Analysis of the transplacental transmission of SARS CoV-2 virus and antibody transfer according to the gestational age at maternal infection.

To quantify transplacental transmission of SARS-CoV-2 virus and antibody transfer in pregnant women and their newborns according to the gestational age at maternal infection. A prospective observational multicenter study including pregnant women with a positive RT-PCR or a positive serology for SARS-CoV-2 and compatible symptoms, from April to December 2020, in 11 French maternities. The study was designed to obtain a systematic collection of mother-infant dyad's samples at birth. SARS-CoV-2 viral load was measured by RT-PCR. IgG and IgM antibodies against the SARS-CoV-2 spike protein were measured by enzyme-linked immunosorbent assay. Antibody concentrations and transplacental transfer ratios were analyzed according to the gestational age at maternal infection. The primary outcome was the rate of SARS CoV-2 materno-fetal transmission at birth. The secondary outcome was the quantification of materno-fetal antibody transfer. Maternal and neonatal outcomes at birth were additionally assessed. Among 165 dyads enrolled, one congenital infection was confirmed {n = 1 (0.63%) IC95% [0.02%; 3.48%]}. The average placental IgG antibody transfer ratio was 1.27 (IC 95% [0.69-2.89]). The transfer ratio increased with increasing time between the onset of maternal infection and delivery (P Value = 0.0001). Maternal and neonatal outcomes were reassuring. We confirmed the very low rate of SARS-CoV-2 transplacental transmission (< 1%). Maternal antibody transfer to the fetus was more efficient when the infection occurred during the first and second trimester of pregnancy.

Acute heart failure in elderly patients admitted to the emergency department with acute dyspnea: a multimarker approach diagnostic study.

BACKGROUND AND IMPORTANCE: Diagnosing acute heart failure (AHF) is difficult in elderly patients presenting with acute dyspnea to the emergency department. OBJECTIVES: To assess the diagnostic accuracy of NT-proBNP, high-sensitivity cardiac troponin-I (Hs-cTnI), soluble ST2 (ST2), galectin-3 and CD146 alone and in combination for diagnosing AHF in elderly patients presenting with acute dyspnea to the emergency department. DESIGN, SETTINGS AND PARTICIPANTS: This was a prospective, multicenter study performed between September 2016 and January 2020, including elderly patients presenting with acute dyspnea to the emergency department of 6 French hospitals. INTERVENTION: Measurement of NT-proBNP, hs-cTnI, ST2, galectin-3 and CD146. OUTCOME MEASURE AND ANALYSIS: The reference standard, AHF, was adjudicated by two independent physicians based on ED and hospitalization clinical, biological (excluding biomarkers), radiological and echocardiography data (performed by a cardiologist in the cardiology department specifically for this study). Three exploratory methods (two using a cross-sectional approach with logistic regression and counting all biomarker combinations, and one using a sequential approach with gray zone optimizations) were applied to create comprehensive combinations of the 5 biomarkers for measuring diagnostic accuracy. MAIN RESULTS: Two hundred thirty-eight patients (median age of 85 years, IQR = 8) were analyzed, and 110 (46%) were diagnosed with AHF. The accuracies of NT-proBNP, CD146, hs-cTnI, galectin-3, and ST2 were 0.72 [95% confidence interval (CI) 0.66-0.77], 0.63 (95% CI 0.57-0.69), 0.59 (95% CI 0.53-0.65), 0.55 (95% CI 0.49-0.61) and 0.51 (95% CI 0.45-0.57), respectively. Regardless of the approach used or how the 5 biomarkers were combined, the best accuracy for diagnosing AHF (0.73, 95% CI 0.67-0.78) did not differ from that of NT-proBNP alone. CONCLUSION: In this study, NT-proBNP alone exhibited the best diagnostic accuracy for diagnosing AHF in elderly patients presenting with acute dyspnea to the emergency departments. None of the other biomarkers alone or combined improved the accuracy compared to NT-proBNP, which is the only biomarker to use in this setting.

