[Unscheduled pediatrician office visits: A national survey]. / Enquête nationale sur les consultations non programmées en pédiatrie de ville.

INTRODUCTION: Unscheduled visits (UV) are defined as visits to the family pediatrician (FP) without an appointment or when the appointment was made less than 24h before. Because the number of FPs has decreased since the 2000s, the FP might be less available for UVs and that might be one of the reasons for the increase in emergency department visits. OBJECTIVES: The main objective of the study was to evaluate the proportion of UVs among visits with a FP. The secondary objective was to describe the daily activity of FPs. METHODS: In February 2012, e-mail requests were sent to 1022 FPs, asking them to complete an anonymous questionnaire online at the website of the French Association of Pediatricians in Outpatient Practice (AFPA). The questionnaire was about 1 day of activity. RESULTS: A total of 434 FPs participated in the study (42.5%). Among the 10,263 visits a day conducted by these FPs, 4574 were UVs (44.6% [95% CI: 43.6-45.5]). Two hundred and fifty FPs (59.5%) could not conduct one or more UVs because of a lack of availability. The number of children who were not treated on the same day because of a lack of availability was 959, i.e., 2.2 children per day and pediatrician. An absence of off-hour pediatricians in outpatient practice during weekends and during the night was reported by 61% (266) and 90% (391) of the FPs, respectively. CONCLUSION: FPs' activity includes a considerable number of UVs. However, a large number of UVs could not be made because of a lack of pediatricians' availability.

[Vitamin D status in 6- to 10-year-old children: a French multicenter study in 326 children]. / Statut en vitamine D des enfants de 6 à 10ans : étude nationale multicentrique chez 326 enfants.

OBJECTIVE: To assess the vitamin D status of children aged 6-10years in the French general population for whom no guidelines have yet been defined due to insufficient data. METHOD: The study was conducted during two winters with very different sunshine levels: 5 March to 17 April 2012 and 8 January to 16 April 2013 in 20 then 22 centers. Three hundred children (60 children for each year of age) attending an ambulatory care unit or outpatient department for a reason unrelated to vitamin D status were included at the end of winter in 20 hospital centers (ten centers in the northern half of France above latitude 46-47°N/Lille: 50°N and ten centers in the southern half of France below latitude 46-47°N/Marseille: 43°N). Centralized 25 hydroxyvitamin D (25(OH)D), alkaline phosphatase (ALP), and parathormone (PTH) assays were performed on leftover blood samples. The currently accepted normal range for 25(OH)D was used to define the following categories: ≤25nmol/L: severe vitamin D deficiency, 25nmol/L100nmol/L: high vitamin D status. A standardized questionnaire was used to collect the child's characteristics, use of a vitamin D supplement, and milk and dairy product intake. The cumulative number of hours of sunshine over the 90days prior to inclusion in each center was obtained from the Météo-France weather bureau. RESULTS: 25(OH)D assays were performed in 326 children; more than 95% of children received milk and dairy products and 38% had received a vitamin D supplement since starting the school year: 3.1% of children in the overall population presented severe vitamin D deficiency, 34.4% presented vitamin D deficiency, 53.1% had a sufficient vitamin D status, and 9.5% had a 25(OH)D concentration >100nmol/L with no impact on serum calcium and urinary calcium. Children living in the north of France generally had lower 25(OH)D levels than children living in the south of France. In the non-supplemented population (n=188), 5.3% of children presented severe vitamin D deficiency, 45.2% presented vitamin D deficiency and 48.4% had sufficient 25(OH)D levels. The percentage of children with severe vitamin D deficiency or vitamin D deficiency was twofold higher during the winter with poor sunshine compared to the sunnier winter with a less marked north/south difference. No case of severe vitamin D deficiency was observed in the supplemented population (n=119); 10-15% of children presented vitamin D deficiency and 22.7% had a 25(OH)D concentration >100nmol/L, while remaining within the acceptable range. Two cases of hypervitaminosis without hypercalcemia were identified: one after an unknown loading dose with a calcium/creatinine ratio in the normal range (0.8); for the second one, no additional information could be obtained. Vitamin D supplementation considerably reduced the north/south difference and the Winter1/Winter2 difference. A child not receiving a vitamin D supplement had a ninefold higher risk of vitamin D deficiency at the end of winter than a child receiving a vitamin D supplement (OR=8.8; 95%CI, 4.6-16.8). CONCLUSION: At least one-third of children aged 6-10years presented deficient 25(OH)D levels. None of the children receiving a vitamin D supplement presented severe vitamin D deficiency, only a small number of children presented vitamin D deficiency (n=16 (13.4%)), and no signs of overload were observed, while one half of non-supplemented children (n=95 (50.5%)) presented at least vitamin D deficiency at the end of winter. These results support the need for vitamin D supplementation during winter in children aged 6-10years.

