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Biomedical subjects

G Breart

Publications and source records attributed to G Breart.

At least 19 recordsLinked to original sources
PubMed1998

How hip and whole-body bone mineral density predict hip fracture in elderly women: the EPIDOS Prospective Study.

We conducted a population-based cohort study in 7598 white healthy women, aged 75 years and over, recruited from the voting lists. We measured at baseline bone mineral density (BMD g/cm2) of the proximal femur (neck, trochanter and Ward's triangle) and the whole body, as well as fat and lean body mass, by dual-energy X-ray absorptiometry (DXA). One hundred and fifty-four women underwent a hip fracture during an average 2 years follow-up. Each standard deviation decrease in BMD increased the risk of hip fracture adjusted for age, weight and centre by 1.9 (95% CL 1.5, 2.3) for the femoral neck, 2.6 times (2.0, 3.3) for the trochanter, 1.8 times (1.4, 2.2) for Ward's triangle, 1.6 times (1.2, 2.0) for the whole body, and 1.3 times (1.0, 1.5) for the fat mass. The areas under the receiver operating characteristic (ROC) curves were not significantly different between trochanter and femoral neck BMD, whereas ROC curves of femoral neck and trochanter BMD were significantly better than those for Ward's triangle and whole-body BMD. Women who sustained an intertrochanteric fracture were older (84 +/- 4.5 years) than women who had a cervical fracture (81 +/- 4.5 years) and trochanter BMD seemed to be a stronger predictor of intertrochanteric ([RR = 4.5 (3.1, 6.5)] than cervical fractures ([RR = 1.8 (1.5, 2.3]). In very elderly women aged 80 years and more, hip BMD was still a significant predictor of hip fracture but the relative risk was significantly lower than in women younger than 80 years. In the 48% of women who had a femoral neck BMD T-score less than -2.5, the relative risk of hip fracture was increased by 3, and the unadjusted incidence of hip fracture was 16.4 per 1000 woman-years compared with 1.1 in the population with a femoral neck BMD T-score > or = -1.

Absorptiometry, Photon↗
PubMed1998

Inhaled salbutamol and beclomethasone for preventing broncho-pulmonary dysplasia: a randomised double-blind study.

UNLABELLED: Early inflammatory lesions and bronchial hyperresponsiveness are characteristics of the respiratory distress in premature neonates and are susceptible to aggravation by assisted ventilation. We hypothesized that treatment with inhaled salbutamol and beclomethasone might be of clinical value in the prevention of bronchopulmonary dysplasia (BPD) in ventilator-dependent premature neonates. The study was double-blinded and placebo controlled. We studied 173 infants of less than 31 weeks of gestational age, who needed ventilatory support at the 10th postnatal day. They were randomised to four groups and received either placebo + placebo, placebo + salbutamol, placebo + beclomethasone or beclomethasone + salbutomol, respectively for 28 days. The major criteria for efficacy were: diagnosis of BPD (with score of severity), mortality, duration of ventilatory support and oxygen therapy. The trial groups were similar with respect to age at entry (9.8-10.1 days), gestational age (27.6-27.8 weeks), birth weight and oxygen dependence. We did not observe any significant effect of treatment on survival, diagnosis and severity of BPD, duration of ventilatory support or oxygen therapy. For instance, the odds-ratio (95% confidence interval) for severe or moderate BPD were 1.04 (0.52-2.06) for inhaled beclomethasone and 1.54 (0.78-3.05) for inhaled salbutamol. CONCLUSION: This randomised prospective trial does not support the use of treatment with inhaled beclomethasone, salbutamol or their combination in the prevention of BPD in premature ventilated neonates.

Administration, Inhalation↗
PubMed1998

Outborn status with a medical neonatal transport service and survival without disability at two years. A population-based cohort survey of newborns of less than 33 weeks of gestation.

OBJECTIVE: Prenatal events are thought to play an important role in long-term handicap, but the specific role of perinatal factors remains controversial. Our study, conducted in the context of this debate, aimed to break down the various components of perinatal management and to assess the relationship between these components and survival without disability at the age of two years. STUDY DESIGN: A prospective geographically-defined study was conducted in 1985 in the Paris metropolitan area. It covered 53430 births (stillbirths and live births), including 539 that occurred between 25 and 32 weeks gestation. The relationship between perinatal management and survival without disability was studied by a multivariate analysis (logistic regression). The analysis was restricted to a group of 202 infants born at 31 or 32 week's gestation, to avoid indication bias. RESULTS: An inborn status (delivery in a tertiary care facility) exerted a protective effect on survival without disability at the age of two years (Adjusted Odds Ratio (OR)=7.51 [1.51; 37.4]), even though the area we studied possessed an excellent Medical Neonatal Transport Service. Multiple pregnancies also seemed to have a protective effect (Adjusted OR=2.45 [0.96; 6.27]). No statistically significant association was seen between survival without disability at two years and the presence of a hospital staff paediatrician in the delivery room. CONCLUSION: These results lead us to consider what the concept of inborn/outborn represents in the perinatal management of infants at high risk.

