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B Blondel

Publications and source records attributed to B Blondel.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Home visits during pregnancy. Review of randomized studies and further questions].

OBJECTIVE: Review of randomized controlled trials concerning home visits during pregnancy. METHODS: Trials were identified from two data bases. Seven trials were retained in two categories: trials on social support and trials focusing on medical surveillance. RESULTS: Home visits focusing on social support led to a slight reduction nearly significant in preterm deliveries. In case of complication during pregnancy, home surveillance did not reduce the rate of preterm deliveries nor the number of hospitalizations. In general, home visits had a positive effect on the women in terms of social support health behavior and knowledge of medical problems. CONCLUSION: For women with complications, the absence of an effect on hospitalizations may be related to lack of coordination between hospital units and home surveillance units. For women at high risk because of psychosocial factors, the published trials do not provide satisfactory answers to the questions raised. Home visits should be evaluated by better integrating the knowledge of the effects of social support on health status at birth and the mother-infant relationship.

Female↗
PubMed1996

[Women with little or no prenatal care during pregnancy. Results of a study of twenty departments].

OBJECTIVES: To estimate the frequency of women who have little or no health care during pregnancy, to assess associated perinatal risk, and to identify the corresponding risk factors. METHODS: Women who consulted less than 4 times or who began consultation during the third trimester were identified in public and private maternity units in 20 French departments. These women were compared with a sample of women from the same institutions who consulted regularly. RESULTS: The percentage of pregnant women with little or no care was 1.1%. Risk of premature birth was increased 4-fold compared with women who consulted regularly. Women who consulted little were very young, multiparous or living alone with no health care insurance. These women stated that the reason for not consulting was that their pregnancy was not accepted, financial difficulties and administrative problems. CONCLUSION: The lack of regular medical care results from social obstacles, especially in foreign born women but is also related to personal problems which are difficult to identify and manage.

Adult↗
PubMed1995

Cell clones cured of persistent poliovirus infection display selective permissivity to the wild-type poliovirus strain Mahoney and partial resistance to the attenuated Sabin 1 strain and Mahoney mutants.

We report the isolation and characterization of HEp-2c cell clones obtained after two successive persistent poliovirus (PV) infections. Once cured, some of the cell clones displayed selective permissivity toward the wild-type Mahoney strain and partial resistance to particular mutants of this strain, including the Sabin 1 strain. Two cell clones, CI 4 and CI 10, were studied in greater detail. The cytopathic effects of Mahoney infection were comparable in the cell clones and in HEp-2c cells. The cytopathic effects of infection by Sabin 1 or Mahoney mutants were greatly delayed in CI 4 and CI 10. In the genomic region encoding the capsid proteins, determinants involved in the resistance of the cell clones to the Mahoney mutants were localized in the amino-terminal part of VP1 (amino acids 22 and 43), the B-C loop of VP1 (amino acids 94-102), and the loop of VP3 connecting its amino-terminal to beta strand B (amino acid 60). These genomic regions are thought to be involved in the early steps of viral infection. Virus adsorption was slower and less efficient on CI 10 cells than on parental HEp-2c cells. Virus adsorption was faster on CI 4 than on HEp-2c cells, and at least as efficient, but there was less receptor-induced structural modification of the capsid, a step that is required for decapsidation. Furthermore, infection of CI 4 by a Mahoney mutant in which the B-C loop of VP1 has been deleted was affected in the later steps of infection. These results indicate that, in cells cured of persistent PV infection, poliovirus multiplication was restricted at several stages and particularly at two steps of virus entry: adsorption and/or the uncoating transitions following adsorption onto the receptor.

Base Sequence↗
PubMed1995

[Usefulness of follow-up in pregnancies. Risk of pregnancies with not enough or no follow-up examinations].

The French system of antenatal care, based on financial incentive, recommends 7 antenatal visits for all pregnancies. Would fewer visits increase perinatal risk? The higher risk of low birthweight and perinatal mortality in women with little or no antenatal care is a well-known observation but data are certainly biased by socioeconomic and environmental conditions. In Western populations, for example, very high risk pregnancies are certainly under-represented in the little or no care comparison groups. Even if the effects of antenatal care may be underestimated, it is highly unlikely that extremely massive risks would be associated with few or no antenatal visits since even in the most favourable conditions, antenatal examinations cannot detect all the possible anomalies which can occur during pregnancy and available means of avoiding perinatal mortality are not perfect. The debate now focuses on optimal antenatal care. Are the 7 visits in France adequate? At present, are there risks of over-medicalization and excessive medical cost? Some answers to these questions may be forth coming from research projects. The perinatal plan, begun in France in 1994, will also provide recommendations for improving the quality of antenatal care.

