Qualité de vie des parents d'enfant atteint d'allergie alimentaire

[Résumé en français] L'allergie alimentaire touche 4 à 8 % des enfants, et les mesures diététiques et la vigilance constante qu'elle impose aux parents est source d'angoisse. La qualité de vie (QV) des parents d'enfant atteint d'allergie alimentaire n'a jamais été étudiée. Objectifs : L'objectif principal de cette étude était de mesurer la QV des parents d'enfant atteint d'aIlergie alimentaire. Les objectifs secondaires de cette étude étaient: de vérifier la connaissance qu'ont les parents de l'allergie alimentaire de leur enfant, de déterminer des déterminants de la qualité de vie des parents. Méthodes : 100 parents d'enfant aIlergique alimentaire suivis dans un service d'aIlergologie universitaire ont rempli et le questionnaire générique de qualité de vie SF-36, et un questionnaire de connaissance. Résultats: Les scores de QV sont globalement élevés, en comparaison à la population générale les femmes de 25-44 ans ont une QV inférieure dans les dimensions mentales. La connaissance des parents est très bonne. Les déterminants de QV identifiés sont des caractéristiques liées aux parents : le sexe et une comorbidité, des caractéristiques liées aux enfants: le nombre d'enfant scolarisé, des caractéristiques liées à l'allergie: les signes cliniques évolutifs, la prescription d'une trousse d'urgence et la prescription d'adrénaline et la connaissance. Conclusions : Contre toute attente la QV des parents d'enfant atteint d'aIlergie alimentaire est bonne, peu d'éléments bibliographiques permettent de discuter ce résultat. Une hypothèse explicative est le phénomène de coping. L'éducation des parents joue un rôle majeur. Néanmoins, l'évolution de la QV des parents n'est pas connue, eIle pourrait l'être en mettant en place des mesures répétées sur une cohorte suivie dès l'annonce du diagnostic.[Résumé en anglais] Background: Food aIlergy affects 4 to 8 % of children, and its management requires from parent considerable time and vigilance, which is stressfull. The impact of this disease on parent's health-related quality of life has not been weIl studied. ' Objectives: Main objective was to assess quality of life in parents with a food aIlergic child, others objectives were to assess parents knowledge of their child food allergy and to identify determinants of parent's quality of life. Methods : 100 Parents of food allergie children from a university-based allergy practice completed the generic instrument SF-36 and a questionnaire that evaluated their knowledge oftheir child's food allergy. Results : Compared with french established norms, women aged 25-44 scored lower in mental scales. Parents' knowledge is exceIlent. Detrminants are parental characteristics : sex and comorbidity, children' characteristic : number of school-aged children, allergy's characteristic : clinical signs, emergency kit, carriyng self-injectable epinephrine and knowledge.Conclusions : Quality of life of parents with a food allergie child is quite good. It might be due to coping strategies. Parental education is essential. Nethertheless, parents' quality of life's evolution is unknowned. Further study is needed to determine more detailed effects of diagnosis of food aIlergy on parents quality of life and the evolution of quality of life.NANCY1-Bib. numérique (543959902) / SudocSudocFranceF

Generational changes in multiple sclerosis phenotype in North African immigrants in France: A population-based observational study

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Le paracétamol : connaissance, usage et risque de surdosage en patientèle urbaine de médecine générale. Étude prospective descriptive transversale

