RESUMEN

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.

Asunto(s)

Deficiencia de Vitamina D/epidemiología , Vitamina D/sangre , Calcio de la Dieta/administración & dosificación , Niño , Femenino , Francia/epidemiología , Humanos , Masculino , Estaciones del Año , Luz Solar , Vitamina D/administración & dosificación , Deficiencia de Vitamina D/diagnóstico , Vitaminas/administración & dosificación

RESUMEN

INTRODUCTION: The number of pediatric emergency consultations for psychological or psychiatric reasons continues to rise, raising the question of the adequacy of existing facilities. Our aim was therefore to identify and characterize a population of adolescents consulting at the pediatric emergency unit at Rouen university hospital. METHODS: This study was conducted from 1 January to 31 December 2006. We distinguished three types of variables in adolescents consulting at the pediatric emergency unit. The main objective was to describe the profile and requirements of these young patients and their subsequent care management as compared to that of other studies. RESULTS: Of the 400 patients consulting over 12years of age, 69% were female and the average age was 13.8years. These cases were mainly attempted suicide in girls and conduct disorder in boys; hospitalization was at the request of the family. These consultations were directly linked to the school calendar and 70% required hospitalization. DISCUSSION: We both analyzed and compared the results of this study to those of other studies to propose solutions to improve the care of these young patients.

Asunto(s)

Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Hospitales Pediátricos/estadística & datos numéricos , Trastornos Mentales/epidemiología , Derivación y Consulta/estadística & datos numéricos , Adolescente , Niño , Trastorno de la Conducta/diagnóstico , Trastorno de la Conducta/epidemiología , Trastorno de la Conducta/terapia , Estudios Transversales , Servicio de Urgencia en Hospital/tendencias , Servicios de Urgencia Psiquiátrica/tendencias , Femenino , Predicción , Francia , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Hospitales Pediátricos/tendencias , Hospitales Universitarios/estadística & datos numéricos , Hospitales Universitarios/tendencias , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Derivación y Consulta/tendencias , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Revisión de Utilización de Recursos/estadística & datos numéricos

RESUMEN

The knowledge regarding celiac disease has increased dramatically in recent years, due to the availability of accurate serologic markers. Mass screening studies have shown that the prevalence of sensitization can be as high as 1/80. The range of symptoms is wide, from the classic growth failure, denutrition and diarrhea in infancy to clinically and histologically asymptomatic sensitized subjects. The interest of a routine mass screening is debated. The classical celiac disease in infancy is well known. Atypical symptoms and potentially associated disease are more frequent and potentially confounding. Physicians should be aware of any clue for celiac disease in atypical cases in order to improve the diagnostic yield, and therefore avoiding short or long term consequences.

Asunto(s)

Enfermedad Celíaca/diagnóstico , Edad de Inicio , Enfermedad Celíaca/clasificación , Enfermedad Celíaca/epidemiología , Enfermedad Celíaca/etiología , Niño , Síndrome de Down/complicaciones , Síndrome de Down/epidemiología , Predisposición Genética a la Enfermedad , Humanos , Factores de Riesgo , Síndrome de Turner/complicaciones , Síndrome de Turner/epidemiología

RESUMEN

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.

Asunto(s)

Prescripciones de Medicamentos/estadística & datos numéricos , Raquitismo/prevención & control , Vitamina D/administración & dosificación , Vitaminas/administración & dosificación , Animales , Lactancia Materna , Niño , Preescolar , Estudios Transversales , Femenino , Francia , Humanos , Lactante , Recién Nacido , Masculino , Leche , Análisis Multivariante , Guías de Práctica Clínica como Asunto

RESUMEN

The aims of the present position paper by the Committee on Nutrition of the French Society of Paediatrics were to summarize the recently published data on vitamin D in infants, children and adolescents, i.e., on metabolism, physiological effects, and requirements and to make recommendations on supplementation after careful review of the evidence. Scientific evidence indicates that calcium and vitamin D play key roles in bone health. The current evidence, limited to observational studies, however, does not support other benefits for vitamin D. More targeted research should continue, especially interventional studies. In the absence of any underlying risk of vitamin D deficiency, the recommendations are as follows: pregnant women: a single dose of 80,000 to 100,000 IU at the beginning of the 7th month of pregnancy; breastfed infants: 1000 to 1200 IU/day; children less than 18 months of age, receiving milk supplemented with vitamin D: an additional daily dose of 600 to 800 IU; children less than 18 months of age receiving milk not supplemented with vitamin D: daily dose of 1000 to 1200 IU; children from 18 months to 5 years of age: 2 doses of 80,000 to 100,000 IU every winter (November and February). In the presence of an underlying risk of vitamin D deficiency (dark skin; lack of exposure of the skin to ultraviolet B [UVB] radiation from sunshine in summer; skin disease responsible for decreased exposure of the skin to UVB radiation from sunshine in summer; wearing skin-covering clothes in summer; intestinal malabsorption or maldigestion; cholestasis; renal insufficiency; nephrotic syndrome; drugs [rifampicin; antiepileptic treatment: phenobarbital, phenytoin]; obesity; vegan diet), it may be justified to start vitamin D supplementation in winter in children 5 to 10 years of age as well as to maintain supplementation of vitamin D every 3 months all year long in children 1 to 10 years of age and in adolescents. In some pathological conditions, doses of vitamin D can be increased. If necessary, the determination of 25(OH) vitamin D serum concentration will help determine the level of vitamin D supplementation.

