Identifying maternal needs following childbirth: A qualitative study among mothers, fathers and professionals.

BACKGROUND: Pregnancy and childbirth are two critical stages in a woman's life. Various studies have suggested that psychological distress is common during the year after childbirth. The objectives of this exploratory study were (1) to explore the needs of mothers in the year following childbirth; (2) to compare these needs between mothers who did not have the feeling of living a psychological disorder or a depression and mothers who lived a psychological disorder or had the impression of living a depression; and (3) to compare the needs expressed by mothers with the perception of professionals and fathers about the mothers' needs. METHODS: First, we proceeded to 22 individual qualitative interviews followed by one focus group, with mothers, with and without experience of psychological distress. Then, we conducted 2 focus groups: one with professionals and one with fathers. RESULTS: Needs of mothers after childbirth have been indexed in four categories: need of information, need of psychological support, need to share experience, and need of practical and material support. Women do not feel sufficiently informed about this difficult period of life. They do not feel sufficiently supported, not only from a psychological point of view but also from a more practical point of view, for example with household chores. They need to share their experience of life, they need to be reassured and they need to feel understood. It seems that some differences exist between mothers' and professionals' experiences but also between mothers' and fathers' experiences. CONCLUSION: Young mothers apparently feel a lack of support at different levels in the year following childbirth. This study provides ways to meet women's needs and to try to prevent the risk of postpartum psychological distress during this period of time.

Exploring the interest in and the usage of the internet among patients eligible for osteoporosis screening.

The aim of this study was to evaluate the interest in the Internet and its usage for health-related issues among people eligible for osteoporosis screening. Self-administered questionnaires have been distributed to subjects who were screened for osteoporosis and to menopausal women. 177 patients have responded to the survey (64.5 ± 10.1 years, 88.1% of women). There are 78.5% of Internet users. Among them, 67.2% said searching information about their health and 74.5% said using the Internet for this purpose. All respondents attributed an average score, out of 10, of 5.7 ± 2.3 regarding the reliability of information that they could find on the Internet. The use of the Internet differs significantly depending on age: those who use the Internet are younger (62.1 ± 8.91 years) than those who do not use it (73.3 ± 9.42 years). The socioeconomic status also has an impact on the Internet use: Internet users have a higher education, are more professionally active and have a higher net monthly household income compared to the group of non-users. Even if age and socioeconomic status appear to be determining factors in the use of the Internet for the search of health information in patients eligible for osteoporosis screening, almost 75% of the study population use the Internet for this purpose. Action to promote health through an Internet platform must therefore take these parameters into account.

[OSTEOPOROSIS AND PERSONALIZED MEDICINE]. / OSTÉOPOROSE ET MÉDECINE PERSONNALISÉE.

Osteoporosis is at the very early stages of the implementation of personalized medicine. However, the development of FRAX®, an algorithm offering the opportunity to calculate, in an individual patient, his/her 10-year fracture risk improves the decision process on the appropriateness to initiate a pharmacological treatment. This algorithm helps the physician to select drugs which are active on non-vertebral fractures only in high risk patients. Taking into consideration patients' preferences, when selecting a therapeutic option, will improve long term adherence and subsequently efficacy and efficiency of the treatments. Attempts to define the natural course of osteoporosis or the response to therapy in individual patients by assessing their genetic profile remains, so far, inconclusive.

Prevalence of sarcopenia: the impact of different diagnostic cut-off limits.

INTRODUCTION: In the definition of the European Working Group on Sarcopenia in Older People (EWGSOP), different cut-off limits are proposed for appendicular lean mass, muscle strength and gait speed. Therefore we aimed to examine the variation in prevalence of sarcopenia obtained with these cut-off limits. MATERIALS AND METHODS: Subjects aged 65 years and older were recruited in an outpatient clinic in Belgium and screened for sarcopenia using the EWGSOP definition. Appendicular lean mass was measured by Dual Energy X-Ray Absorptiometry, muscle strength by a hydraulic handgrip dynamometer and gait speed was measured on a 4-meter distance. Two different cut-off points proposed by the EWGSOP were examined for each variable and 8 diagnostic methods were thereby established. RESULTS: 400 subjects were recruited for this study. Prevalence of sarcopenia varied from 9.25% to 18% depending on the cut-offs applied. When stratified by sex, it seems that the variation in prevalence of sarcopenia was mainly attributable to women. This prevalence ranged from 6.58% to 20.2% for women and only from 13.4% to 14.7% for men. CONCLUSION: Prevalence of sarcopenia varies widely depending on the EWGSOP cut-off points applied for women. This may limit clinical researches and development of therapeutic strategies in the field of sarcopenia.