International audienceIntroduction: Acetaminophen is the most involved active substance in both unintentional and intentional drug poisoning. However, its availability outside community pharmacies is being debated in France.Methods: We made, via a self-administered questionnaire, a prospective assessment of knowledge, use and acetaminophen overdose risk in patients consulting their general practitioner, in the Metz Métropole urban area, between May 2015 and February 2016. We estimated the prevalence of potential unintentional overdosage by capture-recapture method.Results: Among 819 responding patients, only 17.9 % had a sufficient knowledge and 20.3 % were at risk for potential unintentional overdose. The risk was higher for patients aged over 55 years or belonging to socioprofessional categories of laborers and inactive. A good knowledge score was a protective factor for overdose risk (P < 0.0001). The liver toxicity of acetaminophen was particularly unknown. The prevalence of potential unintentional acetaminophen overdose was estimated at 1 to2 % of the population.Conclusion:Proposing acetaminophen outside of pharmacies cannot be recommended in France in such conditions. Information campaigns are needed to limit the risk of unintentional overdose and its consequences on liver toxicity.Introduction: Le paracétamol est la substance active la plus impliquée dans les intoxications médicamenteuses volontaires et involontaires. Néanmoins, sa mise à disposition hors officine, via la grande distribution, est actuellement débattue en France.Méthode: Nous avons réalisé une évaluation prospective de la connaissance, de l’usage et du risque de surdosage en paracétamol à l’aide d’un questionnaire autoadministré dans la patientèle de cabinets de médecine générale de la zone urbaine de Metz Métropole, entre mai 2015 et février 2016. La prévalence des patients en risque potentiel de surdosage involontaire a été estimée par méthode de capture-recapture.Résultats: Parmi les 819 patients ayant répondu, 17,9 % avaient une connaissance satisfaisante et 20,3 % étaient à risque de surdosage potentiel, majoritairement des patients âgés de plus de 55 ans ou appartenant aux catégories socioprofessionnelles des ouvriers et des inactifs. Un bon score de connaissance était un facteur protecteur du risque de surdosage (p < 0,0001). Le risque de toxicité hépatique était particulièrement méconnu. La prévalence des patients à risque potentiel de surdosage involontaire était estimée entre 1 et 2 % de la population.Conclusion: La dispensation du paracétamol hors des pharmacies d’officine ne saurait être recommandée en l’état. Des campagnes d’information sont nécessaires pour limiter le risque de surdosage involontaire et de ses conséquences hépatotoxiques

Does Compliance with Nutrition Guidelines Lead to Healthy Aging? A Quality-of-Life Approach

International audienceOBJECTIVES:We aimed to estimate, in a large French cohort of middle-aged adults derived from the Supplémentation en Vitamines et Minéraux Antioxydants trial, the association of compliance with the guidelines of the French Nutrition and Health Program (PNNS) assessed at inclusion and change in health-related quality of life (HRQoL) over 12 years. A secondary objective was to identify the relative contribution of diet and physical activity to long-term change in HRQoL.DESIGN/SUBJECTS:Subjects were Supplémentation en Vitamines et Minéraux Antioxydants trial participants aged 45 to 60 years at inclusion in the cohort.MAIN OUTCOME MEASURES:Compliance with nutrition guidelines (diet and physical activity) was assessed by the PNNS Guideline Score (maximum 15 points) at inclusion. HRQoL was measured by the Medical Outcomes Survey Short Form 36 (SF-36) at 1 year (initial measurement) and 13 years (final measurement) after inclusion. The primary end point was change in the SF-36 physical component summary (PCS) and mental component summary (MCS) scores over 12 years.RESULTS:In total, 3,005 subjects (mean age 51.4 ± 4.3 years) completed the SF-36 at the initial and final measurement. The mean PNNS Guideline Score was 7.8 ± 1.9 and the mean PCS and MCS was 52.2 ± 6.4 and 50.3 ± 7.0, respectively, at the initial measurement and 48.0 ± 9.6 and 51.2 ± 8.7 at the final measurement. Better compliance with nutritional guidelines was associated with better initial and final HRQoL but not associated with change in HRQoL. Compliance with dietary guidelines was associated with positive change in PCS score but not associated with initial PCS score. In contrast, compliance with dietary guidelines was related to positive initial MCS score but not related to change in MCS score. Compliance with physical activity guidelines was related to initial PCS and MCS scores but not related to change in PCS and MCS scores.CONCLUSIONS:Following physical activity guidelines may be associated with better concomitant HRQoL and following dietary guidelines with better future physical HRQoL

No prognostic value of routine cerebrospinal fluid biomarkers in a population-based cohort of 407 multiple sclerosis patients

