Departments In France Research Articles

PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies.

To assess the different types of management of pediatric foreign body aspirations in order to help define guidelines, depending on clinical presentation. A national survey in France was emailed to all 30 university-affiliated departments of otolaryngology-head and neck surgery and pediatric pulmonologists in France. Data concerning the center and the experience of each participant were collected in order to define an "senior expert" group with experience of extracting more than 10 foreign bodies and a "junior/non-expert" group. Both groups answered questions concerning five clinical cases of foreign body aspiration of different severities. Ninety-eight participants answered this survey (75 otolaryngologists and 23 pulmonologists), representing 28 of the 30 university-affiliated departments in France with a completion rate of 89%. Responses of the senior expert group were similar for clear-cut situations, such as an asymptomatic child with a low probability of foreign body aspiration and for a symptomatic child with respiratory distress. However, for intermediate situations, management varied significantly according to the physician when considering clinical, radiological, and surgical management. In comparison to the senior expert group, the junior non-expert group seemed more precautious in the management of foreign body aspiration for intermediate cases, in particular, concerning the time at which extraction was performed. Conclusion: The management of foreign body aspiration depends on the physician's experience and the center's habits. In order to optimize patient care for foreign body aspiration, we suggested a management algorithm based on the senior expert group responses. What is Known: •Foreign body aspirations (FBA) are dreaded by pediatricians, pediatric otolaryngologists, and pulmonologists particularly because of the potential fatal outcome. • However, consensus concerning their management is not clearly defined in the literature. What is New: •This study is the first to evaluate the management of foreign body aspirations (FBA) from the clinical assessment by the emergency medicine physician to the extraction of the foreign body. • A management algorithm was designed and secondarily validated by the SE group to help to emergency medicine physician and specialist to manage FBA.

Effect of L. reuteri on bowel movements in children aged 6months to 4 years: A double-blind randomized controlled trial.

Chronic constipation is common in children and often requires prolonged laxative treatment. Preliminary studies suggest that the probiotic Limosilactobacillus reuteri (L. reuteri) may be useful in treating constipation in children, but these preliminary results need to be replicated. The objective of this study was to assess the efficacy of L. reuteri in infants and young children with chronic functional constipation. A prospective double-blind randomized placebo-controlled trial was conducted in 5 pediatric departments in France between June 2017 and June 2021. In all, 49 patients-ages 6 months to 4 years, and suffering from chronic constipation per Rome IV criteria-were randomly allocated to the test and control groups. For 4 weeks, all were orally administered 5 daily drops of the test (L. reuteri DSM 17938 at 108 colony-forming units per day) or control (placebo) treatment, respectively. Participants were clinically assessed at 4 and 8 weeks. Parents were asked to daily record the number of spontaneous bowel movements (SBMs), stool consistency, and the use of any additional laxatives. Informed consent was obtained from parents of all recruited patients, and the study was approved by both an ethics committee and the French National Agency for Medicines and Health Products Safety (ANSM). The study is registered on ClinicalTrials.gov (NCT03030664). The change in SBMs relative to baseline was greater in the control group at week 4 (control: 0.27 ± 0.5; test: 0.23 ± 0.5; P = 0.01) and in the test group at week 8 (control: 0.26 ± 0.4; test: 0.22 ± 0.5; P = 0.03). At week 4, the groups did not differ in number of responders (≥3 stools per week, with no non-retentive fecal incontinence), use of rescue medication, scoring of pain during defecation (Faces Pain Scale-Revised), or stool consistency (Bristol Stool Form Scale). This double-blind randomized controlled trial did not confirm the efficacy of L. reuteri for treatment of chronic functional constipation in young children.