Asunto(s)

Calcio/administración & dosificación , Pediatría , Sociedades Médicas , Vitamina D/administración & dosificación , Vitamina D/fisiología , Adolescente , Adulto , Factores de Edad , Desarrollo Óseo/fisiología , Calcio/fisiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Política Nutricional , Necesidades Nutricionales , Embarazo , Valores de Referencia , Estaciones del Año , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/etiología

Asunto(s)

Reflujo Gastroesofágico/tratamiento farmacológico , Prescripción Inadecuada , Inhibidores de la Bomba de Protones/uso terapéutico , Adolescente , Adulto , Niño , Preescolar , Contraindicaciones , Estudios Transversales , Utilización de Medicamentos , Esofagitis Péptica/tratamiento farmacológico , Esofagitis Péptica/epidemiología , Reflujo Gastroesofágico/epidemiología , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/tratamiento farmacológico , Efecto Placebo , Inhibidores de la Bomba de Protones/efectos adversos

Asunto(s)

Raquitismo/epidemiología , Raquitismo/prevención & control , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/prevención & control , Adolescente , Adulto , Anciano , Asma/sangre , Asma/prevención & control , Huesos/metabolismo , Calcio/sangre , División Celular/efectos de los fármacos , División Celular/fisiología , Niño , Preescolar , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/prevención & control , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/prevención & control , Femenino , Humanos , Inmunidad Celular/efectos de los fármacos , Inmunidad Celular/inmunología , Lactante , Recién Nacido , Necesidades Nutricionales , Osteoporosis/sangre , Osteoporosis/epidemiología , Osteoporosis/prevención & control , Fósforo/sangre , Embarazo , Raquitismo/sangre , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre

RESUMEN

Adolescence, a period of growth and acquisition of bone mass, requires adequate calcium and vitamin D intake. This study was designed to assess the impact of a single loading dose of 200,000 IU of vitamin D(3) on the winter vitamin D status of healthy adolescents. Vitamin D status was assessed by 25-OH-D levels before, 3 weeks, and 3 months after this single dose, and safety was assessed by serum calcium and PTH and urinary calcium excretion in random samples from 27, 23, and 17 healthy adolescents derived from the same institution. The 25-OH-D peak value 2 weeks after the vitamin D supplement of 71-129 nmol/l (mean, 96 nmol/l), and a residual level at 3 months of 29-83 nmol/l (mean, 57 nmol/l) serum calcium and urinary calcium excretion expressed by the calcium/creatinine ratio were normal and stable at 2 weeks and 3 months, remaining less than 0.5 for the calcium/creatinine ratio. This simple measure, ensuring good compliance during adolescence, ensures optimal winter vitamin D status with no signs of overload.

Asunto(s)

Conservadores de la Densidad Ósea/administración & dosificación , Colecalciferol/administración & dosificación , Estaciones del Año , Adolescente , Calcifediol/sangre , Calcio/sangre , Calcio/orina , Niño , Femenino , Francia , Humanos , Masculino , Hormona Paratiroidea/sangre , Estudios Prospectivos

Asunto(s)

Docentes Médicos , Pediatría/educación , Selección de Profesión , Movilidad Laboral , Niño , Francia , Humanos , Selección de Personal , Edición , Investigación , Facultades de Medicina

Asunto(s)

Densidad Ósea , Absorciometría de Fotón/métodos , Niño , Humanos , Tomografía Computarizada por Rayos X/métodos

Asunto(s)

Desmineralización Ósea Patológica/etiología , Fibrosis Quística/complicaciones , Adolescente , Desmineralización Ósea Patológica/terapia , Niño , Humanos , Guías de Práctica Clínica como Asunto , Adulto Joven

Asunto(s)

Hipocalcemia/diagnóstico , Femenino , Humanos , Hipocalcemia/etiología , Hipoparatiroidismo/etiología , Recién Nacido , Intercambio Materno-Fetal , Enfermedades Neuromusculares/fisiopatología , Embarazo , Síndrome , Vitamina D/metabolismo

