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Campas-Lebecque MN, Pochelu S, Vautier V, Bacheré N, Beau C, Benoit M, Cammas B, Carré M, Chevrel J, Compain F, Fargeot-Espaliat A, Franc M, Galtier A, Gambert C, Lacoste A, Lienhardt A, Martineau L, Oilleau L, Percot-Blondy M, Tamboura A, Valade A, Barat P. Do children and adolescents with type 1 diabetes suffer from a lack of resources in France? Results from a benchmark study in the New Aquitaine region. Arch Pediatr 2021; 28:301-306. [PMID: 33744119 DOI: 10.1016/j.arcped.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/09/2020] [Accepted: 02/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND A benchmark study was conducted in the southwest of France, in the New Aquitaine region, to investigate metabolic outcomes and availability of resources in pediatric diabetes units. We assessed whether the level of care was in accordance with the International Society for Pediatric and Adolescent Diabetes recommendations. METHODS Demographic and clinical data were collected, as were all HbA1c tests for the 2017 calendar year. Pediatricians specialized in diabetes care were invited to complete an online survey concerning means allocated to the management of type 1 diabetes in their centers. RESULTS Sixteen centers provided data for 1277 patients and 3873 clinical visits. A total of 1115 children suffering from diabetes for more than 1 year were studied. Median HbA1c was 8% (7.4-8.6) for the whole region. Only 29.2% of children had good metabolic control in accordance with the <7.5% target. We identified slight but significant variation in glycemic control among centers (P=0.029). The use of an insulin pump varied greatly among centers but did not explain HbA1c differences. We did not identify a correlation between medical or paramedical time dedicated to the follow-up of diabetic patients and the mean HbA1c of each center. For 100 diabetic patients, follow-up was provided by 0.42 physicians (0.23-1.50), 0.15 nurses (0-0.56), 0.12 dietitians (0-0.48), and 0.07 psychologists (0-0.30). CONCLUSION This study demonstrates a lack of human resources allocated to the management of type 1 diabetes in the region that is far below international recommendations. The proportion of children achieving the international glycemic target is low. There is a clear need to improve glycemic control in children, which will only be possible with improved professional practices, encouraged by benchmark studies, and by increasing the size of our multidisciplinary teams.
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Affiliation(s)
- M-N Campas-Lebecque
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France.
| | - S Pochelu
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France
| | - V Vautier
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France
| | - N Bacheré
- Unité de pédiatrie, CH Layné, 40024 Mont De Marsan, France
| | - C Beau
- Unité de pédiatrie, CH Libourne, 112, rue de la Marne, 33505 Libourne, France
| | - M Benoit
- Unité de pédiatrie, CH de Saintonge, 11, boulevard Ambroise-Paré, 17108 Saintes, France
| | - B Cammas
- 22, rue Guillemin, 33300 Bordeaux, France
| | - M Carré
- Unité de pédiatrie, CH Côte-Basque, 13, avenue Jacques-Loeb, BP, 64109 Bayonne, France
| | - J Chevrel
- Unité de pédiatrie, CH Côte-d'argent, boulevard Yves-Du-Manoir, 40107 Dax, France
| | - F Compain
- Unité de pédiatrie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - A Fargeot-Espaliat
- Unité de pédiatrie, CH de Brive, 1, boulevard du Dr-Verlhac, 19312 Brive La Gaillarde, France
| | - M Franc
- Unité de pédiatrie, CH Agen-Nérac, 47923 Agen, France