[Prophylactic prescription of vitamin D in France: national multicenter epidemiological study of 3240 children under 6 years of age]. / Prescription prophylactique de la vitamine D en France : enquête épidémiologique multicentrique nationale chez 3240 enfants de moins de 6 ans.

AIMS: The aim of the study was to assess compliance with the current recommendations of prophylactic prescription of vitamin D via a multicentric cross-sectional epidemiological survey of 3240 children under 6 years of age. METHOD: Parent questionnaires and data from the health records of children presenting to the emergency departments of 25 teaching hospitals and hospital centers provided information on the children's characteristics, their prescriptions, and other vitamin D intake. Based on the currently applicable recommendations, intakes of 600-1,200 IU/day - 900-1500 IU/day for children with pigmented skin and/or premature and/or hypotrophic children - are considered adequate. RESULTS: In 1606 infants, 9.8% of the prescriptions were below and 23.7% were above the recommendations; in 1256 children between 18 months and 5 years of age, 53.4% of the prescriptions were below and 5.1% were above the recommendations. Children at risk, those from the southern half of France, and those between 18 months and 5 years of age were more likely to receive a prescription below the recommendations; their risk of receiving a prescription above the recommended guidelines was smaller. Of the children aged between 61 and 71 months, 85% had not received any prescription at all during the previous 12 months. These results were compared with the laboratory data collected from a subsample of children. There was a significant correlation between the adequacy of the prescription and the biological vitamin D status both for 25-hydroxyvitamin D (25-OH-D) serological concentrations and for calciuria. CONCLUSIONS: Only 66.6% of the prescriptions in children between 0 and 18 months of age and 41.5% in children between 19 months and 5 years of age comply with the recommendations; 53.4% of the prescriptions in the latter age group are below the current recommendations.

[Parents' attitudes towards childhood fever. A cross-sectional survey in the Lyon metropolitan area (202 cases)]. / L'attitude des parents face à la fièvre de leurs enfants. Une enquête transversale des résidents de l'agglomération lyonnaise (202 cas).

INTRODUCTION: The patient overload in pediatric healthcare facilities is caused in part by parents bringing their children in for consultations for fever. We conducted a survey in the Lyon metropolitan area to improve our understanding of parents' attitudes towards their children's fever. OBJECTIVE: To assess the frequency and characteristics of healthcare utilization and evaluate parents' knowledge and attitudes before consulting. METHODS: A random sample of families with at least one child under 6 years of age and living in the Lyon metropolitan area was surveyed by telephone, according to a closed questionnaire that was answered by the person usually responsible for the child's health. RESULTS: 202 families were questioned: 58.9% defined fever as a temperature over 38 degrees C, and 82% used rectal thermometers to measure temperature. Among 144 parents of children with an episode of fever within the previous 12 months, 73% called a physician during the episode, 44% of them immediately. Working-class parents called more frequently (90%) than parents who were professionals or managers (74%). Most parents (94%) administered medication to the child several times before calling the physician. Paracetamol and ibuprofen were mentioned most often. 93% of fever episodes led to consultations. DISCUSSION: Our results show that 59% of the sample defined fever as a temperature equal to 38 degrees C and that fever episodes lead commonly and quickly to physician visits, but that parents do use physical methods and drugs to reduce fever before calling a physician.

[Acute paediatric care and unplanned consultations - a survey in health care facilities in the "Grand Lyon" area]. / Urgences pédiatriques et consultations non programmées - enquête auprès de l'ensemble du système de soins de l'agglomération lyonnaise.

