implementation of the intervention in seven middle and high schools that have implemented actions (intervention group) and eight middle and high schools that have not implemented actions (control group). In these schools, 1602 adolescents answered the survey before and 1050 after the intervention (samples were independent because of the anonymity of responses). The impact of the intervention on the dietary behavior of teenagers was modeled using logistic regression adjusted on potential confounding variables (sex, age, and educational status). In multivariate analyses, the intervention was associated with more frequent daily intake of breakfast (OR=2.63; 95% CI [1.89; 3.66]) and lower intake of morning snacks (OR=0.66; 95% CI [0.48; 0.90]), higher consumption of starchy foods (OR=1.77; 95% CI [1.30; 2.42]), bread at breakfast, morning snacks, and a light afternoon meal (OR=1.43; 95% CI [1.07; 1.90]), and the food supply sold at recreational times (OR=1.34 95% CI [1.01; 1.78]). These results show that the "Improving food supply in middle and high schools associated with educational support actions" project led to the sales of recommended foods during recreational times and improved students' eating behavior. These results encourage partners to pursue these actions in all volunteer middle and high schools.
Assuntos
Comportamento Alimentar , Abastecimento de Alimentos , Adolescente , Inquéritos sobre Dietas , Feminino , Abastecimento de Alimentos/normas , França , Educação em Saúde , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Instituições AcadêmicasRESUMO
RATIONALE: How ischemic postconditioning can inhibit opening of the mitochondrial permeability transition pore (PTP) and subsequent cardiac myocytes death at reperfusion remains unknown. Recent studies have suggested that de-acetylation of cyclophilin D (CyPD) by sirtuin 3 (SIRT3) can modulate its binding to the PTP. OBJECTIVE: The aim of the present study was to examine whether ischemic postconditioning (PostC) might activate SIRT3 and consequently prevent lethal myocardial reperfusion injury through a deacetylation of CyPD. METHODS AND RESULTS: Using hypoxia-reoxygenation (H/R) in H9C2 cells, we showed that SIRT3 overexpression prevented CyPD acetylation, limited PTP opening and reduced cell death by 24%. In vitro modification of the CyPD acetylation status in MEFs by site-directed mutagenesis altered capacity of PTP opening by calcium. Calcium Retention Capacity (CRC) was significantly decreased with CyPD-KQ that mimics acetylated protein compared with CyPD WT (871 ± 266 vs 1193 ± 263 nmoles Ca(2+)/mg protein respectively). Cells expressing non-acetylable CyPD mutant (CyPD-KR) displayed 20% decrease in cell death compared to cells expressing CyPD WT after H/R. Correspondingly, in mice we showed that cardiac ischemic postconditioning could not reduce infarct size and CyPD acetylation in SIRT3 KO mice, and was unable to restore CRC in mitochondria as it is observed in WT mice. CONCLUSIONS: Our study suggests that the increased acetylation of CyPD following myocardial ischemia-reperfusion facilitates PTP opening and subsequent cell death. Therefore ischemic postconditioning might prevent lethal reperfusion injury through an increased SIRT3 activity and subsequent attenuation of CyPD acetylation at reperfusion.
