Trajectories of functioning in bipolar disorders: A longitudinal study in the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort

OBJECTIVE

We aimed at identifying distinct trajectories of functioning and at describing their respective clinical characteristics in a cohort of individuals with bipolar disorders.

METHODS

We included a sample of 2351 individuals with bipolar disorders who have been followed-up to 3 years as part as the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Global functioning was measured using the Functioning Assessment Short Test. We used latent class mixed models to identify distinct longitudinal trajectories of functioning over 3 years. Multivariable logistic regression models were used to identify the baseline factors that were associated with the membership to each trajectory of functioning.

RESULTS

Three distinct trajectories of functioning were identified: (1) a majority of individuals (72%) had a stable trajectory of mild functional impairment, (2) 20% of individuals had a stable trajectory of severe functional impairment and (3) 8% of individuals had a trajectory of moderate functional impairment that improved over time. The membership to a trajectory of stable severe versus stable mild functional impairment was associated with unemployment, a higher number of previous hospitalizations, childhood maltreatment, a higher level of residual depressive symptoms, higher sleep disturbances, a higher body mass index and a higher number of psychotropic medications being prescribed at baseline. The model that included these seven factors led to an area under the curve of 0.85.

CONCLUSION

This study enabled to stratify individuals with bipolar disorders according to three distinct trajectories of functioning. The results regarding the potential determinants of the trajectory of severe functional impairment needs to be replicated in independent samples. Nevertheless, these potential determinants may represent possible therapeutic targets to improve the prognosis of those patients at risk of persistent poor functioning.

COVID-19 and schools. Guidelines of the French Pediatric Society

The educational and social benefits provided by school far outweigh the risks of a possible COVID-19 contamination of children in school environments or in daycare centers. Following summer break, the back-to-school period in France is taking place in the context of an increasing viral spread and requires strict adherence to health measures to limit the risk of outbreaks in communities. Based on a critical update of the role of children in the transmission of the infection, and of children's susceptibility to infection, the French Pediatric Society published practical guidelines for school re-entry and the management of COVID-19 infections in schools.

Keys for analysis of diagnostic and serologic tests for CoV-2

Based on a review of the medical literature, the authors document the key points regarding the tests available in France to screen for and diagnose of CoV-2 infestation.

Antiviraux chez l’enfant en pratique de ville : infections herpétiques, varicelle, grippe

Les infections liées à l’herpès virus humain (HSV), au virus de la varicelle et du zona (VZV) et au virus de la grippe (Influenza A et B) sont très fréquentes en pédiatrie et sont le plus souvent bénignes avec une guérison spontanée. L’utilisation des antiviraux antigrippaux (inhibiteurs de neuraminidase) a été étudiée dans de larges essais randomisés et fait l’objet de recommandations nationales et internationales. Celle des anti-HSV et anti-VZV n’a pas fait l’objet d’études de la même ampleur et de ce fait, leur prescription est plus discutée avec des bénéfices moins bien définis et variables (à l’exception des infections néonatales et/ou neuro-méningées). L’objectif de cette mise au point est donc de proposer une synthèse des données disponibles dans la littérature concernant les indications des antiviraux en pratique de ville pour les infections liées à l’HSV (gingivostomatite, herpès récurrent, faux panaris herpétique), au VZV (varicelle, zona) et à la grippe.

0206 Sleep Opportunity and Duration are Related to Risk Injury in Elite Athletes

Introduction

Sleep is essential to musculoskeletal recovery, acquisition of new skills and emotional regulation in athletes. Insufficient sleep is detrimental to performance. Recent publications indicate that sleep duration is related to risk for injury in young athletes. We aimed at analyzing the relation between sleep opportunity and duration and the likelihood of an injury among adult elite athletes.

Methods

We studied 7,237 nights recorded with the Sleeprate application by 71 adult elite athletes from diverse sports, during the period September 2018-October 2019. Night recordings included perceived and measured sleep parameters. In addition, athletes reported their previous day nap duration, injuries and illness status. Out of the total number of nights, 4,205 included reported injury status with no injury and no illness for the previous night. Nightly total time in bed (TIB), TIB including reported naps (TIB24hr) and measured total sleep time (TST) were examined.