UNLABELLED: With the increasing number of emergency paediatric consultations, two surveys "on a given day" were performed in the "Communauté Urbaine de Lyon", with the aim of analyzing the causes, circumstances, and relevance of these unplanned consultations, as well as a better understanding of the itinerary of these patients. METHODS: Unplanned consultations concerned children less than 18 years old seen in consultation on Saturday April 21, and Thursday December 13, 2001, in all medical facilities capable of delivering emergency paediatric care. Data collection was performed by filling out a questionnaire given to the family and the physicians (general practitioner who were chosen randomly, or paediatricians volunteering for the study), working in general medicine sectors, at the outpatient emergency consultation of the "Groupement des Pédiatres du Lyonnais", and in all the emergency departments to which children could be addressed (public hospitals and private clinics). "SOS Médecins" did not participate in this study but communicated its activity a posteriori. Six hundred and eighty three consultations on the Saturday and 1183 on the Thursday were analyzed. RESULTS: An estimation of the total number of consultations was performed taking into account the proportion of practitioners participating in the survey, with a total number of 1813 consultations on the Saturday and 4576 on the Thursday. Consultations in the private setting (by practitioners or organized emergency centers) accounted for 82% on the Saturday (general practitioners 70%, paediatricians 12%) and 93% on the Thursday (general practitioners 75%, paediatricians 18%), public hospitals 13% and 4% and private clinics 5% and 2%, respectively. Parents considered the problem to be serious in 10-40% of the cases, depending on the setting. The reason justifying consultation was generally medical (pain or discomfort, fear of complication, less frequently feeling of imminent danger). Non-medical reasons (proximity of the week-end, personal reasons, absence or unavailability of usual practitioner) concerned a fourth of the Thursday consultations and up to half of the Saturday consultations. An urgent consultation was estimated not be justified in 13% of the cases according to the physicians. The main reason for going to a hospital was that "everything would be available on site". On Saturday the absence of the usual practitioner was the most cited reason. The global itinerary was deemed satisfactory by the physicians in 82% of the cases. CONCLUSION: Unplanned consultations are found in three situations: routine and accepted activity of medical office (consultation without an appointment), urgent medical problem (or estimated to be urgent), and the result of a dysfunction between the medical possibilities of the health care system and its use by the parents. This last point opens two possibilities of action which are the information and education of families and the networking of physicians involved in emergency consultations with the aim of reducing hospital consultations by 15-20%.

[Emergencies during the three months after leaving the maternity hospital]. / Urgences des 3 premiers mois suivant la sortie de maternité.

Parents are aware that young age is a risk factor and are more likely to take an infant to the emergency room than an older child with similar symptoms. It is essential that the physician rapidly responds to the concerns of such parents. It is not possible to exhaustively address in a few pages all of the potential emergency conditions that may arise with infants younger than three months. We therefore focus our discussion to the most frequently occurring emergency conditions. In particular, we emphasize the serious nature of such conditions as fever, apparent life threatening, hyperbilirubinemia, weight loss, and excessive crying.

Incidence of upper respiratory tract Mycoplasma pneumoniae infections among outpatients in Rhône-Alpes, France, during five successive winter periods.

In this prospective study, nasal swab samples from patients with acute respiratory infections were evaluated for the presence of Mycoplasma pneumoniae. This PCR-plus-hybridization-based detection was associated with the detection of other viral agents. During the five winter surveillance periods, 3,897 samples were collected by 75 medical practitioners participating in the Groupe Régional d'Observation de la Grippe surveillance network in Rhône-Alpes (France). M. pneumoniae was detected in 283 samples (7.3%); its rate of detection ranged from 10.1 to 2.0% over the five periods, and it was the second most frequently isolated pathogen during the survey, after influenza A. Three high-prevalence winters were observed, yielding an early winter peak of M. pneumoniae infection which was observed in all age groups. No statistically significant difference was detected between rates of infections in the different age groups, but M. pneumoniae infection was significantly related to lower respiratory tract infection during periods of high prevalence. This study defined the frequency of M. pneumoniae detection from nasal swab specimens in patients with acute respiratory infections, confirming its high prevalence and the presence of large outbreaks due to this pathogen.

Immunogenicity and reactogenicity of a booster dose of diphtheria, tetanus, acellular pertussis and inactivated poliomyelitis vaccines given concurrently with Haemophilus type b conjugate vaccine or as pentavalent vaccine.

