[Evaluation of pre-travel prevention and morbidity in child travelers]. / Enquêtes auprès des familles d'enfants voyageurs : évaluation des conseils de prévention et prévalence des maladies rencontrées lors d'un séjour hors d'Europe.

UNLABELLED: International travel is growing, but few data exist on prevention for children traveling. The aim of this study was to describe a population of children traveling from France to countries outside Europe and to evaluate the quality of prevention and healthcare services provided for these travelers. MATERIALS AND METHODS: We conducted a retrospective epidemiological study in three pediatric emergency departments in Paris from August to October 2009 and 2012. Data were collected retrospectively from anonymous questionnaires proposed to families consulting emergency services, irrespective of their reason, who had recently traveled (in the year preceding travel outside the European Union). RESULTS: Of the 166 children included, who for the most part had traveled to visit relatives and friends in Sub-Saharan Africa and North Africa, 76% of their families were from the destination countries, 78% had received prevention counseling, mostly with their doctor. They had been vaccinated against yellow fever, but the hepatitis A vaccine was neglected. The preventive measures had been difficult to achieve in practice. During travel, 54% of children had health problems (39% diarrhea, 29% vomiting, 31% fever) prompting medical care in 28%, 5% were admitted to a hospital, and 4% had return to France earlier than planned. In epidemic areas, 13% of children had malaria. CONCLUSION: There is poor counseling on basic prevention (hygiene, diarrhea, malaria, immunization). Time constraints in pediatricians and competing priorities could explain this problem. The challenge for healthcare providers to reduce these pathologies is to provide services of sufficient quality and clarity. All medical stakeholders have an important role to play.

Prediction of fatty acid profiles in cow, ewe, and goat milk by mid-infrared spectrometry.

Mid-infrared (MIR) spectrometry was used to estimate the fatty acid (FA) composition in cow, ewe, and goat milk. The objectives were to compare different statistical approaches with wavelength selection to predict the milk FA composition from MIR spectra, and to develop equations for FA in cow, goat, and ewe milk. In total, a set of 349 cow milk samples, 200 ewe milk samples, and 332 goat milk samples were both analyzed by MIR and by gas chromatography, the reference method. A broad FA variability was ensured by using milk from different breeds and feeding systems. The methods studied were partial least squares regression (PLS), first-derivative pretreatment + PLS, genetic algorithm + PLS, wavelets + PLS, least absolute shrinkage and selection operator method (LASSO), and elastic net. The best results were obtained with PLS, genetic algorithm + PLS and first derivative + PLS. The residual standard deviation and the coefficient of determination in external validation were used to characterize the equations and to retain the best for each FA in each species. In all cases, the predictions were of better quality for FA found at medium to high concentrations (i.e., for saturated FA and some monounsaturated FA with a coefficient of determination in external validation >0.90). The conversion of the FA expressed in grams per 100mL of milk to grams per 100g of FA was possible with a small loss of accuracy for some FA.

A functional genomic approach to the study of the milking ability in dairy sheep.

To understand the mechanisms underlying milk ability and more precisely the kinetics of milk emission, we compared teat transcriptome profiles from Lacaune ewes in the tails of the milk flow phenotypic distribution. Two different arrays containing respectively 1896 and 13 168 PCR products selected from several tissue-specific cDNA libraries, including mammary gland, allowed the identification of 73 differentially expressed genes between teats from high and low milk flow ewes. Genes involved in muscle contraction were identified as over-expressed, and genes encoding collagen were found to be under-expressed in teats from low milk flow ewes. We confirmed this underexpression of COL1A1 and COL1A2 in low-milk flow ewes using RT-qPCR. These results suggest that milking ability may be due to the capacity of the teat sphincter to relax during mechanical milking. We propose that an optimal condition for mechanical milking may require proper relaxation of the teats. To our knowledge, this is the first transcriptomic analysis studying milking ability, using udder tissue for gene expression profiling, which demonstrates that mechanical milking ability is not only determined by morphological features but also by tissue composition.

Recognising haemorrhagic rash in children with fever: a survey of parents' knowledge.

BACKGROUND: Early recognition and treatment of meningococcal disease improves its outcome. Haemorrhagic rash is one of the most specific signs that parents can learn to recognise. OBJECTIVE: To determine the percentage of parents able to recognise a haemorrhagic rash and perform the tumbler test. METHODS: 123 parents of children consulting for mild injuries were interviewed about the significance and recognition of haemorrhagic rash in febrile children. RESULTS: Although 88% of parents undressed their children when they were febrile, it was never to look specifically for a skin rash. Only 7% (95% CI 3% to 12%) were able to recognise a petechial rash and knew the tumbler test. CONCLUSION: Information campaigns about the significance of haemorrhagic rash and about the tumbler test are needed.

Response to somatic cell count-based selection for mastitis resistance in a divergent selection experiment in sheep.