Endobronchial valves: 1st Multicenter retrospective study on the 2-step approach

BackgroundAlthough the endobronchial valves (EBV) were successfully developed as treatment for severe emphysema, its main complication, pneumothorax, remained an important concern. ObjectiveTo assess whether the placement of Zephyr© endobronchial valves throughout 2 procedures instead of 1 minor the frequency of pneumothorax without lowering the benefits of such treatment. MethodsThis retrospective study was conducted in 15 pulmonology department in France. All the patients met the inclusion criteria of the recommendation set by the expert panel on the Endoscopic Lung Volume Reduction (ELVR) updated in 2019. As recommended, all the scan were analyzed with the StratX© (PulmonX Corporation, Redwood city, CA) protocol, and completed by a Chartis© (PulmonX Corporation, Redwood city, CA) in case of questionable fissure. During the first procedure, all but the most proximal sub-segment of the targeted lobe were occluded. One month after, EBV were placed in the bronchus of the last subsegment. All patients were evaluated before and 3 months after the second procedure. ResultsBetween March 2019 and December 2020, 96 patients received EBV treatment. 12 patients (12.5%) presented a pneumothorax (3 after the 1st step and 9 after the 2nd procedure). Beside pneumothorax, the main adverse event was exacerbation (10.4%) and pneumonia (4.1%). No death were reported. Significant improvement were found for FEV1 (14.6 ± 25.3%), RV (- 0.69 ± 2.1 L), 6MWT (34.8 ± 45.9 m), BODE Score (-1.41 ± 1.41pts), and mMRC scale (-0.85 ± 0.7pts). These results are compared not only to the results previously published using the usual approach but also to our previous publication evaluating the 2-step approach. Some patients presented authentic segmental atelectasis despite infralobar treatment. ConclusionPlacing EBV during 2 procedures instead of one led to a significant decrease of post treatment pneumothoraces without increasing the rate of other complications. It does not seem to alter the benefits of such therapy for severe emphysema. These results must be confirmed by launching a multicenter, prospective, randomized, controlled study to compare the frequency of pneumothorax and the efficacy of this new approach with the usual one-time procedure.

Estimation for dynamical systems using a population-based Kalman filter – Applications in computational biology

Estimating dynamical systems — in particular identifying theirs parameters — involved in computational biology – for instance in pharmacology, in virology or in epidemiology – is fundamental to put in accordance the model trajectory with the measurements at hand. Unfortunately, when the sampling of data is very scarce or the data are corrupted by noise, parameters mean and variance priors must be chosen very adequately to balance our measurement distrust. Otherwise the identification procedure fails. A circumvention consists in using repeated measurements collected in configurations that share common priors – for instance with multiple population subjects in a clinical study or clusters in an epidemiology investigation. This common information is of benefit and is typically modeled in statistics by nonlinear mixed-effect models. In this paper, we introduce a data assimilation methodology compatible with such mixed-effect strategy without being strangled by the potential resulting curse of dimensionality. We define population-based estimators through maximum likelihood estimation. Then, from filtering theory, we set-up an equivalent robust large population sequential estimator that integrates the data as they are collected. Finally, we limit the computational complexity by defining a reduced-order version of this population Kalman filter clustering subpopulations of common observation background. The resulting algorithm performances are evaluated on classical pharmacokinetics benchmark. The versatility of the proposed method is finally fully challenged in a real-data epidemiology study of COVID spread in regions and departments of France.

Assessment of Factors Associated With Community-Acquired Extended-Spectrum β-Lactamase–Producing Escherichia coli Urinary Tract Infections in France