Assuntos
Ciclofilinas/metabolismo , Pós-Condicionamento Isquêmico , Traumatismo por Reperfusão Miocárdica/metabolismo , Sirtuína 3/metabolismo , Acetilação , Animais , Morte Celular , Hipóxia Celular , Peptidil-Prolil Isomerase F , Masculino , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Camundongos Knockout , Proteínas de Transporte da Membrana Mitocondrial , Poro de Transição de Permeabilidade Mitocondrial , Oxigênio/farmacologia , RatosRESUMO
BACKGROUND: The aim of this study was to assess the evolution of food supply (apart from school catering) between school years 2004/2005 and 2009/2010, in middle- and high-schools from the Aquitaine region (southwest France), in order to evaluate the impact of actions conducted within the framework and the program Nutrition, Prevention and Health of children and adolescents in Aquitaine (southwest France). METHODS: Two surveys were carried out among all middle- and high-schools of the Aquitaine region in 2004/2005 (n=536) and 2009/2010 (n=539) within the framework of a regional multidisciplinary public health program "Nutrition, prevention and health of children and teenagers in Aquitaine". For both 2004/2005 and 2009/2010, data were collected using the same questionnaire and dealt with school characteristics and modalities of food supply (apart from school catering). RESULTS: Response rate was 84.1% in 2004/2005 and 79.6% in 2009/2010. The proportion of schools offering food to pupils (apart from school catering) significantly decreased in 5 years (from 80.1% to 50.1%, P<0.001). Between 2004/2005 and 2009/2010, we observed a stabilization in the proportion of schools offering free food (from 19.7 to 17%, P=0.3), a significant decrease of those selling food (from 62.8 to 37.1, P<0.001), offering vending machines (from 43.5 to 7.2, P<0.001) and a significant increase of those offering water supply (from 8.2 to 44%, P<0.001). The composition of each modality of food supply (apart from school catering) has also been improved: less sweet and fat food, more bread and fruits. CONCLUSION: This study shows an overall improvement of food supply apart from school catering (food sale, free food and vending machines) in middle- and high-schools from the Aquitaine region (southwest France) between 2004/2005 and 2009/2010. This improvement is related to the proportion of schools offering food (quantitative improvement), as well as to the composition of food supply (qualitative improvement). These results show an improvement of food supply (apart from school catering), suggesting that actions implemented in the framework of the program "Nutrition, prevention and health of children and adolescents in Aquitaine" may have led to these improvements.
Assuntos
Distribuidores Automáticos de Alimentos , Serviços de Alimentação , Abastecimento de Alimentos/normas , Nível de Saúde , Política Nutricional , Instituições Acadêmicas , Adolescente , Pão , Feminino , Distribuidores Automáticos de Alimentos/normas , Serviços de Alimentação/normas , França , Frutas , Promoção da Saúde/métodos , Humanos , Masculino , Inquéritos Nutricionais , Valor Nutritivo , Inquéritos e Questionários , Água/normasRESUMO
Body mass index (BMI) curves are very useful tools to supervise corpulence during growth and to detect children at risk of overweight and obesity early. In 2009, the French National Nutrition Health Program decided to update the BMI curves used in France. A working group was then created, coordinated by the committee on nutrition of the société française de pédiatrie and by the association pour la prevention de l'obésité en pédiatrie. This article discusses the criteria adopted in elaborating the new curves among the existing references and curves (French references, the International Obesity Task Force [IOTF], the World Health Organization [WHO] standards). It presents recommendations for using the new curves and the BMI values used to define weight insufficiency, overweight, and obesity according to the references utilized.
Assuntos
Índice de Massa Corporal , Sobrepeso/diagnóstico , Sobrepeso/prevenção & controle , Composição Corporal , Peso Corporal , Criança , França , Humanos , Obesidade/prevenção & controle , Valores de Referência , Organização Mundial da SaúdeRESUMO
The Nutrition, Prevention and Health for Children and Teenagers in Aquitaine program is a regional implementation of the French National Program of Nutrition and Health (PNNS). The first of two surveys of a representative sample of Aquitaine preschools was conducted in 2004-2005. This survey showed that more than 2/3 of teachers offered a morning snack to their pupils at around 10 o'clock in the morning, mainly composed of sweet cakes, cookies, or candies. Following this initial survey, actions were implemented starting in September 2005, aiming to stop systematic morning snacks or improve their composition. The same survey was repeated during 2007-2008 in order to analyze the changes in morning snack practices in preschools between 2004-2005 and 2007-2008. Data were collected from teachers of Aquitaine's preschools who filled out questionnaires. Schools were randomly chosen according to their size and whether or not they belonged to a priority education zone (ZEP). The results show that 57.9% of teachers organized a morning snack in 2007-2008, versus 68.7% in 2004-2005. In 2004-2005, 22% of teachers considered the morning snack as "unjustified" compared to 44% in 2007-2008. The composition of morning snacks improved: 17.7% of teachers offered fruit and/or milk in 2007-2008 versus 8.5% in 2004-2005. Morning snacks composed of other foods (such as sweets, chocolate pieces, cookies, pastries, bread, fruit juice) decreased from 60.2% in 2004-2005 to 40.2% in 2007-2008. In 2007-2008, 19% of the teachers reported that children had snacks in their schoolbag versus 34% in 2004-2005. The proportion of teachers reporting children having snacks in their schoolbag decreased from 34% in 2004-2005 to 19% in 2007-2008. Comparison between these two surveys is encouraging as it shows an improvement of the perception and practices of teachers regarding morning snacks. These results encourage the partners of this program to continue the fieldwork actions.
