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To assess the predictive value of a pediatric screening tool by linking 2 independent databases: an educational database that includes data from standardized academic assessments administered during kindergarten and a pediatric database that includes screening results.A database that includes results of the Survey of Well-being of Young Children (SWYC) completed during pediatric visits were linked to an educational database that includes STAR Early Literacy examinations in kindergarten. Linear multilevel regression modeling was used to examine if screening results on the developmental and behavioral sections of the most recently completed SWYC form predicted trends in the percentile rank on the STAR exam over the school year, adjusting for potential confounders.Linking the 2 databases resulted in a sample of 586 children who were administered at least one SWYC evaluation between 24 and 48 months and completed at least one STAR Early Literacy examination in kindergarten. The sample represents a diverse population with 55% Hispanic children, 25% Non-Hispanic black children, and 91% of children receiving a subsidized lunch. After adjusting for confounders, children with a positive developmental or behavioral screen had significantly lower percentile ranks on the STAR exam.Early developmental and behavioral screening results predicted performance on the STAR exam in kindergarten. Children with developmental and behavioral concerns may be less ready to enter kindergarten than peers without such concerns. These preliminary findings provide proof-of-principle of the potential utility of developmental screening tools in identifying children with reduced school readiness who may benefit from intervention prior to kindergarten.

To study the association between neighborhood risk and moderate to severe neurodevelopmental impairment (NDI) at 22-26 months corrected age in children born at34 weeks of gestation. We hypothesized that infants born preterm living in high-risk neighborhoods would have a greater risk of NDI and cognitive, motor, and language delays.We studied a retrospective cohort of 1291 infants born preterm between 2005 and 2016, excluding infants with congenital anomalies. NDI was defined as any one of the following: a Bayley Scales of Infant and Toddler Development-III Cognitive or Motor composite score85, bilateral blindness, bilateral hearing impairment, or moderate-severe cerebral palsy. Maternal addresses were geocoded to identify census block groups and create high-risk versus low-risk neighborhood groups. Bivariate and regression analyses were run to assess the impact of neighborhood risk on outcomes.Infants from high-risk (n = 538; 42%) and low-risk (n = 753; 58%) neighborhoods were compared. In bivariate analyses, the risk of NDI and cognitive, motor, and language delays was greater in high-risk neighborhoods. In adjusted regression models, the risks of NDI (OR, 1.43; 95% CI, 1.04-1.98), cognitive delay (OR, 1.62; 95% CI, 1.15-2.28), and language delay (OR, 1.58; 95% CI, 1.15-2.16) were greater in high-risk neighborhoods. Breast milk at discharge was more common in low-risk neighborhoods and was protective of NDI in regression analysis.High neighborhood risk provides an independent contribution to preterm adverse NDI, cognitive, and language outcomes. In addition, breast milk at discharge was protective. Knowledge of neighborhood risk may inform the targeted implementation of programs for socially disadvantaged infants.

Objective Both small for gestational age (SGA) birthweight and pregnancies complicated by maternal hypertension (HTN) are independently associated with poorer childhood learning outcomes, however the relative contribution of each remains unknown. Study design A retrospective cohort was created in which 2014–2017 third grade Rhode Island Department of Education data were linked to Rhode Island Department of Health birth certificate data. The study population was composed of non-anomalous, singleton births between 22- and 42-weeks’ gestation. Reading and math proficiency were compared among four groups: 1) appropriate for gestational age (AGA) and no maternal HTN (referent), 2) AGA with HTN, 3) SGA without HTN and 4) SGA with HTN. Main outcome measures Bivariable and multivariable log-binomial regression were used to examine the association between subject proficiency and pregnancy complication, adjusting for potential confounders. Results Of the 23,097 who met inclusion criteria, 1004 (4%) were AGA with HTN, 1575 (7%) were SGA without HTN and 176 (1%) were SGA with HTN. Overall, when adjusted for maternal age, gestational age, sex and socioeconomic factors, only children born SGA without HTN had reduced reading proficiency (relative risk (RR) 0.86 95% confidence interval (CI) 0.78, 0.92) and math proficiency (RR 0.88 95% CI 0.82, 0.94) compared to children born AGA without HTN. Conclusion In a diverse, statewide cohort, only SGA without HTN was associated with lower reading and math proficiency compared to uncomplicated pregnancies. This suggests that only decreased fetal growth from causes other than HTN is associated with risk of poorer school-age outcomes, and has implications for early resource allocation.

