Pregnancy is a period of transition with important physical and emotional changes. Even in uncomplicated pregnancies, these changes can affect the quality of life (QOL) of pregnant women, affecting ...both maternal and infant health. The objectives of this study were to describe the quality of life during uncomplicated pregnancy and to assess its associated socio-demographic, physical and psychological factors in developed countries.
A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and BDSP (Public Health Database). Two independent reviewers extracted the data. Countries with a human development index over 0.7 were selected. The quality of the articles was evaluated on the basis of the STROBE criteria.
In total, thirty-seven articles were included. While the physical component of QOL decreased throughout pregnancy, the mental component was stable and even showed an improvement during pregnancy. Main factors associated with better QOL were mean maternal age, primiparity, early gestational age, the absence of social and economic problems, having family and friends, doing physical exercise, feeling happiness at being pregnant and being optimistic. Main factors associated with poorer QOL were medically assisted reproduction, complications before or during pregnancy, obesity, nausea and vomiting, epigastralgia, back pain, smoking during the months prior to conception, a history of alcohol dependence, sleep difficulties, stress, anxiety, depression during pregnancy and sexual or domestic violence.
Health-related quality of life refers to the subjective assessment of patients regarding the physical, mental and social dimensions of well-being. Improving the quality of life of pregnant women requires better identification of their difficulties and guidance which offers assistance whenever possible.
Anecdotal evidence rapidly accumulated during March 2020 from sites around the world that sudden hyposmia and hypogeusia are significant symptoms associated with the SARS-CoV-2 pandemic. Our ...objective was to describe the prevalence of hyposmia and hypogeusia and compare it in hospitalized and non-hospitalized COVID-19 patients to evaluate an association of these symptoms with disease severity. We performed a cross-sectional survey during 5 consecutive days in March 2020, within a tertiary referral center, associated outpatient clinic, and two primary care outpatient facilities in Paris. All SARS-CoV-2-positive patients hospitalized during the study period and able to be interviewed (
n
= 198), hospital outpatients seen during the previous month (
n
= 129), and all COVID-19-highly suspect patients in two primary health centers (
n
= 63) were included. Hospitalized patients were significantly more often male (64 vs 40%) and older (66 vs 43 years old in median) and had significantly more comorbidities than outpatients. Hyposmia and hypogeusia were reported by 33% of patients and occurred significantly less frequently in hospitalized patients (12% and 13%, respectively) than in the health centers’ outpatients (33% and 43%, respectively) and in the hospital outpatients (65% and 60%, respectively). Hyposmia and hypogeusia appeared more frequently after other COVID-19 symptoms. Patients with hyposmia and/or hypogeusia were significantly younger and had significantly less respiratory severity criteria than patients without these symptoms. Olfactory and gustatory dysfunction occurs frequently in COVID-19, especially in young, non-severe patients. These symptoms might be a useful tool for initial diagnostic work-up in patients with suspected COVID-19.
ObjectivesThe perspective of general practitioners’ (GPs) on retirement and the factors influencing their attitude towards retirement have been previously investigated. However, while the number of ...GPs has been declining for many years in France, leading to the emergence of medical deserts, the impact on their patients remains to be explored. The aim of this study was to understand patients’ perceptions of their GP’s retirement.DesignA semistructured interview-based qualitative study was conducted, using Interpretative Phenomenological Analysis.SettingInterviews were conducted in two general practices located in Essonne, Ile-de-France, France, between January and April 2014.ParticipantsThirteen women and five men, aged 21–94 years, were included in this study. Exclusion criteria were the non-declaration of the physician as the declared doctor and being under 18 years of age.ResultsThe GP–patient relationship is a link that is built up over time, over the course of several consultations. Patients choose their GP based on qualities or skills they value. In this way, the physician chosen is unique for their patients; this choice reflects a certain loyalty to their physician. The interaction with the family sphere reinforces this relationship through the multiple links created during care. When a GP retires, this link is broken. Patients’ reactions can range from indifference to real grief.ConclusionThis study confirms the importance of the link between the GPs and their patients and highlights the need to prepare patients for their GP’s retirement.
Consumption of certain foods during pregnancy has been shown to have beneficial effects on childhood asthma and allergic disease development and aggravation. However, most studies provide conflicting ...results and the relationships between maternal preconceptional diet and risks of childhood asthma and allergic disease have not previously been explored. The objective of this study was to assess maternal diet during the year before pregnancy and the last 3 months of pregnancy and investigate their associations with the risks of asthma, wheezing, allergic rhinitis and atopic dermatitis in young children.
