Nothing in Excess: Physical Activity, Health, and Life World in Senegalese Fulani Male Pastoralists, a Mixed Method Approach.

OBJECTIVES: The goal of this study was to evaluate the application of the short form of the International Physical Activity Questionnaire Survey (IPAQ-SF) in the rural Senegalese Fulani pastoralist population by combining quantitative and qualitative methods. DESIGN AND PARTICIPANTS: For the quantitative method, 101 men completed the IPAQ-SF questionnaire measuring moderate, vigorous, and walking physical activity. Self-rated health, BMI, and sociodemographic variables were also collected. With regard to the qualitative methods, a total of 22 participants were recruited and interviewed. Four themes were addressed, including (i) physical activity (PA) and its definition, description, related experiences, and representations of social actors; (ii) PA and health; (iii) PA and sport; and (iv) the body and Fulani world of life (i.e., Pulaagu/Ndimaagu). RESULTS: Sahelian herders have a high level of self-reported PA and a low amount of daily sitting time. The measure of PA as proposed by the IPAQ-SF is not adapted to the Senegalese Ferlo pastoralists, mainly because this scale gives too much importance to leisure-time PA, perceived as unproductive energy expenditure, which is factually and symbolically antinomic to the Fulani lifeworld. Thus, neither intense nor moderate PA is related to self-rated health. However, sedentary lifestyles are linked to self-rated health and, therefore, to mortality and morbidity in Fulani pastoralists. Finally, walking, which is the dominant PA during transhumance and herd surveillance, is related to BMI. It therefore represents a protective factor against the occurrence of overweight and associated chronic non-communicable diseases. CONCLUSION: The mixed method approach developed in this study has shown that the IPAQ-SF is not a valid measure of PA in the population of Fulani male herders from the Ferlo region, given that unproductive energy expenditure is incompatible with the Fulani way of life, which condemns excess and immoderation.

[Tagravpa: Help table and grid for identifying the risk of aggravation and early rehospitalization of elderly persons 75 years and older referred to emergency departments and/or hospitalized in care units]. / Tagravpa : Tableau d'aide et grille de repérage du risque d'aggravation et de réhospitalisation précoce des personnes âgées de 75 ans et plus adressées aux urgences et/ou hospitalisées dans les unités de soins.

People aged 75 and over, frail or dependent are the most frequently hospitalized, particularly via the emergency department, and are sometimes readmitted to hospital less than a month after their discharge. Article 70 of the 2012 social security financing act has set up experiments aimed at improving the care pathway for the elderly. In this context, Marseille University Hospital has developed a table of help and grid for identifying the risk of aggravation of the elderly (Tagravpa). Comprising nine medical-psycho-social items, the grid enables the identification of the risk of aggravation to which is associated a score for identifying the risk of early re-hospitalization for the modeling of care pathways. A study was conducted in two departments. In cardiology for readmission at 1 month the results showed a grid positivity threshold of 6 for sensitivity measured at 56,6% (95% CI: 22,7-84,7) and specificity of 61,5% (95% CI: 40,7-79,1). In Emergency Department the results showed a positivity threshold of 4 for sensitivity at 83,3% (95% CI: 57,7-95,6) and specificity at 45,5% (95% CI: 36,8-54,3). This grid, called TAGRAVPA appears as a simple tool for identifying the risk of early re-hospitalization. It is applicable in a hospital environment, whatever the department and allows the initiation of an adapted path for the elderly person hospitalized or returning home from the emergency department.

Age estimation from the biometric information of hand bones: Development of new formulas.

INTRODUCTION: In the judicial context of the age estimation of living individuals, a new method was recently proposed, based on the collection of biometric information on hand bones radiographs. The aim of this study was to apply this method to a large French sample to provide new tools for age estimation MATERIALS AND METHODS: The study sample consisted of metacarpals and proximal phalanges measurements of 1003 individuals aged less than 21 years. This sample was divided into two subgroups 1-12 and 13-21 years as the age of 13 is a relevant legal threshold for most European countries. A quadratic discriminant analysis was performed to identify the group to which an individual was most likely to belong. Age estimation formulas were also constructed from linear models: for each subgroup and the total sample. RESULTS: The belonging of an individual to the 1-12 or 13-21 subgroup was determined with a correct classification rate of 89.8%. Age estimation formulas became less precise with age, with a mean absolute error ranging between 11 and 21 months. CONCLUSION: We proposed a two-step procedure for age estimation: firstly, the identification of the age group to which the individual is most likely to belong, and secondly, the age estimation of this individual by applying the appropriate formula.

Cone beam computed tomography analysis of the edentulous mandibular symphysis.

