Psychosocial determinants of healthy sleep habits in adults with type 1 and type 2 diabetes.

Background: Many adults with type 1 (T1D) and type 2 diabetes (T2D) have inadequate sleep increasing their risk of hyperglycemia and developing complications. The objective was to identify psychosocial determinants of healthy sleep habits (HSH) among adults with T1D and T2D. Methods: The two HSH were: avoiding screen use in bed and having sleep regularity. Adults (≥18 years) with T1D and T2D were invited to complete an anonymous online survey. The questionnaires were based on the Reasoned Action Approach and formative qualitative research previously conducted in 56 adults with T1D and T2D. Habit was included as an additional variable for screen use in bed. Results: In total, 320 adults with diabetes (T1D: 39%; T2D: 61%) completed the questionnaires (screen use in bed: 174; sleep timing: 146). Close to 75% of participants reported screen use in bed and close to 90% reported sleep timing variability in the last month. Perceived behavioral control (PBC) to avoid screen use in bed (ß = -0.4486, p < 0.0001), habit of using screens in bed (ß = 0.4002; p < 0.0001), and age (ß = -0.0202; p = 0.0086) were determinants of screen use in bed, and this model explained 71% of the variance. PBC for sleep regularity (ß = -0.2909; p = 0.0004) and being female (ß = 0.5057; p = 0.0069) were determinants of sleep timing variability, and this model explained 28% of the variance. The most important beliefs associated with each HSH were identified to obtain information to design targeted interventions. Conclusions: Few adults with diabetes have HSH. Screen use in bed was strongly influenced by habit and the results suggest that both HSH are not easy to adopt among adults with diabetes. Younger adults with diabetes should be prioritized for screen use in bed, while females with diabetes should be prioritized for sleep timing variability. Adults with diabetes should have access to behavior change interventions to encourage them to adopt HSH.

French-speaking Africa and translation: From midwifery to maïeutique?

INTRODUCTION: In the French version of The Lancet Series (2014) midwifery has been translated as maïeutique. Likewise, the term maïeuticien has recently been introduced in some countries to name (male) midwives. This change of terminology has not been the subject of broad stakeholder consultation. The aim of this study is to explore the opinion of African midwives on the use of the terminologies pratique de sage-femme/maïeutique (midwifery) and sage-femme/maïeuticien (midwife). METHODS: A quantitative study was conducted using an online survey among members of francophone professional midwifery associations in 17 French-speaking African countries. RESULTS: From 140 invited midwives, 82 responses were received. The respondents represented 12 francophone African countries. Respondents obviously prefer the terms pratique de sage-femme and sage-femme above maïeutique and maïeuticien. The sage-femme is acknowledged and deeply rooted in African society. Midwifery is comprehensive, while maïeutique does not describe the full scope of midwifery. Though, some respondents believe that maïeutique has the potential to differentiate sages-femmes from other health professionals, can diminishing role ambiguity, and value midwifery practice. Respondents in favor of the term maïeutique are referring to the modernization of the midwifery profession and its scientific evolution. CONCLUSIONS: Internationally, midwives closely follow the developments on the linguistic subject of maïeutique. The results of this study may support current discussion about the evolution and modernization of terminology in the francophone community worldwide. Midwives need to be actively involved in these discussions. Nevertheless, at all times we need to be cautious not to break away from midwives' cherished historical, social, and cultural roots.

[Inventory of the use of natriuretic peptides in France]. / État des lieux de l'utilisation des peptides natriurétiques en France.

Since the introduction of routine assay for natriuretic peptides (NP), there is an increasing number of clinical applications for these assays. Due to the continuously increasing number of prescription of those tests, a reappraisal of the use of natriuretic peptide assays, namely BNP and NT-proBNP in France was necessary. This was achieved through a national survey to obtain a detailed description of NP prescription and realization by French laboratories. A questionnaire was sent in April 2010 to hospital and private clinical chemists. Statistical analysis of results concerned 584 answers. This survey demonstrated an equivalent use of BNP and NT-proBNP both in public or private laboratories together with a huge heterogeneity of tests used within labs. Medical prescription heterogeneity both in public or private sectors confirms the large implication of those tests in clinical diagnosis. These assays are not yet standardized, so clinicians and biologists should be very careful when interpreting the results for diagnostic or therapeutic monitoring.

State of midwifery research in France.

