La mortalité avant et après la naissance est élevée chez les jumeaux, confrontant les parents à un deuil très particulier. L’objectif de cette étude était de décrire les réactions des parents lors du ...décès d’un de leurs jumeaux en réanimation néonatale, la façon dont ils avaient investi l’enfant en vie et le rôle des soignants pour les aider.
Dans une étude qualitative sur le devenir des parents après la perte d’un enfant dans 4 services français de réanimation néonatale, des entretiens semi-directifs ont été conduits 3 ans après le décès. Les entretiens ont été enregistrés, retranscrits et analysés (analyse de discours). Parmi les 166 parents ayant participé, 26 avaient perdu un jumeau.
À propos du décès, les parents ont insisté sur la complexité des sentiments éprouvés, simultanés et antinomiques. Le deuil était rendu particulier par la difficulté à pleurer la perte de l’enfant décédé tout en s’occupant de l’enfant en vie. Le refoulement des affects, un risque de superposition des images de chaque enfant dans l’esprit des parents et de confusion dans les places de chacun ont été observés.
Lors de la perte d’un jumeau, les parents sont submergés par la coexistence de sentiments contradictoires. Les soignants doivent pouvoir entendre les parents évoquer des sentiments contradictoires et les soutenir dans la reconnaissance de l’existence et de la perte d’un des enfants et dans l’investissement de l’enfant en vie. Leur rôle est essentiel pour les aider à construire des histoires différentes avec chaque enfant.
The mortality rate both before and after birth is higher in twins. Parents face a particularly difficult mourning experience when confronted with the loss of 1 of their newborn twins. The aim of this article is to describe how parents experience and cope with this situation over the long term, how they describe the loss at the time of the death in a neonatal intensive care unit (NICU), the way they are able to become attached to the surviving twin, and the role that NICU caregivers can play to help them.
This study is part of a larger qualitative study on parental mourning after the loss of a newborn in 4 NICUs in France. Semi-structured research interviews were conducted 3years after the death. The interviews were recorded, transcribed, and anonymized. Discourse analysis was used to extract the data on different themes. Among the 166 participating parents, 26 had lost a newborn twin.
The parents reported their difficulties when faced with simultaneous contradictory events at the time of the death of a twin child in the NICU. Mourning appeared to be more difficult in this particular case: to combine the loss of a deceased child with the care of the surviving newborn was very complicated. The existence of the “co-twin” was described as an essential support for the parents; however, over the long term, this child could not fulfill the feelings of emptiness. The relation with this surviving child was sometimes disturbed by parental anxiety that the accident could recur. Fathers and mothers showed repression of their sadness and despair. The representations of the 2 children in their parents’ mind were sometimes very close or even overlapping and some parents were confused with regards to the place each of them could have. In the NICU, the caregivers should be able to listen to the parents expressing their contradictory feelings, to sustain the acknowledgement of the loss of 1 child, and in becoming attached to the surviving child. Parents need to be reassured about their living child's health.
When faced with the loss of a newborn twin, parents are overwhelmed by the coexistence of contradictory feelings. The role of the medical staff is essential in building separate stories and having different memories for each child.
To analyse the delivery room management of babies born between 22 and 26 weeks of completed gestational age and to identify the factors associated with the withholding or withdrawal of intensive ...care.
Population-based cohort study.
Our study population comprised 2145 births between 22 and 26 completed weeks enrolled in the EPIPAGE-2 study, a French cohort of very preterm infants born in 2011. The primary outcome measure was withholding or withdrawal of intensive care in the delivery room.
Among infants born alive at 22-23 weeks, intensive care was withheld or withdrawn for >90%. At 24 weeks, resuscitative measures were withheld or withdrawn for 38%, at 25 weeks for 8% and at 26 weeks for 3%. Other factors besides gestational age at birth associated with this withholding or withdrawal for infants born at 24-26 weeks were birth weight <600 g, emergency delivery (within 24 h of the mother's admission) and singleton pregnancy. Although rates of withholding or withdrawal of intensive care varied substantially between maternity units (from 0% to 100%), the variability was primarily explained by differences in distributions of gestational age at birth.
Although gestational age is only one factor predicting survival of preterm infants, practices in France appear to be based primarily on this factor, which thus has direct effects on the survival of extremely preterm infants. The ethical implications of basing life and death decisions only on gestational age before 25 weeks require further examination.