ATHLETIQUE: interest of an adapted physical activity program in patients with juvenile idiopathic arthritis: a feasibility and preliminary effectiveness study.

Background: Juvenile Idiopathic Arthritis (JIA) is associated with joint inflammation, pain and limited joint mobility, impacting the practice of physical activities. Adapted Physical Activities (APA) are an increasingly used method of rehabilitation, but additional studies are needed to define the nature of the most appropriate physical activity for patients with JIA. The "ATHLETIQUE" project aims to evaluate the impact of a program integrating APA sessions with use of a pedometer watch, on disease activity in patients with JIA. Methods: This study will be a randomized, multicenter, open-label, controlled clinical trial with 2 parallel arms. The patients included in this study will be children and adolescents with JIA, aged 6 to 17 years. The experimental group (30 patients) will participate in an APA program for 3 months and will use a pedometer watch for one year. We will evaluate and compare the change in disease activity measurements (primary objective), fatigue, pain, quality of life, level of physical activity, functional capacities, and muscle strength (secondary objectives) after 14, 26 and 50 weeks. The control group (10 patients) will undergo the same evaluations as the experimental group but will not participate in the APA program and will not wear the pedometer watch. Expected results: The APA program may help to promote an active lifestyle with regular physical activity, preventing comorbidities and motor disability. Promising results on disease activity, functional capacities and quality of life would enable us to envisage a larger research program with a view to optimizing and assessing APA for children with JIA. Discussion: This study will be conducted in the short and medium-term, with one-year follow-up, including 3 months of APA sessions for the experimental group. The sessions proposed during the APA program will mainly be aerobic and bodyweight exercises. Furthermore, in contrast to previous studies on this topic, our study will integrate a novel element, namely the use of a pedometer watch. This watch will help to implement strategies to address motivation. This study aims to improve physical and mental well-being, provide a basis for the design of a larger study, and propose recommendations adapted to children with JIA. Trial registration: Registered with ClinicalTrials.gov under the number NCT05572424.

The association between real-life markers of phone use and cognitive performance, health-related quality of life and sleep.

INTRODUCTION: The real-life short-term implications of electromagnetic fields (RF-EMF) on cognitive performance and health-related quality of life have not been well studied. The SPUTNIC study (Study Panel on Upcoming Technologies to study Non-Ionizing radiation and Cognition) aimed to investigate possible correlations between mobile phone radiation and human health, including cognition, health-related quality of life and sleep. METHODS: Adult participants tracked various daily markers of RF-EMF exposures (cordless calls, mobile calls, and mobile screen time 4 h prior to each assessment) as well as three health outcomes over ten study days: 1) cognitive performance, 2) health-related quality of life (HRQoL), and 3) sleep duration and quality. Cognitive performance was measured through six "game-like" tests, assessing verbal and visuo-spatial performance repeatedly. HRQoL was assessed as fatigue, mood and stress on a Likert-scale (1-10). Sleep duration and efficiency was measured using activity trackers. We fitted mixed models with random intercepts per participant on cognitive, HRQoL and sleep scores. Possible time-varying confounders were assessed at daily intervals by questionnaire and used for model adjustment. RESULTS: A total of 121 participants ultimately took part in the SPUTNIC study, including 63 from Besancon and 58 from Basel. Self-reported wireless phone use and screen time were sporadically associated with visuo-spatial and verbal cognitive performance, compatible with chance findings. We found a small but robust significant increase in stress 0.03 (0.00-0.06; on a 1-10 Likert-scale) in relation to a 10-min increase in mobile phone screen time. Sleep duration and quality were not associated with either cordless or mobile phone calls, or with screen time. DISCUSSION: The study did not find associations between short-term RF-EMF markers and cognitive performance, HRQoL, or sleep duration and quality. The most consistent finding was increased stress in relation to more screen time, but no association with cordless or mobile phone call time.

Spatialized temporal dynamics of daily ozone concentrations: Identification of the main spatial differences.