Child, Preschool↗
PubMed1998

Lone hyperuricemia during pregnancy: maternal and fetal outcomes.

OBJECTIVE: Study of maternal and fetal consequences of lone hyperuricemia during pregnancy and demonstration that lone hyperuricemia is not a risk factor regarding the onset of preeclampsia. STUDY DESIGN: Retrospective study of two groups of women, one found to have lone hyperuricemia during pregnancy (n=102) and the others with normal serum uric acid levels (n=100). RESULTS: The only consequence identified of the lone hyperuricemia was a lower birth weight of children born to mothers found to have lone hyperuricemia for more than 2 weeks (P<0.05). CONCLUSIONS: Lone hyperuricemia is not a risk factor regarding the onset of preeclampsia. It is therefore unnecessary to measure serum uric acid level during a normal pregnancy.

Adult↗
PubMed1998

Effect of chloroquine prophylaxis during pregnancy on maternal haematocrit.

Two controlled trials of chloroquine prophylaxis during pregnancy were performed, one in Burkina Faso in 1987, on all pregnant women, and the other in Cameroon in 1992, on primigravidae only. Maternal haematocrit at delivery was found to be significantly higher in those women who had received chloroquine than in those who had not, both in Burkina Faso (37.4% v. 36.5%; P = 0.01) and in Cameroon (34.8% v. 32.8%; P = 0.02). Anaemia, defined as an haematocrit of < 30%, was also less common in those treated with chloroquine (6.3% v. 8.5% in Burkina Faso and 8.3% v. 18.4% in Cameroon) but this difference was not significant in either country. A slight improvement in haematological status when prophylaxis is given has also been observed in similar studies performed in other tropical countries. The present results confirm the usefulness of targeting antimalarial prophylaxis at pregnant women. Such prophylaxis during the first pregnancy also increases birthweight.

Anemia↗
PubMed1997

Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women.

OBJECTIVE: To assess the predictive value of Doppler umbilical artery velocimetry in a low-risk population with normal fetal biometry. STUDY DESIGN: Multicenter prospective study in 17 hospitals with prenatal clinics in France. Two thousand sixteen women who, before 28 weeks gestation were defined as at low risk after routine consultation and after ultrasound. Doppler umbilical artery velocimetry was performed between 28 and 34 weeks gestation. Confounding factors were used to perform multivariate regression. RESULTS: 1903 cases were analysed and 192 (10.1%) had an abnormal Doppler Resistance Index (RI). The abnormal Doppler group contained a significantly higher frequency of severe and moderate small for gestational age infants (SGA), both severe and moderate with a sensitivity of 25.5 and 18.8% respectively. There was no difference in hypertensive disorders or criteria of fetal distress. Mean birth weight was very significantly lower in the abnormal group (162 g). Birth weight was very significantly linked to RI after taking into account confounding variables in the multiple linear regression model (continuous relationship). After multiple logistic regression, the odds ratio associated with an abnormal Doppler result, adjusted for all the confounding factors, was 2.3 (95% CI 1.5-3.7) for moderate SGA and 3.5 (95% CI of 1.8-7.1) for severe SGA. CONCLUSION: Low umbilical Doppler RI is predictive with moderate or severe SGA in a low-risk population with normal fetal biometry, even when the information generally available in clinical practice and ultrasound parameters are taken into account. There is a continuous relationship between RI and birthweight. This predictive value cannot, however, lead to an improvement in neonatal health unless effective measures to prevent SGA exist and umbilical Doppler should not be used in low-risk population on a routine basis.

Birth Weight↗
PubMed1997

Delayed childbearing.

Since around 1980, in countries belonging to European union the mean maternal age at birth increased by 1.5 y (from 27.1 to 28.6). This demographic change has important consequences on the health of the mother and of the neonate. Maternal mortality rates, stillbirth rates and frequency of congenital anomalies are affected. Without improvement in care those rates would have increased by 15 to 35% because of the increase of the mean age at birth. Nevertheless it should be noted that they continue to decrease.

Adult↗
PubMed1996

Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study.

