Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Multidimensional approach of romantic intimacy and its socio-cognitive and emotional factors : From couples in general population to couples confronted with a digestive cancer

Un sentiment global d’intimité se construit à travers des composantes comportementales ainsi que, des expériences d’intimité qui correspondent à la perception de la réactivité du partenaire. De plus, la manière dont les individus appréhendent leurs relations interpersonnelles ainsi que leurs émotions et celles d’autrui, est susceptible d’influencer la construction de cette intimité. La qualité de l’intimité conjugale se caractériserait par trois dimensions : (1) un sentiment de connexion, (2) une bonne communication et (3) un partage de loisirs avec des amis communs (Article 1). En outre, la construction d’un sentiment d’intimité dans une relation de couple dépendrait du profil d’attachement des individus et de leurs compétences émotionnelles à gérer leurs émotions. Cependant, avoir des compétences élevées pour gérer les émotions des autres serait néfaste pour la qualité de l’intimité perçue (Article 2). Dans une interaction conflictuelle de couple, il existe une relation entre la réactivité perçue vis-à-vis de soi et de son partenaire et les réponses physiologiques des partenaires produites au cours de l'interaction. Plus précisément, la perception des partenaires de la réactivité de l’homme serait associée à des patterns d’activations physiologiques émotionnelles différents selon leur sexe. Aussi, la perception de l’homme envers sa propre réactivité lui permettrait une meilleure régulation émotionnelle (Article 3). Les comportements verbaux et non verbaux exprimés par les partenaires seraient également associés à un degré d’intimité différent selon le sexe (Article 4). Dans un contexte de maladie, ces comportements d’intimité exprimés entre les partenaires lors d’une interaction liée à leur vécu du cancer digestif refléteraient un ajustement émotionnel spécifique selon le rôle social de patient et d’aidant (Article 5). Une discussion intégrative de ces différents éléments empiriques nous amène à proposer des pistes de recherches et d’interventions thérapeutiques dans le domaine du couple.An overall feeling of intimacy is constructed through behavioral components as well as, experiences of intimacy that correspond to the perception of partner responsiveness. Besides, the way in which people shape their interpersonal relationships and their own emotions and that of others, might influence the construction of this intimacy. The quality of romantic intimacy would be characterized by three dimensions: (1) a feeling of connection, (2) good communication and (3) sharing of leisure time with mutual friends (Article 1). Furthermore, the construction of a feeling of intimacy in couple relationship would depend on the people’s profile of attachment and their emotional competences to deal with their own emotions. However, have high competences to deal with the emotions of others would be harmful for the quality of intimacy perceived (Article 2). In conflictive interaction of couple, there is a relation between the responsiveness perceived toward oneself and one’s partner. In particular, the husbands’ responsiveness perceived by the two partners would be associated with different patterns of physiological emotional arousal, according to their gender (Article 3). Verbal and nonverbal behaviors expressed by the partners would be also associated with a different level of intimacy according to the gender (Article 4). In a context of disease, these intimate behaviors expressed between the partners during an interaction about their life experience of the digestive cancer would reflect a specific emotional adjustment according to their social role of patient and caregiver (Article 5). An integrative discussion of these empirical evidences leads us to propose future research and clinical interventions in the field of couple relationships

Attachment orientation and relational intimacy: The mediating role of emotional competences

Because emotional exchanges are central in couple interactions, individual competences to manage one’s own emotions and those of others are important to develop a good relational intimacy with a romantic partner over time. It is assumed that individual differences in attachment orientation influence the development of emotional competences and intimacy between romantic partners. While emotional competences are important for the proper functioning of romantic relationships, little is known about their mediating role in the relationship between individual’s attachment orientation and relational intimacy. In five hundred and sixty-four heterosexual subjects, the present study aimed to assess the indirect effects of emotional competences (both intrapersonal and interpersonal) on the relationship between insecure attachment orientations (both avoiding and anxious dimensions) and relational intimacy (i.e., engagement, communication and shared friends dimensions). Direct effects between our variables of interest were also explored. The results highlighted a negative association between both insecure avoiding and anxious attachment orientations and intrapersonal emotional competences. However, only the avoiding orientation was negatively related to interpersonal emotional competences. Furthermore, the anxious attachment dimension was negatively related to a feeling of engagement, in contrast to the avoiding attachment dimension that was associated with a low level of engagement, positive communication, and shared friends. Multi-group analysis highlighted gender invariance in the model. The findings suggest that although insecure attachment has a negative effect on the couple relationship, the capacity to manage one’s own emotions appears to be a protective factor for relational intimacy regarding its mediating role in these associations

Evaluation of the knowledge and attitude of pharmacists about the national malaria control policy in southern Benin

Abstract Background The national strategy against malaria in an endemic country should involve all the health stakeholders. In Benin, the private sector is rarely present in the activities of the National Malaria Control Programme (NMCP), and its surveillance system does not cover private sector outlets that are a non-negligible part of the healthcare system. Objective The aim of this study was to describe the drug delivery practices within private pharmacies of Cotonou and Porto-Novo and the awareness of medicine providers concerning the national policy of malaria treatment. Methods A survey was performed among pharmacy staff members responsible for dispensing medicines and providing advice to patients within pharmacies of Cotonou and Porto-Novo. Dispensing/pharmacy assistants (‘dispensators’) from 82 pharmacies in Cotonou and 19 in Porto-Novo were surveyed. Data entry was performed using Epidata 3.1 software and data analysis was carried out using SPSS software version 21.1. Chi square test was used to compare proportions. A significance threshold of 0.05 was defined for the p value. Results 46% of providers did not know the artemisinin-based combination therapy recommended by the NMCP for treating uncomplicated malaria. 58.7% were not able to recognize the gravity signs of malaria. 89.8% of dispensators were used to deliver an anti-malarial upon patient request, without prior biological confirmation as requested by the NMCP policy. Conclusions Dispensing practices within the studied pharmacies from Cotonou and Porto-Novo were not in adequacy with the NMCP guidelines for uncomplicated malaria, which is a striking weakness in the training of drug providers on key elements of the guidelines for managing malaria. The NMCP needs to help dispensator from private pharmacies sector to standardize drug delivery practices according to its guidelines