Ground-level ozone (O3) is one of the most worrisome air pollutants regarding environmental and health impacts. There is a need for a deeper understanding of its spatial and temporal dynamics. Models are needed to provide continuous temporal and spatial coverage in ozone concentration data with a fine resolution. However, the simultaneous influence of each determinant of ozone dynamics, their spatial and temporal variations, and their interaction make the resulting dynamics of O3 concentrations difficult to understand. This study aimed to i) identify different classes of temporal dynamics of O3 at daily and 9 km2 resolution over a long-term period of 12 years, ii) identify the potential determinants of these dynamics and, iii) explore the spatial distribution of the potential classes of temporal dynamics on a spatial continuum and over about 1000 km2. Thus, 126 time series of 12-year daily ozone concentrations were classified using dynamic time warping (DTW) and hierarchical clustering (study area centered on Besançon, eastern France). The different temporal dynamics obtained differed on elevation, ozone levels, proportions of urbanized and vegetated surfaces. We identified different daily ozone temporal dynamics, spatially structured, that overlapped areas called urban, suburban and rural. Urbanization, elevation and vegetation acted as determinants simultaneously. Individually, elevation and vegetated surface were positively correlated with O3 concentrations (r = 0.84 and r = 0.41, respectively), while the proportion of urbanized area was negatively correlated with O3 (r = -0.39). An increasing ozone concentration gradient was observed from urban to rural areas and was reinforced by the elevation gradient. Rural areas were both subject to higher ozone levels (p < 0.001), least monitoring and lower predictability. We identified main determinants of the temporal dynamics of ozone concentrations. The joint influence of determinants was also synthesized. This study proposed a systematic, and reproducible way to build exposure area mapping.

Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial.

Rationale: Management of first episodes of primary spontaneous pneumothorax remains the subject of debate. Objectives: To determine whether first-line simple aspiration is noninferior to first-line chest tube drainage for lung expansion in patients with complete primary spontaneous pneumothorax. Methods: We conducted a prospective, open-label, randomized noninferiority trial. Adults aged 18-50 years with complete primary spontaneous pneumothorax (total separation of the lung from the chest wall), recruited at 31 French hospitals from 2009 to 2015, received simple aspiration (n = 200) or chest tube drainage (n = 202) as first-line treatment. The primary outcome was pulmonary expansion 24 hours after the procedure. Secondary outcomes were tolerance of treatment, occurrence of adverse events, and recurrence of pneumothorax within 1 year. Substantial discordance in the numerical inputs used for trial planning and the actual trial rates of the primary outcome resulted in a reevaluation of the trial analysis plan. Measurement and Main Results: Treatment failure occurred in 29% in the aspiration group and 18% in the chest tube drainage group (difference in failure rate, 0.113; 95% confidence interval [CI], 0.026-0.200). The aspiration group experienced less pain overall (mean difference, -1.4; 95% CI, -1.89, -0.91), less pain limiting breathing (frequency difference, -0.18; 95% CI, -0.27, -0.09), and less kinking of the device (frequency difference, -0.05; 95% CI, -0.09, -0.01). Recurrence of pneumothorax was 20% in this group versus 27% in the drainage group (frequency difference, -0.07; 95% CI, -0.16, +0.02). Conclusions: First-line management of complete primary spontaneous pneumothorax with simple aspiration had a higher failure rate than chest tube drainage but was better tolerated with fewer adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT01008228).

Early exposure to farm dust in an allergic airway inflammation rabbit model: Does it affect bronchial and cough hyperresponsiveness?

