Chikungunya Virus Infection during Pregnancy, Réunion, France, 2006

Except for prenatal hospital admissions for those infected, this virus had no effect on outcomes

[Prevent postnatal urinary incontinence by prenatal pelvic floor exercise? Rationale and protocol of the multicenter randomized study PreNatal Pelvic floor Prevention (3PN)]

International audienceINTRODUCTION: Female urinary incontinence (UI) is a frequent affection that generates handicap and expenses. There is a link between UI and pregnancy; onset of UI during pregnancy is a risk factor for permanent UI. Postnatal pelvic floor exercise has shown efficacy to improve postnatal UI. However, it remains uncertain if benefits last more than few months. Publication of our rationale for prenatal pelvic floor exercise is an opportunity to expose our pre-specified hypotheses and help health professionals' awareness. OBJECTIVES: The purpose of PreNatal Pelvic floor Prevention (3PN) is to compare the effects of prenatal pelvic floor exercise versus sole written instructions on UI one year after delivery. METHODS AND POPULATION: It is a multicenter, randomized, single blind study. Main inclusion criteria are first, single and non-complicated pregnancy over 18 years. Women randomized in pelvic floor exercise group will undergo eight sessions with a physiotherapist between six and eight months of pregnancy. Our principal criterion is UI score (International Consultation on Incontinence Questionnaire Short Form [ICIQ-SF]) one year after delivery. We plan to include 280 pregnant women in five centers over a 12-month screening period to show a one-point difference on UI score. ETHIC AND FINANCING: The study was approved by the IRB Comit?e protection des personnes Sud-Ouest et Outre-Mer. It was registered by French Health Products Safety Agency (AFSSAPS) and Clinical Trials.gov. It is supported by the French Ministry of Health through the 2007 Hospital Plan for Clinical Research (PHRC). PERSPECTIVES: We plan to assess if prenatal pelvic floor exercise reduces postnatal medical consultations or physiotherapy sessions

Persistent Arthralgia Associated with Chikungunya Virus: A Study of 88 Adult Patients on Reunion Island

International audienceBackground: An outbreak of chikungunya virus infection occurred on Reunion Island during the period 2005-2006. Persistent arthralgia after chikungunya virus infection has been reported, but few studies have treated this aspect of the disease.Methods: Adult patients with laboratory-confirmed acute chikungunya virus infection who were referred to Groupe Hospitalier Sud Reunion during the period 2005-2006 were asked to participate in the study. Patients were assessed a mean of 18 months after acute disease occurred. Assessment consisted of answering questions on a standard form, undergoing a medical examination, and being tested for the presence of IgM antibodies to chikungunya virus.Results: Eighty-eight patients (mean age, 58.3 years; male-to-female ratio, 1.1:1.0) were included in this study. Fifty-eight patients (65.9%) had been hospitalized for acute chikungunya virus infection, and a history of arthralgia before chikungunya virus infection was reported by 39 patients (44%). Fifty-six patients (63.6%) reported persistent arthralgia related to chikungunya virus infection, and in almost one-half of the patients, the joint pain had a negative impact on everyday activities. Arthralgia was polyarticular in all cases, and pain was continuous in 31 patients (55.4%). Overall, 35 patients (39.7%) had test results positive for IgM antibodies to chikungunya virus.Conclusions: Persistent and disabling arthralgia was a frequent concern in this cohort of patients who had experienced severe chikungunya virus infection approximately 18 months earlier. Further studies are needed to evaluate the prevalence of persistent arthralgia in the general population to determine the real burden of the disease

Is Pregnancy Outcome Influenced by Chikungunya Infection? A Case-Control Study in 1401 Pregnant Women Enrolled in the CHIMERE Cohort

International audienceBackground: In 2005—06 a Chikungunya virus outbreak infected 38% of Runion Island population. Forty-two cases of mother to child transmission were described for the first time. The purpose of the CHIMERE cohort study was to determine the consequences of Chikungunya infection on pregnancy outcomes. Methods: In 2006, 1401 pregnant women were enrolled in the CHIMERE cohort. The diagnosis of Chikungunya was based either on serology (IgM & IgG Chikungunya specific serology) planned at inclusion and at delivery, or RT-PCR performed in case of symptoms. We determined that 584 women were not infected by the virus at delivery (IgM− and IgG−), 648 were infected antepartum (IgM+, RT-PCR+, or IgG seroconversion) and 27 before pregnancy, date of infection was imprecise for 50 and assessment was incomplete for 92. We compared pregnancy outcome (prenatal hospitalization, fetal-loss and stillbirth, premature delivery, mode of delivery, birth weight, fetal malformations, newborn hospitalization) between the 584 women free of Chikungunya infection and the 648 infected during pregnancy. This prospective multicentric study has been approved by IRB (CPP de Tours, France). Results: For the 648 women infected by Chikungunya during pregnancy, the infection occurred during the first, second, and third trimester for 15, 59 and 26%, respectively; 50% presented fever, 94% arthralgia and 75% skin rash. The only difference between non-infected and infected women was the number of hospitalization during pregnancy (28 versus 42%, p = 0.0001). Other outcomes, fetal loss and stillbirth (2.2 versus 2.0%), premature delivery (12 versus 10%), cesarean rates (18 versus 16%), birth weight (3067 versus 3121 g), fetal malformations (5.0 versus 5.7%) and newborn hospitalization (6.7 versus 7.4%) were similar. Conclusion: We do not find any impact of Chikungunya infection on pregnancy outcomes except for the number of prenatal hospitalizations

Féminin/masculin

Les textes réunis dans ce volume rendent compte de la diversité des questions soulevées par les rapports féminin/masculin, en un temps où la participation des femmes à la vie de la cité est devenue d’une actualité brûlante, où l’analyse renouvelée de la notion d’identité (et d’identité sexuelle) se trouve au cœur des débats philosophiques. Le développement des études féministes a conduit à examiner les représentations de la femme dans la presse, les arts et les lettres ainsi qu’à s’interroger sur les marques du féminin dans l’écriture, questions dont il convenait d’esquisser un bilan quelque trente ans après le tournant décisif pris par les revendications des femmes dans les années soixante-dix. Les articles présentés dans l’ouvrage Féminin/masculin, sélectionnés à la suite du congrès de la Société des anglicistes de l’enseignement supérieur qui s’est tenu à Rennes en mai 1998, permettent d’aborder ces questions à partir d’études précises, qui interrogent spécifiquement les littératures et les cultures anglo-saxonnes

Study population.

<p>− : seronegative for CHIKV-specific IgM and IgG antibodies ; + : seropositive for CHIKV-specific IgG antibodies; M24: 24^th month, end of follow-up ; Unexposed - Uninfected and Exposed - Uninfected children were pooled as the Uninfected group (grey lozenge) and compared with Exposed - infected children as the Infected group (white lozenge) for RBL (Revised Brunet-Lézine) performance.</p

Revised Brunet-Lezine development quotient scores related to perinatal mother-to-child Chikungunya virus infection, CHIMERE cohort, Reunion Island, 2008.

<p>DQ: development quotient. DQ scores were measured between 15.8 and 27 months of age. Developmental delay is moderate if. ^†85≤DQ ≤70, severe if. ^‡DQ score <70.</p><p>Data are means and 95% confidence intervals. <i>P</i> values are given for Kruskal-Wallis or Fisher exact tests comparing the three groups:</p>##<p><i>P</i> value<0.01 for Fisher exact test comparing unexposed uninfected <i>versus</i> infected children:</p><p>**<i>P</i> value<0.01 for Fisher exact test comparing exposed uninfected <i>versus</i> infected children.</p