Objectives To analyze the distribution of patient-centered medical homes (PCMHs) among US adolescents, and to examine whether disparities exist among subgroups. Study design Data on adolescents ages 12-17 years (n = 34 601) from the 2011-2012 National Survey of Children's Health were used in this cross-sectional study to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Comparisons were made to distribution of PCMH in 2007. Results Although most US adolescents had a usual source of care (91%), only about one-half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR, 0.56; 95% CI, 0.45-0.68) and black adolescents (aOR, 0.55; 95% CI, 0.46-0.66) compared with white adolescents. Those living below 4 times the poverty level had lower adjusted odds of PCMH access. Adolescents with 3-5 special health care needs had lower adjusted odds (aOR, 0.43; 95% CI, 0.35-0.52) of having a PCMH compared with adolescents without any special health care needs. Other than receiving family centered care, every component of PCMH was slightly lower in 2011-2012 compared with 2007. Conclusions PCMH access was lower among minorities, those living in poverty, and those with multiple special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents.

Background Falls represent the leading cause of nonfatal unintentional injuries among children in the United States. Although unintentional injury risks have been studied, neighborhood impact on falls remains underexplored. This study examined the association of neighborhood attributes with rates of fall-related injuries. Methods This is a retrospective study of children who presented to emergency departments within a statewide hospital network for fall-related injuries between 2005 and 2014. Patients’ home addresses were geocoded to identify US Census block groups (BGs). Average annual fall rates were computed for each BG. A neighborhood risk index was constructed using 8 socioeconomic BG measures (education, crowding, vacancy, renter occupancy, poverty, family structure, race/ethnicity, and housing age). Public outdoor recreational facilities in each BG were enumerated. Linear regression analysis was used to assess the association of neighborhood risk and recreational facilities with fall rates. Results From 2005 to 2014, there were 139,986 unintentional injury emergency department visits; of these, 42,691 (30%) were for falls. The largest proportion of falls were among males (58%), children ages 1 to 4 years (39%), non-Hispanic whites (59%), and children with public health insurance (53%). Higher quintiles of neighborhood risk were associated with higher annual fall rates compared to the lowest quintile of risk: quintile 2, β = 0.44, 95% confidence interval (CI), 0.20–0.68; quintile 3, β = 0.85, 95% CI, 0.61–1.10; quintile 4, β = 1.11, 95% CI, 0.85–1.37; quintile 5, β = 1.57, 95% CI, 1.29–1.85. The presence of public outdoor recreational facilities was not associated with fall rates (β = 0.01; 95% CI, –0.14 to 0.15). Conclusion Neighborhood-level socioeconomic characteristics are associated with higher fall-related injuries. Injury prevention programs could be tailored to address these neighborhood risks.