INTRODUCTION: Over the past 50 years, the prevalence of allergic respiratory diseases has been increasing. The Hygiene hypothesis explains this progression by the decrease in the bio-diversity of early microbial exposure. This study aims to evaluate the effect of early-life farm exposure on airway hyperresponsiveness and cough hypersensitivity in an allergic airway inflammation rabbit model. METHOD: A specific environment was applied to pregnant rabbits and their offspring until six weeks after birth. Rabbits were housed in a pathogen-free zone for the control group and a calf barn for the farm group. At the end of the specific environmental exposure, both groups were then housed in a conventional zone and then sensitized to ovalbumin. Ten days after sensitization, the rabbit pups received ovalbumin aerosols to provoke airway inflammation. Sensitization to ovalbumin was assessed by specific IgE assay. Cough sensitivity was assessed by mechanical stimulation of the trachea, and bronchial reactivity was assessed by methacholine challenge. The farm environment was characterized by endotoxin measurement. RESULTS: A total of 38 rabbit pups were included (18 in the farm group). Endotoxin levels in the farm environment varied from 30 to 1854 EU.m-3. There was no significant difference in specific IgE values to ovalbumin (p = 0.826) between the two groups. The mechanical threshold to elicit a cough did not differ between the two groups (p = 0.492). There was no difference in the number of cough (p = 0.270) or the intensity of ventilatory responses (p = 0.735). After adjusting for age and weight, there was no difference in respiratory resistance before and after methacholine challenge. CONCLUSION: Early exposure to the calf barn did not affect cough sensitivity or bronchial reactivity in ovalbumin-sensitized rabbits. These results suggest that not all farm environments protect against asthma and atopy. Continuous exposure to several sources of microbial diversity is probably needed.

Trajectories of cough without a cold in early childhood and associations with atopic diseases.

BACKGROUND: Although children can frequently experience a cough that affects their quality of life, few epidemiological studies have explored cough without a cold during childhood. OBJECTIVES: The objective of the study was to describe the latent class trajectories of cough from one to 10 years old and analyse their association with wheezing, atopy and allergic diseases. METHODS: Questions about cough, wheeze and allergic diseases were asked at 1, 1.5, 2, 3, 4, 5, 6 and 10 years of age in the European prospective cohort of Protection against Allergy: STUdy in Rural Environment (PASTURE). Specific IgE assays were performed at 10 years of age. Questions regarding a cough without a cold were used to build a latent class model of cough over time. RESULTS: Among the 961 children included in the study, apart from the never/infrequent trajectory (59.9%), eight trajectories of cough without a cold were identified: five grouped acute transient classes (24.1%), moderate transient (6.8%), late persistent (4.8%) and early persistent (4.4%). Compared with the never/infrequent trajectory, the other trajectories were significantly associated with wheezing, asthma and allergic rhinitis. For asthma, the strongest association was with the early persistent trajectory (ORa  = 31.00 [14.03-68.51]), which was inversely associated with farm environment (ORa  = 0.39 [0.19-0.77]) and had a high prevalence of cough triggers and unremitting wheeze. Late and early persistent trajectories were also associated with food allergy. Atopic sensitization was only associated with the late persistent trajectory. CONCLUSION: Late and early persistent coughs without a cold are positively associated with atopic respiratory diseases and food allergy. Children having recurrent cough without a cold with night cough and triggers would benefit from an asthma and allergy assessment. Growing up on a farm is associated with reduced early persistent cough.

Fractures reduction with osteoporotic treatments in patients over 75-year-old: A systematic review and meta-analysis.

Background: Osteoporosis consists in the reduction of bone mineral density and increased risk of fracture. Age is a risk factor for osteoporosis. Although many treatments are available for osteoporosis, there is limited data regarding their efficacy in older people. Objective: To evaluate the efficacy of osteoporosis treatments in patients over 75 years old. Methods: We reviewed all published studies in MEDLINE, Cochrane and EMBASE including patients over 75 years old, treated by osteoporosis drugs, and focused on vertebral fractures or hip fractures. Results: We identified 4,393 records for review; 4,216 were excluded after title/abstract review. After full text review, 19 records were included in the systematic review. Most studies showed a reduction in vertebral fracture with osteoporosis treatments, but non-significant results were observed for hip fractures. Meta-analysis of 10 studies showed that lack of treatment was significantly associated with an increased risk of vertebral fractures at one (OR = 3.67; 95%CI = 2.50-5.38) and 3 years (OR = 2.19; 95%CI = 1.44-3.34), and for hip fractures at one (OR = 2.14; 95%CI = 1.09-4.22) and 3 years (OR = 1.31, 95%CI = 1.12-1.53). Conclusion: A reduction in the risk of vertebral fractures with osteoporosis treatments was observed in most of the studies included and meta-analysis showed that lack of treatment was significantly associated with an increased risk of vertebral fractures. Concerning hip fractures, majority of included studies did not show a significant reduction in the occurrence of hip fractures with osteoporotic treatments, but meta-analysis showed an increased risk of hip fractures without osteoporotic treatment. However, most of the data derived from post hoc and preplanned analyses or observational studies.

