Virginie Ehlinger

Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study

BackgroundPuberty is a transition period making physiological development a challenge adolescents have to face. Early pubertal development could be associated with higher risks of poor health. Our objective was to examine risk behaviours, physical and psychological determinants associated with early menarche (<11 years).MethodsEarly menarche was assessed in the Health Behaviour in School-aged Children French cross-sectional survey. Data were collected in 2006 by anonymous self-reported standardized questionnaire from a nationally representative sample of 1072 15 years old girls in school classrooms. Family environment, school experience, physical and psychological factors, risk behaviours (substance use and sexual initiation) were recorded. Logistic regression models were applied (analysing for crude and adjusted relationships between early menarche and risk behaviours controlled for family context).ResultsMedian age at menarche was 13.0 years; 57 girls (5.3%) were early-matured. Controlled for familial environment, early menarche was associated with having had more than two life-drunkenness episodes (adjusted OR = 2.5 [1.3-4.6]), early sexual initiation (adjusted OR = 2.8 [1.3-6.0]) and overweight (adjusted OR = 7.3 [3.6-14.9]).ConclusionEarly-maturing girls may affiliate with older adolescents, hence engage in risk behaviours linked to their appearance rather than their maturity level. Factors associated with early menarche highlight the need to focus attention on early-matured girls to prevent further health problems linked to risk behaviours.

Improving attitudes towards children with disabilities in a school context: a cluster randomized intervention study.

Aimu2002 Although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students’ attitudes towards their disabled peers.

Validation of an instrument for measuring psychosocial and organisational work constraints detrimental to health among hospital workers: The NWI-EO questionnaire.

BACKGROUNDnQuality of care, job satisfaction and the health of registered nurses (RNs) are associated with their exposure to psychosocial and organisational work factors (POWFs).nnnOBJECTIVESnTo develop and validate an extended version of the Revised Nursing Work Index (NWI-R), the NWI-EO (Extended Organisation) tool specifically designed for occupational physicians and those involved in prevention programmes in healthcare institutions to assess the perception of POWFs, and then to determine priorities for preventive action to improve work organisation at the hospital staff level.nnnMETHODSnThe tool was validated in the ORSOSA study, a multicentre French cohort of RNs and NAs (n=4085) recruited in 214 work units of 7 French university hospitals. A total of 34 items (19 candidate items developed by a focus group and 15 items from the NWI-R) were analysed using principal component analysis (PCA) based on a randomised split-half of the data. In addition, construct validity, test-retest reliability, internal consistency and concurrent validity were assessed.nnnRESULTSnResponse rate was 91%. Twenty-two items were selected (9 of the 15 NWI-R items and 13 of the 19 candidate items) by PCA, resulting in an 8-factor solution that explained 53% of the common variance. The stability of the factorial structure of this 22-item NWI-EO questionnaire was confirmed by PCA on the other half-sample as well as by PCA on subgroups (age, gender, occupational group, specialty area, hospital). Reliability, assessed by internal consistency and test-retest, was satisfactory. Concurrent validity with two external measurements of organisational characteristics of work units was also observed.nnnCONCLUSIONnThe NWI-EO was found to have good psychometric properties. Several POWFs accessible to prevention programmes can be evaluated with this tool: poor communication in the work unit, lack of support from senior nurses, inadequate staffing to perform duties, poor relationships between workers, frequency of interruptions during tasks, low level of shared values within the team with regard to work, lack of support from the administration, and changes in planned vacations and time off. We believe the NWI-EO is a useful tool for assessing POWFs among RNs and NAs in order to determine priorities for preventive action to improve work organisation at the unit level.

Socioeconomic Disparities and Prevalence of Autism Spectrum Disorders and Intellectual Disability.

Background and Objectives Study of the impact of socioeconomic status on autism spectrum disorders (ASD) and severe intellectual disabilities (ID) has yielded conflicting results. Recent European studies suggested that, unlike reports from the United States, low socioeconomic status is associated with an increased risk of ASD. For intellectual disabilities, the links with socioeconomic status vary according to the severity. We wished to clarify the links between socioeconomic status and the prevalence of ASD (with or without ID) and isolated severe ID. Methods 500 children with ASD and 245 children with severe ID (IQ <50) aged 8 years, born 1995 to 2004, were recruited from a French population-based registry. Inclusions were based on clinical diagnoses reported in medical records according to the International Classification of Diseases, 10th Revision. Socioeconomic status was measured by indicators available at block census level which characterize the population of the child’s area of residence. Measures of deprivation, employment, occupation, education, immigration and family structure were used. Prevalences were compared between groups of census units defined by the tertiles of socioeconomic level in the general population. Results Prevalence of ASD with associated ID was higher in areas with the highest level of deprivation and the highest percentage of unemployed adults, persons with no diploma, immigrants and single-parent families. No association was found when using occupational class. Regarding ASD without associated ID, a higher prevalence was found in areas with the highest percentage of immigrants. No association was found for other socioeconomic indicators. The prevalence of isolated severe ID was likely to be higher in the most disadvantaged groups defined by all indicators. Conclusion The prevalence of ASD with associated ID and of severe isolated ID is more likely to be higher in areas with the highest level of deprivation.

