Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo.

BACKGROUND: Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended. OBJECTIVE: To investigate the prevalence of thyroid dysfunction and thyroid peroxidase-specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified. METHODS: A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti-TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening. RESULTS: Forty-three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results <3months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease. CONCLUSION: The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti-TPO antibodies is advisable in these high-risk subpopulations.

Randomised controlled trial of prophylactic etamsylate: follow up at 2 years of age.

AIM: To assess the role of etamsylate in reducing the risk of haemorrhagic brain damage and its consequences. DESIGN: Follow up of babies recruited into a randomised controlled trial. METHODS: A total of 334 infants born before 33 weeks gestation in France and Greece were randomly allocated within the first four hours of birth either to receive etamsylate or to act as controls. The principal outcomes in the trial were death or impairment and/or disability at the age of 2 years. RESULTS: Fifty nine children were lost to follow up. A total of 115 (34%) either died or had some impairment or disability, and 88 (26%) either died or had severe impairment or disability at 2 years of age. These outcomes did not differ significantly between the two randomised groups: relative risks and 95% confidence intervals 1.14 (0.78 to 1.4) and 1.17 (0.82 to 1.68) respectively. The findings were similar for all the prespecified subgroup analyses stratified by key prognostic factors at trial entry: country of birth, gestational age < or >or= 29 weeks, inborn or outborn, age < or >or= 1 hour, and with or without cerebral scan abnormality. CONCLUSION: These findings do not support the use of etamsylate. Other strategies need to be evaluated for the prevention of mortality and morbidity in these vulnerable infants.

[Cameroon, Africa in miniature: health situation in 1995]. / Le Cameroun, Afrique en miniature: bilan sanitaire en 1995.

PIP: 12 million people of more than 250 ethnic groups speaking approximately 200 different languages comprise the population of Cameroon. Cameroon is therefore a highly diverse and complex country in which the health system and health status vary widely by region. Several systems coexist more or less well. The public sector is in disarray. Since 1992, the Minister of Public Health has promoted a national health policy of decentralization designed to maximize available resources at the district level. The nonprofit private sector has an important place in Cameroon's health system, offering a wide network of services throughout the country. While nonprofit organizations' effectiveness and importance are not in question, health program managers would like to see a more coordinated provision of services. The private, for-profit sector operates in the large cities, while traditional medicine is omnipresent. The country, population, economy, health system, mortality, nutritional status, infectious diseases, epidemics, and other diseases in Cameroon are discussed. Cameroon is far from providing Health for All by Year 2000.^ieng

[Short and mid-term outcome of a cohort of 1157 newborn infants with respiratory distress syndrome]. / Devenir à court et moyen terme d'une cohorte de 1157 nouveau-nés atteints de détresse respiratoire.

BACKGROUND: Data concerning neonates with acute respiratory distress syndrome (RDS) are still scarce. The characteristics and follow-up of a French cohort which has participated in an international trial concerning the efficacy of artificial surfactant have been studied. POPULATION AND METHODS: One thousand one hundred and fifty-seven neonates admitted from October 1990 to December 1991 in 27 French intensive care units because of RDS due to hyaline membrane disease were included in the study, whatever their birthweight and gestational age (GA). RESULTS: Three hundred and sixteen neonates (27.3%) were born from twin or multiple pregnancies. Fourty-five (5.5%) of the mothers had been given corticosteroids for the week preceding delivery. 55.5% were delivered by cesarean section. Mean GA was 31.0 +/- 2.9 weeks and mean birth-weight was 1,603 +/- 625 g. Two hundred and sixty-six neonates (23%) were small for GA. Two hundred and twenty-three died after a mean survival of 4.2 days (63% before the end of the first week and 80% before the end of the third week). Fifty percent of these deaths were due to respiratory distress, 28% to severe brain disorders and 9% to infections. The bronchopulmonary dysplasia rate was 21.7%. Early ultrasound scan of the brain showed major injuries in 19.5% of cases; the second scan performed in 822 infants was normal in 84.3%. CONCLUSIONS: Taking into account GA, mortality and morbidity rates were similar to those of the other non-French participating centres.

[Ambulatory blood pressure in the young adult with hypertension history during childhood]. / Pression artérielle ambulatoire chez l'adulte jeune aux antécédents d'hypertension artérielle de l'enfant.