Predictors of Gaming Disorder or Protective from It, in a French Sample: A Symptomatic Approach to Self-Regulation and Pursued Rewards, Providing Insights for Clinical Practice.

Gaming disorder (GD) is a new health condition still requiring a lot of evidence established around its underlying and related psychological mechanisms. In our study we focused on Massively Multiplayer Online Role Playing Games (MMORPGs), a specific very popular and engaging game genre, to determine that benefit, motivation and control aspects could be predictive of a dysfunctional engagement in gaming. In total, 313 participants were recruited from private forums of gamers between May 2009 and March 2010. They filled out a questionnaire on their socio-demographic data and their weekly gaming time. They also completed different psychometric assessments such as the DSM IV-TR criteria for substance dependence adapted to gaming such as the Dependence Adapted Scale (DAS), the external rewards they expected from gaming (External Motives), the expected internal reward they expected from gaming (Internal Motives), the Zuckerman Sensation Seeking Scale (ZSSS), and the Barratt impulsiveness Scale (BIS-10). Results showed that some psychological factors related to online gaming represented risk factors for GD in participants (i.e., competition and advancement motives, reduced anxiety, solace, greater personal satisfaction, and sense of power), whereas some others were found to be protective factors from GD (i.e., recreation, enjoyment and experience seeking) in participants. Additionally, the study found that disinhibition, boredom susceptibility, thrill and adventure seeking, and high impulsivity were correlated to GD in participants. In conclusion, not only motives for gaming and impulsivity could be predictors for GD, but maladaptive coping strategies based on experienced relief in-game from negative feelings (anxiety and boredom) or experienced improvement in-game of self-perception (personal satisfaction, sense of power) could play as well a role of negative reinforcers for GD. Some benefits from gaming, typically entertainment and enjoyment, are shown to be protective factors from GD, playing the role of positive reinforcing factors. They are worthy of being identified and promoted as functional gaming habits. These findings can feed the clinical and health promotion fields, with a more in-depth understanding of diverse psychological factors in gamers, identifying those at risk for GD and those protective from it. The current work can foster a more balanced approach towards gaming activities, taking their opportunities for mankind and controlling for their adverse effects in some individuals.

Do Individuals with Internet Gaming Disorder Share Personality Traits with Substance-Dependent Individuals?

(1) Background: Internet gaming disorder (IGD) shares many similarities with substance use disorder (SUD), contributing to its recognition as an addictive disorder. Nevertheless, no study has compared IGD to other addictive disorders in terms of personality traits established as highly co-occurring with SUDs. (2) Methods: We recruited a sample of gamers (massively multiplayer online role-playing games) (MMORPGs) via online in-game forums. We compared 83 individuals with IGD (MMORPG-IGD group) to 47 former heroin addicts under methadone maintenance treatment (MMT; MMT group) with regard to alexithymia, impulsivity, sensation seeking and aggressiveness assessed through self-administered scales, being TAS-20, BIS-10, Z-SSS and BDHI, respectively. (3) Results: Our results draw a relatively similar personality profile between groups but indicate that the subject traits are generally more pronounced in the MMT cohort. The overall lesser intensity of these traits in the MMORPG-IGD group might reflect the greater variability in the severity of the IGD. (4) Conclusions: IGD shares personality traits with MMT, and intensity may be influenced by the severity of the addiction or by certain direct environmental factors, and might also influence the propensity towards one behavior rather than another.

Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo.

Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC). While the number of cases has increased steadily in the DRC over the last 30 years, the environmental risk factors that drive the spatiotemporal dynamics of MPX transmission remain poorly understood. This study aimed to investigate the spatiotemporal associations between environmental risk factors and annual MPX incidence in the DRC. All MPX cases reported weekly at the health zone level over a 16-year period (2000-2015) were analyzed. A Bayesian hierarchical generalized linear mixed model was conducted to identify the spatiotemporal associations between annual MPX incidence and three types of environmental risk factors illustrating environment as a system resulting from physical, social and cultural interactions Primary forest (IRR 1.034 [1.029-1.040]), economic well-being (IRR 1.038 [1.031-1.047]), and temperature (IRR 1.143 [1.028-1.261]) were positively associated with annual MPX incidence. Our study shows that physical environmental risk factors alone cannot explain the emergence of MPX outbreaks in the DRC. Economic level and cultural practices participate from environment as a whole and thus, must be considered to understand exposure to MPX risk Future studies should examine the impact of these factors in greater detail.

Environmental noise exposure is associated with atherothrombotic risk.

There is growing evidence that environmental noise exposure could increase the risk of atherothrombotic events, including acute myocardial infarction (MI). We analysed the burden of environmental noise on atherothrombotic risk in MI patients. From the RICO survey, 879 consecutive MI patients included from 2004 to 2008 and living in an urban unit of > 237,000 inhabitants were analysed. Atherothrombotic risk was calculated using the TRS-2P score. TRS-2P categories were split into low (TRS-2P = 0/1) (40.8%), medium-low (TRS-2P = 2) (25.7%), medium-high (TRS-2P = 3) (21.8%) and high risk (TRS-2P ≥ 4) (11.6%). Noise exposure was associated with atherothrombotic risk, with the LAeq,24 h (OR (95% CI): 1.165 (1.026-1.324)) and Lnight (OR (95CI): 1.157 (1.031-1.298)), for each 10 dB(A) increase. After adjustment, noise exposure remained a predictor of atherothrombotic risk, with LAeq,24 h (OR (95% CI): 1.162 (1.011-1.337)) and with Lnight (OR (95% CI): 1.159 (1.019-1.317)). The relationship with transportation Lnight was significant for men (OR (95% CI): 1.260 (1.078-1.472)) but not for women (OR (95% CI): 0.959 (0.763-1.205)). We found a significant association between residential traffic noise exposure and atherothrombotic risk in men but not in women. These results could have major consequences for secondary prevention.

Improvement of downscaled ozone concentrations from the transnational scale to the kilometric scale: Need, interest and new insights.

BACKGROUND: Ground-level ozone is a major public health issue worldwide. An accurate assessment of ozone exposure is necessary. Modeling tools have been developed to tackle this issue in large areas. However, these models could present inaccuracies at the local scale. OBJECTIVES: The objective of this study was i) to assess whether O3 concentrations estimated by transnational modeling at the kilometric scale (9 km2) could be improved, ii) to propose a potential correction of these downscaled ozone concentrations and iii) to evaluate the efficiency and applicability of such a correction. METHOD: The present work was carried out in three phases. First, the performance of a transnational modeling platform (PREV'EST) was assessed at 6 geographic points by comparison with data from 6 air quality monitoring stations. Performance indicators were used for this purpose (MBE (mean bias error), MAE (mean absolute error), RMSE (root mean square error), r (Pearson correlation coefficient), and target plots). Second, several corrections were developed using MARS (multivariate adaptive regression splines) and integrating different sets of variables (mean temperature, relative humidity, rainfall amount, wind speed, elevation, and date). Their performance was evaluated. Third, external validation of the corrections was conducted using the data from six additional air quality monitoring stations. RESULTS: The uncorrected PREV'EST model presented a lack of exactitude and precision. These concentrations did not reproduce the interday variability of the measurements, leading to a lack of temporal contrast in exposure data. For the best performance enhancement, the correction applied improved MBE, MAE, RMSE and r from 14.67, 19.23, 23.18 and 0.67 to 0.00, 8.00, 10.19 and 0.91, respectively. External validation confirmed the efficiency of the corrections at the regional scale. CONCLUSIONS: We propose a validated and efficient methodology integrating local environmental variables. The methodology is adaptable according to the context, needs and data available.