| | - A Galtier
- Unité de pédiatrie, CH Samuel Pozzi, 9, boulevard Pr-Calmette, 24100 Bergerac, France
| | - C Gambert
- Unité de pédiatrie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - A Lacoste
- Polyclinique Bordeaux Rive Droite, 24, rue des Cavailles, 33310 Lormont, France
| | - A Lienhardt
- Unité d'endocrinologie et diabétologie pédiatrique, CHU Dupuytren, 8, avenue Larrey, 87042 Limoges, France
| | - L Martineau
- Unité de pédiatrie, CH d'Angoulême, rond point de Girac, 16959 Angoulême, France
| | - L Oilleau
- Unité de pédiatrie, CH de Pau, 4, boulevard Hauterive, 64046 Pau, France
| | - M Percot-Blondy
- Unité de pédiatrie, CH de Périgueux, 80, avenue Pompidou, 24019 Périgueux, France
| | - A Tamboura
- Unité de pédiatrie, CH de Rochefort, 1, avenue de Béligon, 17301 Rochefort, France
| | - A Valade
- Unité de pédiatrie, CH Côte-Basque, 13, avenue Jacques-Loeb, BP, 64109 Bayonne, France
| | - P Barat
- Unité d'endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie Rabat Léon, 33076 Bordeaux, France
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Thielemans L, Trip-Hoving M, Landier J, Turner C, Prins TJ, Wouda EMN, Hanboonkunupakarn B, Po C, Beau C, Mu M, Hannay T, Nosten F, Van Overmeire B, McGready R, Carrara VI. Indirect neonatal hyperbilirubinemia in hospitalized neonates on the Thai-Myanmar border: a review of neonatal medical records from 2009 to 2014. BMC Pediatr 2018; 18:190. [PMID: 29895274 PMCID: PMC5998587 DOI: 10.1186/s12887-018-1165-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 06/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Indirect neonatal hyperbilirubinemia (INH) is a common neonatal disorder worldwide which can remain benign if prompt management is available. However there is a higher morbidity and mortality risk in settings with limited access to diagnosis and care. The manuscript describes the characteristics of neonates with INH, the burden of severe INH and identifies factors associated with severity in a resource-constrained setting. METHODS We conducted a retrospective evaluation of anonymized records of neonates hospitalized on the Thai-Myanmar border. INH was defined according to the National Institute for Health and Care Excellence guidelines as 'moderate' if at least one serum bilirubin (SBR) value exceeded the phototherapy threshold and as 'severe' if above the exchange transfusion threshold. RESULTS Out of 2980 records reviewed, 1580 (53%) had INH within the first 14 days of life. INH was moderate in 87% (1368/1580) and severe in 13% (212/1580). From 2009 to 2011, the proportion of severe INH decreased from 37 to 15% and the mortality dropped from 10% (8/82) to 2% (7/449) coinciding with the implementation of standardized guidelines and light-emitting diode (LED) phototherapy. Severe INH was associated with: prematurity (< 32 weeks, Adjusted Odds Ratio (AOR) 3.3; 95% CI 1.6-6.6 and 32 to 37 weeks, AOR 2.2; 95% CI 1.6-3.1), Glucose-6-phosphate dehydrogenase deficiency (G6PD) (AOR 2.3; 95% CI 1.6-3.3), potential ABO incompatibility (AOR 1.5; 95% CI 1.0-2.2) and late presentation (AOR 1.8; 95% CI 1.3-2.6). The risk of developing severe INH and INH-related mortality significantly increased with each additional risk factor. CONCLUSION INH is an important cause of neonatal hospitalization on the Thai-Myanmar border. Risk factors for severity were similar to previous reports from Asia. Implementing standardized guidelines and appropriate treatment was successful in reducing mortality and severity. Accessing to basic neonatal care including SBR testing, LED phototherapy and G6PD screening can contribute to improve neonatal outcomes.
