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Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures.
Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus.
Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05).
This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.
Évaluer l’efficience du palmitate de palipéridone (PP) par rapport aux antipsychotiques les plus communément utilisés en France.
Un modèle médico-économique a été développé afin de simuler la progression d’une cohorte de patients atteints de schizophrénie à travers quatre états de santé (« Stable-traité », « Stable-non-traité », « En-rechute », « Décédé »). PP a été comparé à rispéridone injectable à libération prolongée (ILP), aripiprazole ILP, olanzapine ILP, halopéridol décanoate et olanzapine orale (OO). Les coûts, les années de vie pondérées par la qualité de vie (« Quality-adjusted-life-year » ; QALY) et le nombre de rechutes ont été estimés sur cinq ans selon une perspective tous payeurs. Supposés stabilisés suite à une décompensation clinique, les patients initiaient un antipsychotique et passaient en phase de prévention de la rechute en cas de succès après trois mois. Ils/elles pouvaient arrêter leur traitement après une rechute, un manque de tolérance ou par choix, et passer sur la ligne de traitement suivante jusqu’à la troisième ligne (c.-à.-d. clozapine). Afin de prendre en compte l’observance, les probabilités de rechute en phase de prévention ont été calculées à partir de taux d’hospitalisation sur des données françaises en vie réelle. Les données de tolérance et d’utilité ont été dérivées d’études internationales, et les coûts de sources françaises. La robustesse des résultats a été testée via des analyses de sensibilité.
À 5 ans, PP est le moins coûteux des ILP et est associé à un surcoût de 249 € par rapport à OO. Rispéridone ILP et PP sont associés aux plus grands nombres de QALY. PP domine tous les autres ILP en termes de rechute évitée hormis olanzapine ILP.
PP est le moins coûteux des antipsychotiques ILP en France. OO est l’antipsychotique le moins coûteux, mais est associée à un nombre plus faible de QALY gagnées et de rechutes évitées comparé aux antipsychotiques ILP.
La lutte contre les violences faites aux femmes demeure encore aujourd’hui un enjeu sociétal majeur. À l’occasion de la Journée internationale de lutte contre les violences faites aux femmes le 25 novembre 2013, une enquête sur le regard des professionnels de santé face aux violences faites aux femmes a été organisée en collaboration entre le CHU de Martinique, l’association « Union des Femmes de la Martinique », l’Inserm U669 IPOM, l’association AFORPOM et la Délégation Régionale aux Droits des Femmes et à l’Égalité.
L’enquête a été réalisée le 19 novembre 2013 sur le site du CHU de Martinique par des enquêteurs (étudiants) et via l’intranet du CHU de Martinique.
Parmi les professionnels, 95,7 % ont accepté de répondre au questionnaire anonyme qui leurs a été proposés (72 % de femme et 28 % d’hommes). Cinq cent sept questionnaires ont été documentés. Le test du Chi2 et le test exact de Fischer ont été utilisés : à la question « Abordez-vous le sujet de façon systématique ? », Il n’y a pas de différence significative : entre les hommes et les femmes ou si la personne est concernée dans sa vie personnelle. On observe une différence significative pour ce qui concerne le secteur d’activité (les sages-femmes, kiné, psychologue et assistante sociale) posent plus souvent cette question par rapport aux autres professionnels (médecin, étudiants, infirmier[ère]s, aides-soignants) (p < 0,0001). Les personnes sensibilisées dans leur vie professionnelle posent la question de façon plus systématique (p = 0,0018).
Mieux former les professionnels est un atout pour mieux prendre en charge les femmes victimes de violences, 85 % pensent qu’une formation est nécessaire pour aborder ces questions et 82 % souhaitent une formation (95 % pour les aides-soignantes, 90 % pour les infirmier[ère]s et les étudiants, 83 % pour les internes contre 60 % pour les médecins).
L’utilisation prolongée et les associations de benzodiazépines (BZD) anxiolytiques et hypnotiques exposent à des risques à court et long terme (dépendance, démence, troubles psychomoteurs…). Selon la Haute Autorité de santé (HAS), il n’y a pas lieu d’associer une BZD et un apparenté (zopiclone ou zolpidem) le soir.
– Évaluer les habitudes de prescription des BZD et de leurs apparentés hypnotiques dans une population de patients suivis en psychiatrie hospitalière.