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is considered a leading pathogen contributing to the global burden of antimicrobial resistance. To better understand factors associated with the heterogeneity of community-acquired ESBL-producing E coli urinary tract infections (UTIs) in France. This cross-sectional study performed from January 1 to December 31, 2021, was based on data collected via PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a nationwide clinical laboratory surveillance system in France. Strains of E coli isolated from community urine samples from January 1 to December 31, 2019, from 59 administrative departments of metropolitan France were included. Quasi-Poisson regression models were used to assess the associations between several ecological factors available on government and administration websites between 2010 and 2020 (demographic population structure, living conditions, baseline health care services, antibiotic consumptions, economic indicators, animal farming density, and environmental characteristics) and the number of ESBL-producing E coli strains isolated from urine samples of individuals with community-acquired UTI in 2019. Among 444 281 E coli isolates from urine samples tested in 1013 laboratories, the mean prevalence of ESBL-producing E coli was 3.0% (range, 1.4%-8.8%). In an adjusted model, the number of community-acquired ESBL-producing E coli UTIs in each department was positively associated with the percentage of children younger than 5 years (adjusted β1 coefficient, 0.112 [95% CI, 0.040-0.185]; P = .004), overcrowded households (adjusted β1 coefficient, 0.049 [95% CI, 0.034 to 0.062]; P < .001), consumption of fluoroquinolones (adjusted β1 coefficient, 0.002 [95% CI, 0.001-0.002]; P < .001), and tetracyclines (adjusted β1 coefficient, 0.0002 [0.00004 to 0.00039]; P = .02), and poultry density (adjusted β1 coefficient, 0.0001 [95% CI, 0.0001-0.0002]; P < .001). The social deprivation index (adjusted β1 coefficient, -0.115 [95% CI, -0.165 to -0.064]; P < .001) and the proportion of water surface area (adjusted β1 coefficient, -0.052 [-0.081 to -0.024]; P = .001) were negatively associated with a higher number of community-acquired ESBL-producing E coli UTIs. The findings of this cross-sectional study suggest that multiple human health, animal health, and environmental factors are associated with the occurence of community-acquired ESBL E coli UTI. Strategies to mitigate ESBL in the community should follow the One Health approach and address the role played by fluoroquinolones, tetracycline use, poultry density, overcrowded households, and preschool-aged children.

Impact of meteorological factors and psychiatric disorders : a French exploratory study.

Introduction : The objective of our work was to study the link between meteorological factors (temperature, sunshine duration, rain, wind, humidity) and psychiatric disorders. For this purpose, we conducted two exploratory studies in France : the first one, studying the link between the weather and suicidal behaviors (suicides and suicide attempts); the other one between alcohol use disorders (AUD) and the weather. Methods : We analyzed the number of deaths by suicide and suicide attempts in metropolitan France (2009-2018) from French national&nbsp;hospitalization&nbsp;databases;&nbsp;patients who were admitted to an emergency department for an alcohol related condition were included using the Oscour database, and we used meteorological database from national weather services. Based on this model, we determined the association of suicides and suicide attempts with weather factors, and then between AUD and meteorological factors. Results: The number of suicides and suicide attempts decreased over the last ten years in France (mean decrease of 14.49% and 11.69% per year). We observed a significant and recurrent seasonal pattern of suicides and suicide attempts in France, with a peak in spring. The suicide and suicide attempt rates were higher in the northern departments of France. We found significant positive correlations between the number of alcohol-related ED visits and the mean temperature (r = 0.55; p = 1.87e) and the duration of sunlight (r = 0.42; p = .0015). Negative correlations were also found significant with rain (r = −0.40; p = .0014), humidity (r = –0.41; p = .0023) and wind speed (r = −0.40; p = .0031).&nbsp; Conclusion: The number of suicides and suicide attempts decreased in France over the last 10 years, with large and recurrent seasonal variations. Emergency visits for AUD seem to increase with the temperature and duration of sunlight, and decrease with rain, humidity and wind speed.

Decrease and seasonal changes of suicides and suicide attempts in France over the last 10 years

