KNOWLEDGE, ATTITUDES AND READINESS TO MANAGE INTIMATE PARTNER VIOLENCE AMONG PERINATAL CARE PROVIDERS PRACTICING IN GYNECOLOGY AND OBSTETRICS IN FRANCE

International audienc

Quality Indicators during Delivery and the Immediate Postpartum Period: A Modified Delphi Study

International audienceBackground: Our research hypothesis was that most French indicators of quality of care have been validated by experts who are not clinicians and might not always be meaningful for clinicians. Our objective was to define a core set of measurable indicators of care quality during delivery and the immediate postpartum period relevant to clinical practice. Methods: A steering committee comprising nine specialists in obstetrics and/or public health conducted a literature review to develop potential indicators. A panel of obstetrician-gynecologists and midwives working in a delivery unit rated each indicator for appropriateness in a two-round Rand-modified Delphi procedure and a physical meeting. The consensus among the panelists was assessed. Results: In the first round, 145 panelists (110 obstetrician-gynecologists and 35 midwives) assessed 77 indicators and 3 definitions: 6 related to labor onset, 20 to delivery, 3 to pain management, 23 to neonatal morbidity/mortality, and 28 to maternal morbidity. In the second round, 132 panelists (98 obstetriciangynecologists and 34 midwives) assessed 42 indicators and 1 definition. The final set comprised 50 indicators and 2 definitions. Conclusions: This Delphi procedure selected 50 indicators that reflect the quality of perinatal care. These indicators should be recorded in each French maternity ward's birth register for each delivery

Knee Osteoarthritis People are Less Active than the General Population: an epidemiological study.

International audienceObjective. Describing the level and factors affecting the physical activity practices of knee osteoarthritis (OA) patients.Design. Propective epidemiological study.Patients and Methods. 548 knee osteoarthritis patients were interviewed via self-administered anonymous questionnaires. Main Outcome Measurement The main outcome was physical activity level, evaluated by the International Physical Activity Questionnaire (short version) (IPAQ). Secondary outcomes included sociodemographic and clinical data, comorbidities, as well as barriers to and facilitators of practicing regular physical activity evaluated over 24 specific elements. Results. The study population’s mean age was 67.6 years (SD 7.9), including 73.9% women and 30.9% obese individuals with a mean body mass index (BMI) of 28.2 kg/m2 (SD 5.7). Multi-joint osteoarthritis (OA) affected 92%, 71.6% of whom had comorbidities. The mean Visual Analogue Scale (VAS) pain intensity score was 4.5/10 (SD 2.5), 51.4% better than the Patient Acceptable Symptom State (PASS). Mean WOMAC function was 36.6/100 (SD 20.7), 57.5% better than PASS; 67% of patients used analgesics, half of them at least once a week. According to the IPAQ, 42.6% of patients reported high activity levels, 38.6% moderate, 18.8% low, the median IPAQ total activity score was 2628 metabolic equivalent of task (MET)-min/week and time spent sitting was 257.1 min/week. Only a third of patients received non-pharmacological treatment corresponding to the latest recommendations. Variables significantly related to inactive/minimally active physical activity levels were BMI (p=0.0294), gender (p=0.0008), and biomedical barriers, related to self-efficacy (p=0.0118).Conclusions. The OA study population was less active, more sedentary, and had more comorbidities and more barriers to physical activity practice than the overall population. This study could help better adapt health care measures, while taking into account patients’ overall status, including symptoms of OA pathology and comorbidities, providing tailored educational strategies with respect to physical activity

Intérêt de la técarthérapie sur une cicatrice de césarienne douloureuse : protocole d’un essai clinique randomisé

International audienc

Physical activity level and association with behavioral factors in knee osteoarthritis.

International audienceBackground: The effects of physical activity (PA) in disease prevention and therapy have well-known effects on lower-limb osteoarthritis (OA), decreasing pain and improving function.Objective: We aimed to describe the level and factors affecting PA practices of people with knee OA.Design: Prospective epidemiological study.Setting: In all, 548 people with knee OA were interviewed by use of self-administered anonymous questionnaires.Main outcome measurement: The main outcome was physical activity level evaluated by the International physical activity questionnaire (IPAQ) (short version). Secondary outcomes included sociodemographic and clinical data, comorbidities, and barriers to and facilitators of practicing regular PA evaluated by 24 specific elements.Results: The mean (SD) age of the study population was 67.6 (7.9) years; 73.9% were women and 30.9% had obesity (mean [SD] body mass index [BMI] 28.2 [5.7] kg/m2). Multi-joint OA affected 92% of the population, and 71.6% had comorbidities. The mean (SD) visual analog scale score for pain intensity was 4.5/10 (2.5), which was 51.4% better than the patient acceptable symptom state (PASS). The mean (SD) Western Ontario and McMaster Universities Osteoarthritis Index function score was 36.6/100 (20.7), which was 57.5% better than the PASS. In total, 67% of patients used analgesics, half of them at least once a week. According to the IPAQ 42.6% of patients reported high, 38.6% moderate, and 18.8% low PA level; the median IPAQ total activity score was 2628 metabolic equivalent of task (MET)-min/week and time spent sitting was 257.1 min/day. Only one third of participants received non-pharmacological treatment corresponding to the latest recommendations. Variables significantly related to inactive or minimally active PA levels were BMI (P = 0.0294), sex (P = 0.0008), and biomedical barriers, related to self-efficacy (P = 0.0118).Conclusions: The OA study population was less active, more sedentary, and had more comorbidities and more barriers to PA practice than the overall population

