[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%.

Formulas for threshold computations.

Given a continuous variable S, which density functions on two subgroups omega + and omega - of a population omega are known (with for instance a higher mean value on omega + than on omega -), we first define two strategies for classification in these groups; the first one (MWC) consists in determining a threshold alpha such that classifying in omega + when S greater than or equal to alpha, in omega - otherwise, leads to the highest percentage of well-classed elements. The second one consists in choosing the most probable group, given the observed value of S. We give mathematical formulas for the thresholds involved in these two strategies when the density functions, determined by the application of the maximum entropy principle, are those of normal distributions. These formulas prove that the two considered strategies are frequently equivalent, and we give simpler formulas when the partial variances of S on omega + and omega - are unknown or approximately equal. All the formulas are adapted to the case where a cost coefficient is introduced to display the unequal seriousness of the two possible errors (misclassification in omega + or omega -). Then we consider an example, where we see that the computed thresholds can be graphically validated from empirical curves and have the same performances on the learning sample and on a test sample.

Ultrastructural changes associated with peripheral neuropathy in HIV/AIDS.

Light and electron microscopic studies were performed on neuromuscular biopsy specimens from 12 neurologically affected seropositive patients, 7 with the acquired immune deficiency syndrome (AIDS), 2 with AIDS-related complex, and 3 with no symptoms except for neuropathy. All patients had an axonal injury associated or unassociated with demyelination and peripheral neurogenic atrophy. Capillary lesions were consistently present, which seems to be a new finding. Moreover, tubuloreticular inclusions (TRIs) were found in endomysial (9 of 12 cases) and endoneurial (7 of 12 cases) vessels. Statistical analysis showed that TRIs in more than 20% of endomysial vessels correlated with a survival time shorter than 12 months (P = 0.028). Thus the quantification of TRIs seems to be one of the vital prognostic elements in this patient population.

Automatic classification of cells in cell cycle phases based on Ki-67 antigen quantification by fluorescence microscopy.

Ki-67 antigen is thought to be a marker of cell proliferation, as it can be detected in cycling cells, i.e. cells in G1, S, G2 and M phases, but not in resting cells. The immunocytochemical staining pattern obtained by the Ki-67 monoclonal antibody varies, depending on the cell cycle phases. Analysis of double staining of Ki-67 antigen and DNA in the MCF-7 cell line by videomicrofluorometry allows the description of both the level and the pattern of Ki-67 staining in the form of a set of parameters defining each cell. These parameters were measured in MCF-7 cell populations characterized according to their position in the cell cycle. They were submitted to a statistical analysis (principal component and discriminant analysis) which allowed the determination of the optimal parameters to characterize a given cellular group and permitted the use of these parameters for an automatic classification of cells in the different cell cycle phases. In G1, S, G2, prophase + metaphase and anaphase + telophase cells, these parameters allowed a classification of cells with a good-classification rate of 94.37%. A comparison of this method with methods based on the DNA histogram and bromodeoxyuridine uptake was performed. The classification coefficients stemming from the discriminant analysis were introduced into a program to obtain, automatically, the Ki-67 labelling index and the percentages of cells in each phase. This method, which allows a quick evaluation of the proliferation and the phase indices, may be more widely applicable.

Strategies for graphical threshold determination.

Determining a threshold for a quantitative variable (arising in biological measurements for instance) is a common problem in medical decision making. We define seven commonly used strategies: each one leads to an optimal determination. To these strategies correspond relevant empirical curves: the ROC curve for strategies involving the sensitivity or the specificity, the predictive ROC curve (P-ROC curve) for strategies involving the positive and negative predicting values, and the well classified frequencies curve (WCF curve) for classification strategies where all misclassifications have the same importance. For one of the considered strategies, there also exists a theoretical formula for the optimal threshold, elicited within a classical probabilistic model, which gives a considerable advantage to this strategy. These strategies are applied to a stimulated example containing 702 cases, where we see that they lead to different optimal threshold values. Finally, we briefly review a practical application in the determination of thresholds for glycemia measurements, leading to the choice of one of them as the optimal one to consider in the gestational diabetes mellitus prediction.

[Role of acute alcoholism in violent death. Statistics of the Lyon Medico-Legal Institute (1981-2)]. / Rôle de l'alcoolisme aigu dans le déterminisme des morts violentes. Bilan de l'Institut médico-légal de Lyon (1981-1982).

Over a 2-year period (1981-1982), blood alcohol levels were measured in 1371 post-mortem examinations performed at the medico-legal Institute of Lyon. These levels were higher in men, in subjects who died between 9 p.m. and 3 a.m., in corpses found in water and in subjects killed by a fall or in a fire. Among the 4 main types of death (homicide, suicide, accident and natural death), those by homicide had the highest, and those by suicide the lowest blood alcohol concentrations.