Very early signs of autism reported by parents include many concerns not specific to autism criteria

This study assessed parents’ first concerns about their autistic child. This information was categorized so that it could help healthcare professionals improve early detection of autism. We designed a questionnaire using an open-ended format, and 459 questionnaires were completed by parents to assess difficulties encountered in obtaining a diagnosis for their child. Answers about their first motive of concerns were categorized and compared with regards to age, gender, birth order, age of onset, delay in seeking professional advice, and delay in diagnosis. Concerns about social development or autistic behaviors were frequent, but not exclusive. Parents were divided into three clusters of concerns: (a) an “early awareness group”: which included motor problems and passivity (14.6 months); (b) “intermediate awareness group”: included emotional, hyperactivity, and sleep problems (15.3 months); and (c) a “later awareness group”: which included communication problems, poor social interaction, and autistic-type behaviors (22.3 months). Parents who noticed general concerns not specific to autism were worried earlier, but received a later diagnosis. We suggest that motor problems, and/or emotional problems, and/or the level of a child's activity should encourage frontline professionals to seek autistic symptoms in infants.     

Obstacles to comprehensive dental care in patients with sustained limitations of their decision‐making abilities: findings from a Delphi study

The objective of this study was to explore the therapeutic limitations experienced by a panel of special‐care dentists in France when treating patients with sustained limitations of their decision‐making abilities. We used a Delphi technique conducted in three rounds from 01 June 2014 to 30 September 2015. A first questionnaire comprising open‐ended questions was addressed to 72 panellists. A content analysis of the returned questionnaires served to draft a second questionnaire comprising closed‐ended questions; this was sent to the 28 panellists who responded in the first round. A third questionnaire was sent to the 20 panellists who responded in the second round to give them an opportunity to reconsider their response in the context of the second‐round response group. Sixteen panellists answered the last round. A large majority agreed on the importance of providing comprehensive care, but they encountered obstacles at two time points: (i) when proposing the care; and (ii) when setting it up. The panel put forward recommendations in two main areas: (i) the training of those involved in oral health decisions; and (ii) dental care management and organization of the care system. The study provided a foundation for building future orientations in health care for patients with limited decision‐making abilities.     

Blood lead levels and risk factors in young children in France, 2008–2009

BackgroundThe exposure of children to lead has decreased in recent years, thanks notably to the banning of leaded gasoline. However, lead exposure remains a matter of public health concern, because no toxicity threshold has been observed, cognitive effects having been demonstrated even at low levels. It is therefore important to update exposure assessments. A national study was conducted, in 2008–2009, to determine the blood lead level (BLL) distribution in children between the ages of six months and six years in France. We also assessed the contribution of environmental factors.MethodsThis cross-sectional survey included 3831 children recruited at hospitals. Two-stage probability sampling was carried out, with stratification by hospital and French region. Sociodemographic characteristics were recorded, and blood samples and environmental data were collected by questionnaire. Generalized linear model and quantile regression were used to quantify the association between BLL and environmental risk factors.ResultsThe geometric mean BLL was 14.9 μg/l (95% confidence interval (CI) = [14.5–15.4]) and 0.09% of the children (95% CI = [0.03–0.15]) had BLLs exceeding 100 μg/l, 1.5% (95% CI = [0.9–2.1] exceeding 50 μg/l. Only slight differences were observed between French regions. Environmental factors significantly associated with BLL were the consumption of tap water in homes with lead service connections, peeling paint or recent renovations in old housing, hand-mouth behavior, passive smoking and having a mother born in a country where lead is often used.ConclusionsIn children between the ages of one and six years in France, lead exposure has decreased over the last 15 years as in the US and other European countries. Nevertheless still 76,000 children have BLL over 50 μg/l and prevention policies must be pursued, especially keeping in mind there is no known toxicity threshold.