The tendency of subjects to maintain their relative position within the distribution of blood pressure (BP) has been defined as "tracking". Regarding this phenomenon, the purpose of the study was to evaluate the interest of ambulatory BP monitoring (ABPM) in the assessment of arterial hypertension in young adults (YA) with childhood hypertension history (CHH). 52 subjects, 20.1 +/- 2.4 years old, 26 men, 26 women issued from a cohort of 150 children with high BP levels (greater than 97.5 th percentile) during their infancy (school check-up), were included in the study. An ABPM was performed with space-labs system 90202 from 8 a.m. to 6 p.m., measurements every 15 minutes (37.6 +/- 7.4 readings). Left ventricular mass index (LVMI) was determined with echocardiography, (Penn convention). Office BP, measured with mercury apparatus in lying and standing position, was respectively, 131.0 +/- 14.6/81.9 +/- 9.7 and 130.1 +/- 14/86.6 +/- 9.9. According to JNC 1988, this casual BP identified 40 normotensives (NT), 9 borderlines (BL) and 5 hypertensives (HT); 10 of them had a "high normal" diastolic BP (85-90 mmHg) ABP recordings of the study group were compared to day-time reference values of NT. Three subgroups are individualized: G1 NT, G2 HT, G3 BL. [table; see text] *p: less than 0.001; p: less than 0.01. Wall thickness (WTh) and LVMI were significantly higher in hypertensives (G2 + G3) than in normotensives (G1): [table; see text] There was a significant correlation between LVMI and mean systolic ABP (p less than 0.01: r = 0.44), but not with office SBP.(ABSTRACT TRUNCATED AT 250 WORDS)

[The health of foreign populations in France]. / La santé des populations d'origine étrangère en France.

In France, 8% of the population are foreign. They come from the lowest socio-economic level. In distinguishing the new arrivals from those who have lived in France for several years, the migrant related health patterns are applied. Health problems of foreigners in France can be examined in a number of different ways: --Foreign workers are found in unskilled work and in jobs where they are constantly subjected to hazards of the workplace, occupational health risks and accidents. --The quality of maternal and child health care among foreign women is lower than among the French. --Foreign children are hospitalized more often and for longer than French children. The types of illness are not specific. The truancy rate is more significant than the national mean. --Restrictions on the opportunities for enjoying certain social rights, administrative and financial obstacles encountered as well as difficulties in communication all make it harder to meet the needs of this section of the population.

[Respiratory symptoms in schoolchildren in Toulouse. Influence of atmospheric pollution]. / Symptômes respiratoires chez les enfants d'âge scolaire à Toulouse. Influence de la pollution atmosphérique.

In order to get a better knowledge on respiratory illnesses of children in Toulouse, and to evaluate the influence of air pollution, 1,000 children between 8 and 11 years of age, living in five different areas of the city were observed during one year (March 1985-March 1986), together with the measure of twenty pollutants. A questionnaire was used to assess the history of respiratory diseases and the chronic respiratory pathology. According to the areas, no difference appeared, other than the frequent cough which is more important in an area with lower social income (p less than 0.01). The acute respiratory illnesses, as noted during the year of observation, had a different pattern according to the areas (p less than 0.0001). Amongst the five pollutants used for the analytic study through the cross-correlations, four: nitrogen monoxide and dioxide, black fumes, and ammonia particulate derivatives are related to the respiratory diseases.

[Severe course of a primary BVD infection in a BVD-seronegative dairy herd]. / Een ernstig klinisch verloop van een primaire BVD-infectie in een BVD-seronegatieve melkveekoppel.

A severe course of a primary BVD infection in a seronegative dairy herd is reported. Approximately one third of the animals was very ill and showed severe diarrhoea, with temperatures varying from 39 degrees C to 41 degrees C. At the time of the outbreak, twenty-four cows had been pregnant for more than three months. Four animals aborted their calves, two mummies were born and two cows were found not to be pregnant at drying off during the next three months following the outbreak. In addition many of the newborn calves were weak and showed relatively low birth weights. The BVD virus was probably introduced into the herd by a purchased calf, which had pneumonia when it arrived on the farm.

[Multidisciplinarity in public health: the global approach and territorial dimensions]. / Pluridisciplinarité en santé publique: approche globale et dimension territoriale.

The GRES 31 is a small study group which was established in 1982 in Toulouse, France. Its aims are to promote health among underprivileged groups such as gypsies, immigrants from North Africa... in the local communities. The local community is envisaged as an area where the social structure which has become pathogenic (bad work conditions, destruction of human links...) can be reshaped for a healthy life. The approach of GRES 31 is "global": the health problems of an individual cannot be separated from the overall life context of his group. The ethnic culture and collective behaviour of the group is closely related to the demand for care and the health outcome. On such a pre-requisite, the social scientist has to play his role together with the health professionals. The term of "research" (i.e. "social research") is to be supplemented by that of "experiment". Moreover, health promotion cannot merely imply guidance from the outside but primarily participation from inside the local communities. Such an approach is not a novelty: as a matter of fact, the works of the French hygienists in the 19th century paved the way for a pluri-disciplinary perspective in health work. In some circumstances, the "researchers-experimenters" cannot avoid certain conflicts among themselves: for example when an ill child is endangered by the observance of the ethnic traditions of his own group. More generally, efforts to reduce "clinical imperialism", "State interventionism", "local bureaucracy"... could be of light weight when dealing with "macro-problems" such as nuclear risk, AIDS, or health cost containment.

[Partial 7q trisomy]. / Trisomie 7q partielle

A 17-month old boy is partially trisomic for 7q22 and 7q31 due to a probable insertion in the paternal chromosome 13. The phenotype of the patient is similar to that of two other patients reported in the literature.