Cognitive Impairment in Late-Life Depression: A Comparative Study of Healthy Older People, Late-Life Depression, and Mild Alzheimer's Disease Using Multivariate Base Rates of Low Scores.

Late-Life Depression (LLD) is often associated with cognitive impairment. However, distinction between cognitive impairment due to LLD and those due to normal aging or mild Alzheimer's Disease (AD) remain difficult. The aim of this study was to present and compare the multivariate base rates of low scores in LLD, mild AD, and healthy control groups on a battery of neuropsychological tests. Participants (ages 60-89) were 352 older healthy adults, 390 patients with LLD, and 234 patients with mild AD (i.e., MMSE ≥ 20). Multivariate base rates of low scores (i.e., ≤ 5th percentile) were calculated for each participant group within different cognitive domains (verbal episodic memory, executive skills, mental processing speed, constructional praxis, and language/semantic memory). Obtaining at least one low score was relatively common in healthy older people controls (from 9.4 to 17.6%), and may thus result in a large number of false positives. By contrast, having at least two low scores was unusual (from 0.3 to 4.6%) and seems to be a more reliable criterion for identifying cognitive impairment in LLD. Having at least three low memory scores was poorly associated with LLD (5.9%) compared to mild AD (76.1%) and may provide a useful way to differentiate between these two conditions [ χ ( 1 ) 2 = 329.8, p < 0.001; Odds Ratio = 50.7, 95% CI = 38.2-77.5]. The multivariate base rate information about low scores in healthy older people and mild AD may help clinicians to identify cognitive impairments in LLD patients, improve the clinical decision-making, and target those who require regular cognitive and clinical follow-up.

Hyperendemicity of cysticercosis in Madagascar: Novel insights from school children population-based antigen prevalence study.

OBJECTIVE: Taenia solium (Ts) cysticercosis is a neglected zoonotic disease particularly prevalent in Madagascar. Few data are available for children, current data mainly rely on antibody prevalence. We sought to determine the Ts-antigen seroprevalence-determining active cysticercosis-amongst school children from various cities in Madagascar (excluding the capital) and evaluated associated risk factors. METHODS: In seven cities in Madagascar, the presence of cysticercosis in school children (n = 1751) was investigated in 2007 using the B158/B60 antigen (Ag)-ELISA. RESULTS: The overall prevalence based on Ag detection was 27.7% [95%CI: 10-37%]. Risk factors associated with Ag positivity were age, biotope, altitude and annual average rainfall. CONCLUSION: These results highlight the high prevalence of active cysticercosis in Madagascar among school children in an urban setting. This high prevalence as well as the risk factors unraveled point to the emergency to implement appropriate Public Health measure son a national scale.

Evaluation of Attachment Style and Social Support in Patients With Severe Migraine. Applications in Doctor-Patient Relationships and Treatment Adherence.

Objectives: The aim of this observational study was to describe social support and patterns of attachment among patients with migraine. We hypothesized that in comparison to the general population, insecure attachment is overrepresented in migraine patients, and that these patients have less social support. We also aimed to study the specific relationship between attachment and social support. We hypothesized that patients with an insecure attachment style have less social support than patients with a secure attachment style. Methods: A total of 101 consecutive patients (88.1% women) aged between 25 and 60 (average age = 41.4) were recruited at the Specialized Center for the Consultation of Primary Headaches at the Regional University Hospital Center of Besançon (France). Migraine impact and disability were evaluated using the Headache Impact Test (HIT-6) questionnaire and Migraine Disability Assessment (MIDAS) questionnaire. Patients also completed several self-administered psychological questionnaires in their validated French versions: the Medical Outcome Survey 36-Item Short-Form Health Survey, the Cungi Scale, the State-Trait Anxiety Inventory, the Beck Depression Inventory, the Relationship Scales Questionnaire and the Sarason's Social Support Questionnaire. Results: The distribution of attachment profiles was different from that of the general population, with an overrepresentation of insecure attachment styles (p = 0.018). Our study showed that migraine patients had less social support than the general population, both in terms of the number of people providing support (p = 0.002) and the level of satisfaction concerning this social support (p = 0.000). We also found that neither the number of available persons score nor the satisfaction score were statistically different between the four attachment categories (p = 0.49). Patient's attachment style and social support influence the patient-doctor relationship, the therapeutic alliance and health behaviors such as treatment adherence. Conclusions: Based on the data we obtained, we developed applications in patient care for people with particular attachment styles and low social support. A treatment plan adapted to the patient's attachment profile should be created to develop "precision medicine" using a personalized approach to the doctor-patient relationship. We would also recommend encouraging patients to participate in support groups, in order to strengthen their attachment systems and gain social support. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03577548, identifier NCT03577548.