RESUMEN

A high prevalence of low bone mineralization is documented in adult patients with cystic fibrosis (CF). Osteopenia is present in as much as 85% of adult patients and osteoporosis in 13 to 57% of them. In children, studies are discordant probably because of different control database. Denutrition, inflammation, vitamin D and vitamin K deficiency, altered sex hormone production, glucocorticoid therapy, and physical inactivity are well known risk factors for poor bone health. Puberty is a critical period and requires a careful follow-up for an optimal bone peak mass. This review is a consensus statement established by the national working group of the French Federation of CF Centers to develop practice guidelines for optimizing bone health in patients with CF. Recommendations for screening and for calcium, vitamin D and K supplementation are given. Further work is needed to define indications for treatment with biphosphonates and anabolic agents.

Asunto(s)

Desmineralización Ósea Patológica/etiología , Desmineralización Ósea Patológica/terapia , Fibrosis Quística/complicaciones , Osteoporosis/etiología , Adolescente , Desmineralización Ósea Patológica/epidemiología , Densidad Ósea , Calcio/metabolismo , Niño , Preescolar , Ejercicio Físico , Femenino , Humanos , Absorción Intestinal , Masculino , Estado Nutricional , Osteoporosis/epidemiología , Osteoporosis/terapia , Pubertad , Vitamina D/uso terapéutico

RESUMEN

As an effect of increased globalisation, animal diseases, in particular those transmissible to man, have an immediate global economic and social impact. This fact, dramatically illustrated by the current avian influenza epizootic in South-East Asia and Eastern Europe, clearly demonstrates the crucial importance of the national Veterinary Services (VS) for the prevention, early detection and response for the efficient control of animal diseases. Complying with this mission for the VS presupposes the existence of appropriate governance and legislation and of an official system to control their quality and reliability- an obvious weakness in many developing and in transition countries. The World Organisation for Animal Health (OIE) has therefore developed a project aiming at strengthening the VS in those countries facing the greatest animal health threats and to bring them into line with OIE international standards already adopted by the same countries. Based on the evaluation of the VS and subsequent actions at the global, regional and national levels, the project will have a significant beneficial impact on the targeted countries as well as the international community as a whole, not only in the fields of agriculture, food security and production, and food safety, but also for the local and global prevention of emerging and re-emerging diseases of veterinary and public health importance. The project will be implemented in strong collaboration with the Food and Agriculture Organization. The actions proposed must be considered eligible for the concept of International Public Good.

Asunto(s)

Enfermedades de los Animales/epidemiología , Enfermedades de los Animales/prevención & control , Enfermedades Transmisibles Emergentes/veterinaria , Medicina Veterinaria/normas , Animales , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/prevención & control , Enfermedades Transmisibles Emergentes/transmisión , Países Desarrollados , Países en Desarrollo , Humanos , Cooperación Internacional , Control de Calidad , Medición de Riesgo , Medicina Veterinaria/métodos , Zoonosis

Asunto(s)

Hipofosfatemia/terapia , Enfermedad Aguda , Adolescente , Anorexia Nerviosa/complicaciones , Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/terapia , Niño , Preescolar , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/etiología , Complicaciones de la Diabetes/terapia , Humanos , Hipofosfatemia/diagnóstico , Hipofosfatemia/etiología , Lactante , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/etiología , Enfermedades del Prematuro/terapia , Fosfatos/administración & dosificación , Fosfatos/sangre

RESUMEN

A 15-year-old boy was first referred for a clinical presentation of revealed peritonitis. Abdominal endoscopy showed normal appendix but the presence of purulent peritoneal fluid. Antibiotics were immediately administered. Ten hours later clinical signs of meningitis occurred, and lumbar puncture was performed. CSF bacterial meningitis characteristics were present but no bacteria was observed. However Neisseria meningitidis type C was detected by direct peritoneal fluid examination and by 24(th) hour blood culture. Peritoneal and the CSF fluid culture were negative, but DNA analysis from peritoneal fluid was positive.

Asunto(s)

Meningitis Meningocócica/diagnóstico , Neisseria meningitidis Serogrupo C , Peritonitis/microbiología , Adolescente , Humanos , Masculino

RESUMEN

Few data are available regarding calcium and vitamin D intake in toddlers, despite a remaining high growth velocity. Therefore, a study was carried out in the Rouen geographical area where the sunshine is limited. It appears that a great majority of the children studied (9/10) received plain milk, and subsequently only small quantities of vitamin D or calcium enriched milk. Nevertheless, 12% of primarily 4 to 6 year-old children do not received daily minimum requirements, and 6% of them had vitamin D insufficiency, which was demonstrated by 25OHD plasma concentrations. These concentrations declined from 18 months to 6 years old were related to discontinuation in vitamin D supplements. A great variability was observed in vitamin D supplementation as no official recommendations were followed. Modalities of this supplementation should be reconsidered.