– Suivre sur 6 années l’évolution de ces pratiques de prescription et l’émergence d’alternatives thérapeutiques aux BZD.
– Établir un parallèle avec les recommandations et les actualités de la littérature au sujet de ces risques pendant cette même période.
L’étude rétrospective a été réalisée au centre hospitalier Henri-Laborit (Poitiers) en sélectionnant les ordonnances informatisées comportant des BZD et/ou apparentés sur une période allant du 1er janvier 2008 au 31 décembre 2013, par tranche d’une année. Les associations de ces molécules et leurs posologies ont été répertoriées.
L’analyse de 6511 ordonnances a notamment mis en évidence que la prescription de zolpidem ou zopiclone seuls, sans association à une benzodiazépine, est majoritaire (77,5 % des ordonnances en moyenne) jusqu’en 2010. Puis elle diminue fortement (plus que 38 % en 2013) et elle est inférieure à celle de benzodiazépine seule pendant les 3 années suivantes. Parallèlement, le nombre total d’ordonnances dans cet hôpital est en constante augmentation. L’association de benzodiazépine et d’apparentés sur une même ordonnance reste peu courante, dans 2 % des prescriptions en moyenne, mais la prise des deux se situe le soir dans 91 % des cas (69–100 %).
L’étude montre une diminution de prescription d’hypnotiques apparentés aux BZD, allant de pair avec les mises en garde sur leurs effets indésirables et aux actions de l’HAS. Leur association en soirée à des BZD reste présente et une étude prospective auprès des prescripteurs pour connaître leur choix d’alternative thérapeutique est nécessaire.
Since reports have underscored that panic attacks (PA) may be an identifiable state occurring in schizophrenia, we studied the symptomatology of PA in a group of schizophrenic patients. Of 40 patients (21 males and 19 females) attending a clinic for maintenance therapy of schizophrenia, 19 (36.8%) had a lifetime history of PA. Seven among those 19 patients (36.8%) had or had had spontaneous panic attacks, not related to phobic fears or delusional fears, and for the 12 remaining patients, the PA were related to paranoid ideas. Moreover, the paranoid subtype of schizophrenia tends to be more often associated with a history of panic attack than other subtypes of schizophrenia (52.6% vs 23.8%; χ2 = 3.5, P = .06). It seems that there are at least two types of PA in schizophrenic patients. The first one could be independent from the psychotic feature, with no psychopathological link. The second kind of PA could be directly related to a schizophrenic disorder, and found in patients with the paranoid subtype.
Patients with schizophrenia display significant working memory and executive deficits. In patients with obsessive-compulsive disorder (OCD), several studies suggest that working memory dysfunction may be one of the causes of compulsive checking behaviors. Hence, this study aimed at assessing whether patients with schizophrenia were impaired on an image comparison task used to measure checking behaviors, and whether the origin and profile of impairment on this task was different between schizophrenia and OCD.
Eye movement recordings were used to assess the checking behavior of 24 patients with schizophrenia and 24 control participants who had to decide whether two images were different or identical. The verbal and visuo-spatial components of participants’ working memory were measured using the reading span and backward location span tests.
Compared to controls, patients with schizophrenia had reduced working memory spans and showed excessive checking behavior when comparing the two images. However, the intensity of their checking behavior was not significantly related to their working memory deficits.
Several recent studies demonstrated that the excessive checking behaviors displayed by patients with OCD were related to working memory dysfunction. The absence of a relationship between the excessive checking behavior of patients with schizophrenia and their working memory deficits suggests that checking behaviors do not have the same origin in the two disorders.
In Europe, in the late 19th century and the first half of the 20th century, new nosologic categories were formulated that could not be framed within Manic-Depressive Psycosis or Kraeplins' Demencia Praecox: Bouffée delirante by the French, Cycloid Psychosis by the German, Reactive and Schizophreniform Psychosis by the Scandinavians. These are concepts that are currently classified in the ICD-10 under Acute and Transitory Psychotic Disorders.
Cycloid Psychosis are characterized by an abrupt onset and polimorfic symptomatology namely delusions, hallucinations in every sensory modality, confusion, akinesia or hyperkinesia, feelings of ecstasy, which can vary with time. They have a recurring course, rapid remission followed by the reinstatement of the premorbid personality.