BACKGROUND: The high reactogenicity of whole cell pertussis vaccines discourages their use in children. While acellular pertussis vaccines are less reactogenic, their use in diphtheria-tetanus-acellular pertussis (DTPa)-based combinations with Haemophilus influenzae type b conjugate vaccine (Hib) and poliomyelitis vaccines must be evaluated. OBJECTIVES: To assess the immunogenicity and reactogenicity of a booster dose of diphtheria, tetanus, acellular pertussis and inactivated poliomyelitis vaccine (DTPa-IPV) given concurrently with Hib as a mixed vaccine or as separate injections, in comparison with a whole cell pertussis vaccine (DTPw-IPV-Hib). MATERIALS AND METHODS: This open, randomized, controlled study involved 145 healthy children ages 15 to 24 months. Immunogenicity was evaluated for all vaccine antigens, and reactogenicity was assessed with diary cards. RESULTS: Serum antibody responses to all vaccine antigens was at least as good as that observed with the pentavalent whole cell vaccine. DTPa-IPV was well-tolerated and less reactogenic than the DTPw-IPV vaccine. Administration of DTPa-IPV and Hib vaccine either separately or mixed did not alter the immunogenicity or reactogenicity profiles. CONCLUSION: DTPa-IPV vaccine, either separately or mixed with Hib vaccine, was at least as immunogenic and less reactogenic than the DTPw-Hib vaccine. Mixing DTPa-IPV and Hib vaccines did not alter the safety profile when compared with separate injections of both vaccines. A mixed DTPa-IPV-Hib vaccine can be recommended for routine use as a booster dose in primed children.

[Clinical data on the diagnosis of colic in infants. Survey in 2,773 infants aged 15-119 days. Groupment des pédiatres de la région de Lyon (GPRL), le Groupment lyonnais de recherche en pédiatrie ambulatoire (GLYRPA), l'association des pédiatres de la région stéphanoise (APRS) et la Formation pédiatrique grenobloise (FPG)]. / Eléments cliniques du diagnostic de coliques du nourrisson. Enquête chez 2773 nourrissons âgés de 15 à 119 jours. Groupement des pédiatres de la région de Lyon (GPRL), le Groupement lyonnais de recherche en pédiatrie ambulatoire (GLYRPA), l'association des pédiatres de la région stéphanoise (APRS) et la Formation pédiatrique grenobloise (FPG).

BACKGROUND: Crying is called "Infantile colic" when such cries are numerous, paroxystic, difficult to comfort, and without an obvious cause. METHODOLOGY: An information mailing on the study (named Encolie) and the associated methodology was distributed in April 1995 to 212 private practice pediatricians. They have included in the study all infants aged 15 to 119 days who were seen during consultation from June 12 to June 27. They filled out a two page, 32 item, epidemiological questionnaire. Question 31 asked; "following this consultation, would you call for an 'infantile colic' diagnosis for this child? Yes, no. if no, what is your diagnosis?" RESULTS: One hundred and sixty-nine private practice pediatricians out of 212 (79.7%) participated in the study, and have included 2,797 infants 2,773 infant files were analyzed. The 625 infants identified as "colic" (22.5% of all cases), differed from the 2,148 identified as "non-colic" by the following factors: average age (51.3 vs 61.3 days), birth weight (2,226 vs 3,307 g), being a first born (52.7 vs 45.1% of cases), and mother's anxiety (47.8 vs 29.1% of cases). Significant differences were observed concerning feeding behavior (slow or gluttonous feeding), digestive symptoms, and unexplained crying, always more frequent in the case of the infants identified as "colic". These infants received more drugs, and their parents were given more advice on diet and hygiene. The symptoms supporting the "infantile colic" diagnosis were derived using a statistical regression model. They included: frequent and/or unexplained crying at the time of the study, frequent and/or unexplained crying in the past, abdominal distention at the time of the clinical examination, and frequent gas emissions as indicated by parental questioning. Factors associated with this diagnosis were: young age of the child, drugs administered before the consultation, maternal anxiety, anomalies in feeding behavior, and to a lesser degree, low birth weight and mother or father atopy. CONCLUSION: Given the sample size and origin, and the rigor of both the study and the analysis, we believe that these data could be extrapolated to the usual pediatrician's patient population. This highlighting of differences between our two groups indicate the validity of this diagnosis.