Asunto(s)

Calcio de la Dieta , Fenómenos Fisiológicos Nutricionales Infantiles , Vitamina D , Animales , Bovinos , Preescolar , Suplementos Dietéticos , Femenino , Francia , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Leche/química , Estado Nutricional

Asunto(s)

Raquitismo/fisiopatología , Deficiencia de Vitamina D/fisiopatología , Preescolar , Humanos , Raquitismo/etiología

RESUMEN

OBJECTIVE: Evaluation of the varicella severity through a prevalence study of hospital admissions justified by a complication directly related to the onset of an acute episode of varicella. METHODS: Retrospective study in one paediatric center in France with a follow-up of a paediatric cohort from April 1987 to December 2002. This general paediatric hospital recruits children from a 400,000 inhabitants area. Inclusion criterion: diagnosis main or associated of varicella. EXCLUSION CRITERIA: congenital or acquired immunodepression, including long-term oral high dosage steroid therapy. RESULTS: Three hundred and forty-three (343) complications of varicella were reported in 309 children hospitalised for a symptom in relationship with varicella. Most of children (75%) were <2 years of age. The annual number of hospitalisations varied with a maximum of 44. An increase of the number of hospitalisations was reported since 1997 but particularly since 2000. Main complications were gastro-intestinal (75), neurological (68), bronchopulmonary (52), and skin and soft tissue infections (52). Superinfections of soft tissues such as Streptococcus pyogenes cellulitis and life-threatening complications, which occurred in children treated by a short-course of corticosteroïds for an acute episode such as an asthma crisis, were mostly noticed since 1995. Two deaths occurred. CONCLUSION: These data collected over 16 years as part of a retrospective survey of a paediatric cohort show that varicella, often considered as a mild disease, can be responsible for severe complications in young immunocompetent children. The digestive complications (30%) are the main complication in our study with existence of gingivitis-stomatitis but also lower digestive manifestations (erosive gastritis aspect through endoscopy). These data have all the more to be taken into account because a vaccine, developed for healthy children, is now available in France. A national survey of hospitalised varicella has been set up since March 2003.

Asunto(s)

Varicela/complicaciones , Adolescente , Varicela/epidemiología , Niño , Preescolar , Francia , Hospitalización , Hospitales , Humanos , Lactante , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de Tiempo

RESUMEN

Although systematic vitamin D supplementation in adolescents remains debated, rickets is nevertheless a well recognized pathology in this age group. Adolescence is an at-risk period because of rapid growth, insufficient calcium intake and/or vitamin D status. Surveys have shown that calcium intake is insufficient (< 1000 mg a day) in 45% of boys and 71% of girls and that vitamin D status is deficient (25-OH-D < 10 ng/ml). The aims of the study carried out by the Calcium Group of the Société Française de Pédiatrie, were to evaluate the frequency of rickets, and to define the criteria for the adolescent population at risk. Forty-one adolescents with rickets were hospitalized between 1985 and 2000. Most of the cases were from the Northern France: 20 from Paris and suburbs, eight from the North-West, four from the North, four from the North-East; five were from the Center of France. The mean age was 13 years and two months for the 28 girls, and 14 years and four months for the 13 boys. Eighty per cent of the adolescents were from immigrant families (33/41): 15 were from sub-Saharan Africa, ten from North Africa, six from Pakistan and two from Turkey. Two thirds of the adolescents were hospitalized in the 2nd quarter of the year. Some adolescents suffered from lower limb pain, 16 had deformations of lower limbs, particularly genu valgum, associated with pain; seven others had either muscle spasms (4), tetany (3). Serum calcium level was low (average 1.84 mmol/l: [1.1-2.5]), and serum 25-OH D level was extremely low. Radiographic characteristics observed were metaphyseal strips on the knees, with condensed edges at times, with the presence of bone demineralization. The treatment combined calcium and vitamin D, and was often administered intravenously when a hypocalcemia was detected. Rickets is not frequent in adolescents, but nonetheless this pathology is not exceptional, and the number of cases is probably under-estimated. Rickets affects immigrant adolescents in particular but nevertheless could also present a certain risk period for the general population.

Asunto(s)

Emigración e Inmigración , Raquitismo/etiología , Vitamina D/uso terapéutico , Adolescente , Calcio/administración & dosificación , Estudios Epidemiológicos , Etnicidad , Femenino , Francia/epidemiología , Humanos , Incidencia , Masculino , Raquitismo/epidemiología , Factores de Riesgo