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Biomedical subjects

J P Collet

Publications and source records attributed to J P Collet.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Infectious risk in day-nursery children].

High proximity in daycare centers is a well established risk factor for upper respiratory tract infections as well as Haemophilus influenza meningitis. Many studies have also reported the development of gastroenteritis as well as hepatitis A outbreaks in daycare centers; however, because of lack of controls, these studies do not provide enough information about the excess of risk attributable to daycare attendance. Main risk factors such as age, or seasons, are still very important in daycare centers and studies have also shown that a protection occurs rapidly after the beginning of attendance, may be in relation to the stimulation of the non-specific immunity. All these results do not provide enough data to implement a rational intervention project. More studies have to be carried out to assess the long term consequences (at school age for instance) of these infections. In order to make a rational decision regarding daycare attendance, it is important to have a global assessment of all the effects related to attendance (which are numerous and sometimes opposite); studies focusing on a single aspect of daycare attendance, or on its short term effect, may result in partial and misleading conclusions.

Child, Preschool↗
PubMed1992

Surrogate endpoints: a basis for a rational approach.

In clinical trials, the clinical endpoint is often replaced by an intermediate endpoint, known in some instances as a "surrogate" endpoint. The reasons for the substitution are often both practical and financial. At present, no theoretical basis or practical guidelines exist to help in the choice of surrogate endpoints. An approach is proposed here, based on three provisos which can be verified using one of a series of equations, if sufficient data on the pathophysiology and epidemiology of the disease are available. It is shown that even a strong statistical correlation is not a sufficient criterion for the definition of a surrogate endpoint. It is apparent that results obtained with the commonly used "surrogate" endpoints should be cautiously considered, and that the assessment of treatments should, when possible, be based on clinical rather than intermediate endpoints.

Clinical Trials as Topic↗
PubMed1992

[Meta-analysis of therapeutic trials of primary prevention in ischemic cardiopathies by hypocholesteremic treatment].

The prevention of lipid-related coronary risk by lipid lowering drugs or diet has been the object of several therapeutic trials. This meta-analysis comprises the 6 available primary prevention trials (representing 30,695 subjects). There was an overall reduction of non-lethal infarcts (-26%) and coronary events (-18%) in the treatment groups. There was a tendency to less coronary deaths (-10%), though not statistically significant, and no difference in mortality due to all causes was observed. Some questions remain unanswered about the fact that the reduced incidence of ischaemic heart disease did not affect global mortality. This fact could be explained by an inadequate duration of treatment or follow-up, to an effect limited to chronic infarction or to eventual unidentified adverse effects (the meta-analysis does not show any significant differences in mortality due to cancer or accidental death).

Anticholesteremic Agents↗
PubMed1992

[Current day-care structures for young children. Social and economic aspect based on the situation in the Rhône district].

The French public day-care system is intended for children under the age of 3. All structures are under the supervision of the "protection maternelle et infantile" (mother and child health service) and, before opening, must have the agreement of the Conseil général (department council). In the Rhône department (main town: Lyon) in 1990, 5020 children under the age of 3, from a total of 67,500, were in public daycare. The public daycare system complies with about 21% of all requests for child care. Recently, family day nurseries have developed more rapidly than collective daycare, being more flexible and less expensive. The costs for running a day nursery are shared between parents (28%), municipality (50%), national social support (20%) and other fundings (2%).

Child Day Care Centers↗
PubMed1992

Immunomodulators and primary prevention of respiratory infections: methodological considerations.

Immunomodulators have been evaluated mainly for their efficacy as a secondary preventive treatment to protect sick children from the recurrence of infections. We investigated the efficacy of one such product, IMOCURR, as a primary preventive treatment in children attending daycare, who face a very high risk of recurrent infections. EPICUR is a double-blind trial which was designed to study the efficacy of IMOCURR versus placebo. In order to have sufficient statistical power, data collection was based on a daily follow-up procedure and all important concomitant risk factors, such as age, environment and season, were controlled at the study design stage. The sample size required was calculated to be at least 400 children and a total of 423 were actually included. The results obtained for the total follow-up period and those obtained for the treatment period only were very different. This finding raises important questions which have methodological implications. This paper discusses these implications.