Introduction: The objective of this study was to examine the evolution of suicides and suicide attempts over the last 10 years in France, according to the season. Methods: We analyzed the number of deaths by suicide and suicide attempts in metropolitan France (2009-2018) from French national databases, on a daily, weekly or monthly basis. Seasonal variation in suicide rates was modeled using a cosinor function. Based on this model, we determined the association of suicides and suicide attempts with geographic characteristics of the departments, age, gender, and psychiatric disorders. We also collected data on the means of suicide and suicide attempt. Results: The number of suicides and suicide attempts decreased over the last ten years in France (mean decrease of 14.49% and 11.69% per year). We observed a significant and recurrent seasonal pattern of suicides and suicide attempts in France, with a peak in spring. The suicide and suicide attempt rates were higher in the northern departments of France. Suicides are more common among men (75%) and middle-age individuals (45-54 years old), while suicide attempts affected more frequently women (62%) and young adults (15-19 and 40-49 years old). Nearly two-thirds of the patients who attempted suicide suffered from comorbid psychiatric disorder, with mood disorders being the most frequent psychiatric disorder. Voluntary drug intoxication was the most common means of suicide attempt (80%), while hanging was the most common means of suicide (54%). Conclusion: The number of suicides and suicide attempts decreased in France over the last 10 years, with large seasonal variations. Further studies are warranted to better understand the underpinning physiological and meteorological factors that may influence these seasonal variations.

What the Chlordecone Pollution Says About Modes of Inhabiting the World: Examining the Intersection of Socio-Racial Inequality and Environmental Degradation in Tropiques Toxiques by Jessica Oublié et al.

In Tropiques Toxiques (2020), Jessica Oublié et al. use the graphic novel as a medium to convey the stories of people in the departments of France, in particular Guadeloupe and Martinique, whose lives have been affected by chlordecone, a toxic pesticide used in banana plantations between the years 1972 and 1993. The intimate dive into people’s lived experiences in the French Caribbean is paired with the elaboration of attentive scientific knowledge around the contamination caused by chlordecone and its continued effects. While the substance was already under scrutiny for its toxic effects on human and wildlife in the 1970s in the US, successive governments in France allowed the use of chlordecone to sustain and intensify the production of bananas against international competitors, until it was officially banned in 1993. As a point of departure, this article argues that such human-made ecological disaster forefronts the intersection of socio-racial inequality and environmental degradation, while questioning the practice of nonknowledge on the issue of chlordecone poisoning. How, then, does the graphic novel break the cycle of ignorance and call attention to socio-racial disparities not just in accessible knowledge, but also in protection of French citizens? And finally, what can chlordecone contamination say about our modes of inhabiting the world and the importance of imagining alternatives?

Use of Whole-Genome Sequencing to Explore Mycobacterium tuberculosis Complex Circulating in a Hotspot Department in France.

The Seine-Saint-Denis is the French metropolitan department with the highest incidence of tuberculosis (TB). Our aim was to explore epidemiological and phylogenetic characteristics of TB strains in this hotspot department. We performed WGS on 227 strains of Mycobacterium tuberculosis complex isolated from patients at the Avicenne Hospital from 2016 to 2021 and randomly selected to represent the clinical diversity of French TB localization. Clinical and demographic data were recorded for each TB patient. The mean age of patients was 36 years old. They came from Africa (44%), Asia (27%), Europe (26%) and America (3%). Strains isolated from extrapulmonary samples were associated with Asian patients, whereas strains isolated from pulmonary samples were associated with European patients. We observed a high level of lineage diversity in line with the known worldwide diversity. Interestingly, lineage 3 was associated with lymph node TB. Additionally, the sensitivity of WGS for predicting resistance was 100% for rifampicin, isoniazid and ethambutol and 66.7% for pyrazinamide. The global concordance with drug-susceptibility testing using the phenotypic approach was 97%. In microbiology laboratories, WGS turns out to be an essential tool for better understanding local TB epidemiology, with direct access to circulating lineage identification and to drug susceptibilities to first- and second-line anti-TB drugs.

