Developmental Model of Depression Applied to Prenatal Depression: Role of Present and Past Life Events, Past Emotional Disorders and Pregnancy Stress

Several risk factors for depression during pregnancy have already been established. However, very few studies have conducted a multivariate analysis incorporating both the major predictors of depression in women, in accordance with comprehensive developmental models of depression, and specific stressors associated with the biological and psychosocial state of the mother-to-be.We used a cross-sectional cohort design to analyze the associations between prenatal depression and potential risk factors. 693 French-speaking women with singleton pregnancies at 20-28 weeks' gestation were consecutively recruited at Caen University Hospital. Fifty women with missing values were subsequently excluded from the analysis. Depressive symptoms were assessed on the Edinburgh Postnatal Depression Scale. Risk factors were either extracted from the computerized obstetric records or assessed by means of self-administered questionnaires. The associations between prenatal depression and the potential risk factors were assessed using log-binomial regression models to obtain a direct estimate of relative risk (RR). The following factors were found to be significant in the multivariate analysis: level of education (p<0.001), past psychiatric history (adjusted RR=1.8, 95% confidence interval (CI): 1.1;2.8, p=0.014), stress related to the health and viability of the fetus (adjusted RR=2.6, 95% CI: 1.6;4.1, p<0.001), and stress related to severe marital conflicts (adjusted RR=2.4, 95% CI: 1.5;3.9, p<0.001) or to serious difficulties at work (adjusted RR=1.6, 95% CI :1.04;2.4, p=0.031). An association was also found with the previous delivery of a child with a major or minor birth defect (adjusted RR=2.0, 95% CI: 1.04;4.0, p=0.038). Univariate analyses revealed a strong association with childhood adversity (parental rejection: RR=1.8, 95% CI: 1.2;2.8, p=0.0055 and family secrets: RR=2.0, 95% CI: 1.2;3.1, p=0.0046) and with lack of partner support (RR=0.50, 95% CI: 0.30;0.84, p=0.0086).Our study identifies several risk factors that could easily be assessed in clinical practice. It draws attention to the impact of previously delivering a child with a birth defect. The association with childhood adversity warrants further study

Techniques d'analyse et de mise en oeuvre des programmes GAMMA

Available from INIST (FR), Document Supply Service, under shelf-number : TD 20448 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

Dérivation systématique d'un algorithme de segmentation d'images . Un exemple d'application du formalisme GAMMA

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L'apprentissage de la médecine à la lumière du modèle de Butler

Contexte : Pour enseigner nous avons besoin d’une description claire du processus d’apprentissage. But : Disposer d'un schéma simple et assez complet auquel on puisse se référer. Matériel : Nous proposons l'utilisation d'un modèle reconnu développé par F. Butler. Il comporte 7 étapes : (1) la situation de l'apprenant : environnement et facteurs individuels ; (2) la motivation; (3) la structuration des connaissances par des liens appropriés; (4) l'expérimentation du savoir ; (5) l'évaluation de ce qu'on a fait ; (6) la répétition des exercices ; (7) la généralisation qui vise à adapter l'utilisation de son savoir à des contextes variés. Pour chaque étape le processus de facilitation induit par l'enseignant est expliqué, tandis que pour l'étudiant sont décrits : l'activité d'apprentissage, le processus cognitif et le résultat de l'apprentissage. Nous avons appliqué le modèle à l'enseignement traditionnel qui est celui de la plupart des Facultés de médecine françaises. Résultats : A travers des réflexions personnelles que chacun reformulera dans son cadre, nous constatons que de nombreuses leçons pratiques peuvent être tirées. Conclusion : Le modèle de Butler peut jouer un rôle important pour développer la pédagogie en médecine. Il offre un schéma opérationnel aux étudiants et futurs professeurs. Il procure des bases d'évaluation pour les enseignements actuels et futurs

Assessment of concordance between diffusion of carbon monoxide through the lung using the 10 s breath-hold method, and the simultaneous NO/CO technique, in healthy participants

International audienc

FRENCH versus ESI: comparison between two nurse triage emergency scales with referent scenarios