International audienceBackground: We aimed to determine the association of clinical and routine cerebrospinal fluid biochemical markers (total protein, IgG index and oligoclonal bands) with disability in multiple sclerosis and whether these biomarkers assessed at diagnosis add prognostic value. Methods: We followed a cohort of patients included in the Multiple Sclerosis Lorraine Register (eastern France) who had a diagnosis of multiple sclerosis for at least 5 years, as well as biological markers values and MRI findings (Barkhof's criteria). In a Cox regression model, endpoint was time to score of 4 on the Expanded Disability Status Scale (EDSS) (i.e., limited time walking without aid or rest for more than 500 m). Results: For 407 patients included, the median time from multiple sclerosis onset to EDSS score 4 was 4.5 years [2.2-7.2]. Cerebrospinal fluid total protein factor < 500 mg/L was associated with EDSS score 4 on bivariate analysis (hazard ratio 0.66, 95% confidence interval 0.46-0.95, p = 0.02). On multivariate analysis, older age at disease onset (= 50 years) and initial primary progressive course of MS but not biological markers predicted worse prognosis. Conclusion: Routine cerebrospinal fluid biological markers at diagnosis were not prognostic factors of multiple sclerosis progression

B vitamin and/or n-3 fatty acid supplementation and health-related quality of life: ancillary findings from the SU.FOL.OM3 randomized trial.

BACKGROUND: Despite growing attention to nutrition and quality of life in cardiovascular disease survivors, the impact of dietary factors according to disease type or to quality of life domain is poorly understood. We investigated the effects of B vitamin and/or n-3 fatty acid supplementation on health-related quality of life among survivors of stroke, myocardial infarction, or unstable angina. METHODS: We performed ancillary analyses of the SU.FOL.OM3 trial (2003-2009; France). In total, 2,501 men (mean age = 61 y) and women (mean age = 63 y) were randomized in a 2×2 factorial design to: 1) 0.56 mg 5-methyl-tetrahydrofolate, 3 mg vitamin B6, 0.02 mg vitamin B12; 2) 600 mg eicosapentaenoic and docosahexaenoic acids in a 2∶1 ratio; 3) B vitamins and n-3 fatty acids combined; or 4) placebo. Health-related quality of life was evaluated at follow-up with the Medical Outcomes Study 36-Item Short Form Health Survey. Data from 2,029 individuals were used in this analysis. RESULTS: After 3.1±0.4 y, no effects of supplementation with either B vitamins or n-3 fatty acids on quality of life (physical or mental health domains) were found. However, participants receiving B vitamins had slightly more activity limitations due to emotional problems compared with those not receiving B vitamins (mean difference = 3.8; 95% CI: 0.4, 7.1). A significant interaction of treatment by prior disease revealed an inverse association between n-3 fatty acids and vitality among myocardial infarction survivors (mean difference = 2.9; 95% CI: 0.5, 5.2). CONCLUSIONS: There were no beneficial effects of supplementation with relatively low doses of B vitamins or n-3 fatty acids on health-related quality of life in cardiovascular disease survivors. The adverse effects of B vitamins on activity limitations and of n-3 fatty acids on vitality among individuals with prior myocardial infarction merit confirmation

Neutralizing antibodies and fatigue as predictors of low response to interferon-beta treatment in patients with multiple sclerosis.

International audienceBackgroundThe clinical impact of neutralizing antibodies against interferon-beta (NAb) is controversial. Their presence can lead to a decrease in interferon-beta (IFNß) efficacy. Fatigue reported in patients with multiple sclerosis (MS) may be associated with an unfavorable clinical course. We conducted a prospective multicentre study to assess the association between response to IFNß, NAb and fatigue.MethodsPatients with relapsing-remitting MS on IFNß treatment were included. During the second year of treatment, the patients were analyzed for NAb status and non-response criteria to IFNß (number of relapses ¿1 during the follow-up period, increase in the Expanded Disability Status Scale ¿0.5). The score on the Modified Fatigue Impact Scale (MFIS pathological if score ¿35) was noted for each patient.ResultsOf the 176 patients included: 22.3% were NAb positive, 54.5% presented non-response criteria to IFNß, and 57.4% had a pathological MFIS score. Fatigue was increased in NAb¿+¿patients (p¿=¿0.0014) and they were more likely to present non-response criteria to IFNß (p¿=¿0.041) than NAb- patients. Multivariate logistic regression analysis showed that the presence of NAb was related to fatigue (p¿=¿0.0032) and denoted disease activity in these patients (p¿=¿0.026).ConclusionsThis study demonstrates the impact of NAb on the non-clinical response to IFNß. Fatigue assessment is an indicator of IFNß responsiveness and a predictive biomarker of deterioration on patient¿s neurological status

