Biomedical subjects
Publications and source records attributed to J P Merlin.
This paper presents practical guidelines for nutrition and feeding of infants and toddlers including vitamin D, vitamin K and fluoride supplementations and preventive measures at risk for food allergy based on family history.
OBJECTIVE: The study was carried out by the GFHGNP to determine the annual incidence of symptomatic celiac disease in children. PATIENTS AND METHODS: The diagnostic criteria were: symptomatic patients diagnosed under 15 years of age during 1996, villous atrophy and positivity of antigliadin and/or other antibodies. Cases were collected from referral centers, general hospital pediatric departments and private pediatricians with endoscopic practice. RESULTS: The study involved roughly half of the French pediatric population in 41 out of the 95 French districts. In all, 124 patients were collected: 76 girls and 48 boys. By geographical areas, in 30 districts where collection of data was complete which counted 186,285 births, the yearly incidence varied from 1/1731 births to 1/3110. (0.57@1000 to 0.32@1000). On the whole there were 77 cases i.e. an annual incidence of 1/2419 or 0.41@1000 (confidence interval 95%: 0.32 to 0.50@1000). Lower incidences were observed in the district of Paris: 1/4865 (0.21@1000) and Lyon: 1/3310 (0.27@1000). Those lower incidences could be explained by the difficulties of collecting the data in the biggest urban areas. The first signs occurred before one year of age in 73% of the cases, during the second year of life in 20.5% and after 3 in only 6.5%. The diagnosis was made before 2 years of age in 77% of the cases and after 3 in only 13%. In order of frequency symptoms were: failure to thrive (80%), diarrhea (59%), anorexia (59%), abdominal distension (57%), weight under 2 standard deviations (43%), short stature (43%). CONCLUSION: Compared with previous studies in two French districts between 1975 and 1990, the annual incidence of symptomatic celiac disease in children appears to be on the rise. The usual clinical signs continue to be observed.
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BACKGROUND: Passive tobacco smoking is responsible for increased respiratory morbidity in young children. This point is not always understood by parents and the use of a sensitive marker for nicotine exposure may help them to smoke less. POPULATION AND METHODS: Urinary cotinine concentration was measured in 72 children, aged from 1 to 5 years, that had been admitted to our unit during October and November 1991 for various causes. The results were correlated with the smoking habits of their parents. Urine samples were obtained during the first hours after admission and the cotinine concentration was measured by HPLC. Concentrations > 5 micrograms per liter were considered to be positive. RESULTS: A total of 67 urine samples were analysed: 43 (64.2%) were positive with cotinine concentrations of 5 to 77 micrograms/l (mean: 19.7). Both parents of 21 children were smokers; the fathers of 18 children and the mothers of 11 children, alone, smoked. There was therefore at least one smoker in the environment of 50 children. There was a highly positive correlation between parental smoking and urinary cotinine (p < 0.0001). For the infants with only one parent who was a smoker, their urinary cotinine was higher when the smoker was the mother rather than the father. CONCLUSIONS: An urinary cotinine of > 6 micrograms per liter is a precise, sensitive, test for passive smoking in young children. This test is well accepted by families and its result may persuade parents to stop or moderate their use of tobacco. This test also could be used, as part of a pulmonary check-up, as a public health indicator.