Assuntos
Creches/estatística & dados numéricos , Docentes , Alimentos , Promoção da Saúde/métodos , Política Nutricional , Estudantes , Bebidas , Cacau , Doces , Pré-Escolar , Laticínios , Inquéritos sobre Dietas , Carboidratos da Dieta/administração & dosagem , Feminino , Alimentos/normas , França/epidemiologia , Frutas , Humanos , Masculino , Planejamento de Cardápio/normas , Valor Nutritivo , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Health professionals who monitor the growth of children are also involved in the early detection of overweight. Appropriate tools are required for this purpose. OBJECTIVE: The study sought to identify predictive markers of the development of subsequent overweight using a simple set of criteria. METHODS: A consecutive cohort was composed of 1424 grade 4 children in Aquitaine, France, aged 8-9 years. Body mass index (BMI) was calculated during school health assessments at 8-9 years of age. Data from previous assessments at 3-4 and 5-6 years of age were also collected. RESULTS: Of the 189/1424 children (13.9 %) who were overweight according to the French national cut off for children aged 8-9 years, 67 (33.8 %) were already overweight at 3-4 years and 107 (54.1 %) at 5-6 years. Of the 134 (9.4 %) who were overweight at 5-6 years, 43.3 % were already overweight at 3-4 years and 79.9 % were overweight at 8-9 years. On the other hand, 76 of these 134 children (56.7 %) were not overweight at 3-4 years, so they had become overweight between the two assessments. The combination of the criterion "overweight at 3-4 years or 5-6 years" and "increase in BMI>1kg/m(2) between 3-4 years and 5-6 years" appears to be the best predictor of the risk of overweight at 8-9 years, with good sensitivity (75.3 %) and specificity (87.9 %). CONCLUSION: A predictive tool based on BMI changes between ages 3-4 years and 5-6 years could be used for the early detection of the risk of developing overweight and obesity. The tool is easy to use, especially for health care in schools. Furthermore, the present findings confirm the value of following up and managing children who are already overweight between the ages of 3 and 6 years.
Assuntos
Programas de Rastreamento , Sobrepeso/diagnóstico , Idade de Início , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Diagnóstico Precoce , Feminino , Seguimentos , França , Humanos , Masculino , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Risco , Serviços de Saúde EscolarAssuntos
Sobrepeso/prevenção & controle , Criança , França , Humanos , Obesidade/prevenção & controleAssuntos
Fenômenos Fisiológicos da Nutrição Infantil , Política Nutricional , Obesidade/prevenção & controle , Saúde Pública , Adolescente , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Aleitamento Materno , Criança , Pré-Escolar , Exercício Físico , Feminino , França , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Sobrepeso/prevenção & controle , GravidezRESUMO
Tissue Doppler imaging and strain rate imaging are quantitative methods for assessing myocardial function and have been shown to overcome the limitations of current ultrasound methods in assessing the complex changes in regional myocardial function that occur in differing ischemic substrates. Tissue Doppler imaging (TDI) measures in real time the myocardial velocity gradient which is an index of myocardial deformation. Strain and strain rate (SR) imaging has been shown to be a sensitive technique for quantifying regional myocardial deformation. Strain rate is less load-dependent that strain and provides therefore a better measure of contractility. In the setting of ischemia, experimental studies have shown that strain imaging was an accurate method for quantitative evaluation of regional myocardial function and may yield important physiological data. In myocardial infarction, transmural extension of scar distribution in the infarct zone is proportionally related to the reduction in systolic function measured by the radial transmural velocity gradient or by strain rate imaging. Measurement of both systolic and post-systolic deformation both at rest and during a graded dobutamine infusion may help to distinguish between transmural and non transmural infarcts. In conclusion, strain imaging has the ability to evaluate of regional myocardial function. Strain rate has not replaced conventional grey-scale imaging in the assessment of regional left ventricular function and the implement of these new indices in the routine clinical practice will need additional clinical and large-scale studies.