Female↗
PubMed1995

Home visits during pregnancy: consequences on pregnancy outcome, use of health services, and women's situations.

This review of eight randomized controlled trials assessed two different types of home visits during pregnancy: (1) those offering social support to high-risk women; and (2) those providing medical care to women with complications. In both categories, pregnancy outcome was not improved when women received home visits. The summary odds ratio for preterm delivery (< 37 weeks) was 1.0 (95% CI: 0.8 to 1.1). Nor did the home visits decrease the rate of hospital admission for women with complications (mainly threatened preterm labor or toxemia); the corresponding summary odds ratio was 0.9 (95% CI: 0.7 to 1.2). Nevertheless in some trials home visits had positive effects on women (medical knowledge, support levels, health habits, and satisfaction). The randomized controlled trials provide little evidence that programs offering home visits are effective in improving either pregnancy outcome or the use of health services. A better integration of hospital and home services might allow a more rational use of health services for women with complications. In addition, we need to define more precisely the content of home visits providing social support. For this, further research is required on how emotional support, health education, and advice influence the health of women and infants and mother-child interactions.

Female↗
PubMed1995

Did preterm deliveries continue to decrease in France in the 1980s?

To study the trends in gestational age and birthweight in France, we compared data from three surveys that were based on representative samples of births in 10 French regions and were conducted in 1972, 1981 and 1988-89. Only single livebirths were considered in the analysis. The rate of preterm births decreased from 7.9% in 1972 to 5.8% in 1981 and 4.0% in 1988-89. The corresponding rates of children with a birthweight below 2500 g were 5.4, 4.3 and 4.7%. The mean birthweight of preterm babies born in 1988-89 was lower than the mean birthweight of those born in 1972 and 1981. The reduction in preterm births cannot be attributed to the improved accuracy of gestational age determination, but the general use of ultrasound may have played a major role in the apparent reduction of the mean birthweight of preterm babies.

Birth Weight↗
PubMed1995

[Psychological effects of embryonal reduction. From the decision making to 4 months after delivery].

The psychological effect of reducing the number of embryons was studied prospectively in two Paris hospitals. All women who had multifetal pregnancy reduction (n = 18) were contacted for interviews just after the operation, during pregnancy, and four months after delivery. The decision to reduce the number of embryons was painful and led to a guilty feeling. After operation, nearly one-half of the women suffered psychologically. To justify their decision, and contain their emotions, the women spoke of the problems related to having triplets and, most importantly, the medical arguements explained by the physician. Medical counselling is thus essential to help this couples at the time of the operation. The pregnancy period is almost always a period of calm for these women. Nevertheless, four months after delivery, 5 women expressed a psychological malaise related to the reduction, and 2 women refused to continue the study because they did not want to revive their suffering. This study shows that psychological problems are of major importance after multifetal pregnancy reduction and can occur several months after delivery. These negative conclusions should however be examined in light of the consequences if reduction had not been performed.

Adult↗
PubMed1994

Randomised controlled trial of routine cervical examinations in pregnancy. European Community Collaborative Study Group on Prenatal Screening.

Preterm delivery is strongly associated with neonatal mortality and morbidity. In some European countries, cervical examinations are used routinely during pregnancy to identify women at risk of preterm delivery. We sought to evaluate the efficacy and secondary effects of these routine cervical examinations. We did a randomised controlled trial in seven European countries, comparing two policies--namely, an attempt to do a cervical examination at every prenatal visit (2803 women) and avoidance of cervical examination if possible (2799). The median number of cervical examinations was 6 in the experimental group and 1 in the controls. There were 6.7% preterm (< 37 weeks) deliveries in the experimental group and 6.4% in the control group (risk ratio 1.05 [95% confidence interval 0.85-1.29]; non-significant). The low birthweight rate was 6.6% in the experimental group and 7.7% in the controls (non-significant). Premature rupture of membranes was not significantly more frequent in the experimental group (27.1% vs 26.5%). Our findings do not support the routine use of cervical examinations during pregnancy.

Adult↗
PubMed1994

Substitutions in the capsids of poliovirus mutants selected in human neuroblastoma cells confer on the Mahoney type 1 strain a phenotype neurovirulent in mice.