The "Happy-Mums" website dedicated to the perinatal period: Evaluation of its acceptability by parents and professionals.

OBJECTIVE: Pregnancy and childbirth are associated with new needs for mothers, especially an eagerness for information. The aim of this study was to evaluate whether the Happy-Mums.be website meets the expectations and needs of its future users. DESIGN: After the development of the Happy-Mums.be website, it was submitted to parents and professionals and evaluated by an online survey, which consisted of the third round of an ongoing Delphi survey. SETTING AND PARTICIPANTS: The panel involved in the survey included parents (both mothers and fathers) and professionals (health professionals and early childhood professionals, orbiting mothers of children aged 0-2 years). FINDINGS: Twenty-eight parents and professionals participated in the third round of the Delphi survey. The participants indicated that Happy-Mums.be was useful and easy to use. They attributed a mean score of 8 out of 10 for the content, design and quality of the information on the Happy-Mums.be website. The majority of participants said that they would recommend the website both during pregnancy and the postnatal period. CONCLUSIONS: Happy-Mums.be meets the needs and expectations of parents and professionals in terms of both content and design. More specifically, the quality of the information found on Happy-Mums.be was judged to be significantly better than the information found on other websites.

The internet as a source of information used by women after childbirth to meet their need for information: A web-based survey.

OBJECTIVE: the aims of this survey were: (a) to evaluate the need of information after childbirth and what questions do 'new' mothers ask themselves; (b) to assess why and how women use the Internet to meet their need of information; (c) to describe how the respondents evaluate the reliability of the information found; (d) to understand how the information found on the Internet affects women's decision-making; and (e) to appreciate how health professionals react to the information found by the women. DESIGN: this study used a large web-based survey that was widely broadcasted on various websites and social networks. SETTING AND PARTICIPANTS: belgian women who had a child under 2 years old and who agreed to participate were included in the study. FINDINGS: 349 questionnaires were valid for analyses. After childbirth, 90.5% of women admitted to using the Internet to seek information about themselves or about their baby, regardless of socioeconomic status or age. There were various reasons for seeking information on the Internet, but the most frequent reason the women expressed was to find information 'on their own' (88.1%). The most searched for topic was breastfeeding. The women believed that the information was quite useful (82.7%) but they assigned an average score of 5.3 out of 10 for the quality of the information they found on the Internet. Approximately 80% of the women felt that the Internet helped them control a decision that they made 'a little', 'often' or 'very often'. Professionals are not always willing to talk about information found on the Internet with mothers. Therefore, many women believed that health professionals should suggest reliable Internet websites for new mothers. CONCLUSIONS: the integration of the Internet and new technologies could be a useful tool during postpartum management.

What should a website dedicated to the postnatal period contain? A Delphi survey among parents and professionals.

OBJECTIVES: Mothers have a great need for information during the postnatal period. Trying to meet this need, mothers are increasingly turning to the Internet. Nevertheless, many women have stated that they often or always found that the information that they found on the Internet was incomplete or wrong. Many women therefore believe that health professionals should suggest reliable Internet websites for new mothers. The aim of this study was therefore to find a consensus on the content of a reliable and centralized website dedicated to mothers from the end of pregnancy to 1 year after childbirth. DESIGN: Two rounds of an online Delphi survey were used in this study. SETTING AND PARTICIPANTS: The panel of participants involved in the survey included parents (both mothers and fathers) and professionals (health professionals and professionals of early childhood for mothers of children aged 0 to 2 years). FINDINGS: Ninety-six parents and professionals participated in the first round (37.7 ± 9.76 years; 84.4% of women) and 78 in the second round. The majority of participants (94.6%) thought that a centralized website could help mothers from pregnancy to one year after childbirth. The content that the experts would like to find on a website were themed into five categories: "infants' information", "parents' information", "administrative information", "professionals' information" and "type of resources". In each category, experts highlighted the key words that they found important and should be reported on the website. The most important items highlighted by participants were baby's feeding/breastfeeding (92.8%), babies' needs (84.1%), baby blues (77.9%), postpartum depression (72.1%), management of the couple's relationship (72.1%), women's right to postnatal care (83.6%), links to reliable documents (63.9%) and a list of useful contacts (52.5%). CONCLUSIONS: This study helped to understand the questions that mothers ask themselves during the postpartum period and provided priorities to respond to their questions in the process of developing a website.