Association between moderated level of air pollution and fetal growth: the potential role of noise exposure.

This study aims to analyze, in a population of singletons, the potential confounding or modifying effect of noise on the relationship between fetal growth restriction (FGR) or small for gestational age (SGA) and environmental exposure to air pollution. All women with single pregnancies living in one of two medium-sized cities (Besançon, Dijon) and who delivered at a university hospital between 2005 and 2009 were included. FGR and SGA were obtained from medical records. Outdoor residential exposure to nitrogen dioxide (NO2) and particulate matter (PM10) was quantified at the mother's address at delivery over defined pregnancy periods; outdoor noise exposure was considered to be the annual average daily noise levels in the façade of building (LAeq,24 h). Adjusted odds ratios (ORa) were estimated by multivariable logistic regressions. Among the 8994 included pregnancies, 587 presented FGR and 918 presented SGA. In the two-exposure models, for SGA, the ORa for a 10-µg/m3 increase of PM10 during the two last months before delivery was 1.18, 95%CI 1.00-1.41 and for FGR, these ORa were for the first and the third trimesters, and the two last months before delivery: 0.77 (0.61-0.97), 1.38 (1.12-1.70), and 1.35 (1.11-1.66), respectively. Noise was not associated with SGA or FGR and did not confound the relationship between air pollution and SGA or FGR. These results are in favor of an association between PM10 exposure and fetal growth, independent of noise, particularly towards the end of pregnancy, and of a lack of association between noise and fetal growth.

Pneumothorax and the environment: A systematic review of the impact of air pollution and meteorology, and a meta-analysis on meteorology factors.

A relationship between the occurrence of spontaneous pneumothorax (SP) and meteorological factors has been observed but with contradictory results. The objectives of this systematic review was to synthesis the current body of evidence to the relationships between the occurrence of SP and environmental determinants such as meteorological factors and air pollutants. We conducted a systematic search of MEDLINE, Scopus, Cochrane Library and gray literature from inception up to 31st December 2020, to find published scientific research articles based on the following eligibility criteria: original studies and population-based articles describing the relationship between meteorological factors or air pollutants and the occurrence of SP. For the meta-analysis, studies involving a quantitative analysis of the exposure variable (atmospheric pressure, temperature, humidity and wind speed) and the impact of the occurrence of SP with comparable methodology were selected. General characteristics and methodological information for each study were assessed. The quality was evaluated according to the Newcastle-Ottawa Scale. Fourty four and 13 studies were respectively included in the qualitative and quantitative analyses. The variability of the study design with moderate quality and the different measurements of the exposure variables highlight the contrasting results. The results of the meta-analyses are in favor of a higher temperature observed in the day with SP than in the days without SP (maximum: MD 0.25 (-0.08, 0.58) p = 0.14; I2 = 26%, p = 0.21; mean: MD 0.22 (-0.15, 0.59) p = 0.24; I2 = 45%, p = 0.07). The small number of studies focused on air pollution did not allow us to conclude to determine the potential impact of exposure to air pollutants on the occurrence of SP. Meteorological conditions seem to be related to SP occurrence, especially increased temperature.