[Cross-sectional study of school integration of asthmatic children in a general population sample]. / Etude transversale de l'intégration scolaire des enfants asthmatiques issus d'un échantillon de la population générale.

AIMS: Asthma is one of the most frequently encountered chronic illnesses in children. The aim of the present study was to investigate the problem of integration of asthmatic subjects at school by assessing the reactions of parents and teachers, and also by considering the medical aspects. POPULATION AND METHODS: A cross-sectional random study was carried out during autumn 1994 including 4,251 primary school children aged between five and 14 years, and including teachers from 188 classes and 26 schools in Grenoble and its inner suburbs. The first screening questionnaire was completed by the parents, and data on 3,799 children were obtained; from this, 191 currently asthmatic children were identified. One hundred and forty-six parents of the identified asthmatics subsequently answered a second questionnaire on the severity of the illness and its effects on school attendance and educational activities. The 186 teachers from the schools involved were interviewed about their knowledge of the disorder, and about what they knew of the treatment and management of asthmatic children in school. RESULTS: It was found that the cumulative prevalence of asthma amounted to 7.6%, and that the prevalence over the previous 12-month period was 4.3%. Sixteen percent of the asthmatic children reported an asthma-associated school absence of more than six days during the six preceding months. In 45.2% of cases, physical exercise was responsible for an asthmatic attack, but premedication was used in only 21% of cases. Nine percent of the children had obtained a medical certificate which exempted them from participating in sports activities and physical exercise. Seventy-three percent of the parents had informed the teachers of their child's illness, but the information communicated was incomplete. It was found that the teachers did not have a thorough knowledge of the disorder, but that many of them (92.7%) would appreciate further information on the subject and on its management. Eighty-three percent of the teaching staff were unaware that the ministerial circular No. 93-248 of 22 July 1993 had been issued on the proposed management of chronic disorders at school, advocating a combined effort on the part of the parents, the child's physician, the school doctors and the teachers in setting up a concerted plan of action. CONCLUSIONS: This study has demonstrated that the school integration of asthmatic children remains problematical both as regards treatment and the pursuit of indoor and outdoor school activities. Integration could be improved by using parent-doctor-teacher liaison forms, thereby maintaining closer communication regarding the child's needs. When this is not sufficient, an individualized asthma management plan could be introduced in collaboration with the parents, doctors and teachers, which might result in improved treatment and integration of asthmatic children in school.

Back pain and spinal alignment abnormalities in schoolchildren.

OBJECTIVES: To study the prevalence of back pain and spinal alignment abnormalities in children aged 10 to 14 years; to define subsets of subjects with similar clinical profiles; and to identify factors associated with pain in the thoracic or lumbar spine. PATIENTS AND METHODS: 972 five- and nine-graders completed a back pain questionnaire at school and were examined by a school physician for spinal alignment abnormalities and for motion range limitation in the spine and/or lower limbs. Multivariate analysis was used to define clinical subsets and to identify factors associated with back pain. RESULTS: The point prevalence of back pain increased with age, from 14.3% in the ten-year-olds to 24% in the 14-year-olds. Girls were more likely than boys to report back pain, which was usually located in the low back. The prevalence of scoliosis increased with age and was higher in the girls. Multivariate analysis identified five clinical profiles: no spinal pain; nonserious spinal pain with no impact on medical service utilization or physical activities; spinal pain unrelated to an injury; injury-related spinal pain not treated by drugs or physical therapy; and injury-related spinal pain treated by drugs and physical therapy. Several factors associated with spinal pain were identified, with variations across the five groups.

[Pediatric anesthesia and pharmacokinetics of propofol administered at a constant rate]. / Anesthésie pédiatrique et pharmacocinétique du propofol administré a débit constant.

The pharmacokinetic properties of propofol given at a constant rate, were studied in 10 children. Propofol was administered at a dose according to I.C.I. Pharma advices. For minor surgery, a low quality of general anesthesia was observed in correlation with low plasma levels of propofol. An increase in dosage would be necessary in children above 8 years old.

[Anesthesia and intensive care of congenital diaphragmatic hernia. 10 years' development. Apropos of 21 cases]. / Anesthésie-réanimation des hernies diaphragmatiques congénitales evolution sur 10 ans. A propos de 21 cas.

A post-operative follow-up in 21 cases of Congenital diaphragmatic hernia (C.D.H.) was carried out on 2 groups of patients. The first consisted in patient treated a long time ago by different anaesthetic methods which were not very precise. The other sample was recent, and a strict anesthetic procedure was used, analgesia and curarization with mechanical ventilation. Post-operative complications decreased on the ratio of 1/7, the intensive care stay being halved. The overwhelming importance of the correct anaesthetic procedure was underlined. An overall survival rate of 76% gives hopes for a better future for patients suffering from this malformation.

[Closed-circuit anesthesia in children]. / Anesthésie en circuit fermé chez l'enfant.

The aim of this study is to demonstrate how easy and suitable is the closed system in infants and children. An original circuit, adapted from the Bain-Spoerel system, is used. Its principle is to draw-up the expired gas through a soda lime canister by a pump, whose flow is 14 l.min-1. ("Circuit Bisontin"). For this study, 20 infants and children underwent anesthesia with isoflurane, in spontaneous or mechanical ventilation (with a "bag in the bag" principle ventilator). The lowest body weight was 2.7 kg. The advantages are a minimal dead space and no expenditure of energy during spontaneous ventilation thanks to an internal high flow and the absence of internal one-way valve. Gas monitoring is achieved by a four gas analyser (Capbomac Datex).