Assuntos
Ecocardiografia Doppler , Contração Miocárdica , Isquemia Miocárdica/diagnóstico por imagem , Miocárdio/patologia , Sobrevivência de Tecidos , Função Ventricular Esquerda , Animais , Ecocardiografia Doppler em Cores , Ecocardiografia Doppler de Pulso , Humanos , Interpretação de Imagem Assistida por Computador , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
OBJECTIVE: To determine whether long-term consumption of a fermented infant formula could influence the incidence of acute diarrhea and its severity in healthy infants. METHOD: Nine hundred seventy-one infants, ranging in age from 4 to 6 months, were included in a randomized, double-blind, placebo-controlled trial during a period of 5 months. They consumed daily either a fermented infant formula (FF) (fermentation with Bifidobacterium breve C50 and Streptococcus thermophilus 065) or a standard infant formula (SF) of the same nutritional composition. EVALUATION CRITERIA: Number and duration of acute diarrhea episodes were evaluated. Severity of the episodes was determined by the number of hospital admissions, incidence of dehydration, number of medical consultations, number of oral rehydration solution prescriptions, and number of formula switches. RESULTS: Growth of the infants and acceptability of the formulas were identical in the two groups. Incidence, duration of diarrhea episodes, and number of hospital admissions did not differ significantly between groups. Episodes were less severe in the FF (fermented formula) group. There were fewer cases of dehydration 2.5%versus 6.1% (P = 0.01), fewer medical consultations (46%v 56.6%, P = 0.003), fewer ORS prescriptions 41.9%v 51.9% (P = 0.003) and fewer switches to other formulas (59.5%v 74.9%, P = 0.0001) in FF infants compared to SF. CONCLUSION: A fermented formula may reduce the severity of acute diarrhea among healthy young infants. This outcome may be linked to the bifidogenic effects of fermentation products and their interactions with the intestinal immune system.
Assuntos
Bifidobacterium/fisiologia , Diarreia Infantil/prevenção & controle , Alimentos Infantis , Fórmulas Infantis , Probióticos/administração & dosagem , Streptococcus thermophilus/fisiologia , Doença Aguda , Diarreia Infantil/epidemiologia , Diarreia Infantil/terapia , Método Duplo-Cego , Tolerância a Medicamentos , Feminino , Fermentação , França/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Alimentos Infantis/microbiologia , Alimentos Infantis/normas , Intestinos/efeitos dos fármacos , Intestinos/imunologia , Masculino , Placebos , Soluções para Reidratação/uso terapêutico , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To compare the influence of weight-reducing diets containing different amounts of protein and CHO on body composition in obese adolescents and to examine dietary and physical activity behaviours during follow-up. DESIGN: Prospective randomised study comparing two weight-reducing diets with the same energy (1750 kcal) and fat (31%) content, but different protein and carbohydrate contents: PROT- (15% protein, 54% CHO) vs PROT+ (19% protein, 50% CHO). PATIENTS: Massively obese 11- to 16-year-old children (32 boys and 89 girls). SETTING: A 9-month treatment in a medical centre (boarding school) plus a 2-y follow-up in free-living patients examined at home 1 and 2 y after treatment. MEASUREMENTS: Anthropometry, bioelectrical impedance, nutritional intakes and physical activity. RESULTS: Of the 121 eligible children (61 in PROT- and 60 in PROT+), 82% completed the trial until the end of weight loss treatment and 60% were followed 2 y after treatment. Body mass index (BMI) value at inclusion was 36.3 kg/m(2) or 4.3 z-scores (2.9-5.9). BMI z-score decreased to 1.7 at the end of treatment and went back to 2.8 (0.8-6.1) 2 y after treatment. This corresponded to a weight loss of 30.3 kg and weight regain of 21.3 kg. After treatment, energy intake increased and physical activity decreased. The contribution of energy ingested at breakfast decreased while snacking increased. For all measurements, no dietary group differences existed at baseline or at any time during the intervention and follow-up. CONCLUSION: A higher protein content of the diet did not confer any benefit in the treatment of childhood obesity. Substantial weight loss was obtained with a moderately energy-restricted diet and normal fat content. After weight loss, mean weight increased in spite of moderate energy intake, together with a drift towards obesity-associated behavioural patterns. The causes of the inability to adopt normal weight subjects' behaviour permanently deserve to be investigated further.
