Emerging signals of climate change from the equator to the poles: new insights into a warming world

The reality of human-induced climate change is unequivocal and exerts an ever-increasing global impact. Access to the latest scientific information on current climate change and projection of future trends is important for planning adaptation measures and for informing international efforts to reduce emissions of greenhouse gases (GHGs). Identification of hazards and risks may be used to assess vulnerability, determine limits to adaptation, and enhance resilience to climate change. This article highlights how recent research programs are continuing to elucidate current processes and advance projections across major climate systems and identifies remaining knowledge gaps. Key findings include projected future increases in monsoon rainfall, resulting from a changing balance between the rainfall-reducing effect of aerosols and rainfall-increasing GHGs; a strengthening of the storm track in the North Atlantic; an increase in the fraction of precipitation that falls as rain at both poles; an increase in the frequency and severity of El Niño Southern Oscillation (ENSO) events, along with changes in ENSO teleconnections to North America and Europe; and an increase in the frequency of hazardous hot-humid extremes. These changes have the potential to increase risks to both human and natural systems. Nevertheless, these risks may be reduced via urgent, science-led adaptation and resilience measures and by reductions in GHGs

Access to pediatric rheumatology care and diagnostic pathway in Juvenile idiopathic arthritis (JIA)

Au début de l’évolution de l’arthrite juvénile idiopathique (AJI), il existe une fenêtre d’opportunité pendant laquelle l’introduction d’une thérapeutique efficace améliore considérablement le devenir des patients. Une meilleure compréhension du délai d’accès au rhumatologue pédiatre (RP) et du parcours de soins des enfants est nécessaire. Dans une cohorte française, le délai médian d’accès au RP était de 3,3 mois et bien que les formes non systémiques d’AJI ne soient pas des urgences, 45% étaient passés par ce service. Dans une cohorte indienne ce délai était 4,1 mois. Un quart des patients avait été diagnostiqué et traité par des médecins autres que le RP. Dans la littérature, le délai d’accès au RP variait entre 3 et 10 mois. Les patients présentant une forme systémique d’AJI avaient le délai d’accès le plus court. Certains paramètres clinico-biologiques comme la présence d’un gonflement articulaire, de fièvre, d’une élévation de la CRP ou de la VS étaient associés avec un délai plus court. Inversement, des enthésites, un âge plus élevé au début des symptômes ou une douleur isolée allongeaient le délai. Étonnamment, le délai d’accès au RP variait assez peu entre les pays ou régions du monde alors que les systèmes de soins sont très différents. Des recommandations de prise en charge diagnostique standardisées préconisant une formation des médecins de premier recours à l’AJI, une collaboration entre les différents intervenants hospitaliers et libéraux et un accès direct, facile et rapide (dans les 4 semaines après la demande de consultation) au RP doivent être élaborées afin de réduire le délai d’accès aux soins spécialisés à ces enfants et limiter la perte de chance.JIA studies demonstrate that there is a “window of opportunity” early in the disease course during which appropriate management improves outcomes. A better understanding about access to pediatric rheumatology (PR) care and care pathways is required. In a French cohort, median time to first PR visit was 3.3 months, the median number of health care practitioners met was 3 and although non-systemic JIA are not an emergency, 45% were referred to the emergency room. In an Indian cohort, median time from symptom onset to first PR visit was 4.1 months and median distance travelled 119.5 km. 24% were previously diagnosed as JIA and managed by non pediatric rheumatologists before first PR visit with a worse outcome. In the literature, the median time to first PR visit ranged from 3 to 10 months, with some disparities between referral pathway and patient characteristics. Patients with systemic-onset JIA had the shortest time to referral. Some clinical and biological factors such as swelling, fever, elevated CRP and/or ESR were associated with a shorter time to first PR visit. Conversely, enthesitis, older age at symptom onset, or pain were associated with a longer time. Whatever the country or world region, and despite disparities in healthcare system organization and health care practitioner availabilities, times to access PR were not wide-ranging. Standardized clinical guidelines, doctors training, collaboration networks between hospital and outpatient practice, and fast-track pathways to facilitate prompt referral to specialized teams during the 4 weeks after referral have to be implemented to reduce worldwide disparities in health care

Accès aux soins et parcours diagnostique des patients atteints d'arthrite juvénile idiopathique