BACKGROUND/PURPOSE: Overdenture with single symphyseal implant is one of the useful clinical approach for elderly edentulous patients. We aimed to evaluate edentulous patients with regards to the relationship between dimensions, bone characteristics, cancellous densities, and cortical thickness of the mandibular symphyseal region using cone beam computed tomography (CBCT). MATERIAL AND METHODS: We analyzed 103 CBCT from pre-implant investigations. All included patients were healthy without any disorders affecting bone metabolism. We performed 13 measurements for each patient: 9 of height, width, and thickness (mm) and 4 of density (Hounsfield Units; HU). Fisher's exact test was applied to examine the association between two categorical variables, the Pearson correlation coefficient to measure the strength of linear relationship between two quantitative variables. We used the two-sample Student's t-test to compare mean symphysis height between men and women, the paired Student's t-test to compare mean lingual and buccal cortical thickness. For all tests, the threshold of significance was fixed at 5%. RESULTS: Men and women significantly differed with regards to mean total symphysis height (p = 0.004) and the distribution of Cawood and Howell classifications (p = 0.033). Symphysis height was negatively correlated with mean density of cancellous bone (r = -0.453, p < 0.001). Mean lingual cortical thickness significantly differed from mean vestibular thickness (p < 0.001, paired Student's t-test). CONCLUSION: Present findings supported that symphyseal measurements are parameters that reflect the symphysis bone characteristics, and can guide the choice of a suitable implant design.

Preoperative simplified geriatric assessment in planned hip and knee arthroplasty.

INTRODUCTION: Hip and knee arthroplasties are the most common planned orthopedic surgical procedures in older persons. It would be useful to identify frailties before surgery to improve the outcome of older patients. PURPOSE: The objective of this work was to identify the criteria of a simplified comprehensive geriatric assessment (mini-CGA) that were associated with unplanned hospital readmission and postoperative complications within 3 months after the planned hip and/or knee arthroplasty in patients ≥ 65 years. METHODS: This prospective study was carried out in the orthopedic department of Marseille University Hospital from January to May 2019. A mini-CGA was performed preoperatively. RESULTS: One hundred four patients were included in the study. The rate of early readmission within 3 months after surgery was 12.5% and the rate of postoperative complications was 40.4%. In multivariate analysis, dependence in the activities of daily living (ADL ≤ 5) was the only factor associated with unplanned readmission (aOR = 9.9, 95% CI 1.9-50.8), and living alone was the only factor associated with postoperative complications (aOR = 3.2, 95% CI 1.2-8.8). CONCLUSIONS: We found that the ADL score was associated with the risk of unplanned readmission in older patients undergoing planned arthroplasty, and that living alone was associated with postoperative complications. A preoperative mini-CGA appears essential to limit postoperative morbidity.

Maturation of the human foetal basioccipital: quantifying shape changes in second and third trimesters using elliptic Fourier analysis.

During prenatal development, the brain is considered the best maturation criterion for the estimation of foetal physiological age, regardless of the conditions of pregnancy. Unfortunately, the brain lyses very quickly after death, but fortunately, the brain also has a major influence over osseous structures of the cranial base during development. Therefore, we considered the osseous structures of the cranial base potential indirect maturation indicators of foetal age. Because of its early formation and robustness, the basioccipital is a cranial base bone that is often used for studies in biological anthropology. Studies generally use conventional morphometry and bone size ratio to highlight morphological changes occurring during the foetal period and to create age estimation methods. These methods usually define thresholds beyond which the morphology of the basioccipital changes, but do not fully consider the form that might be valuable precisely to visualize its development or improve age estimation methods. Using geometric morphometric methods, the present study aims to analyse the development of the basioccipital during the second and third trimesters of foetal life by quantifying and visualizing shape changes in the inferior view. Basioccipital shapes are used as direct indicators of the maturation of the cranial base and as indirect indicators of the maturation of the brain and, by extension, the whole body. A sample of 221 anonymized computed tomographic (CT) scans of normal foetuses, ranging from 18 to 41 gestational weeks (GW), was used. Elliptic Fourier analysis (EFA) was used to quantify the basioccipital outline, and maturation stages were established to visualize shape changes with a principal component analysis. Our study allowed us precisely to quantify and continuously visualize shape changes occurring during prenatal life. Additionally, this study provides the first evidence of two distinct linear shape trajectories of the basioccipital. Foetuses aged between 18 and 26 GW have a rapid shape change with well-individualized stages, whereas shape changes are less visible in the second trajectory (27-41 GW). Furthermore, intra-stage shape variation is higher for the basioccipital at the beginning of the second and third trimesters than at the first trimester. By using geometric morphometric methods and EFA, this study shows that it was possible to go beyond classical methods. Indeed, the developed methodology enabled the first quantification of the overall shape changes of the basioccipital between gestational ages. The morphological shape changes throughout the foetal period can be useful for anthropological studies and provide new perspectives for immature age estimation methods.