The study sample consisted of 1140 mother-child pairs from the EDEN cohort. Mothers had responded to the food frequency questionnaires used to assess diet before and during pregnancy. Children were followed up using health questionnaires. The health outcomes studied were: asthma, wheezing, allergic rhinitis and atopic dermatitis by the age of 3 years.
Using multivariable-adjusted logistic regression models, significant inverse associations were observed between cooked green vegetable consumption before pregnancy and childhood asthma; consumption of eggs and raw vegetables before and during pregnancy, consumption of grains before pregnancy, and consumption of cooked green vegetables during pregnancy and allergic rhinitis. For the first time, a significant positive association was found between meat intake during the preconceptional period and a risk of wheezing, allergic rhinitis and atopic dermatitis.
Based on our findings, preconceptional and prenatal maternal intake of certain type of food groups may be preventive against asthma, wheezing and allergic rhinitis, whereas higher maternal intake of meat before pregnancy may increase the risk of wheezing, allergic rhinitis and atopic dermatitis in young children.
The main objective of this study is the evaluation of the accuracy and reliability of a handheld point of care ultrasound device (POCUS-hd) for intrauterine pregnancy (IUP) detection compared to ...comprehensive reference transabdominal ultrasound (TU). The secondary objectives were to evaluate POCUS-hd for intrauterine pregnancy (IUP) detection compared to transabdominal and transvaginal ultrasound (TUTV), evaluate the inter-device agreement and inter-rater reliability of gestational age during early pregnancy.
It is an observational transverse study with consecutive patient recruitment. Two blinded operators systematically used POCUS-hd and reference transabdominal ultrasound for IUP diagnosis. The accuracy of POCUS-hd for IUP diagnosis was expressed as sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV). The gestational age (GA) was assessed based on the crown-rump length. The reliability and agreement of gestational age evaluation were assessed by Bland-Altman plots, kappa statistic, and intraclass correlation coefficients (ICC).
POCUS-hd compared to TU had a sensitivity of 95-100%, a specifcity of 90-100%, PPV of 95-100% and NPV of 90-100%. Inter-rater agreement for IUP detection using POCUS-hd was very good, kappa=1.0; CI95% 0.9-1.0. The inter-device agreement limits (mean difference ± 2SD) for GA were: -3 to +2.3 days by Operator 1, -3.4 to +3.3 days by Operator 2 for POCUS-hd vs. TU and -3.1 to +2.3 days for POCUS-hd versus TUTV.
This handheld POCUS device is an accurate and reliable diagnostic tool that can be used for IUP positive findings and GA assessment during early pregnancy by clinicians in family planning settings or general practice.
The purpose of this study was to examine the association between pre and post environmental tobacco smoke (ETS) exposure and behavioral problems in schoolchildren.
In the cross-sectional 6 cities ...Study conducted in France, 5221 primary school children were investigated. Pre- and postnatal exposure to secondhand tobacco smoke at home was assessed using a parent questionnaire. Child's behavioral outcomes (emotional symptoms and conduct problems) were evaluated by the Strengths and Difficulties Questionnaire (SDQ) completed by the parents.
ETS exposure during the postnatal period and during both pre- and postnatal periods was associated with behavioral problems in children. Abnormal emotional symptoms (internalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.72 (95% Confidence Interval (CI)= 1.36-2.17), whereas the OR was estimated to be 1.38 (95% CI= 1.12-1.69) in the case of postnatal exposure only. Abnormal conduct problems (externalizing problems) were related to ETS exposure in children who were exposed during the pre- and postnatal periods with an OR of 1.94 (95% CI= 1.51-2.50), whereas the OR was estimated to be 1.47 (95% CI=1.17-1.84) in the case of postnatal exposure only. Effect estimates were adjusted for gender, study center, ethnic origin, child age, low parental education, current physician diagnosed asthma, siblings, preterm birth and single parenthood.
Postnatal ETS exposure, alone or in association with prenatal exposure, increases the risk of behavioral problems in school-age children.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Backgroud
Evidence about the relationship between prenatal maternal depression and the development of childhood asthma and allergies in early life is scarce. We aimed to examine this relationship by ...using data set of EDEN mother-child cohort study. A total of 1139 children were followed-up until the age of 5 years.