BACKGROUND: The ability of ultrasonographic measurements to discriminate between patients with hip fracture and age-matched controls has until now been tested mainly through cross-sectional studies. We report the results of a prospective study to assess the value of measurements with ultrasound in predicting the risk of hip fracture. METHODS: 5662 elderly women (mean age 80.4 years) had both baseline calcaneal ultrasonography measurements and femoral radiography (dual-photon X-ray absorptiometry, DPXA) to assess their bone quality. Follow-up every 4 months enabled us to identify incident fractures. 115 hip fractures were recorded during a mean follow-up duration of 2 years. FINDINGS: Low calcaneal ultrasonographic variables (obtained from measurements of broadband ultrasound attenuation by, and speed of sound through the bone) were able to predict an increased risk of hip fracture, with similar accuracy to low femoral bone mineral density (BMD) obtained by DPXA. The relative risk of hip fracture for 1 SD reduction was 2.0 (95% CI 1.6-2.4) for ultrasound attenuation and 1.7 (1.4-2.1) for speed of sound, compared with 1.9 (1.6-2.4) for BMD. After control for the femoral neck BMD, ultrasonographic variables remained predictive of hip fracture. The incidence of hip fracture among women with values above the median for both calcaneal ultrasound attenuation and femoral neck BMD was 2.7 per 1000 woman-years, compared with 19.6 per 1000 woman-years for those with values below the median for both measures. INTERPRETATION: Ultrasonographic measurements of the os calcis predict the risk of hip fracture in elderly women living at home as well as DPXA of the hip does, and the combination of both methods makes possible the identification of women at very high or very low risk of fracture.

Absorptiometry, Photon↗
PubMed1996

Fetal heart rate monitoring by telephone during pregnancy--opinion of users and non-users of a new technology.

OBJECTIVE: To compare the opinions of obstetricians who currently use fetal heart rate monitoring (FHRM) by telephone with the opinions of obstetricians in favour of this technique, but who do not use it. STUDY DESIGN: A mail questionnaire was sent to the 612 members of a professional organization of obstetricians. The response rate was 76%. RESULTS: Fourteen percent of the respondents used FHRM by telephone and 43% did not use it, but were in favour of it. Compared with current users, non-users who were in favour of this technique indicated a wider range of clinical indications for monitoring, considered a greater proportion of women to be eligible, and wanted more frequent monitoring. These differences cannot be explained by the characteristics of the obstetricians (age, type of practice or attitude towards FHRM performed in maternity unit). CONCLUSION: Our survey shows a risk of extensive use of FHRM by telephone if this technique becomes easily accessible.

Female↗
PubMed1995

Increase of birth weight following chloroquine chemoprophylaxis during the first pregnancy: results of a randomized trial in Cameroon.

A randomized trial was carried out from 1991 to 1993 among women attending an antenatal clinic in Ebolowa, Cameroon where malaria is hyperendemic and transmission occurs at a high level all year round. All pregnant women attending the clinic for their first prenatal visit between October 1991 and November 1992 were alternately assigned to chloroquine (CQ) or control (CT) groups. Chloroquine was given under observation at a weekly oral dose of 300 mg. At delivery, smears from maternal, cord, and placental blood were made and stained with Giemsa for parasites. An in vivo chloroquine sensitivity investigation was carried out on women attending the postnatal consultation to evaluate the level of chloroquine resistance in the target population. The efficacy of chloroquine was moderate in placental infection (39.2% infected in the CQ group versus 57.8% in the CT group: P = 0.05), probably because of a resistance to chloroquine estimated to be 10.9%. In the CQ group, the mean birth weight was significantly higher (P = 0.02) and the proportion of low birth weight newborns was lower (10.5% versus 27.7%; P = 0.02). A strong correlation between placental infection and birth weight was observed: the mean birth weight difference between infected and noninfected placentae was 359 g (P < 0.0001) and the proportion of low birth weight new born babies was 35.6% versus 5.9% (P = 0.0001). In Cameroon, in spite of a moderate resistance to chloroquine, this drug proved to be highly effective in increasing birth weight when administered to primigravidae. We therefore think such a prophylaxis should be recommended only to primigravidae in high transmission areas.

Adolescent↗
PubMed1994

Comparative efficacy and tolerance of ibuprofen syrup and acetaminophen syrup in children with pyrexia associated with infectious diseases and treated with antibiotics.

A double-blind, randomised, parallel group study has been done comparing the efficacy and tolerability of 7.5 mg/kg ibuprofen syrup (n = 77) and 10 mg.kg-1 acetaminophen syrup (n = 77) in 154 children (6 months to 5 years) with fever (> or = 38 degrees C) associated with infectious diseases and treated with antibiotic therapy. The area under the percentage reduction in temperature curve captured the net effect of each drug and provided the best estimate for comparison of efficacy during a defined period. Temperature evolution over time was not significantly different between the two groups. Nevertheless, the temperature reduction over the first 4 h of treatment (H0-H4) was significantly higher after ibuprofen (60%) than acetaminophen (45%). Both ibuprofen and acetaminophen were well tolerated. In conclusion, significant antipyretic activity, good tolerability and its availability as a syrup make ibuprofen an effective means of fever control in children.