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MESH Headings
- ABO Blood-Group System
- Blood Group Incompatibility/complications
- Glucosephosphate Dehydrogenase Deficiency/complications
- Hospitalization
- Humans
- Hyperbilirubinemia, Neonatal/complications
- Hyperbilirubinemia, Neonatal/epidemiology
- Hyperbilirubinemia, Neonatal/mortality
- Hyperbilirubinemia, Neonatal/therapy
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/therapy
- Myanmar/epidemiology
- Phototherapy
- Retrospective Studies
- Risk Factors
- Thailand/epidemiology
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Affiliation(s)
- L. Thielemans
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôspital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Trip-Hoving
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - J. Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - C. Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - T. J. Prins
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - E. M. N. Wouda
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- University of Groningen, Groningen, The Netherlands
| | - B. Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Salaya, Thailand
| | - C. Po
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - C. Beau
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - M. Mu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - T. Hannay
- University of Glasgow, Glasgow, Scotland UK
| | - F. Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - B. Van Overmeire
- Neonatology-Pediatrics, Cliniques Universitaires de Bruxelles - Hôspital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - R. McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - V. I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
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Beau C, Vivian N, Münsterberg A, Dresser DW, Lovell-Badge R, Guerrier D. In vivo analysis of the regulation of the anti-Müllerian hormone, as a marker of Sertoli cell differentiation during testicular development, reveals a multi-step process. Mol Reprod Dev 2001; 59:256-64. [PMID: 11424211 DOI: 10.1002/mrd.1030] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anti-Müllerian hormone (AMH) is a member of the TGF-beta family which elicits its main action during male sex differentiation. This hormone is probably the most convenient marker of Sertoli cell differentiation and maturation throughout testicular development. Studying AMH gene regulation may thus be one way of identifying effectors of Sertoli cell differentiation. To this end we first tried to locate and then to characterise DNA elements responsible for in vivo transcriptional control of AMH expression. We obtained transgenic mice expressing a reporter gene (LacZ), under control of various putative AMH regulatory sequences. Analysis of transgenic animals revealed that activation of the AMH gene probably requires a two-step regulatory process. The first step corresponds to the initial activation of the AMH gene occurring at around 12.0 dpc. It requires the presence of regulatory DNA encompassed within a maximum of 370 bp upstream of the translation start site of the gene, delimited by the presence of an upstream housekeeping gene (SAP-62). Following this initial transient phase, a second phase seems to account for the persistence of AMH gene expression until the onset of puberty. As the 370 bp regulatory region is not sufficient on its own to allow the triggering of this second phase, it seems possible that additional control elements are required for normal AMH expression throughout testicular development. The complete array of regulatory elements remains to be located. Mol. Reprod. Dev. 59:256-264, 2001.
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Affiliation(s)
- C Beau
- GERM/INSERM U435, Université de Rennes 1, Campus de Beaulieu, Rennes Cedex, France
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Abstract
Anti-Müllerian hormone (AMH), also known as Müllerian inhibiting substance (MIS), is one of the earliest and best-known markers of Sertoli cell differentiation and is expressed until around puberty. The present study is aimed at the better understanding of the molecular pathways involved in testicular development and establishment of adult functions with regards to AMH regulation. We found, within the mouse AMH promoter, putative GATA motifs (A/T)GATA(A/G), known to be specifically bound by members of the GATA transcription factor family. We then carried out RNase protection assays and immunohistochemical techniques aimed at comparing precisely the chronological expression patterns of AMH and GATA-1, this latter being expressed in the testis after birth. Using both approaches we found an inverse and close relationship between AMH and GATA-1 mRNA and protein expression during the pre-pubertal period. These results allowed us to define a transitory 4-5-day period, starting from 3 dpp when both proteins are heterogeneously expressed in Sertoli cells and showed that the appearance of GATA-1 is associated with the decrease of AMH expression in these cells. Furthermore DNA-protein interaction in in vitro studies showed first that GATA-1 binds with various affinities on sites found in the AMH promoter and second that the proximity of the two strongest affinity sites leads to a synergistic binding effect. Altogether, the present study suggests that GATA-1 participates in AMH gene repression during the pre-pubertal period.
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Affiliation(s)
- C Beau
- GERM/INSERM U. 435, Université de Rennes 1, Rennes, Bretagne, France
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