Development of a biometric method to estimate age on hand radiographs.

Age estimation of living individuals aged less than 13, 18 or 21 years, which are some relevant legal ages in most European countries, is currently problematic in the forensic context. Thus, numerous methods are available for legal authorities, although their efficiency can be discussed. For those reasons, we aimed to propose a new method, based on the biometric analysis of hand bones. 451 hand radiographs of French individuals under the age of 21 were retrospectively analyzed. This total sample was divided into three subgroups bounded by the relevant legal ages previously mentioned: 0-13, 13-18 and 18-21 years. On these radiographs, we numerically applied the osteometric board method used in anthropology, by including each metacarpal and proximal phalange of the five hand rays in the smallest rectangle possible. In that we can access their length and width information thanks to a measurement protocol developed precisely for our treatment with the ORS Visual® software. Then, a statistical analysis was performed from these biometric data: a Linear Discriminant Analysis (LDA) evaluated the probability for an individual to belong to one of the age group (0-13, 13-18 or 18-21); and several multivariate regression models were tested for the establishment of age estimation formulas for each of these age groups. The mean Correlation Coefficient between chronological age and both lengths and widths of hand bones is equal to 0.90 for the total sample. Repeatability and reproducibility were assessed. The LDA could more easily predict the belonging to the 0-13 age group. Age can be estimated with a mean standard error which never exceeds 1 year for the 95% confidence interval. Finally, compared to the literature, we can conclude that estimating an age from the biometric information of metacarpals and proximal phalanges is promising.

Age at menarche in a group of French schoolgirls.

BACKGROUND: Mean age at menarche in France decreased from 12.78 years in 1979 to 12.6 years in 1994. The aim of this study was to determine mean age at first menstruation in French adolescent girls in order to study the secular trend. METHODS: Age at first menstruation was noted to the nearest month during recording of anthropometric measurements in three secondary schools in the Aisne administrative department, France, in classes in years 7, 8, 9 and 10. A total of 339 girls aged 11-15 ½ years were examined. The majority were from a social background of workers, employees and middle managerial staff. Mean age at first menses and standard deviation were calculated using the probits method. RESULTS: Mean age was 12.5 ± 0.08 years (χ(2) γ=14 = 16.7, P > 0.05), indicating that it had remained stable for more than 15 years. CONCLUSIONS: A secular decline has already been observed in Belgium, Britain, Hungary, Scandinavia and the USA. In all these countries, age at menarche has reached a stable level at around 13 ± 0.5 years.

Body Fat Mass Assessment: A Comparison between an Ultrasound-Based Device and a Discovery A Model of DXA.

Objective. To examine measurement of body composition by ultrasound compared with a reference technique:dual energy X-ray absorptiometry (DXA). We evaluated the accuracy of a portable ultrasound-based device in estimating total body fat mass with those assessed by DXA in adult. Methods. Body fat mass has been estimated using a portable ultrasound-based device in comparison with a contemporary reference DXA apparatus: the Hologic Discovery A. Anthropometric data has been assessed in order to maximize the output of the software associated with the ultrasound-based device. A cross-validation between ultrasound technique (US) and DXA was developed in this study. Total body fat mass estimated by ultrasound was compared with this DXA model in a sample of 83 women and 41 men. Results. Ultrasound technique (US) of body fat (BF) was better correlated with DXA in both women (r (2) = 0.97, P < 0.01) and men (r (2) = 0.92, P < 0.01) with standard errors of estimates (SEE) being 2.1 kg and 2.2 kg, respectively. Conclusion. The use of a portable device based on a US produced a very accurate BF estimate in relation to DXA reference technique. As DXA absorptiometry techniques are not interchangeable, the use of our ultrasound-based device needs to be recalibrated on a more contemporary DXA.

[Secular trends in anthropometrical measurements observed in three to 11-year-old French children between 1953 and 2005]. / Évolution séculaire des dimensions anthropométriques chez des enfants français âgés de trois à 11ans, entre 1953 et 2005.

This study covers a fifty-year period between 1953 and 2005 and looks at secular trends in stature, weight and sitting height sizes among French boys and girls between the ages of 3 and 11. A special modelling in function to the age and variable for each child was established so that a comparison could be made in the kinetic growth patterns over these same two periods. Statistical analysis shows a significant increase in growth, of 0.8cm per decade in stature, characterised by a certain increase in the lower limbs and the weight (0.8kg per decade) together with a proportional increase on the body mass index. Positive secular trends of this anthropometric nature are generally thanks to improved eating and sanitary habits and this study enables us to build and elaborate new standards in growth patterns essential for monitoring auxological development in 3 to 11-year-old children in the years 2000 and onwards.

