Les mesures d’éviction allergénique sont à la base du traitement de l’allergie aux acariens, associées à un traitement médicamenteux pour contrôler l’ensemble des symptômes cliniques. Ces traitements ...sont institués selon des schémas thérapeutiques progressifs pour la rhinite (recommandations ARIA) et pour l’asthme (recommandations GINA). Associés à ces traitements, dans les formes plus sévères, une immunothérapie allergénique peut être proposée pour améliorer le contrôle de la maladie et tenter de limiter son aggravation.
Measures of allergen avoidance are the basis of therapy for mite allergy, associated with drug therapy to control the set of clinical symptoms. These measures are applied according to published progressive therapeutic recommendations for rhinitis (ARIA) and for asthma (GINA). Associated with these measures, in the most severe cases allergen immunotherapy can be proposed to improve control of the disease, with the aim of limiting its worsening.
L’exploration allergologique d’une conjonctivite persistante ou intermittente peut être d’interprétation difficile. Une hyperréactivité conjonctivale (HRC) non spécifique, une sensibilisation ...allergénique localisée, l’implication des protéases polliniques dans la conjonctivite saisonnière non allergique (CSNA) peuvent rendre compte d’un bilan allergologique négatif: les différentes études avérant ces notions sont exposées ainsi que les examens biologiques complémentaires de la sphère oculaire. Un point est fait sur les différentes méta-analyses détaillant l’efficacité de l’Immunothérapie spécifique pour les symptômes oculaires allergiques.
The results of allergy tests conducted to determine the cause of persistent or transient conjunctivitis may be difficult to interpret. The tests for non-specific conjunctival hyperreactivity (CHR) or localised allergen sensitization, or to determine the implication of pollen proteases in seasonal non-allergic conjunctivitis (SNAC) may give negative results: this paper describes the various studies attesting these notions as well as additional ocular laboratory tests. An update is provided on the various meta-analyses describing the efficacy of specific immunotherapy for the treatment of eye allergy symptoms.
Contexte Malgré les études animales montrant les effets nuisibles de l’exposition à la caféine pendant la grossesse sur le développement cérébral ultérieur chez la progéniture, il existe peu de ...données épidémiologiques humaines sur le sujet. Objectif Évaluer l’influence de l’exposition prénatale à la caféine sur le développement cognitif, les comportements et le tempérament de l’enfant. Méthodes Une modélisation multivariée a été réalisée en utilisant les données d’une cohorte mère-enfant française EDEN. L’échantillon ( n = 1113) a été évalué de la grossesse jusqu’à l’âge de 5 ans. Les mesures incluaient : l’exposition prénatale à la caféine ; les caractéristiques individuelles et familiales disponibles pendant la grossesse et le suivi ; le quotient intellectuel des enfants ; leurs symptômes psychiatriques et leur tempérament. Résultats Dans cet échantillon la consommation modérée de caféine pendant la grossesse n’était pas associée chez les enfants à la cognition, aux comportements ou au tempérament. Cependant, les niveaux élevés de consommation de caféine étaient négativement liés au développement cognitif avec une réponse de type effet-dose. Conclusions La consommation élevée de caféine pendant la grossesse peut être associée à un moins bon développement cognitif chez les enfants. Ce résultat suggère l’intérêt de discuter des seuils de consommation de café préconisés par l’OMS chez la femme enceinte.
Introduction
The context of the COVID-19 pandemic has changed the daily life of families and children. Screen exposure was increased during this period to maintain social relationships, work ...remotely, and occupy leisure time.
Objectives
To explore the association of continued above-recommendation screen use for one year since May 2020 with behaviour problems in the summer of 2021 in children aged 3 to 14 years.
Methods
Data came from the French EpiCov cohort study, and were collected in May 2020 and at first (Autumn 2020) and second follow-up (Summer 2021) among 1,089 participants with children aged 3 to 14. Children had a 1-year above-recommendation screen use if their daily mean time exceeded recommendations at the three follow-up times (one hour, for children aged 3-5, two for the older ones). Behaviour problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) and valid cut-offs for Internalizing (emotional or peer problems) and Externalizing (conduct problems or hyperactivity/inattention) problems completed in summer 2021. Data were analysed using adjusted logistic regression.
Results
1-year above-recommendation screen use was not associated with internalizing problems (OR 95% CI: 1.20 0.90-1.59). Regarding the subscales, it was associated with a higher risk of peer problems (1.42 1.04-1.95). A higher risk of externalizing problems was found only in 11-14-year-olds (1.63 1.01-2.63), especially conduct problems in 11-14-year-olds (1.91 1.15-3.22) but not in other age groups.
Conclusions
This study found that maintaining screen time beyond recommendations for 1 year since the onset of the pandemic was associated with peer problems in children aged 3-14 years and externalizing and conduct problems in 11-14 years. Despite this very specific context, exposure to screens is not trivial. If this situation were to occur again, we would have to anticipate, with prevention messages, by keeping schools open.