Additional Use of A beta(42)/A beta(40) Ratio with Cerebrospinal Fluid Biomarkers P-Tau and A beta(42) Increases the Level of Evidence of Alzheimer's Disease Pathophysiological Process in Routine Practice

International audienceBackground: Cerebrospinal fluid (CSF) biomarkers have recently been included in the criteria for the diagnosis of Alzheimer's disease (AD). Since interpretation of CSF profile requires the combination of three parameters, biological data are not always conclusive and isolated elevation of phosphorylated tau (P-tau) or reduction of amyloid-beta (A beta)(42) alone can be observed. In these cases, A beta(42)/A beta(40) ratio could be more relevant than A beta(42) absolute values by considering inter-individual variations in the total amyloid load. Objective: The objective of this study was to assess the use of A beta(42)/A beta(40) ratio to improve the accuracy of biological conclusions in the diagnosis of patients with ambiguous CSF A beta(42) or tau results. Methods: Among 386 lumbar punctures analyzed in the lab in 2 years, 122 showed ambiguous biological data that were completed by CSF A beta(40) quantification and A beta(42)/A beta(40) ratio calculation. A biological conclusion was then made using 0.05 as the A beta(42)/A beta(40) ratio cut-off. Results: Our results showed that one-third of the biological profiles of patients with atypical dementia were ambiguous. The addition of A beta(42)/A beta(40) ratio increased the proportion of interpretable biological profiles from 69% to 87%, without changing the conclusion when usual biomarkers (A beta(42) and P-tau) were concordant. Conclusion: Our results support the use of the A beta(42)/A beta(40) ratio in addition to the usual CSF AD biomarkers for patients with ambiguous biological profiles. This method could be specifically directed to this population in order to improve the level of certainty for clinical routine practice

10-year cumulative and bidirectional associations of domain-specific physical activity and sedentary behaviour with health-related quality of life in French adults: Results from the SU.VI.MAX studies

International audienceBACKGROUND:The directionality of the associations of domain-specific physical activity (PA) and sedentary behaviour (SB) with health-related quality of life (HRQoL) in adults remain insufficiently known. This study investigated the longitudinal associations of 10-year cumulative levels of PA and SB with HRQoL and the reverse associations.METHODS:A sample of 2093 (47.8% men) participants from a cohort of French adult (SU.VI.MAX) was included. Data were collected at 3 time points (1998, 2001 and 2007) using the Modifiable Activity Questionnaire (MAQ) for PA (leisure-time and occupational) and SB (screen-viewing, reading and total sitting time) and the DUKE Health Profile for HRQoL. The cumulative level (from 0 to 3) referred to the number of time points where a high PA level, high SB or good HRQoL was reported. Regression models examined the 10-year cumulative level of PA, SB as predictors of HRQoL and reverse associations.RESULTS:The 10-year cumulative level of high PA, both leisure-time and occupational, predicted a higher HRQoL while the 10-year cumulative level of high screen-viewing time and high total sitting time was associated with lower HRQoL. For the reverse association, cumulative level of good HRQoL predicted more leisure-time PA, less screen-viewing time and less total sitting time but was not related to occupational PA.CONCLUSION:Relationships between PA, SB and HRQoL are complex and should not be oversimplified in one or the other direction. Taking into account domain-specific PA and SB in health promotion programs appears of prime importance to design interventions aiming at improving HRQoL