Children and screens: Groupe de Pédiatrie Générale (Société française de pédiatrie) guidelines for pediatricians and families.

The Groupe de Pédiatrie Générale (General Pediatrics Group), a member of the Société française de pédiatrie (French Pediatrics Society), has proposed guidelines for families and doctors regarding children's use of digital screens. A number of guidelines have already been published, in particular by the French Academy of Sciences in 2013 and the American Academy of Pediatrics in 2016. These new guidelines were preceded by an investigation into the location of digital screen use by young children in France, a survey of medical concerns on the misuse of digital devices, and a review of their documented benefits. The Conseil Supérieur de l'Audiovisuel (Higher Council on Audiovisual Technology) and the Union Nationale de Associations Familiales (National Union of Family Associations) have taken part in the preparation of this document. Five simple messages are proposed: understanding without demonizing; screen use in common living areas, but not in bedrooms; preserve time with no digital devices (morning, meals, sleep, etc.); provide parental guidance for screen use; and prevent social isolation.

Children and screens: A survey by French pediatricians.

INTRODUCTION: Screens are increasingly prevalent within families. The excessive use of screens by children has negative consequences. To measure the use of screens, we undertook an investigation among children being followed by pediatricians. METHODS: An invitation to participate was sent electronically to 1460 private practice pediatricians. They were asked to complete the questionnaire on screen use by children under 12 years of age during a consultation, according to statements made by parents. RESULTS: One hundred and forty-four pediatricians submitted completed questionnaires involving 428 children. Among the 197 children under 3 years of age, 92 had played with an interactive screen for a median duration of 30min during the preceding week; 29% of the children were alone at the time. One hundred and thirty-nine children had watched television for a median weekly duration of 75min. Of the 231 children 3-11 years of age, 108 had played with an interactive screen for a median time of 30min the day before the consultation, and 50% of them were alone at the time. One hundred and seventy-two children watched television for a median daily duration of 45min. There was a correlation between these children's screen time and their mother's (r=0.36). The television was on during meals and continuously in 35% and 21% of the families, respectively. CONCLUSIONS: Children start looking at screens early, too often watching unsuitable programs, and too often without a parent's present. Regardless of the child's age, pediatricians must ask parents how much time their children are viewing screens, advise them accordingly, and warn them of the consequences of excessive use.

[Catch-up vaccination of worldwide newcoming (adopted, refugee or migrant) children in France]. / Mise à jour des vaccinations de l'enfant arrivant de l'étranger (adopté, réfugié ou migrant) en France.

In France, international adoption includes around to 90,000 children since 1980 and near 300,000 immigrant children were counted in 2008. This population is heterogeneous, according to age and country of origin, and its large number. It is not easy to completely and surely assess the vaccine status of the child. Due to a great variability of individual situations, it is not possible to have systematic and unchangeable rules. This article aims to give an update of catch-up vaccination of internationally adopted or refugee or migrant children in France. The vaccination status of a child who recently arrived in France is complex and has to be adapted to his country of origin. Some of them were never vaccinated whereas the vaccine status of others is uncertain or unknown. Three parameters have to be considered: the age of the child, the country of origin, and sometimes serology in the case of doubts of his vaccine status. Catch-up vaccination of foreign children has to be adapted to French vaccine recommendations, as a reference, and to vaccines already administered to the child.

[Update on vaccine research. Proceedings of the 15th annual conference on vaccine research organized by the National Foundation for Infectious Diseases]. / Actualités en matière de recherche vaccinale. Compte-rendu de la 15(e) conférence annuelle sur la recherche vaccinale organisée par la National Foundation for Infectious Diseases.

Every year, the National Foundation for Infectious Diseases brings together more than 300 participants to review progress in vaccine research and development and identify the most promising avenues of research. These conferences are among the most important scientific meetings entirely dedicated to vaccine research for both humans and animals, and provide a mix of plenary sessions with invited presentations by acknowledged international experts, parallel sessions, poster sessions, and informal exchanges between experts and young researchers. During the Fifteenth Conference that took place in Baltimore in May 2012, various topics were addressed, including the scientific basis for vaccinology; exploration of the immune response; novel vaccine design; new adjuvants; evaluation of the impact of newly introduced vaccines (such as rotavirus, HPV vaccines); vaccine safety; and immunization strategies. The new techniques of systems biology allow for a more comprehensive approach to the study of immune responses in order to identify correlates of protection and to design novel vaccines against chronic diseases such as AIDS or malaria, against which natural immunity is incomplete.

[Current events in vaccination]. / Actualités en matière de vaccination.

The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve - but for how long ? - the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.

[Current events in vaccination]. / Actualités en matière de vaccination.

The annual meeting of the Infectious Disease Society of America (IDSA); which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve--but for how long?--the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55%, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.

[Lead exposure in pregnant women and newborns: a screening update]. / Intoxication au plomb chez la femme enceinte et le nouveau-né: bilan d'une enquête de dépistage.