Trends in prevalence and characteristics of post-neonatal cerebral palsy cases: a European registry-based study.

The present paper aims to analyze trends over time in prevalence of cerebral palsy of post-neonatal origin, to investigate whether changes are similar according to severity and to describe the disability profile by etiology. Post-neonatal cases, birth years 1976 to 1998, were identified from the Surveillance of Cerebral Palsy in Europe collaboration (19 population-based registries). A recognized causal event occurring between 28 days and 24 months of age was considered to define the cases. Trends in prevalence were explored using graphical methods (Lowess and Cusum control chart) and modeled with negative binomial regressions. Over the study period, 404 cases were identified as post-neonatal cases (5.5% of the total). Mean prevalence rate was 1.20 per 10,000 live births (95% CI [1.08-1.31]). A significant downward trend was observed (p=0.001), with an accentuated decrease in the 1990 s. The prevalence of severe cases which account for around one third of the total also significantly decreased over time (p<0.001). In 46% of cases, an infectious aetiology was reported; the corresponding prevalence significantly decreased since 1989. No significant decrease was observed for the rate of cases due to a vascular episode or of traumatic origin. Our results emphasize the need of large population-based surveillance systems to reliably monitor trends in prevalence in rare subgroups of children like those with acquired cerebral palsy. The decrease of the overall prevalence as well as those of the most severe cases may be partly due to public health actions targeted to prevent such events.

Policy of feeding very preterm infants with their mother's own fresh expressed milk was associated with a reduced risk of bronchopulmonary dysplasia.

Since 2005, the French Food Safety Agency has recommended that very preterm or low‐birthweight babies should be fed with pasteurised, expressed breastmilk, and feeding policies on this vary widely in French neonatal units. We investigated the differences between using a mothers expressed milk, in fresh or pasteurised forms, for very preterm infants.

Social Context of Preterm Delivery in France in 2011 and Impact on Short‐Term Health Outcomes: the EPIPAGE 2 Cohort Study

BACKGROUNDnLow socio-economic context increases the risk of preterm delivery and may affect short-term outcomes in children born preterm. We described the social context of preterm delivery in France in 2011 and compared it with the general population of deliveries over the same period. We also studied how social context influenced pregnancy and delivery characteristics in the preterm population, and how it affected mortality and short-term morbidity in liveborn preterm children (<35 weeks).nnnMETHODSnWe created an individual socio-economic vulnerability index, derived from multiple correspondence analysis based on maternal social information in the French National Perinatal Survey (NPS-2010). Weighted coordinates were applied to families from the EPIPAGE 2 study, a population-based cohort of preterm infants born in 2011, to quantify the infants exposure to socio-economic vulnerability. Multivariable logistic models were used to relate the socio-economic context to pregnancy and delivery characteristics, and to assess its impact on short-term outcomes of the infants.nnnRESULTSnAmong mothers of preterm infants, gestational age decreased as socio-economic conditions worsened. In the most deprived group, women had more irregular pregnancy care, a higher prevalence of infection during pregnancy, and a lower rate of antenatal corticosteroid administration. The most deprived group was associated with a higher risk of severe morbidity for the preterm neonates.nnnCONCLUSIONnOur results emphasise the need for a large population-based surveillance system to identify the most deprived mothers, and to propose appropriate follow-up and care to these women and their infants in order to enhance long-term health.

Associations between life contexts and early sexual initiation among young women in France

CONTEXTnEarly sexual initiation (before age 16) has been linked to an increased risk of teenage pregnancy and STDs. Most research on correlates of early sexual initiation is from the United States; no similar work has been conducted in France, where the sociocultural environment differs.nnnMETHODSnCross-sectional data from the 2010 Health Behaviour in School-Aged Children survey were used to examine the relationships of personal, family, peer, school and neighborhood characteristics with early sexual initiation among 1,094 French females in grades 8-10. Two-level logistic regressions were used to identify associations.nnnRESULTSnTwenty-five percent of respondents had had sex before age 16. Early sexual initiation was primarily -associated with individual-level characteristics. Young women had an elevated likelihood of having initiated sex early if they went out after school at least four times a week (odds ratio, 2.0), had repeated a grade (1.8), lived with a single parent or in a stepfamily (1.8 and 1.5, respectively), perceived a low level of parental monitoring (1.6) or had two or more male friends (2.8). At the environmental level, respondents who attended school in areas with a high proportion of residents who were foreigners had a reduced likelihood of having initiated sex early (0.5-0.6).nnnCONCLUSIONSnAlthough early sexual initiation in France was essentially linked to individual-level variables, further research is needed to understand its relationship with neighborhood characteristics. Such studies should include additional environmental variables, test new hypotheses and employ a longitudinal approach.