A divergent selection experiment in sheep was implemented to study the consequences of log-transformed somatic cell score (SCS)-based selection on resistance to natural intramammary infections. Using dams and progeny-tested rams selected for extreme breeding values for SCS, we created 2 groups of ewes with a strong divergence in SCS of approximately 3 genetic standard deviations. A survey of 84 first-lactation ewes of both the High and Low SCS lines indicated favorable responses to SCS-based selection on resistance to both clinical and subclinical mastitis. All clinical cases (n = 5) occurred in the High SCS line. Additionally, the frequency of chronic clinical mastitis, as detected by the presence of parenchymal abscesses, was much greater in the High SCS line (n = 21) than in the Low SCS line (n = 1). According to monthly milk bacteriological examinations of udder halves, the prevalence of infection was significantly greater (odds ratio = 3.1) in the High SCS line than in the Low SCS line, with predicted probabilities of 37 and 16%, respectively. The most frequently isolated bacteria responsible for mastitis were staphylococci: Staphylococcus auricularis (42.6% of positive samples), Staphylococcus simulans, Staphylococcus haemoliticus, Staphylococcus xylosus, Staphylococcus chromogenes, Staphylococcus lentus, Staphylococcus warneri, and Staphylococcus aureus. The incidence of positive bacteriology was greater in the High SCS line (39%) than in the Low SCS line (12%) at lambing, indicating that High SCS line ewes were especially susceptible to postpartum subclinical mastitis. Negativation of bacteriological results from one sampling time point to the next was markedly different between lines after weaning (e.g., 41 and 84% in the High and Low SCS lines, respectively). This result was consistent with differences in the duration of infection, which was much greater in the High SCS line compared with the Low SCS line. Finally, ewes from the High SCS line consistently had greater SCS in positive milk samples than did ewes from the Low SCS line (+2.04 SCS, on average), with an especially large difference between lines during the suckling period (+3.42 SCS). Altogether, the preliminary results suggest that the better resistance of Low SCS line ewes, compared with High SCS line ewes, was principally characterized by a better ability to limit infections during the peripartum period, to eliminate infections during lactation, and quantitatively to limit the inflammation process and its clinical consequences.

Epidemiology of malpractice lawsuits in paediatrics.

UNLABELLED: A systematic review of malpractice lawsuits involving children identified six articles and 227 cumulative paediatric published cases. The prevalence of medical lawsuits resulting in payment to plaintiff was found to be 50% less frequent than that in adults. The most frequent and severe errors were among infants, including diagnostic errors of meningitis, gastroenteritis and pneumonia. The most implied unit was emergency department (58%). The patients and/or families were compensated in 23- 68% of cases. CONCLUSION: These data can increase physicians' awareness of disorders and age groups at high risk of medical errors. This could lead to minimize the risk of medical malpractices and to improve patient safety.

[Improvement in the management of acute diarrhoea in France?]. / Prise en charge des diarrhées aiguës en France: quels progrés?

The management of acute diarrhoea in France improved during the last ten years, with a large increase of oral rehydration solution (ORS) prescription in infants. Severity assessment is too often based on an uncertain evaluation of weight loss instead of a clinical determination. Telephone triage is not accurate without use of protocols and decision-making guidelines. Laboratory tests are rare in ambulatory management but still too frequent in hospital management of children with oral rehydration. ORS prescription of general practitioners regularly increased: 16% in 1988, 29% in 1996, 39% in 2001; and 71% in 2005 (after their reimbursement). The quality of oral rehydration advice remains insufficient. Intravenous rehydration on admission remains still too frequent. Drugs prescriptions include 2 or 3 drugs, with a decrease of loperamide and antibiotics, and an increase of racecadotril (81%). Lactose-free milk prescriptions in infants dropped from 46% in 1996 to 16% in 2005. Isolation and disinfection procedures are insufficient. Rotavirus nosocomial infections incidence is high: 1,6 to 6,3/1000 children less than 5 years of age, contributing to high direct costs.

Decline in pneumococcal meningitis after the introduction of the heptavalent-pneumococcal conjugate vaccine in northern France.

BACKGROUND: The impact of the heptavalent-pneumococcal conjugate vaccine on the incidence of pneumococcal meningitis in Europe has not yet been assessed. OBJECTIVE: To determine whether heptavalent-pneumococcal conjugate vaccine implementation in northern France has resulted in a decrease in the incidence of pneumococcal meningitis in children. DESIGN: Multicentre retrospective cohort study from 2000 through 2005. SETTINGS: All paediatric departments of the 18 hospitals in northern France. PATIENTS: Patients <18 years of age, admitted for laboratory-confirmed pneumococcal meningitis during the study period, were included. INTERVENTIONS: Data were collected from medical files and the microbiological laboratories of each hospital and compared with the regional hospital discharge codes, using a capture-recapture method. MAIN OUTCOME MEASURES: The study assessed and compared global and age-related incidence rates of pneumococcal meningitis in 2001 (pre-vaccine era) and 2005. RESULTS: 77 cases were found through the capture-recapture method. The incidence rate of pneumococcal meningitis varied from 1.65/100,000 children <18 years in 2001 to 0.80/100,000 children in 2005 (53% reduction, 95% CI 31 to 74; p = 0.08). This has so far been significant only for children <2 years of age (8.9/100,000 in 2001 to 1.8/100,000 in 2005; 82% reduction, 95% CI 52 to 95; p = 0.03). CONCLUSION: A decline in pneumococcal meningitis has been observed in infants since heptavalent-pneumococcal conjugate vaccination began in our area.

[Severity assessment of acute diarrhoea]. / Critères de gravité d'une diarrhée aiguë

Clinician should recognize any life-threatening causes of diarrhoea, such as intussusceptions, surgical abdomen, and haemolytic uraemic syndrome. The following clinical features should alert: abdominal pain with tenderness, with or without guarding, pallor, jaundice, oligo-anuria, bloody diarrhoea, systemically unwell out of proportion to the level of dehydration, shock. The risk of dehydration is related to age (highest in young infants<6 months), and frequency of watery stools (>8/day) and vomiting (>2/day before 1 year and >4/day after 1 year), but these historical points have a moderate sensitivity. The severity of dehydration is rarely estimated with accuracy in terms of weight loss (third sector with full colon, absence of accurate baseline pre-dehydration weight). Combinations of examination signs perform markedly better than any individual sign in predicting dehydration (poor rate agreement, clinically unhelpful likelihood ratio). The presence of at least three signs better correlate with dehydration. Laboratory tests are not helpful. New studies are mandatory to validate severity scoring systems.