Impact of COVID-19 pandemic on access to online therapeutic education programs for children with sickle cell disease

BackgroundSickle cell disease (SCD) is a lifelong disease for which outcomes may be influenced by patients' self-care knowledge. Therapeutic education (TPE) is a patient-centered teaching instrument based on patient's adaptative processes and needs. TPE was developed in the Paris area by a pediatric health network using interactive face-to-face meetings. The COVID-19 pandemic has impacted the TPE modalities by promoting online training. Our aims were to evaluate the accessibility of patients with SCD to online TPE. MethodsWe compared sessions of TPE before and after the onset of the pandemic: the number of sessions, performed face-to-face or online, individual or in a group. We also recorded the number of participants in each session and their age, school level, and department in France. FindingsWe observed an increase in the total number of trained children, but participation varied greatly according to the geographical area of residence, with a decrease from 22.4% to 4.9% in the proportion of attendees living in the most socio-economically deprived French departments. DiscussionOnline TPE is feasible for patients with SCD but with unequal access according to socio-economic status. Application to practiceAccess to TPE needs to be improved for patients living in socially disadvantaged areas.

Evaluation of Clinical Relevance and Biological Effects of Antirituximab Antibodies in Patients With Pemphigus

The clinical relevance of antirituximab antibodies (ARAs) in patients with pemphigus who are treated with rituximab (RTX) is currently unknown. To determine the prevalence of ARAs in patients with pemphigus who are treated with RTX and their association with complete remission (CR) and relapse. This post hoc analysis of the Ritux3 trial was conducted from January 2010 to December 2015 in 25 dermatology departments in France and included 42 patients with moderate-to-severe pemphigus who were randomized to receive treatment with RTX. Five additional patients were recruited for an ancillary study. The proportions of patients who achieved CR or relapsed after an initial treatment cycle of RTX were compared depending on whether patients had ARAs. Patients were treated with 1000 mg of RTX on days 1 and 15 and 2 maintenance infusions of 500 mg at months 12 and 18. Rates of relapse and sustained CR at month 36. Levels of ARAs, antidesmoglein 1/3 antibodies, RTX serum concentrations, and peripheral blood CD19+ B-cell frequency were measured. Of 42 participants with vs without ARAs, the mean (SD) age was 55 (17) years and 56 (17) years, respectively; 25 (59.5%) were women. Antirituximab antibodies were detected in the serum samples of 13 of 42 patients (31%) during the first year. Nine patients who experienced relapse before month 12 were excluded because they received additional infusions and could not be further analyzed. Among the 33 remaining patients, 2 patients (6.1%) experienced relapse after month 12, and 31 (95.9%) maintained a sustained CR until month 36. The rate of sustained CR was not different whether patients had ARAs (11 of 13 [85%]) or not (20 of 20 [100%]) (P = .15). Both groups (ARA+ vs ARA-) also had similar CD19+ B-cell depletion and RTX levels, but patients with ARAs had higher anti-desmoglein 3 antibody (DSG3 Abs) levels compared with those without ARAs (mean [SD], 30.1 [50.9] AU/mL vs 4.0 [4.3] AU/mL; P = .03). The 2 patients with ARAs who experienced relapse after month 12 had an undetectable RTX level, incomplete B-cell depletion, and higher anti-DSG3 Abs level than the 11 patients who maintained a sustained CR with ARAs (RTX mean [SD] concentration, 0 ug/mL vs 12.5 [2.2] ug/mL; P = .03; incomplete B-cell depletion, 2 of 2 vs 4 of 11; P = .19; mean [SD] anti-DSG3 Abs levels, 103.5 [61.5] AU/mL vs 19.5 [11.0] AU/mL; P = .001) or patients without ARAs (mean [SD] RTX concentration, 0 ug/mL vs 13.5 [1.8] ug/mL; P = .02; incomplete B-cell depletion, 2 of 2 vs 5 of 20; P = .09; mean [SD] anti-DSG3 Abs level, 103.5 [61.5] AU/mL vs 4.0 [1.0] AU/mL; P < .001). The results of this cohort study suggest that ARAs are frequently detected in patients with pemphigus who are treated with RTX and generally are not associated with patient outcomes. Only a few patients with the combination of ARAs, low RTX concentration, incomplete B-cell depletion, and persistent serum anti-DSG3 Abs seem at high risk of relapse.