Health-related quality of life among community-dwelling people aged 80 years and over: a cross-sectional study in France.

International audienceThe proportion of people living to a very old age is continuously increasing. One of the possibilities explored in policies and services to meet this health and societal challenge is to encourage the very old to continue living at home. This initiative is in line with the wishes of most elderly people. However, owing to the great changes that occur during old age attention should be paid to health-related quality of life (HRQoL). The aims of this study were to assess HRQoL in French community-dwelling people aged 80 years and over and to investigate the sociodemographic and health characteristics and life events associated with HRQoL

Validation of the French version of the LEIPAD in community-dwelling people aged 80 years and above

International audienc

Deprescribing in older adults in a French community: a questionnaire study on patients’ beliefs and attitudes

International audienceBackground; General practitioners (GPs) have a central role to play on reduction of polypharmacy and deprescribing. This study aimed to assess beliefs and attitudes towards deprescribing in patients, aged 65 years or older in primary care, and to identify factors associated with deprescribing and their willingness to stop medication.Methods: A questionnaire study was performed between 23 May and 29 July 2022 on patients aged 65 years or older attending a GP’s surgery in a French area. We used the French version of the revised Patients’ Attitudes Towards Deprescribing self-report questionnaire (rPATD), which measures four subscales (“Burden”, “Appropriateness”, “Concerns about stopping” and, “Involvement”), patients’ willingness to stop one of their regular medicines, and patients’ satisfaction with their current medicines. Results The study enrolled 200 patients. Median age was 76 years old (IQR 71–81), 55% were women, and 42.5% took 5 or more medications per day. Although most patients (92.5%) were satisfied with their current medicines, 35% were reluctant to stop medications they had been taking for a long time, and 89.5% were willing to stop medication if asked to by their GP. Patients aged less than 75 years old reported more concerns about stopping. Women and patients with higher educational attainment showed significantly higher involvement in medication management. Conclusions The majority of older adults were willing to stop one or more of their regular medicines if asked to do so by their GP. GPs should address deprescribing into their current practice

Rapport d'étude sur la qualité des soins prodigués en maisons de naissance en France.: Analyse des données de l'année 2018, par le groupe de recherche sur les maisons de naissance