Rates of vaginal birth after cesarean delivery have decreased and cesarean delivery rates have increased in the last 2 decades. Evidence on short-term neonatal outcomes is available, but data on long-term childhood outcomes following vaginal birth after cesarean delivery are insufficient. Long-term childhood outcome data are essential in decision-making regarding mode of delivery.This study aimed to evaluate the association between delivery mode and long-term educational outcomes of the children of pregnant individuals with a previous cesarean delivery.This was a retrospective cohort study linking Rhode Island third-grade education data from 2014 to 2017 to birth certificate data. Data were obtained from a statewide database using Department of Education data, and were linked to Department of Health birth certificate data. Participants were children of multiparous women who were term, singleton births without congenital anomalies. Children delivered by primary cesarean delivery were excluded. The exposure was mode of delivery classified as vaginal birth after cesarean delivery, repeated cesarean delivery, or repeated vaginal birth. The primary outcome was children's third-grade reading and math proficiency. Bivariate analyses were conducted to assess differences in demographic variables. Bivariable and multivariable log-binomial regression was used to examine the association between subject proficiency and predictors including mode of delivery, maternal education, sex, child race or ethnicity, and lunch subsidy.Of the 10,923 children who met the inclusion criteria, 2.0% were delivered by vaginal birth after cesarean delivery, 22.0% by repeated cesarean delivery, and 76.0% by repeated vaginal delivery. After adjustment for confounders, there was no difference in reading proficiency (adjusted risk ratio, 0.98; 95% confidence interval, 0.84-1.15) or math proficiency (adjusted risk ratio, 0.99; 95% confidence interval, 0.84-1.15) between those born by vaginal birth after cesarean delivery and those born by repeated cesarean delivery. There was no difference found in either proficiency between children born by repeated vaginal birth and those born by repeated cesarean delivery (reading: adjusted risk ratio, 0.97; 95% confidence interval, 0.93-1.01; math: adjusted risk ratio, 0.97; 95% confidence interval, 0.92-1.02).In comparison with repeated cesarean delivery, both vaginal birth after cesarean delivery and repeated vaginal birth were not associated with differences in educational outcomes. This may aid in counseling about long-term safety outcomes regarding vaginal birth after cesarean delivery and may assist in shared decision-making when selecting between trial of labor after cesarean delivery and repeated cesarean delivery.

Background Operative vaginal delivery rates continue to drop nationally with many citing neonatal safety concerns as a primary driver of this decrease. Previous evidence on short-term neonatal outcomes does not support this concern. Objective This study aimed to better understand the impact of delivery mode on childhood educational outcomes. Study Design A statewide retrospective cohort was created in which third grade Rhode Island Department of Education data for 2014 to 2017 were linked to Rhode Island Department of Health birth certificate data. Children’s third grade reading and math proficiencies were compared by the mode of delivery listed in their birth certificates. The study population was limited to children who were term, singleton births without congenital anomalies. The mode of delivery was classified as operative vaginal (forceps or vacuum), primary cesarean, or spontaneous vaginal delivery. Children born via repeat cesarean delivery were excluded. Bivariate analyses were conducted to assess differences in demographic variables between mothers and children by mode of delivery and between reading and math proficiencies and mode of delivery. Bivariable and multivariable log-binomial regression was used to examine the association between subject proficiency and predictors including mode of delivery, gestational age, sex, race/ethnicity, and lunch subsidy. Results Of the 18,247 children who met the inclusion criteria, 6% were delivered by operative vaginal delivery, 19% by primary cesarean delivery, and the remaining 75% by spontaneous vaginal delivery. After adjustment for confounders including gestational age at delivery, child’s race/ethnicity, sex, and socioeconomic factors, there was no difference in reading proficiency (adjusted risk ratio, 1.03; 95% confidence interval, 0.96–1.10) or math proficiency (adjusted risk ratio, 1.01; 95% confidence interval, 0.95–1.08) in those born by operative vaginal delivery compared with primary cesarean delivery, and no difference was found in either proficiency when spontaneous vaginal delivery was compared with primary cesarean delivery (reading, adjusted risk ratio, 0.97; 95% confidence interval, 0.93–1.01; math, adjusted risk ratio, 0.98; 95% confidence interval, 0.94–1.01). Conclusion Operative vaginal delivery was not associated with differences in later childhood educational outcomes after adjusting for baseline differences. This should assuage previous concerns about long-term safety outcomes after operative vaginal delivery and may assist in shared decision making when operative vaginal or primary cesarean delivery is being considered.

The first observation of coherent elastic neutrino-nucleus scattering (CE ν NS), reported by the COHERENT Collaboration in 2017, paved the way for a new generation of experiments using reactor ν e and aiming at precisely measuring this process. In this context, the BASKET (Bolometers At Sub-KeV Energy Thresholds) R&D project investigates the use of cryogenic detectors for a reactor CE ν NS experiment. This article reports on the first test of a Mo-doped lithium tungstate scintillating bolometer ( ⊘ 18 × 7 mm, 8 g), performed in an aboveground laboratory at CSNSM, Orsay (France). The detector bolometric performance (energy and time response, particle identification capabilities) and radiopurity have been studied and confirm the promising potential of lithium tungstate-based bolometric detectors for the measurement of CE ν NS at reactors.

