Assessment of a new home-based care pathway for children newly diagnosed with type 1 diabetes.

AIM: To compare the outcomes of home-based and conventional hospital-based care for children newly diagnosed with type 1 diabetes mellitus. METHODS: A descriptive study was conducted of all children newly diagnosed with diabetes mellitus at the Timone Hospital in Marseille, France, between November 2017 and July 2019. The patients received either home-based or in-patient hospital care. The primary outcome was the length of initial hospital stay. The secondary outcome measures were glycemic control in the first year of treatment, families' diabetes knowledge, the effect of diabetes on quality of life, and overall quality of care. RESULTS: A total of 85 patients were included, 37 in the home-based care group and 48 in the in-patient care group. The initial length of hospital stay was 6 days in the home-based care group versus 9 days in the in-patient care group. Levels of glycemic control, diabetes knowledge and quality of care were comparable in the two groups despite a higher rate of socioeconomic deprivation in the home-based care group. CONCLUSION: Home-based care for children with diabetes is safe and effective. This new healthcare pathway provides good overall social care, especially for socioeconomically deprived families.

Developing and Validating an Individual-Level Deprivation Index for Children's Health in France.

BACKGROUND: Deprivation generates many health inequalities. This has to be taken in account to enhance appropriate access to care. This study aimed to develop and validate a pediatric individual-level index measuring deprivation, usable in clinical practice and in public health. METHODS: The French Individual Child Deprivation Index (FrenChILD-Index) was designed in four phases: item generation then reduction using the literature review and expert opinions, and index derivation then validation using a cross-sectional study in two emergency departments. During these last two phases, concordance with a blinded evaluation by an expert enabled us to determine thresholds for two levels of moderate and severe deprivation. RESULTS: The generation and reduction phases retained 13 items. These were administered to 986 children for the derivation and validation phases. In the validation phase, the final 12 items of the FrenChILD-Index showed for moderate deprivation (requiring single specific care for deprived children) a sensitivity of 96.0% [92.6; 98.7] and specificity of 68.3% [65.2; 71.4]. For severe deprivation (requiring a multidisciplinary level of care), the sensitivity was 96.3% [92.7; 100] and specificity was 91.1% [89.2; 92.9]. CONCLUSIONS: The FrenChILD-Index is the first pediatric individual-level index of deprivation validated in Europe. It enables clinical practice to address the social determinants of health and meet public health goals.

Tap Water Consumption Is Associated with Schoolchildren's Cognitive Deficits in Afghanistan.

Environmental influence on intelligence quotient (IQ) is poorly understood in developing countries. We conducted the first cross-sectional investigation to assess the role of socio-economic and environmental factors on schoolchildren's IQ in Jalalabad, Afghanistan. A representative sample of 245 schoolchildren aged 7-15 was randomly selected in five schools. Children's records included: non-verbal IQ TONI-1 scale, body mass index, socio-economic status, and further environmental indicators (water supply, proximity to a heavy-traffic road, use of surma traditional cosmetics). The mean age of the children was 11.7 years old (±2.0 years), and 70.2% and 29.8% were male and female, respectively. The children's mean IQ was 83.8 (±12.6). In total, 37 (14.9%) of the children were overweight, 78 (31.5%) were living below the USD 1.25 poverty line, 133 (53.6%) used tap water supply, 76 (30.6%) used surma, and 166 (66.9%) were exposed to heavy road traffic. The children's IQ was significantly and independently lowered by tap water use (-3.9; 95% CI [-7.1; -0.6]) and by aging (-1.4; 95% CI [-2.2; -0.6]), as revealed in multivariate analysis, independently of gender, socio-economic status, exposure to heavy road traffic, overweight status, and surma use. Lower IQ among older children is possibly attributed to chronic stress experienced by adolescents due to living conditions in Afghanistan. While using tap water prevents fecal peril, it may expose children to toxic elements such as lead which is known to lower their intellectual development.

Evaluation of the Impact of Pneumococcal Conjugate Vaccine on Pediatric Community-Acquired Pneumonia Using an Emergency Database System.

BACKGROUND.: A 13-valent pneumococcal conjugate vaccine (PCV13) seems to be associated with a reduction of community-acquired pneumonia (CAP) in children. METHODS.: To explore the link between PCV13 implementation and children' visits in emergency departments (EDs) for pneumonia, we analyzed mandatory Electronics Emergency Department Abstracts (EEDA), in 7 EDs, located in southern France, from 2009 to 2014. Diagnosis related to visits were coded using International Classification Diseases-10 codes. All codes available for EEDA were used to define bacterial pneumonia (BP), viral pneumonia (VP), and nonspecific pneumonia (NSP). For adjustment, we also used codes related to influenza and bronchiolitis. Comparisons between periods (pre-PCV13, transitional, early post-PCV13, and late post-PCV13) were made by logistic regression. On daily aggregated data, a general linear model was constructed with daily proportion of BP as dependent variable, period as fixed factor, and daily proportion of viral respiratory infections (flu plus bronchiolitis) as covariate. RESULTS.: Among 718 758 visits, 7284 were coded as CAP. A significant decline in CAP was noted only for children between 2 and 5 years of age. In contrast, the proportion of BP was dramatically reduced: 2.49 vs 5.17/1000 visits (odds ratio, 0.48; 95% confidence interval, 0.42-0.55), whereas the proportion of VP was similar and NSP increased. After adjustment on influenza plus bronchiolitis, the decrease of BP remained significant. CONCLUSIONS.: Electronics Emergency Department Abstracts analysis confirms an important reduction in children ED visits for BP after PCV13 implementation. The EEDA also allow a real-time surveillance of pneumonia and an adjustment on confounding factors, such as viral respiratory infections.

