[Why is perinatal and infant mortality high in the Seine-Saint-Denis district? A consultation with healthcare providers using a Delphi process]. / Quelles sont les causes de la mortalité périnatale et infantile élevée en Seine-Saint-Denis ? Consultation des professionnels du département par un processus Delphi.

OBJECTIVE: In Seine-Saint-Denis, stillbirth and infant mortality rates are markedly higher than in other French departments. Before implementing an audit on stillbirths and neonatal deaths in 2014, we carried out a Delphi consensus process with healthcare providers to generate research hypotheses. MATERIALS AND METHODS: A Delphi process in 3 questionnaires was conducted in 2013 with 32 healthcare providers (pediatricians, obstetricians, general practitioners, midwives, social workers, psychologists, pediatric nurses) and user representatives. The first questionnaire asked open questions about why mortality rates were higher and possible solutions to remedy the situation. In subsequent questionnaires, the panel ranked factors identified in the first questionnaires by importance. RESULTS: One hundred and thirty factors were identified from 42 pages of text responses in the first round. From these, the 75 most highly ranked were grouped into 14 main topics organized around three themes: 1) more underlying health problems in the population, 2) access and organization of care, 3) the health consequences of poor socioeconomic conditions. Coordination of care, provider and patient communication, and access to care were highlighted. CONCLUSION: The Delphi consensus process identified a wide range of hypotheses for the higher mortality in Seine-Saint-Denis which are adapted to the local context and based on the concerns of health practitioners.

Powdered milk micellar casein prevents oral colonization by Streptococcus sobrinus and dental caries in rats: a basis for the caries-protective effect of dairy products.

Three animal studies were performed to investigate the influence of the macromolecular structure of milk casein on caries incidence and the possible ecological changes of the oral microbiota by such casein fractions. Towards this end, rats were infected with mixed bacterial suspensions of Streptococcus sobrinus OMZ 176 and Actinomyces viscosus Ny1. Various milk protein fractions were incorporated into carefully balanced powdered cariogenic diets to constitute the sole major protein component. Diets containing micellar casein had a pronounced and highly significant effect on almost all clinical and microbiological parameters examined. Both the formation of advanced dentinal fissure (B) and smooth surface (E) caries lesions was inhibited by diets containing micellar casein; this caries-inhibiting effect appeared to be due mainly to modifications within the plaque microbiota. The proportion of S. sobrinus in the oral cavity of rats was reduced (73-80%) by micellar casein-containing preparations, whereas the A. viscosus population was increased. Both these microbiological parameters were always negatively correlated. This appears to be the first example of a food component other than dietary sugars, selectively modifying the composition of the dental plaque microbiota of rats in such a way as to reduce its pathogenic potential. It also demonstrates the importance of establishing a molecular basis for the role of food components, which prove to be beneficial to oral health.

Technical aspects of phosphorus reduction and mineral adaptation in infant formulae.

Adapted milk-based formulae are complex products which simulate the protein and mineral composition of breast milk. The desired casein-to-whey protein ratio (40:60) in these formulae could be obtained by mixing cow's milk and whey. Unfortunately, this would yield formulae with too high a mineral content and a very unfavourable Ca:P ratio. The adjustment of the mineral content and the Ca:P ratio is the most sophisticated step in manufacture of such formulae. For this purpose, whey is demineralized with ion-exchange resins, electrodialysis or a combination of both processes. The demineralized whey (DW) obtained must be standardized in minerals by the addition of well-selected salts. After the standardization, whey is pasteurized, concentrated and dried, to give finally, the demineralized and standardized whey powder (DWPS). Addition of this ingredient to whole milk or skim milk leads to the standard adapted milk-based formula. Partial replacement of milk in the standard formula by caseinate leads to a low-phosphate formula with a Ca/P ratio equivalent to that found in breast milk. Because DWPS is quantitatively the most important ingredient of adapted milk-based formulae, the second most important being cow's milk, the nutritional and processing quality of DWPS strongly affects the heat stability and the nutritional and final quality of such formulae.

Tryptic phosphopeptides from whole casein. II. Physicochemical properties related to the solubilization of calcium.

Casein phosphopeptides (CPP) were produced by tryptic hydrolysis of sodium caseinate and further purified by precipitation and chromatography on QAE-Sephadex A-25. Their physico-chemical properties were compared with the properties of an enzymically dephosphorylated equivalent preparation (DPP). Binding of Ca2+ to the peptides was measured using a Ca selective electrode and was found to increase with pH and to show 1/1 stoicheiometry Ca/Porg in CPP at pH 6.5 and 7.6. Klotz plots indicated equivalent binding sites at these two pH values, but some heterogeneity was seen at pH 3.5. In contrast, DPP did not bind significant amounts of Ca2+. CPP effectively inhibited the formation of insoluble calcium phosphates at different Ca/P ratios. The effective CPP concentration was 10 mg/l and complete stability of calcium phosphate solutions was obtained at about 100 mg/l. This stabilizing effect was dependent on the presence of organic P.