The oscillation results published by the Double Chooz Collaboration in 2011 and 2012 rely on background models substantiated by reactor-on data. In this analysis, we present a background-model-independent measurement of the mixing angle θ13 by including 7.53 days of reactor-off data. A global fit of the observed antineutrino rates for different reactor power conditions is performed, yielding a measurement of both θ13 and the total background rate. The results on the mixing angle are improved significantly by including the reactor-off data in the fit, as it provides a direct measurement of the total background rate. This reactor rate modulation analysis considers antineutrino candidates with neutron captures on both Gd and H, whose combination yields sin2(2θ13)=0.102±0.028(stat.)±0.033(syst.). The results presented in this study are fully consistent with the ones already published by Double Chooz, achieving a competitive precision. They provide, for the first time, a determination of θ13 that does not depend on a background model.

Introduction A 10 K run was organized in southwestern France in early April 2017. Several dozens of runners had discomforts, some of them very serious faint. Early health care was provided by first aid workers on site. Fire and emergency Service and the local hospital activated their emergency response plan. The Regional Health Agency called on the local Poison Control Center (PCC) and the Regional office of the French National Agency for Public Health to investigate the outbreak. The purpose of the survey was to describe the event and to determine the causes of these discomforts, and the risk factors of their occurrence. Methods An exploratory survey was set up to describe the event. Telephone interviews were conducted with the race organizer, the first aid station director, paramedics and the local hospital. People transported to the hospital were asked about their consumption (water, food, doping substances, medication, etc.) before and during the race, their risk factors for hyperthermia, as well as their symptoms through an individual questionnaire. A telephone survey was conducted by an epidemiologist. Emergency and hospitalization reports as well as the results of biological and toxicological analyses were evaluated by a toxicologist from the regional PCC. Results The running event gathered 4280 participants, including 70 dropouts. The event started at 6:30 PM. First participants arrived on site at 4:30 PM, which implied a 2-hour-wait under unusual heat for the season (27 °C at 6 PM). The first aid station took care of 31 people during and after the event for severe dehydration and hypoglycemia, especially after the 7th and the 8th km A total of 17 people (2 women and 15 men, between 23 and 52 years old) were transported to the hospital, 15 of them for a medical consultation and 2 were hospitalized in intensive care. They all recovered; no deaths were reported. Individual risk factors could be investigated for 7 men who were transported to hospital, including the 2 admitted to intensive care. Of these, 2 were overweight, 1 reported chronic pathology (asthma). None had used alcohol or other psychoactive substances within 24 hours of the race. It was the first participation to such an event for only one man. However, this man practiced running on a regular basis. Four runners spontaneously reported a lack of water or difficulties to access to the water, particularly at the 7th km. Eight hospitalization reports were sent to regional PCC. The clinical and biological analyses of these patients were consistent with heat stroke. Toxicology tests did not indicate any presence of toxic substances. For one of the patients, the consumption of a prescribed medication (corticoid) may have contributed to the occurrence of the heat stroke. Discussion The investigation was consistent with heat stroke. Relatively hot conditions, prolonged exposure to heat before the race, limited access to water stations and some unclear waypoints may have been aggravating factors. A delay in preventive health care (rehydration–cooling) was also reported. These elements were taken into account by the organizers for the organization of the next races. The organization of a sport's events during a heat wave requires specific precautions to be taken by the organizers and by participants. Prompt medical assistance during the race is needed.