Environmental conditions experienced during early growth and development markedly shape phenotypic traits. Consequently, individuals of the same cohort may show similar life-history tactics ...throughout life. Conditions experienced later in life, however, could fine-tune these initial differences, either increasing (cumulative effect) or decreasing (compensatory effect) the magnitude of cohort variation with increasing age. Our novel comparative analysis that quantifies cohort variation in individual body size trajectories shows that initial cohort variation dissipates throughout life, and that lifetime patterns change both across species with different paces of life and between sexes. We used longitudinal data on body size (mostly assessed using mass) from 11 populations of large herbivores spread along the "slow-fast" continuum of life histories. We first quantified cohort variation using mixture models to identify clusters of cohorts with similar initial size. We identified clear cohort clusters in all species except the one with the slowest pace of life, revealing that variation in early size is structured among cohorts and highlighting typological differences among cohorts. Growth trajectories differed among cohort clusters, highlighting how early size is a fundamental determinant of lifetime growth patterns. In all species, among-cohort variation in size peaked at the start of life, then quickly decreased with age and stabilized around mid-life. Cohort variation was lower in species with a slower than a faster pace of life, and vanished at prime age in species with the slowest pace of life. After accounting for viability selection, compensatory/catch-up growth in early life explained much of the decrease in cohort variation. Females showed less phenotypic variability and stronger compensatory/catch-up growth than males early in life, whereas males showed more progressive changes throughout life. These results confirm that stronger selective pressures for rapid growth make males more vulnerable to poor environmental conditions early in life and less able to recover after a poor start. Our comparative analysis illustrates how variability in growth changes over time in closely related species that span a wide range on the slow-fast continuum, the main axis of variation in life-history strategies of vertebrates.
In piezophilic microorganisms, enzymes are optimized to perform under high hydrostatic pressure. The two major reported mechanisms responsible for such adaptation in bacterial species are changes in ...amino acids in the protein structure, favoring their activity and stability under high-pressure conditions, and the possible accumulation of micromolecular co-solutes in the cytoplasm. Recently, the accumulation of glutamate in the cytoplasm of piezophilic
Desulfovibrio
species has been reported under high-pressure growth conditions. In this study, analysis of the effect of glutamate on the enzymatic activity of the thioredoxin reductase/thioredoxin enzymatic complex of either a piezosensitive or a piezophilic microorganism confirms its role as a protective co-solute. Analysis of the thioredoxin structures suggests an adaptation both to the presence of glutamate and to high hydrostatic pressure in the enzyme from the piezophilic strain. Indeed, the presence of large surface pockets could counterbalance the overall compression that occurs at high hydrostatic pressure to maintain enzymatic activity. A lower isoelectric point and a greater dipolar moment than that of thioredoxin from the piezosensitive strain would allow the protein from the piezophilic strain to compensate for the presence of the charged amino acid glutamate to interact with its partner.
We examined the long-term effects (28 years) of habitat loss and phenotypebased selective harvest on body mass, horn size, and horn shape of mouflon (Ovis gmelini musimon) in southern France. This ...population has experienced habitat deterioration (loss of 50.8% of open area) since its introduction in 1956 and unrestricted selective hunting of the largest horned males since 1973. Both processes are predicted to lead to a decrease in phenotype quality by decreasing habitat quality and by reducing the reproductive contribution of individuals carrying traits that are targeted by hunters. Body mass and body size of both sexes and horn measurements of males markedly decreased (by 3.4-38.3%) in all age classes from the 1970s. Lamb body mass varied in relation to the spatiotemporal variation of habitat closure within the hunting-free reserve, suggesting that habitat closure explains part of these changes. However, the fact that there was no significant spatial variation in body mass in the early part of the study, when a decline in phenotypic quality already had occurred, provided support for the influence of selective harvesting. We also found that the allometric relationship between horn breadth and horn length changed over the study period. For a given horn length, horn breadth was lower during the second part of the study. This result, as well as changes in horn curve diameter, supports the interpretation that selective harvesting of males based on their horn configuration had evolutionary consequences for horn shape, since this phenotypic trait is less likely to be affected by changes in habitat characteristics. Moreover, males required more time (approximately four years) to develop a desirable trophy, suggesting that trophy hunting favors the reproductive contribution of animals with slow-growing horns. Managers should exploit hunters' desire for trophy males to finance management strategies which ensure a balance between the population and its environment. However, for long-term sustainable exploitation, harvest strategy should also ensure that selectively targeted males are allowed to contribute genetically to the next generations.