We present a case study of a female, 26 year old patient. The first psychotic episode occurred 2 years ago and was followed by complete recovery. Recently, there was a recrudescence of the symptomatology. She presented with a polimorfic symptoms, alternating between mutism and psychomotor agitation, disorientation, incoherent speech and almost total insomnia. There was an absence of response to antipsychotic medication. Therefore, the patient was submitted to electroconvulsive therapy with an overall improvement of symptoms, maintaining some puerility. The aim of this case study was to draw attention to the diagnosis of Cycloid Psychosis, and it confirms the efficacy of electroconvulsive therapy in its treatment.
Depression is one of the main causes of disability in the Western countries. This evidence presents new challenges for somatic medicine, such as surgery.
To determine the influence of patients’ depression on (i) length of hospital stay (LOS, which is a proxy of recovery) after major surgery, and (ii) LOS anticipated by surgeon preoperatively.
To explore the influence of depression on recovery after major surgery, and whether and how surgeons take into account patients’ emotional and psychological status in the care of their patients.
Prospective multicentre observational study. Depression was assessed with HADS (HADS > 8 showing the presence of significant depression). Two cox PH models were fitted to evaluate the influence of depression on patients’ LOS (first model) and anticipated LOS (second model). Adjustment variables were (i) preoperative (age, sex, anxiety, diagnosis, BMI, biology), (ii) intraoperative (blood transfusion, length of intervention), (iii) postoperative (morbidity).
Of 372 recruited patients (which had undergone major liver surgery), 69 (18,5%) had HADS>8. After adjustment, depression was a risk factor for a prolonged LOS (HR 1.96, 95%CI 1.44–2.63). However, depression was unrelated to the anticipated LOS (HR 1.26, 95%CI 0.90–1.66).
1 in 5 patients presented a significant level of depression. Depression was independently associated to longer LOS (ie. longer recovery time after surgery). However this data was not taken into account by surgeons, which failed to integrate that in their previsions. A psychiatric culture and education need to be developed in surgery, as well as more collaboration.
Parents of children with disabilities are at increased risk of experiencing psychological stress compared to other parents. Children's high levels of internalizing and externalizing problems have been found to contribute to this elevated level of stress. Childhood disability often imposes a social and emotional burden for children and their families.
With this study we evaluated several parents’ psychological aspects and the emotional behavioral functioning of their children with disability.
To investigate the possible correlation between parenting stress, level of depression in parents and behavior problems in their children, taking in to account the differences between mothers and fathers.
standardized forms (CBCL, PSI, BDI) were completed from 57 (28 mothers) parents of children aged from 6 to18 years, focusing on psychological well-being includes depression, parenting stress, family resilience and family adjustment.
The mean age of our sample was 41.55 ± 5.4. The level of depression and stress index were higher in mothers than in fathers. Parenting stress was significantly associated with children internalizing and externalizing behavior problems in children.
The results of this investigation indicate the importance of examining relations between parenting stress and behavior problems in children with disabilities. Objective of ensuring the rehabilitation process aimed at the welfare of the family. These patterns have implications for both developmental theory and for service provision for individuals with disability and their families.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Triply Periodic Minimal Surfaces (TPMS) possess locally minimized surface area under the constraint of periodic boundary conditions. Different families of surfaces were obtained with different topologies satisfying such conditions. Examples of such families include Primitive (P), Gyroid (G) and Diamond (D) surfaces. From a purely mathematical subject, TPMS have been recently found in materials science as optimal geometries for structural applications. Proposed by Mackay and Terrones in 1991, schwarzites are 3D crystalline porous carbon nanocrystals exhibiting a TPMS-like surface topology. Although their complex topology poses serious limitations on their synthesis with conventional nanoscale fabrication methods, such as Chemical Vapour Deposition (CVD), schwarzites can be fabricated by Additive Manufacturing (AM) techniques, such as 3D Printing. In this work, we used an optimized atomic model of a schwarzite structure from the D family (D8bal) to generate a surface mesh that was subsequently used for 3D-printing through Fused Deposition Modelling (FDM). This D schwarzite was 3D-printed with thermoplastic PolyLactic Acid (PLA) polymer filaments. Mechanical properties under uniaxial compression were investigated for both the atomic model and the 3D-printed one. Fully atomistic Molecular Dynamics (MD) simulations were also carried out to investigate the uniaxial compression behavior of the D8bal atomic model. Mechanical testings were performed on the 3D-printed schwarzite where the deformation mechanisms were found to be similar to those observed in MD simulations. These results are suggestive of a scale-independent mechanical behavior that is dominated by structural topology.