Disclosure of Interest
None Declared
This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder ...(ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT in individuals with ADHD. Random-effects meta-analyses pooled standardized mean differences (SMD) between CCT and comparator arms. RCT quality was assessed with the Cochrane Risk of Bias 2.0 tool (PROSPERO: CRD42021229279). Thirty-six RCTs were meta-analysed, 17 of which evaluated working memory training (WMT). Analysis of outcomes measured immediately post-treatment and judged to be "probably blinded" (PBLIND; trial n = 14) showed no effect on ADHD total (SMD = 0.12, 95%CI-0.01 to -0.25) or hyperactivity/impulsivity symptoms (SMD = 0.12, 95%-0.03 to-0.28). These findings remained when analyses were restricted to trials (n: 5-13) with children/adolescents, low medication exposure, semi-active controls, or WMT or multiple process training. There was a small improvement in inattention symptoms (SMD = 0.17, 95%CI0.02-0.31), which remained when trials were restricted to semi-active controls (SMD = 0.20, 95%CI0.04-0.37), and doubled in size when assessed in the intervention delivery setting (n = 5, SMD = 0.40, 95%CI0.09-0.71), suggesting a setting-specific effect. CCT improved WM (verbal: n = 15, SMD = 0.38, 95%CI0.24-0.53; visual-spatial: n = 9, SMD = 0.49, 95%CI0.31-0.67), but not other neuropsychological (e.g., attention, inhibition) or academic outcomes (e.g., reading, arithmetic; analysed n: 5-15). Longer-term improvement (at ~6-months) in verbal WM, reading comprehension, and ratings of executive functions were observed but relevant trials were limited in number (n: 5-7). There was no evidence that multi-process training was superior to working memory training. In sum, CCT led to shorter-term improvements in WM, with some evidence that verbal WM effects persisted in the longer-term. Clinical effects were limited to small, setting specific, short-term effects on inattention symptoms.
During the perinatal period, women's perceived quality of life (QOL) may be altered due to physiological, psychological, and bodily changes, as well as changes in family functioning.
to explore in a ...sample of women from the general population, the associations between physical and mental QOL at 1 year post-partum and i) pregnancy social support, demographic, socioeconomic, medical and child health-related factors, paternal and maternal psychological characteristics at 2 months and 1 year post-partum, ii) antenatal preventive measures (early prenatal interview/antenatal classes).
We used data from the “French Longitudinal Study since Childhood” (ELFE), a representative cohort of children and their parents followed from birth to adulthood. Data were collected from mothers in the maternity ward, at 2 months and 1-year post-partum. QOL was assessed using the SF12 physical (PCS-12) and mental (MCS-12) subscales.
Women with both low PCS-12 and MCS-12 scores were more likely to have high maternal age and to experience psychological difficulties during pregnancy. They also had more frequent PNDS, quarrels with insults within the couple, low sleep time at 2 months postpartum, and more frequently received psychological, social and child caregiver support, and were more often housewives or students at 1-year post-partum. Others factors are specific for low PCS-12 or MCS-12. There was no association with antenatal preventive measure and QOL at 1-year post-partum.
Factors influencing maternal QOL are multiple and multidimensional and can mostly be identified during the ante or early postnatal period. A graduated and coordinated preventive and curative pathway would improve women's health. An ecosystemic approach to pregnancy and the perinatal period could help preventing the negative effects of environment on mothers and thus infants during the “1000-day period”.
•During the perinatal period, women's perceived quality of life may be altered.•Factors influencing maternal QOL are multiple and multidimensional and can mostly be identified during the ante or early postnatal period.•A graduated, coordinated preventive pathway would improve women's health.•An eco-systemic approach to pregnancy and the perinatal period could help preventing the negative effects of environment on mothers and thus infants during the “1000-day period”.
Les réactions d’hypersensibilité immédiate aux produits de contraste (PC) gadolinés sont moins fréquentes que celles aux PC iodés mais, comme pour ces dernières, elles peuvent faire l’objet de ...demandes d’exploration allergologique. Dans la littérature, seuls quelques rares cas de chocs et anaphylaxies sévères et documentés précisément sur le plan allergologique sont décrits. Nous proposons un bref rappel sur la nature et la structure des produits gadolinés avant d’évoquer les différentes interrogations soulevées par les derniers cas décrits et notamment en ce qui concerne la possibilité de réactions croisées entre les PC gadolinés de la classe des macrocycliques et ceux linéaires et la validité des tests cutanés de diagnostic.
Immediate hypersensitivity reactions to gadolinium contrast agents (CAs) are less frequent than reactions to iodinated CA but, as with the latter, they can also be the reason for an allergy workup. Only a few rare cases of shock and severe, precisely documented anaphylaxis to gadolinium CAs are described in the literature. We propose a short summary on the nature and the structure of gadolinium CAs before discussing the different questions raised by recently published cases, notably questions concerning the possibility of cross-reactions between gadolinium CAs, in particular between macrocyclic and linear gadolinium molecules, and the validity of skin tests for diagnosis.
The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical ...practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc
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and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.
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