Introduction La France est un pays de faible endemie pour la tuberculose avec un taux autour de 7 cas pour 100 000 habitants. En Nouvelle-Aquitaine, ce taux tombe a 4,5 cas pour 100 000 habitants. Au Pays-Basque (sud-ouest de la France), le centre de lutte antituberculeuse (CLAT) enregistre chaque annee environ 25 declarations obligatoires (DO) de tuberculose. Methodes Entre le printemps et l’ete 2016, le CLAT de Bayonne a recu 4 DO de tuberculoses concernant des patients scolarises dans le meme lycee d’Anglet. Nous avons donc alerte l’ARS et organise au sein du CLAT le depistage du premier cercle des eleves. Il concernait 163 personnes du lycee (eleves, enseignants, personnel non enseignant). Chaque personne a beneficie d’une consultation medicale, d’une radiographie thoracique et d’un test tuberculinique confirme, s’il etait positif, par un test de detection de l’interferon gamma. Resultats Le depistage de ce premier cercle a permis de diagnostiquer 2 nouveaux cas de tuberculose maladie et 40 infections tuberculeuses latentes, soit un taux d’ITL de 26,5 %. A l’issue de ces resultats, nous avons decide apres reflexion entre le CLAT, l’ARS et les medecins scolaires d’etendre le depistage a l’ensemble de l’etablissement (eleves et personnels), soit 1813 personnes. Le but de cette presentation est d’expliquer la difficulte a organiser en urgence un tel depistage avec mobilisation de moyens humains (infirmieres pour les prelevements sanguins, medecins pour les examens cliniques, secretaires pour la gestion des dossiers, le suivi de la reception et de la restitution des resultats, personnels de l’etablissement scolaire pour l’obtention des autorisations parentales chez les mineurs, encadrement du lycee pour fluidifier le depistage), de moyens materiels (locaux au sein de l’etablissement, camion radiologique installe pendant la duree du depistage au sein du lycee, partenariat avec un laboratoire d’analyses biologiques). Dans le meme temps, il a fallu en partenariat avec l’ARS gerer la communication aupres des personnels de l’etablissement, des familles et des medias locaux. Conclusion Meme en region de faible endemie tuberculeuse, une epidemie est toujours possible. L’organisation d’un depistage a grande echelle et en urgence comporte de nombreuses difficultes tant materielles qu’humaines et necessite une extraordinaire complementarite des differents intervenants. Notre experience pourrait bien sur « aider » d’autres CLAT qui se retrouveraient dans la meme situation.

Introduction – objectifs Parmi les infections invasives a meningocoque (IIM), le serogroupe B est predominant en France et certains clones peuvent conduire a des epidemies prolongees. Une epidemie d’IIM B:14:P1.7,16 a ete detectee en 2012 dans les Pyrenees Atlantiques (PA) et a conduit a la mise en œuvre d’une campagne de vaccination par le vaccin MenBvac ® . Materiels et methodes La surveillance des IIM repose sur la declaration obligatoire et la caracterisation des souches par le Centre national de reference (CNR). Le suivi du taux d’adhesion a la vaccination de la population a repose sur l’analyse d’un fichier des personnes domiciliees, travaillant ou etudiant sur la zone et complete pour chaque personne ayant debute sa vaccination. Resultats Entre juillet et septembre 2012, quatre cas d’IIM B:14:P1.7,16 (un deces) ont ete declares autour de Lagor (PA), avec une incidence sur cette zone de 14 cas pour 100 000 habitants. Deux nouveaux cas ont ete declares en avril 2013 sur cette meme zone. Les lecons tirees de l’experience de la Seine Maritime ont conduit le Haut conseil de sante publique (HCSP) a recommander une vaccination des contacts puis la vaccination des 2 mois-24 ans par le MenBvac en juillet 2013. Fin 2013, la couverture vaccinale tous âges etait de 18,9 % pour la premiere dose en population generale. Tous les contacts des cas etaient vaccines. Conclusion La detection de cette epidemie a permis de mettre en place rapidement une campagne de vaccination aupres de la population concernee. Aucun nouveau cas d’IIM B:14:P1.7,16 n’a ete recense depuis avril 2013 suite aux vaccinations realisees aupres de tous les contacts des cas puis en population generale malgre une faible adhesion actuelle. Les regroupements temporo-spatiaux d’IIM B ont ete pris en compte par le HCSP dans les recommandations d’utilisation du nouveau vaccin Bexsero ® .