Identification of Factors Affecting Bacterial Abundance and Community Structures in a Full-Scale Chlorinated Drinking Water Distribution System

Disentangling factors influencing suspended bacterial community structure across distribution system and building plumbing provides insight into microbial control strategies from source to tap. Water quality parameters (residence time, chlorine, and total cells) and bacterial community structure were investigated across a full-scale chlorinated drinking water distribution system. Sampling was conducted in treated water, in different areas of the distribution system and in hospital building plumbing. Bacterial community was evaluated using 16S rRNA gene sequencing. Bacterial community structure clearly differed between treated, distributed, and premise plumbing water samples. While Proteobacteria (60%), Planctomycetes (20%), and Bacteroidetes (10%) were the most abundant phyla in treated water, Proteobacteria largely dominated distribution system sites (98%) and taps (91%). Distributed and tap water differed in their Proteobacteria profile: Alphaproteobacteria was dominant in distributed water (92% vs. 65% in tap waters), whereas Betaproteobacteria was most abundant in tap water (18% vs. 2% in the distribution system). Finally, clustering of bacterial community profiles was largely explained by differences in chlorine residual concentration, total bacterial count, and water residence time. Residual disinfectant and hydraulic residence time were determinant factors of the community structure in main pipes and building plumbing, rather than treated water bacterial communities

Relationship Dynamics of Couples Facing Advanced-Stage Parkinson’s Disease: A Dyadic Interpretative Phenomenological Analysis

International audienceBackground/Objective Several studies have examined the impact of Parkinson’s disease (PD) on the quality of couples’ relationships. To date, few studies have explored how couples experience their relationship dynamic by taking into account the disease stage. The objectives of this study were to understand the experience of each partner and to study the mechanisms that underlie their couple organization in the advanced stage of PD. Methods Semistructured individual interviews conducted with fifteen patients and their partners were the subject of a dyadic interpretative phenomenological analysis. Results Three themes were identified from the analysis: the first, “A Closeness That Separates,” allows the identification of different patterns of interactions that lead to emotional distancing between the partners; the second, “The Adversity Is Not Unbearable, But Going It Alone Would Be,” emphasizes the importance of how the assisting partner provides support; and the third, “Be Prepared for Anything and Facing an Uncertain Future,” reveals the extent and modes of the dyadic regulation of the emotions linked to what the future may hold. Conclusion Psychological support is important to help couples express both their feelings and their respective needs in the evolving context of PD

Dealing with the diagnosis of Parkinson's disease and its implications for couple functioning in the early stage: An interpretative phenomenological analysis.

BackgroundFor couples facing Parkinson's disease, marital relationships are significantly impacted, even at the early stages of the disease. However, very few studies have explicitly explored the functioning of the couple and how both partners deal with Parkinson's disease. The aim of this study was to explore the experiences and strategies of couples facing Parkinson's disease in the early stage using dyadic interpretative phenomenological analysis.MethodsFifteen couples agreed to participate in the study. Semistructured interviews were conducted with each partner separately regarding his or her individual experience with Parkinson's disease, the couple's history, the impact of the diagnosis on the functioning of the couple, and his or her projections for the future.ResultsThree higher-order themes emerged from the analyses. The first theme, "Being tested by the diagnosis", highlights 4 dyadic configurations according to the individual's and the couple's capacity for adjustment following the diagnosis: "noncongruent", "collapsed", "relieved" and "avoidant". The second theme, "Talking about everything except the disease", underlines that communication about the disease is often avoided both within the couple and with relatives to protect the persons with Parkinson's disease or respect their wishes. The third theme, "Supporting each other", describes the different levels of harmony between the two partners in the management of daily life and symptoms and their relational impacts.ConclusionThese results allow us to better understand the experiences of both partners and to highlight the importance of promoting better acceptance of the diagnosis by persons with Parkinson's disease to allow better communication between partners and with relatives. Such support prevents disease-specific distress and facilitates better adjustment in the later stages of the disease

The Profile of Emotional Competence (PEC): A French short version for cancer patients

International audienceBackground: Intrapersonal and interpersonal Emotional Competence (EC) predicts better health and disease adjustment. This study aimed to validate a short version of the Profile of Emotional Competence (PEC) scale for cancer patients.Methods: Five hundred and thirty-five patients with cancer completed a self-reported questionnaire assessing their intra- and interpersonal EC (PEC), their anxiety and depression symptoms (HADS), and their health-related quality of life (QLQ-C30). Confirmatory factor analyses and Item Response Theory models with the Partial Credit Model were performed to validate and reduce the scale.Findings: The Short-PEC (13 items), composed of 2 sub-scores of intra- (6 items) and interpersonal (7 items) EC, showed an improved factorial structure (Root Mean Square Error of Approximation (RMSEA) = 0.075 (90% confidence interval 0.066-0.085), comparative fit index = 0.915) with good psychometric properties.Discussion: Future studies should use the Short-PEC to explain and predict the adjustment of cancer patients. The short-PEC could be also used in clinical routine to assess the level of EC of patients and to adapt psychosocial intervention