Methods
Prenatal maternal depression was self-reported by using the Centre for Epidemiological Studies-Depression scale (CES-D) questionnaire and was classified into binary variable (maternal depression CES-D score of≥16 and no maternal depression CES-D score of <16). Asthma and allergies in the first 5 years were assessed by using the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). Adjusted odds ratio (aOR) was estimated for the relationship between prenatal maternal depression and early life asthma and allergies by marginal models through the method of generalized estimating equation (GEE) when adjusting for the confounders.
Results
In our study population, 13.67 % of the mothers had clinical significant depression (the total scores for CES-D ≥16) during pregnancy. For children ages 5 years, the prevalence of wheezing, physician-diagnosed asthma, physician-diagnosed eczema and allergic rhinoconjunctivitis were 46.78, 20.99, 29.17, and 22.54%, respectively. Prenatal maternal depression was associated with ever allergic rhinoconjunctivitis (aOR 1.87 95% confidence interval {CI}, 1.33–2.62). No significant relationships were found between prenatal maternal depression and wheezing, physician-diagnosed asthma and physician-diagnosed eczema (aOR 1.12 95% CI, 0.91–1.39, aOR 1.23 95% CI, 0.81–1.85 and aOR 1.17 95% CI, 0.86–1.61, respecitvely).
Conclusion
Prenatal maternal depression was related to ever allergic rhinoconjunctivitis in the first 5 years of life in children of EDEN mother-child cohort study.
Introduction: The prevalence of poor mental health during pregnancy is estimated at 10% and it appears to be associated with increased maternal and child morbidity. This pilot study aims to assess ...the impact on pregnant women, their mental health, and health care trajectory of early identification of poor mental health during pregnancy.Method: This interventional study was carried out in three districts of Paris and included two groups. The intervention group was composed of pregnant women whose screening for poor mental health consisted in systematically asking them, in the first trimester of pregnancy, a single question. The control group was composed of pregnant women monitored as usual. All of these women benefited from a telephone interview eight to twelve weeks after their recruitment in order to assess their mental health in the second trimester of pregnancy and describe their care pathway.Results: In the intervention group, women benefited from early prenatal interview more often and they felt that their medical care had improved their well-being during pregnancy more frequently (P < 0.05). Women in the control group found it harder to express their psychological difficulties, expressed them less frequently and had trouble with medical care follow-up when offered (P < 0.05).Conclusion: The early screening for poor mental health by a single question during pregnancy seems to positively change the care pathway of pregnant women with poor mental health. In addition, it could improve the well-being of pregnant women in the second trimester of pregnancy.
Introduction : La prévalence du mal-être psychologique prénatal maternel est estimée à 10 %, et ce mal-être semble être associé à une morbidité maternelle et infantile accrues. Cette étude pilote ...vise à évaluer l’impact d’un repérage précoce d’un mal-être psychologique sur le parcours de soins des femmes enceintes et sur leur santé mentale. Méthode : Une étude interventionnelle a été réalisée dans trois arrondissements parisiens et a comporté : un groupe de femmes enceintes bénéficiant d’un repérage systématique d’un mal-être psychologique au 1 er trimestre de grossesse par une question unique, et un groupe de femmes enceintes suivies de façon classique. L’ensemble de ces femmes ont bénéficié d’un entretien téléphonique unique huit à douze semaines après leur recrutement afin d’évaluer leur santé mentale au 2 e trimestre de grossesse et de décrire leur parcours de soins. Résultats : Trente-neuf femmes en mal-être psychologique au 1 er trimestre de grossesse ont été incluses. Les femmes du groupe intervention ont plus souvent bénéficié d’un entretien prénatal précoce (EPP) et ont eu plus fréquemment l’impression que leur prise en charge médicale avait amélioré leur bien-être psychologique. À l’inverse, celles du groupe sans intervention ont significativement moins parlé de leurs difficultés psychologiques, ont eu plus de difficultés à en parler, à réaliser la prise en charge lorsqu’elle était proposée ou à consulter pour celles-ci. Et aucune d’entre elles n’a bénéficié d’un EPP. Conclusion : Le repérage précoce et systématique d’un mal-être psychologique par la question unique semble modifier positivement le parcours de soins et la santé mentale des femmes enceintes ayant un mal-être psychologique.
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