Acetaminophen↗
PubMed1993

Epidemiology and risk factors of osteoporosis.

Recent osteoporosis research has been oriented increasingly toward understanding the determinants of peak bone mass acquisition during childhood and adolescence. Genetic factors may account for approximately half of the variability in peak femoral bone mass density, and racial differences in bone mass have been shown to appear early in life. Physical activity appears to play an important role in increasing bone mass during childhood. Most fractures in the elderly have been found to be associated with reduced bone mass and could therefore be considered osteoporotic. Retrospective reviews of medical records from residents of Rochester, Minnesota, suggest that approximately one third of women with vertebral deformities seek medical attention. Other cross-sectional data suggest that vertebral deformities cause substantial back pain and disability only if vertebral height ratios fall 4 SD below the mean.

Aging↗
PubMed1992

Determinants of hormonal replacement therapy in recently postmenopausal women.

Although the efficacy of hormonal replacement therapy (HRT) on the consequences of the menopause is not questioned, it appears that in Europe and in the USA only a small proportion of women are users of HRT. In this study, we examined the prevalence and the determinants of HRT among 1986 French menopausal women, aged 45 to 55 years, presenting to a preventive medicine centre. Overall, 8.1% of women reported current use of HRT. The estrogen preparation most commonly reported was transcutaneous 17 beta-oestradiol. The first determinant of current HRT was birth-place. Women born in France were nearly four times more likely to be on treatment than foreign-born women. A surgical menopause multiplied the probability of current HRT by 2, as did a high level of education. An age at first pregnancy of more than 20 and less than 4 children were also positively linked with HRT use. Even in this population of recently menopausal women, volunteering to undergo health evaluation, the prevalence of HRT was low. The reservations towards HRT may be partly due to the women themselves, and partly due to the physicians. It seems very important to inform the medical profession about the risks and benefits of HRT, and to understand more precisely the reasons why so few women use HRT.

Administration, Cutaneous↗
PubMed1992

Home visits for pregnancy complications and management of antenatal care: an overview of three randomized controlled trials.

OBJECTIVE: To examine whether a policy of home visits reduces the amount of antenatal care provided by hospital maternity units. DESIGN: A meta-analysis of three randomized controlled trials. SETTING: 9 maternity units in France. SUBJECTS: 1410 women with pregnancy complications. INTERVENTION: 1 or 2 home visits a week by a midwife. MAIN OUTCOME MEASURES: Admission rate and length of stay in hospital. RESULTS: The home-visiting system did not affect the hospital admission rate (typical odds ratio = 0.9; 95% CI = 0.7-1.2). In each trial, the length of hospital stay did not differ between the intervention and the control groups. CONCLUSIONS: The home-visiting system did not greatly alter the practice of antenatal hospital admission in the maternity units studied. The results question the way the health services were used and suggest that a better integration of hospital and home services is needed to make a more rational use of health care resources.

Female↗
PubMed1992

Effect of chloroquine chemoprophylaxis during pregnancy on birth weight: results of a randomized trial.

To determine the effect of chloroquine chemoprophylaxis during pregnancy on birth weights, a randomized trial was carried out in 1987 and 1988 in Banfora, Burkina Faso (West Africa). Seven hundred forty-five randomly selected women treated with chloroquine sulfate were compared to with 719 controls who received no treatment. In spite of an unquestionable effect of chloroquine in preventing placental infection (4.1% infected placentas in the treated group versus 19.0% in the controls), the mean difference in birth weights between the two groups (6 g) was not significant. The difference in the proportion of low birth weight (LBW) newborn babies in two groups (16.3% versus 16.4%) was also not significant. However, there was a strong relationship between placental infection and birth weight (the mean birth weight difference between infected and uninfected placentas was 113 g, and the proportion of LBW babies was 26.0% in infected placentas versus 14.8% in uninfected placentas). The small difference in birth weights observed between the two groups may be due to the fact that the prevalence rate of placental infection is low and that prophylaxis is effective only on a portion of the subjects in the treated group. It may also indicate that malaria is only one of several risk factors responsible for LBW. The relatively small increase in birth weight, the expected poor acceptance of mass prophylaxis, and the spreading of chloroquine-resistant Plasmodium strains should be considered before extending malaria chemoprophylaxis to all pregnant women. It might be worth considering to limit prophylaxis to primigravidae.

Adult↗