Adjuvants, Immunologic↗
PubMed1991

Sick population--treated population: the need for a better definition. The VALIDATA Group.

There are many questions concerned with therapy and its application. Depending on the perspective of the study there can be several "populations" which, when considered individually, may give different, or even inconsistent conclusions. These populations are: the sick population, the therapist's target population, the eligible population for a study, the study population, the treatment target population, and the treatment distribution population. Semantic precision, giving a better definition of the populations, is an essential prerequirement in order to tackle scientifically all the facets of assessment of therapy. Accurate definition will help in the study of areas as varied as the methodology, the therapeutic studies, the validity of the recommendations made, the impact of these recommendations on prescription, and finally, the consequences of the prescription in terms of public health (clinical and economical). Several examples are given to show the relationship between these populations and the importance of an accurate definition for each. Guidelines for the identification of these populations are provided. In this overall approach to therapy, epidemiology is an essential, complementary tool to clinical trials.

Adrenergic beta-Antagonists↗
PubMed1991

Drug prescription in young children: results of a survey in France. Epicrèche Research Group.

A 8.5-month prospective study was performed in the Rhône area of France to study the incidence of infectious diseases in children in day care, and the qualitative and quantitative aspects of drug prescriptions for young children. The families of 1.359 children agreed to participate (98.5% of those selected). During the follow-up period 3.605 infections episodes were reported and 10.706 medications were used, an average of 3.0 medications per episode. Antibiotics were used in the treatment of 2.333 infectious episodes (65%) amoxycillin (36%), cephalosporin (23%), macrolide (17%) and trimethoprim-sulphamethoxazole (9%). Acetylsalicylic acid and paracetamol were used 865- and 1.568-times, respectively. Drugs with multi-active components represented 11.3% of the total number of systemic medicines reported. Paracetamol was prescribed in 59% of cases in a multi-active component drug, whereas this type of product accounted for 83.5% of the antihistamines (used 932-times). The rationale behind the paediatric prescribing habits of French medical doctors is discussed in relation to results previously obtained in other European countries.

Anti-Bacterial Agents↗
PubMed1991

Daycare attendance and risk of first infectious disease.

The health hazards of daycare attendance for the development of upper and lower respiratory tract infections have been well documented; however the importance and the mechanism of this association have not been well defined. In order to ascertain the risk associated with the beginning of daycare (DC) attendance we conducted a survey on 1263 children aged from 3 months to 3 years; the analysis focused on the risk of developing an initial episode of common cold with fever, a first otitis and a first wheezy bronchitis (WB) within the 2 month period following admission to DC. For each 2 month period, the risk of a first infectious event was much higher in children who had just begun attending DC than in children who remained at home; the risk ratio varied from 1.7 to 2.4 for common cold, from 1.5 to 1.9 for otitis and from 1.8 to 3.2 for WB. Because age at onset of the first infectious event may be related to a higher risk of repeated events we consider that admission to DC under 12 months of age should be questioned.

Age Factors↗
PubMed1991

Dysfibrinogenemia and thrombosis.

A thrombotic tendency (venous or arterial) has been reported in some cases of dysfibrinogenemia. We report here the mechanism by which these thrombosis may occur. It may be related either to a defective clot lysis due to a poor reactivity toward fibrinolytic enzymes or to a defective thrombin binding capacity of the abnormal clot. Acquired fibrin clot structure anomalies may also be responsible for a defective thrombolysis.

Fibrin↗
PubMed1990

[Neuroblastoma in the Rhone-Alpes area: epidemiologic data].

An epidemiological study of neuroblastoma in the Rhône-Alpes area was carried out over a 5 year period. The aim was to set up a background for a screening program in order to increase the number of neuroblastoma diagnosed in children before age 1, and decrease or eliminate advanced stage neuroblastomas.

Adolescent↗