Background The objectives of this study were to assess qualitatively mothers’ physical and psychological health, their perception of their child’s health and development, and their difficulties with ...childcare from 2 months post discharge to 1 year after a very preterm delivery.
Methods The study population included all mothers who delivered before 33 weeks of amenorrhea between November 1998 and November 1999 in a Parisian maternity unit and between February 2000 and February 2001 in a maternity unit located in Rouen (France). Twenty‐one of the 38 mothers contacted agreed to participate (55%). Semi‐structured interviews were conducted by a clinical psychologist at the woman’s home. They were taped, fully transcribed and subjected to content analysis.
Results The main difficulties reported by mothers at 1 year were fatigue, depressive mood, anxiety and physical symptoms. Depressive mood was associated with social isolation, post‐traumatic symptoms, withdrawal and feelings of guilt. Most mothers also described their child as being difficult and tiring. Mothers’ reports about their own health and difficult behaviour of their child were more negative at 1 year than at 2 months post discharge.
Conclusions The mothers’ psychological distress following a very preterm birth did not improve between 2 months post discharge and 1 year after delivery. Comprehensive follow‐up care programmes should take into account this consequence of a very preterm birth and provide access to adequate psychological support, care or treatment.
Investigating the factors shaping the activity of large herbivores is of prime importance because changes in their activity patterns may indicate physiological stress, which can affect reproduction ...and survival of individuals, and thereby population growth. Although climatic conditions are known to impact the activity patterns of large herbivores, few studies have investigated this relationship at a fine temporal scale. From a continuous monitoring of activity, we assessed the influence of temperature and wind on the summer activity of female mouflon (
Ovis gmelini musimon
Pallas, 1811 ×
Ovis
sp.) facing summer droughts. Females showed a marked bimodal activity pattern, with activity peaks occurring after dawn and before dusk. When temperature increased and wind speed decreased, the morning activity peak occurred earlier, while the evening activity peak was delayed. Hence, under stressing climatic conditions, female mouflon decreased their diurnal activity while increasing their nocturnal activity. However, this nocturnal increase did not prevent the activity rate over 24 h to decrease during hot nonwindy days compared with cool windy days. Although the occurrence of wind mitigated the negative influence of heat on the diurnal activity, wind had no effect at the daily scale. These findings emphasize the importance of working at different temporal scales when assessing the activity patterns of free-ranging vertebrates.
Bioluminescent bacteria have been studied during a one-year survey in 2011 at the deep ANTARES site (Northwestern Mediterranean Sea, 2000m depth). The neutrino underwater telescope ANTARES, located ...at this station, has been used to record the bioluminescence at the same depth. Together with these data, environmental variables (potential temperature, salinity, nutrients, dissolved organic carbon and oxygen) have been characterized in water samples. The year 2011 was characterized by relatively stable conditions, as revealed by minor variability in the monitored oceanographic variables, by low bioluminescence and low current speed. This suggests weak eukaryote participation and mainly non-stimulated light emission. Hence, no processes of dense water have affected the ANTARES station during this survey. Abundance of bioluminescent bacteria belonging to Photobacterium genus, measured by qPCR of the luxF gene, ranged from 1.4×102 to 7.2×102genesmL−1. Their effective activity was confirmed through mRNA luxF quantification. Our results reveal that bioluminescent bacteria appeared more active than the total counterpart of bacteria, suggesting an ecological benefit of this feature such as favoring interaction with macro-organisms. Moreover, these results show that part of the bioluminescence, recorded at 2000m depth over one year, could be due to bioluminescent bacteria in stable hydrological conditions.
•A survey of bioluminescent bacteria at the ANTARES station under low environmental variability is proposed•The main contribution during low bioluminescence and stable conditions is due to bacteria•Bioluminescent bacteria appear more active than the total counterpart of bacteria•Similar investigations are needed during a convection event impacting this station
PDF