‘Discourses of climate delay’ pervade current debates on climate action. These discourses accept the existence of climate change, but justify inaction or inadequate efforts. In contemporary discussions on what actions should be taken, by whom and how fast, proponents of climate delay would argue for minimal action or action taken by others. They focus attention on the negative social effects of climate policies and raise doubt that mitigation is possible. Here, we outline the common features of climate delay discourses and provide a guide to identifying them.
Several lines of evidence suggest that children born via Cesarean section (C-section) are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of babies born via C-section. Preliminary evidence indicates partial restoration of microbes. However, there is insufficient evidence to determine the health benefits of the procedure. Several studies, including trial, are currently underway. At the same time, in the clinic setting, doctors are increasingly being asked to by expectant mothers to have their babies seeded. This article reports on the current research on this procedure and the issues it raises for regulators, researchers, physicians, and patients.
This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2–5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6–5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47–0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Noonan syndrome and related disorders are a group of clinically and genetically heterogeneous conditions caused by mutations in genes of the RAS/MAPK pathway. Noonan syndrome causes multiple congenital anomalies, which are frequently accompanied by hypertrophic cardiomyopathy (HCM). We report here a Tunisian patient with a severe phenotype of Noonan syndrome including neonatal HCM, facial dysmorphism, severe failure to thrive, cutaneous abnormalities, pectus excavatum and severe stunted growth, who died in her eighth month of life. Using whole exome sequencing, we identified a de novo mutation in exon 7 of the RAF1 gene: c.776C > A (p.Ser259Tyr). This mutation affects a highly conserved serine residue, a main mediator of Raf-1 inhibition via phosphorylation. To our knowledge the c.776C > A mutation has been previously reported in only one case with prenatally diagnosed Noonan syndrome. Our study further supports the striking correlation of RAF1 mutations with HCM and highlights the clinical severity of Noonan syndrome associated with a RAF1 p.Ser259Tyr mutation.
Transoral laser microsurgery is an increasingly common treatment modality for glottic carcinoma. This study aimed to determine the effect of age, gender, stage and time on voice-related quality of life using the Voice Handicap Index-10.
Primary early glottic carcinoma patients treated with transoral laser microsurgery were included in the study. Self-reported Voice Handicap Index testing was completed pre-operatively, three months post-operatively, and yearly at follow-up appointments.
Voice Handicap Index improvement was found to be dependent on age and tumour stage, while no significant differences were found in Voice Handicap Index for gender. Voice Handicap Index score was significantly improved at 12 months and 24 months. Time versus Voice Handicap Index modelling revealed a preference for non-linear over linear regression.
Age and stage are important factors, as younger patients with more advanced tumours show greater voice improvement post-operatively. Patient's Voice Handicap Index is predicted to have 95 per cent of maximal improvement by 5.5 months post-operatively.
As part of the evaluation of the French plan for the elimination of measles and rubella, we conducted a seroprevalence survey in 2013, aimed at updating seroprevalence data for people 18–32 years old. A secondary objective was to estimate measles incidence in this population during the 2009–2011 outbreak, and thus estimate the exhaustiveness of measles mandatory reporting. We used a cross-sectional survey design, targeting blood donors 18–32 years old, living in France since 2009, who came to give blood in a blood collecting site. We included 4647 people in metropolitan France, 806 people in Réunion Island and 496 in the French Caribbean. A further 3942 individuals were interviewed in the south-east region of metropolitan France to estimate the exhaustiveness of measles mandatory reporting. One of the main findings of this survey is that the proportion of people 18–32 years old susceptible to both measles and rubella infections remained high in France in 2013, 9.2% and 5.4%, respectively, in metropolitan France, even after the promotion campaigns about vaccination catch-up during and following the major measles epidemic in 2009–2011. Applying our results to French census data would suggest that around 1 million people aged 18–32 years old are currently susceptible to measles in France, despite this age group being one of the vaccination targets of the national measles elimination plan. Another important finding is that only an estimated 45% of the true number of cases in this age group was actually notified, despite notification being mandatory.