Increased incidence of cutaneous Staphylococcusaureus infections after the 2010 floods in the Var department of France: Rumour or reality?

BackgroundNatural disasters are typically associated with the emergence of infectious diseases. On 15 June 2010, severe storms caused flooding in the Var department (France). A rumour about increased risk of Staphylococcusaureus skin infections after bathing in the sea began to circulate on Internet a few days after the floods. The aim of this study was to compare the rumour with the true incidence of cases of infection. MethodsSince 1999, we have been conducting a prospective survey of S. aureus skin infections in our hospital to study their clinical, laboratory and epidemiologic features. We compared data on cases of Staphylococcus skin infection recorded in our institution from 2008 to 2012. ResultsWe found that there was no increase in S. aureus skin infections after the floods compared to the previous and subsequent years. ConclusionWe had a unique opportunity to check the rumoured increase in incidence of infectious disease with the true incidence. In our study, the fear of S. aureus skin infections following flooding proved to be unfounded.

The Model of the Observation and Treatment Hospital, and the Debate on ‘Open’ Services in France at the Beginning of the Twentieth Century: The Example of the Esquermes Psychiatric Hospital

Summary The history of the French mental-hygiene movement has long been confined to the interwar period. It has focused on the role of Dr Édouard Toulouse, regarded as the founder of the country’s first open psychiatric unit. This article seeks to reposition this narrative in the long term by investigating the experiments conducted on the ground at the beginning of the twentieth century and, more particularly, the origin and operation of a little-known establishment, the psychiatric hospital at Esquermes in Lille, in the Nord department of France. Conceived in 1907, opened in 1912 and closed in 1944, this hospital remained on the margins of the mental-hygiene movement and has been largely forgotten by historians. Nevertheless, it marks an important stage in the French debate on so-called open services and, more generally, the reform of the legal regime governing the treatment of the mentally ill.

An Archipelagic Node in Global Migration? The Stakes of Comparison and Irony in Nathacha Appanah’s Tropique de la violence

Abstract Nestled in the Mozambique Channel, the island of Mayotte is an overseas department of France, wrenched away from the Comoran archipelago in 1975. This act of colonial mutilation gave birth to an ultra-peripheral “French” territory that persists as a beacon of hope for Comoran clandestine migrants, thousands of whom have perished on the treacherous sea crossing since 1995. In her novel Tropique de la violence (2016), Mauritian author Nathacha Appanah inscribes the Mahoran tragedy within a global imaginary of migration. This essay explores the risks and merits of such a comparative approach: as Appanah’s references to the Mediterranean “migration crisis” foster transnational empathy, do they simultaneously reproduce the colonial gaze? After all, the polyphonic novel does not give a voice to the Comoran migrant herself. Is this a gesture of narrative violence, or a way of forcing us to confront silences that can never be filled? Through a series of detailed close-readings, the essay argues that Tropique de la violence takes a nuanced and often ironical approach to the facile equivalences between the Indian Ocean and the Mediterranean (in terms of migratory tragedy), as well as between Mayotte and France (in terms of political status). This exploration culminates in an examination of the novel’s own complex positionality as a French-language novel written by a Mauritian author about Mayotte. Simultaneously branded as too foreign and yet not foreign enough, Tropique de la violence both embodies and exceeds Indian Ocean circularities.

Seasonal changes and decrease of suicides and suicide attempts in France over the last 10 years