JIA studies demonstrate that there is a “window of opportunity” early in the disease course during which appropriate management improves outcomes. A better understanding about access to pediatric rheumatology (PR) care and care pathways is required. In a French cohort, median time to first PR visit was 3.3 months, the median number of health care practitioners met was 3 and although non-systemic JIA are not an emergency, 45% were referred to the emergency room. In an Indian cohort, median time from symptom onset to first PR visit was 4.1 months and median distance travelled 119.5 km. 24% were previously diagnosed as JIA and managed by non pediatric rheumatologists before first PR visit with a worse outcome. In the literature, the median time to first PR visit ranged from 3 to 10 months, with some disparities between referral pathway and patient characteristics. Patients with systemic-onset JIA had the shortest time to referral. Some clinical and biological factors such as swelling, fever, elevated CRP and/or ESR were associated with a shorter time to first PR visit. Conversely, enthesitis, older age at symptom onset, or pain were associated with a longer time. Whatever the country or world region, and despite disparities in healthcare system organization and health care practitioner availabilities, times to access PR were not wide-ranging. Standardized clinical guidelines, doctors training, collaboration networks between hospital and outpatient practice, and fast-track pathways to facilitate prompt referral to specialized teams during the 4 weeks after referral have to be implemented to reduce worldwide disparities in health care.Au début de l’évolution de l’arthrite juvénile idiopathique (AJI), il existe une fenêtre d’opportunité pendant laquelle l’introduction d’une thérapeutique efficace améliore considérablement le devenir des patients. Une meilleure compréhension du délai d’accès au rhumatologue pédiatre (RP) et du parcours de soins des enfants est nécessaire. Dans une cohorte française, le délai médian d’accès au RP était de 3,3 mois et bien que les formes non systémiques d’AJI ne soient pas des urgences, 45% étaient passés par ce service. Dans une cohorte indienne ce délai était 4,1 mois. Un quart des patients avait été diagnostiqué et traité par des médecins autres que le RP. Dans la littérature, le délai d’accès au RP variait entre 3 et 10 mois. Les patients présentant une forme systémique d’AJI avaient le délai d’accès le plus court. Certains paramètres clinico-biologiques comme la présence d’un gonflement articulaire, de fièvre, d’une élévation de la CRP ou de la VS étaient associés avec un délai plus court. Inversement, des enthésites, un âge plus élevé au début des symptômes ou une douleur isolée allongeaient le délai. Étonnamment, le délai d’accès au RP variait assez peu entre les pays ou régions du monde alors que les systèmes de soins sont très différents. Des recommandations de prise en charge diagnostique standardisées préconisant une formation des médecins de premier recours à l’AJI, une collaboration entre les différents intervenants hospitaliers et libéraux et un accès direct, facile et rapide (dans les 4 semaines après la demande de consultation) au RP doivent être élaborées afin de réduire le délai d’accès aux soins spécialisés à ces enfants et limiter la perte de chance

MISS questionnaire in French version: a good tool for children and parents to assess methotrexate intolerance

International audienceThe aim of this study was to assess the relevance for children and parents to use the French-validated version of the methotrexate intolerance severity score (MISS), a measure of methotrexate intolerance for children suffering from juvenile idiopathic arthritis. The French-version MISS was developed following the "Guidelines for the process of cross-cultural adaptation of self-report measures." The new version was tested in families of children with juvenile idiopathic arthritis who completed the questionnaire twice at a 2-week interval. Item correlations, Cronbach's alpha, and kappa coefficients were computed to evaluate acceptability, internal consistency, and reproducibility. A culturally acceptable version to French was obtained. A total of 71 individuals were included from May 2015 to November 2015. The results show very good acceptability: good response rate (80%), few missing data (\textless1%) and good understanding of parents and children. The inter-item, dimension-item, and inter-dimension correlations were satisfactory (except for "vomiting" items-other items correlation). Cronbach's alpha coefficient was well higher than the usually recommended value of 0.6. The results of validity of internal and external consistencies were satisfactory. We also found good agreement between the test-retest for every family. The empirical discriminative cut-off point of 3 showed a sensitivity of 86% and a specificity of 83%. The MISS questionnaire is quick to complete, easy to use. It can be completed by children or their parents with no significant difference. This validated French-version MISS can help study prevalence and risk factors of methotrexate intolerance, better detect this intolerance, and provide better support for patients on long-term treatment

Skeletal impairment in Pierson syndrome: Is there a role for lamininβ2 in bone physiology?

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Emerging signals of climate change from the equator to the poles: new insights into a warming world

Peer reviewed: TrueAcknowledgements: We acknowledge the World Climate Research Programme, which, through its Working Group on Coupled Modelling, coordinated and promoted CMIP6. We thank the climate modeling groups for producing and making available their model output, the Earth System Grid Federation (ESGF) for archiving the data and providing access, and the multiple funding agencies who support CMIP6 and ESGF.The reality of human-induced climate change is unequivocal and exerts an ever-increasing global impact. Access to the latest scientific information on current climate change and projection of future trends is important for planning adaptation measures and for informing international efforts to reduce emissions of greenhouse gases (GHGs). Identification of hazards and risks may be used to assess vulnerability, determine limits to adaptation, and enhance resilience to climate change. This article highlights how recent research programs are continuing to elucidate current processes and advance projections across major climate systems and identifies remaining knowledge gaps. Key findings include projected future increases in monsoon rainfall, resulting from a changing balance between the rainfall-reducing effect of aerosols and rainfall-increasing GHGs; a strengthening of the storm track in the North Atlantic; an increase in the fraction of precipitation that falls as rain at both poles; an increase in the frequency and severity of El Niño Southern Oscillation (ENSO) events, along with changes in ENSO teleconnections to North America and Europe; and an increase in the frequency of hazardous hot-humid extremes. These changes have the potential to increase risks to both human and natural systems. Nevertheless, these risks may be reduced via urgent, science-led adaptation and resilience measures and by reductions in GHGs.</jats:p

Liste des auteurs et collaborateurs

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