Is individual social deprivation is associated with adverse perinatal outcomes? Results of a French multicentre cross-sectional survey

Introduction: French national health programmes take into account social deprivation in their implementation, those targeting perinatal outcomes, especially. The main aim of the present work was to assess the association between individual social deprivation and adverse perinatal outcomes. Methods: A multicentre cross-sectional population-based survey was performed between October and December 2007. Eligible women delivered a baby in one of the three maternity hospitals of Clermont-Ferrand area, and read and spoke French fluently. Women who had undergone voluntary termination of pregnancy were excluded. Individual social deprivation was measured by the EPICES score. Standard prenatal follow-up defined by having less than 7 consultations and quality of prenatal care defined by having at least four consultations were measured. Adverse perinatal outcomes were measured by a composite criterion defined by women who had the occurrence of the three main causes of pregnancy-related disorders: preterm delivery, and/or diabetes, and/or obstetrical hypertension.Results: Of the 471 eligible women, 464 were finally included. One hundred and fifteen (24.78%) women were socially deprived. The most deprived women had poor standard prenatal follow-up (p=0.003) and poor quality of prenatal care (0.03). Nationality was the sole confounding factor identified. Deprived women had a two-fold greater risk of adverse perinatal outcomes, adjusted odds ratio 1.95 [1.15; 3.29]. Discussion: Social deprivation was associated with adverse perinatal outcomes. Social deprivation should be systematically screened in pregnant women standard follow-up, among migrant women, especially

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

Economic analysis of a nurse-led programme for comorbidities management of rheumatoid arthritis patients

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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

Assessment of the advantage of the serum S100B protein biomonitoring in the management of paediatric mild traumatic brain injury—PROS100B: protocol of a multicentre unblinded stepped wedge cluster randomised trial

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Intégration du test d’ADN foetal dans le dépistage du syndrome de Down en France : une analyse coût-efficacité

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Cost-effectiveness threshold of Down Syndrome maternal serum markers for cffDNAtest as a second tier

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Protocol for the e-POWUS Project: multicentre blinded-randomised controlled trial of ultrasound speed choice to improve sonography quality in pregnant women with obesity

International audienceIntroduction During pregnancy, maternal obesity increases the risk of fetal abnormalities. Despite advances in ultrasound imaging, the assessment of fetal anatomy is less thorough among these women. Currently, the construction of ultrasound images uses a conventional ultrasound propagation velocity (1540 m/s), which does not correspond to the slower speed of propagation in fat tissue. The main objective of this randomised study is to compare the completeness of fetal ultrasonography according to whether the operator could choose the ultrasound velocity (1420, 1480 or 1540 m/s) or was required to apply the 1540 m/s velocity. Methods and analysis This randomised trial is an impact study to compare a diagnostic innovation with the reference technique. The trial inclusion criteria require that a pregnant woman with obesity be undergoing a fetal morphology examination by ultrasound from 20 +0 to 25 +0 gestational weeks. Randomisation will allocate women into two groups. The first will be the ‘modulable speed’ group, in which operators can choose the speed of ultrasound propagation to be considered for the morphological analysis: 1420, 1480 or 1540 m/s. In the second ‘conventional speed’ group, operators will perform the morphological examination with the ultrasound speed fixed at 1540 m/s. The adjudication committee, two independent experts, will validate the completeness of each examination and the quality of the images. Ethics and dissemination This research protocol does not change the standard management. The only possible impact is an improvement of the ultrasound examination by improving the quality of the image and the completeness of morphological examination. The Agence du Médicament et produits de santé approved this study (2018-A03478-47). The anonymised data will be available on request from the principal investigator. Results will be reported in peer-reviewed journals and at scientific meetings. Trial registration number ClinicalTrials.gov ( http://www.clinicaltrials.gov ) Registry ( NCT04212234 )

Evaluation of the capillary assay of C-reactive protein (CRP) through the lenght of consultation in pediatric emergencies and its economic impact.

International audienceFever is a frequent reason for consultation in pediatric emergency departments and raises the question of biological and radiological examinations. Rapidly obtaining the result of C-reactive protein (CRP) level is essential in front of the steady increase of the number of visits. We carried out a prospective study within the pediatric emergency department of the University Hospital of Clermont-Ferrand from January to April 2017, in order to evaluate the interest of the capillary CRP in point of care (POCT). In two periods, 68 patients (28 controls without and 40 cases with capillary CRP assayed on a Afinion® AS100) with naked fever greater than 48 hours were included. After a study of the analytical performances of Afinion® and a verification of the homogeneity and the comparability of the two groups on clinical criteria (age, sex, duration of the fever, antibiotics treatment) and biological (values of CRP), the interest of the CRP in POCT was evaluated. In the POCT group, a significant drop in the median of the emergency room consultation time (60 (IQR 33-125) versus 180 (IQR 158-208) minutes), the number of biological acts by patient (1 (IQR 1-3) versus 7 (IQR 3-8)), the global cost of biological and radiological examinations per patient (5.4 (IQR 5.4-32.6) versus 153.8 (IQR 46.9-180.4) euros), and the cost of reagents spent by the laboratory per patient (5.2 (IQR 5.2-6.4) versus 33.2 (IQR 2.3-34.2) euros). Thus, in the context of a clinical-biological partnership, the use of CRP in POCT present a practical and an economic interest