Les maisons de naissance (MDN) font partie intégrante de l'offre de soins en périnatalité dans la plupartdes pays à haut niveau de ressources économiques. Elles proposent un changement de paradigme enoffrant un modèle de soins continu, patient-centré, innovant, avec un accouchement réalisé enambulatoire et qui valorise la salutogénèse (soins de prévention). La France a récemment autorisél'ouverture de 8 MDN qui sont en cours d'expérimentation.OBJECTIFNous avons cherché à évaluer la qualité des soins qui y sont prodigués à travers plusieurs dimensions : lapertinence, l'efficacité et la sécurité des soins.MATÉRIEL ET MÉTHODESNous avons mené une étude épidémiologie descriptive nationale de l'activité des 8 maisons de naissancefrançaises à partir des données informatisées renseignées dans le dossier commun d'évaluationAUDIPOG de l'année 2018. La population d'étude concernait toutes les femmes suivies en MDN pendantla grossesse et ayant un accouchement planifié dans ces structures.RÉSULTATSAu total, 649 femmes ont été prises en charge en MDN au cours du travail pendant l'année 2018, 506 yont effectivement accouché et 143 ont été transférées et ont accouché dans les maternités partenaires(22%). Les critères d'éligibilités des femmes pour accoucher en MDN ont été respectés dans plus de 99%des cas. Concernant l'efficacité des soins, l'étude montrait très peu d'interventions au cours du travailparmi les femmes ayant accouché en MDN : moins de 3% de rupture artificielle des membranes, moinsde 2% d'épisiotomies et 90,5% d'accouchements par voie basse spontané, 6,5% par voie instrumentaleet 3% de césarienne. A savoir que chez les femmes transférées, il a été observé 15% de césariennes.Parmi les critères de sécurité, pour l'ensemble des femmes ayant été prises en charge en MDN quel quesoit le lieu final d'accouchement, l'étude montrait 1,4% d'HPP sévères, 0,5% de déchirures périnéalesdes 3° et 4ème degrés et 0,4% de ré-hospitalisation dans le mois suivant l'accouchement. Lescomplications néonatales étaient très peu fréquentes avec 0,3% d'enfants avec une mauvaise adaptationà la vie extra-utérine à 5 minutes de vie et 1,7% d'enfants ayant nécessité des gestes de réanimation à lanaissance. Un décès néonatal a été identifié (0,2% IC95%[0,0%- 0,9%]).Résumé RAPPORT D'ÉTUDE SUR LA QUALITÉ DES SOINSPRODIGUÉS EN MAISONS DE NAISSANCE EN FRANCENovembre 2019Les maisons de naissance (MDN) font partie intégrante de l'offre de soins en périnatalité dans la plupartdes pays à haut niveau de ressources économiques. Elles proposent un changement de paradigme enoffrant un modèle de soins continu, patient-centré, innovant, avec un accouchement réalisé enambulatoire et qui valorise la salutogénèse (soins de prévention). La France a récemment autorisél'ouverture de 8 MDN qui sont en cours d'expérimentation.OBJECTIFNous avons cherché à évaluer la qualité des soins qui y sont prodigués à travers plusieurs dimensions : lapertinence, l'efficacité et la sécurité des soins.MATÉRIEL ET MÉTHODESNous avons mené une étude épidémiologie descriptive nationale de l'activité des 8 maisons de naissancefrançaises à partir des données informatisées renseignées dans le dossier commun d'évaluationAUDIPOG de l'année 2018. La population d'étude concernait toutes les femmes suivies en MDN pendantla grossesse et ayant un accouchement planifié dans ces structures.RÉSULTATSAu total, 649 femmes ont été prises en charge en MDN au cours du travail pendant l'année 2018, 506 yont effectivement accouché et 143 ont été transférées et ont accouché dans les maternités partenaires(22%). Les critères d'éligibilités des femmes pour accoucher en MDN ont été respectés dans plus de 99%des cas. Concernant l'efficacité des soins, l'étude montrait très peu d'interventions au cours du travailparmi les femmes ayant accouché en MDN : moins de 3% de rupture artificielle des membranes, moinsde 2% d'épisiotomies et 90,5% d'accouchements par voie basse spontané, 6,5% par voie instrumentaleet 3% de césarienne. A savoir que chez les femmes transférées, il a été observé 15% de césariennes.Parmi les critères de sécurité, pour l'ensemble des femmes ayant été prises en charge en MDN quel quesoit le lieu final d'accouchement, l'étude montrait 1,4% d'HPP sévères, 0,5% de déchirures périnéalesdes 3° et 4ème degrés et 0,4% de ré-hospitalisation dans le mois suivant l'accouchement. Lescomplications néonatales étaient très peu fréquentes avec 0,3% d'enfants avec une mauvaise adaptationà la vie extra-utérine à 5 minutes de vie et 1,7% d'enfants ayant nécessité des gestes de réanimation à lanaissance. Un décès néonatal a été identifié (0,2% IC95%[0,0%- 0,9%]).Au total, on identifiait 22% de transferts maternels pendant le travail, principalement hors contexted'urgence, 6% de transferts de mères (pour HPP principalement) et 6% de transferts de nouveau-nés(principalement pour surveillance de situations à risque - risque infectieux, risque liés au poids ou à unictère) dans la période post-natale

Measuring the readiness to screen and manage intimate partner violence: Cross-cultural adaptation and psychometric evaluation of the PREMIS tool for perinatal care providers

International audienceIntroduction: Pregnancy and perinatal periods are significant risk factors of intimate partner violence (IPV), a major public health problem that could begin or intensify during these periods. Perinatal care providers have a major role in the identification and the management of IPV. This study aimed to cross-culturally adapt into French the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool, a reliable instrument to assess the knowledge, attitudes and preparedness to address IPV, and to evaluate its psychometric properties. Methods: The PREMIS was cross-culturally adapted by conducting forward and backward translations, following international guidelines. An online cross-sectional study was conducted to assess the psychometric properties of the PREMIS-French in perinatal care providers: data completeness, factor analysis, score distribution, floor and ceiling effects, internal consistency, item-total correlations, inter-subscale correlations and test-retest reliability. Results: The PREMIS was successfully translated and cross-culturally adapted to the context of metropolitan France. The results obtained from 360 perinatal care providers showed good acceptability. Exploratory factor analysis of the “Opinions” items resulted in a six-factor solution with six of the eight subscales of the original structure identified. Good internal consistency (Cronbach’s alpha ranging from 0.54 to 0.97) and good test-retest reliability (intraclass correlation coefficients ranging from 0.46 to 0.92) for the “Background” and “Opinions” subscales were found. Discussion: This study provides evidence of the good psychometric properties of the PREMIS-French. This valid instrument will help to understand perinatal care providers’ barriers to IPV screening and management and will help to focus on specific lacks of knowledge for developing IPV education programs