Results

Average TIB was significantly shorter (508±77 minutes, mean±STD) in healthy days preceding injuries than in healthy days preceding days with no injury (525±70 minutes, p<.001). Similar results were found when comparing the TIB24hr (injury: 517±83 minutes, no injury: 543±76 minutes, p<.001) and TST (injury: 443±72 minutes, no injury: 457±69 minutes, p<.001).

Conclusion

Average sleep opportunities of the elite athletes in this study were in accordance with their age and workouts load. The time athletes allow themselves as an opportunity for sleep is inversely correlated to the chances of developing an injury. These findings corroborate published research regarding sleep duration and risk of injury in athletes, yet our findings are based on real life data of elite athletes, and demonstrate the importance of sleep as part of the elite or professional athlete’s routine, suggesting that even as little as around 20 minutes of added sleep may be efficient in preventing injury.

Support

N/A

Socioeconomic inequalities and type 2 diabetes complications: A systematic review

BACKGROUND AND OBJECTIVES

A socioeconomic gradient related to type 2 diabetes (T2D) prevalence has been demonstrated in high-income countries. However, there is no evidence of such a socioeconomic gradient regarding diabetes complications. Thus, the aim of this systematic review was to collect data on risk of complications according to socioeconomic status in patients with T2D.

METHODS

PubMed and EMBASE were searched for English-language observational studies evaluating the prevalence or incidence of micro- and macrovascular complications according to individual and geographical socioeconomic status (SES). Observational studies reporting the prevalence and risk of micro- and macrovascular diabetes complications, according to an individual or geographical index of deprivation, were selected, and estimated crude and adjusted risks for each complication were reported.

RESULTS

Among the 28 included studies, most described a clear relationship between SES and diabetes complications, especially retinopathy (in 9 of 14 studies) and cardiopathy (in 8 of 9 studies). Both individual and area-based low SES was associated with an increased risk of complications. However, very few studies adjusted their analyses according to HbA_1c level.

CONCLUSION

Evaluation of SES is necessary for every T2D patient, as it appears to be a risk factor for diabetes complications. However, the available studies are insufficient for gradation of the impact of low socioeconomic level on each of these complications. Regardless, strategies for the improved screening, follow-up and care of high-risk patients should now be implemented.

P08.02 Israeli experience with Patient Reported Outcomes (PROs) in the field of neuro oncology - Quality of Life Assessment Metrics (QAM)

BACKGROUND

With the development of personalized medicine, it is necessary to take into consideration PROs, including quality of life (QOL) to adjust the treatment and follow up. Trends of QOL outcomes are of special interest for neuro oncologic patients in the setting of chemo-radiotherapy due to the high incidence of pseudo progression (worse MRI with no tumor progression). There are several QAM in the field of neuro oncology. We used the quality of life questionnaire (QLQ-30) for brain cancer with the QLQ-BN20 supplement, and Functional assessment of chronic illness therapy (FACIT) with the FACT-Br supplement (version 4). We looked at the level of agreement between the two assessment tools for QAM for Israeli patients with different brain tumors.

MATERIAL AND METHODS

Forty patients were recruited between September 2017 to May 2018 at Sheba Medical Center after local IRB approval. Patients fulfilled the two types of questionnaires at 4 time points: before radiotherapy, with radiotherapy completion, at three months follow up and before another intervention. The difference between the two metrics was measured by t-test and performed by Bland-Altman plot. The association between QAM and MRI after radiotherapy and doctor assessment was measured by Linear regression.