Is STAN monitoring associated with a significant decrease in metabolic acidosis at birth compared with cardiotocography alone? Review of the three meta-analyses that included the recent US trial.

Sir, We read with interest the recent meta-analysis (MA) by Blix et al. (1) reporting that intrapartum surveillance with STAN monitoring resulted in a significant decrease in metabolic acidosis at birth compared with cardiotocography (CTG) alone (OR 0.64, 95% CI 0.47–0.88). This finding conflicts with the Cochrane MA by Neilson et al. (2) and MA by Saccone et al. (3) which found no decrease in metabolic acidosis with STAN monitoring (RR 0.72, 95% CI 0.43–1.20 and RR 0.81, 95% CI 0.44–1.46, respectively). The conflicting results in these three recent MAs based on the same six trials including the last US trial (4), require explanation. Two main reasons could be suggested. First, revised data for two of the six trials (the Swedish and Dutch trials) were published years later (5,6). Only Blix et al. used the revised data appropriately for a more precise MA of STAN monitoring (1). Moreover, the Finnish trial, unlike the others, presented corrected data for calculating metabolic acidosis using base deficit in the extracellular-fluid, required for comparability. Secondly, the MAs used different statistical methods: Blix et al. (1) performed a trial sequential analysis (TSA), whereas the others (2,3) did traditional aggregate MAs. We would like to clarify whether these contradictory findings are due to the use of different data, the type of statistical analysis or both. Do the trials published so far show that STAN monitoring decreases the risk of metabolic acidosis at birth significantly? The differences between the statistical methods employed lie in the parameters estimated (OR vs. RR), the weights given to each study’s data (Mantel–Haenszel vs. inverse variance method), and the recognition of the heterogeneity between studies (fixed-effects vs. random-effects model) while performing MA. As Blix et al. stated, each method employed has its pros and cons, especially in an MA with moderate heterogeneity between the studies. We conducted an MA of the revised data using five different MA methods available in STATA 14 software (metan function): fixed-effects model with Mantel–Haenszel method, fixed-effects model with inverse variance, random effects model with DerSimonian & Laird method with heterogeneity estimated by the Mantel–Haenszel model, random-effects model with DerSimonian & Laird method and heterogeneity estimated by the fixed-effects inverse variance model, and Peto’s method for pooling ORs. Table 1 provides the results for metabolic acidosis by each method. Although the results of the random-effects model were at the borderline of significance, with an upper confidence interval limit of 0.998, the results were consistent and significant with p-values <0.05 with all five methods. In conclusion, applying the revised and comparable data produces a significant 35% decrease in metabolic acidosis at birth compared with traditional CTG monitoring, as Blix et al. reported. Unlike them, we think that metabolic acidosis, a combination of a low pH at birth and base deficit >12 mmol/L, remains one of the best indicators available at birth for the immediate assessment of fetal well-being and the risk of hypoxic-ischemic encephalopathy (7). By making it possible to reduce the incidence of metabolic acidosis by one-third, as well as by better standardizing decisions for immediate operative delivery, the use of STAN for intrapartum surveillance of women at risk appears to be a valuable alternative to CTG alone. Table 1. Results for metabolic acidosis in all 6 trials published comparing STAN to CTG alone, applying the revised data published*.

Socialization Instances Linked to Cannabis Experimentation Among French Teenagers

France presents one of the highest prevalence of teenagers aged 15-year-olds who report they already have experienced cannabis in Europe. Data from the French 2010 Health Behavior in School-aged Children (HSBC) survey and environmental parameters typifying schools ‘neighborhoods were used to study cannabis experimentation. We conducted a two-level logistic regression (clusters being schools) on 4,175 French 8th–10th graders from 156 schools. Several individual parameters were linked to cannabis experimentation. Living in a non-intact family, feeling insufficiently monitored, having poor communication with mother and being from a family with a high socio-economic status (SES) were all associated with increased risk of cannabis experimentation. At environmental level, only being in a priority education area was linked to this behavior, without explaining differences among schools.