Assuntos
Comportamento do Adolescente , Dieta Redutora , Obesidade Mórbida/dietoterapia , Adolescente , Análise de Variância , Antropometria , Criança , Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Exercício Físico , Comportamento Alimentar , Feminino , Seguimentos , Hormônio do Crescimento Humano/sangue , Humanos , Estilo de Vida , Masculino , Obesidade Mórbida/fisiopatologia , RecidivaRESUMO
Considering the high prevalence and the increasing trends, obesity is now considered as a public health problem in numerous countries. The main aim of the National Program of Nutrition and Health is to stop the increasing prevalence of childhood obesity. In this frame work, a group of experts has established a new presentation of the corpulence curves, adapted for clinical practice, to define normal weight and obesity. Weight status is now currently assessed on the basis of weight and height measurements, after computing the Quetelet index or body mass index (BMI) corresponding to weight (m) divided by square of height (weight/height2). As body proportion varies during growth, age must be taken into account. Various curves were published. In 1982, based on the French sample of the international growth study, BMI curves were published. They were revised in 1991. The third and 97th centiles define the normal weight range. Overweight is defined by BMI values greater than the 97th centile. In the year 2000, a new international definition was established. Two centiles were constructed to define overweight and obesity. The new BMI charts adapted for clinical practice, proposed by the French National program of nutrition and health, include the French reference curves plus the centile defining obesity in the international definition. Thus, in the new French charts, the area above the 97th centile is split in two levels (degree 1 obesity and degree 2 obesity). Drawing the BMI curve for each child, like drawing weight and height curves, is a simple act which can be done routinely. The age at adiposity rebound (an indicator predicting the risk of adult obesity) can be read from the curve. It allows to identify an early phase of obesity development, even at the time when overweight is not yet clinically visible. When obesity appears clearly, the identification is easy. The use of BMI curves is particularly useful in two situations: (1) in very young overweight children, the curves allow to identify children who have a real risk of developing obesity. (2) By the age of 6 years, when due to normal physiological variations, clinical assessment can be misleading. The BMI curves allow to identify children at risk. When a child is identified as having a real risk of obesity, simple preventive measures, adapted for each subject, could avoid a development toward massive obesity, which may become difficult to reduce if managed too late.
Assuntos
Índice de Massa Corporal , Desenvolvimento Infantil , Proteção da Criança , Obesidade/prevenção & controle , Medicina Preventiva , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Valores de Referência , Fatores de RiscoRESUMO
The article discusses how one hospital with a large outpatient service, evaluated the role of nursing in ambulatory care. Using a validated conceptual framework consisting of Ambulatory Care Areas of Responsibility and Nursing Activities, data was collected and a profile was created detailing the nursing role in each clinic or service.
Assuntos
Assistência Ambulatorial/organização & administração , Hospitais Pediátricos , Hospitais de Ensino , Descrição de Cargo , Enfermagem Pediátrica/organização & administração , Humanos , Modelos de Enfermagem , Pesquisa em Avaliação de EnfermagemRESUMO
BACKGROUND: Neonatal hyperthyroidism is a relatively rare condition. It can be severe and difficult to treat when the maternal hyperthyroidism has recently been recognized. CASE REPORT: A baby was born at 37 weeks of gestational age to a mother whose hyperthyroidism was only suspected at the 34th week. The mother was not given propylthiouracil until the day before delivery. At birth, the newborn presented with meconial fluid; it weighed 2,380 grams, was 46 cm long and had a head circumference of 32 cm. Clinical examination showed exophthalmos, tachycardia, hepatosplenomegaly, restlessness, moderate goiter and premature craniosynostosis. Laboratory data showed elevated serum free T4 (76 pmol/l), unmeasurable TSH, and the presence of thyroid-stimulating immunoglobulins. The infant was given propranolol (10 mg/day), and carbimazol (3.75 mg/day) from day 13. Clinical and biological improvement allowed the carbimazol to be stopped at 1 month. A relapse was treated with carbimazol plus L-thyroxine. Both drugs were discontinued at the age of 4 months. At 12 months, the baby is perfectly well and has developed normally. CONCLUSION: This transient thyrotoxicosis was due to the transplacental passage of TSH receptor antibodies. Its management was difficult because the mother was treated late during her pregnancy.