RESULTS

Forty patients completed 162 questionnaires overall (QLQ-30 and FACIT): 8 patients completed questionnaires at all 4 time points, 7 patients completed questionnaires - 3 times, 6 patients- twice, and 19 patients- once. Three patients didn’t answer FACIT questionnaires and 3 other patients didn’t answer QLQ questionnaires. Patients population included 40% (16/40) with astrocytoma [25% (4/16), 31.2% (5/16), 43.8% (7/16) of them with WHO Grade 2,3,4 respectively], 25% (10/40) with meningioma [60% (6/10), 20% (2/10), and 20% (2/10) of them with WHO Grade 1,2 and 3 respectively], 20% (8/40) with brain metastasis, and other tumors (6/40) consisted 15% of the patient population. We found a significant difference between QAM means of agreement of the two metrics used (p<0.001). There was a significant correlation between QAM and MRI after radiotherapy (p=0.013; R2=0.369 and p=0.025; R2=0.292 for QLQ and FACIT questionnaire, respectively). There was no significant correlation between physician examination and QAM metrics (p=0.880; R2=0.002 and p=0.724; R2=0.009 for QLQ and FACIT questionnaires respectively).

CONCLUSION

Patients’ evaluation success depends on the appropriate assessment metrics. QLQ questionnaires were a more appropriate tool in our patient population confirmed by MRI assessment compared to physicians’ evaluation. Our study shows a significant difference between two well validated tools. Further research is needed to establish the source of this difference and adjust QAM for neuro oncologic patients accordingly.

C-19 An fMRI Study of Age-Associated Changes in Basic Visual Discrimination

Objective

The study was conducted to determine age-associated changes in functional brain response, measured with fMRI, during visual discrimination with regard to three elementary components of visual perception: shape, location, and velocity. A secondary aim was to validate the method used to isolate the hypothesized brain regions associated with these perceptual functions.

Method

Items from the Visual Assessment Battery (VAB), a simultaneous match-to-sample task, assessed visual discrimination in 40 healthy adults during fMRI. Participants were aged 51-91 and recruited from a larger community sample for a study on normal aging. The tasks were designed to isolate neural recruitment during discrimination of either location, shape, or velocity by using tasks that were identical aside from the perceptual skill required to complete them.

Results

The Location task uniquely activated the dorsal visual processing stream, the Shape task the ventral stream, and the Velocity task V5/MT. Greater age was associated with greater neural recruitment, particularly in frontal areas (uncorrected voxel-level p < .001, family-wise error cluster-level p□.05).

Conclusions

Results validated the specialization of brain regions for spatial, perceptual, and movement discriminations and the use of the VAB to assess functioning localized to these regions. Anterior neural recruitment during visual discrimination increases with age.

Guidelines of the French Society of Otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version

OBJECTIVES

To present the guidelines of the French Society of Otolaryngology-Head and Neck Surgery concerning the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric ENT infections.

METHODS

Based on a critical analysis of the medical literature up to November 2016, a multidisciplinary workgroup of 11 practitioners wrote clinical practice guidelines. Levels of evidence were classified according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system: GRADE A, B, C or "expert opinion". The first version of the text was reworked by the workgroup following comments by the 22 members of the reading group.

RESULTS

The main recommendations are: NSAIDs are indicated at analgesic doses (e.g. 20-30 mg/kg/day for ibuprofen) in combination with paracetamol (acetaminophen) in uncomplicated pediatric ENT infections (acute otitis media, tonsillitis, upper respiratory infections, and maxillary sinusitis) if: o pain is of medium intensity (visual analogue scale (VAS) score 3-5 or "Evaluation Enfant Douleur" (EVENDOL) child pain score 4-7) and insufficiently relieved by first-line paracetamol (residual VAS≥3 or EVENDOL≥4); o pain is moderate to intense (VAS 5-7 or EVENDOL 7-10). When combined, paracetamol and ibuprofen are ideally taken simultaneously every 6h. It is recommended: (1) o not to prescribe NSAIDs in severe or complicated pediatric ENT infections; (2) o to suspend NSAIDs treatment in case of unusual clinical presentation of the infection (duration or symptoms); (3) o not to prescribe NSAIDs for more than 72h.