Prevalence of Concomitant Bone and Muscle Wasting in Elderly Women from the SarcoPhAge Cohort: Preliminary Results.

BACKGROUND: Recent studies suggest that bone and muscle wasting are closely interconnected. OBJECTIVE: The aim was of this study is to assess the prevalence of osteoporosis in a population of women diagnosed with sarcopenia. Participants, setting and design: We analyzed cross-sectional data of women, aged 65 years and above, for whom bone mineral density was available at the time of inclusion in the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, an ongoing prospective study with the aim to assess consequences of sarcopenia. MEASUREMENTS: Muscle strength was evaluated with a hydraulic hand-dynamometer, appendicular lean mass and bone mineral density by Dual-Energy X-Ray Absorptiometry and physical performance by the Short Physical Performance Battery test (SPPB). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People definition, i.e. a low muscle mass plus either low muscle strength or low physical performance. A bone mineral density T-score equal to or below -2.5SD at the lumbar spine, at the total hip or at the femoral neck was used to define osteoporosis (World Health Organization definition). RESULTS: A total of 126 women aged 74.38±6.32 years were included. Among them, 26 were assessed with sarcopenia (20.6%) and 34 (27.0%) with osteoporosis. There were more osteoporotic women among sarcopenic subjects (46.1%) than among non-sarcopenic subjects (22.0%) (p-value=0.011). A significant lower appendicular lean mass index was observed in osteoporotic women (p-value=0.025). We also observed, in osteoporotic subjects, a lower muscle strength (p-value=0.023). Numerical values of bone mineral density were lower in the sarcopenic population but the differences did not reach the level of statistical significance. CONCLUSION: Our study demonstrated that muscle mass and strength are lower in patients with osteoporosis. Prospective changes in bone and muscle mass will be investigated during the follow-up of our cohort.

Added value of a triaxial accelerometer assessing gait parameters to predict falls and mortality among nursing home residents: A two-year prospective study.

BACKGROUND: Gait impairment seems to be a risk factor for falls and mortality. Because gait change cannot be determined easily with classical clinical tests, some authors have suggested that it might be useful to use a gait-analysis system among elderly community-dwelling people. OBJECTIVE: The main objective of the present study was to determine the predictive value of a quantitative evaluation of the gait characteristics in nursing home residents for the occurrence of falls and death performed using a tri-axial accelerometer (Locométrix®). MATERIAL AND METHODS: One hundred elderly nursing home residents (80 women and 20 men, mean age 86.4 ± 6.04 years) were included in this study with the aim to follow them for 2 years. Deaths and falls were systematically recorded. A quantitative evaluation of a 10-second walk was performed with a tri-axial accelerometer (Locometrix®). Demographic data (i.e age, sex, body mass index) and clinical data (i.e. fall risk evaluated by the Tinetti test) were also recorded. RESULTS: During the two years of follow-up, 27 patients died. After adjustment on all potential confounding variables, only body mass index was significantly associated with the risk of mortality with an odds ratio of 0.86 (95% CI: 0.77-0.96, p=0.04). At the end of the study period, 440 falls had occurred (mean: 4.44 ± 6.79 falls per patient) but no single factors were independently associated with fall incidence. CONCLUSION: Our results show that a quantitative gait analysis performed using a tri-axial accelerometer is not predictive of long-term falls and mortality among nursing home residents.

Estimation of sarcopenia prevalence using various assessment tools.