UNLABELLED: Human lead exposure has many sources. Relative importance of these sources varies widely according to geographic regions and human lifestyle. The impact of lead exposure on health has been well studied and public health interventions have been conducted. OBJECTIVE: The aim of this study was to evaluate current prevalence of lead burden in neonates, and seek for sources of maternal and fetal intoxication. POPULATION AND METHODS: A prospective multicentre study was conducted by the "Réseau périnatal 92" on a population of pregnant women attending 3 maternal wards in the north of 'Hauts-de-Seine' department in France. Between December 2003 and May 2004, a total of 1021 pregnant women were included. All patients signed an informed consent before participating in the study. Cord blood samples were collected at delivery for lead measurements. RESULTS: The mean cord blood lead concentration was 23.2 microg/l. Eighteen neonates over 1021 (1.8%) had lead levels above 100 microg/l. An environmental query was conducted by the social and public health office of the department (DDASS), and data were collected regarding the state of the housing and the lifestyle of the concerned family. Main sources of lead intoxication were 'tagine' food plates in 83.3% of cases, 'khôl' powder (used as eyeliner) in 88.9% of cases and substandard housings in 22.2% of cases. A specialized paediatric follow-up for the 18 neonates was performed. CONCLUSION: With the exception of substandard housing (old lead painting), other sources of lead intoxication were discovered: 'tagine' plates and 'khôl' powder. Almost all of these products came from Morocco. A public health intervention would be able to inform the population about these yet unknown sources of lead intoxication.

[Evaluating the effectiveness of child lead poisoning prevention programs]. / Evaluation des résultats d'actions de prévention du saturnisme infantile.

PROBLEM: A multi annual screening and prevention program against lead poisoning was implemented in a suburb of the Paris area. We attempted to assess the effectiveness of this program based on data available from children screening and follow-up. METHODS: Indicators of effectiveness included the evolution of blood lead levels at screening and the frequency of secondary increases in blood lead levels. Buildings inclusion dates were used to control for the increasing selection of less exposed children. RESULTS: A total of 3,660 children were screened between 1992 and 2000. We observed a regular decrease in blood lead levels at screening, in the highest blood lead levels obtained for each child and in the proportion of children whose blood lead levels increased after screening: the proportion of children with initial blood lead levels >=15 micro g/dl fell from 17.4% in the 1992-1996 period to 4.1% in the 1997-2000 period. A multivariate analysis taking into account the first year that children were screened in a given building showed that less exposed children were included over time, but found also an additional independent decrease in blood lead levels that can be related to the effectiveness of prevention efforts. A "building by building" analysis of 30 buildings where more than 20 children were located over the whole study period confirmed that the incidence of lead poisoning decreased within most of these buildings. CONCLUSIONS: Taking into account buildings'inclusion dates makes it possible to distinguish program effectiveness from the consequences of including less exposed children The effectiveness of preventive actions is associated with several interacting factors, including the participation of families and the active involvement of local technical staff and policy makers. The finding that the decrease in blood lead levels leveled off after 1997 calls for further actions.

[Compliance with the vaccination recommendations for 0- to 24-month-old infants in general or paediatric practice]. / Suivi des recommandations vaccinales des nourrissons de 0 à 24 mois: à propos d'une enquête en médecine libérale.

PURPOSE: To describe the vaccine practice of general practitioners and paediatricians for the 0-24-month-old infants and their deviations to the official recommendations. RESULTS: One thousand three hundred and fifty-five practitioners, 46 +/- 8-year-old took part in the survey. Among them 42.7% were general practitioners and 57.3% were paediatrician. Only one third of them, strictly complied with the official vaccination recommendation (33.1%). This percentage was higher for the general practitioners (43.4%) than for the paediatricians (25.5% P < 0.001). When practitioners adapted the vaccination program, their modifications essentially concerned the first administration of the DTCP Hib vaccine, which was delayed of 1 or 2 months. Some vaccines were specifically concerned by the modifications. The ROR was delayed and the vaccination coverage reached only 75% at 18 months. General practitioners adapted the vaccination calendar more often than paediatricians (16.9 vs. 9.0%: P < 0.05). The B Hepatitis vaccination schedule was the most frequently adapted one by general practitioners as well as paediatricians to deal with multiple injections (53.5%), and the age of the infants (39.1%). CONCLUSION: The availability of hexavalent vaccination containing B Hepatitis should contribute to increase the vaccination coverage of the population against B Hepatitis and could allow an antipneumococcal vaccination through an heptavalent vaccine without increasing the number of injections. On the other hand, general practitioners and paediatricians must actively contribute to increase the ROR vaccination coverage.

[Screening for lead poisoning in children by measuring lead levels in housing: a study of the Paris region]. / Dépistage du saturnisme infantile à partir de la recherche de plomb dans l'habitat: une étude en région parisienne.

Screening programs for lead poisoning in France rely usually on the preliminary identification of risk factors among children seen in Maternal and Child Health (MCH) clinics. To assess the potential relevance of screening strategies based on the quantification of exposure to lead in housing, we estimated first the prevalence of exposure to lead in a representative sample of older buildings, then the prevalence of lead poisoning among children living in those buildings where high levels of lead had been found. Exposure to lead was measured in dust and paint samples collected in hallways and other collective areas of the buildings. Venous blood samples were collected from the children aged 10 months to 6 years residing in buildings where lead exceeded 1.5 g/kg in paint samples or 1000 micrograms/m2 in dust samples. Paint and dust samples were collected in 137 buildings: 74% presented high dust and/or paint lead contents. Blood samples were collected from 145 out of a total of 189 children residing in these buildings: blood lead levels (PbB) were higher than or equal to 10 micrograms/dl for 65% of these children; 29% were higher than or equal to 15 micrograms/dl, 16% higher than or equal to 20 micrograms/dl. Out of 42 children with PbB > or = 15 micrograms/dl, 21 had not been previously identified through the screening program conducted in local MCH clinics. Clinic-based and environment-based screening appeared to be complementary. It seems thus justified to develop screening strategies based on the assessment of exposure to lead in the environment.