Estimation of gestational age from tooth germs: Biometric study of DentaScan images.

The few available studies on fetal age estimation concern very small samples, and statistical analysis is sometimes inadequate. In this survey, we used germs of deciduous teeth to estimate fetal age. Forty-nine fetuses and 40 mandibles were scanned, and observations and measurements were made on DentaScan images. After checking their repeatability and reproducibility (analysis of variance), we defined thresholds using Fisher's linear discriminant analysis to calculate the probability that a fetus was over or below a predefined age threshold. The forensic threshold which is of particular interest in France is 22 weeks amenorrhea. Relationships between fetal age and deciduous germ measurements were then sought by multiple linear regression. The thresholds gave very good results: 91.84% of good probability for the threshold of 22 weeks amenorrhea with no chance of error. The most precise age evaluation obtained nevertheless gave a range of ±4.6 weeks amenorrhea, so greater accuracy is still needed.

Child pedestrian anthropometry: evaluation of potential impact points during a crash.

This paper highlights the potential impact points of a child pedestrian during a crash with the front end of a vehicle. Child anthropometry was defined for ages between 3 and 15 years. It was based on the measurement of seven different segment body heights (knee, femur, pelvis, shoulder, neck, chin, vertex) performed on about 2,000 French children. For each dimension, the 5(th), 50(th) and 95(th) percentile values were reported, and the corresponding linear regression lines were given. Then these heights were confronted with three different vehicle shapes, corresponding to a passenger car, a sport utility vehicle and a light truck, to identify impact points. In particular, we show that the thigh is directly hit by the bumper for children above 12 years of age, whereas the head principally impacts the hood. The influence of child anthropometry on the pedestrian trajectory and the comparison with test procedures in regulation are discussed.

Ultrasound measurement of total body fat in obese adolescents.

BACKGROUND/AIMS: To compare body fat (BF) measurements obtained with a new ultrasound method with those assessed by dual-energy X-ray absorptiometry (DEXA) in obese adolescents. METHODS: In 94 adolescents (57 females and 37 males) aged 12-19 years and body mass index (BMI) exceeding 30 kg.m(-2), the z-score BMI for age was 6.7 (adolescent girls) and 6.6 (adolescent boys) >97th percentile. BF was measured using DEXA and a method based on ultrasound measurements, body weight, height, abdominal circumference and mid-thigh circumference. RESULTS: Obesity class I was noted in 39%, II in 28% and III in 33% of the patients. BF by ultrasound correlated closely with BF by DEXA, in both females (r = 0.958) and males (r = 0.981), with standard errors of the estimates (SEE) being 2.9 and 2.5 kg, respectively. The ultrasound method was more accurate than the skinfold technique (n = 24; SEE: 2.2 vs. 6.5 kg, respectively). In 13 adolescents who had marked weight loss after 6 months of treatment, the decrease in DEXA-measured BF correlated closely with the decrease in ultrasound-measured BF (r = 0.95). CONCLUSIONS: Our innovative portable ultrasound technique has advantages in terms of reliability, reproducibility, accuracy and costs for screening and monitoring obese adolescents. A patent application has been submitted. Our method should prove valuable for epidemiological studies.

[Probabilistic approach to age estimation of children by dental maturation]. / Approche probabiliste de l'estimation de l'âge chez l'enfant à partir de la maturation dentaire.

Two probabilist methods of age prediction in children are proposed: they are both based on the radiological presence of erupted teeth or germs. Using an apprenticeship sample of known age and sex, we established several discriminant models (+/- 13, +/- 16, +/- 18 years old). We also evaluated a Bayesian model with the following age groups: < 13, [13-16[, [16-18[, > or = 18 years old, or [X and Y] years old. When applied on a known test sample, Fisher's linear functions presented a success rate greater than 90%, above 13 years threshold, and below 16 and 18 years thresholds, and Bayesian approach, greater than 85%. Therefore, these methods provide an interesting alternative for children age determination that can be applied in biological and forensic anthropology, too.

New forensic approach to age determination in children based on tooth eruption.

The present study proposes equations for age determination both in living and dead children, obtained with the help of stepwise ascending multiple linear regression. The equations should be applied, based on the number of erupted teeth and tooth germs, which were detected on radiographs, during clinical examination and in infant skeletal remains. The proposed equations proved to be efficient just like Demirjian's method used as a reference today, and permit age estimation till 20 years of age.