Symptoms associated with teething and response to three treatments, including homeopathic medicine: a multicenter prospective observational study among 190 French pediatricians.

BACKGROUND: Primary tooth eruption in infants is associated with a range of local and systemic symptoms although this remains a subject of much debate. In addition, data are limited on the role of physicians in managing infant teething, and on the benefit of homeopathic treatments. METHODS: We conducted an observational, multicenter, prospective survey evaluating teething symptoms, and symptom course following routine medical management by French pediatricians in 597 infants aged from 3 to 24 months. We also examined the response to treatment with routinely prescribed teething medications; the homeopathic agent, Camilia® and topically applied gingival agents (Delabarre® or Dolodent®). RESULTS: Most infants (96.6%) had buccogingival symptoms and 93.3% had at least one general symptom. Fever (≥38 °C) was reported in 15.2% of infants. For teething, 212 infants were prescribed Camilia®, 172 a gingival solution (Delabarre® or Dolodent®) and 213 received Camilia® along with a gingival agent. Infants prescribed both a homeopathic and a gingival treatment had a significantly higher number of symptoms at presentation compared with those prescribed a single agent. There were no significant differences in symptom course across these three treatment groups. Systemic analgesics/antipyretics were prescribed in 68.8% of cases. Parent satisfaction with medical management and prescribed treatments was high. CONCLUSIONS: Teething is frequently associated with transient local and systemic upset in infants and is a significant concern to parents. Camilia® provides a similar benefit to topical therapy, and is frequently used by pediatricians in France.

ARIZONA study: is the risk of post-herpetic neuralgia and its burden increased in the most elderly patients?

BACKGROUND: In a context of change in the demographic profile of the older population, to identify an age threshold for increased risk and burden of herpes zoster (HZ) in 70+ patients. METHODS: Post hoc analysis of the 12-month French nationwide prospective observational ARIZONA cohort study. HZ was assessed by means of the following validated questionnaires: Neuropathic Pain Symptom Inventory (NPSI), Zoster Brief Pain Inventory (ZBPI), Short-Form health survey (SF-12), and Hospital Anxiety and Depression Scale (HADS). RESULTS: 644 general practitioners included 1,358 volunteer patients with acute HZ in the ARIZONA study; 609 patients (45%) were 70+. In 70+ patients, age did not increase rash severity or HZ-related pain intensity at diagnosis, but increased by 64% the frequency of ophthalmic zoster (from 5.5% in 70-74 years age-group to 9.0% in 85+ patients, p = NS). Age was significantly associated with low physical health as assessed by the SF-12 Physical Component Summary (SF-12 PCS) score and bad mood as assessed by the HADS depression score (p < 0.001). Within the year following HZ, post-herpetic neuralgia (PHN) was systematically but not significantly more frequent in 85+ patients than in the 70-74, 75-79, or 80-84 years age-groups (19.0% vs. 13.3%/15.3%/11.6% at month 3; 15.1% vs. 7.3%/11.0%/12.2% at month 6; 15.2% vs. 6.0%/8.0%/6.0% at month12, respectively). SF-12 PCS and HADS depression scores improved from day 0 to month 12 in all patients (p < 0.001). 85+ patients were more impaired than younger patients (p < 0.001), but without clear difference according to PHN. CONCLUSIONS: This study did not show in 70+ patients a clear and significant age threshold at which disease burden increased, although for some domains the impact seemed higher among the oldest patients; the cut-off of 70 years remains thus relevant for clinical and epidemiological studies. However, at individual level, assessment of the burden of HZ and HZ-related pain appears necessary to improve management and prevent functional decline in the most vulnerable 70+ patients.

Assessment of patient satisfaction with outcomes of and ophthalmic care for cataract surgery.

PURPOSE: To assess patient satisfaction with cataract surgery care. SETTING: Private and public health ophthalmic centers, France. METHODS: This prospective longitudinal multicenter observational study enrolled patients attending consultation for a preoperative visit from September 2007 to February 2008. Patients were eligible if they had uncomplicated cataract and agreed to participate. At the preoperative visits, medical data and disease history were collected. At the first postoperative visit (at 1 to 7 days), the following data were collected: patient status, surgical procedure, and follow-up (patient management, complications, medications). Patients completed a questionnaire after each visit to assess satisfaction with their management and follow-up before, during, and after surgery (up to 30 days postoperatively). RESULTS: Of the 781 patients enrolled by 91 ophthalmologists, 41 were excluded for not meeting eligibility criteria, leaving 740 patients in the statistical analysis. Cataract extraction was by phacoemulsification. The incision was 2.2 to 3.2 mm in 94.7% of cases, and the intraocular lens was acrylic in 96.3% of cases. Anesthesia was mainly topical (56.8%) or local (42.1%). The most frequent postoperative treatments were nonsteroidal antiinflammatory eyedrops and combined steroidal and antibacterial eyedrops (95.9% and 94.7%, respectively). Most patients (96.4%) said the surgery results met their expectations, and 67.2% reported being able to perform activities they could not do preoperatively. Overall, 98.2% of patients said they were satisfied with their management. CONCLUSION: Assessment of the management and follow-up of patients having cataract surgery showed that the care provided was in accordance with the expectations of French patients. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Management of gastro-esophageal reflux disease in primary care. Results from an observational study of 2,474 patients (AO).

OBJECTIVE: The aim of the present study was to describe the management of gastro-esophageal reflux disease (GERD) by primary care physicians (PCPs). METHODS: This prospective survey was conducted in patients with suspected or previously diagnosed GERD. PCPs completed questionnaires at first consultation (M0) and at a 3-month follow-up visit (M3). RESULTS: 2 474 patients were available for analysis at M0 and 1 993 at M3. GERD was the reason for consultation in 84% of patients; 33% were consulting about reflux symptoms for the first time. Symptoms occurred once daily in 55% of patients and were considered very disruptive or incapacitating by 51%. Upper gastrointestinal endoscopy was performed at any time in 57% of patients and at M0 in 20%. Only 48% of demands for endoscopy agreed with current recommendations and this rate was not influenced by PCP training in the previous 6 months. Lifestyle measures were recommended in 95% of patients at M0. Proton pump inhibitors were prescribed in 98%, to be taken "on-demand" in 22-57% depending on symptom frequency. Therapeutic management was considered as very satisfactory by 81% of patients. CONCLUSIONS: GERD managed in primary care is severe, leading to expensive, but effective diagnostic investigations and treatments. Agreement with recommendations for endoscopy is poor.