BACKGROUND: Sarcopenia is defined as a progressive and generalized loss of muscle mass with either a loss of muscle strength or a loss of physical performance but there is no recommendation regarding the diagnostic tools that have to be used. In this study, we compared the prevalence of sarcopenia assessed using different diagnostic tools. METHODS: To measure muscle mass, muscle strength and physical performance, we used for each outcome two different diagnostic tools. For muscle mass, we used Dual Energy X-Ray Absorptiometry (DXA) and bio-electrical impedance analysis (BIA); for muscle strength, we used a hydraulic dynamometer and a pneumatic dynamometer; for physical performance we used the Short Physical Performance Battery test (SPPB test) and the walk speed. Eight diagnostic groups were hereby established. RESULTS: A total of 250 consecutive subjects were recruited in an outpatient clinic in Liège, Belgium. Estimated prevalence of sarcopenia varied from 8.4% to 27.6% depending on the method of diagnosis used. Regarding muscle mass, BIA systematically overestimated muscle mass compared to DXA (mean estimated prevalence with BIA=12.8%; mean prevalence with DXA=21%). For muscle strength, the pneumatic dynamometer diagnosed twice more sarcopenic subjects than the hydraulic dynamometer (mean estimated prevalence with PD=22.4%; mean estimated prevalence with HD=11.4%). Finally, no difference in prevalence was observed when the walking speed or the SPPB test was used. A weak overall kappa coefficient was observed (0.53), suggesting that the 8 methods of diagnosis are moderately concordant. CONCLUSION: Within the same definition of sarcopenia, prevalence of sarcopenia is highly dependent on the diagnostic tools used.

Quality of life and physical components linked to sarcopenia: The SarcoPhAge study.

INTRODUCTION: The SarcoPhAge project is an ongoing longitudinal study following community-dwelling elderly subjects with the objective to assess some health and functional consequences of sarcopenia. The sarcopenia diagnosis algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and used in the present study needs further validation through cross-sectional and longitudinal studies. The aim of the present study is to assess, using this algorithm, the prevalence of sarcopenia and the clinical components linked to this geriatric syndrome. METHODS: Participants were community dwelling subjects aged 65years or older. To diagnose sarcopenia, we applied the definition of the EWGSOP. Muscle mass was measured by dual-energy X-ray absorptiometry, muscle strength by a hydraulic dynamometer and physical performance by the SPPB test. Large amounts of socio-demographic, anamnestic and clinical data were collected in all subjects. RESULTS OVER ONE YEAR: 534 subjects were recruited for this study (60.5% of women, mean age of 73.5±6.16years), among whom 73 subjects were diagnosed sarcopenic, which represents a global prevalence of 13.7%. Prevalence was 11.8% in men and 14.9% in women. Sarcopenic subjects were older; had a lower Body Mass Index, lower calf, waist, wrist and arm circumferences; presented more cognitive impairments (Mini-Mental State Examination), more comorbidities; were more often malnourished; and consumed more drugs. After adjustment for age, BMI, cognitive status, nutritional status, number of comorbidities and number of drugs, sarcopenic subjects had a worse physical health-related quality of life (SF-36) for the domain of physical functioning, were at higher risk of falls (Timed Up and Go test), were more frail (Fried), presented more often tiredness for the achievement of activities of daily living (Mobility-test), presented less fat mass and obviously less lean mass. Sarcopenic women were also more dependent for housekeeping and handling finances (Lawton scale) than non-sarcopenic ones. CONCLUSION: Sarcopenia seems to be associated with many harmful clinical components making this geriatric syndrome a real public health burden. Follow-up data of the SarcoPhAge study will be helpful to assess the outcomes of sarcopenia based on the EWGSOP diagnosis algorithm and its different proposed cut-offs.

Bone forming agents for the management of osteoporosis.

Osteoporotic fractures are a major cause of morbidity in the population. Antiresorptive agents have been, for more than 15 years, the mainstay of osteoporosis treatment worldwide. However, these medications provide only limited fracture reduction and may be linked to skeletal and non-skeletal long-term safety concerns. Therefore, some patients are considered candidates for bone-forming agents because they remain severely osteoporotic or because they failed antiresorptive therapy. Over the last decade, a particular interest was shown in the development of medications able to increase osteoblasts number, lifespan or activity, hence stimulating bone formation Peptides from the parathyroid hormone family and strontium ranelate were shown to significantly reduce fracture rates. The European Medicines Agency recently confirmed that strontium ranelate is the treatment of choice for patients with severe osteoporosis, men and women, without cardiovascular contra-indications for whom other anti-osteoporosis medications are inappropriate. New therapeutic options, including monoclonal antibodies against sclerostin seem to be promising but their role in the armamentarium of osteoporosis will depend on the results of the current phase 3 studies, assessing anti-fracture efficacy and long-term safety.