OBJECTIVE: We describe French midwives' experience and perception of research and publication as well as their publications in scientific and professional journals. DESIGN: We conducted an online cross sectional survey of midwives from June to November 2016; complemented by a bibliometric analysis of their publications in any language. SETTING: This study was conducted in France, where it is necessary to question some midwifery and obstetrical practices. PARTICIPANTS: 146 midwives working/residing in France or holding/studying in France for a PhD or a Masters' degree at the time of the study; or having already published articles in any scientific or professional journal. FINDINGS: Of the 146 eligible midwives, 91.8% were female; 15 (10.3%) had a PhD degree, 26 (17.8%) and 80 (54.8%) were preparing a PhD and a Master's degree, respectively. A total of 140 midwives (95.8%) were working in midwifery and 54 (37.0%) respondents reported having already participated in midwifery research programs. Publication experience was reported by 73 midwives, including 26 (17.8%) who have published at least one article on midwifery in a journal accessible online and peerreviewed. 97.2% of midwives with publication experience consider it useful to publish but 75.7% consider that it is a difficult process. Lack of time, not mastering scientific writing and English language are their main barriers to publication. We identified 218 articles published by these midwives before January 2016, including 180 (82.6%) on maternal and perinatal health. Of their 134 unique articles on midwifery accessible online, 77 (57.5%) dealt with bio-medical topics, 49 (36.6%) with health system issues, and 17 (12.7%) used human and social sciences approaches. Pregnancy and birth were the two most studied reproductive life phases. Eighty-nine (28.4%) of these 314 articles were about midwifery practices or interventions. Since 1990, 93 articles have been published on midwifery in peer-reviewed journals, including 32 in the French language. The number of publications increased significantly with time with a progression coefficient at +1.18% per year, in particular in scientific journals (+0.78% per year). KEY CONCLUSIONS AND IMPLICATION: We evidenced that even though midwives in France have a still limited experience of research, and few of them have completed a PhD degree, or receive a salary for doing research, they publish an increasing number of scientific articles on midwifery topics. However, very few research programs in France examine aspects of midwifery. This scarcity is a major barrier to the involvement of midwives in research. Scientific publications about midwifery in French language are limited mainly due to the lack of adequate and specialized journal in French. However, publishing in French would facilitate the access to knowledge and evidence of midwifery practitioners in Frenchspeaking countries, including French-speaking Africa, where maternal mortality ratios can be very high. We suggest and discuss a number of approaches to increase access to scientific knowledge on midwifery in France and French-speaking countries.

[Hemolysis interferences on frequently required stat analysis: a French multicentric study]. / Interférence de l'hémolyse sur les examens de biologie médicale utilisés en biochimie d'urgence : étude multicentrique nationale.

Hemolysis should lead to changes in test results. Our study evaluated the impact of hemolysis on 26 blood measurements of stat biochemistry markers (sodium, potassium, chloride, urea, creatinine, glucose, total protein, calcium, magnesium, inorganic phosphorus, uric acid, C-reactive protein, total bilirubin, ASAT, ALAT, LDH, creatine kinase, alkaline phosphatase, γ glutamyl-transferase, lipase, alcohol, iron, ß hCG, troponins, natriuretic peptides) determined with 13 different types of instruments in 17 hospital laboratories. Four pools of samples (collected from lithium heparin or EDTA or sodium fluoride tubes, according to the measured parameters) were overloaded with five increasing concentrations of whole blood lysate (final concentration from 0 to 2.000 mg/dL). Replication was performed for each assay, average values were calculated and differences between results with and without lysate were analyzed. A difference exceeding the square root of the sum of both squared analytic and biologic imprecisions for each analyte, was judged to be significant. Except homogeneous and expected impact of hemolysis on certain parameters like potassium, LDH... (due to their intra-erythrocyte concentration) a heterogeneous effect was found for other parameters, according to the analyzer and/or to the methodology. In summary, this study confirms the importance of mastering the measurement of the hemolysis and leads to several recommendations: (i) biologists should have a good knowledge of the impact of hemolysis on the measurements they perform, depending on their chosen analyzers; (ii) if an interference is noticed, it is recommended to add to the result a relevant comment and to check that the comment is properly edited in the laboratory computer software and appears on printed and transmitted results.

Is induced abortion with misoprostol a risk factor for late abortion or preterm delivery in subsequent pregnancies?

OBJECTIVE: To examine whether a first or second trimester induced abortion with misoprostol influences the risk of late abortion or preterm delivery in subsequent pregnancies. STUDY DESIGN: Case-control study in a teaching hospital from January 2005 to June 2006. The cases had singleton pregnancies delivered at 16-36 weeks of gestation after spontaneous late abortions, preterm labor or preterm premature rupture of membrane, or induction of labor for preterm premature rupture of membrane before 37 weeks. The control group was composed of the two consecutive spontaneous singleton deliveries at >or=37 weeks of gestation after each new case (ratio 2/1). The principal outcome measure was late abortion or preterm delivery. The association between late abortion or preterm delivery and a previous induced abortion with misoprostol was first assessed with the Cochran-Mantel-Haenszel chi-square test. Conditional logistic regression models adapted for clustered data were then further used to quantify the effect size, measured by estimated odds ratios (ORs) with their 95% confidence intervals (95% CI). RESULTS: The study included 245 cases and 490 controls. There was no significant difference in mean maternal age, number of pregnancies, parity, smoking, or history of first trimester miscarriage between cases and controls. However, a history of late abortion or previous preterm delivery was significantly more frequent among cases than controls. Forty (16.3%) cases and 56 (11.5%) controls had a history of cervical ripening with misoprostol before vacuum curettage or evacuation, or of medical abortion by misoprostol alone or with mifepristone (OR 1.51, 95% CI: 0.95-2.39; p=0.08). After adjustment for maternal age and number of pregnancies with a multivariable conditional regression model, the adjusted OR was estimated at 1.33 (95% CI: 0.81-2.17; p=0.25). CONCLUSION: Despite the need for prudence, these results provide some reassurance that induced abortion with misoprostol during the first or second trimester of pregnancy is safe for subsequent pregnancies.