Family compliance with counseling for children traveling to the tropics.

BACKGROUND: The number of people, both adults and children, traveling abroad, is on the rise. Some seek counseling at travel medicine centers before departure. METHODS: A prospective study was conducted among children <16 years visiting a travel medicine center in Marseille, France, from February 2010 to February 2011. Parents were contacted by telephone 4 weeks after their return, and asked about compliance with pre-travel advice. RESULTS: One hundred sixty-seven children were evaluated after their trip. Compliance with immunizations, malaria chemoprophylaxis, and food-borne disease prevention was 71, 66, and 31%, respectively. Compliance with malaria chemoprophylaxis varied significantly with destination, and was higher for African destinations. Significant features associated with poor compliance with chemoprophylaxis were a trip to Asia or the Indian Ocean, age <5 years, and a monoparental family. Compliance with prevention of food- and water-borne diseases was higher in children < 2 years of age. CONCLUSIONS: A ≥ 80% compliance with pre-travel counseling in children traveling overseas was achieved only for drinking bottled water, using repellents, a routine vaccine update, and yellow fever immunization.

[Screening and prevention of tuberculosis, an experiment in Marseille]. / Dépistage et prévention de la tuberculose, une expérience à Marseille.

In order to apply the recommendations of the French High Council on Public Health (CSHPF), the association "Médecins du Monde" and the departmental centre for the fight against tuberculosis led; in 2010-2011, two campaigns for on-site screening, in Marseille, with Roma families in situations of precariousness. These campaigns came up against a number of difficulties which must be addressed in order to make them more effective.

Family nutritional support improves survival, immune restoration and adherence in HIV patients receiving ART in developing country.

In developing countries, access to antiretroviral treatment for persons living with HIV is still in progress. Malnutrition represents another cause of acquired immunodeficiency and premature death. This evaluation program estimated the impact of family nutritional support during the first year of antiretroviral treatment in West Africa's sub-Sahara region. Family nutritional support was proposed to patients with CD-4 cell count <200 /mm3 and/or developing a WHO stage III/IV or with body mass index <18.5 kg/m2 and receiving antiretroviral treatment. Follow-up of 62 patients receiving support was compared to 118 patients who had only received antiretroviral treatment the year before. Average body mass index, CD-4 cell count were 20.7 and 20.5, 217 and 191/mm3 respectively in supported and control groups (NS). Twenty-two (36%) and 56 (48%) were WHO stage III/IV (NS) respectively in supported and control groups. One patient who received support and twelve controls died (Mortality Ratio=0.19; p<0.05). Increase in CD-4 cell count was around 1.7 times higher (+ 114 vs. + 68 CD-4 cells/mm3 respectively in supported and control groups; p<0.05) and observance was improved in supported group (p<0.005). The evolutions of WHO stage and body mass index were not different but the study period was short. Family nutritional support for persons living with HIV initiating antiretroviral treatment in a developing country showed a positive impact after six months. This family intervention could be integrated into AIDS interventions as an effective and comprehensive community-based primary care.

Interobserver variability in assessing segmental function can be reduced by combining visual analysis of CMR cine sequences with corresponding parametric images of myocardial contraction.

OBJECTIVE: To evaluate if color-coded parametric images could help subjective visual analysis and improve interobserver agreement in the evaluation of segmental contraction (SC) in CMR. BACKGROUND: Routine evaluation of SC in CMR remains mostly based on visual analysis of cine loops and subsequent interobserver variability remains a potential drawback. MATERIALS AND METHODS: Three short axis cine loops were obtained in 33 subjects (18 myocardial infarction, 15 control), and 528 segments were analyzed. From each cine loop a single static parametric image resuming wall motion information was generated using Factor Analysis of Medical Image Sequences. Three readers (R1, R2, R3) scored left ventricular SC in 4 classes in 2 steps: visual assessment of cine loops alone and by combining cine loops with the corresponding parametric image. Reference segmental scores were obtained by consensus. Global contraction indexes were calculated in each step of the analysis. RESULTS: When parametric images were combined with cine loop assessment, interobserver agreement was enhanced for paired readers: R1-R2: kappa = 0.66 (combined analysis) vs. kappa = 0.60 (cine alone); R2-R3: kappa = 0.67 vs. kappa = 0.65; R3-R1: kappa = 0.71 vs. kappa = 0.67 and absolute agreement with consensus was higher for the 3 readers: R1: 91% vs. 85%; R2: 87% vs. 83% and R3: 94% vs. 89%. When considering global wall motion indexes, interobserver agreement was also enhanced: R1 vs. R2 : r = 0.91 vs. 0.85; R2 vs. R3: 0.95 vs. 0.91; R3 vs R1: 0.98 vs. 0.91. CONCLUSION: Adding a color-coded static parametric image to routine subjective visual assessment of SC reduces interobserver variability.