Poliovirus (PV) type 1 mutants selected in human neuroblastoma cells persistently infected (PVpi) with the wild-type Mahoney strain exhibited a mouse-neurovirulent phenotype. Four of the five substitutions present in the capsid proteins of a PVpi were demonstrated to extend the host range of the Mahoney strain to mice. These new mouse-neurovirulent determinants were located in the three-dimensional structure of the viral capsid; two of them (residues 142 of VP2 and 60 of VP3) were located in loops exposed at the surface of the protein shell, whereas the other two (residues 43 of VP1 and 62 of VP4) were located on the inside of the capsid. VP1 residue 43 and VP2 residue 142 substitutions were also selected in a PVpi derived from the attenuated Sabin strain. We suggest that the selective pressure of human neuroblastoma cell factor(s) involved in early steps of PV multiplication could be responsible for the arising of amino acid substitutions which confer adaptation to the mouse central nervous system to PV.

Amino Acid Sequence↗
PubMed1994

International infant mortality rates: bias from reporting differences.

International infant mortality statistics have caused concern in the United States, since the US ranking relative to other developed countries has declined since World War II. This paper suggests that there may be international differences in reporting of very-low-birthweight infants and perinatal deaths and that such reporting differences bias comparisons of national perinatal and infant mortality rates. Efforts must be made to adopt standard conventions for the inclusion of small, early infants and fetal deaths in rate calculations.

Bias↗
PubMed1994

[Two-year follow-up cohort studies on triplets: development of children and mother-child relationship].

BACKGROUND: The number of triplets births has increased during the last 15 years. The psychomotor development of triplets, problems concerning long-term relationships between the mother and her children and between the children themselves are still incompletely studied. PATIENTS AND METHODS: Eleven families with triplets, consecutively born at the Clinique Baudelocque, were assessed at home for 2 years by the same psychologist. IQ was measured in each child at the age of 2 years using the Brunet-Lezine test. At this age, all mothers completed the Symptom-Check List allowing to assess eventual relationship difficulties between the mother and their children. RESULTS: The psychomotor development of the children (IQ = 100) was similar to the mean score in the general population. The mother reported great physical fatigue during the first year after birth and psychological difficulties during the second year. They mentioned behavioral problems and difficult relationships among the triplets. They complained of not being able to fulfill the children's demands. In four families, more severe difficulties, potentially damaging the psychological well-being of the children, required an intervention during the survey. CONCLUSIONS: Improved and prolonged help to families with triplets is necessary, requiring the participation of pediatricians, nurses, psychologists, social workers and specialized people.

Child Development↗
PubMed1994

[Follow-up of mothers of triplets 2 years after delivery. Results of a longitudinal study].

The aim of the study was to assess the health of mothers of triplets, two years after delivery. As part of a longitudinal study, 11 mothers having delivered consecutively in clinique Baudelocque were interviewed at home. They reported considerable fatigue and stress. Four women suffered with anxiety and depressive symptoms and three of them used psychotropic medication. Considering the possible consequences of maternal depression upon the child development, one third of the children in the study are particularly at risk. These results showed that the difficulties experienced by mothers of triplets persisted and remained important even under favourable medical and social circumstances.

Child Development↗
PubMed1993

Poor antenatal care and pregnancy outcome.

OBJECTIVES: To characterize women receiving poor antenatal care and assess their perinatal risk. DESIGN: Computerized data. SETTING: Public hospital setting Paris (1987-1990). Comparison with representative sample in Ile-de-France region (n = 6423). METHODS: Poor attenders with less than 3 visits (n = 210) were compared with good attenders with 3 visits or more (n = 5631). RESULTS: Poor attenders were younger and had higher rates of perinatal mortality (4.7%), preterm delivery (Odds ratio 5.2:4.3-6.3) and low birth weight (Odds ratio 4.6:3.7-5.6). CONCLUSION: Women with poor antenatal care have a greater risk for adverse pregnancy outcome. This risk cannot be attributed to unfavourable living conditions only.

Adult↗
PubMed1993

Trends in multiple deliveries and infertility treatments in France.

OBJECTIVE: To point out the association between infertility treatments and the increasing number of multiple deliveries. DESIGN: Comparison over time of the incidence of multiple deliveries, the proportion of deliveries resulting from assisted conception (AC), and ovulation inductor sales. DATA: Use of existing statistics: vital statistics, surveys of AC centres and ovulation inductor sales. RESULTS: Between 1972 and 1989 the incidence of twin deliveries rose from 8.8/1000 to 11.2/1000, and the incidence of triplet deliveries from 0.9/10,000 to 4.4/10,000. This upward trend was particularly remarkable among women aged 30 to 39. Since 1978, the triplet delivery rates and the sales of Human Menopausal Gonadotrophin have been rising similarly. Between 1985 and 1989, 26 per cent of the triplet deliveries followed assisted conception and nearly 50 per cent were estimated to be due to ovulation inductor agents. CONCLUSIONS: The results suggest a strong influence of infertility treatments and especially ovulation inductor agents in the dramatic increase of triplet deliveries.

Adult↗