Abstract Objectives Acute triage is needed to prioritize care and achieve optimal resource allocation in busy emergency departments. The main objective is to compare the FRench Emergency Nurse Classification in Hospital scale (FRENCH) to the American scale Emergency Severity Index (ESI). Secondary objectives are to compare for each scale the over and under-triage, the triage matching to the gold standard and the inter-individual sorting reproducibility between the nurses. Methods This is a prospective observational study conducting among the nursing staffs and nursing students, selected from Caen University College Hospital and Lisieux Hospital Center emergency departments between two months. Each group individually rank 60 referent clinical cases composed by scales designers. An assessment of scale practicality is collected after for each tool. The collected parameters are analyzed by a Cohen kappa concordance test (κ). Results With 8151 triage results of gold standard scenarios sorting in two scales by the same nurses, the FRENCH scale seems to give better triage results than the US ESI scale (nurse: FRENCH 60% and ESI 53%, p = 0.003 ; nursing students: FRENCH 49% and ESI 42%, p < 0.001). In the two groups ESI has also a big tendency to under-sort (p = 0.01), particularly for the most severe patients (p < 0.01). The interobserver sorting concordance for any experience gives good results for the FRENCH and the ESI without any difference (nurses : FRENCH KPQ=0.72 ESI KPQ=0.78; p = 0.32 ; students KPQ=0.44 KPQ=0.55; p = 0.22). Conclusion The ESI and FRENCH scales comparison on 8151 sorting results shows direct validity in favor of FRENCH one and similar interobserver agreement for both scales

How Satisfied Are Women 6 Months after a Pessary Fitting for Pelvic Organ Prolapse?

Background: The non-surgical solution for Pelvic Organ Prolapse (POP) typically consists of a pessary fitting. We aimed to assess patient satisfaction and symptom improvement 6 months after a pessary fitting and to identify risk factors associated with pessary failure. Methods: Six months after a pessary fitting, patient satisfaction was assessed by the PGII score; symptoms and quality of life were assessed using validated questionnaires (PFDI-20, ICIQ-SF, PISQ-12, USP, and PFIQ-7). Results: Of the 190 patients included in the study (mean age of 66.7 years), 141 (74%) and 113 (59%) completed the follow-up questionnaires at 1 and 6 months, respectively. Nearly all the women were menopausal (94.6%) and 45.2% declared being sexually active at inclusion. The satisfaction rate was 84.3% and 87.4% at 1 and 6 months, respectively. The global symptom score PFDI-20 had significantly improved at 6 months. A high body mass index (RR = 1.06, CI95%: [1.02&ndash;1.09]), as well as high PFDI-20 (1.05 [1.01&ndash;1.09]), PFIQ7 (1.04 [1.01, 1.08]), and PISQ12 scores at inclusion (0.75 [0.60, 0.93]), as well as higher GH and GH/TVL measurements (1.49 [1.25&ndash;1.78] and 1.39 [1.23&ndash;1.57], respectively) were associated with pessary failure. Conclusions: Pessary seems to be an effective treatment for POP with high patient satisfaction. Higher BMI, higher symptom scores, and greater genital hiatus measurements before insertion are risk factors for failure at 6 months

Behavioral profiles of clinically referred children with intellectual giftedness.

International audienceIt is common that intellectually gifted children--that is, children with an IQ ≥ 130--are referred to paediatric or child neuropsychiatry clinics for socio-emotional problems and/or school underachievement or maladjustment. These clinically-referred children with intellectual giftedness are thought to typically display internalizing problems (i.e., self-focused problems reflecting overcontrol of emotion and behavior), and to be more behaviorally impaired when "highly" gifted (IQ ≥ 145) or displaying developmental asynchrony (i.e., a heterogeneous developmental pattern, reflected in a significant verbal-performance discrepancy on IQ tests). We tested all these assumptions in 143 clinically-referred gifted children aged 8 to 12, using Wechsler's intelligence profile and the Child Behavior Checklist. Compared to a normative sample, gifted children displayed increased behavioral problems in the whole symptomatic range. Internalizing problems did not predominate over externalizing ones (i.e., acted-out problems, reflecting undercontrol of emotion and behavior), revealing a symptomatic nature of behavioral syndromes more severe than expected. "Highly gifted" children did not display more behavioral problems than the "low gifted." Gifted children with a significant verbal-performance discrepancy displayed more externalizing problems and mixed behavioral syndromes than gifted children without such a discrepancy. These results suggest that developmental asynchrony matters when examining emotional and behavioral problems in gifted children

Performance Evaluation of the VIDAS® Measles IgG Assay and Its Diagnostic Value for Measuring IgG Antibody Avidity in Measles Virus Infection

International audienc