The objective of this study was to examine the evolution of suicides and suicide attempts over the last 10 years in France. We analyzed the number of deaths by suicide and suicide attempts in metropolitan France (2009–2018) from French national databases, on a daily, weekly or monthly basis. Seasonal variation in suicide rates was modeled using a cosinor function. Based on this model, we determined the association of suicides and suicide attempts with geographic characteristics, age, gender, means used and psychiatric disorders. The number of suicides and suicide attempts decreased over the last ten years in France (mean decrease of 14.49% and 11.69% per year). We observed a significant and recurrent seasonal pattern of suicides and suicide attempts in France, with a peak in spring. The suicide and suicide attempt rates were higher in the northern departments of France. Suicides were more frequent for men (75%) and middle-age individuals (45–54 years old), while suicide attempts were more frequent for women (62%) and young adults and middle-age individual (15–19 and 40–49 years old). Nearly two-thirds of the patients who attempted suicide suffered from comorbid psychiatric disorders. Mood disorders was the most frequent comorbid psychiatric disorder (54%). Voluntary drug intoxication was the most common means of suicide attempt (80%), and hanging was the most common means of suicide (54%). The number of suicides and suicide attempts decreased in France over the last 10 years, with large and recurrent seasonal variations. These findings could be used to alert and adjust prevention policies, as well as developing preventive strategies such as chronotherapeutics.

Rare genetic admixture and unidirectional gene flow between Vipera aspis and Vipera berus at their contact zone in western France

Abstract Asp vipers (Vipera aspis) and adders (Vipera berus) coexist in the Loire-Atlantique department in France where the two species reach their respective range limits. This contact zone is of special interest since hybridization has been recently discovered there. We carried out extensive sampling to further investigate the hybrid status of morphologically typical individuals and to evaluate the proportion of genetically admixed individuals in this area. Using microsatellite markers, no hybrids with typical morphological traits of either asp vipers or adders were detected. All recently investigated individuals with intermediate morphological traits were shown to be hybrids. A rather low proportion of genetically admixed individuals (1.5-3%) and a very small number of supposed second-generation hybrids suggest reduced fertility of first-generation hybrids or low viability of their progeny. The investigation of mtDNA of newly sampled hybrids support the finding that hybridization only occurs between female V. aspis and male V. berus. Several possible explanations for the unidirectional hybridization are discussed and consequent future studies suggested.

Prevalence of overweight, obesity, and early adiposity rebound in nursery school children in southeastern France

BackgroundThe aim of the present study was to assess the prevalence of overweight, obesity, and early adiposity rebound in nursery school children aged 3.5–4.5 years and to evaluate associations with deprivation. MethodsA cross-sectional study was conducted in the Bouches-du-Rhône department in southeastern France. Data for all nursery school children aged 3.5–4.5 years were collected during systematic medical examinations. The prevalence of overweight and obesity was determined using French, International Obesity Task Force (IOTF), and World Health Organization reference values. A French ecological deprivation index was used to assess associations with deprivation. ResultsAmong 19,295 children included in the study, the prevalence of overweight (IOTF-25 < BMI < IOTF-30) was 9.1% and the prevalence of obesity (BMI > IOTF-30) was 2.6%. Children attending nursery schools in the most disadvantaged areas were 4.3 times more likely to be affected by obesity than those from schools in the most advantaged areas (OR: 4.32; 95% CI: 2.98–6.25, p < 0.001), after adjusting for gender, age group, and school status. Early adiposity rebound was observed in 2131 of 9872 children (21.6%). ConclusionPrograms to prevent childhood overweight and obesity in France should be intensified and take account of major persistent social inequalities. Medical practitioners should learn to systematically assess BMI curve dynamics and early adiposity rebound.

A Clinical and Psychopathological Approach to Radicalization Among Adolescents.

Recent studies have shown higher rates of radicalization of adolescents than in the 2000s. Since 2015, radicalization prevention units have been implemented in child and adolescent psychiatry departments in France. We aimed to report on the psychopathology of adolescents who were followed up in a university department due to their “radical conduct.” Based on the available clinical data (from child psychiatry consultations, long-term family and/or individual therapy, and psychological testing) for 20 adolescents with “radical conduct,” we examined the nature of their radical conduct, their psychopathology, their family characteristics, and the existence or absence of traumatic experiences. Among the 20 adolescents, 4 had radical conduct associated with a delusional syndrome (schizophrenia or a psychotic episode after substance abuse). For the other 16, we found no psychotic conditions. The analysis of other data showed that the adolescents shared some characteristics, such as an important prevalence of intrafamilial violence, sexual abuse, imprisonment of family members, traumatic family histories, and significant psychological control or dependence phenomena occurring in divided families. This diversity of psychopathologies appears consistent with previous studies highlighting the relevance of diverse profiles depending on the presence of a delusional syndrome, the individual's gender and the individual's attraction to violence. Finally, we discuss some psychopathological hypotheses and make therapeutic recommendations. We believe that child and adolescent psychotherapy/psychiatry has a role to play in countering violent extremism by offering adolescents a way out of radical commitment.