Introduction La dysfonction autonome cardiaque (DAC) contribue a l’elevation de la pression arterielle et du risque cardiovasculaire chez les diabetiques. L’obesite est souvent associee a une DAC. Le but etait, chez les obeses sans diabete connu, d’evaluer le role de la DAC dans l’hypertension arterielle (HTA) et le role respectif de la DAC et de l’HTA dans l’augmentation du risque coronarien. Patients et methodes Nous avons inclus 377 patients obeses ou en surpoids (IMC 39 ± 7 kg/m 2 ), âges de 38,3 ± 14,6 ans. Une charge en glucose a ete effectuee. Une DAC a ete definie par au moins un test anormal parmi 3 tests (respiration profonde, orthostatisme, Valsalva), sous dependance vagale predominante, evaluant la variabilite de la frequence cardiaque. La DAC etait consideree severe si 2 ou 3 tests etaient anormaux. Le score UKPDS de risque d’evenements coronariens a 10 ans a ete calcule. Resultats Une DAC etait presente chez 158 patients (44 %) et l’HTA chez 131 patients (35 %). La prevalence de l’HTA etait significativement plus elevee chez les patients avec DAC severe (50 %) que chez ceux sans (30 %) ou un seul test (38 %) de DAC anormal (p = 0,01). Le score UKPDS etait significativement different entre les 4 groupes (p Conclusion Chez les obeses sans diabete connu, la presence d’une DAC pourrait, du fait d’une predominance sympathique, contribuer a l’elevation tensionnelle et a aggraver le risque coronarien chez les hypertendus.

Introduction Le nerf vague est un nerf mixte compose de 20 % de fibres efferentes et 80 % de fibres afferentes. La stimulation du nerf vague (VNS) a deja ete approuvee comme therapeutique de certaines formes d’epilepsies et de depression chez l’Homme. La VNS a aussi ete experimentee avec succes chez l’animal dans des modeles d’inflammation peripherique telle que la pancreatite. Des travaux recents ont montre que cet effet anti-inflammatoire etait lie a l’activation des efferences vagales [1,2]. En effet, les terminaisons de ces fibres liberent en peripherie de l’acetylcholine qui, en se liant au recepteur alpha-7-nicotinique porte par les macrophages, inhibe la secretion des cytokines pro-inflammatoires (TNFalpha notamment). L’objectif de ce travail etait d’utiliser la stimulation electrique du nerf vague afin d’ameliorer voire de prevenir une colite experimentale chez le rat. Materiels et Methodes La colite etait chimiquement induite par injection intra-colique d’acide trinitrobenzene sulfonique (TNBS ; 30 mg/kg ; 50 % ethanol, 250 μL). La stimulation vagale etait realisee grâce a une electrode placee de maniere chronique au niveau de la portion cervicale du nerf vague gauche (parametres de stimulation : 1 mA, 5 Hz, 500 μs, 10 secondes ON, 90 secondes OFF) ; l’animal etait stimule pendant 3 heures le jour de l’injection du TNBS et pendant les 4 jours suivants. Les parametres physiologiques de temperature corporelle et d’activite locomotrice etaient suivis en continu par telemetrie (systeme DataScience) pendant cette periode. L’animal etait sacrifie 5 jours apres l’administration du TNBS, le colon etait preleve pour une analyse histologique, une mesure de l’activite enzymatique de la myeloperoxydase (MPO) et une quantification des cytokines par ELISA et RT-PCR. Resultats Les resultats preliminaires mettaient en evidence chez les animaux stimules : a) une amelioration clinique avec absence de perte ponderale, b) une l’inflammation colique reduite objectivee par la diminution des taux de MPO au dessus de la lesion et c) l’apparition d’une correlation entre la surface lesionnelle et les taux d’ARNm du TNF alpha dans cette meme zone, traduisant un controle local de l’inflammation. Conclusion Les donnees experimentales preliminaires montrent l’interet d’activer la voie cholinergique par stimulation nerveuse pour obtenir un effet anti-inflammatoire au niveau du tube digestif. La VNS pourrait etre envisagee comme therapeutique potentielle des maladies inflammatoires chroniques de l’intestin (colite radique, MICI : maladie de Crohn, rectocolite hemorragique) chez l’Homme.