Iron Deficiency in Patients with Inflammatory Bowel Diseases: A Prospective Multicenter Cross-Sectional Study

BackgroundIron deficiency (ID) is a frequent condition in patients with inflammatory bowel disease (IBD).AimOur aim was to investigate the prevalence of ID in patients with IBD.MethodsThis was a prospective multicenter cross-sectional study conducted in 21 gastroenterology departments in France between January and March 2020. All adult patients with confirmed IBD who were admitted to the hospital were eligible for inclusion. ID was defined as ferritinemia ≤ 100 μg/L in patients with signs of inflammation (C-reactive protein (CRP) ≥ 5 mg/L) or ferritinemia < 30 μg/L in the absence of inflammation.ResultsIn total, 1036 IBD (685 Crohn’s disease and 351 ulcerative colitis) patients (52.1% women) with a mean age of 41.8 ± 15.5 years were recruited. Approximately half of the patients (504, 51.1%) were in disease remission at the time of enrollment. Systematic monitoring of iron status was performed in 12/21 (57%) participating centers, including measurements of ferritin (12/12, 100%), hemoglobin (11/12, 92%), transferrin saturation (TSAT) (6/12, 50.0%), and serum iron (5/12, 42%). About one-fifth of the patients had been treated with intravenous iron (218, 21.0%), whereas only a small percentage received oral iron (36, 3.5%). ID occurred in 97 patients (23.7% CI 95% 19.8–28.1). Patients with moderate/severe IBD activity (OR: 3.66; CI 95% 24.4–61.2; p = 0.007) or concomitant anemia (OR: 3.66; CI 95% 1.97–6.78; p < 0.001) had an increased likelihood of having ID.ConclusionPatients with moderate/severe IBD activity or concomitant anemia are at increased risk of ID. Early detection and management of ID in patients with IBD is recommended.

Memorializing Masculinity?

The Black Lives Matter movement has delivered a timely reminder of the colonial narratives underpinning commemorative statuary in the public sphere. Crucial to this renewed scrutiny of public memorialization is a consideration of the intersection of political and historical narratives with systems of oppression such as gender and race. This essay explores the gendering of colonial and anticolonial commemorative statuary on display in the French Caribbean islands of Martinique and Guadeloupe. As overseas departments of France, these islands remain politically, administratively and economically tied to their former colonizer. The essay traces the evolution in Antillean memorialization from the glorification of the white male colonizer or abolitionist to the celebration of slave resistance through the figure of the maroon. It examines a range of public artworks dating from 1904 to 2002, questioning the extent to which these memorials, whether commemorating colonial history, abolitionist rhetoric or anticolonial resistance, uphold “great men of history” narratives. The essay explores the subversion of classical representations of colonial and abolitionist figures through the vandalism and destruction of a number of statues of abolitionist Victor Schoelcher. It examines the masculine iconography of resistance, often premised on the radical appropriation of classicist forms to celebrate male resistors, while women and their roles in anticolonial struggle are commonly obscured or depicted in ways which uphold dominant racial narratives and gender stereotypes. Finally, the essay explores the subversive anticolonial forms employed in several recent installations, which move beyond mimetic depictions of the male body to showcase elements usually excluded from representation, including the grotesque, disfigured or wounded body, or to eschew portrayals of the (gendered and racialized) body altogether. These works point to more inclusive ways of portraying not only resistance to colonialism, but also the suffering and the collective humanity of enslaved peoples.